Veterinary Antimicrobial Usage in Central Ethiopia

In this post I’ll summarize a recently published paper out of Addis Ababa University’s College of Veterinary Medicine on one of my primary areas of interest in veterinary research: antimicrobial stewardship and resistance. But first, an exciting update:

Welcome to the Party, Easton Elias!

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On Friday, May 17th, Easton officially joined our family, as Easton Elias Coatney. He will be baptized Elias, probably at the same time as boy #4 (aka Quartus). Elias is the Greek form of Elijah, who (after Moses) is arguably the most faithful and powerful prophet in the Old Testament. Two of my favorite stories concerning Elijah are his role in God’s victory over the prophets of Baal, and God’s revelation of himself to Elijah when he was hiding from Ahab and Jezebel, the wicked rulers of Israel.

Easton is three years old, and will turn four in August. He enjoys sharks, singing, and basically anything that his big brother Charlie is interested in. We’re grateful to God for the opportunity to add Easton to our family, and for what he is teaching us as adoptive parents.

The finalization of the adoption removes one of the major hurdles keeping us from moving to Mekelle as soon as possible. Now we can begin slogging through the process of obtaining the necessary documentation to prove that the Easton is ours for visa purposes in Ethiopia.  The other major hurdles are the birth of Quartus and completion of the month-long training that we had to cancel in April due to the passing of my father.

Veterinary medicinal product usage among food animal producers and its health implications in Central Ethiopia

I’ve decided that I’ll summarize these veterinary papers utilizing the research paper format, so that (hopefully) my summary is easy to follow. My intent is to distill each section such that someone with only a basic understanding of veterinary science (i.e., can tell the difference between a cow and a horse) can understand what they’re reading.

This article (see the photo at the top of the post for bibliographic information) was published in BMC Veterinary Research by researchers at Addis Ababa University’s College of Veterinary Medicine (commonly referred to by it’s location, Bishoftu in Oromiya, or Debre Zeit in Amharic), Utrecht University and Wageningen University in the Netherlands, and Kansas State University.

The abstract states that the purpose of the study was “to assess knowledge, awareness, and practices related to drug use and resistance in food animals among the farmers in and around Bishoftu town.” Questionnaires and visits to local pharmacies were the primary means of investigation. The abstract concludes: “there is a general lack of awareness among food animal owners about the correct use of antibiotics [drugs to combat bacterial infections] and anthelmintics [drugs to combat parasitic worms].”

Background

Here the authors explain why it matters whether or to what extent local livestock producers understand the relationship between antimicrobial stewardship and resistance. They discuss the fact that most antimicrobials (this is the catch-all term that includes antibiotics, anthelmintics, and any other drugs that fight bacteria, viruses, and parasites) used in animals are also used in humans, and that the development in resistance in livestock can result in resistance in humans as well.

The article assumes an understanding of how resistance occurs. For those who aren’t clear on this and who are interested, here’s a very brief (and, necessarily, oversimplified) primer: Every antimicrobial drug has a “mechanism of action;” that is, it kills the microbe in a specific way. Maybe it attacks the cell wall, or it stops the microbe’s DNA from replicating, or prevents the microbe from producing the proteins it needs to live or reproduce. However, some microbes may possess the means to “defeat” a particular drug’s mechanism of action. For example, if a drug that attacks the cell wall needs to bind to the cell wall in order to attack it, then a bacteria that is able to prevent that binding can’t be attacked, and is therefore “resistant” to that drug.

Bacteria may inherently possess this resistant characteristic, or it may be the result of a spontaneous genetic mutation, or the gene responsible for the resistance could be easily transferred between bacteria (for example, on a piece of genetic material called a plasmid). In any case, when a drug “works,” and kills off all the susceptible bacteria (maybe 99% of the total population), and the signs of illness/infection disappear, that one percent of resistant bacteria that are left reproduce, filling the void that the susceptible bacteria left, so that when the signs of illness/infection reoccur, the drug that worked previously no longer works.

Understanding how resistance works in reality is much more complicated than it is in theory, particularly because there are so many variables. Every drug works differently; every species of bacteria/virus/etc. might respond differently, and different means of resistance will occur even within the same species. Every drug and every microbe will potentially act differently in different species of animals, so that we really can’t understand how resistance to a specific drug in a specific type of bacteria in a cow will affect resistance to that drug in that bacteria in a human without studying that specific combination.

We do know enough to be concerned about these interconnections, though, such that we recognize the need for good antimicrobial stewardship, and that we do all that we can to minimize the development of antimicrobial resistance – particularly in drugs that are important in human health.

Materials and Methods

The authors interviewed 120 dairy, beef, and poultry owners around the city of Bishoftu. These farmers were selected randomly and interviewed face-to-face in the local language. Another 100 animal owners were interviewed at veterinary clinics or pharmacies in the area.

Results/Discussion

A lot of interesting data was collected in this paper; see the paper itself for the details. The most significant results include the following:

80% of the respondents were unable to define what an antimicrobial is or its purpose. Only 14% of respondents were aware of the existence and consequences antimicrobial resistance, and of that 14%, only 9% were aware that irresponsible use of antimicrobials in animals could lead to resistance in humans.

66% of those purchasing antimicrobials received counseling on usage from animal health assistants; 10% from veterinarians; 6% from non-animal health professionals, and the remaining 18% received no counseling on the proper use of antimicrobials.

70% of owners did understand the information they received from drug dispensers, and were unable to read/understand the drug labels, which were in English. Often the farmers identified the drugs they used only by color.

Antimicrobials were used indiscriminately, without adequate diagnosis, and treatment failure was extremely common. Withdrawal times (allowing for the drug to leave the animal’s system before its meat or milk is consumed by people) were ignored. Antimicrobials were frequently sold without prescription papers, and illegal drug vendors who improperly stored drugs were common.

Conclusions

The primary public health concerns based on the results of this study include the failure of medications, development of antimicrobial resistance, and occurrence of drug residues in food animal products (which may cause hypersensitivity/allergic reactions, damage to genetic material, or increase the risk for certain cancers in humans). The authors encourage the Ethiopian Veterinary Drug and Feed Administration and Control Authority to improve its surveillance of illegal drug vendors, and to raise awareness among livestock owners about the need for better antimicrobial stewardship.

This paper is useful to me as a researcher because it gives me support for potentially creating programs that will improve antimicrobial stewardship in Ethiopia. A key part of any veterinary college’s research program is extension: the application of cutting-edge research among practicing veterinarians and producers.

I’m excited to get started helping the Ethiopian veterinary community in whatever capacity I’m able.

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