antimicrobial resistance

No prescription, no problem! A mixed-methods study of antimicrobial stewardship relating to working equines in drug retail outlets of Northern India

Multidrug resistance (MDR) is already occurring among some equids in India. Donkeys and mules are a mobile species moving between regions and international borders, often populating areas of India where private community pharmacies, or medical stores, are the primary healthcare provider for both humans and animals. This article highlights how the capacities of drug retail outlet workers might affect their antibiotic dispensing practices, particularly in relation to donkeys and mules, in order to consider how this might impact the development of antimicrobial resistance (AMR) on a wider scale. A mixed-methods approach was implemented using patient simulation method (n = 28), semi-structured interviews (SSIs) (n = 23), focus group discussions (FGDs) with veterinary practitioners and non-governmental organisation animal health workers (n = 2 FGDs), and participant observation. Fewer than 48 per cent of drug retail outlet workers admitted to having had any formal training in pharmaceuticals at all, while 78 per cent reported having no formal training in animal-related pharmaceuticals. Moreover, 35 per cent of all participants sold antibiotics without a prescription, unprompted and without specifically being asked for antibiotics. Of the antibiotics dispensed, only 21 per cent were correctly dispensed for the symptoms presented, and all dosages dispensed were incorrect (underdosed). Furthermore, 43 per cent of drug retail outlet workers interviewed believe that some antibiotics can be legally dispensed without a prescription. Equine owners in northern India are frequently being sold antibiotics without a prescription and, in most cases, with incorrect diagnoses, treatment choice, and dosage. A substantial gap in capacities exists amongst Drug Retail Outlet (DRO) workers, with few being sufficiently qualified or trained to dispense antibiotics to animal owners. The study highlights the need for further training of private DRO workers as well as knowledge extension and awareness training for both DRO workers and animal owners regarding antimicrobial resistance and its potential impact upon livelihoods. It also illustrates the need to identify a balance whereby greater enforcement of regulation at all levels is implemented, while at the same time maintaining sufficient access to medicine for rural populations.

Journal
Volume
9
Issue
6
Start page
295
Publication date
Research output
Country

The role, importance and impact of veterinary drug retail outlets (VDRO) on the welfare of equines and their owners in India

Status
Researcher(s)
Start date
End date
Country

In spite of their official classification under “livestock”, and the significant role they play in the livelihoods of millions in the developing world, equines and those who depend upon them for their livelihoods tend to be ignored within the research agenda. It is also the case that other livestock are often valued over working equines due to their 'direct link to food and nutritional security'. Equine welfare in this case, with respect to veterinary treatment, might therefore suffer as a consequence of this placement of value. Couple this with the fact that the majority of donkey and mule owners in developing countries live in marginalised or poor communities and it becomes clear that the medicating practices of equine owners require further investigation to understand how they make decisions regarding the veterinary treatment of their animals, and who they source their medication and advice from when their animals require medications. This research will attempt to fill some of these gaps in knowledge.

Methodology

Fieldwork focussed largely on communities working in brick kilns but also incorporated some working in construction. A small proportion of the research aimed to capture any differences between sites where Donkey Sanctuary India (DSI) partners had provided veterinary interventions and advice and sites not visited by DSI. A mixed methods approach was identified as most appropriate in capturing the lived experience of donkey owners as well as members of the veterinary retail outlet workforce, and was undertaken through semi-structured interviews (enabling quantitative and qualitative data capture), focus groups, patient simulation method, knowledge assessment through the use of vignettes. Both donkey owners/users as well as a purposive sample of VDRO workforce members and veterinary service providers was recruited for participation. Equine welfare was measured using the Equid Assessment Research Scoping (EARS) tool. Videos were also taken of each equid/ group of equids for qualitative behavioural assessment. Fieldwork was carried out in February/ March due to their relative seasonal reliability in terms of weather, as well as corresponding with the early brick kiln season in the specified study location.

Aims

This project contributes to, what is currently, a limited existing body of knowledge regarding equine health service provision in India. It focused primarily on the role of veterinary drug retail outlets in urban areas such as Haldwani), peri-urban areas (such as Rewari and Firozabad), and rural areas (within Uttarakhand or Rajasthan).

The research aimed to understand:

  • User perception and experience of veterinary drug retail outlets in terms of affordability, availability, accessibility, acceptability, quality of service and sustainability.
  • The extent to which users depend on the services of veterinary drug retail outlets in the treatment of their animals and equines
  • The characteristics (outlet type, products stocked, drugs stocked, drug sources), capacities (training, education, skills), and drug prescribing practices of the retail outlet and its workforce
  • The impact of the above variables on donkey/mule welfare

Further to these aims, the project sought to identify constraints to equine owners with regards to equine welfare, as well as to examine the working constraints of the veterinary drug retail outlet workforce in the designated region of study.

Data collected regarding the above points was analysed alongside equine welfare data collected via the EARS tool in order to discover any potential correlation between equine welfare and retail outlet-related variables.

A small proportion of this study included comparison work between Donkey Sanctuary India sites and sites where there has been little to no intervention by an equine-related organisation.

Objectives

The purpose of this research project was to identify the role, importance, and impact of veterinary drug retail outlets (VDROs) on working equine welfare in India. The research gathered relevant data regarding health and wellbeing of donkeys in greatest need internationally, as well as aiding to understand associated biosecurity and environmental risks (such as cross contamination or antimicrobial resistance), and equine lifecycle and disease.

Conclusions

The study highlighted significant issues around the capacity of retail drug outlets particularly; a lack of knowledge, education and training in the dispensing of drugs to equids meant many equids received either the wrong treatment or incorrect dosage for presenting symptoms; when antimicrobials were offered this malpractice has considerable implications for antimicrobial resistance in equid populations. This is of particular concern when considering the highly mobile nature of working equids; frequently crossing borders whilst being translocated for migratory work and when being sold. For more in depth details of the study findings please read the two research outputs below.

Outputs

Nye, Caroline, Tamlin Watson, Laura Kubasiewicz, Zoe Raw, and Faith Burden. 2020. "No Prescription, No Problem! A Mixed-Methods Study of Antimicrobial Stewardship Relating to Working Equines in Drug Retail Outlets of Northern India" Antibiotics 9, no. 6: 295. https://doi.org/10.3390/antibiotics9060295

 

Nye, Caroline, Tamlin Watson, Laura M. Kubasiewicz, Zoe Raw, and Faith Burden. 2021. "‘Don’t Put the Cart before the Mule!’ Challenging Assumptions Regarding Health-Related Treatment Practices of Working Equid Owners in Northern India" Animals 11, no. 5: 1307. https://doi.org/10.3390/ani11051307

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