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

Antimicrobial resistance (AMR) is a global health issue affecting humans and livestock. Reduction in antimicrobial use (AMU) and appropriate use of antimicrobials in livestock production systems have been encouraged. Lack of access to qualified veterinarians, policies regulating AMU and knowledge of AMU and AMR have been identified as drivers of inappropriate AMU behavior in developing countries. Hence, para-veterinarians take a lead role in providing veterinary services to livestock farmers in developing countries. Our previous work found Fijian farmers lack knowledge and understanding of AMU and AMR. However, the attitude, knowledge, and behavior of Fijian veterinary professionals toward AMU and AMR is currently unknown. Therefore, this qualitative study used face-to-face, semi-structured interviews to explore and understand Fijian veterinarian and para-veterinarians' attitude, knowledge, and behavior toward AMU and AMR. A sample of at least ten participants was targeted and recruited from the Central and Western divisions of Viti Levu, Fiji. The Theory of Planned Behavior (TPB) informed the development of the semi-structured interview guide. The interviews were audio-recorded and analyzed using reflexive thematic analysis and deductively using the TPB framework. Our analysis generated three key themes: 1) Antimicrobials prescribed and used based on availability and cost rather than clinical need, 2) Para-veterinarians awareness and knowledge of AMR influence treatment decisions, and 3) Limited resources impede effective consultation and veterinary service delivery. This study demonstrated para-veterinarians (not veterinarians) lacked knowledge and understanding of AMU and AMR. The availability and cost of antimicrobials rather than clinical justification drove antimicrobial prescribing amongst the para-veterinarians. Veterinarians did not visit farms to provide veterinary services; therefore, para-veterinarians provided the veterinary services to the livestock farmers. Lack of human resources, antimicrobials, and physical resources incapacitated veterinary service delivery, where services to farmers' were delayed or not provided at all. Terms of reference for veterinary service delivery and para-veterinarian training framework targeting prescribing, dispensing, use of antimicrobials and risks associated with inappropriate AMU are recommended as part of antimicrobial stewardship (AMS) programmes. Allocation of physical and human resources to Fijian veterinary services should be considered part of AMS programmes to improve veterinary service delivery to livestock farmers and optimize the AMU at the country level.

Factors Associated with Antimicrobial Use in Fijian Livestock Farms.

Antimicrobial stewardship (AMS) programmes in human health and livestock production are vital to tackling antimicrobial resistance (AMR). Data on antimicrobial use (AMU), resistance, and drivers for AMU in livestock are needed to inform AMS efforts. However, such data are limited in Fiji. Therefore, this study aimed to evaluate the association between farmer (socio-economic, demographic) and livestock production and management factors with AMU. Information was collected using purposive and snowball sampling from 236 livestock farmers and managers located in Central and Western divisions, Viti Levu, Fiji. Multinomial logistic regression was used to determine the factors associated with AMU in farms using an aggregated livestock farm model. Farms that raised cattle only for dairy (farm factor) were more likely to use antibiotics and anthelmintics (p = 0.018, OR = 22.97, CI 1.713, 308.075) compared to mixed cattle and poultry farms. Farms that maintained AMU records were more likely to use antibiotics (p = 0.045, OR = 2.65, CI 1.024, 6.877) compared to farms that did not. Other livestock production and management factors had no influence on AMU on the livestock farms. AMU in livestock farms was not influenced by the socio-economic and demographic characteristics of the farmer. There were differences between livestock enterprises regarding their management. The lack of association between management system and AMU could be because there was so much variation in management system, levels of farmer knowledge and awareness of AMU, and in management of farm biosecurity. Future studies exploring farmers' knowledge and awareness of AMU and livestock management are required to design AMS programmes promoting prudent AMU in all livestock farms locally.

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

Antimicrobial resistance (AMR) is a global health issue affecting humans and livestock. To mitigate AMR risks, responsible use of antimicrobials in livestock production systems have been advocated. Studies have reported patterns of antimicrobial use (AMU) in livestock production systems; however, there is limited information on the drivers of AMU and AMR. Therefore, this study aimed to explore and understand the attitude and knowledge of Fijian livestock farmers on AMU and AMR. Livestock farmers and managers from the Central and Western divisions of Viti Levu, Fiji were recruited using purposive and snowball sampling methods. Face-to-face one-to-one semi-structured qualitative interviews were conducted. Interview questions were informed by the Theory of Planned Behavior (TPB). Interview transcripts were analyzed inductively using reflexive thematic analysis and deductively using the TPB framework. A total of 19 cattle and poultry farmers took part. Our analysis generated four themes: (1) Uninformed use of antimicrobials and unaware of AMR, (2) Safeguarding livestock and generating income source as primary motivators for using antimicrobials (3) Medicine shortage results in hoarding and self-prescribing, and (4) Farm decisions on AMU and livestock management influenced by foreign farmers and veterinarians. Livestock farmers used medicines in livestock production; however, they could not differentiate amongst different types of medicine, including antimicrobials. Antimicrobials were used to prevent diseases in livestock and promote production of food and financial security but without any awareness of the risks of AMR. Additionally, farmers hoarded and self-prescribed medicines. Farmers rationed antimicrobials by not completing the entire course of antibiotics to save them for future use. Based on past experiences, farmers expressed dissatisfaction with the veterinary services provided by the government. They sought help online and from foreign farmers and veterinarians. We propose the need for antimicrobial stewardship (AMS) programmes focused on promoting rational use of antimicrobials and awareness of AMR amongst farmers in the Fijian livestock production systems. These programmes need to consider the anthropological, socio-cultural, economic, and environmental factors driving AMU. Future studies are underway to explore the attitude and knowledge of Fijian veterinarians, para-veterinarians and pharmacists on AMU and AMR to gain a broader systems knowledge to inform the design of AMS programmes.

Categorisation of Antimicrobial Use in Fijian Livestock Production Systems.

Antimicrobial resistance (AMR) is a major global threat to human and animal health. The use of antimicrobials in the livestock sector is considered to contribute to AMR. Therefore, a reduction in and prudent use of antimicrobials in livestock production systems have been advocated. This cross-sectional survey aimed to investigate the extent of imprudent antimicrobial use (AMU) and to determine whether the AMU practice was affected by either the farming system or species of farmed livestock in the largest island (Viti Levu) of Fiji. A total of 276 livestock enterprises were surveyed and antimicrobials were used on 309 occasions over 90 days. Overall, in 298 of 309 (96%) incidents, antimicrobials were used imprudently, comprising antibiotics, 160 of 170 (94%) and anthelmintics, 138 of 139 (99%). Prudent use of antibiotics was associated with commercial farming systems (X2 = 13, p = 0.001), but no association was observed with anthelmintic use (p > 0.05). Imprudent antibiotic use was associated with dairy (OR = 7.6, CI = 1.41, 41.57, p = 0.018) followed by layer and beef (p > 0.05) compared to broiler enterprises. Imprudent AMU was more common in the backyard and semi-commercial enterprises compared to commercial broiler enterprises. Policies promoting the prudent use of antimicrobials in Fiji should focus on smaller livestock production systems and enterprises.