WASH-nutrition integration as a global policy priority for antimicrobial stewardship in low- and middle-income countries

ABSTRACT Antimicrobial resistance (AMR) is a global health threat predicted to hit 10 million deaths per year by 2050. Most conventional antimicrobial stewardship (AMS) strategies focus on clinical settings, failing to address community-level overuse, a primary driver of AMR in low- and middle-income countries. This commentary leverages novel evidence to argue for the prioritization of water, sanitation, and hygiene (WASH)-nutrition integration as a global health policy and first-line defense strategy against AMR. This argument is grounded on a target article that utilized causal mediation analysis to establish how low-cost household level WASH and nutrition interventions reduced pediatric antibiotic use via multiple biological pathways. This transforms prevention into a measurable antimicrobial defense strategy through antibiotic doses averted and limits antibiotic demand. These findings provide an empirical basis for integrated preventive measures, a quantifiable scorecard for securing political and fiscal commitment and redefinition of AMS as an element of global health policy and environmental conservation.