Antimicrobial Resistance Modelling

We will raise antibiotic use in Indonesia's livestock sector and its potential impact on environmental pollution. The model design will be made from the Cisadane River. The model offering insights into potential threats and introducing novel aspects, including predictive risks which then can be proposed as reference for environmental experts.

Executive Director: Muhammad Irfan Afif

The spread of antibiotic residues and bacterial resistance due to antibiotic use, especially in the livestock sector, has raised concerns about potential health risks. Arief et al. (2016) reported that as many as 72.3% of chicken farmers in Indonesia rely on and follow standard operational procedures (SOP) for antibiotic applications without veterinary supervision. This is particularly crucial in the Cisadane river basin area, as it is the largest chicken farming area in the western region of Java Island, Indonesia. With a population of 168,028,579 chickens, there is a high risk of AMR development and spread in this area which could impact 14,993,754 people living in the surrounding.  Therefore, risk assessment becomes crucial from an ecological and environmental health perspective. Identifying antibiotic concentrations is key to assessing this risk. A model is needed to predict antibiotic pollution levels in the river, considering the hydrodynamic parameters and the chemical, physical, and biological characteristics of the river. This modeling will be very useful for environmental experts, supports government policies in supporting one health, and is able to raise the important issue of the risk of antibiotic resistance to gain public awareness.

Target Audience and Solution

The solution serves multiple beneficiaries with specific needs:

1. Society

   • The public will gain awareness and understanding of the urgency in mitigating the risk of antimicrobial resistance.
   • This will lead to increased public awareness and realization of the importance of using antibiotics carefully and in accordance with recommendations.

2. Environmental Experts

   • Environmentalists will benefit from the latest modeling, enabling them to access and implement modeling for various cases in Indonesia, thereby accelerating the benefits of this modeling in different locations.

3. Government of the Republic of Indonesia

   • As the policy maker, the government will utilize the study results to form regulations in high-risk areas, effectively addressing the threat of antimicrobial resistance.

Through campaign programs on various social media and strategic partners, in collaboration with non-governmental organizations, environmental alliances, and related government institutions in all regions in Indonesia, this program will build overall awareness for the Indonesian people.

We will of course carry out publications in the form of scientific papers and national seminars to accelerate the benefits of this program to the general public. We will even open the opportunities to maximize the use of this modeling so that it can be used by environmental experts by making it an R package that can be widely accessed. During the initial period, we will provide monitoring and evaluation services for our model if there is input from various experts who use this model, so that in the future this model can continue to be refined.

This modeling will have widespread benefits, first of all it will build awareness among the public. When people know the conditions and potential risks, people will at least have the desire to change habits that previously resulted in antibiotic residue pollution in rivers. Second, invite the government to jointly adopt a national action plan to regulate strategies for handling ARGs and preventing the spread of antibiotic residues in the environment. Indonesia has a National Action Plan on Antimicrobial Resistance Control including Ministries, Agencies, Regional Governments, and working partners (professional organizations, development partners, regional and international organizations, mass organizations, industries, business associations, educational institutions, and communities). An atmosphere that can support the modeling created to build policy formulation and synchronization of program and activity in the framework of implementing policies and controlling the execution of policies at the site.

The strategy for controlling antimicrobial resistance using this model over the next 3 years is divided as follows:

Year 1 Focus:

1. Increase awareness and understanding of AMR control through inter-sector communication, education, seminar, focus group discussion and training.
2. Enhance knowledge and scientific evidence through surveillance and research in multiple locations and risk prediction and mitigation.

Year 2 Focus:

1. Strengthen the modeling evaluated from various studies in the first year.
2. Publish journal, proceeding, and submit academic manuscript results to be used as a blueprint for the national action plan on antimicrobial resistance control, 2025-2029.

Year 3 Focus:

1. Encourage sectors to improve sanitation facilities, hygiene, and infection prevention and control.
2. Optimize and monitor the implementation of follow-up sanctions for violations of antimicrobial use standards, especially in animals, plants, and waste processing installations in the drug industry and hospitals.
3. Develop integrated governance and coordination to control antimicrobial resistance.

Monitoring and evaluation will be carried out to measure the success of this activity. These benchmarks will be carried out qualitatively and quantitatively. Qualitative monitoring is carried out by direct monitoring in the field to ask questions regarding the community's perspective on the various activities carried out. Quantitatively, this is done by measuring target achievements and input. The monitoring results are used as evaluation material for future policy improvements.

 Measurement of Objective Achievement

The measurement shall be expressed in achievement realization percentage, and shall be performed by comparing the achievement to the defined target formulated through the following equation:

The measurement is expressed by the input achievement percentage

of the expected target output. The availability percentage shall be performed by comparing the output target in the activity clusterization matrix to the realization evaluation. The realization percentage is calculated by comparing available resources to the following realizations:

 The outcome of the realization percentage calculation shall be measured by the valuation range table, as follows:

The biggest challenge in Indonesia is the community's habits, which require efforts to increase public awareness not only about the risks but also about mitigation and solutions to this problem. Additionally, antibiotic residues are a form of water pollution that is globally distributed and may have been detected at all levels in the aquatic environment. This study necessitates connectivity between sectors to foster collaboration. Funding is also crucial, as diverse scientific evidence is needed in different regions to monitor the extent of damage caused by antibiotic residues. Moreover, resistance studies in Indonesia are relatively expensive due to limited technology, tools, and human resources.