Fijian Farmers' Attitude and Knowledge Towards Antimicrobial Use and Antimicrobial Resistance in Livestock Production Systems–A Qualitative Study

Abstract

Antimicrobial resistance (AMR) is a global health issue affecting humans and livestock. To mitigate AMR risks, responsible use of antimicrobials in livestock production systems have been advocated. Studies have reported patterns of antimicrobial use (AMU) in livestock production systems; however, there is limited information on the drivers of AMU and AMR. Therefore, this study aimed to explore and understand the attitude and knowledge of Fijian livestock farmers on AMU and AMR. Livestock farmers and managers from the Central and Western divisions of Viti Levu, Fiji were recruited using purposive and snowball sampling methods. Face-to-face one-to-one semi-structured qualitative interviews were conducted. Interview questions were informed by the Theory of Planned Behavior (TPB). Interview transcripts were analyzed inductively using reflexive thematic analysis and deductively using the TPB framework. A total of 19 cattle and poultry farmers took part. Our analysis generated four themes: (1) Uninformed use of antimicrobials and unaware of AMR, (2) Safeguarding livestock and generating income source as primary motivators for using antimicrobials (3) Medicine shortage results in hoarding and self-prescribing, and (4) Farm decisions on AMU and livestock management influenced by foreign farmers and veterinarians. Livestock farmers used medicines in livestock production; however, they could not differentiate amongst different types of medicine, including antimicrobials. Antimicrobials were used to prevent diseases in livestock and promote production of food and financial security but without any awareness of the risks of AMR. Additionally, farmers hoarded and self-prescribed medicines. Farmers rationed antimicrobials by not completing the entire course of antibiotics to save them for future use. Based on past experiences, farmers expressed dissatisfaction with the veterinary services provided by the government. They sought help online and from foreign farmers and veterinarians. We propose the need for antimicrobial stewardship (AMS) programmes focused on promoting rational use of antimicrobials and awareness of AMR amongst farmers in the Fijian livestock production systems. These programmes need to consider the anthropological, socio-cultural, economic, and environmental factors driving AMU. Future studies are underway to explore the attitude and knowledge of Fijian veterinarians, para-veterinarians and pharmacists on AMU and AMR to gain a broader systems knowledge to inform the design of AMS programmes.

Fijian Veterinarian and Para-Veterinarians' Behavior, Attitude and Knowledge Toward Antimicrobial Use and Antimicrobial Resistance: A Qualitative Study

“…There is therefore a greater chance of incorrect clinical diagnosis and use of antimicrobials when compared to clinical diagnosis and treatment by a veterinarian in the field ( 30 ). The current approach could set a precedence that self-diagnosis and self-prescribing of antimicrobials by Fijian livestock farmers was acceptable and the norm in everyday livestock production and management despite findings from our previous study demonstrating that farmers lacked knowledge and understanding of AMU and AMR ( 16 ). These practices may further aggravate and create obstacles for the implementation of behavioral interventions to safeguard AMU.…”

“…This present study and our earlier study also alluded to the supply chain issue related to medicines where only a limited range of antimicrobials was available for use ( 16 ). The findings are consistent with those reported by Dione et al ( 55 ) in Uganda where supply chain constrains were identified as potential drivers of inappropriate AMU ( 55 ).…”

“…The access to veterinary services and utilizing the local knowledge is quite similar as other studies have demonstrated that farmers only access para-veterinarians if they perceive that para-veterinarians have better training; therefore, there is a general perception of lack of expertise, knowledge and expectation of compromised serviced delivered by the local para-veterinarians ( 60 ). Therefore, farmers opt for information and advice from other sources, which may associate a high chance of inappropriate AMU on farms due to being influenced by non-veterinary experts ( 16 , 30 ).…”

“…In Fiji, there is limited knowledge about the veterinary services and veterinary professionals apart from the shortage of veterinarians, lack of legislation regulating AMU in livestock production and lack of detailed scope of practice for para-veterinarians particularly relating to prescribing and dispensing of antimicrobials in the Fijian veterinary legislation (current one dates to 1956) ( 28 , 29 ). Our recent study found Fijian farmers lack knowledge and understanding of AMU and AMR, driving inappropriate AMU ( 16 ). Additionally, our study demonstrated that farmers lacked confidence in the local provision of veterinary services, and livestock farmers themselves mitigated farm biosecurity risks including prescribing of antimicrobials ( 16 ).…”

“…Our recent study found Fijian farmers lack knowledge and understanding of AMU and AMR, driving inappropriate AMU ( 16 ). Additionally, our study demonstrated that farmers lacked confidence in the local provision of veterinary services, and livestock farmers themselves mitigated farm biosecurity risks including prescribing of antimicrobials ( 16 ). However, psychological (attitude and knowledge), including other contextual drivers of AMU and AMR in livestock production from Fijian veterinary services professionals perspectives are unknown ( 11 , 13 , 30 ).…”