Supply Chain and Delivery of Antimicrobial Drugs in Smallholder Livestock Production Systems in Uganda

Abstract

This study assessed the veterinary drug supply chain in Uganda, the constraints faced by the actors, and how the challenges influence the use of antimicrobial (AMs) by livestock farmers. We carried out stakeholder consultation workshops, key informant interviews and a knowledge, practices, and awareness survey with actors of the veterinary drug supply chain. We also profiled drugs stored in 23 urban and peri-urban drug shops in Lira and Mukono districts to record the commonly sold drugs. The veterinary drug supply chain is made of several actors including wholesalers, retailers, Animal Health Service Providers (AHSP) and farmers. Nearly ninety per cent of drug retailers and veterinary practitioners did not receive specialized training in veterinary medicine, and most of veterinary practitioners have been in the drug business market for more than 10 years. Antibiotics and anti-helminthics were the most stocked drugs by retailers, with antibiotics ranking highest in terms of contribution to annual financial profits, accounting for 33%. The choice of a drug by veterinary practitioners was mainly informed by past success with efficacy of the drug, and financial capacity of the client (the farmer) to meet the treatment cost. Many veterinary practitioners were not conversant with veterinary drug policies of the country, with Mukono having a higher number (72%) compared to Lira (37%). Veterinary practitioners from Lira district compared to Mukono and those mainly serving small scale farmers relative to large scale smallholders were more knowledgeable about antibiotics and AMR. Several supply chain constraints were identified as potential drivers of misuse of antibiotics that could contribute to AMR. These included low level of education of supply chain actors, particularly drug retailers, poor handling of drugs at purchase and administration practices, low enforcement of policies and regulations, and lack of awareness of stakeholders about policies that regulate drug use. Thus, future interventions to reduce misuse of AM drugs in livestock production systems in Uganda such as capacity building, should also target veterinary input suppliers, and deliberately involve a strong policy advocacy component.

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

“…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 ). Therefore, we suggest a critical review of the procurement processes so that an informed forecast and procurement of veterinary medicines, including antimicrobials can take place to ensure a sustainable supply of veterinary medicines in the Fijian veterinary clinics.…”

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

“…Imprudent use of antimicrobials resulting from self-prescribing with under and overuse have been reported in developing countries ( 6 , 11 ). Our results also suggest that incomplete courses of antimicrobials took place due to the high costs of the antimicrobials; thus, farmers used antimicrobial sub-therapeutically and saved the rest for future use, which have been similarly reported in other studies ( 18 , 48 , 49 ).…”

“…Our results demonstrated that farmers self-prescribed antibiotics and did not complete the full course of antibiotics. The treatment decisions were based on their past experience instead of on the advice of the veterinary professionals, a practice similarly reported in other studies ( 48 ). Imprudent use of antimicrobials resulting from self-prescribing with under and overuse have been reported in developing countries ( 6 , 11 ).…”

Geographic and Socioeconomic Influence on Knowledge and Practices Related to Antimicrobial Resistance among Smallholder Pig Farmers in Uganda

“…Without a correct diagnosis, there is an obvious risk of inappropriate antibiotic use, which in this regard increases the risk of AMR development in both districts, independently of the access to animal health services. It has previously been shown that, due to the lack of laboratory services, animal health service personnel in these districts often recommend broad-spectrum antibiotics like oxytetracycline to farmers [ 35 ], which are known to be prone to induce resistance [ 36 , 37 ].…”

“…However, as in many other countries antibiotics can constitute an important source of income for veterinarians, one should therefore be aware that there might be economic incentives for veterinary practitioners to recommend antibiotic treatment to farmers, increasing the risk for over- and misuse [ 38 ]. Regarding the income for veterinarians from sales of pharmaceuticals, Dione et al [ 35 ] found antibiotics to be the most profitable drug category in both Lira and Mukono. Favorably, from an AMR perspective, the proportions of farmers that used veterinary drugs in response to disease problems without prior consultation from a professional animal health worker were low in both districts.…”