Holistic Approach Towards Unravelling Antibiotic Resistance in East Africa The potential harm that increasing levels of antibacterial resistance (ABR) will have on human health is vast, as a consequence the effects of this will be felt across society and at the economic level. It is predicted that by 2050, 10 million lives per year and a cumulative 100 trillion US Dollars of economic output may be lost worldwide. In order to address this looming problem a co-ordinated global response is required to try and halt the rise of ABR. Efforts are underway to tackle the rise in resistance, however agenda-setting is dominated by High Income Countries (HICs) and may not reflect priorities or needs of Low and Middle Income Countries (LMICs), where the levels of resistance and also the types of disease caused by bacteria may be different.  One of the most vulnerable regions to the increase in antibiotic resistance is Africa where, in comparison to other regions of the world, the burden of infectious diseases is highest. The economic, cultural and ethnic diversity of Africa mean that the problems surrounding ABR across African countries are likely be distinct from other regions of the world, and therefore require regional solutions and approaches. For example, the availability of antibiotics can be patchy, and the routes of access to antibiotics are variable (including traditional healers, public and private medical practitioners and over-the-counter antibiotic access). Social, cultural and lifestyle drivers of ABR in Africa also have specific features - closer communal living in cities with variable water/sanitation, and closer animal husbandry in rural communities.   This project aims to address ABR in Africa and fill the gaps in knowledge. The research will target three main areas that comprise the problem: the bacteria that are antibiotic resistance and cause disease; the amount of antibiotics that are used to treat disease; and the behaviour of humans that governs how antibiotics are used and supplied. The three elements incorporate epidemiological, economic, cultural and societal factors that interact and contribute to the problem.    Bringing together research covering these 3 elements will provide a holistic view of ABR in East Africa. The project will establish a surveillance network across Uganda, Kenya and Tanzania that is comprised of sentinel sites that monitors and characterized the ABR bacteria that cause disease at that location, maps the use of antibiotics in the sentinel hospitals and the surrounding communities, and captures the behaviour and attitudes of humans that is responsible for their use in these setting. The project also recognises antibiotics are not exclusively used for human medicine, therefore our surveillance will also cover the use of antibiotics in veterinary medicine in the linked communities to provide a 'One Health' view. Using a multidisciplinary approach, encompassing, microbiology, genomics, epidemiology, statistics, social sciences and geography, we will seek to explore and describe the relationships between the elements, and identify the drivers of ABR.  Using this knowledge, we will identify interventions, such as public health and infection control measures and legislation changes, that can be made to control ABR at national and regional level. At the global level, the output of this project will add to the worldwide picture of ABR. This information will also be of value to global development agencies such as the WHO and FAO, to direct funding into effective interventions critical to the region. The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world.