Improving antibiotics use in West Africa: exploring current situation and developing strategies for behaviour change. A study protocol for a multidisciplinary interventional research project (Preprint)

BACKGROUND Antimicrobial resistance (AMR) is recognized as a global concern, with particularly severe consequences in low- and middle-income countries. While it may occur naturally, it is also an anthropogenic problem linked to the irrational use of antibiotics in humans and animal husbandry, and the use of pesticides in plant agriculture. Generally, data on AMR and evidence of effective and feasible multifaceted interventions are limited in many African countries. OBJECTIVE This study aims at (i) assessing baseline data on AMR pathogens in Burkina Faso and Ghana, (ii) understanding perceptions and quantifying usage of antibiotics among healthcare workers, communities, and livestock farmers, and (iii) defining and refining an AMR intervention using a design thinking approach. METHODS This multidisciplinary study will be conducted in two rural districts and will consist of two phases. First, baseline data will be collected on AMR pathogens along dominant food production chains. ESBL-producing Escherichia coli and Klebsiella pneumoniae will be selected as indicator mechanisms for AMR because of their high occurrence among animals and humans. The perception and understanding of AMR and antibiotic use among different stakeholders and community members will be assessed using epidemiologic and socio-anthropological methods. Qualitative methods will include participant observations, in-depth and key informant interviews, and focus group discussions. The quantitative part will consist of the development of an inventory of circulating antibiotics, a point prevalence and a household survey. Second, an intervention on AMR will be developed collaboratively with different stakeholders and community members using a design thinking approach to improve antibiotic usage. RESULTS Data collection started in April 2022. The analysis of the microbiological, anthropological, and socio-epidemiological data is ongoing in both countries. The intervention development has been initiated in Ghana, but did not start yet in Burkina Faso. All results are planned to be submitted to peer-reviewed journals by December 2025. First, manuscripts will be published for each discipline. Afterwards, the results of the three disciplines will be combined in multidisciplinary papers, and a publication of the evaluation of the intervention will follow. CONCLUSIONS Owing to the multifactorial nature of AMR, different perspectives need to be considered to develop a holistic context-based intervention that is tailored to local needs. This study stands out in its combination of different disciplinary and epistemological perspectives following the One Health paradigm and taking a design thinking approach to develop an intervention. Thereby, collaboration across disciplines and social levels, and a participatory bottom-up approach will be promoted to achieve a common understanding of problems and needs and to develop an accepted and efficacious intervention. The national AMR networks and policymakers will be continuously involved in the project.