Leveraging Geospatial Analysis to Understand the AMR Crisis in Remote and Mountainous Regions: Lessons from Northern Pakistan

Antimicrobial resistance (AMR) is a critical global health threat, exacerbated by overuse and misuse of antibiotics, limited and understaffed healthcare infrastructures, poor accessibility to health services, and weak regulations. It also poses a significant burden on healthcare sectors with mortality and morbidity on the rise, and piling pressure on hospitals by prolonged hospital stays. Due to geographical isolation, traditional healthcare practices, and limited access to modern medical services, remote regions present distinct challenges in controlling the spread of resistant pathogens and AMR remains largely underexplored. This chapter delves into AMR in northern Pakistan’s Khyber Pakhtunkhwa (KPK) region, where malpractice, non-certified practitioners (quacks), and limited healthcare access intersect with antibiotic misuse, creating an environment conducive to the development of resistance. As most of these conditions are not unique to KPK, this study offers relevant perspectives to rural, remote, and mountainous communities across the planet. This case study uses data from a retrospective analysis conducted at Saidu Group of Teaching Hospitals (SGTH) Swat KPK in 2021, including 548 patients’ case histories. The study assessed resistance to common antibiotics, i.e., cefixime, cotrimoxazole, doxycycline, and ciprofloxacin using culture sensitivity tests. Geospatial techniques, including hotspot analysis, local indicators of spatial autocorrelation (LISA) and geographically weighted regression (GWR) identified local AMR clusters and significant risk factors. AMR prevalence correlates with demographic and socioeconomic variables, including rates of illiteracy, rural proportion, disability, and media exposure. Based on observed local correlations, geospatial analysis can help identify high-risk sub-regions (tehsils), allowing for targeted interventions, more feasible and cost-effective than region-wide measures. The findings from KPK provide valuable insights for policymakers and healthcare planners, offering a model for targeting high-risk areas in remote settings elsewhere. By focusing on specific risk factors and sub-regions, this study offers a practical approach to mitigating the growing threat of AMR in challenging environments by integrating geospatial techniques to understand AMR patterns and inform evidence-based interventions.