Antimicrobial Resistance Research Hub - Policy

Fleming Fund Kenya country grant

admin — Fri, 09 Apr 2021 09:28:12 +0000

Fleming Fund Kenya country grant

The cornerstone of the Fleming Fund is the country grants program. Through a competitive tender process, organizations or a consortium are selected for funding awards to support the country’s national action plan, by reinforcing existing surveillance systems, strengthening laboratory infrastructure, developing human capacity or technical skills and using protocols for appropriate antimicrobial use.

Activities are expected to support existing government health systems and work in tandem with relevant government ministries.

Lead grantee

PATH

Sub-grantees

Aga Khan University
International Livestock Research Institute
Kenya Medical Research Institution
University of Nairobi
Washington State University

More information

Pillar

Policy

Country

Kenya

Region

Africa, Eastern and Southern Africa

Contacts

Donors/Investors

Situation analysis on antimicrobial resistance surveillance and control in Vietnam

Ekta Patel — Tue, 03 Mar 2020 20:14:28 +0000

Contact details: Hung Nguyen-Viet (h.nguyen@cgiar.org). International Livestock Research Institute, Hanoi - Vietnam.

Background

Vietnam is a large country in South East Asia with over 96 million people and was previously one of the world’s poorest nations. It is now a middle-income country with strong aspirations of becoming an industrialised country by 2020. Agriculture contributes 15% of the Gross Domestic Product (GDP) and the livestock sector, predominantly pigs, contributes 30% of agricultural GDP¹. In 2018, the fisheries sector produced 7.74 million tons (3.59 million tons from capture and 4.15 million tons from aquaculture) and the export value of seafood increased by 8.3% to 9 billion United States dollars. Vietnam is facing the challenge of antimicrobial resistance (AMR) because of the overuse of antimicrobials in humans and animals. In response, the government and partners have developed several programs. This brief outlines the current situation of antimicrobial resistance in Vietnam from the perspective of human health, livestock and aquaculture.

Evaluation and planning

In 2010, the Global Antibiotic Resistance Partnership compiled the first comprehensive report on AMR. The report analysed the development of AMR in Vietnam and outlined the way forward for AMR surveillance². However, the report focused mainly on the human health sector with little discussion on livestock and aquaculture. In 2013, Vietnam developed a 2013–20 national action plan to combat AMR. The action plan addresses raising community awareness, improving the surveillance system, safeguarding access to antimicrobials, encouraging the safe use of antimicrobials in human health and livestock production, and supporting infection control measures³. In 2017, the Ministry of Agriculture and Rural Development launched a 2017–20 national action plan to reduce the risk of AMR through the control of antimicrobial use (AMU) in livestock production and aquaculture⁴.

In the human health sector, a surveillance network was established in 2013 under the Vietnam Resistance Project funded by the Swedish International Development Cooperation Agency. In 2016, the Ministry of Health established the national surveillance system on antimicrobial resistance which comprises 16 central and provincial hospitals that are enrolled in the United Kingdom National External Quality Assessment Scheme⁵. In 2017, ten hospitals developed antimicrobial resistance databases.

In the livestock sector, surveillance of antimicrobial resistance in animals is still at a nascent stage. Surveillance in animals and food of animal origin is carried out by the Department of Animal Health under the Ministry of Agriculture and Rural Development. The ministry collates and reviews all the information generated on antimicrobial resistance and antimicrobial use to better understand the epidemiology of antimicrobial resistance and develop policies on antimicrobial use. The department also registers drugs imported for veterinary use, manages data on imports and manufacture of antimicrobials, and leads antimicrobial resistance surveillance. Active antimicrobial resistance surveillance was conducted in healthy pig and poultry populations in five provinces between September 2017 and March 2018; the target pathogens were E. coli and non-typhoidal Salmonella.

In the aquaculture sector, surveillance for antimicrobial resistance in catfish was piloted in 2013–14 in 75 catfish ponds in six big catfish farms. The focus was on antimicrobial resistance in enteric bacteria (E. coli and Salmonellaspp.) and aquatic bacteria (Aeromonas spp. and Vibrio spp.) isolated from pond water, supply water, pond sediment and catfish. More work has been done on Pangasius and shrimp production in the Mekong.

The laboratory network for surveillance is developed in the human health and livestock sectors. In the human health sector, laboratories are mainly in hospitals and hygiene, epidemiology and Pasteur institutes whereas, in the animal health sector, there are seven regional animal health offices and two veterinary and animal hygiene centres. Because of the need for multi-sectoral collaboration in antimicrobial resistance surveillance, the One Health approach has been identified to bring together the human and animal health sectors⁶. Environmental surveillance is almost absent.

Interventions

In the human health and livestock sectors, most of the interventions by national and international partners are aligned with the national action plans to combat antimicrobial resistance. Interventions in the agriculture sector include surveillance, implementation of Good Agricultural Practices and strengthening of inter-sectoral collaboration through a One Health approach.

The Government of Vietnam, United Nations agencies and international organisations regularly organise antimicrobial resistance awareness events. The Fleming Fund, the Centers for Disease Control and Prevention (CDC), and the Food and Agriculture Organization of the United Nations (FAO) are amongst key international players supporting antimicrobial resistance surveillance. In addition to research institutions such as the Oxford University Clinical Research Unit, the French Agricultural Research Centre for International Development (CIRAD) and the International Livestock Research Institute (ILRI) and national partners working on animal health. Research interventions are aimed at better understanding people’s behaviour around antimicrobial resistance and antimicrobial use and identifying solutions including alternatives to antimicrobial use.

The drivers of antimicrobial resistance in Vietnam include overuse of antimicrobials and purchase and use of antimicrobials after self-diagnosis (in both humans and animals). In hospitals, antimicrobial resistance arises from overcrowding and inadequate infection control, use of broad-spectrum antibiotics instead of narrow-spectrum drugs and prescribing of expensively branded antibiotics over less expensive first-line generic products². In agriculture, the use of antimicrobials for livestock growth promotion and disease prevention is common. Therefore, the interventions should involve practical measures that need to be incentive-based to tackle these challenges.

Anchoring and scaling

The national action plans set out the framework for interventions to tackle antimicrobial resistance. Therefore, scaling out of interventions should be done within this framework. The Department of Drug Management in the Ministry of Health and the Department of Animal Health in the Ministry of Agriculture and Rural Development are the key ministerial coordinating bodies for antimicrobial resistance interventions. In addition, the national steering committee on the prevention of antimicrobial resistance, with leadership from the two ministries, is responsible for setting priorities and assigning reference laboratories for antimicrobial resistance surveillance.

While the national action plan and regulations are in place at the central level, these policies need to be channelled to the local district and commune levels through strengthening the capacity of animal health workers and improving public awareness on antimicrobial resistance and rational use of antimicrobials. Practical solutions include improving biosecurity, revising the curricula of veterinary courses and targeting research to inform policymaking. In addition to funding from international sources, activities aimed at tackling antimicrobial resistance should be included in annual government budgets to ensure sustainability of data collection and analysis and interventions⁷. Additionally, for anchoring it is necessary to construct impact pathways and theories of change and then use this as a tool for testing program assumptions and adapting the program.

For the past decade, Vietnam has promoted a multi-sectoral One Health approach to tackling antimicrobial resistance⁸. Factors that may influence the implementation of a One Health strategy at national level include governance and operational frameworks, divergence of institutional cultures, level of knowledge, technical capacities, allocation of resources, conflicting commercial interests and influence of international partners⁶.

More information

The World Bank. 2017. Available here.
Global antibiotic resistance partnership (GARP) Vietnam National Working Group. Situation analysis: Antibiotic use and resistance in Vietnam. 2010. Available here.
Ministry of Health of Vietnam. National action plan on combatting drug resistance 2013-2020. 2013. Available here.
Ministry of Agriculture and Rural Development of Vietnam. National action plan for antimicrobial use management and antimicrobial resistance prevention in animal husbandry and aquaculture in the period 2017-2020. Available here.
Fleming Fund. First Fleming Fund Country Grant to Vietnam. Available here.
Bordier et al. 2018. Antibiotic resistance in Vietnam: moving towards a One Health surveillance system One Health for AMR surveillance in Vietnam. BMC Public Health (2018) 18:1136. Available here.
Ministry of Agriculture and Rural Development. 2018. One Health knowledge sharing workshop: Addressing antimicrobial resistance through cross-sectoral capacity building. Hanoi, Vietnam, 18–19 June 2018.
Vietnam One Health Partnership for Zoonoses. Annual One Health Forum 2018. Summary of proceedings.
Mitchell, M.E.V., Alders, R., Unger, F., Hung Nguyen-Viet, Trang Thi Huyen Le and Toribio, J.-A. 2020. The challenges of investigating antimicrobial resistance in Vietnam – what benefits does a One Health approach offer the animal and human health sectors?

Download a pdf version of this project here:

CS_Vietnam.pdf

A cross-sectional survey of practices and knowledge among antibiotic retailers in Nairobi, Kenya

Ekta Patel — Mon, 30 Sep 2019 08:03:37 +0000

Background

In this study, Dishon Muloi and colleagues aimed to investigate the patterns of antibiotic sales in humans and livestock in urban Nairobi, Kenya, and evaluate the level of awareness and common behaviours related to antibiotic use and AMR amongst human and veterinary pharmacists. Information on antibiotic sales data was collected from drug stores across the city where sales data were interpreted as representing antibiotic usage.

Research Highlights

The study showed a considerable overlap in the antibiotic classes sold for human and animal use in urban Nairobi, with marked variations in the sale of some antibiotic classes such as cephalosporins and fluoroquinolones – mostly found in human drug stores. This overlap of antibiotic classes, including of critically important antimicrobials emphasises the need for prudent use of all antimicrobials and continued monitoring and surveillance of antimicrobial usage in low- and middle-income countries in urban settings.

Authors

Dishon Muloi^1,2,4*, Eric M Fèvre^3,4*, Judy Bettridge^3,4, Robert Rono⁴, Daniel Ong’are⁴, James M Hassell^3,4, Maurice K Karani⁴, Patrick Muinde⁴, Bram van Bunnik^1,2, Alice Street⁶, Margo Chase-Topping^2,8, Amy B Pedersen⁷, Melissa J Ward^2,5, Mark Woolhouse^1,2

Institutions involved

1 Usher Institute of Population Health Sciences & Informatics, University of Edinburgh, Edinburgh, UK
2 Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, UK
3 Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
4 International Livestock Research Institute, Nairobi, Kenya
5 Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
6 Social Anthropology, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
7 Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
8 The Roslin Institute, University of Edinburgh, Edinburgh, UK

* Contributed equally to this work

Funding

UK Medical Research Council, Biotechnology and Biological Sci- ence Research Council (UK), the Economic and Social Research Council (UK), the Natural Environment Re- search Council (UK), through the Environmental & Social Ecology of Human Infectious Diseases Initiative (ESEI), Grant Reference: G1100783/1. This work also received support from the CGIAR Research Program onAgriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute (IFPRI)

More information

Read the full publication here: https://hdl.handle.net/10568/103442

One Health in Action: Operational Aspects of an integrated surveillance system for zoonoses in Western Kenya

Ekta Patel — Wed, 25 Sep 2019 06:24:48 +0000

Background

A lack of integration between the animal health and human health surveillance sectors in Kenya have led to inefficiencies and the under reporting of diseases, particularly zoonotic diseases. Laura Falzon and her colleagues aimed to develop an integrated and cost-effective surveillance and reporting system for 15 zoonotic diseases piloted in counties in western Kenya. This surveillance system was based on co-located sentinel sites, including livestock markets, slaughterhouses, and hospitals. The paper highlights the challenges faced in implementing such a system, and reports on the operational and logistical aspects of the system.

Research Highlights

The general structure of co-located sentinel sites was successful as it allowed for comparisons between the human and animal populations, while also fostering relationships between the two sectors and increasing awareness of zoonotic diseases. The importance of engaging with local stakeholders in the field, as well as providing timely feedback through public engagement sessions, was recognized as essential for ongoing compliance and to build rapport. Finally, the work identified numerous pre-requisites for such integrated activities, including a multi-disciplinary team, adequate funding, and political goodwill and commitment. The latter were facilitated by the presence of a government One Health coordinating unit known as Zoonotic Disease Unit (ZDU) which creates an environment for integrated activities, including surveillance at the regional levels. This work therefore helped provide the evidence base for the devolution of surveillance activities to the regional level.

Authors

Laura C. Falzon^1,2*,Lorren Alumasa², Fredrick Amanya², Erastus Kang’ethe³, Samuel Kariuki⁴, Kelvin Momanyi², Patrick Muinde², Maurice Murungi², Samuel Njoroge⁴, Allan Ogendo⁵, Joseph Ogola⁶, Jonathan Rushton¹, Mark Woolhouse⁷and Eric Fevre^1,2*.

Institutions involved

¹Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom

²International Livestock Research Institute, Nairobi, Kenya

³Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya

⁴Kenya Medical Research Institute, Nairobi, Kenya

⁵Veterinary Department, Busia County Government, Busia, Kenya

⁶Veterinary Department, Bungoma County Government, Bungoma, Kenya

⁷Centre for Immunity, Infection and Evolution and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom

Funding

This work was supported by the Biotechnology and Biological Sciences Research Council, the Department for International Development, the Economic and Social Research Council, the Medical Research Council, the Natural Environment Research Council and the Defense Science and Technology Laboratory, under the Zoonoses and Emerging Livestock Systems (ZELS) programme and CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), led by the International Food Policy Research Institute (IFPRI).

More information

Full publication available here: https://doi.org/10.3389/fvets.2019.00252

Situation analysis on antimicrobial resistance surveillance and control in Kenya

Cevelyn — Tue, 26 Feb 2019 20:24:13 +0000

Contact details: Bernard Bett (bernard.bett@cgiar.org). International Livestock Research Institute, Nairobi - Kenya.

Background

Antimicrobial resistance is a major health challenge worldwide. Field studies and hospital records suggest that there is a high prevalence of antimicrobial-resistant bacteria in various parts of Kenya. The burden of antimicrobial resistance has, however, not been determined due to lack of reliable surveillance data. A recent study reported that there are over 200 antibiotic-resistant genes in the country¹, with a significant proportion of these being mobile genetic elements that are transmissible between different species of bacteria.¹

There is limited understanding on the factors that promote the occurrence, maintenance and transmission of antimicrobial resistance but it is believed that misuse of antimicrobials, high incidence of infectious diseases and lack of access to quality healthcare are some of the key drivers. Socio-economic practices, including local and international travel, are also thought to aid the dissemination of antimicrobial-resistant bacteria. Kenya has formulated intersectoral teams and coordination mechanisms to address this challenge.

This brief outlines the status of antimicrobial resistance surveillance and control in the country. These topics will also be discussed during this meeting as a case study to represent low- and middle-income countries which the CGIAR Antimicrobial Resistance Hub will work with to strengthen national capacities for antimicrobial resistance interventions.

Evaluation and planning

Antimicrobial resistance surveillance aims to monitor antimicrobial use and detect occurrence and spread of antimicrobial-resistant bacteria. The Ministry of Health has already rolled out a surveillance strategy that will recruit 28 hospitals as sentinel surveillance sites by 2022. By the end of 2018, two of these sites had been used to pilot the system and two more will be launched by the end of 2019. The initial situation analysis conducted in the country showed a high rate of resistance for respiratory, enteric and hospital-acquired infections, especially to the widely available antibiotics like penicillin and cotrimoxazole². The antimicrobial resistance secretariat plans to collate additional data from research studies conducted in various institutes.

In the livestock sector, a surveillance protocol has been developed and reviewed. Research surveys show that resistance is prevalent in Escherichia coli isolates from beef and poultry and this is against commonly used drugs, namely, tetracycline, cotrimoxazole, streptomycin, ampicillin, quinolones and third-generation cephalosporins, in that order. Multidrug-resistant Staphylococcus aureus, including methicillin-resistant S. aureus, has been isolated from milk samples from lactating animals in northern Kenya³. In that study, resistance to tetracycline was highest (67%), followed by ampicillin, oxacillin, clindamycin, cephalexin, erythromycin, kanamycin and ciprofloxacin, in that order. Surveys on knowledge, attitudes and practices on antimicrobial use show that antibiotics are generally used to treat a wide range of syndromes in livestock, even those that do not deserve to be treated with these drugs.

Not much work has been done on antimicrobial resistance in aquaculture and agriculture. More work is also needed to determine the role of the environment in maintaining antimicrobial-resistant bacteria. Metagenomic and phylogenetic analyses are therefore required to better understand transmission patterns of antimicrobial-resistant bacteria in these environments, given that they serve as important points of contact between people, livestock and wildlife. Hotspots identified should be mapped to inform the deployment of risk-based interventions.

Interventions

A lot of effort has been devoted to creating an enabling environment for antimicrobial resistance prevention and control; for example, the implementation of antimicrobial resistance control policies and multisectoral fora. There have also been media campaigns to raise awareness of antimicrobial resistance^4,5.

Kenya has ratified the 68th World Health Assembly resolution that recommended the adoption of the Global Action Plan on antimicrobial resistance developed by the World Health Organization, the World Organization for Animal Health and the Food and Agriculture Organization of the United Nations. One of the goals of the resolution was that all member countries would, by 2017, develop their respective national action plans aligned with the objectives of the Global Action Plan. This marked a critical step in the control of antimicrobial resistance in Kenya.

Kenya’s National Action Plan was launched on 13 November 2017 during the World Antibiotic Awareness Week. The plan⁶ provides a collaborative and interdisciplinary framework for managing antimicrobial resistance and prioritizes (i) awareness raising through communication, education and training, (ii) strengthening the evidence base for tracking antimicrobial use and resistance through improved surveillance and research, (iii) reducing the incidence of infection through effective sanitation, hygiene and infection prevention measures to limit reliance on antimicrobials, (iv) optimizing antimicrobial use in human and animal health and (v) developing an economic case for sustainable investment taking into account the needs of the country and investments in new medicines, diagnostic tools and vaccines. The plan should now be used to guide a coordinated response to limit antimicrobial use and curtail the transmission of antimicrobial-resistant bacteria.

Anchoring and scaling

Partnerships, policies, legislations and funding are some of the critical requirements for anchoring and scaling up of antimicrobial resistance interventions. Implementation of the National Action Plan is led by the National Antimicrobial Stewardship Interagency Committee in partnership with the antimicrobial resistance secretariat and the intergovernmental committee. The antimicrobial resistance secretariat works with the Ministry of Health, the Ministry of Agriculture, Livestock, Fisheries and Irrigation, universities, research organizations, civil societies and other relevant actors. With the establishment of a devolved governance structure, counties are expected to play an active role in implementing policies developed by the national government. The current policy, therefore, provides for the establishment of county antimicrobial stewardship interagency committees and county technical working groups.

The National Action Plan espouses One Health approaches to antimicrobial resistance prevention and is supported by multiple laws governing antimicrobial use such as the Pharmacy and Poisons Act, the Food, Drugs and Chemical Substances Act, the Medical Practitioners and Dentists Act, the Animal Diseases Act, the Public Health Act, the Pest Control Products Act and the Veterinary Surgeons and Veterinary Para-Professionals Act.

Most of the work on antimicrobial resistance that is currently being implemented in Kenya is funded by multiple development partners. Plans are being made to secure sustainable funding, mainly through the relevant government departments.

More Information

1. Naval Research Laboratory. 2017. High prevalence of antibiotic resistance in Kenya. ScienceDaily, 11 July 2017. https://www.sciencedaily.com/releases/2017/07/170711121501.htm

2. Kariuki, S. Research on antimicrobial resistance and One Health perspective in Kenya.

3. Omwenga, I. et al. 2018. Prevalence and antimicrobial resistance profiles of Staphylococcus aureus isolated from raw milk in pastoral areas of Northern Kenya. Presented at the 15th International Symposium of Veterinary Epidemiology and Ecology, Chiang Mai, Thailand, 12–16 November 2018.

4. The World Antibiotic Resistance Awareness week is celebrated annually in November.

5. National Antimicrobial Resistance Symposium in Kenya. https://www.reactgroup.org/news-and-views/news-and-opinions/year-2018/national-amr-symposium-in-kenya/

6. National Action Plan on Prevention and Containment of Antimicrobial Resistance, June 2017. https://www.afro.who.int/publications/

Download a pdf version of this project here:

CS_Kenya.pdf

Review of Evidence on Antimicrobial Resistance and Animal Agriculture in Developing Countries

Cevelyn — Sun, 17 Feb 2019 13:55:44 +0000

Contact details:

Delia Grace Randolph (d.randolph@cgiar.org). Program Leader (joint) Animal and Human Health. International Livestock Research Institute.

Report Overview

The use of antimicrobials in animals, especially in livestock production and aquaculture as a key driver of antimicrobial resistance (AMR) has gained attention in recent years. While in many high-income countries (HICs) there is available information about how and how much antimicrobials are used in animal production, in low-and-middle-income countries (LMICs) this information is inexistent or insufficient. Lack of surveillance programs in these countries means that the contribution of the agricultural sector to the AMR problem is often neglected or misestimated.

Animal origin resistant bacteria with zoonotic potential can be in animal source food products, posing a risk to human health. Moreover, the increasing demand of animal products is driving the intensification of livestock and fish production systems, increasing the likelihood of antimicrobial use (AMU), especially in LMICs where fewer restrictions have been imposed on antimicrobial use.

To be able to understand the magnitude of the problem in LMICs, information regarding the quantity and quality of antimicrobial use, acceptability and feasibility of regulations to AMU in agriculture, and the cost-benefit of these regulations is critical for proposing evidence-based solutions.

In this report, Grace (2015), identified key evidence gaps in our knowledge of livestock- and fisheries-linked antimicrobial resistance in the developing world and documented ongoing or planned research initiatives on this topic by key stakeholders.

Research impact

By filling in the gaps of current knowledge about how LMICs are using antimicrobials we contribute to improving the understanding and magnitude of the AMR problem, providing a starting point for discussions in what direction and how researchers and policymakers should move the AMR agenda forward in these countries.

Institutions involved

International Livestock Research Institute (ILRI).

Research Subject Area(s)

Animal Health, Antimicrobial Use (AMU), Antimicrobial Resistance (AMR)

Funding

UK Department for International Development (DFID)

Find the report here:

Grace, D. 2015. Review of Evidence on Antimicrobial Resistance and Animal Agriculture in Developing Countries. International Livestock Research Institute. Available at: http://a4nh.cgiar.org/files/2015/06/EoD_Consultancy_June15_Ag_Related_AMR.pdf

Supporting the implementation of the Antimicrobial Resistance (AMR) National Plan in Kenya

Cevelyn — Sat, 16 Feb 2019 12:54:42 +0000

Contact details:

Eric Fèvre (eric.fevre@liverpool.ac.uk).Institute of Infection and Global Health (IGH), University of Liverpool and jointly appointed at the International Livestock Research Institute, Nairobi, Kenya.

Background

In June 2017, the Kenyan government published its National Action Plan on Prevention and Containment of Antimicrobial Resistance 2017 – 2022. The plan was elaborated with the support of many international organizations, funding agencies, research institutes, and governmental institutions. It embraces interdisciplinary collaborations through a One Health platform where local institutions worked together with academia and stakeholders to provide a policy framework that concentrates on the containment of emergent resistant bacteria.

The main objectives of the plan are focussed on improving awareness and understanding of AMR, strengthening surveillance and research programmes, improving sanitation, hygiene and preventive measure, optimizing use of antimicrobials in animals and humans, and developing an economic case which accounts for the country needs and for a sustainable investment on medicines, diagnostics, vaccines and other interventions.

Project overview

The aim of this activity was to contribute to the dissemination and implementation of the Kenyan National Action plan for AMR. With collaborative funding from the UK Medical Research Council and the Fleming Fund, the National Plan was distributed to all counties (devolved authorities in Kenya) in advance of national workshops to discuss implementation.

Specific areas of the plan where additional evidence is required to develop specific policy were identified, and we worked with partners to gather and synthesise that evidence. For example, CGIAR researchers were part of the team that conducted a ‘Baseline Mapping of the Veterinary Medicinal Products Supply Chain in Kenya” in order to understand the national landscape of veterinary microbial drugs in Kenya, how they are used, how they move around the country and where they originate. Further detailed studies on levels of knowledge amongst drug retailers and on-farm users were also carried out, in combination with biological assessment of drug efficacy.

Activity impact

The National Action Plan is a guide to implementation of AMR policy in the country. It identifies specific areas where data are lacking on which to base sound decisions, such as in the area of drug access in the veterinary sector. The research targets these gaps and provides empirical evidence for policymakers.

Researchers

Eric Fèvre¹^,2, Katie Hamilton¹, Nicholas Bor², Stella Kiambi²^, 3, Naphtal Mwanziki⁵

Institutions involved

University of Liverpool Institute of Infection and Global Health, and Centre for Genomic Research, UK.
International Livestock Research Institute (ILRI), Kenya.
Food and Agriculture Organization of the United Nations (FAO).
Kenya Ministry of Health.
Kenya Department of Veterinary Services.
Government of Kenya Veterinary Medicines Directorate.
Government of Kenya AMR Task Force.

Research Subject Area(s)

One health, Policy framework, AMR, Policy Implementation

Funding

This activity was collaboratively funded by Global Challenges Research Fund, UK Medical Research Council (MRC), The Fleming Fund Foundation, UK, and the CGIAR research program on Agriculture for Nutrition and Health (A4NH).

More information

National Action Plan on Prevention and Containment of Antimicrobial Resistance 2017 - 2022. Republic of Kenya. Available on: https://www.flemingfund.org/wp-content/uploads/0cff5e08e6a64fcf93731d725b04792e.pdf
Other papers in press – forthcoming

Download a pdf version of this project here:

National_Plan_Kenya.pdf

A systems approach to livelihood-sensitive veterinary antimicrobial stewardship in Thai Nguyen, Vietnam

Cevelyn — Sat, 16 Feb 2019 12:32:00 +0000

Contact details:

Tarni L. Cooper (t.cooper@uq.edu.au) PhD fellow. International Livestock Research Institute, Vietnam.School of Veterinary Science, and Centre for Communication and Social Change, School of Communication and Arts, The University of Queensland, Australia.

Background

In response to the threat posed by antimicrobial resistance (AMR), global attention is increasingly focussed on antimicrobial stewardship (AMS). AMS involves the coordinated effort of all stakeholders to use antimicrobials appropriately, to reduce the development and spread of AMR. In some countries characterised by industrialised livestock systems, veterinary AMS has seen considerable success, largely attributed to greater regulation.

Countries dominated by smallholder systems are likely to be less responsive to such ‘top-down’ approaches. Vietnam has developed a National Action Plan on AMR and AMU reduction in livestock and aquaculture and is working to increase awareness of the problem. However, there remain significant challenges to achieving widespread AMS in farming communities. Effective AMS policy and action in Vietnam will need to be sensitive to the needs of farming communities.

Project overview

This research project aimed to build an understanding of how antimicrobials were used in the livelihood strategies of smallholder farmers and their animal health networks. The project followed an iterative, mixed-methods design and combined epidemiological and Communication for Development approaches. The first study, in two provinces, revealed complex livelihoods interacting with decisions around antimicrobial use. Based on these findings, cross-sectional and longitudinal surveys were conducted. The final stage involved stakeholder workshops interpreting data and co-constructing an understanding of the system in which AMS decisions were made. Finally, stakeholders came together, to identify leverage points for livelihood-sensitive intervention.

Main findings

Two important stakeholder groups were identified, farmers and animal health workers. There was no clear distinction between private and public health workers as government veterinarians were also involved in private enterprise. Women dominated sales of animal health products but had less access to training. Self-reported adherence to global AMS criteria was low in both groups, and this was triangulated with longitudinal data. While weaknesses in the system were apparent, there were also strengths, which were identified as promising leverage points for improved AMS. For example, certain traditional practices for treating gastrointestinal disease were consistent with AMS and will be actively encouraged.

Stakeholder groups reviewed data and gave the researchers new insights before developing lists of proposed interventions. Representatives of the groups then worked together to discuss the lists from their different perspectives and negotiated a single, livelihood-sensitive list. The final list of proposed actions has been presented to the government and other stakeholders. A follow-on research activity to support one of these actions, addressing the gender education gap, was completed in December 2018.

Conclusions

This iterative approach aided a more nuanced, multi-perspective understanding of local constraints and opportunities for AMS. Our research addresses the question of how we might support smallholder farmers and animal healthcare workers to improve AMS within their current livelihoods’ context.

Research impact

This research contributes to the global effort for greater antimicrobial stewardship (AMS). Beyond implications for the communities studied, the research yields a transferrable approach to contextualising antimicrobial practices in smallholder farming communities. Further, systems practice brings community stakeholders together in support of livelihood-sensitive policy and action for AMS. Concrete, community-developed recommendations for improving AMS are being considered and/or implemented.

Researchers

Tarni L. Cooper ¹^,²^,³, R. Soares Magalhães¹, E. van de Fliert², D. Grace³, H Nguyen-Viet³, P. Pham-Duc⁵, P. Phan-Thi-Hong⁴, T. Pham Thi⁴, B. Nguyen-Thanh⁴, B. Bui-Thi⁴, N. Tran-Thi⁵, N. Nguyen Huu⁶, H. Nguyen Thi Thu⁶, N. Le Thi Hang⁷.

Institutions involved

School of Veterinary Science, The University of Queensland, Australia.
Centre for Communication and Social Change, School of Communication and Arts, The University of Queensland, Australia.
International Livestock Research Institute, Vietnam.
Faculty of Animal Science and Veterinary Medicine, Thai Nguyen University of Agriculture and Forestry, Vietnam.
Centre for Public Health and Ecosystem Research, Hanoi University of Public Health, Hanoi, Vietnam.
Faculty of Economics and Rural Development, Vietnam National University of Agriculture
FocusGroupGo Vietnam.

Funding

Funded by the CGIAR Research Program on Agriculture for Nutrition and Health and the Australian Government Research Training Program.

Research Subject Area(s)

Antimicrobial stewardship (AMS), Systems Thinking, Sustainable livelihoods, Epidemiology, Communication for Development.

More information

*This study is an ongoing PhD research project developed by Tarni Cooper at ILRI Vietnam/ University of Queensland. More information will be available once the final results of the research have been published.

Download a pdf version of this project here:

AMS_Vietnam.pdf