Migrant labour and antimicrobial resistance in two Nepali factories: A biosocial analysis

Occupational environments contribute to antimicrobial resistance (AMR) through pollutants, injuries and the everyday use of medicines. This mixed-method study, conducted in 2023 and 2024, explores the biosocial dynamics linking working conditions and antibiotic resistance among migrant and local workers in a cement factory and a steel factory in Nepal. Combining ethnographic observation, survey data and microbiological testing, we compare labour organisation, occupational hazards, antibiotic use and Escherichia coli (E. coli) susceptibility across the two sites. Hazards and injuries were structured differently between the factories. In the steel factory, migrant workers used more antibiotics to treat work-related illness. Reduced E. coli susceptibility was more common among migrant workers in the steel factory, and among local workers in the cement factory. The organisation of industrial work and labour migration contribute to the multifactorial development of AMR, alongside clinical and agricultural antibiotic use. Combining ethnography, pharmacology and microbiology, our biosocial analysis identifies the workplace as an under-recognised site in the production of AMR and points to the need for occupationally grounded approaches to AMR prevention.