ANTIBIOTIC USE, DISPOSAL AND AWARENESS OF HUMAN HEALTH RISK 1 ASSOCIATED WITH CONSUMING ANTIBIOTICS IN GROUNDWATER AMONG 2 PEOPLE LIVING IN INFORMAL SETTLEMENTS OF KISUMU, KENYA

10 11 Background : Informal settlements across SSA have proliferated with increased urban population. 12 Characterized by inadequate water supply, inhabitants resort to groundwater for domestic use. This 13 happens oblivious of water contamination with emerging contaminants in form of antibiotics and 14 their derivatives. Development of antibiotic resistant genes and antibiotic resistant bacteria, causes 15 ill health, thus interventions that increase level of awareness of health effects of consuming water 16 contaminated with antibiotics are requisite. This involves protecting human, animal and 17 environmental in totality in a One-Health approach. This study sought to determine antibiotic use, 18 disposal and level of awareness of health effects associated with consuming water contaminated 19 with antibiotics. 20 Methods : A cross-sectional study of a random sample of 447 households in selected informal 21 settlements of Kisumu County, Kenya was conducted in September 2019. A structured 22 questionnaire was generated based on research questions and administered to heads of households 23 to assess, antibiotic use, disposal and level of awareness of health effects associated with 24 consuming water contaminated with antibiotics. Data was entered and analyzed in SPSS version 25 20. Results : Level of awareness of health effects of consuming water contaminated with antibiotics was low, 35% (n=156), especially among households where a member had used an antibiotic 28 within one month prior to the time of study; p=0.03. Groundwater was used by 99.8% (n=446) for 29 various purposes, including drinking (9% (n=40)), cooking (18%(n=43)), washing utensils (79% 30 (n=353)), clothes (96% (427)) and house (95% (421)). About half the households reported 31 antibiotic use 43% (n=193). Among this, 74% (n=144) consulted a health worker in a healthcare 32 facility for prescription. Respondents who had taken antibiotics did not always complete doses but 33 reported to have kept the remainder for next time they would get sick (54%). About 32% disposed 34 remainder of antibiotics in pit latrines, compost pits (10%) while 4% reported to have burnt them. 35 Conclusion and recommendation : Groundwater is the major water source for domestic use in 36 informal settlements. With low awareness of risks associated with consuming water contaminated 37 with antibiotics, a looming public health concern due to antibiotic resistance necessitate attention 38 to avert health effects that may lead to ill health.

questionnaire was generated based on research questions and administered to heads of households 23 to assess, antibiotic use, disposal and level of awareness of health effects associated with 24 consuming water contaminated with antibiotics. Data was entered and analyzed in SPSS version 25 20.

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Conclusion and recommendation: Groundwater is the major water source for domestic use in 36 informal settlements. With low awareness of risks associated with consuming water contaminated 37 with antibiotics, a looming public health concern due to antibiotic resistance necessitate attention 38 to avert health effects that may lead to ill health.

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Antibiotics are antimicrobial drugs used to kill or prevent bacteria growth and there are various 46 classes of antibiotics used in humans and animals [1][2]. Antibiotic use is limited to persons 47 confirmed to be suffering from a given infection and also is prescribed by a health worker in a 48 health facility. Antibiotics have been classified as an emerging source of contaminants which need 49 attention to prevent negative consequences to non-targeted humans, animals and ecosystems [3]. 50 They can get into the environment through a various channels of entry including through; hospital 51 3 waste disposal, wastewater, sewage, animal waste and pit latrines adjacent groundwater sources 52 [4][5] [6].

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Proliferation of informal settlements in cities in the SSA had led to increase need for housing [4]. 55 This upsurge has led to increased demand for safe water for domestic use and sanitation [4]. While 56 the quantity and quality of groundwater continue to be explored as source to supplement surface 57 water sources used in most cities and towns, increased population and therefore human activity 58 may lead to its contamination with a myriad of pollutants which include antibiotics [7][8].

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Others reported to have found the water in use since they were born and could have been in use 109 for more than 32 years.   been found to be higher in areas where population density is high [18]. Antibiotics get into 137 groundwater through various ways that include direct dumping with garbage, excreted through 138 feces and urine, from hospital and industrial waste [1][19] and some of the antibiotics have been 139 detected in water [20]. Some respondents reported to have kept the remainder of antibiotics not 140 utilized for future use whereas others disposed in a pit latrine, compost pit or burned.     Availability of data and materials 205 All data related to this study will be made available upon request.

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Consent to participate in the study was obtained from the study participants before the interview 214 was conducted. The study participants signed an informed consent form. 216 Not applicable 217