Changing Food Systems in Kenya and Malawi and the Challenge of Tackling Antimicrobial Resistance

这一研究伙伴关系涉及一项为期两年的工作计划，重点关注迅速变化的禽肉消费文化和农业系统（特别是低收入和中等收入国家）如何影响农业中抗生素的使用/滥用，从而对应对全球抗菌素耐药性（AMR）健康挑战产生影响。AMR，或者通俗地说，耐药感染，是世界卫生组织（WHO）的五大优先事项之一。2016年奥尼尔关于“全球应对耐药感染”的报告警告说，如果不解决这一挑战，预计在未来30年内，全球范围内因抗生素耐药性导致的死亡人数将达到每年约1000万人。农业和粮食系统中的抗菌素耐药性是一个令人关注的关键领域，据报道，大肠杆菌、弯曲杆菌和沙门氏菌等细菌菌株对某些抗生素产生耐药性的病例越来越多。虽然抗生素是维持农场健康和福利的必要工具，但问题是它们在动物身上的不当和不成比例的使用，从而减少了人类的可用性，也催化了耐药性。研究伙伴关系的第一个目标是评估城市饮食的变化（包括增加肉类消费）、粮食系统的转变与农业中抗生素的使用/滥用之间的关系。鉴于肯尼亚和马拉维的家禽生产和消费迅速增长，以及生产中抗生素使用的增加和监管不力，它将重点关注肯尼亚和马拉维的家禽部门，特别是内罗毕和利隆圭的城市环境。此外，肯尼亚和马拉维分别是中低收入国家和最不发达国家，预计到2050年抗菌素耐药性造成的死亡率将是最高的。第二个目标是在这些背景下制定具有文化和地理敏感性的抗生素减少和管理倡议方法，以改善其政府“抗生素耐药性国家行动计划”的实施。该研究的前提是，减少农业抗生素滥用的政策和目标虽然是由世卫组织和“同一个健康”议程制定的，但如果它们的实施能够响应农民在其所处的特定粮食系统背景下所经历的具体压力、限制和机遇，以及塑造日常农业实践的文化价值观，则最有可能有效。该伙伴关系汇集了肯尼亚、马拉维和英国的一个跨学科团队和更广泛的研究人员和决策者网络。核心小组代表内罗毕非洲人口与健康研究中心、马拉维大学、纽卡斯尔大学、南安普敦大学和伦敦大学学院。该伙伴关系的合作涉及地理、历史、流行病学、医学、人类学、微生物学和艺术等学科之间的对话，以了解文化价值观和习俗如何与肯尼亚和马拉维特定食品系统和家禽部门的抗生素使用/滥用密不可分。该伙伴关系还包括其顾问委员会中有影响力的抗微生物药物耐药性政策机构，包括英国食品标准局、联合国食品法典委员会、马拉维卫生部和肯尼亚国际牲畜研究所作为项目伙伴。这种伙伴关系的模式包括一个相互交织的范围研究方案，包括在肯尼亚和马拉维收集二级和初级数据，以及在伦敦、内罗毕和利隆圭举行的三个密集讲习班。研究将加深对日常文化和自给农业和商业农业实践中抗生素使用和抗菌素耐药性意识的理解。根据这项研究，将向肯尼亚和马拉维的抗菌素耐药性政策制定者提出关于具有文化敏感性和有效的抗生素管理方法的建议。

This research partnership involves a two-year programme of work focused on the ways in which rapidly changing cultures of poultry meat consumption and agricultural systems in particular Low and Middle Income Countries (LMICs) shape antibiotic use/misuse in farming, with implications for tackling the global antimicrobial resistance (AMR) health challenge. AMR, or in lay terms drug-resistant infections, is one of the top five priorities for the World Health Organization (WHO). The 2016 O'Neill report into 'Tackling Drug-Resistant Infections Globally' warns that if the challenge is left unaddressed, deaths resulting from AMR on a global scale are predicted within the next three decades to reach some 10 million per year. AMR in agriculture and food systems is a critical area of concern, with increasing cases reported of strains of bacteria such as E.Coli, Campylobacter and Salmonella developing resistance to particular groups of antibiotics. While antibiotics are a necessary tool to maintain health and welfare on the farm, the problem is their inappropriate and disproportionate use in animals, thereby reducing availability for humans and also catalysing resistance. The first aim of the research partnership is to evaluate the relationships between changing urban diets incorporating increased meat consumption, transforming food systems and the use/misuse of antibiotics in agriculture. It will do so through a focus on the poultry sectors of Kenya and Malawi, in particular the urban contexts of Nairobi and Lilongwe, given the rapid rise of poultry production and consumption in both places and the increased and weakly regulated use of antibiotics in production. Moreover, Kenya and Malawi are a Lower Middle Income Country and a Least Developed Country, respectively, on a continent predicted to see the highest mortality rate from AMR by 2050. The second aim is to generate culturally and geographically sensitive approaches to antibiotic reduction and stewardship initiatives in these contexts, in ways that improve implementation of their governments' AMR National Action Plans. The premise of the research is that policies and targets for the reduction of antibiotic misuse in agriculture, whilst shaped by the WHO and a 'One Health' agenda, are most likely to be effective if their implementation is responsive to the specific pressures, constraints and opportunities experienced by farmers in the context of the particular food systems in which they are embedded, and to the cultural values shaping everyday farming practice.The partnership brings together an interdisciplinary team and wider network of researchers and policy-makers across Kenya, Malawi and the UK. The core team represent the African Population and Health Research Center in Nairobi, the University of Malawi, Newcastle University, Southampton University and UCL. Collaboration in the partnership involves dialogue between the disciplines of Geography, History, Epidemiology, Medicine, Anthropology, Microbiology and Art to understand how cultural values and practices are integral to antibiotic use/misuse in the particular food systems and poultry sectors of Kenya and Malawi. The partnership also involves influential AMR policy institutions on its advisory board, including the UK's Food Standards Agency, the UN's Codex Alimentarius, Malawi's Ministry of Health and the International Livestock Research Institute in Kenya as Project Partners. The model for the partnership involves a programme of interwoven scoping research, involving secondary and primary data collection in Kenya and Malawi, and three intensive workshops in London, Nairobi and Lilongwe. Research will develop understanding of the embeddedness of antibiotic use and AMR awareness in everyday cultures and practices of subsistence and commercial farming. From this research, recommendations will be made to Kenyan and Malawian AMR policy-makers regarding culturally-sensitive and effective approaches to antibiotic stewardship.