Social-Cultural Factors Contributing to Antimicrobial Resistance in Livestock Farmers and Community Households in Kayonza District, Rwanda

Background Information

Social and cultural factors are the foremost contributors to antimicrobial resistance (AMR) which is a global public health challenge, that has escalated in recent years due to the misapplication and abuse of antibiotics in both human and animal health sectors to cause immunization in one health [1], Uwera N, et al. [2]. The deficiency in the implementation of effective measures to fight against resistance of infectious microbes/ pathogens against commonly used drugs may result in escalated deaths reaching 10 million per year by 2050, [1, 3, 4]. AMR immunizes human health livelihoods and poses substantial challenges to livestock inventions and food security on social-cultural strategies. The relationships between human, animal, and environmental health need the synergistic partnership of environmental quality hygiene on physical, biological, and chemical prevention and control to enable quality hygiene limited or no complexity in hostile against AMR [5, 6]. However, the information on how social culture and KAP of livestock farmers contribute to the prevalence of AMR in livestock in Kayonza District, and the control methods employed by farmers and veterinary service providers to mitigate its spread remain unclear and documented.

Globally, the increasing prevalence of antimicrobial- resistant bacteria in livestock has been an unyielding issue among livestock farmers [3, 4], with intensive livestock farming practices. Studies have revealed that the use of antibiotics in animal farming contributes meaningfully to the rise of AMR [2, 7]. The selective use of antibiotics, such as managing them as growth promoters or for disease prevention in healthy animals, accelerates resistance development [3, 4]. In Sub-Saharan Africa, where Rwanda belongs, the challenges of AMR are exacerbated by weak regulatory frameworks [3, 4], limited access to veterinary services, and inadequate public awareness of the dangers of antibiotic misuse [8]. The livestock sector in this region plays a vital role in rural livelihoods and food security. However, the uncontrolled practice of antibiotics in animal farming has led to an increased in resistant pathogens/ microbes, which hover both animal and human health [3, 4, 9]. Studies in Kenya, Uganda, and Tanzania have reported high levels of AMR in livestock, particularly in bacteria such as Escherichia coli and Salmonella [10], to use of undescribed drugs or medicine to treat animals, which is but social-cultural practice [2], When focusing on better disease surveillance prevention and control, in the district, policy implementation and farmer Health education [2], In the livestock industry, there is widespread use of antibiotics for both therapeutic and prophylactic purposes, which has contributed to the emergence of resistant bacterial strains [4], The Rwanda Agriculture and Animal Resources Development Board (RAB) has been working with local farmers and veterinary service providers to promote the responsible use of antimicrobials, yet more efforts are needed to enforce regulations and monitor antibiotic usage patterns [2].

Social Cultural Factors Contributing to Antimicrobial Resistance

Investigation of social-cultural factors contributing to the practice of antibiotics by smallholder farmers in low- income nations, like Rwanda showed that these populations are serious to misuse of drugs due to limited access to both health facilities and veterinary services, [3, 4, 11]. The study used qualitative interviews to look at farmers’ attitudes, beliefs, and behaviours around the use of antibiotics in livestock farming. The results showed that farmers often used antibiotics as a preventative measure rather than in response to illnesses that were, diagnosed and that cultural norms and attitudes regarding animal health and productivity had a significant control on antibiotic usage practices. Furthermore, it shown that peer pressure and social networks had a significant control on how farming community households used antibiotics [2, 12]. Livestock farmers and community households’ beliefs and behavior in livestock production, been demonstrated to contribute largely due to the socioeconomic variable in the society plus, in addition to social-cultural factors in larger portions. Marshall BM, et al. [13] assert that stewardship initiatives that encourage the prudent use of antibiotics are essential for reducing resistance. Strict antibiotic usage restrictions and veterinary supervision are frequently a part of these programs. In addition, promoting biosecurity procedures on better animal husbandry techniques decreases the prerequisite of using antibiotics [14]. Better cleanliness, immunization, and less stress for animals are some of these methods [2].

One Health Concept Health Ecosystems, for Population Health Animal and Vegetation

One health Ecosystem is an interdisciplinary approach that creates the interconnection between animals, vegetation, aquatic, and human-wellbeing [2, 15]. The health of one directly or indirectly affects one another in the ecosystem. Thus, contributes to several health challenges in the ecosystem including antimicrobial resistance (AMR), people from the veterinary sector, human health professionals, environmental scientists, lawmakers, and others must work together [2, 16]. The One Health paradigm emphasizes on the value of multidisciplinary and integrated research methodologies to address antimicrobial resistance (AMR) head-on [2, 5], Researchers should work with experts from a variety of fields, including microbiology, ecology, social science, human and veterinary medicine, epidemiology, and more, to gain a deeper understanding of the complex drivers and dynamics of antimicrobial resistance (AMR) [2], Mitigate, antimicrobial resistance (AMR) and minimize trade-offs and unintended consequences across industries, Rüegg SR, et al. [17] highlighted the necessity of interdisciplinary collaboration [2]. Mitigation of the antimicrobial resistance (AMR), in the One Health approach promotes cross-sector cooperation and community involvement from all pertinent parties to implement evidence-based policies, treatments, prevention, and control. The study conducted research in Kayonza District, Rwanda, and discovered that cooperation between government agencies, agricultural extension services, veterinary associations, healthcare providers, and community participation to prevent and control ill health social cultural practices mediated unmated needs to improve monitoring and surveillance systems, on AMR change the behavior of livestock farmers and veterinary service providers [2].

Knowledge, Attitude, and Practices (KAP) Contribution to Antimicrobial Resistance and Control Methods by Livestock Farmers and Veterinary Service Providers to Prevent Control Drug Resistance

Study of China on the contribution of KAP by pig farmers

Conceptual Framework

regarding antibiotic uptake and resistance by Dyar OJ, et al. [18], showed that a sizable percentage of farmers were ill- informed about dosing schedules and withdrawal periods, indicating breaches in the understanding of proper antibiotic use procedures [2], Economic considerations were found, to have a control over attitudes toward the usage of antibiotics, with farmers giving cost-effectiveness precedence above antimicrobial stewardship guidelines. AMR in pig populations emerged because of common practices such as preventive antibiotic use and over-the-counter antibiotic purchases [19].

The control of KAP on antimicrobial usage practices underscored by a survey of Swiss cattle farmers and veterinarians undertaken by Visschers. According to the study, beliefs about the severity of the disease and the effectiveness of antibiotics shaped farmers’ views toward their use, while worries about animal welfare and financial issues also had a role. Farmers’ and veterinarians’ limited understanding of antibiotic resistance mechanisms and the importance of using antibiotics sparingly in preventing AMR highlights the necessity for focused teaching initiatives [2], Magar and colleagues, 2022. In contrast, a study conducted in Vietnam by Nhung NT, et al. [20] discovered that although chicken farmers had a comparatively high degree of understanding of AMR, their attitudes and practices frequently did not follow advised antimicrobial stewardship guidelines. Farmers reported continuing to use antibiotics for growth promotion and disease prevention despite knowledge of the dangers of abusing them (Figure 1).

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Demographic Profile

The study opined equal gender respondents of livestock farmers and veterinary services providers in Kayonza males 125 (50.7%), while females 120 (49.3%), indicating good sustainability of the program farming as a source of economy in Kayonza District (Figure 2).

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Social-Cultural Factors Contributing to Antimicrobial Resistance among Population Health in Kayonza District

The study opined that social-cultural factors contribute to antimicrobial resistance by only 21.7% (54), which is significant in population health, with a p-value of .047 and 95% CI, and may hinder the performance of community veterinary services to prevent and control antimicrobials, due to limited of access to quality one healthcare facilities. Thus, 27.5% (69) participants, contributed to the uptake of traditional medicine belief, besides utilization from family or community households, with RR (0.634, .056), and OD (1.43). Demonstrating that cultural beliefs or practices of livestock farmers highly contributed to the uptake of antimicrobials at community households is protective to neighbouring farmers but constantly chance to contribute resistance to populations that have not developed. Thus, critical to prevention and control, social and cultural variables via community participation in health education on the effects of antimicrobial misuse and promote and improve livestock management (Figure 3).

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The result, confirmed during the KII discussion with a series of findings from veterinary doctors, “The majority of livestock farmers only seek veterinary advice, after attempting their traditional methods and finding that they are failed or ineffective. Therefore, when they rush or call for veterinary service when the prognosis is worsening and when a cow dies and they know the illness is not related to zoonotic, they cannot burrow the carcasses but must boil them to eat to avoid a double loss.” KII in Kayonza district on August 25, 2024.

Extend Knowledge, Attitude, and Practice (KAP) Contribution to Antimicrobial Resistance

The results showed that 19.3% (47) of respondents are aware of and believe in self-medication practices, which contributes to high risks of antibiotic resistance that need accessibility of veterinary consultation to enable prevention and control. Also 24.6% (61) of livestock farmers in the district shared this belief, practices indicating a reliance on local veterinary services, from top to bottom level of perception and trust in veterinary service providers contributes to limited resistance with a significant of 0.045 P values. The use of traditional beliefs and remedies practices, such as herbal medicines or other non-scientific methods, reported by a percentage of respondents (Figure 4).

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Community participation in social culture, taboos, stigmas, livestock farmers’ partnerships, the district’s community veterinarian, and the affordability of services at the time of seeking medical significance in the uptake of both herbal medicine and antibiotics the main contributed, knowledge, attitudes, and practices (KAP) among the community households in Kayonze District. In addition, study also opined in FGDs findings:

“(We usually use our appropriate knowledge, attitude, and experiences in managing our cattle during many illnesses, and only seek veterinary doctors for advice, when the cow are deathly seriously sick. But if die we slaughter and share the carcasses with the other community households, in exchange for maize or other food as barter trade instead of burying it, so longs give little cash and sell skin to get sugar for the following day)” FGD held on 26/08/2024