Engage, track and optimize antibiotics use in Tanzania poultry farming

This project aims to optimize antibiotics use in poultry farming through implementation of health and socioeconomically friendly interventions developed on ground of multi-sectoral, transdisciplinary community centric approach at the point of understanding the pattern of antibiotics use and bacterial distribution in chicken products and human involved in its supply chain.   

Hamu Joseph Mlyuka

Surveys among chicken growers have confirmed use of antibiotics as growth promoters. This has further been confirmed by lab based studies whereby traceable amount of antibiotics has been identified. But, to date there is no study which has clearly detailed the interaction of traceable amount of antibiotics and bacterial as well as comparative distribution of bacteria in chicken and human subjects involved in processing chicken products including keeping, slaughtering and eating. Failure to clearly detail the connection between antibiotics in poultry farming and human health deters objectively engagement of poultry farming community in fighting against overuse or misuse of antibiotics which are key factors for selection pressure and AMR. Of note, AMR claim >1,200,000 annually at global level. Socioeconomically, extra healthcare expenditure amounting to US$ 100 trillion is expected to be incurred by 2050. Low and middle income countries (LMICs) are at several folds risks of AMR owing to high infectious diseases burden, weak regulatory system and limited investment in Research & Development for new antimicrobials. Henceforth, remained untouched AMR is going to reverse civilization and bring us to pre-antibiotics era.  

Poultry farmers as group of animal keepers are condemned for misuse and overuse of antibiotics which are also used in human health. Currently, we are aware of traces of some antibiotics from chicken products at slaughter house in Dar es Salaam, Tanzania but we have scarcity of data on whether the traces amounts have already induced selection pressure to develop resistant strains. In addition, if there are resistant strains there is scarcity of data on important entry point of resistant strains along the continuum of chicken-human interface. Finally, despite the continued condemnation, community centered interventions which take into account the trilogy of health, social and economic aspects are very limited pushing poultry farmers into a black market which has limited insight from normal regulatory mechanism and potentiate risk of further misuse and overuse of antibiotics.  
Henceforth, this multi-sectorial transdisciplinary project is going to put the poultry farmers at the center in understanding the pattern of antibiotics use, bacterial population at chicken-human interface and use the obtained data to develop health and socioeconomically friendly interventions to optimize use of antibiotics in poultry farming. By doing so poultry farmers will no longer be marginalized and both human, chicken and ecosystem health will thrive. 

The outputs from this project include at least two reports and at least four articles published in open access journal. These documents will provide details of data on drivers and pattern of use of antibiotics during poultry farming in Tanzania. In addition, the reports and articles will have data detailing the distribution of bacterial population along the continuum of chicken-human interface. Furthermore, the reports and published articles will provide details on performance of the multi-sectoral, transdisciplinary community centric developed and implemented contextually and setting relevant health and socioeconomically friendly interventions with regards to optimizing antibiotics use during poultry farming in Tanzania.
The developed reports and open accessible published articles will add highly valuable repository of literature useful to policymakers, scientific researchers and implementers engaged in activities focused on optimization of antibiotics use in poultry farming and other livestock keeping for instance during revision of National Action Plan on AMR in Tanzania and other LMICs context and settings. 
Furthermore, regular meetings involving transdisciplinary invitees from multi-sectoral, poultry farmers and general community will provide further awareness on AMR significantly contributing on implementation of one health approach further strengthening interventions to curb emergency and spread of AMR in LMICs and global wise. 

Poultry farming is highly thriving economic activity which is not capital intensive to start and has high turnover rate suitable for realization several SGDs including; 1 (no poverty); 2 (zero hunger); 3 (good health and wellbeing); 5(gender equality); 8 (decent work and economic growth) and; 10 (reduced inequality) especially in LMICs. Meanwhile there is exponential emergency and spread of AMR in LMICs which threatens animal, human and ecosystem health. Therefore, through this project’s activities carried out by multi-sectoral, transdisciplinary and community engagement in the process of understanding drivers and pattern of use of antibiotics, distribution of bacterial population at chicken-human interface followed by development and implementation of health and socioeconomically friendly interventions we expect to optimize use of antibiotics in poultry farming without affecting economic and social return on investment.
Multi-sectoral, transdisciplinary and community engagement was successfully employed in Denmark to whereby 1998 all Agricultural Growth Promoters (AGP) which have potential for cross-resistance for poultry and human bacteria (e.g. like avoparcin AGP versus vancomycin antibiotic) were banned with affecting meat production. For instance from 1994 to 2001 Denmark had 54.6% country wide decrease in use of antimicrobials. Also, it is the country with lowest AMR incidence among European countries. 

Multi-sectoral, transdisciplinary and community engagement is a core of this project and allows easy scaling in the upcoming years. In Tanzania there exist one health desk under the Prime Minister Office (PMO) which is an avenue for multi-sectoral engagement to address AMR. The Kibong’oto Infectious Diseases Hospital’s (KIDH) one health hub of excellence has well-established relationship with the PMO one health desk giving opportunity for easy engagement and sustainability this platforms made up of multi-stakeholders and transdisciplinary with expertise on health (human, animal and ecosystem), social, economics and data at every step. Therefore, the first six months will involve generation of data on drivers and pattern of antibiotics use and bacterial population distribution at chicken-human interface by involving poultry farmers at one district of Dar es Salaam, City of Tanzania. The second half will involve development of health and socioeconomically friendly interventions to be implemented for in year 2 within same district. The third year will involve further engagement of PMO one health desk to shape the policy, regulation and guidelines on use of antibiotics growth promoters in Tanzania paving the way for country wide adoption and subsequently building case for expanding to other East African Community states. 

Key outputs indicators
1. Report on baseline survey on drivers and pattern of use of antibiotics-First six months
2. Report on baseline survey on distribution of bacterial population at chicken-human interface-First six months
3. Report on developed health and socio-economically friendly interventions-at the end of month 12
4. Report on implementation of developed interventions in a selected district-at the end of 24th month.
5. Report on deliberation of multi-sectorial, transdisciplinary and community engagement meeting to address policy, regulation and guidelines on use of antibiotics growth promoters in poultry farming in Tanzania at the end of year 3
Key outcome indicators
1. Percentage change of drivers and pattern of antibiotics use in poultry farming (baseline and end of year two)
2. Change in mean concentration in chicken products of selected antibiotics at the end of 24th month of the project.
3. Percentage change in bacterial population distribution at chicken-human interface at end of year 2 of project implementation
4. Percentage change of outbreak of poultry diseases among poultry farmers before and after the end of year 2 during implementation of the project.
5. Change in mean income earned before and after implementation of interventions at the end of year 2.
6. Level of perception and acceptability of interventions among poultry farmers at the end of year two. 

Delayed legal and administrative procedures for signing grant agreement 
This requires the project to employ administrator who will ensure close follow to expedite signing of grant agreement between funder and receiving institution(s).
Slow processing of ethical and regulatory approval 
Application for expedited review at local and national ethical review boards will significantly reduce this. Therefore, the project has to allocate budget for this. 
Delayed disbursement of fund during implementation
Project team including accountant officer(s) should institute practice of earlier forecasting of budget and making request of funds at least 1 to 2 months before an activity to give time department/directorate of finance to process the disbursement. 
Very slow and hyperinflation procurement process
Project team must always ensure the procurement department/directorate understand the ceiling budget for a certain equipment, reagent or consumables and whenever possible share the current market price which give them a snapshot insight when deciding suitable vendor. In addition, regular forecasting of activities ahead to give room of at least two months for procurement office to work is important.  
Low cooperation from poultry farmers
The project is going to have community engagement core group to address misconception about the project so as to increase participation of poultry farmers.

We are applying to Trinity challenge so as to raise fund to implement this project including addressing barriers mentioned earlier.

Herein is the list of organizations which we are looking forward to collaborate for implementation of this project.

1. The University of St. Andrews (UStAn)-Scotland
2. Kibong’oto Infectious Diseases Hospital (KIDH)-Tanzania
3. Muhimbili University of Health and Allied Sciences (MUHAS)-Tanzania
4. University of Dodoma (UDOM)-Tanzania
5. Kilimanjaro Clinical Research Organization (KCRI)-Tanzania
6. Sokoine Agriculture University (SUA)-Tanzania
7. Makerere University (MU)-Uganda
8. National Institute for Medical Research (NIMR)-Tanzania