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Background Antibiotic resistance is a global concern threatening achievements in health care since the discovery of antibiotics. In Kenya, this topic remains understudied in a context of rising demand for livestock products, intensifica- tion and the concomitant increase in antibiotic use. Our study investigates drivers and practices of antibiotic use in poultry farming. The study was conducted in Kiambu County, Kenya. Methods A qualitative research methodology was employed: fourteen key informant interviews, twenty in-depth interviews, and four focus group discussions were undertaken. The interviews were semi-structured. Themes and subthemes from the interviews were generated through inductive analysis. Findings Of the farmers interviewed, sixty eight percent were female, thirty three percent of the sampled farmers could not read, and the majority (eight five percent) of farmers had reared poultry for at least ten years. Research find- ings showed that farmers extensively used antibiotics. Antibiotic use was influenced by factors such as high disease burden, access to medicines and economic pressure. Common practices included prophylactic use, use of antibiotics to enhance production, self-prescription use, use of combination antibiotics (A combination antibiotic is one in which two or more antibiotics are added together for additional therapeutic effect.), and antibiotics classified as critically important in human medicine. Key information sources for the farmers were agro- veterinary dispensers, sellers of day-old chicks, and peer-learning. External factors driving the inappropriate use of antibiotics included access to the antibiotics, influence by marketers such as sellers of day-old chicks, and branding. Use of antibiotics was also driven by economic factors among the farmers, sellers of day-old chicks and agro-veterinary dispensers. Conclusions Our findings indicate widespread use of antibiotics among poultry farmers in our study site. The use of antibiotics is influenced by an interplay of issues at the farmers’ level as well as broader social, economic and struc- tural level factors. A multifaceted One Health approach focusing on regulatory frameworks, knowledge transfer, and research is required to promote stewardship and judicious use of antibiotics. Keywords Antibiotic resistance, One health, Qualitative methods, Poultry, Drivers, Perceptions and practices *Correspondence: Background Jeniffer Waiyego Kariuki Antibiotics have significantly improved health by reduc - Jenykariuki@gmail.com ing morbidity and mortality from infectious diseases Institute of Tropical Medicine, Antwerp, Belgium Department of Microbiology, Immunology and Transplantation, Leuven, . The benefits risk being eroded due to the continued Louvain, Belgium emergence and spread of antibiotic-resistant bacteria . Faculty of Medicine, University of Yaoundé, Yaoundé, Cameroon The situation is especially dire as there is limited devel - International Livestock Research Institute, Nairobi, Kenya University of Liverpool, Liverpool, UK opment of new antibiotics to replace those that have become less effective . Antibiotic resistance increases © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Kariuki et al. Antimicrobial Resistance & Infection Control (2023) 12:3 Page 2 of 11 patients’ length of hospital stay, treatment cost, and mor- A better understanding of farmers’ practices and driv- bidity and mortality. Estimates show that as of 2014, sev- ers of use may offer important insights into the drivers enty thousand to two hundred thousand people die each of antibiotic resistance in poultry production in Kenya. year globally as a result of antibiotic-resistant related This, therefore is the main objective of our study. infections . Low and Middle Income Countries (LMICS) are driv- Materials and methods ing the increase in global consumption of antibiotics. The study area Factors influencing this include high disease burden and The study took place in Kiambu County in February 2019 unregulated access to antibiotics . With increased anti- (Fig. 1). Kiambu County is a peri-urban region in central biotic consumption, resistance in LMICs is widespread: Kenya. The County has an area of 2543.2 km and a popu- multiple drug-resistant bacteria have been isolated from lation of 1,942,205 people . The main economic activ - almost all countries on the African continent [4, 5]. ity of the population in Kiambu is smallholder farming, Among the leading causes of the emergence of anti- employing close to 75 percent of the population. Kiambu biotic resistance is the widespread use of antibiotics in County produces poultry in large numbers, which may livestock . In LMICs, the use of antibiotics in livestock be due to the peri-urban location of the County . production is expected to increase by a 100-fold by 2030 According to the country-integrated plan 2018–2020, due to increased demand for animal protein. Projections Kiambu County had a poultry population of approxi- suggest that the demand for poultry meat in Nairobi, mately 2.5 million birds . Kabete Sub County was Kenya, will grow from six metric tons in the year 2000 selected because of the high chicken density and because to thirty thousand metric tons in 2030, with an accompa- it hosts the primary egg market in the County. nying 30-fold increase in production . This increased poultry production, as observed elsewhere, is likely to Summary of study design and data collection methods lead to extensive use of antibiotics . A qualitative study design was employed to shed light on Most antibiotics used to treat infections in humans are the possible drivers of antibiotic use among poultry farm- also used in animals to enhance production or for the ers in Kiambu County. The research team was composed treatment of infection . This creates an interdepend - of a veterinarian, an ethnographer and a professor of ence between human, animal and environmental health microbiology. Data for the study were collected through and a potential transfer of resistance. A One Health (1) key informant interviews, (2) focus group discussions approach that entails the collaborative efforts of different (FGDs), (3) in-depth interviews with farmers, (4) obser- sectors and disciplines is paramount to addressing this vations and photographs. A semi-structured question- challenge. Describing the use of antimicrobials by farm- naire with open-ended questions was used to guide the ers may provide valuable understandings of practices and discussions and interviews. possible drivers of antibiotic use and inform interven- tions to promote prudent use of antibiotics. Description of study participants The research was undertaken among poultry-rearing Statement of the problem farmers. Poultry farms in Kiambu County can be classi- Kenya has been reported to have a severe AMR prob- fied as small, medium, and large-scale systems with the lem: approximately two hundred different resistant genes medium scale being the majority . Small scale was have been identified in bacteria isolates. High prevalence classified as fifty birds or fewer, medium was classified of antibiotic-resistant bacteria in poultry has also been as fifty to five hundred birds and large scale was between reported [10, 11]. Poultry farmers are reported to rarely five hundred to six thousand birds. Key informants com - seek consultation services from a veterinarian and there- prised three different groups. The first group included fore self-prescription of antibiotics is prevalent . In veterinarians and livestock production officers working this study, we suggest that poultry farmers have a sig- in Kiambu County. These are trained personnel employed nificant role to play in how antibiotics are used. A recent by the County Government for administrative purposes study by Muloi et al. indicates that poultry farmers use in livestock production, and have detailed knowledge critically important antibiotics such as colistin and fosfo- of the livestock production system. The second group mycin in production . There is, however, a dearth of of key informants comprised agro-veterinary dispens- information on how and why farmers use antibiotics in ers (AVDs) working in veterinary shops and animal feed poultry farming and the possible drivers of antibiotic use. shops in Kiambu County. They have diploma-level (col - lege or post-high school vocational) education in animal health, and they are an important group as they serve the poultry farmers by dispensing veterinary medicine. The Antimicrobial resistance. K ariuki et al. Antimicrobial Resistance & Infection Control (2023) 12:3 Page 3 of 11 Fig. 1 Maps of Kenya and Kiambu County showing the study site (Kabete Sub County) on the use of antibiotics by poultry farmers in their poultry farms (source: https:// kiambu. go. ke/ polit ical- units/) third group of key informants comprised chairpersons of female farmers were represented (refer to section "Partic- poultry associations. ipant profiles " for gender disaggregation). Two sampling methods were employed for the selecting the farmers who participated in the FGDs and interviews: purposive Data collection and snowball sampling. For the initial selection of partici- Key informant interviews pants, purposive sampling was used where farmers who Fourteen key informants were interviewed using our fit within the above criteria were identified with the help semi-structured interview guide. Informants were of the local chief and division animal health assistant. For selected through convenience sampling with the help subsequent groups, snowballing was used where the first of the local veterinarian. Criteria for selection included: group of farmers (identified through purposive sampling) professionals that had worked in agro-veterinary dispen- helped identify other farmers. The FGDs were under - saries, animal feed stores, as veterinarians or animal pro- taken in both Swahili and Gikuyu languages using a semi- duction officers for at least one year, and were engaged structured guide containing open-ended questions. Data in this work full-time. Participants included two veteri- were recorded through notetaking and audio recording of narians, two livestock production officers, six AVDs, two livestock feed sellers, and two community-based leaders in the poultry industry (Table 1). Upon compiling the list of the professionals, we contacted them via telephone, Table 1 Table showing a summary of participants interviewed explained the study, and booked appointments for an in- on antibiotic use on poultry farms in Kiambu County person interview at their convenience. Method of data collection Participant Number of participants Focus group discussions Four FGDs were undertaken. Each group had around Key informant interview Agro-vet dispensers 6 six participants, with men and women represented. We Field veterinarians 2 chose to mix groups in order to ensure gender inclusiv- Animal feed sellers 2 ity. Group discussions lasted approximately one hour Day old chick sellers 2 each. To ensure diversity in response, the study included Stakeholders in poultry 2 participants from the three strata of poultry farming, i.e. industry small, medium, and large-scale farms. Farmers above In-depth interviews Poultry farmers 20 eighteen years of age were selected and both male and 4 Focus group discussion Poultry farmers 24 Kariuki et al. Antimicrobial Resistance & Infection Control (2023) 12:3 Page 4 of 11 Ethical clearance and informed consent the interviews. Information saturation was reached with Ethical approval for the study was granted for one year the fourth group. through International Livestock Research Institute’s (ILRI) institutional research ethics committee Ref: ILRI- In‑depth interviews IREC2018-29 on 6/12/18. Twenty farmers were interviewed during the in-depth Written consent was sought and gained from all par- interviews. We conducted twenty interviews because this ticipants prior to interviews or discussions. was the point at which saturation was reached. By satura- tion, we mean that a range of responses had been given Data management and analysis and those responses were repeated with no new informa- Data were anonymized and no names were connected tion. To triangulate information gathered through the with the written data. Basic demographic data were kept focus group discussions and interviews, antibiotic use with each narrative such as gender and age of participant, practices within the farm were also observed and photo- as well as a general location and the type of farm. It was graphs of products used within the farms were taken. unnecessary for our records to keep personal informa- tion on participants. Data were stored on an external A note on gender and livestock hard drive as a backup, which was kept in a secure loca- In the context of our study, male household heads tra- tion, as was the laptop computer used for data storage ditionally make most financial decisions regarding the and management. farm and livestock. Highly commercial ventures are con- Data analysis was conducted using an inductive trolled by men, and less commercial or smaller profit approach and thematic analysis. There was first a com - making ventures are the remit of women. Chickens are plete read-through of all the material collected from the kept within the homestead and immediate area, and not key informants, FGDs and in-depth interviews. The data taken out to pasture, and therefore are the responsibil- collected in Swahili and Gikuyu were translated into Eng- ity of women. Livestock such as cattle or goats, which are lish by the first author. The data were then transcribed also of high value, are the responsibility of men. This phe - verbatim and imported into NVIVO 12 for data manage- nomenon has been reported elsewhere with both crops ment and storage. We then analyzed the content of the and livestock . Broadly speaking, our study sample narrative data and identified emerging themes and sub - indicated that smaller-scale poultry farms were run by themes, and then organized the data within their relevant women and the larger ones (and therefore those which thematic categories. made larger financial profits) were run by men. The first author is from this ethnic community, Results although not this geographical area and therefore has in- Practices around the use of antibiotics depth personal experience of cultural and social norms. Widespread self‑prescribed use of antibiotics It was important to us to ensure that a mix of genders Widespread, over-the-counter use of antibiotics was was represented in the study, as well as making sure that reported to be common among farmers. This was dis - farmers were selected based on their full authorization to cussed by the farmers themselves, reported in FGDs, and make decisions on the farms. from key informants. Key informants, such as extension officers, classified farmers’ use of antibiotics as ‘over - Participant profiles use’. This form of self-prescribing, participants said, was Despite men traditionally being the heads of households, influenced by disease burden, knowledge of antibiotic in our study the majority of farmers were female: sixty brands, ease of access, and poor regulation of sale. Farm- eight percent (30/44). About one-third (37 percent) were ers in our study did not have access to regular veterinary thirty to fourty years of age, eleven percent were forty advice, and there were no herd treatment plans in place. to fifty years, while thirty three percent were fifty years Farmers’ reported that their choice of an antibiotic was and above. Most of the participants had a minimum of informed by (1) previous successful use of the antibiotic primary school education (66 percent). The majority (85 for a similar condition, (2) popularity and availability of a percent) of the farmers had been keeping poultry for brand, (3) broad-spectrum activity of the antibiotic, and more than ten years. However, we did not record gender (4) perceived potency of an antibiotic. The farmers in on each individual transcript. our study perceived the characteristics of the medicines through previous successful use, peer learning, and from the AVDs. The area was served by several agro-veterinary By which we mean collection of the same information using more than one shops. Antibiotics were therefore easily available to the method, which aids in gaining an in-depth and rigorous understanding of a phenomenon. K ariuki et al. Antimicrobial Resistance & Infection Control (2023) 12:3 Page 5 of 11 Table 2 List showing commonly used antibiotic brand names, active ingredients and classification under WHO list of critically important medicines 2018 Product Trade name Active ingredient Drug group WHO –critically important number antimicrobials for human medicine A Aliseryl Erythromycin Macrolide Critically important Oxytetracycline Tetracycline Highly important Streptomycin Aminoglycoside Critically important Colistin Polymixin Critically important B Tetracolivit Tetracycline Tetracycline Highly important Colistin Polymixin Critically important C Fluquin oral solution Enrofloxacin (not used in human but Fluoroquinolone Highly important metabolized to ciprofloxacin) Sulphamethoxazole Sulfonamides Highly important D Neoxy vitamin Ws Neomycin Aminoglycoside Critically important E Oxytetracycline Tetracycline Highly important F Biotrim Trimethoprim b.p Sulfonamides Highly important Sulphamethoxazole Sulfonamides Highly important G Trimovet Trimethoprim Sulfonamides Highly important Sulphamethoxazole Sulfonamides Highly important H Tylodoxin Doxycycline hydrate Synthetic tetracycline Highly important Tylosin tartrate Macrolide Critically important I Alamycin egg Oxytetracycline Tetracycline Highly important J Limoxin Oxytetracycline Tetracycline Highly important K Skajcycline Oxytetracycline Tetracycline Highly important L Chick formula Oxytetracycline HCl Tetracycline Highly important M Egcocin chick formula Oxytetracycline Tetracycline Highly important N Esb3 Sulfaclozine sodium monohydrate Sulfonamides Highly important O Ampiclox Ampicillin Penicillin Critically important Cloxacillin Penicillin Critically important farmers, and farmers did not require a prescription to in day-old chicks were reportedly prevalent. Broiler and purchase them: layer farmers reported using antibiotics as disease proph- ylaxis in day-old chicks and mature birds. Almost all There was a time when my birds were dying in large farmers reported using antibiotics to protect chicks from numbers, around 200 at a time, and I couldn’t treat disease upon arrival from hatcheries. The most commonly them. I went to a doctor at Wangige who conducted used antibiotic combination by market name for disease the postmortem. He advised me to mix Limoxin and prophylaxis in chicks was product A (refer to Table 2 for Tylodoxin. Following this, I discovered this combina- expansion of brands). AVDs also ranked product A as tion to be very strong. So recently, I noticed that the the most commonly bought antibiotic combination for birds were having some infections and I mixed the controlling disease in chicks. This brand was reportedly Limoxin and Tylodoxin again. If your birds are hav- preferred because of its broad-spectrum activity. Farmers ing diarrhea and respiratory disease, it is usually indicated that they used the antibiotics on the advice of very severe, and they die immediately. Even then I sellers of day-old chicks for protection against infections. make the mixture, I give birds for three days. Both farmers and AVDs indicated that product A had Poultry farmer, Kiambaa. gained popularity in the past year. For disease prevention in mature birds, sulphonamide-based antibiotics were reported by farmers in the FGDs to be the most popular. Prophylactic and overuse of antibiotics for improved egg production To protect the day-old chicks from infections we Use of antibiotics for disease prophylaxis From FGDs use Product A which is an antibiotic for 7 days. We and interviews with farmers, poultry diseases such as apply it in water; we also add glucose and liquid Newcastle disease, infectious bronchitis and omphalitis Kariuki et al. Antimicrobial Resistance & Infection Control (2023) 12:3 Page 6 of 11 Fig. 2 Showing the antibiotics commonly used by poultry farmers in their farms in Kiambu expressed as a proportion of the farms using antibiotics in the past six months (n = 44) paran. ffi prior to the study (refer to Fig. 2). Most of the farms Poultry farmer, Gitaru. where antibiotics were used were large scale where broil- Product A is mostly used by farmers for the day-old ers and layers were reared. On the farms where antibiot- chicks. They prefer it because they say that it is pow - ics were used, 47 percent used combination antibiotics. erful as it has a combination of four antibiotics and vitamins. We also like it a lot because it has broad- Support of diagnosis by laboratories AVDs reported spectrum activity, you give it and you are sure. mainly depending on symptomatic disease diagnosis. In AVD, Kikuyu. exceptional cases such as high mortality rates, farmers were referred to the government and university labora- tories located near most farms. Though farmers in FGDs indicated laboratory charges were affordable, seeking Use of antibiotics to enhance egg production Participat- diagnostic services was constrained by a long turnaround ing farmers in the interviews and FGDs also discussed time for processing of results. using antibiotics in sub-therapeutic doses as production enhancers. Products C, D and I (tetracycline) were the Yes, we take our chickens to the Kabete laboratory most popular, marketed to enhance egg production of lay- especially when they are dying in large numbers so ers. Equally, AVDs reported that these products sold rela- that they can determine if the problem originates tively quickly. Farmers said that they associate the con- from the hatchery. The only problem is that it takes a tainers’ yellow color and a picture of an egg with increased long time. Sometimes I just choose to go to the agro- production. Commonly, antibiotics were administered veterinary shop although the prices are not high at from a young age until the start of the laying period. Anti- the laboratory. There is laxity on the government biotics were also administered whenever farmers noticed side, they work slowly and sometimes you may hear that birds had production problems. On individual farm that they have gone on strike. visits, product I containers were the most common, sug- Poultry farmer, Kanyariri. gesting that this product was commonly administered compared to others. Drivers of antibiotics use For the Alamycin egg, I use this when the birds are Economic drivers of overuse of antibiotics young. I start giving the birds when they are about Economic influence on disease control In the FGDs profit one month old and continue until they start laying. maximization was reported to be a significant driver I also give when the production goes down until they influencing disease control practices for the farmers in start laying properly. our study, and antibiotic compliance practices such as the Poultry farmer, Ndumbuini. observation of a withdrawal period of antibiotics were not Of the farmers interviewed, 78 percent (34/44) always observed. All interviewed farmers indicated that reported the use of an antibiotic in the past six months they operated on very tight profit margins. Prices of eggs K ariuki et al. Antimicrobial Resistance & Infection Control (2023) 12:3 Page 7 of 11 had dropped from approximately USD 3.00 per tray to less vaccines are packed in large doses and therefore it is than USD 2.00 per tray (a tray has thirty eggs). However, not economical to vaccinate. animal feed cost was reported to be quite high compared Poultry farmer, Uthiru. to profit margins realized from sale of either eggs or meat. Poultry rearing has also become very unprofitable Economic influence on dispensers of antibiotics because of the bad markets; therefore, our profits Economic motivation was discussed by the AVDs and margins are very little. key informants to contribute to the overuse of antibi- Poultry farmer, Kinoo. otics. As the consultation services offered by the AVDs This is important because if poultry are not financially were free, the farmers had to purchase some medicines productive because they are sick, then farmers will feel from the agro-veterinary for the enterprises to remain the need to administer antibiotics. Cost of operation viable. Market competition among the agro-veterinary played an important role in disease control, significantly shops was also reported by the AVDs and field veterinar - constraining health seeking behavior of poultry farmers ians to be a driver of the use of more potent antibiotics for their chickens. Farmers perceived the cost of on-farm perceived by the veterinarians and dispensers. The AVDs veterinary services to be high, yet on the other hand, were compelled by competition to give potent antibiotics consultation at the agro-veterinary shop was offered as a to ensure positive outcomes on disease control and cus- free service as the farmer was expected to buy medicine tomer retention. after consultation. Field animal health professionals also Some agro-veterinary shops also prescribe strong indicated that farmers were hesitant to have farm-level [more potent] antibiotics so that they can create a consultations, as the fees charged for this service were good name for their shops because of competition. relatively high. Field Veterinarian. Most farmers do not like calling the veterinarian You have to be very careful because if the bird does because they think that they know and therefore they not respond to medicine they may not come to your go and ask for the medicines directly. They also do shop again as there are nine more agro-veterinary not like paying for the consultation services, whether shops around here. you treat the birds or not. Here you have to do some- AVD in Wangige. thing as the doctor so that they can pay. Most farm- ers are small-scale farmers and so they do not expect you to charge anything. Sometimes they will ask Discussion you; did you make all this money in the short period Our study contributes to the existing understanding of that you were here. Sometimes they will think for antibiotic use by poultry farmers in their farms. It dem- instance how comes I charged USD 50.00 in such a onstrates that farmers’ use of antibiotics is driven by an short period that I was with them. interplay of social and economic factors. Injudicious use Field veterinarian, Kanyariri. enhances the risk of AMR in animals, humans and the environment. From the FGDs and interviews with the farmers, the cost of routine vaccinations was perceived as prohibi- tive. Even though the farmers were aware that vaccina- Infection control practices tion should be undertaken regularly, the cost of vaccines Diseases posed a significant challenge among the inter - was cited as a limiting factor. Most vaccines were packed viewed poultry farmers driving antibiotic use. Central to in 100 doses and required refrigeration, yet indigenous reducing antibiotics use is disease control through meas- poultry farmers owned an average of 20 chickens. The ures such as biosecurity procedures and vaccination. This majority of these farmers considered it uneconomical to has been demonstrated among pig farms in Belgium, purchase 100 doses if only 20 birds needed to be vacci- where biosecurity level was associated with the amount nated. Cost also limited the observation of important of antibiotics used . Biosecurity in poultry produc- bio-security measures such as frequent changing of bed- tion is anchored on three core principles: cleaning, segre- ding in the chicken houses. gation, and disinfection . Combined, these measures reduce the risk of introduction and spread of disease. In For the indigenous birds, we also use some antibiot- our study, there was a low level of adoption of biosecurity ics but not as much as what is used in the large scale measures. Cost–benefit analysis of biosecurity may act poultry farming. On vaccination of the indigenous as an incentive, encouraging farmers to implement these birds we do not often vaccinate them because the measures in their poultry farms . Kariuki et al. Antimicrobial Resistance & Infection Control (2023) 12:3 Page 8 of 11 In commercial chickens, vaccination coupled with the The World Health Organization (WHO) lists the use of biosecurity measures may significantly reduce majority of antibiotics used for prophylaxis of disease in antibiotic use without compromising levels of produc- our study as important and critical medicine in human tion . In our study, most broiler and layer farmers health. In our study, colistin use was reported in 13 per- vaccinated their birds against infectious poultry diseases, cent of poultry farms. This is consistent with the find - although not routinely. A study of beef farmers in Ten- ings of Muloi et al., who reported that colistin was an nessee in the USA found that packing vaccines in large antibiotic of choice for poultry farmers: 16 percent of amounts was a key hindrance in the purchase and use of veterinary shops dispensed colistin to poultry farmers in vaccines, as was similarly reported by keepers of indige- Nairobi, Kenya . The study by Muloi does not explain nous birds in our study . To encourage the utilization the drivers of this practice. As previously indicated, our of vaccines by indigenous bird keepers, manufacturers findings point to the promotion of the use of this anti - should consider packing vaccines in smaller numbers of biotic by sellers of day-old chicks with a view to prevent doses. omphalitis. While the use of colistin in poultry produc- tion has been banned in countries such as China because of its human medical importance, in most LMICs it is Use of antibiotics for disease control and production still used in livestock production [4, 21, 28, 29]. The wide - Similar to other studies conducted among poultry farm- spread use of colistin in livestock production in China ers in LMICs [21, 22], we found that antibiotics were is thought to be a significant driver in the emergence of reported to be used in sub-therapeutic doses to enhance plasmid-mediated MCR-1 in Enterobacteriales isolated production, especially in layers and broilers. The appli - in humans . cation of antibiotics in sub-therapeutic doses results in In our study, the use of poultry droppings as animal selection pressure stimulating the emergence of resistant feed was very common, and poultry was often housed bacteria . Similarly, studies in Vietnam and Cambodia with other species such as cattle and pigs. This creates found that antibiotics were widely used to protect day- potential pathways for the transfer of antibiotic-resist- old chicks against infections on arrival [24, 25]. The study ant bacteria including transfer to the environment, to in Vietnam does not explain the drivers of this practice, cattle and pigs fed on the droppings, and ultimately to but findings of our study strongly point to the influence humans at the top of the food chain. Colistin is excreted of sellers of chicks encouraging antibiotic usage for the in its bioactive form. Therefore, the antibiotic is avail - prevention of omphalitis. Poor sanitary conditions at the able in sub-therapeutic doses in chicken droppings and hatchery and on the farm are linked to a high prevalence may induce selection pressure in the gut of the animals of omphalitis in chicks . The use of antibiotics for that consume the poultry droppings as animal feeds. This prophylaxis may affect the curative use of these antibiot - creates an avenue for the spillover of resistant microbes ics in human and animal medicine. from animals to humans through physical contact or the In our study, the most commonly used brand for food chain. Similar strains of resistant genes have been prophylaxis in day-old chicks, product A (refer to Table 2 reported in humans and animals, and examples include for reference on active ingredients), gained popularity in plasmid-mediated resistance to colistin in Klebsiella the past year. There may have been an economic motiva - spp, suggesting transmission of AMR from animals to tion for the sellers of the chicks to market this product. humans [31, 32]. This underscores the need for a One To effectively reduce the use of antibiotics in poultry, Health approach through multiple sectoral and cross- suppliers of chicks form a very important target group. disciplinary cooperation to address the AMR challenge. Use of combined antibiotic brands and critically important Source of veterinary services antibiotics in poultry production Farmers sought veterinary services from AVDs but as In our study, a significant proportion of antibiotic brands noted in a study from Ghana, they did not form part of used (53.3 percent) contained more than two differ - the farm management . In our study, the high cost of ent groups of antibiotics sold as a single product. For on-farm consultation was reported to be a key hindrance instance, product A, the most commonly used antibi- to the involvement of veterinary professionals in the otic brand for disease prophylaxis in chicks, had a com- management of poultry farms. In addition, while there bination of four different important antibiotics (ref to were veterinary laboratories near farms, most farmers Table 2). The use of combination antibiotics has been and AVDs did not utilize them citing the long turnaround reported as a key driver of the emergence of multiple time for results. Lack of integration of prescriptions drug-resistant bacteria due to the exposure of bacteria to with extension services or laboratory diagnosis results different antibiotic classes . in the use of broad-spectrum antibiotics for perceived K ariuki et al. Antimicrobial Resistance & Infection Control (2023) 12:3 Page 9 of 11 improved treatment outcomes. Although in many con- economic factors at the farmers’ level as well as broader texts, drugs are administered without laboratory diag- social, economic and structural level conditions. noses, in the context of our study, very few farmers ever sought such services. Self-prescription of antibiotics was the second most Appendix important route to seeking veterinary services for poul- try farmers. This was driven by widespread knowledge Theme Sub-theme Questions of antibiotic brands compounded by factors such as ease Semi structured of access to antibiotics and financial pressure (the high questionaire cost of veterinary consultation). Antibiotic resistance is reported to be higher in settings where self-prescribed Practice Self-prescription and When and why did you medication start rearing poultry? antibiotics are used frequently [33, 34]. In LMICs, where Peer learning(leaning Do you rear commer- the sale of antibiotics is poorly regulated, delinking finan - from other farmers cially or as subsistence? cial gains from the sale of antibiotics has been suggested What is your market for your poultry—eggs? as a possible intervention toward reduction of self-pre- Meat? Very local or scription use of antibiotics . further afield markets? What are some of the challenges that you Recommendations face while rearing your To increase the efficacy of farmers’ understanding of poultry? AMR, research programs should adopt a collaborative How do you keep your poultry healthy and effort between social scientists, environmental scien - productive? tists, animal health and human health practitioners, i.e. When your chickens a One Health approach. This will give a more complete get sick what do you normally do? picture of the risks we are facing from possible overuse Who advises you on of antibiotics, and a better understanding of farmers’ how to take care of needs. Actions such as surveillance of antimicrobial use your chickens? On which occasions do and resistance when implemented in synergy across dis- you call a veterinarian? ciplines and sectors increase the potential for the reduc- Do you use any tradi- tion of AMR. tional medicines for your chickens? Probably the most salient factor in antibiotic use is What are some of the financial. If farmers could be shown more effective and medicines that you use either free or inexpensive ways of keeping their poultry in the production of your chickens? healthy, they would be less likely to overuse antibiot- Who purchases and ics. Day-old chicks are very vulnerable to disease and so who administers medi- farmers are immediately dosing them with antibiotics. cine when chickens get sick? One important node for any future intervention would How do you know the be supplier of these chicks to ensure that they are healthy amount to use? when they reach the farmer. Conclusions Our findings indicate widespread use of antibiotics among poultry farmers in our study site. The qualita - tive methodology provides in-depth insight into some of the drivers of the regular use of antibiotics by poul- try farmers, which would likely not have been revealed through quantitative methods. Although specific to this geographical location, our findings contribute to a broader body of evidence on antibiotic use in poultry across LMICs. In our study, findings indicate that the use of antibiotics is influenced by an interplay of social and By which we mean issues at the level of government policy, as well as national and international political conditions. Kariuki et al. Antimicrobial Resistance & Infection Control (2023) 12:3 Page 10 of 11 Author contributions Theme Sub-theme Questions JWK: Conceptualization, Investigation, Formal Analysis, Methodology, Semi structured Writing—Original Draft Preparation. JJ: Conceptualization, Investigation, questionaire Supervision, Writing—Review & Editing. MPN: Writing—Review & Editing. OH: Conceptualization, Methodology, Investigation, Supervision, Writing—Review Knowledge Literacy What is the level of edu- & Editing. All authors read and approved the final manuscript. Education on antibi- cation for the poultry otic use by dispensers farmers? Funding Knowledge on dis- Are you able to read Not applicable. ease control and understand the Identification of information provided Availability of data and materials antibiotics with the medicines? Qualitative data for this study may be made available upon request from the Identification antibiot - Does the dispenser corresponding author. ics by trade names provide information Knowledge on antibi- to you when they sell otic resistance the drug? If so which Declarations Source of information information? for antibiotic use’ Are you aware of antibi- Ethics approval and consent to participate otic resistance? Please Research ethics committee at the International Livestock Research Institute explain (ILRI) cleared the research protocol: REF number ILRI-IREC2018-2. Written How does anti-biotic informed consent was sought from the study participants before the FGDs resistance develop? and the interviews. For a few participants who could not read, oral recorded What are the conse- consent was sought and verified by literate community members. Participants quences of antibiotic were assured that their participation in the study was voluntary and their resistance? responses would be handled with confidentiality. Who is at risk from antibiotic resistance Consent for publication Can using antibiotics in Written informed consent to publish results was obtained from all the poultry have effect in interviewees. humans, if so what are some of these effects? Competing interests What is withdrawal The authors declare that they have no competing interests. period and why is it important? Received: 14 March 2022 Accepted: 11 December 2022 Attitude Expectations Are there any expecta- Disease control tions that you have of Tradition beliefs veterinarian when treat- Possible benefits of ing your chickens? antibiotic use on the What are the biggest poultry issues for you in the References Risk perception of health of your chickens? 1. Aminov RI. The role of antibiotics and antibiotic resistance in nature. antibiotic use What are the big- Environ Microbiol. 2009;11(12):2970–88. Cost issues (veterinary gest issues you see in 2. O’Neill. Tackling drug-resistant infections globally: final report and recom- consultation, antibiot- accessing medicines or mendations. 2016. ics) medical knowledge for 3. Klein EY, Van Boeckel TP, Martinez EM, Pant S, Gandra S, Levin SA, et al. your chickens? Global increase and geographic convergence in antibiotic consumption What is your opinion on between 2000 and 2015. Proc Natl Acad Sci. 2018;115(15):E3463–70. the use of antibiotics / 4. 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Antimicrobial Resistance & Infection Control – Springer Journals
Published: Jan 5, 2023
Keywords: Antibiotic resistance; One health; Qualitative methods; Poultry; Drivers; Perceptions and practices
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