Antibiotic stewardship in agricultural communities in Africa and Asia: A unified One Health strategy to optimise antibiotic use in animals and humans
Lead Research Organisation:
London Sch of Hygiene and Trop Medicine
Department Name: Infectious and Tropical Diseases
Abstract
Antibiotic medicines are a vital resource for treating bacterial infections both in humans and in animals. Unfortunately, all around the world, some infections are becoming resistant to the antibiotics used to treat them. This could lead to a future scenario in which illnesses last longer, deaths increase, and the cost of treatment rises. Resistance additionally threatens livelihoods due to farmers' reliance on antimicrobials in livestock production to meet growing demand. Under this scenario, the greatest impact will be felt in low-income countries, where infectious diseases are common and many families lack financial security. Antibiotic resistance is now considered to be one of the biggest threats to global health. The UN General Assembly has called for concerted action by every national government to limit the development and spread of drug resistance. The World Health Organization advocates urgent action, research and investment, through both the development of new antimicrobials and more responsible use of existing drugs.
Poor prescription practices such as overuse of antibiotics, partial doses, or non-adherence to the full treatment course, all create situations which are conducive to the selection and spread of resistant mutations. Health workers, pharmacists, farmers, caregivers and patients can all help tackle resistance by only dispensing antibiotics when they are truly needed, and by using the right drug in the right quantities. Improving the use of antibiotics thus ultimately involves developing effective interventions to guide the treatment decisions made by health workers, patients and farmers to discourage indiscriminate use.
The private sector plays an important role in provision of health care in many low-income countries, with a majority of patients and farmers depending on drug shops and informal providers for medicines - and cannot be overlooked in strategies to control misuse of antibiotics. Neither can antibiotic resistance be addressed by focusing on one sector in isolation - a holistic approach is needed for the effective control of antibiotics in animals and humans. Yet regulation of the private sector is an acknowledged weakness of the health system in many low-middle income countries.
The proposed cluster aims to address this challenge. We shall pool the knowledge and insights that have been generated in six projects previously funded by GCRF, to compare the situations, norms, experiences, and motivations that affect antibiotic use in humans and animals across a range of countries in Africa and Asia - to identify processes that can deter misuse of these valuable medicines and/or incentivize good practice. Our particular focus will be on antibiotics purchased from drug shops and informal providers in rural agricultural areas with limited access to healthcare. Our projects also look at the influence of interactions between private providers, government health workers and public officials, to gain a better understanding of how health systems in low-income countries can more effectively raise the quality of care available from private providers and improve treatment practices. We shall use this collective evidence to design an overarching intervention strategy, comprised of mutually-reinforcing components, aimed at combatting misuse of antibiotics purchased from drug shops and improving rural treatment services for humans and animals. This strategy will be tested in future studies.
Ultimately, the intervention strategies we develop are intended be of value to national governments, Ministries of Health and Ministries of Agriculture, in low-middle income countries in the formulation and enactment of national plans to counter the threat of antibiotic resistance. Our findings can also be used to strengthen health services in rural areas.
Poor prescription practices such as overuse of antibiotics, partial doses, or non-adherence to the full treatment course, all create situations which are conducive to the selection and spread of resistant mutations. Health workers, pharmacists, farmers, caregivers and patients can all help tackle resistance by only dispensing antibiotics when they are truly needed, and by using the right drug in the right quantities. Improving the use of antibiotics thus ultimately involves developing effective interventions to guide the treatment decisions made by health workers, patients and farmers to discourage indiscriminate use.
The private sector plays an important role in provision of health care in many low-income countries, with a majority of patients and farmers depending on drug shops and informal providers for medicines - and cannot be overlooked in strategies to control misuse of antibiotics. Neither can antibiotic resistance be addressed by focusing on one sector in isolation - a holistic approach is needed for the effective control of antibiotics in animals and humans. Yet regulation of the private sector is an acknowledged weakness of the health system in many low-middle income countries.
The proposed cluster aims to address this challenge. We shall pool the knowledge and insights that have been generated in six projects previously funded by GCRF, to compare the situations, norms, experiences, and motivations that affect antibiotic use in humans and animals across a range of countries in Africa and Asia - to identify processes that can deter misuse of these valuable medicines and/or incentivize good practice. Our particular focus will be on antibiotics purchased from drug shops and informal providers in rural agricultural areas with limited access to healthcare. Our projects also look at the influence of interactions between private providers, government health workers and public officials, to gain a better understanding of how health systems in low-income countries can more effectively raise the quality of care available from private providers and improve treatment practices. We shall use this collective evidence to design an overarching intervention strategy, comprised of mutually-reinforcing components, aimed at combatting misuse of antibiotics purchased from drug shops and improving rural treatment services for humans and animals. This strategy will be tested in future studies.
Ultimately, the intervention strategies we develop are intended be of value to national governments, Ministries of Health and Ministries of Agriculture, in low-middle income countries in the formulation and enactment of national plans to counter the threat of antibiotic resistance. Our findings can also be used to strengthen health services in rural areas.
Planned Impact
As antibiotic resistance is recognized as one of the greatest threats facing global public health, research on how to contain the emergence and spread of antimicrobial resistance is urgently needed by policy makers and national health authorities. Attempts that seek to change practice at the national level without taking into account what is happening in communities is likely to fail as it is at the frontline of medicine use that the most dramatic changes need to take place.
The proposed will provide policy-relevant data on antibiotic quality in primary health care settings and animal production in India, Uganda and other LMICs and the results will provide an essential component in the construction of workable solutions to support the prudent use of antibiotics in both settings. For example, in Uganda, the results will add to the current sustained investments in surveillance and control implemented by the Fleming fund and others in Uganda. It will provide evidence for the committee charged with implementing Uganda's first Antimicrobial Resistance (AMR) National Action Plan (NAP). The Ugandan co-investigators on this application are all members of this Taskforce. Beyond Uganda, results from this research and subsequent interventions will provide a valuable case study for work in other countries with similar health care systems and challenges. In India, the research will be disseminated to the Ministry of Health, health and animal husbandry departments and members of the AMR Coordination Committee and Task Force, the Indian Pharmaceutical Association, medical associations of Indian doctors and infectious disease physicians, and informal providers and rural communities.
Similarly, other Co-Is have developed relationships with key stakeholders in Pakistan, Cambodia, Tanzania, Kenya so that our findings will extend beyond these two countries of focus. We also have a Latin American Co-I from Colombia so our stakeholder impact will extend to that region as well. These engagements will be strengthened over the duration of this project through the interactive workshops and also through the rapid feasibility/intervention readiness research that will be conducted in India and Uganda.
When we disseminate our findings, we will conduct a stakeholder analysis to identify key individuals who are likely to work as policy champions and who will identify policy windows and opportunities for policy implementation at global and national levels. We anticipate that these champions will be critical to our research being taken into policy.
Finally, we will communicate with the scientific community by publishing in international peer-reviewed journals with high impact factors. To reach the broad multidisciplinary audience to whom this research will be of interest, including those in LMICs, we shall publish in open-access journals. Results will also be actively disseminated through our professional contacts in international and regional organisations, and academic networks and invited talks. Research briefs that summarize the key findings and are designed for a policy audience will also be disseminated through the websites, newsletters and press offices of our host institutions.
The proposed will provide policy-relevant data on antibiotic quality in primary health care settings and animal production in India, Uganda and other LMICs and the results will provide an essential component in the construction of workable solutions to support the prudent use of antibiotics in both settings. For example, in Uganda, the results will add to the current sustained investments in surveillance and control implemented by the Fleming fund and others in Uganda. It will provide evidence for the committee charged with implementing Uganda's first Antimicrobial Resistance (AMR) National Action Plan (NAP). The Ugandan co-investigators on this application are all members of this Taskforce. Beyond Uganda, results from this research and subsequent interventions will provide a valuable case study for work in other countries with similar health care systems and challenges. In India, the research will be disseminated to the Ministry of Health, health and animal husbandry departments and members of the AMR Coordination Committee and Task Force, the Indian Pharmaceutical Association, medical associations of Indian doctors and infectious disease physicians, and informal providers and rural communities.
Similarly, other Co-Is have developed relationships with key stakeholders in Pakistan, Cambodia, Tanzania, Kenya so that our findings will extend beyond these two countries of focus. We also have a Latin American Co-I from Colombia so our stakeholder impact will extend to that region as well. These engagements will be strengthened over the duration of this project through the interactive workshops and also through the rapid feasibility/intervention readiness research that will be conducted in India and Uganda.
When we disseminate our findings, we will conduct a stakeholder analysis to identify key individuals who are likely to work as policy champions and who will identify policy windows and opportunities for policy implementation at global and national levels. We anticipate that these champions will be critical to our research being taken into policy.
Finally, we will communicate with the scientific community by publishing in international peer-reviewed journals with high impact factors. To reach the broad multidisciplinary audience to whom this research will be of interest, including those in LMICs, we shall publish in open-access journals. Results will also be actively disseminated through our professional contacts in international and regional organisations, and academic networks and invited talks. Research briefs that summarize the key findings and are designed for a policy audience will also be disseminated through the websites, newsletters and press offices of our host institutions.
Organisations
- London Sch of Hygiene and Trop Medicine, United Kingdom (Collaboration, Lead Research Organisation)
- Oswaldo Cruz Foundation (Fiocruz) (Collaboration)
- Makerere University, Uganda (Collaboration)
- International Livestock Research Institute (ILRI) (Collaboration)
- Universidad Antonio Nariño (Collaboration)
- University of Glasgow, United Kingdom (Collaboration)
- Royal Veterinary College, United Kingdom (Collaboration)
- Makerere University College of Health Sciences (Collaboration)
- West Bengal University of Animal and Fishery Sciences (Collaboration)
Publications

Arnold JC
(2021)
"If It Works in People, Why Not Animals?": A Qualitative Investigation of Antibiotic Use in Smallholder Livestock Settings in Rural West Bengal, India.
in Antibiotics (Basel, Switzerland)

Gautham M
(2021)
What are the challenges for antibiotic stewardship at the community level? An analysis of the drivers of antibiotic provision by informal healthcare providers in rural India
in Social Science & Medicine



Hutchinson E
(2023)
Is it possible for drug shops to abide by the formal rules? The structural determinants of community medicine sales in Uganda.
in BMJ global health

McCubbin KD
(2021)
Unsafe "crossover-use" of chloramphenicol in Uganda: importance of a One Health approach in antimicrobial resistance policy and regulatory action.
in The Journal of antibiotics

Meenakshi Gautham
(2020)
Mobilising informal healthcare providers in India may help its response to covid-19
in BMJ Opinion

Myers J
(2022)
Crossover-Use of Human Antibiotics in Livestock in Agricultural Communities: A Qualitative Cross-Country Comparison between Uganda, Tanzania and India.
in Antibiotics (Basel, Switzerland)
Description | We are finding that there are many similarities in the factors that influence availability and use of antibiotics at community-level in agricultural communities across a range of countries in Africa, Asia and South America. These include limited access to veterinary services, economic constraints, and high reliance on informal private providers for the provision of medicines. In several places, we have also encountered instances of off-label crossover-use of antibiotics between animals and humans. We are in the process of documenting these findings. |
Exploitation Route | The ODA cuts jeopardised the intended outcomes of this funding (a joint interdisciplinary research proposal drawing on the learnings of previously GCRF-funded grants). Ultimately, the outcomes will therefore depend on finding sources of alternative funding, which will not be realised in the timeframe of the original grant. It is thus too soon to be able to report significant advances in outcomes from this funding. |
Sectors | Agriculture, Food and Drink,Environment,Healthcare,Government, Democracy and Justice,Pharmaceuticals and Medical Biotechnology |
Description | Collaboration with Brazilian researchers working on antimicrobial stewardship |
Organisation | Oswaldo Cruz Foundation (Fiocruz) |
Country | Brazil |
Sector | Public |
PI Contribution | Hosting and joint supervision of a PhD student from Brazil, on exchange programme funded by Brazilian government; Collaboration on a research paper |
Collaborator Contribution | Joint supervision of a Brazilian PhD student; Collaboration on a research paper |
Impact | None yet - this is a new multidisciplinary collaboration. Disciplines involved: Public health, veterinary medicine |
Start Year | 2022 |
Description | Collaboration with researchers at International Livestock Research Institute (ILRI) working on antimicrobial stewardship |
Organisation | International Livestock Research Institute (ILRI) |
Country | Kenya |
Sector | Charity/Non Profit |
PI Contribution | I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual. Researchers from ILRI have been invited to attend some of these meetings and their work on antimicrobial stewardship in livestock production systems has been informed and influenced by the insights shared by projects in our cluster. |
Collaborator Contribution | The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. Researchers from ILRI have been invited to attend some of these meetings and have shared insights from their work on antimicrobial stewardship in livestock production systems with other projects in our cluster. This has expanded our collective understanding. |
Impact | None as yet. Findings from our cluster, including publications and unpublished theses, have been disseminated internally within their network. |
Start Year | 2020 |
Description | International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) |
Organisation | London School of Hygiene and Tropical Medicine (LSHTM) |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual. |
Collaborator Contribution | The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. |
Impact | This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process. |
Start Year | 2020 |
Description | International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) |
Organisation | Makerere University |
Department | School of Public Health |
Country | Uganda |
Sector | Academic/University |
PI Contribution | I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual. |
Collaborator Contribution | The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. |
Impact | This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process. |
Start Year | 2020 |
Description | International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) |
Organisation | Makerere University College of Health Sciences |
Country | Uganda |
Sector | Academic/University |
PI Contribution | I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual. |
Collaborator Contribution | The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. |
Impact | This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process. |
Start Year | 2020 |
Description | International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) |
Organisation | Royal Veterinary College (RVC) |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual. |
Collaborator Contribution | The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. |
Impact | This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process. |
Start Year | 2020 |
Description | International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) |
Organisation | Universidad Antonio Nariño |
Country | Colombia |
Sector | Academic/University |
PI Contribution | I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual. |
Collaborator Contribution | The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. |
Impact | This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process. |
Start Year | 2020 |
Description | International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) |
Organisation | University of Glasgow |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual. |
Collaborator Contribution | The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. |
Impact | This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process. |
Start Year | 2020 |
Description | International network of researchers working on antibiotic stewardship using a One Health approach (Colombia, India, Pakistan, Tanzania, Uganda, UK) |
Organisation | West Bengal University of Animal and Fishery Sciences |
Country | India |
Sector | Academic/University |
PI Contribution | I am co-PI (together with Meenakshi Gautham, LSHTM) for this GCRF Cluster award. The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. The work of the cluster is co-ordinated by myself and my research team at LSHTM. The cluster launched during the COVID-19 pandemic and all international research workshops to date have been virtual. |
Collaborator Contribution | The AgriAMU Cluster, launched in 2020, brings together a set of six GCRF-funded projects examining antibiotic stewardship in agricultural communities in Africa and Asia. Lead researchers from these six projects meet regularly to share findings and insights gained from their work, to make cross-country comparisons, to identify and critically examine common challenges to antibiotic stewardship in animals and humans, and to apply a One Health approach in developing a common framework for addressing these challenges, suited for use in agricultural communities in low-middle income countries. |
Impact | This is a multidisciplinary collaboration including the following disciplines: epidemiology, anthropology, health economics, health systems and policy research, public health, biomedicine and veterinary medicine. Members of the cluster have collaborated on two peer-reviewed articles to date (both accepted for publication in early 2021). Further cross-country collaborative outputs are in process. |
Start Year | 2020 |
Description | Research collaboration with researchers in veterinary medicine to compare antibiotic use amongst humans and animals, retail sector supply and regulatory systems for human and veterinary medicines in Uganda |
Organisation | Royal Veterinary College (RVC) |
Department | One Health (Infectious Diseases) |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | Supervision of MSc students to support data collection in Uganda, data analysis and interpretation, and preparation of manuscripts for submission to peer-reviewed journals; Ongoing discussions to identify research priorities and funding opportunities arising from these research findings |
Collaborator Contribution | Joint supervision of MSc students to support data analysis and interpretation, and preparation of manuscripts for submission to peer-reviewed journals; Ongoing discussions to identify research priorities and funding opportunities arising from these research findings |
Impact | A poster was presented at launch of CGIAR Agriculture for Nutrition and Health Antimicrobial Resistance (AMR) Hub at the International Livestock Research Institute in Nairbi, Kenya in February 2019. https://www.cgiar.org/news-events/news/launching-today-cgiar-antimicrobial-resistance-hub A number of manuscripts are in preparation. Multidisciplinary - public health epidemiology, veterinary medicine, anthropology, chemistry (drug quality). |
Start Year | 2018 |
Description | Research collaboration with respect to private health care providers in Uganda |
Organisation | Makerere University |
Country | Uganda |
Sector | Academic/University |
PI Contribution | Intellectual input, including expertise in epidemiology, public health research, health system research, health economics, anthropology, intervention trials and research methods |
Collaborator Contribution | Intellectual input, including expertise in public health research, health system research, intervention trials and research methods Experience in conducting research in low-income settings New collaborations with researchers with expertise in One Health added in 2018. |
Impact | Hansen KS, Clarke SE, Lal S, Magnussen P & Mbonye AK. (2017) Cost-effectiveness analysis of introducing malaria diagnostic testing in drug shops: A cluster-randomised trial in Uganda. PLoS One; 12(12): e0189758. Bruxvoort KJ, Leurent B, Chandler CI, Ansah EK, Baiden F, et al. (2017) The impact of introducing malaria rapid diagnostic tests on fever case management: a synthesis of ten studies from the ACT consortium. Am J Trop Med Hyg. 97(4): 1170-1179. Hopkins H, Bruxvoort KJ, Cairns ME, Chandler CI, Leurent B, et al. (2017). Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings. BMJ; 356: j1054. Lalani M, Kitutu FE, Clarke SE & Kaur H. (2017) Antimalarial medicine quality field studies and surveys: a systematic review of screening technologies used and reporting of findings. Malaria Journal; 16(1): 197. Buregyeya E, Rutebemberwa E, LaRussa P, Lal S, Clarke SE, Hansen KS, Magnussen P & Mbonye AK. (2017). Comparison of the capacity between public and private health facilities to manage under-five children with febrile illnesses in Uganda. Malaria Journal; 16(1): 183. Mbonye AK, Buregyeya E, Rutebemberwa, E, Clarke SE, Lal S, Hansen KS, Magnussen P & LaRussa P. (2017) Referral of children seeking care at private health facilities in Uganda. Malaria Journal; 16(1): 76. Visser T, Bruxvoort K, Maloney K, Leslie T, Barat LM, et al. (2017) Introducing malaria rapid diagnostic tests in private medicine retail outlets: A systematic literature review. PLoS One; 12(3): e0173093 Burchett HE, Leurent B, Baiden F, Baltzell K, Björkman A, et al. (2017) Improving prescribing practices with rapid diagnostic tests (RDTs): synthesis of 10 studies to explore reasons for variation in malaria RDT uptake and adherence. BMJ Open; 7(3): e012973 Hutchinson E, Hutchison C, Lal S, Hansen SC, Kayendeke M, Nabirye C, Magnussen P, Clarke SE, Mbonye A, Chandler C. (2017) Introducing rapid diagnostic tests for malaria into the retail sector: What are the unintended consequences? BMJ Global Health, 2: e000067 Mbonye AK, Buregyeya E, Rutebemberwa E, Clarke SE, Lal S, Hansen KS, Magnussen P, LaRussa P. (2016) Prescription for antibiotics at drug shops and strategies to improve quality of care and patient safety: a cross-sectional survey in the private sector in Uganda. BMJ Open, 6: e010632. Rutebemberwa E, Buregyeya E, Lal S, Clarke SE, Hansen KS, Magnussen P, LaRussa P & Mbonye AK. (2016) Assessing the potential of rural and urban private facilities in implementing child health interventions in Mukono district, central Uganda-a cross sectional study. BMC Health Services Research, 16:268 Mbonye AK, Buregyeya E, Rutebemberwa E, Clarke SE, Lal S, Hansen KS, Magnussen P & LaRussa P. (2016) Treatment and prevention of malaria in pregnancy in the private health sector in Uganda: implications for patient safety. Malaria J, 15(1):212 Mbonye A, Clarke S, Lal S, Chandler C, Hutchinson E, Hansen KS & Magnussen P. (2015). Introducing rapid diagnostic tests for malaria into registered drug shops in Uganda: lessons learned and policy implications. Malaria Journal 14: 448 Hutchinson E, Chandler C, Clarke SE, Lal S, Magnussen P, Kayendeke M, Nabirye C, Kizito J & Mbonye AK. (2015) "It puts life in us and we feel big": Shifts in the local health care system during the introduction of rapid diagnostic tests for malaria into drug shops in Uganda. Critical Public Health 25 (1): 48-62 Mbonye AK, Magnussen P, Lal S, Hansen KS, Cundill B, Chandler C & Clarke SE. (2015). A cluster randomised trial introducing rapid diagnostic tests into registered drug shops in Uganda: Impact on appropriate treatment of malaria. PLoS One 10 (7): e0129545 |
Start Year | 2015 |
Description | A virtual presentation for AMR scientists, practitioners and champions in India. |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | This presentation on the informalities of antibiotic practices that were common to informal as well as formal providers, the role of the pharmaceutical industry and the regulatory challenges, was much appreciated for its clarity and depth. In fact a senior physician cum researcher sent a funny text message afterwards: 'When I grow up I want to be a researcher like you!' The study findings inspired the audience to understand the multi-factorial and multi-stakeholder nature of the challenges and some members of this group have expressed an interest in supporting further dialogue with stakeholders. The talk was arranged by the Indian Initiative for the Management of Infectious Diseases, and the WHO Collaborating Centre for Research in Surgical care Delivery in LMICs at the University of Mumbai, India. |
Year(s) Of Engagement Activity | 2021 |
Description | A virtual seminar for a One Health academic group at the University of Glasgow |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Postgraduate students |
Results and Impact | About 45 students and faculty at the Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences,University of Glasgow, attended my talk on the 'challenges of antibiotic stewardship in community settings in India'. The talk was followed by an animated discussion about the study findings as well as methods, especially analytical tools. A number of interesting comparisons were identified between the India work and the experiences of some of the faculty in Tanzania. We hope to keep the dialogue going in the months to come. |
Year(s) Of Engagement Activity | 2021 |
Description | Interview - Meenaksh Gautham - React Newsletter - 2021-01-25 |
Form Of Engagement Activity | A magazine, newsletter or online publication |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Third sector organisations |
Results and Impact | React is a global network dedicated to advocating and stimulating global engagement on antibiotic resistance. The publication of this interview in the React newsletter led to invitations for other presentations (like the IIMAR one described separately). A research group also reached out from the University of Oslo to discuss collaboration potential. |
Year(s) Of Engagement Activity | 2021 |
URL | https://www.reactgroup.org/news-and-views/news-and-opinions/year-2021/dr-meenakshi-gautham-informal-... |
Description | Setting up committees for development of standard antibiotic use guidelines for para health providers in the human and veterinary sectors |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Since January 2021, our project team held extensive consultations with groups of medical, veterinary, pharmaceutical and high-level government stakeholders. All groups have strongly recommended four clear areas for interventions. These include tierwise guidelines for antibiotic use in human and livestock health starting with para-professionals, continuing training and orientation (ideally digital) about antibiotics for all supply chain actors and communities, prescription audits for professionals and a code of conduct for pharmaceutical industry stakeholders. Moving forward with these recommendations, we constituted Expert Committees to work with the project team on developing a set of guidelines focusing especially at the primary level of the health care system for human and livestock health. Guidelines do not exist for para workers and this is an essential first step for standardizing antibiotic practices. The two committees are focusing on a set of priority conditions that are most frequently seen and treated with antibiotics by para health providers. A significant impact has been that medical experts who were earlier opposed to para health providers using any medicines and antibiotics have gradually shifted their views and realised that a more practical and effective approach would be to allow some essential antibiotics to be widely available so that the rest can be more strictly monitored. |
Year(s) Of Engagement Activity | 2022 |
URL | https://oasisamr.com/intervention-guidelines/# |
Description | Stakeholder consultations with groups of medical, veterinary, pharmaceutical and policy/regulatory stakeholders. These were conducted as part of our intervention co-design process to develop antibiotic stewardship for community settings in India. |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Aim of the workshops: To co-design, with diverse stakeholders, a One Health antibiotic stewardship intervention for community settings in India. Objectives of the workshops: Present evidence to stimulate reflection and dialogue amongst stakeholders regarding their roles within the healthcare system in the context of AMR. Enable a deeper understanding of the alignments and misalignments between antibiotic stewardship practices and the realities of the health and antibiotic systems (private and public), supply chain incentives and business models, and community needs. Engage stakeholders in the co-design of an intervention for antibiotic stewardship in primary care and community settings. Develop and evaluate a strategy for multi-stakeholder engagement to influence policy. We organised four workshops with groups of medical and veterinary practitioners, pharmaceutical industry leaders and senior managers, and policymakers. Workshop participants (approximately 50 in total) agreed with our study findings and participated in animated discussions. Several common recommendations that emerged across the four groups. These included: -Development of tier-wise guidelines for antibiotic use in human and livestock health, starting at the level of the para healthcare providers (as these do not exist at present). -Continuing training and orientation about antibiotics for all supply chain actors and communities -Antimicrobial resistance surveillance at different tiers of the health system to understand patterns of resistance -Prescription audits for health professionals - Development of an evidence based code of conduct/marketing for the pharmaceutical stakeholders to align the promotion and marketing of antibiotics with guidelines. - Strengthening mentorship and referral links between formal and informal providers in human and veterinary sectors, to create stepped care models for less accessible rural areas. As a next step, we have established two task groups to work on antibiotic use guidelines for para health providers for human and for animal health, and a third one will develop a pharmaceutical code of conduct with industry stakeholders. |
Year(s) Of Engagement Activity | 2021,2022 |
URL | https://oasisamr.com/key-stakeholder-consultations/ |
Description | Stakeholder workshop with Ministry of Health - October 2021 |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | Following an earlier webinar series held during the period of national lockdown in June/July 2021, we were requested by the Ministry of Health to set up a regular forum to share emerging research findings and strengthen the dialogue and engagement between researchers, public health officials, drug regulators, professional councils, practitioners and other stakeholders in the medical retail sector. With the lifting of travel restrictions in late 2021, it was possible to respond to this request and to organise the first of two further in-person workshops, in October 2021. This format was much better suited to participatory group work needed to debate and probe issues, negotiate solutions and advance collaboration between stakeholders with diverse interests, operating in a highly-contested space. This two-day workshop was convened by the Commissioner of Health Services, Ministry of Health, Uganda in collaboration with health systems researchers based at Makerere University, Uganda and London School of Hygiene & Tropical Medicine, UK. The aim of the workshop was to serve as a stimulus for debate on how the medical retail sector in Uganda could be strengthened and improved. The workshop opened by presenting evidence on some of the challenges seen in the medical retail sector in Uganda, including: shortages and surpluses within the health workforce; issues of regulation, corruption, perverse incentives and saturated markets; antimicrobial resistance, crossover-use of antibiotics; substandard medicines; and problems of accessing medicines during the COVID-19 pandemic. Drawing on their own experience, participants were encouraged to identify and rank the main challenges currently facing the medical retail sector in Uganda, and worked together to identify potential solutions to address the two top-priorities. Participants have since reported that the series of policy-oriented research webinars and participatory workshop has led to an increased understanding and appreciation of the role of different stakeholders within the health system, a recognition of mutual interests and common concerns, and resulted in more positive relationships and interactions between regulators and private sector practitioners, than experienced hitherto. It is hoped that this has opened the door and laid the foundation for meaningful policy change going forward. |
Year(s) Of Engagement Activity | 2021 |
Description | Webinar series with Ministry of Health - June/July 2021 |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | A series of five half-day webinars were held in June-July 2021 to share and review research findings on the "Medical Retail Sector in Uganda: An overview of current challenges and policy options" with Ministry of Health officials, drug regulators, professional councils, practitioners and other stakeholders in the medical retail sector. Originally this has been planned as a stakeholder consultation workshop, to be held in-person, but due to national lockdown and travel restrictions in Uganda and UK, was shifted online. The meeting was convened by the Commissioner of Health Services, Ministry of Health, Uganda in collaboration with health systems researchers based at Makerere University, Uganda and London School of Hygiene & Tropical Medicine, UK. The aim of the webinar series was to update professionals on policy-relevant research findings and to serve as a stimulus for debate on how the medical retail sector in Uganda could be strengthened and improved. The medical retail sector plays a critical role in access to treatment services in Uganda, for example, serving at the first point of care for over 60% of episodes of fever in children. Evidence presented during the the five seminars included: (ii) the role of the medical retail sector within the Ugandan health system and how that has changed over time; (ii) response to the challenges of antimicrobial resistance (AMR) and COVID-19 to service delivery; (iii) interventions to support antimicrobial stewardship in the retail sector; (iv) policy options to regulate and encourage quality improvement in service provision and (v) vulnerabilities and resilience within the medical retail sector: and what we can learn from COVID-19 pandemic. The webinars were well attended, with over 80 participants online, throughout the series; and generated lively debates at the end of each session. At the end of the webinar series, we were requested by the Ministry of Health to set up a regular forum to share emerging research findings and strengthen the dialogue and engagement between public health officials and researchers. With the lifting of travel restrictions in late 2021, it was possible to respond to this request and to organise two further in-person workshops, in October 2021 and February 2022. This format was much better suited to participatory group work needed to debate and probe issues, negotiate solutions and advance collaboration between stakeholders with diverse interests, operating in a highly-contested space. Participants have since reported that the series of policy-oriented research webinars and participatory workshops led to an increased understanding and appreciation of the role of different stakeholders within the health system, a recognition of mutual interests and common concerns, and resulted in more positive relationships and interactions between regulators and private sector practitioners, than experienced hitherto. It is hoped that this has opened the door and laid the foundation for meaningful policy change going forward. |
Year(s) Of Engagement Activity | 2021 |