An analysis of antibiotic use in humans in three East African livestock production systems

Antibiotic use, which is widespread in low- and middle-income countries (LMICs) due to high rates of infection and inadequate healthcare, contributes to the emergence and spread of antimicrobial resistance (AMR). We examined antibiotic use in humans in three agricultural communities of northern Tanzania, spanning smallholder, agropastoral and pastoral production systems. We conducted a cross-sectional mixed-method study, combining household ( n = 1226) and exit ( n = 708) surveys, interviews ( n = 30) and retail outlet observations ( n = 135). Smallholders and agropastoralists accessed a broader range of antibiotics compared to pastoralists, although pastoralists showed greater familiarity and used them more frequently. Overall, the most popular antibiotics were in the World Health Organization’s ACCESS category (first-line antibiotics with lower AMR potential) and included amoxicillin, followed by trimethoprim and sulfamethoxazole. Other ACCESS antibiotics were metronidazole that ranked third among smallholder and agropastoral groups, and tetracycline that was third among pastoralists. WATCH antibiotics (second-line treatments that should be used with caution) were used occasionally, especially ciprofloxacin. The majority (70–80%) of antibiotics were obtained from private retail outlets and self-treatment was widespread. Although doctors were the preferred source of information, guidance from pharmacy vendors, past experiences or prescriptions or advice from friends were widely used. Antibiotics were used to treat a variety of conditions, and unnecessary use was frequent. While administration routes and dosages were generally appropriate, financial constraints often prevented completion of full courses. Antibiotic use was associated with illness type with diarrhoea being treated most often (OR = 1.68 compared to flu), and insurance coverage increased the odds of antibiotic use for any disease by 83%. Pastoralists were less likely to treat disease episodes with antibiotics. These findings can guide context-specific interventions to promote appropriate antibiotic use and health behaviours to mitigate AMR risks in households, with relevance for similar settings across LMICs.