{
  "abstract": "Objectives Antimicrobial resistance is a growing global public health threat driven by interactions between human, animal and environmental factors. Rural settings in low- and middle-income countries may face increased risk due to unregulated antibiotic use, close human–animal interactions, and environmental contamination. This study explored community-level knowledge, attitudes and practices related to antibiotic use and resistance among caregivers of children in rural South India using a One Health perspective.Design Qualitative study using focus group discussions and thematic analysis.Setting Four rural villages in Tirunelveli district, Tamil Nadu, India.Participants Seventy-seven primary caregivers of children aged 2–12 years from households with backyard animals, purposively selected from a rural cohort study.Results Three themes emerged. First, human health practices included reliance on home remedies, reuse of prescriptions, self-medication and incomplete antibiotic courses alongside misconceptions about antibiotics. Second, environmental factors such as untreated water consumption, open defecation, poor drainage and improper waste disposal were perceived to increase infection risks. Third, animal-related pathways included close child–animal contact, antibiotic use in livestock and unsafe disposal of animal waste. Limited healthcare access and transport costs influenced treatment-seeking behaviour.Conclusions Interconnected caregiver practices, environmental conditions and animal husbandry behaviours create multiple pathways for antimicrobial resistance transmission. Integrated, community-based interventions addressing behaviour change, healthcare access and environmental management are essential to support antibiotic stewardship within a One Health framework.",
  "authors": [
    {
      "affiliations": [
        "Division of Environment Monitoring and Exposure Assessment (Water and Soil), ICMR-National Institute for Research in Environmental Health, Bhopal, India",
        "Department of Health Sciences, Savitribai Phule Pune University, Pune, India"
      ],
      "name": "Kamini Charan"
    },
    {
      "affiliations": [
        "Model Rural Health Research Unit, Tirunelveli, India"
      ],
      "name": "Velappan Lakshmi Kandhan"
    },
    {
      "affiliations": [
        "Model Rural Health Research Unit, Tirunelveli, India"
      ],
      "name": "R Sahaya Rishika"
    },
    {
      "affiliations": [
        "Model Rural Health Research Unit, Tirunelveli, India"
      ],
      "name": "Palavesam Kalimuthu"
    },
    {
      "affiliations": [
        "Model Rural Health Research Unit, Tirunelveli, India",
        "Tirunelveli Medical College, Tirunelveli, India"
      ],
      "name": "A Charles Pon Ruban"
    },
    {
      "affiliations": [
        "Model Rural Health Research Unit, Tirunelveli, India",
        "ICMR-National Institute of Epidemiology, Chennai, India"
      ],
      "name": "Mohan Babu Karthikeyan"
    },
    {
      "affiliations": [
        "Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India"
      ],
      "name": "Krushna Chandra Sahoo"
    },
    {
      "affiliations": [
        "Model Rural Health Research Unit, Tirunelveli, India",
        "ICMR-National Institute of Epidemiology, Chennai, India",
        "Faculty of Medical Sciences, Academy of Scientific and Innovative Research, Ghaziabad, India"
      ],
      "name": "Manickam Ponnaiah"
    },
    {
      "affiliations": [
        "Model Rural Health Research Unit, Tirunelveli, India",
        "ICMR-National Institute of Epidemiology, Chennai, India",
        "Faculty of Medical Sciences, Academy of Scientific and Innovative Research, Ghaziabad, India"
      ],
      "name": "Girish Kumar Chethrapilly Purushothaman"
    },
    {
      "affiliations": [
        "Division of Environment Monitoring and Exposure Assessment (Water and Soil), ICMR-National Institute for Research in Environmental Health, Bhopal, India",
        "Faculty of Medical Sciences, Academy of Scientific and Innovative Research, Ghaziabad, India",
        "Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Vishal Diwan"
    }
  ],
  "title": "Primary caregivers’ practices and perceptions on antibiotic use and resistance: a one health qualitative study in rural South India",
  "uid": "4d6efd13-1071-51fb-a3f4-8735bf14a1ed"
}