Antimicrobial Resistance (AMR) is a global health emergency that threatens modern medicine and incurs great cost to human health. The World Health Organization as part of a quadripartite joint ...initiative with the Food and Agriculture Organization of the United Nations, World Organisation for Animal Health, and United Nations Environment Programme, has recently published a One Health Priority Research Agenda for AMR. In this article we present a multidisciplinary approach, proposed by behavioural science experts, One Health experts and AMR experts to support the implementation of the Priority Research Agenda. We review, using specific examples of complex interventions designed to tackle AMR in which behavioural science has been embedded, five main steps: Define - what behaviours are a priority in each context; Diagnose - What are the barriers and enablers to the behaviours prioritised? Design - what interventions exist and what new or enhanced interventions could work to tackle the barriers identified? and, Implement and Evaluate the intervention(s). The approach presented will be useful for funders and researchers who wish to incorporate methods, frameworks and insights from the behavioural sciences into research plans, proposals and protocols in relation to a multisectoral One Health agenda and produce findings that are more relevant to policymakers.
The poultry sector contributes significantly to Kenya's food and economic security. This contribution is expected to rise dramatically with a growing population, urbanization, and preferences for ...animal-source foods. Antimicrobial resistance is putting the poultry sector in Kenya-and worldwide-at risk of production losses due to the failure of medicines for animal (and human) health. The emergence and spread of antimicrobial resistance has been linked to overuse and misuse of antimicrobials in poultry and other sectors. Previous studies have documented poultry farmer antimicrobial use but without systematic consideration of the contexts (i.e., drivers) as important targets for behavior change, particularly in low- and middle-income countries. To improve understanding of antimicrobial use patterns in poultry systems, we conducted a mixed-methods knowledge, attitudes, and practices study of 76 layer farms in Kiambu County; Kenya. We found that commonly used antibiotics were often labeled for prophylactic, growth promotion, and egg production improvement purposes. Antimicrobial use was also motivated by the presence of diseases/disease symptoms, most of which could instead be managed through infection prevention measures. The results suggest that improving vaccination and biosecurity practices on farms and engaging with drug-makers to ensure proper labeling and marketing of antimicrobial drugs may represent important areas of opportunity for social behavior change communication and/or behavioral science interventions (i.e., nudges) to reduce disease burdens and promote prudent antimicrobial use. We conclude our findings with suggestions for further research into the behavioral insights at play in these scenarios to fuel future intervention development.
IntroductionAwareness-raising campaigns play a central role in efforts to combat drug resistance. These campaigns assume that knowledge deficits drive poor practices that increase resistance. ...Therefore, increasing awareness will promote prudent practices and reduce resistance. However, most awareness campaigns have been developed and evaluated in high-income and public health settings. Consequently, it is not clear whether these campaigns are effective in low-income and middle-income countries and/or within animal health settings.MethodsFocus group discussions and in-depth interviews were used to collect narratives of veterinary drug use among Maasai pastoralists (n=70), animal health professionals (n=10) and veterinary drug sellers (n=5). Thematic analysis was used to identify recurring themes across narratives and groups.ResultsNarratives of Maasai and animal health professionals indicated that Maasai treated their livestock with limited input from the professional sector and that non-prudent treatment practices were observed (eg, using antimicrobials as ‘energizers’). Professionals linked these practices to knowledge and attitudinal deficits among the Maasai, while Maasai narratives highlighted the importance of climatic uncertainties and cultural beliefs surrounding veterinary care.ConclusionNarratives of veterinary drug use from animal health professionals are consistent with the knowledge deficit assumption guiding awareness-raising efforts. In contrast, Maasai narratives highlight how animal health practices are patterned by cultural norms interacting with factors largely outside of Maasai control, including a constrained professional veterinary sector. If these cultural and structural contexts remain unconsidered in awareness-raising strategies, current campaigns are unlikely to motivate practices necessary to limit drug resistance, especially within low-income and middle-income settings.
Introduction Antimicrobial resistance (AMR) poses a significant global threat to public, animal, and environmental health, consequently producing downstream economic impacts. While top-down ...approaches to addressing AMR (e.g., laws regulating antimicrobial use) are common in high-income countries, limited enforcement capacities in low- and middle-income countries highlight the need for more bottom-up approaches. Within agriculture, efforts to apply bottom-up approaches to AMR have often focused on the promotion of biosecurity, which should reduce the need for antimicrobials by mitigating disease risk and limiting AMR transmission. Traditionally, efforts to encourage biosecurity adoption have emphasized training and awareness-raising initiatives. However, a growing body of research suggests a disconnect between knowledge and behavior, highlighting the existence of a knowledge–action gap. Method To understand the barriers and enablers patterning the knowledge-action gap in on-farm biosecurity uptake, we draw upon models from behavioral science. We analyzed in-depth interviews and two focus group discussions with smallholder poultry producers in Ghana to understand factors underlying the intention–action gap in adopting biosecurity. As an analytical framework, we draw upon the Theoretical Domains Framework in combination with the Capability-Opportunity-Motivation Behavioral Model. Results and discussion While smallholder poultry farmers in Ghana were aware of the importance of biosecurity practices, they struggled with consistent implementation. Financial constraints, challenges in adapting practices to the local context, and limited resources hindered adoption. Additionally, cognitive biases like prioritizing short-term gains and underestimating disease risks played a role. However, some farmers found motivation in professional identity and social influences. These findings highlight the need for designing biosecurity interventions that consider human behavioral factors and the context in which behavior occurs. This underscores the importance of collaboration across disciplines, including veterinary science and the social and behavioral sciences. Implications and recommendations for researchers and practitioners are discussed.
To honour the 100 years anniversary of the first publication about African swine fever (ASF) a webinar with a particular focus on disease control in the smallholder sector was organized. This article ...is based on the webinar, summarizing the early history of ASF research, reflecting on the current global disease situation and bringing forward some suggestions that could contribute towards achieving control of ASF.
The first description of ASF by R. Eustace Montgomery in 1921 laid the foundations for what we know about the disease today. Subsequent research confirmed its association with warthogs and soft ticks of the Ornithodoros moubata complex. During the latter half of the 21st century, exponential growth of pig production in Africa has led to a change in the ASF‐epidemiology pattern. It is now dominated by a cycle involving domestic pigs and pork with virus spread driven by people. In 2007, a global ASF epidemic started, reaching large parts of Europe, Asia and the Americas. In Europe, this epidemic has primarily affected wild boar. In Asia, wild boar, smallholders and industrialized pig farms have been affected with impact on local, national and international pig value chains. Globally and historically, domestic pigs in smallholder settings are most frequently affected and the main driver of ASF virus transmission. Awaiting a safe and efficacious vaccine, we need to continue focus on other measures, such as biosecurity, for controlling the disease. However, smallholders face specific challenges linked to poverty and other structural factors in implementing biosecurity measures that can prevent spread. Improving biosecurity in the smallholder sector thus remains an important tool for preventing and controlling ASF. In this regard, interdisciplinary research can help to find new ways to promote safe practices, facilitate understanding and embrace smallholders’ perspectives, engage stakeholders and adjust prevention and control policies to improve implementation.
Animal health service providers can play an important role in limiting drug resistance by promoting responsible and prudent use of veterinary drugs. Recognizing this potential, international agencies ...and governments have called for these providers to receive drug stewardship training, particularly providers in low- and middle-income countries where top-down regulations (e.g., national regulation of veterinary prescriptions) are largely unfeasible. The success of these stewardship trainings to promote responsible and prudent use will depend on many factors, including understanding how livestock-keeping communities currently interact with animal health service providers. Here, we use a mixed methods approach to identify and understand animal health seeking practices among Maasai pastoralists in Tanzania. Combining qualitative interviews (N = 31) and structured surveys (N = 195), we show the majority of Maasai respondents (≈80 %) do not frequently consult animal health service providers with most relying on advice from family and friends. Logistic regression models of health seeking practices find that increasing age, education, observance of treatment failure, and herd disease burdens are associated with greater odds of seeking out health services. Quantitative results were supported by data from focus group discussions and in-depth interviews that showed Maasai view animal health service providers as measures of last resort, whose input is largely sought after self-treatment with veterinary drugs fail. We argue patterns of animal health seeking among the Maasai are partially the consequence of their high confidence in their own abilities in livestock disease and treatment and generally low confidence in the skills of animal health service providers. We link this high sense of self-efficacy to the culturally engrained process by which Maasai develop mastery in animal health and how the roles and norms in Maasai culture surrounding animal health influence Maasai perceptions of animal health professionals. Our results highlight the need for more research to understand Maasai perceptions of animal health service providers as well as the knowledge, attitudes, and practices of these providers. Finally, our study emphasizes that the success of drug stewardship trainings will require efforts to first understand the cultural and historical contexts driving health seeking practices that impact perceptions of animal health service providers and animal health practices more generally.
Enabling, supporting and promoting positive health-related behaviours is critical in addressing the major public health challenges of our time, and the multifaceted nature of behaviours requires an ...evidence-based approach. This statement seeks to suggest how a much-needed enhanced use of behavioural and cultural science and insights for health could be advanced.
and methods: Public health authorities of Europe and Central Asia and international partner organizations in September 2023 met in Copenhagen, Denmark, to discuss the way forward. Drawing on 1) country reporting to WHO, 2) interview study with public health authorities and 3) the meeting deliberations, this meeting statement was developed.
The meeting statement presents a joint call for step-change accelerated use of evidence-based approaches for health behaviours. Actionable next steps for public health authorities and international and regional development partners in health are presented.
The way forward involves increased resource allocation, integration of behavioural insights into health strategies, advocacy through case and cost-effectiveness examples and capacity building.
We report a case of ceftriaxone-induced immune hemolytic anemia in a 10-year-old with chronic active Epstein–Barr virus disease and hemophagocytic lymphohistiocytosis. After chemotherapy, she became ...febrile and received ceftriaxone. She rapidly developed respiratory failure and anemia. Her direct antiglobulin test was positive for IgG and C3. To confirm this was ceftriaxone-induced complement-mediated hemolysis, we adapted the complement hemolysis using human erythrocytes (CHUHE) assay by adding exogenous ceftriaxone to the patient’s serum which enhanced lysis of her erythrocytes. We confirmed that ceftriaxone initiated a classical complement pathway-mediated hemolysis by in vitro reversal with peptide inhibitor of complement C1 (PIC1).
International Trade Morgan, Cortney O'Toole; Skinner, Christopher H; Bentes, Pablo M ...
The International lawyer,
04/2013, Volume:
47, Issue:
4
Journal Article
Peer reviewed
This article outlines die most important developments in international trade law during 2012. It summarizes developments in international trade negotiations (both in the WTO and bi-lateral ...negotiations), WTO dispute settlement activities, and U.S. trade remedies cases. PUBLICATION ABSTRACT
PDF
