Antimicrobial Use/Consumption Surveillance in Zimbabwe: Desk Review Report

Antimicrobial Resistance (AMR) now poses a significant global threat to animal and human health, and over the years, inappropriate antimicrobial use (AMU), both in animals and humans, has been identified as the most significant driver of AMR. Recognizing the urgent need to tackle AMR, in 2015, the WHO, WOAH and FAO endorsed a Global Action Plan (GAP) on AMR, which includes five strategic objectives targeted at curbing AMR development. Amongst these objectives is the need to “strengthen knowledge through surveillance and research”. Zimbabwe, one of many African countries experiencing challenges arising from AMR in both the animal and human health sectors, needs to map a way forward to address this critical challenge. The objectives of this report were firstly to determine the current status of antimicrobial use or consumption (AMU/C) surveillance in Zimbabwe in the animal sector and identify gaps in knowledge. Secondly, to explore AMU/C surveillance strategies in food-producing animals in other countries, including data collection methods, data entry platforms, data analysis and reporting. Finally, to provide a situational analysis of existing systems, plans, software platforms and human and physical resources in relevant institutions in Zimbabwe to identify potential strategies for implementing AMU/C surveillance in the country. Methods The objectives were addressed through various methods, including key informant interviews of personnel in key government institutions such as the Department of Veterinary Services (DVS) and the Medicines Control Authority of Zimbabwe (MCAZ), among others. Information was also derived from relevant publications searched from scientific databases, including PubMed and PLOS. Key findings The first part of the report describes the situation analysis of Zimbabwe, which details the country’s animal production sector and the Department of Veterinary Services (DVS), and AMR & AMU/C surveillance initiatives in the country, including the reporting of AMU/C data to the WOAH. The second part of the report reviews global standards and methods for AMU/C in animals, including the WOAH standards for AMC data collection. Also included in this section are the AMU/C surveillance strategies in food-producing animals in Low-and Middle-Income Countries (LMICs) and high-income countries (HICs). The report also includes a brief on the different types of antimicrobial use metrics and indicators used in AMU/C surveillance in food-producing animals, as well as their advantages and disadvantages. The last section of the report includes proposals for implementing AMU/C surveillance in Zimbabwe and a feasibility assessment for each proposal. Conclusion and recommendations Zimbabwe generally has adequate human resource capacity to implement AMU/C surveillance in food-producing animals. The key personnel to perform these activities will need to be identified and adequately capacitated through training and provision of other key resources. To coordinate the AMU/C surveillance activities, the relevant institutions, the DVS and MCAZ, will need to collaborate closely to conduct the process activities efficiently. Of paramount importance is that the two government institutions will also need to establish funding mechanisms for AMU/C surveillance in food-producing animals in order to make it sustainable

Measurement of antibiotic use on poultry farms in Zimbabwe: Evaluation of a tool and procedures

Introduction The emergence of antimicrobial resistance (AMR) as a major global threat to human and animal health and development cannot be overemphasised. Since the misuse and overuse of antimicrobials have been identified as the main drivers of AMR globally, Zimbabwe, through a collaboration between the Department of Veterinary Services (DVS) and the Food and Agriculture Organization (FAO), developed and piloted an antimicrobial use (AMU) tool in the poultry production sector, to quantify antimicrobial use. The purpose of this study was to evaluate the tool and procedures used in the pilot survey and its ability to collect quality AMU data. We identified areas of improvement and developed recommendations for implementation in future AMU surveys in the poultry sector in Zimbabwe. Methods This research used mixed methods, involving quantitative and qualitative approaches. This involved initially piloting a predesigned antibiotic use (ABU) data collection tool in practice, then assessing the tool's ability to collect quality data, and finally evaluating the procedures that enabled and limited the collection of ABU data. The tool was assessed by evaluating the completeness of data collected in the pilot survey and its consistency, appraising the items included in the tool, and determining the analysability of data collected. The procedures used were evaluated by observing the tool's administration in the field and through a focus group discussion involving all data collectors of the pilot survey. Findings AMU data was collected from 191 farms, about 50% of the initially targeted 384 broiler farms. There were missing data on various questions in the tool, including farm georeferences, bird populations, and information about the treatment, including the identification of the antibiotic active ingredient and their concentrations, routes of administration, treatment dosage and duration, as well as the age and weight of birds at the time of treatment. Inconsistencies were also noted in the data collected, particularly in the way antibiotics were recorded. The analysability of data collected was negatively affected by the missing data and question phrasing, in particular, those to do with the treatment of birds with antibiotics, which were found to have excluded the majority of survey respondents from further analyses. Broiler farms in communal areas were over-represented in the pilot survey due to most data collectors working in these areas. Various challenges were encountered during the recruitment of participants, including farmers not keeping birds at the time of the survey, farmers declining to participate in the study due to lack of incentives, some farms being in remote locations, and political interference. Most data collectors in the pilot survey, who were recruited from the Agricultural Extension Services (AGRITEX) department within the Ministry of Agriculture, indicated that the timing of the survey (January to May of the calendar year) was not conducive for them since it coincided with the cropping season in Zimbabwe, which induced high workloads, leaving less time to participate in data collection activities. Conclusions and recommendations The pilot AMU survey in broiler production serves as an important milestone in establishing a monitoring system for the use of antimicrobials in food producing animals in Zimbabwe. To a moderate extent, the pilot tool and procedures used in broilers enabled the collection of AMU data, but some key challenges also arose, mainly related to questionnaire design (i.e., question formulation), data collection procedures, participant recruitment, timing of the survey and inadequate training of data collectors, among other issues. Key recommendations made included using the ‘Drug Bag’ method in monitoring the use of antibiotics in poultry, carefully selecting enumerators to ensure representation of different farming scales, adequately training data collectors prior to surveys, and giving them standard operating procedures to use in data collection to ensure consistency. More research needs to be done in this area of monitoring the use of antimicrobials in food producing animals in Zimbabwe and beyond, to strengthen capacities to collect quality AMU data, thereby contributing to antimicrobial stewardship efforts, and in turn with the global fight against AMR

Towards a bottom-up understanding of antimicrobial use and resistance on the farm: A knowledge, attitudes, and practices survey across livestock systems in five African countries.

The nutritional and economic potentials of livestock systems are compromised by the emergence and spread of antimicrobial resistance. A major driver of resistance is the misuse and abuse of antimicrobial drugs. The likelihood of misuse may be elevated in low- and middle-income countries where limited professional veterinary services and inadequately controlled access to drugs are assumed to promote non-prudent practices (e.g., self-administration of drugs). The extent of these practices, as well as the knowledge and attitudes motivating them, are largely unknown within most agricultural communities in low- and middle-income countries. The main objective of this study was to document dimensions of knowledge, attitudes and practices related to antimicrobial use and antimicrobial resistance in livestock systems and identify the livelihood factors associated with these dimensions. A mixed-methods ethnographic approach was used to survey households keeping layers in Ghana (N = 110) and Kenya (N = 76), pastoralists keeping cattle, sheep, and goats in Tanzania (N = 195), and broiler farmers in Zambia (N = 198), and Zimbabwe (N = 298). Across countries, we find that it is individuals who live or work at the farm who draw upon their knowledge and experiences to make decisions regarding antimicrobial use and related practices. Input from animal health professionals is rare and antimicrobials are sourced at local, privately owned agrovet drug shops. We also find that knowledge, attitudes, and particularly practices significantly varied across countries, with poultry farmers holding more knowledge, desirable attitudes, and prudent practices compared to pastoralist households. Multivariate models showed that variation in knowledge, attitudes and practices is related to several factors, including gender, disease dynamics on the farm, and source of animal health information. Study results emphasize that interventions to limit antimicrobial resistance should be founded upon a bottom-up understanding of antimicrobial use at the farm-level given limited input from animal health professionals and under-resourced regulatory capacities within most low- and middle-income countries. Establishing this bottom-up understanding across cultures and production systems will inform the development and implementation of the behavioral change interventions to combat antimicrobial resistance globally