Antimicrobial redistribution: health practitioner One health perspectives on antimicrobial use in livestock for antimicrobial resistance education in Zimbabwe

Abstract Background and objectives Antimicrobial resistance (AMR) is a growing challenge to global health, encompassing human, animal and environmental health. In Zimbabwe, AMR is driven by antimicrobial misuse, weak infection control and poor regulation of antimicrobial use in agriculture. While policy has identified education as key in addressing AMR, there are gaps in AMR education frameworks. This paper explores Zimbabwean health practitioners’ understandings of the interconnections between human, animal and environmental health practices and how these understandings can strengthen AMR education frameworks to address antimicrobial misuse. Methods Operationalizing participatory workshops at two hospitals in Harare, the paper qualitatively analyses discussions from 25 doctors, nurses and pharmacists on the interconnections between human, animal and environmental health in AMR development and challenges of AMR educational practice. Results The paper identifies how health practitioners perceive recurring antimicrobial redistribution pathways from patients to (i) livestock for disease prevention and growth, (ii) family and community through informal sharing and (iii) local environment through unintentional contamination. Economic pressures, lack of knowledge and awareness and weak regulatory enforcement are perceived as drivers of antimicrobial redistribution, emphasizing the importance of AMR education to engage with both behavioural and systemic drivers as part of a One health framework. Conclusions The paper contributes to AMR research by mapping perceived drivers of antimicrobial redistribution, highlighting how One health approaches can be integrated into AMR education frameworks. A cross-sectoral educational approach is proposed for engaging health practitioners, veterinarians, farmers, communities and policymakers in antimicrobial stewardship and behavioural change for more sustainable use of antimicrobials.