Knowledge and Practices on Antibiotic Use and Antibiotic Resistance Among Smallholder Pig Farmers in Timor-Leste

Abstract

Antibiotic resistance is an emerging global health threat which is linked to the overuse and misuse of antibiotics. This study was conducted to understand the knowledge and practices of smallholder pig farmers on antibiotic use and resistance in Timor-Leste. A cross-sectional study using a structured face-to-face interview was conducted in three municipalities. The interview was piloted and implemented in the local Tetun language. This study found that knowledge of antibiotics was very poor as only 12.7% (95% CI: 6.3–23.9) of farmers reported knowing what antibiotics were, and of these only one was able to correctly explain how an antibiotic worked. None of the farmers knew about antibiotic resistance and were able to explain the concept correctly. After the definition of antibiotic was explained to the farmer, only 3.6% (95% CI: 0.8–14.9) reported that their pigs had ever received antibiotics, and the majority of farmers whose pigs had not received antibiotics reported the lack of access to veterinary services. When used, antibiotics were only used for treatment with no reported use for disease prevention or growth promotion. None of the commonly used antibiotics were critically important antimicrobials. Compliance with withdrawal periods was not routinely followed. There is a need to improve access to government veterinary services for farmers in Timor-Leste, while addressing identified knowledge gaps on antibiotics and promoting prudent use practices. The findings from this study serve as baseline information to inform future interventions.

Knowledge, attitudes and practices of government animal health workers on antibiotic use and antibiotic resistance in Timor-Leste

“…There was a limited range of antibiotics available to GAHWs, and similar findings have been reported in other LMICs ( 12 , 59 ). The classes of antibiotics commonly used by technicians in animals in this study such as tetracycline are consistent with previous studies in Timor-Leste ( 25 , 34 ). Prior to this study, it was thought that the species which most frequently received antibiotics from GAHWs were pigs and local chickens because they are the most owned species by households ( 19 ).…”

“…This was much lower than GAHWs in Bhutan where almost all participants (95.4%) indicated that resistant bacteria are difficult to treat ( 9 ), although the participants in the Bhutan study included a small proportion of veterinarians. It was however positive that the knowledge of antibiotic resistance among GAHWs was higher than smallholder pig farmers in Timor-Leste, where none of the farmers could explain the concept of antibiotic resistance ( 34 ). There was low awareness of the efforts to combat antibiotic resistance, with less than a third having knowledge of the National Action Plan for Antimicrobial Resistance compared to 59.8% for the equivalent in Nigeria ( 35 ).…”

“…The majority of participants never chose an antibiotic based on cost and this was different to findings in other studies ( 12 , 35 , 44 , 60 ). The absence of cost considerations is likely due to veterinary medicines usually being provided free-of-charge by GAHWs to farmers in Timor-Leste ( 34 ). Almost all participants never considered choosing an antibiotic based on a laboratory test or antibiotic prescribing guidelines, which reflects the current state where there is limited laboratory access and no prescribing guidelines specific to the country.…”

“…In Timor-Leste, there have been no studies investigating the knowledge, attitudes and practices (KAP) of antibiotic use and antibiotic resistance among GAHWs, although there was a recent study which found very poor knowledge of antibiotics and antibiotic resistance among smallholder pig farmers ( 34 ). In other LMICs, studies investigating the KAP of antibiotic use among animal health workers has showed poor knowledge of antibiotic resistance and poor antibiotic use practices ( 9 , 12 , 35 , 36 ).…”

“…This could then inform strategies to improve prudent use of antibiotics among GAHWs, which has potential to be impactful in combatting antibiotic resistance in animals since this group administers the majority of veterinary antibiotics in Timor-Leste ( 25 ). Furthermore, GAHWs are a common source of knowledge on antibiotic use for farmers in Timor-Leste ( 34 ), and are well-placed to promote and encourage prudent use among farmers provided they are well-trained. Therefore, this study aims to understand the knowledge, attitudes and practices on antibiotic use and antibiotic resistance of GAHWs in Timor-Leste.…”