Assessment of Drivers of Antimicrobial Usage in Poultry Farms in the Mekong Delta of Vietnam: A Combined Participatory Epidemiology and Q-Sorting Approach

Abstract

In the Mekong Delta of Vietnam, poultry farmers use high amounts of antimicrobials, but little is known about the drivers that influence this usage. We aimed to identify these drivers using a novel approach that combined participatory epidemiology (PE) and Q-sorting (a methodology that allows the analysis of the subjectivity of individuals facing a common phenomenon). A total of 26 semi-structured collective interviews were conducted with 125 farmers representative of the most common farming systems in the area (chickens, meat ducks, and mobile grazing ducks), as well as with 73 farmers' advisors [veterinarians, veterinary drug shop owners, and government veterinarians/commune animal health workers (CAHWs)] in five districts of Dong Thap province (Mekong Delta). Through these interviews, 46 statements related to the antimicrobials' perceived reliability, costs, and impact on flock health were created. These statements were then investigated on 54 individuals (28 farmers and 26 farmers' advisors) using Q-sorting interviews. Farmers generally indicated a higher propensity for antimicrobial usage (AMU) should their flocks encounter bacterial infections (75.0–78.6%) compared with viral infections (8.3–66.7%). The most trusted sources of advice to farmers were, in decreasing order: government veterinarian/CAHWs, their own knowledge/experience, veterinary drug shop owners, and sales persons from pharmaceutical and feed companies. The highest peak of AMU took place in the early phase of the production cycle. Farmers and their advisors showed considerable heterogeneity of attitudes with regards to AMU, with, respectively, four and three discourses representing their views on AMU. Overall, farmers regarded the cost of AMU cheaper than other disease management practices implemented on their farms. However, they also believed that even though these measures were more expensive, they would also lead to more effective disease prevention. A key recommendation from this finding would be for the veterinary authorities to implement long-term sustainable training programs aiming at reducing farmers' reliance on antimicrobials.

Veterinary Drug Shops as Main Sources of Supply and Advice on Antimicrobials for Animal Use in the Mekong Delta of Vietnam

“…According to the farmers' opinions, antimicrobial retail prices had little impact on their specific choice of veterinary drug shop. This is consistent with a previous study conducted in the area, where poultry farmers stated that they would be willing to accept a three to four-fold hike in prices without altering their AMU behaviour [16]. It has been shown that antimicrobials intended for veterinary use are extremely affordable in the region (average of 0.56 cents of a USD per kilogram treated) and represent only a small fraction of overall chicken production costs [12].…”

“…This behaviour is partly driven by the prevailing farming conditions that lead to a high incidence of disease and mortality [8]. In addition, farmers often use antimicrobials prophylactically as a replacement for good farming practices [16]. In the Mekong Delta of Vietnam, there are three to six veterinary drug shops per commune (~32 km 2 ), compared with only one or two government veterinarian/s or commune animal health worker/s.…”

“…In the Mekong Delta of Vietnam, there are three to six veterinary drug shops per commune (~32 km 2 ), compared with only one or two government veterinarian/s or commune animal health worker/s. Farmers have more regular access to local veterinary drug shops than contact with any other animal health advisors [16]. It has been suggested that pharmacy owners should play a central role in antimicrobial stewardship [17,18].…”

A survey of retail prices of antimicrobial products used in small-scale chicken farms in the Mekong Delta of Vietnam

“…A study on antimicrobials of human use in Mongolia found that lower-priced antimicrobials were also those purchased more frequently e [17]. This underlines that factors other than retail price drive antimicrobial consumption intended for animal use in the Mekong Delta, and is consistent with the farmers' perception that retail price is not a limiting factor for AMU [18]. Results indicate that the farmers are making judgements on the value of the products when confronted with disease or when treating older flocks that are more valuable.…”

“…Data on AMU and their retail prices were obtained from 203 complete cycles of native chicken flocks raised for meat in 102 farms. The median flock size at restocking was 300 [Inter-quartile range (IQR) 200-495], and the median duration of production cycles was 18 [IQR [16][17][18][19][20] weeks. The median cumulative mortality over the whole production cycle across flocks was 14.10% .…”