Supporting Evidence-Based Policy: a longitudinal study of AMR risk behaviours among livestock keeping communities in India and Kenya

Lead Research Organisation: Royal Veterinary College
Department Name: Pathobiology and Population Sciences

Abstract

Anti-microbial resistance (AMR) is set to rival climate change as one of the largest barriers to health and wellbeing in the 21st century (Aarestrup, 2015; O'Niel, 2015; Woolhouse et al., 2015). And like climate change, AMR is likely to have a preferential impact on communities of the poor (Heffernan, 2017). Yet, to date, the inter-relationship between poverty and AMR has not been well explicated. This is particularly true with regard to animal agriculture. Indeed, while 2/3rds of the global poor are livestock keepers (Lin and Heffernan, 2009a, 2010) very little is known about the factors facilitating AMR among this population. We do know however, that AMR emerges out of the social, cultural and behavioural milieu in which disease and healing is situated. And in this case the environment in which livestock are produced. Therefore, the aim of the project is to explore three inter-related drivers: social, behavioural and environmental to the emergence of AMR among two communities of the livestock dependent poor: Maasai pastoralists in Kenya and subsistence dairy producers in Orissa, India. Both of these communities had participated in a large-scale study on animal healthcare service delivery funded by DFID in 1999 (Heffernan and Misturelli, 2000; Heffernan, 2001). In this manner, the research will draw on a historical dataset to compare a variety of parameters important to the emergence of AMR. Ranging from animal healthcare seeking behaviours/preferences to livestock-based livelihoods to access to service providers to farmer of understanding disease etiologies and access to livestock pharmaceuticals and antibiotic use, including dosages and timing over a 17-year period. Thus the study offers a unique opportunity to explore behavioural change over time. Such an historical assessment is beneficial on two levels: first, the strength and directionality of these forces on AMR emergence can be measured and thereby, better understood and second, the analysis offers a unique opportunity to support evidence-based decision-making.

The risk of the rapid ascendancy of AMR as a global threat is that the development community will formulate policies on a weak evidential base. Equally problematic, much of the current research exploring AMR focuses on bio-prospecting in one-off exercises. Therefore, it is likely that this approach will create an evidence base biased towards single outcomes. And in this manner, related decision-support tools will be limited in their ability to predict change by the singular, deterministic nature of the underpinning data (Heffernan and Yu, 2010; 2007; Yu and Heffernan, 2009). To address this issue, the project will create and deliver the 'AMR forecaster' an easy to use ranking and weighting framework based on the longitudinal dataset. The aim is to enable policy makers, researchers and practitioners to use the simple on-line tool to assess the relative risk of AMR emergence among the communities involved.

Finally, however, we know that changing behaviour regarding the use of antibiotics is imperative both in the global North and South (O'Neil, 2015; Woolhouse et al., 2013; 2015). Previous studies have shown that children can be effective entry points for livestock-related knowledge at the community level (LDG, 2011). Therefore, the project team will produce and disseminate learning material on AMR to local school children, and measure the transfer of key messages or 'memes' on wider households members.

Planned Impact

The project has two sets of beneficiaries: direct and indirect. Equally, in each of the countries involved, project benefits will be derived on three levels: community, household and institutional.

The direct beneficiaries, at the community level, include the livestock-keeping households, who will participate in the project. Households will benefit from an increasing awareness of the cost of AMR on their livelihoods and the behavioural shifts required to prevent it. Children of these households will further benefit from the school outreach element. Indeed, by engaging schools in the project, wider impacts at the community level are likely to accrue over years to come. Further, by measuring the ability of children to foster new knowledge pathways at the household level with the consequent ability of AMR 'memes' to flow across these pathways, the project has the potential to alter development praxis. Local NGO and CBO partners will also gain by alternately engaging with vs. driving the iterative and reflexive learning processes fostered by the project. It is anticipated that a greater understanding of the behavioural drivers to AMR among this group will be used to inform future projects and programmes. Indirect beneficiaries include the wider population of community members and school-going children who will be exposed to both project findings and learning materials.

Across both countries, 30 communities and 300 households will directly participate in the study. Further, within each of the study sites, 10 primary schools will be targeted for engagement activities. As such, the total population of community-level beneficiaries is estimated to be 6,500 individuals. Project activities are estimated to indirectly impact an additional 3,000 individuals in each of the countries involved. Therefore, the total number of direct and indirect beneficiaries at the community level is estimated at over 9,000 individuals.

Direct beneficiaries at the institutional level are the policy makers and planners who will utilize the decision-support tool. Use of the forecasting tool will better support evidenced based policy-making and resource allocation at the institutional level. In this manner, national-level gains will be accrued by relevant and targeted interventions to decrease the emergence of AMR. Equally, armed with this knowledge, national-level policy makers will ultimately be able to better inform donor-led projects and programmes of the social and behavioural forces impacting AMR among the poor. Policy change and related impacts however generally occur over a longer time period than the 24 months of the pump-priming grant. Thus, future policy-level benefits, while expected, are largely outwith the ability of the project team to specifically define and measure.

By disseminating project results via a variety of AMR networks, the project findings will reach decision-makers at the global level. Currently UN agencies such as WHO, OIE and FAO are leading global action against AMR. However, as noted above, most of the activities are focusing on commercial livestock systems, providing critical evidence of a crucial but largely overlooked population, has the potential to raise issues related to poverty and AMR up the agenda for global action.

Publications

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Related Projects

Project Reference Relationship Related To Start End Award Value
ES/P00492X/1 01/01/2017 07/09/2017 £202,120
ES/P00492X/2 Transfer ES/P00492X/1 08/09/2017 31/07/2019 £180,089
 
Title 'Riya to the Rescue' 
Description A comic book created for Indian school children ages 8-12. The comic book was created by local artists with the narrative and visuals pre-tested for age-appropriateness and cultural relevance with regard to the emergence of AMR in humans and animals. Nine focus group discussions were held in a range of schools to co-design characters and storylines for the comic, which is designed to raise awareness of the development and drivers of AMR and provide information about positive antimicrobial stewardship to promote behaviour change. 
Type Of Art Creative Writing 
Year Produced 2019 
Impact The comic 'Riya to the Rescue' has been distributed to 2500 students across India, through schools in in Delhi, Hyderabad, Maharashtra, Gujarat, Odisha, Andhra Pradesh and Punjab. It has also been used as part of school outreach activities in Delhi, by an Indian public engagement initiative 'Superheroes Against Superbugs'. Children can disrupt closed knowledge groups at the household level. Therefore, we anticipate knowledge dissemination and behaviour change to be much broader than in the children alone. In order to make the comic available even more widely, we are hosting it on the Comics Uniting Nations website, a UNICEF partnership with the goal of making the Sustainable Development Goals accessible to the citizens of the world through comics. 
 
Title 'The Adventures of Nanjala and Otieno' 
Description The Comic book was created for Kenyan school children ages 8-12. The visuals and narrative were pre-tested for age appropriateness and cultural relevance among 15 pilot groups of school children in Kenya. The comic is designed to raise awareness of the development and drivers of AMR and provide information about positive antimicrobial stewardship to promote behaviour change. 
Type Of Art Creative Writing 
Year Produced 2019 
Impact 2500 copies of the comic have been distributed to a range of schools in Kenya in Kiambu and Kajiado districts. In addition, copies were distributed more widely across Kenya as part of activities for National Antimicrobial Awareness Week in November 2019. A workshop was held in Nairobi to promote the use of the comics in schools as part of science education provision and to raise awareness of them at a national policy level. Attendees included eight national-level policy professionals, with representatives from the Kenyan Directorate of Veterinary Services, FAO and OIE. Also in attendance were twenty-three school teachers from across Nairobi and Kiambu districts as well as six practising veterinarians, some working in a government capacity. Children can disrupt closed knowledge groups at the household level. Therefore, we anticipate knowledge dissemination and behaviour change to be much broader than in the children alone. In order to make the comic available even more widely, we are hosting it on the Comics Uniting Nations website, a UNICEF partnership with the goal of making the Sustainable Development Goals accessible to the citizens of the world through comics. 
 
Title Comic Books Illustrations for AMR 
Description A range of images by artists in Kenya and India have been created to develop two contextually-appropriate comics books on AMR for school children. Five thousand copies of the comics have been distributed to children across India and Kenya, and in order to make the comics available even more widely, we are hosting them on the Comics Uniting Nations website. 
Type Of Art Image 
Year Produced 2019 
Impact Pilot versions of the visuals were tested among over 200 children across a range of schools in India and Kenya, affording us the opportunity to better understand children's knowledge and conceptualisation of AMR in addition to discussing proper use and disposal of these drugs. The final publications have been very positively received by students and widely praised by teachers in the schools to which they have been distributed, as well as by other members of the AMR and international development research communities. One teacher from a school in Pune, India, wrote to the project team to say "The comic 'Riya to the Rescue' is indeed an extremely innovative attempt to enlighten the students about antibiotic resistance. It, being so colourful and attractive, appeals to the students and makes a lasting impression on their young minds". 
 
Description The study explored a range of behavioural drivers at the community level to AMR over a twenty-year period. Across our two study countries, critical differences have arisen in terms of the morbidity of key livestock infectious diseases and the increasing use of antibiotics. Interestingly, farmer-led, livestock disease priorities have also shifted. Easy access to antibiotics, however, is the norm. The misuse of critical antibiotics remains high in terms of the frequency of dosing, anecdotally farmers in some communities were reporting drugs that no longer worked or required significantly longer treatment periods. Knowledge of AMR at the community-level was low. Equally problematic, the level of knowledge among local healthcare providers regarding the both global and national rates of AMR was also low. Our key achievements include:

1. A comparative dataset of the drivers of AMR emergence among 523 subsistence farmers in Kenya and India over a 20-year period.

2. A metric of key risk factors important to the emergence of livestock-derived antimicrobial resistance at the community-level.

3. An on-line decision-support tool to enable policy makers and practitioners to disaggregate the drivers of AMR at the community-level and explore the impact of potential policy changes.

4. Two locally designed comic books on AMR aimed at children ages 8-12 have been distributed to over 50 schools and 5000 children across both Kenya and India.

Over the course of the project, we have generated new knowledge about access to antibiotics as well as a new understanding of healthcare seeking behaviours and attitudes to healthcare professionals. Comparison of this data with previous datasets has enabled us to identify longitudinal changes within the same communities, revealing substantially increased accessibility of antimicrobials now compared with twenty years ago, coupled with very variable access to healthcare professionals, particularly for animals. In many of the communities studied in Kenya, antimicrobials are available without prescription from 'Agrovet' livestock drug stores, which are now present in far greater numbers than in the initial study in 1999. This has significant implications for development of antimicrobial resistance (AMR) and is an important finding, which will provide evidence to support new policies aimed at reducing AMR in both countries.

The data gathered also provides critical information about the drivers underlying use of antimicrobials and the key risk factors for emergence and spread of AMR. We have used these findings to develop a metric to explore the risk of AMR emergence at the community level. Hence, the metric assigns scores to a range of risk factors related to the use of antibiotics from the priority livestock disease to excessive or extra-label use to improper disposal and the mixing of herds at water sources etc. In this manner, a total 'risk score' was calculated for each community. The metric was then used to underpin an on-line decision-support tool created specifically for policy makers and practitioners, to assist them in identifying the most effective interventions to prevent the emergence and spread of AMR. Across all of the communities, there was extremely limited knowledge of AMR. To address this issue held focus group discussions with a range of stakeholders from farmers, vets and para-professional to schoolchildren. As part of the educational outreach component of the project we created and delivered two comic books on AMR. Our aim here was to utilise effective imagery and narrative to convey information about both human and livestock antibiotic use, which was both engaging and culturally acceptable. Finally, we disseminated the results of the project to in-country research organisations and NGOs and formed a range of new interdisciplinary research collaborations. And in doing so we have expanded on our project findings to identify convergent issues particularly in related to the environmental component of AMR.
Exploitation Route Our research findings will be of particular use to policymakers seeking to understand the context-specific drivers of AMR at the community level and will aid in evidence-based policy-making across the livestock sector. By supporting user-generated content, the tool will enable policy makers and planner to upload existing data and explore risk factors in new geographies. Further, by enabling access to the underlying data, our decision support tool will support the wider research community in identifying the drivers of risk and the relative role and impact of a range of drivers, at the community-level. Finally, the comic books which have been developed as part of the public engagement element of the project will be used by school teachers in both countries to deliver key messages on AMR and the importance of good antimicrobial stewardship to students. The comic books produced by this project can provide insight into the types of imagery/narrative which may be used to successfully deliver key messages on AMR. The comics may also serve as useful examples to other researchers, NGOs and governments to help inform their own public engagement strategies.
Sectors Agriculture, Food and Drink

URL http://www.amrtool.com
 
Description Our work engaging local communities and indeed, working with school children and teachers to enhance their understanding of both the global and local threat of AMR is a critical non-academic, output of this project. The comic book in both countries has created a lot of interest among teachers and children as such, in the short-term our activities have had a direct impact on raising awareness of this issue. While we did not evaluate any attitudinal changes associated with the comics, we have used the strength of the demand for the comic as a proxy for interest and the scope of our awareness raising. Across the final phase of the project we scaled-up the distribution to reach a wider and more socio-economically diverse range of schools. We have partnered with the Superheroes Against Superbugs initiative in India, who run workshops and outreach activities on AMR in schools across the country. They have distributed our comics at their workshops and used them as an additional learning resource during their engagement activities. In order to maximise the impact of the comics, we are also in the process of adding them to the Comics Uniting Nations website, in association with UNICEF, ensuring that they are a freely available, globally accessible resource. The other core audience for the outputs of this project is policy makers and practitioners. By creating an open access, on-line, decision-support tool that enables stakeholders to assess the risk of the emergence of AMR at the community level, we have created a forum for decision-makers to assess ex-ante the potential impact of an intervention. Finally, our project has sparked wider interest by both academic and non-academic institutions. This has allowed us to both engage wider stakeholder groups and develop our networks, widening the reach and impact of the project.
First Year Of Impact 2017
Sector Agriculture, Food and Drink,Education,Healthcare
Impact Types Societal,Policy & public services

 
Description Engaging local communities/teachers/livestock healthcare service providers on AMR in India
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Engaging local communities, including school teachers, and their healthcare providers in the appropriate use, storage and disposal of antibiotics is a first step to changing the behaviour of farmers and wider community members with regard to antibiotic stewardship. Understanding the dynamics and drivers to use is equally the first step to creating policies relevant to the communities involved. We have held a range of activities in India which have achieved influence. Stakeholder meetings were held at the community level across our study sites, through which we transferred critical information about antimicrobial resistance and discussed access and appropriate use/disposal of antibiotics, with a focus on livestock and human interactions and promotion of positive antimicrobial stewardship behaviours. Attendees included professional practitioners as well as members of the public. Many attendees were previously unaware of the issue of AMR and reported intention to change their behaviours, including stopping prophylactic use of antibiotics in livestock and checking expiry dates on medication before use. During the project we directly engaged school children and teachers across 9 schools in India, raising awareness on issues related to AMR, including enhancing understanding of the causes and drivers and highlighting behaviours which promote good antimicrobial stewardship. In addition, the comic 'Riya to the Rescue' has been distributed to 2,500 students across India, through schools in Delhi, Hyderabad, Maharashtra, Gujarat, Odisha, Andhra Pradesh and Punjab. It has also been used as part of school outreach activities in Delhi, by an Indian public engagement initiative 'Superheroes Against Superbugs'. Children can disrupt closed knowledge groups at the household level. Therefore, we anticipate knowledge dissemination and behaviour change to be much broader than in the children alone. One teacher from a school in Pune, India, wrote to the project team to say "The comic 'Riya to the Rescue' is indeed an extremely innovative attempt to enlighten the students about antibiotic resistance. It, being so colourful and attractive, appeals to the students and makes a lasting impression on their young minds".
 
Description Engaging local communities/teachers/livestock healthcare service providers on AMR in Kenya
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact We have held a range of activities in Kenya which have achieved impact. Stakeholder meetings were held at the community level across our study sites, through which we transferred critical information about antimicrobial resistance and discussed access and appropriate use/disposal of antibiotics, with a focus on livestock and human interactions and promotion of positive antimicrobial stewardship behaviours. Attendees included professional practitioners as well as members of the public, with divisional veterinary staff represented at several meetings. Many attendees were previously unaware of the issue of AMR and reported intention to change their behaviours, including stopping prophylactic use of antibiotics in livestock and checking expiry dates on medication before use. We hosted a high-level workshop for teachers and policy makers to discuss approaches for effectively engaging young people on the topic of AMR. We highlighted a number of open-access resources available to teachers and also promoted the use of the AMR comics created as part of this project as a classroom tool and a resource which students can take away and share with their wider communities. During the discussion session, teachers raised some of the challenges they face when teaching students about AMR, and there was commitment from government officials to work on these issues. We have agreed to provide a full report of all our research findings, as well as a summary of the meeting feedback to officials to support the agreed actions. During the project we directly engaged school children and teachers across 15 schools in Kenya, raising awareness on issues related to AMR, including enhancing understanding of the causes and drivers and highlighting behaviours which promote good antimicrobial stewardship. In addition, 2,500 copies of the comic 'The Adventures of Nanjala and Otieno' have been distributed to a range of schools in Kiambu and Kajiado Districts. Comics were also distributed as part of activities for National Antimicrobial Awareness Week in November 2019. Children can disrupt closed knowledge groups at the household level. Therefore, we anticipate knowledge dissemination and behaviour change to be much broader than in the children alone.
 
Description Addressing Livestock-derived Antimicrobial pollution in the Nairobi River in Kenya
Amount £150,000 (GBP)
Funding ID EP/T024682/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 04/2020 
End 04/2021
 
Description ESRC Festival of Social Science Sponsorship Funding - AMR Avengers: Empowering Children to Fight Superbugs
Amount £1,000 (GBP)
Funding ID YP45 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 11/2019 
End 11/2019
 
Title A Decision-Support Tool for Identifying AMR Risk Hotspots 
Description The decision-support tool maps hotspots of risk for AMR emergence or transmission among livestock keepers in LMIC countries. Our pilot tool utilises a novel risk metric, applied to data collected at the individual and community-level, to map livestock disease priorities and access to animal healthcare services against knowledge of antibiotic use. The aim is to enable decision-makers and planners to better visualise behavioural elements and access issues related to antibiotic use among livestock keepers and subsequently the development of resistance. Furthermore, the tool gives policymakers the opportunity to adjust factors to see which has the greatest impact on reducing risk within each setting. The tool also offers the ability to upload additional data collected by users, so that the metric can be applied to new locations. It is freely available worldwide to policymakers at www.amrtool.com. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2019 
Provided To Others? Yes  
Impact The development of the tool has created a better understanding of the interactions of core-behavioural drivers of antibiotic use among poor livestock keepers in LMIC countries. We anticipate this will lead to further publications in this area. In addition, use of the decision support tool will enable policymakers to make evidence-led informed decisions on which interventions are likely to be most effective within their specific country contexts. 
URL http://www.amrtool.com
 
Title The AMR Risk Metric 
Description The Risk Metric weighs a series of factors classified as risks for the emergence or transmission of AMR from livestock-related sources, to quantify AMR risk as the community-level. The metric can be applied to a range of communities to rank them in terms of level of risk. The specific elements of the metric include: 1. The livestock disease involved and the expected/predicted use of antibiotics. 2. Farmer behaviour regarding dosage and antibiotic disposal. 3. Potential environmental exposure: sources of livestock contact. 4. Access to and use of animal healthcare services. 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2019 
Provided To Others? No  
Impact For each community involved in the study, the risk metric was calculated, geo-referenced and the results published in the Decision-Support Tool, which is freely available online . 
URL http://www.amrtool.com
 
Title A database and metric underpinning the AMR Risk Hotspot Decision Support Tool 
Description A database and related metric assessing the risk of AMR emergence and transmission at the community level, based on a number of key factors within the data, including social and behavioural aspects of access to and use of antibiotics. These underpin the online open-access decision-support tool, giving policy-makers access to the project dataset and robust evidence on drivers of AMR at the community level in different LMIC settings. 
Type Of Material Computer model/algorithm 
Year Produced 2019 
Provided To Others? Yes  
Impact The focus on metrics enables us to better understand the synergy and interaction of the drivers of AMR at the community-level in our partner countries: Kenya and India. Use of the online open-access decision support tool gives policy-makers the ability to formulate predictive, rather than reactive, AMR policies. 
 
Title A database of qualitative and quantitative data at the household-level regarding AMR behaviours in India and Kenya 
Description This database is comprised of over 500 household-level interviews conducted across Kajiado and Kiambu Counties in Kenya and Gujarat and Maharashtra States in India. The interviews contain both qualitative and quantative data ranging from beliefs and behaviours to livestock disease priorities, access to healthcare providers and use/storage/disposal of antibiotics. This will be combined with a historical dataset in the same communities to explore changes over time. 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? No  
Impact When finalised the database will be publically available. Journal articles based on this data are currently in preparation. Elements of the database have informed the creation of the AMR risk metric which underpins the online decision-support tool. 
 
Description India Partnership 
Organisation Arupa Mission Research Foundation
Country India 
Sector Charity/Non Profit 
PI Contribution Our role involves training staff in qualitative and quantitative data collection approaches, engaging the wider stakeholder community, in addition to local community and household-level data collection. We jointly undertook a range of stakeholder meetings, community-level focus groups and household-level interviews. In total, we engaged with over 200 households across Gujarat and Maharashtra States.
Collaborator Contribution Our partners liaise with local communities, collect data and engage the wider stakeholder community.
Impact Outputs from this partnership include a database comprised of over 200 household-level interviews conducted across Gujarat and Maharashtra States. Our partnership is on-going and additional expected outputs include upcoming publications based on this data.
Start Year 2018
 
Description India Partnership 
Organisation BAIF Development Research Foundation
Country India 
Sector Charity/Non Profit 
PI Contribution Our role involves training staff in qualitative and quantitative data collection approaches, engaging the wider stakeholder community, in addition to local community and household-level data collection. We jointly undertook a range of stakeholder meetings, community-level focus groups and household-level interviews. In total, we engaged with over 200 households across Gujarat and Maharashtra States.
Collaborator Contribution Our partners liaise with local communities, collect data and engage the wider stakeholder community.
Impact Outputs from this partnership include a database comprised of over 200 household-level interviews conducted across Gujarat and Maharashtra States. Our partnership is on-going and additional expected outputs include upcoming publications based on this data.
Start Year 2018
 
Title AMR Decision-Support Tool 
Description The software is an open-access online decision-support tool, which utilises the data gathered on drivers underlying use of antimicrobials and key risk factors for emergence and transmission of AMR. An underlying metric calculates AMR risk at the community level based on a number of key factors within the data, including social and behavioural aspects of access to and use of antibiotics. It allows users to make adjustments to each element of the metric to reduce this risk, giving policy-makers the ability to formulate predictive, rather than reactive, AMR policies. The tool (available at www.amrtool.com) gives policy makers access to the project dataset and also allows users to upload their own data into the tool to apply the metric to other locations and contexts. The overall aim is to enable policy makers and planners to identify and better understand the critical behavioural factors underpinning the potential emergence of AMR at the community level. 
Type Of Technology Webtool/Application 
Year Produced 2019 
Impact We are still analysing the impacts of the tool and are monitoring traffic to the site to evaluate uptake and analyse user interactions with the data. We anticipate significant long-term impact, particularly if uptake is high among policy-makers and additional data is added by users to broaden the geographical coverage. 
URL http://www.amrtool.com
 
Description NERC Sustainable Development Goal (SDG) Interactions: The role of environmental science 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact During my presentation on interdisciplinary research, I explored the array of challenges of unwrapping the complexities of AMR in the developed vs. developing economies using examples from Kenya.
Year(s) Of Engagement Activity 2017
 
Description AMR Roundtable Presentation 1 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The WASH AMR Round table was attended by a range of stakeholders from WHO and DFID among others. My presentation helped spark a discussion around decision-support tools and the differences between the factors driving AMR among resource poor communities vs. those in the North.
Year(s) Of Engagement Activity 2017
 
Description Blog for LIDC website 'Anyone can be a superhero: Creating a comic book on antimicrobial resistance with students in India' 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact A blog post for the website of the London International Development Centre (LIDC) detailing the work of the project on creating educational comic books for school children in India to raise awareness of AMR and promote behaviour change for improved antimicrobial stewardship. The blog successfully highlighted the project activity and several requests for further information have been made by groups interested in adopting this approach for elements of their own work.
Year(s) Of Engagement Activity 2018
URL https://lidc.ac.uk/anyone-can-be-a-superhero-creating-a-comic-book-on-antimicrobial-resistance-with-...
 
Description Blog for LIDC website 'Medicines and the Maasai: studying antimicrobial resistance in the pastoralist communities of Kenya' 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact A blog was written for the website of the London International Development Centre (LIDC) detailing the fieldwork phase of the project work and providing background to the project and the global health challenge of AMR. The blog was promoted through LIDCs social media channels and newsletters and has raised awareness of the project and stimulated discussion around AMR.
Year(s) Of Engagement Activity 2019
URL https://lidc.ac.uk/medicines-and-the-maasai-studying-antimicrobial-resistance-in-the-pastoralist-com...
 
Description Blog post for LIDC website 'Resistance to change? Re-framing policy in the global fight against AMR' 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact A blog post written for the website of the London International Development Centre (LIDC) discussing the challenges faced when formulating effective policies to combat AMR globally, with particular focus on LMICs. The blog post was promoted through LIDC's social media channels and newsletters and raised awareness of AMR and the project, as well as stimulating discussion on the specific nature of the challenge in LMICs and the pressures faced by policy makers.
Year(s) Of Engagement Activity 2019
URL https://lidc.ac.uk/resistance-to-change-re-framing-policy-in-the-global-fight-against-amr/
 
Description Chair MRC Workshop on Antimicrobial Resistance 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Chair, MRC workshop on AMR for awardholders.
Year(s) Of Engagement Activity 2017
 
Description Engaging local communities in Kenya and India on issues relating to AMR 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Study participants or study members
Results and Impact Five stakeholder meetings were held at the Community-level across our study sites in Kenya and India. On average 20-35 community members joined the meetings. We transferred critical information about antimicrobial resistance and discussed access and appropriate use/disposal of antibiotics with a focus on livestock and human interactions and promotion of positive antimicrobial stewardship behaviours. Attendees included professional practitioners as well as members of the public, with divisional veterinary staff represented at several meetings. Many attendees were previously unaware of the issue of AMR and reported intention to change their behaviours, including stopping prophylactic use of antibiotics in livestock and checking expiry dates on medication before use.
Year(s) Of Engagement Activity 2018,2019
 
Description Engaging school children in India and Kenya on issues relating to AMR 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Schools
Results and Impact We directly engaged over 150 school children across a wide range of schools, 17 in total, in Kenya and India to raise awareness on issues relating to AMR including enhancing their understanding of causes and drivers and describing behaviours which promote good antimicrobial stewardship. We engaged the children in the illustration styles and content of the comic books, holding 21 focus group discussions exploring the artists' rendition of particular scenes for understanding/semiotic meaning. The schools were uniformly positive and requested to be involved in further research.
Year(s) Of Engagement Activity 2018,2019
 
Description Hamied Foundation UK-India Antimicrobial Resistance Meeting, 4th & 5th Feb 2019, London 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The Academy of Medical Sciences and the Hamied Foundation UK-India held a two day meeting on Antimicrobial Resistance 4th & 5th Feb 2019, London.

The meeting was organised to support research linkages between the UK/India to address AMR with a specific focus on the findings from research exploring interactions between human and animal health and the environment. The PI was invited to present on project findings, which sparked a wider discussion on AMR and the environment, particularly in relation to the role and impact of livestock keeping.
Year(s) Of Engagement Activity 2019
URL https://www.youtube.com/watch?v=z_ybnelbpwo
 
Description High-level policy workshop on AMR education in Kenya 
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 We hosted a high-level workshop in Nairobi to share our experience of creating the comics and discuss approaches for effectively engaging young people on topics of global health, including AMR. We were extremely encouraged by the excellent attendance of policy professionals at the meeting, with delegates from FAO and OIE, as well as the Kenyan Directorate of Veterinary Services. We feel that the particular value of this meeting was in inviting front-line professionals to share ideas and discuss challenges and potential solutions with the decision-makers. In attendance were twenty-three school teachers from across the Nairobi and Kiambu districts, as well as six practising veterinarians, some working in a government capacity. A constructive discussion resulted, with commitment from government officials to work on these issues. We have agreed to provide a full report of all our research findings, as well as a summary of the meeting feedback to officials to support the agreed actions. At the close of the workshop, teachers collected copies of the comics to distribute within their own schools, providing them with valuable resources to begin highlighting the challenge of AMR to their own pupils.
Year(s) Of Engagement Activity 2019
 
Description Interdisciplinary research and AMR 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Presentation to Royal Veterinary College students on interdisciplinary research using AMR and the issues and problems in Kenya as an example.
Year(s) Of Engagement Activity 2018
 
Description Interdsciplinarity & the GCRF: an example of AMR in developing economies 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Professional Practitioners
Results and Impact I was invited to present to researchers at Queen Mary University about the GCRF using an example from my own work relating to this project. The aim was to engage the audience in both the issues and understanding the role of interdisciplinarity in unwrapping complex problems such as AMR in the global South.
Year(s) Of Engagement Activity 2017
 
Description Invited blog post for University of Leeds website 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact An invited blog post for the University of Leeds 'Changing the Story' website, highlighting the project activities and in particular the use of comics as an engagement tool for school children. The blog post raised awareness of the project and the global health challenge of AMR with a wider audience and was promoted through the social media channels of the University of Leeds, prompting interest and requests for further information.
Year(s) Of Engagement Activity 2019
URL https://changingthestory.leeds.ac.uk/2019/08/22/community-engagement-a-critical-part-of-the-fight-ag...
 
Description Online panel discussion on antimicrobial resistance 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact An interactive online debate hosted by SciDev.net to which the PI was invited to contribute as a panellist. The debate explored how policy makers, and antimicrobial producers, prescribers, and users, can be encouraged to prevent the overuse of antimicrobials and what can be done to curb the rise of drug-resistant infections in low- and middle-income countries. Amongst those participating were pharmaceutical company representatives, academics, medical practitioners and members of the general public from across the globe.
Year(s) Of Engagement Activity 2020
URL https://www.scidev.net/global/health/multimedia/debate-how-can-we-change-antimicrobial-use-to-preven...
 
Description Participation in AMR Metrics and Measures workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact I attended a CGIAR sponsored workshop on AMR metrics and measures. The group discussed AMR and One Health interactions which was useful for this project. Another related issue that arose from the workshop related to consistency and clarity of the purpose of metrics for AMR vs. AMU.
Year(s) Of Engagement Activity 2017
 
Description Presentation at the World One Health Congress 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact A poster presentation to be given on the findings of the project at the World One Health Congress in Edinburgh, to a broad audience comprising academics, policymakers, practitioners and students. The presentation is an opportunity to highlight the key findings of the project and raise awareness of the project activities, including our engagement activities and development of the decision-support tool. We aim to increase traffic to the online tool through promoting it to a wide range of relevant stakeholders as part of this conference.
Year(s) Of Engagement Activity 2020
 
Description The Academy of Medical Sciences: AMR Workshop February 3-5th 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The conference linked a wide range of researchers and policy makers working across the field of AMR, interest on the day in further collaboration and follow-up queries were received regarding the preliminary findings of the reserach project that were presented.
Year(s) Of Engagement Activity 2019
 
Description UK schools events - AMR Avengers: Empowering Children to Fight Superbugs 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Schools
Results and Impact The project team held a series of interactive events in UK schools sharing the project findings and promoting the creation of the comic books with around 90 students, as part of the ESRC Festival of Social Science. This involved performing a puppet show raising awareness of AMR and promoting positive antimicrobial stewardship behaviours, as well as craft activities and an AMR-themed quiz. The response of the children and feedback from teachers on these events was extremely positive, and we have had requests from other schools to hold the event for their students.
Year(s) Of Engagement Activity 2019