Supporting Evidence-Based Policy: a longitudinal study of AMR risk behaviours among livestock keeping communities in India and Kenya

支持循证政策：印度和肯尼亚畜牧社区抗菌素耐药性风险行为的纵向研究

• 批准号: ES/P00492X/2
• 负责人: Claire Heffernan
• 金额: $ 22.95万
• 依托单位: Royal Veterinary College
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FP00492X%2F2
• 关键词: Supporting; Evidence; Based; Policy; longitudinal

Anti-microbial resistance (AMR) is set to rival climate change as one of the largest barriers to health and wellbeing in the 21st century (Aarestrup, 2015; O'Niel, 2015; Woolhouse et al., 2015). And like climate change, AMR is likely to have a preferential impact on communities of the poor (Heffernan, 2017). Yet, to date, the inter-relationship between poverty and AMR has not been well explicated. This is particularly true with regard to animal agriculture. Indeed, while 2/3rds of the global poor are livestock keepers (Lin and Heffernan, 2009a, 2010) very little is known about the factors facilitating AMR among this population. We do know however, that AMR emerges out of the social, cultural and behavioural milieu in which disease and healing is situated. And in this case the environment in which livestock are produced. Therefore, the aim of the project is to explore three inter-related drivers: social, behavioural and environmental to the emergence of AMR among two communities of the livestock dependent poor: Maasai pastoralists in Kenya and subsistence dairy producers in Orissa, India. Both of these communities had participated in a large-scale study on animal healthcare service delivery funded by DFID in 1999 (Heffernan and Misturelli, 2000; Heffernan, 2001). In this manner, the research will draw on a historical dataset to compare a variety of parameters important to the emergence of AMR. Ranging from animal healthcare seeking behaviours/preferences to livestock-based livelihoods to access to service providers to farmer of understanding disease etiologies and access to livestock pharmaceuticals and antibiotic use, including dosages and timing over a 17-year period. Thus the study offers a unique opportunity to explore behavioural change over time. Such an historical assessment is beneficial on two levels: first, the strength and directionality of these forces on AMR emergence can be measured and thereby, better understood and second, the analysis offers a unique opportunity to support evidence-based decision-making. The risk of the rapid ascendancy of AMR as a global threat is that the development community will formulate policies on a weak evidential base. Equally problematic, much of the current research exploring AMR focuses on bio-prospecting in one-off exercises. Therefore, it is likely that this approach will create an evidence base biased towards single outcomes. And in this manner, related decision-support tools will be limited in their ability to predict change by the singular, deterministic nature of the underpinning data (Heffernan and Yu, 2010; 2007; Yu and Heffernan, 2009). To address this issue, the project will create and deliver the 'AMR forecaster' an easy to use ranking and weighting framework based on the longitudinal dataset. The aim is to enable policy makers, researchers and practitioners to use the simple on-line tool to assess the relative risk of AMR emergence among the communities involved. Finally, however, we know that changing behaviour regarding the use of antibiotics is imperative both in the global North and South (O'Neil, 2015; Woolhouse et al., 2013; 2015). Previous studies have shown that children can be effective entry points for livestock-related knowledge at the community level (LDG, 2011). Therefore, the project team will produce and disseminate learning material on AMR to local school children, and measure the transfer of key messages or 'memes' on wider households members.

抗微生物耐药性（AMR）将与气候变化竞争，成为21世纪世纪健康和福祉的最大障碍之一（Aarestrup，2015; O'Niel，2015; Woolhouse等人，2015年）的报告。与气候变化一样，AMR可能会对贫困社区产生优先影响（Hongnan，2017）。然而，到目前为止，贫困和AMR之间的相互关系还没有得到很好的解释。在畜牧业方面尤其如此。事实上，虽然全球三分之二的穷人是牲畜饲养者（Lin和Hongnan，2009年a，2010年），但对促进这一人群中AMR的因素知之甚少。然而，我们确实知道，抗菌素耐药性是从疾病和治疗所处的社会、文化和行为环境中产生的。在这种情况下，牲畜的生产环境。因此，该项目的目的是探索三个相互关联的驱动因素：社会，行为和环境，以在两个社区的牲畜依赖穷人中出现抗生素耐药性：肯尼亚的马赛牧民和印度奥里萨邦的自给奶制品生产商。这两个社区都参与了1999年由英国国际发展部资助的一项关于动物医疗保健服务提供的大规模研究（Heffernan和Misturelli，2000; Heffernan，2001）。通过这种方式，研究将利用历史数据集来比较对AMR出现重要的各种参数。从动物保健寻求行为/偏好到以畜牧业为基础的生计，到获得服务提供者，到农民了解疾病病因，以及获得畜牧药品和抗生素使用，包括17年期间的剂量和时间。因此，这项研究提供了一个独特的机会，探索随着时间的推移行为的变化。这样的历史评估在两个层面上是有益的：首先，可以测量这些力量对AMR出现的强度和方向性，从而更好地理解，其次，分析提供了一个独特的机会，以支持基于证据的决策。抗菌素耐药性作为一种全球性威胁迅速上升的风险是，发展界将在证据基础薄弱的基础上制定政策。同样有问题的是，目前探索AMR的大部分研究都集中在一次性的生物勘探上。因此，这种方法很可能会建立一个偏向单一结果的证据基础。通过这种方式，相关的决策支持工具在预测变化的能力方面将受到基础数据的单一性和确定性的限制（Hongnan和Yu，2010; 2007; Yu和Hongnan，2009）。为了解决这个问题，该项目将创建并提供“AMR预测器”，这是一个基于纵向数据集的易于使用的排名和加权框架。其目的是使政策制定者、研究人员和从业人员能够使用简单的在线工具来评估相关社区出现AMR的相对风险。然而，最后，我们知道，在全球北方和南方，改变使用抗生素的行为都是必要的（O'Neil，2015; Woolhouse et al.，2013; 2015）。以往的研究表明，儿童可以成为社区一级获取畜牧业相关知识的有效切入点（LDG，2011年）。因此，项目组将制作并向当地学童传播关于AMR的学习材料，并衡量关键信息或"模因"在更广泛的家庭成员中的传播情况。