Title: Supporting Evidence-Based Policy: a longitudinal study of AMR risk behaviours among livestock keeping communities in India and Kenya
Funder: Arts and Humanities Research Council

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.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS;3.4 VACCINES;3.5 RESOURCES AND INFRASTRUCTURE (PREVENTION)
Health categories: INFECTION