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Papers by Mark Caudell

Clinical Infectious Diseases

Background Colonization with antimicrobial-resistant bacteria increases the risk of drug-resistan... more Background Colonization with antimicrobial-resistant bacteria increases the risk of drug-resistant infections. We identified risk factors potentially associated with human colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) in low-income urban and rural communities in Kenya. Methods Fecal specimens, demographic and socioeconomic data were collected cross-sectionally from clustered random samples of respondents in urban (Kibera, Nairobi County) and rural (Asembo, Siaya County) communities between January 2019 and March 2020. Presumptive ESCrE isolates were confirmed and tested for antibiotic susceptibility using the VITEK2 instrument. We used a path analytic model to identify potential risk factors for colonization with ESCrE. Only 1 participant was included per household to minimize household cluster effects. Results Stool samples from 1148 adults (aged ≥18 years) and 268 children (aged <5 years) were analyzed. The likelihood of colonization incre...

JAC-Antimicrobial Resistance, 2021

Objectives To assess the feasibility of the Farmer Field School approach to address the complex p... more Objectives To assess the feasibility of the Farmer Field School approach to address the complex problem of antimicrobial resistance in agriculture, specifically within small-to-medium-scale layer poultry systems in Ghana and Kenya. Impact was assessed across three domains relevant to the emergence and selection of antimicrobial resistance, including infection, prevention, and control practices, engagement with animal health professionals, and knowledge, attitudes, and practices on antimicrobial use and antimicrobial resistance. Methods Farmer Field Schools were held in Ghana (N = 2) and Kenya (N = 3) across an eight-month period with an average of 18 participants in each school. After completion, a quantitative evaluation survey was administered to participants and a sample of non-participants (Ghana; N = 97) (Kenya; N = 103). Logistic and ordinary least squares regression were used to assess differences between participants and non-participants on the three domains. Results Partici...

Clinical Infectious Diseases

Background We estimated the prevalence of colonization with extended-spectrum cephalosporin-resis... more Background We estimated the prevalence of colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) from a hospital and associated communities in western Guatemala. Methods Randomly selected infants, children, and adults (<1, 1–17, and ≥18 years, respectively) were enrolled from the hospital (n = 641) during the coronavirus disease 2019 (COVID-19) pandemic, March to September 2021. Community participants were enrolled using a 3-stage cluster design between November 2019 and March 2020 (phase 1, n = 381) and between July 2020 and May 2021 (phase 2, with COVID-19 pandemic restrictions, n = 538). Stool samples were streaked onto selective chromogenic agar, and a Vitek 2 instrument was used to verify ESCrE or CRE classification. Prevalence estimates were weighted to account for sampling design. Results The prevalence of colonization with ESCrE and CRE was higher among hospital patients compared to community pa...

Scientific Reports

We estimated the prevalence of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE)... more We estimated the prevalence of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE), carbapenem-resistant Enterobacterales (CRE), and methicillin-resistant Staphylococcus aureus (MRSA) in communities and hospitals in Kenya to identify human colonization with multidrug-resistant bacteria. Nasal and fecal specimen were collected from inpatients and community residents in Nairobi (urban) and Siaya (rural) counties. Swabs were plated on chromogenic agar to presumptively identify ESCrE, CRE and MRSA isolates. Confirmatory identification and antibiotic susceptibility testing were done using the VITEK®2 instrument. A total of 1999 community residents and 1023 inpatients were enrolled between January 2019 and March 2020. ESCrE colonization was higher in urban than rural communities (52 vs. 45%; P = 0.013) and in urban than rural hospitals (70 vs. 63%; P = 0.032). Overall, ESCrE colonization was ~ 18% higher in hospitals than in corresponding communities. CRE colonization was h...

Microorganisms

Antimicrobial resistance (AMR) has been clearly identified as a major global health challenge. It... more Antimicrobial resistance (AMR) has been clearly identified as a major global health challenge. It is a leading cause of human deaths and also has a toll on animals, plants, and the environment. Despite the considerable socio-economic impacts, the level of awareness of the problem remains woefully inadequate, and antimicrobials are not generally recognized as a global common good, one that everyone has a role and responsibility to conserve. It is imperative for antimicrobial stewardship to be more widely implemented to achieve better control of the AMR phenomenon. The Food and Agriculture Organization (FAO) of the United Nations plays an important role in promoting and facilitating antimicrobial stewardship. The specific needs to be addressed and barriers to be overcome, in particular, in low- and middle-income countries in order to implement antimicrobial stewardship practices in agrifood systems are being identified. As a global community, it is essential that we now move beyond di...

Scientific Reports, 2020

To examine the effects of poor sanitation and hygiene on the prevalence of antimicrobial-resistan... more To examine the effects of poor sanitation and hygiene on the prevalence of antimicrobial-resistant bacteria, we surveyed households in two rural and two urban communities in Guatemala (N = 196 randomly selected households). One adult (≥ 18-years old) and, when available, one child (≤ 5 years-old) provided a stool sample. Up to 48 presumptive Escherichia coli isolates were collected from each stool sample (n = 21,256 total) and were subjected to breakpoint assays for ten antibiotics. Mixed-effects logistic models were used to identify potential factors influencing the likelihood of harboring antibiotic-resistant bacteria. For nine out of ten antibiotics, the odds of detecting resistant bacteria decreased by ~ 32% (odds ratios, OR 0.53–0.8, P < 0.001) for every unit of improvement of a hygiene scale. Hygiene differences between households had a greater impact on prevalence compared to antibiotic use differences. The likelihood of detecting resistant isolates was lower for five anti...

Nature Communications, 2020

Antibiotic use and bacterial transmission are responsible for the emergence, spread and persisten... more Antibiotic use and bacterial transmission are responsible for the emergence, spread and persistence of antimicrobial-resistant (AR) bacteria, but their relative contribution likely differs across varying socio-economic, cultural, and ecological contexts. To better understand this interaction in a multi-cultural and resource-limited context, we examine the distribution of antimicrobial-resistant enteric bacteria from three ethnic groups in Tanzania. Household-level data (n = 425) was collected and bacteria isolated from people, livestock, dogs, wildlife and water sources (n = 62,376 isolates). The relative prevalence of different resistance phenotypes is similar across all sources. Multi-locus tandem repeat analysis (n = 719) and whole-genome sequencing (n = 816) of Escherichia coli demonstrate no evidence for host-population subdivision. Multivariate models show no evidence that veterinary antibiotic use increased the odds of detecting AR bacteria, whereas there is a strong associat...

Cross-Cultural Research, 2015

Theoretical explanations for fertility transformations, such as the demographic transition, have ... more Theoretical explanations for fertility transformations, such as the demographic transition, have primarily emphasized one of three influences: (a) decreasing mortality rates, (b) economic development, and (c) the transmission of female empowerment norms. Empirical tests suggest that the relative contribution of these factors on predicting fertility varies across populations and time periods. Identification of the factors underlying this variation will ultimately be aided by the pooling of cross-national and time-series data. To this end, the current study combines data from 167 countries across a 40-year time period (i.e., 1970-2010). A fixed effects model is specified to examine how the three factors predict within-country variability in adolescent and total fertility rates. Results indicate that all three variables are associated with fertility patterns in theoretically consistent ways, although the association is often non-linear. In addition, the level of association between eco...

Journal of Ethnobiology and Ethnomedicine, 2017

Background: Human and animal health are deeply intertwined in livestock dependent areas. Livestoc... more Background: Human and animal health are deeply intertwined in livestock dependent areas. Livestock health contributes to food security and can influence human health through the transmission of zoonotic diseases. In lowincome countries diagnosis and treatment of livestock diseases is often carried out by household members who draw upon both ethnoveterinary medicine (EVM) and contemporary veterinary biomedicine (VB). Expertise in these knowledge bases, along with their coexistence, informs treatment and thus ultimately impacts animal and human health. The aim of the current study was to determine how socio-cultural and ecological differences within and between two livestock-keeping populations, the Maasai of northern Tanzania and Koore of southwest Ethiopia, impact expertise in EVM and VB and coexistence of the two knowledge bases. Methods: An ethnoveterinary research project was conducted to examine dimensions of EVM and VB knowledge among the Maasai (N = 142 households) and the Koore (N = 100). Cultural consensus methods were used to quantify expertise and the level of agreement on EVM and VB knowledge. Ordinary least squares regression was used to model patterns of expertise and consensus across groups and to examine associations between knowledge and demographic/sociocultural attributes. Results: Maasai and Koore informants displayed high consensus on EVM but only the Koore displayed consensus on VB knowledge. EVM expertise in the Koore varied across gender, herd size, and level of VB expertise. EVM expertise was highest in the Maasai but was only associated with age. The only factor associated with VB expertise was EVM expertise in the Koore. Conclusions: Variation in consensus and the correlates of expertise across the Maassi and the Koore are likely related to differences in the cultural transmission of EVM and VB knowledge. Transmission dynamics are established by the integration of livestock within the socioecological systems of the Maasai and Koore and culture historical experiences with livestock disease. Consideration of the nature and coexistence of EVM and VB provides insight into the capacity of groups to cope with disease outbreaks, pharmaceutical use patterns, and the development of community health interventions.

Royal Society Open Science, 2016

Population growth in the next half-century is on pace to raise global carbon emissions by half. C... more Population growth in the next half-century is on pace to raise global carbon emissions by half. Carbon emissions are associated with fertility as a by-product of somatic and parental investment, which is predicted to involve time orientation/preference as a mediating psychological mechanism. Here, we draw upon life-history theory (LHT) to investigate associations between future orientation and fertility, and their impacts on carbon emissions. We argue 'K-strategy' life history (LH) in high-income countries has resulted in parental investment behaviours involving future orientation that, paradoxically, promote unsustainable carbon emissions, thereby lowering the Earth's K or carrying capacity. Increasing the rate of approach towards this capacity are 'rstrategy' LHs in low-income countries that promote population growth. We explore interactions between future orientation and development that might slow the rate of approach towards global K. Examination of 67 000 individuals across 75 countries suggests that future orientation interacts with the relationship between environmental risk and fertility and with development related parental investment, particularly investment in higher education, to slow population growth and mitigate per capita carbon emissions. Results emphasize that LHT will be an important tool in understanding the demographic and consumption patterns that drive anthropogenic climate change.

PloS one, 2017

Frequent and unregulated use of antimicrobials (AM) in livestock requires public health attention... more Frequent and unregulated use of antimicrobials (AM) in livestock requires public health attention as a likely selection pressure for resistant bacteria. Studies among small-holders, who own a large percentage of the world's livestock, are vital for understanding how practices involving AM use might influence resistance. We present a cultural-ecological mixed-methods analysis to explore sectors of veterinary care, loosely regulated AM use, and human exposure to AMs through meat and milk consumption across three rural to peri-urban Tanzanian ethnic groups (N = 415 households). Reported use of self-administered AMs varied by ethnic group (Maasai: 74%, Arusha: 21%, Chagga: 1%) as did consultation with professional veterinarians (Maasai: 36%, Arusha: 45%, Chagga: 96%) and observation of withdrawal of meat and milk from consumption during and following AM treatment (Maasai: 7%, Arusha: 72%, Chagga: 96%). The antibiotic oxytetracycline was by far the most common AM in this sample. With...

Current Anthropology, 2016

Sidama people occupy a subsistence niche partitioned between traditional enset agropastoralism an... more Sidama people occupy a subsistence niche partitioned between traditional enset agropastoralism and transitional maize farming. Enset production is low risk and requires multiple years for cultivation and processing. Maize farming is high risk and high yield, requiring one growing season from planting to harvest. Contrasting enset and maize farming, we examine effects of crop loss and social shocks on Sidama impulsivity. We argue that impulsivity is a psychological process that is differentially activated by environmental shocks in the stable, traditional enset regime and unstable, transitional maize regime. Using a robust psychometric model derived from Barratt impulsiveness scale items, we demonstrate two dimensions of Sidama impulsivity: careful control (CC) and acts without thinking (AWT). Both dimensions are associated with environmental shocks, but the associations are moderated by socialecological regimes. In the enset regime, effects of shocks on impulsivity are muted. However, increased impulsivity is significantly associated with shocks in the global market-dependent maize regime. Effects on CC were significant for social shocks but not crop loss, while AWT was associated with crop loss and social shocks. Results may indicate domain-specific aspects of impulsivity in response to environmental perturbation. Impulsivity may be adaptive in the context bidirectional predictive processing in active cultural niche construction. Human thought is cultural (Bloch 2012; D'Andrade 1995; Sperber and Hirchfeld 2004; Strauss and Quinn 1997). Familiar and shared ways of thinking that worked for extended periods of time-often generations-give people reliable mental models for action: How shall I greet a person of equal status? What is the appropriate response to an insult? These mental models inform predictable outcomes inferred through regular interaction with people and environments in patterned practices (Roepstorff et al. 2010). But how do people react when favored habits and familiar actions result in unexpected or undesirable outcomes? Culture change is an intrapsychic phenomenon when old perceptions of normality are replaced by new ones. We wonder, what psychological processes facilitate culture change, and when are they activated? We draw on insights from social-ecological systems, niche construction, cognitive science, psychometrics, and cultural ecology to examine impulsivity among Sidama people occupying a fragmented subsistence niche at the intersection of traditional enset and transitional maize production. Recent developments in Sidama subsistence provide a case study in culture change. Most Sidama are agropastoral farmers living in the highlands to Rift Valley lowlands in Southwest Ethiopia. People have grown enset (Ensete ventricosum [Welw.] Cheesman), a root and stem staple crop, in this region since prehistoric times (Brandt 1984, 1996). The Sidama are one of the two most enset-reliant societies of the enset complex (Brandt et al. 1997; Quinlan et al. 2014; see also Shack 1963). Meanwhile, maize (Zea mays subsp. mays L.

Journal of Ethnobiology, 2015

Enset (Ensete ventricosum) is the traditional staple food of Sidama people who live in Rift Valle... more Enset (Ensete ventricosum) is the traditional staple food of Sidama people who live in Rift Valley lowlands to highlands in southwest Ethiopia. Enset is drought resistant, but it matures slowly, requires substantial manure inputs from cattle, and intensive processing. Maize, introduced to Sidamaland in the midtwentieth century, is common in midlands and lowlands. Maize matures rapidly and provides more kcal/kg than enset, but it is prone to failure in dry years and requires chemical fertilizer, which is subject to global market price fluctuations. We compare cultural ecology, productivity, failure, and resilience of enset and maize in 410 farms across four Sidama ecological zones. The risks and benefits of enset and maize are complexly associated with variable local environments. Enset offers drought-resistant produce that, with sufficient manure inputs, is adequate for subsistence in the wet highlands, but its performance is more variable elsewhere. Fertilized, maize yields larger harvests than enset, but vulnerability to rainfall and global processes create special challenges. Maize and enset appear to be in different adaptive cycle phases: maize grows quickly and maize farms rebounded from crop loss within four years. Only half of enset farms recovered within six years after crop failure, complicating farming decisions in an environment with tremendous localized variation. In general, the Sidama zone shows a pattern of regional diversity with local specialization for maize only, enset only, or mixed maize and enset cultivation. In some areas maize has become a preferred crop and food for younger people.

Antibiotics, 2021

The poultry sector contributes significantly to Kenya’s food and economic security. This contribu... more The poultry sector contributes significantly to Kenya’s food and economic security. This contribution is expected to rise dramatically with a growing population, urbanization, and preferences for animal-source foods. Antimicrobial resistance is putting the poultry sector in Kenya—and worldwide—at risk of production losses due to the failure of medicines for animal (and human) health. The emergence and spread of antimicrobial resistance has been linked to overuse and misuse of antimicrobials in poultry and other sectors. Previous studies have documented poultry farmer antimicrobial use but without systematic consideration of the contexts (i.e., drivers) as important targets for behavior change, particularly in low- and middle-income countries. To improve understanding of antimicrobial use patterns in poultry systems, we conducted a mixed-methods knowledge, attitudes, and practices study of 76 layer farms in Kiambu County; Kenya. We found that commonly used antibiotics were often labe...

BMJ Global Health, 2022

IntroductionAwareness-raising campaigns play a central role in efforts to combat drug resistance.... more IntroductionAwareness-raising campaigns play a central role in efforts to combat drug resistance. These campaigns assume that knowledge deficits drive poor practices that increase resistance. Therefore, increasing awareness will promote prudent practices and reduce resistance. However, most awareness campaigns have been developed and evaluated in high-income and public health settings. Consequently, it is not clear whether these campaigns are effective in low-income and middle-income countries and/or within animal health settings.MethodsFocus group discussions and in-depth interviews were used to collect narratives of veterinary drug use among Maasai pastoralists (n=70), animal health professionals (n=10) and veterinary drug sellers (n=5). Thematic analysis was used to identify recurring themes across narratives and groups.ResultsNarratives of Maasai and animal health professionals indicated that Maasai treated their livestock with limited input from the professional sector and that...

Preventive Veterinary Medicine, 2021

Animal health service providers can play an important role in limiting drug resistance by promoti... more Animal health service providers can play an important role in limiting drug resistance by promoting responsible and prudent use of veterinary drugs. Recognizing this potential, international agencies and governments have called for these providers to receive drug stewardship training, particularly providers in low- and middle-income countries where top-down regulations (e.g., national regulation of veterinary prescriptions) are largely unfeasible. The success of these stewardship trainings to promote responsible and prudent use will depend on many factors, including understanding how livestock-keeping communities currently interact with animal health service providers. Here, we use a mixed methods approach to identify and understand animal health seeking practices among Maasai pastoralists in Tanzania. Combining qualitative interviews (N = 31) and structured surveys (N = 195), we show the majority of Maasai respondents (≈80 %) do not frequently consult animal health service providers with most relying on advice from family and friends. Logistic regression models of health seeking practices find that increasing age, education, observance of treatment failure, and herd disease burdens are associated with greater odds of seeking out health services. Quantitative results were supported by data from focus group discussions and in-depth interviews that showed Maasai view animal health service providers as measures of last resort, whose input is largely sought after self-treatment with veterinary drugs fail. We argue patterns of animal health seeking among the Maasai are partially the consequence of their high confidence in their own abilities in livestock disease and treatment and generally low confidence in the skills of animal health service providers. We link this high sense of self-efficacy to the culturally engrained process by which Maasai develop mastery in animal health and how the roles and norms in Maasai culture surrounding animal health influence Maasai perceptions of animal health professionals. Our results highlight the need for more research to understand Maasai perceptions of animal health service providers as well as the knowledge, attitudes, and practices of these providers. Finally, our study emphasizes that the success of drug stewardship trainings will require efforts to first understand the cultural and historical contexts driving health seeking practices that impact perceptions of animal health service providers and animal health practices more generally.

Antibiotics, 2020

International organizations and governments have argued that animal health service providers can ... more International organizations and governments have argued that animal health service providers can play a vital role in limiting antimicrobial resistance by promoting the prudent use of antimicrobials. However, there is little research on the impact of these service providers on prudent use at the farm level, especially in low- and middle-income countries where enforcement of prudent-use regulations is limited. Here, we use a mixed-methods approach to assess how animal health-seeking practices on layer farms in Ghana (n = 110) and Kenya (n = 76) impact self-reported antimicrobial usage, engagement in prudent administration and withdrawal practices and perceptions of antimicrobial resistance. In general, our results show that the frequency of health-seeking across a range of service providers (veterinarians, agrovets, and feed distributors) does not significantly correlate with prudent or non-prudent use practices or the levels of antimicrobials used. Instead, we find that patterns of ...

The nutritional and economic potentials of livestock systems are compromised by the emergence and... more The nutritional and economic potentials of livestock systems are compromised by the emergence and spread of antimicrobial resistance. A major driver of resistance is the misuse and abuse of antimicrobial drugs. The likelihood of misuse may be elevated in low- and middle-income countries where limited professional veterinary services and laissez faire access to drugs are assumed to promote non-prudent practices (e.g., self-administration of drugs). The extent of these practices, as well as the knowledge and attitudes motivating them, are largely unknown within most agricultural communities in low- and middle-income countries. The main objective of this study was to document dimensions of knowledge, attitudes and practices related to antimicrobial use and antimicrobial resistance in livestock systems and identify the livelihood factors associated with these dimensions. A mixed-methods ethnographic approach was used to survey households keeping layers in Ghana (N=110) and Kenya (N=76),...

Pastoralism, 2019

Across pastoralist groups, dairy products often fulfill major nutritional, economic, and socio-cu... more Across pastoralist groups, dairy products often fulfill major nutritional, economic, and socio-cultural functions. These contributions are jeopardized by poor milk quality with studies among pastoralist groups showing dairy products can harbour a long list of pathogens. These potential risks underscore the need for more effective dairy hygiene interventions. Here, we determine how health messages advocating the "novel" method of pasteurization versus boiling, and administered in narrative versus technical formats, can have an impact on hygiene practices and milk quality in Maasai pastoralists. Four Maasai villages in northern Tanzania were purposively selected to receive intervention strategies that varied in message format (narrative or technical) and heat treatment advocated (boiling or pasteurization). Census lists were used to randomly select 30-35 households in each village (N = 125). Across three visits, milk hygiene knowledge and attitudes were monitored, hygiene practices were directly measured by smart thermometers that recorded heat treatment, and milk quality was determined by calculating total bacterial counts (TBCs) (N = 1007). Compared to initial levels, TBCs in the pasteurization-narrative village (N = 33) exhibited a 73.4% decrease (OR 0.148-0.480) after 7 days and a 59.1% decrease (OR 0.216-0.734) after 14 days. The boilingnarrative (N = 28) exhibited a significant decrease at 7 days (− 68.8%, OR 0.161-0.606), but this decrease was not significant after 14 days (− 35.5%, OR 0.322-1.253). There were no significant decreases for the pasteurizationtechnical (N = 29) or boiling-technical (N = 31) villages after 7 or 14 days. In addition, narrative health formats led to significantly greater retention of health messages and peer-to-peer sharing. Interventions to improve milk quality in pastoralist and other livestock-dependent communities may benefit from enabling the "novel" method of pasteurization. More broadly, our results suggest that the use of narrative messages can promote healthy behaviours when cultural norms are contrary to best health practices as well as enhance the sustainability and scalability of interventions targeted at hard-to-reach populations, including most pastoralist communities.

Clinical Infectious Diseases

JAC-Antimicrobial Resistance, 2021

Clinical Infectious Diseases

Scientific Reports

Microorganisms

Scientific Reports, 2020

Nature Communications, 2020

Cross-Cultural Research, 2015

Journal of Ethnobiology and Ethnomedicine, 2017

Royal Society Open Science, 2016

PloS one, 2017

Current Anthropology, 2016

Journal of Ethnobiology, 2015

Antibiotics, 2021

BMJ Global Health, 2022

Preventive Veterinary Medicine, 2021

Antibiotics, 2020

Pastoralism, 2019

Animal health service providers can play an important role in limiting drug resistance by promoti... more Animal health service providers can play an important role in limiting drug resistance by promoting responsible and prudent use of veterinary drugs. Recognizing this potential, international agencies and governments have called for these providers to receive drug stewardship training, particularly providers in low- and middle-income countries where top-down regulations (e.g., national regulation of veterinary prescriptions) are largely unfeasible. The success of these stewardship trainings to promote responsible and prudent use will depend on many factors, including understanding how livestock-keeping communities currently interact with animal health service providers. Here, we use a mixed methods approach to identify and understand animal health seeking practices among Maasai pastoralists in Tanzania. Combining qualitative interviews (N=31) and structured surveys (N=195), we show the majority of Maasai respondents (≈80%) do not frequently consult animal health service providers with most relying on advice from family and friends. Logistic regression models of health seeking practices find that increasing age, education, observance of treatment failure, and herd disease burdens are associated with greater odds of seeking out health services. Quantitative results were supported by data from focus group discussions and in-depth interviews that showed Maasai view animal health service providers as measures of last resort, whose input is largely sought after self-treatment with veterinary drugs fail. We argue patterns of animal health seeking among the Maasai are partially the consequence of their high confidence in their own abilities in livestock disease and treatment and generally low confidence in the skills of animal health service providers. We link this high sense of self-efficacy to the culturally engrained process by which Maasai develop mastery in animal health and how the roles and norms in Maasai culture surrounding animal health influence Maasai perceptions of animal health professionals. Our results highlight the need for more research to understand Maasai perceptions of animal health service providers as well as the knowledge, attitudes, and practices of these providers. Finally, our study emphasizes that the success of drug stewardship trainings will require efforts to first understand the cultural and historical contexts driving health seeking practices that impact perceptions of animal health service providers and animal health practices more generally.