Knowledge, attitudes, and practices associated with antimicrobial use and antimicrobial resistance among livestock farmers in Botswana.

INTRODUCTION Improper antimicrobial use (AMU) in livestock production is a key driver of antimicrobial resistance (AMR). Despite this, data on AMU among livestock farmers in low- and middle-income countries remains limited. The present study assessed knowledge, attitudes, and practices (KAP) regarding AMU and AMR amongst livestock farmers in Botswana.

METHODS A cross-sectional Knowledge, Attitudes, and Practices (KAP) survey was conducted among livestock farmers in southern Botswana, with participant recruitment facilitated by district veterinary service officers. Informed consent was obtained from all participants and surveys were administered by trained research personnel using visual aids to enhance participants recall. Responses to open-ended survey questions assessing knowledge were graded on a standardized 0-5 scale using a rubric while attitude and behavior questions were assessed using binary Yes/No responses.

RESULTS A total of 191 farmers participated in the study (71 % male; median age 52 years; median farming experience 14 years). All farmers (100 %,191/191), reported using either antimicrobials or anthelmintics (ivermectin), in the preceding 12 months, accounting for a total of 3322 treatment episodes. Tetracyclines were the most commonly used antimicrobials (53 %,1756/3322), followed by sulphonamides (18 %, 34/191). Cephalosporin, fluoroquinolone and aminoglycoside use was not reported. The farmers, who primarily reared cattle, small ruminants, and chickens, most commonly procured antimicrobials and anthelmintics at agriculture supply stores (91 %,174/191) typically with the guidance of veterinarians or animal health technician (veterinary paraprofessionals), but without a prescription from the veterinarians. Most farmers (66 %,127/191) used antimicrobials for treatment purpose, mainly to treat enteric illness. A total of 34 % of farmers (64/191) reported using antimicrobials for prophylactic purposes. Knowledge about the principles of prudent AMU was generally good although awareness of AMR was limited.

CONCLUSION AMU was relatively common among livestock farmers in southern Botswana, primarily for treatment of diseases, with tetracyclines being the most commonly used antimicrobials. Overall, farmers demonstrated generally good knowledge about the principles of prudent AMU. However, comprehensive knowledge of AMR was sub-optimal, reaffirming the need for policy interventions to enhance antimicrobial stewardship in the livestock sector.