Voluntary optimisation of antimicrobial consumption in swine and poultry production in Thailand: a policy analysis.

Antimicrobial resistance (AMR) is a global health concern with significant implications on economies and health security, affecting humans, animals, food, and the environment. To tackle this issue, promoting responsible antimicrobial use in livestock production has emerged as a crucial intervention. In 2018, Thailand introduced the Voluntary Optimization of Antimicrobial Consumption (VOAC) programme, with the objective to encourage responsible antimicrobial use practises. This study aimed to analyse the context, content, process and actors of the VOAC programme. A qualitative method including document reviews and key informant interviews were applied. In-depth interviews were conducted with 18 key informants who are key stakeholders from public and private sectors involved in the policy formulation, design of policy contents and implementation of VOAC: policy makers or officers responsible for animal health (n = 12), animal producers (n = 2), animal product traders or retailers (n = 2), and farm veterinarians (n = 2). Interview transcripts were validated by informants for accuracy, and triangulated with document review findings. Deductive approach was applied for data analysis and interpretation based on Walt and Gilson's policy analysis framework. The VOAC farm certification comprises of Raised Without Antibiotics (RWA) and Reducing Antibiotic Use (RAU), both aiming to combat AMR in food animals. Global and national factors, including increased public awareness, policy commitments, export requirements from the European Union, and international organisation advocacies, influenced the development of the programme led by the Department of Livestock Development (DLD), under the Ministry of Agriculture and Cooperatives. Collaboration with the private sector facilitated policy clarity, with implementation primarily executed through regional, provincial, and district livestock officers. Integration of the programme with the pre-existing Good Agriculture Practise certification system enabled cost-effective implementation without additional resources. In 2022, DLD official data reported 214 RWA farms (112 pig and 102 broiler), and 230 RAU farms (83 pig and 147 broiler). Incentives for farms to participate in the programme include improving corporate image and demonstrating corporate responsibility addressing AMR in food products. Recommendations include optimising certification strategies, increasing consumer awareness of RWA and RAU products and strengthening monitoring and evaluation systems.

Antimicrobial consumption in food-producing animals in Thailand between 2017 and 2019: The analysis of national importation and production data.

Antimicrobial resistance (AMR) threatens health security and the economy worldwide. AMR bacteria can spread across humans, animals, food webs and the environment. Excessive use of antimicrobials in food-producing animals has been recognised as one of the main drivers of the emergence of resistant bacteria. This study aims to quantify and identify patterns of antimicrobial consumption in food-producing animals in Thailand in a three-year period (2017-2019). Milligrams of active ingredient from total volume of imported and locally manufactured products minus exports were obtained from Thai FDA. Annual population production of food-producing animals in 2017, 2018 and 2019 was compiled and validated through cooperation between the Department of Livestock Development (DLD), Department of Fisheries (DOF). The total amount of antimicrobial consumption for food-producing animals decreased 49.0% over the three-year period from 658.7 mg/PCUThailand in 2017 to 336.3 mg/PCUThailand in 2019. In 2017, the most common antimicrobials used was macrolides which was replaced by aminopenicillins and pleuromutilins in 2019, while tetracyclines was consistently common over the three-year period. Consumption of the WHO Critically Important Antimicrobials (CIA) group declined significantly over this period, from 259.0 in 2017 to 193.2 mg/PCUThailand in 2019 (a 25.4% reduction). Findings from this study were in line with national policies which curtails prudent use of antimicrobials in food-producing animals. The government should maintain the decreasing trend of consumption, in particular of the CIA category. Improving information systems which captures consumption by specific species contributes to precision of interventions to minimise prudent use in each species.

Population knowledge and awareness of antibiotic use and antimicrobial resistance: results from national household survey 2019 and changes from 2017.

BACKGROUND: Lack of knowledge and awareness on antimicrobial resistance (AMR) can result in irrational use of antibiotics, which is one of the major drivers of AMR. One goal of the Thailand National Strategic Plan on AMR (2017-2021) is a 20% increase in public knowledge and awareness of antibiotic use and AMR by 2021. This study assesses antibiotic use, level of knowledge and awareness of antibiotic use and AMR and the factors associated with their knowledge and awareness in the Thai population in 2019. It compares findings with a similar national survey in 2017. METHODS: An AMR module was integrated into the Health and Welfare Survey, a biennial national household survey conducted by the National Statistical Office since 2017. The 2019 survey took place in March, through face-to-face interviews with 27,900 Thai adults aged 15 years or above who participated in the survey and compares 2019 findings with those from 2017. RESULTS: One month prior to the survey, 6.3% of population reported use of antibiotics (reduced from 7.9% to 2017), of which 98.1% received antibiotics through healthcare professionals and almost half (43.2%) for flu symptoms. During the last 12 months, 21.5% of Thai adults received information on the appropriate use of antibiotics and AMR (increased from 17.8% to 2017); mostly through health professionals (82.7%). On knowledge, 24.3% of adults gave correct answers to more than three out of six statements (three true and three false statements) (increased from 23.7% to 2017). The overall mean score of awareness of appropriate antibiotic use and AMR is 3.3 out of total score of 5. CONCLUSIONS: Although progress was made on knowledge and awareness between 2017 and 2019, certain practices, such as use of antibiotics for flu symptoms and receiving information about antibiotic use and AMR, are inappropriate and inadequate. These findings require significant action, notably strengthening health professionals' ability to prescribe and dispense antibiotics appropriately and effective communication with patients. The government should promote specific information on rational use of antibiotics and AMR to specific target groups.

Surveys of knowledge and awareness of antibiotic use and antimicrobial resistance in general population: A systematic review.

BACKGROUND: Currently, various tools exist to evaluate knowledge and awareness of antibiotic use and antimicrobial resistance (AMR) and are applied by various organizations. Previous systematic reviews have focused mainly on study findings such as levels of knowledge and AMR awareness. However, the survey procedures and data instruments used ought to be scrutinized as well, since they are important contributors to credible results. This review aims to assess the study methods and procedures of existing population-based surveys and explore key components which determine the general population's levels of knowledge and awareness of antibiotic use and AMR. METHODS: We searched existing literature for population -based surveys which sought knowledge and awareness of antibiotic use or AMR in the general population. Databases searched included Ovid, MEDLINE and EMBASE, PsycINFO and Scopus, domestic journals and gray literature sources. Population-based cross-sectional studies published in English or Thai from January 2000 to December 2018 were included in the review. Quality assessment was conducted using the 'Appraisal Tool for Cross-Sectional Studies' (AXIS). RESULTS: All 22 studies included in the analysis had clear objectives focusing on assessing people's levels of knowledge, awareness, attitudes and behavior relating to antibiotic use and awareness of AMR. These studies had employed appropriate methodologies for population-based cross-sectional surveys relative to research questions. More than half of studies (14 out of 22) had scientifically soundly designed methodologies which captured the representativeness of the population; whereas the remaining studies had unclear sample size estimations, inappropriate sample frames and selection biases. Half of the studies had tested the validity and reliability of the questionnaire. The common questions used by these surveys were categorized into four themes: behavior related to antibiotic use, knowledge and awareness of antibiotic use, knowledge and awareness of AMR and others such as receiving information about antibiotic use and AMR or cross-cutting issues like self-medication. CONCLUSION: This review identified four key features of good practices in antibiotic use and awareness surveys: a) clear survey objective; b) scientifically sound sampling techniques ensuring representativeness; c) strategies for recruitment of samples and survey administration methods; and d) credible measurement to prevent non-sampling biases. During questionnaire design, the health systems context in terms of access to health services and antibiotics should be taken into account. In conclusion, to maximize the use of surveys, the application of findings in surveys and associated factors related to antibiotic use and AMR should primarily generate public health interventions and target specific groups to make progress in solving AMR problems.