Containing antimicrobial resistance in rural Cambodia: a one-health multi-disciplinary intervention to improve village healthcare and farming practice

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Antibiotic resistance has been termed the greatest menace of the current century by the World Health Organization. If appropriate measures to mitigate antibiotic resistance are not taken immediately, it is estimated that millions of people will die, in the near future due to complications arising out of inability to treat resistant infections and most of this burden will fall on the poor, underdeveloped part of the world. The main drivers of antibiotic resistance are antibiotic use and antibiotic residues in the environment. Both generate resistant bacteria. Appropriate monitoring and mitigation of both is neglected in poorer countries due to inadequacy of awareness, infrastructure, economics, political will, socio-cultural dimensions and a myriad of other factors. Resistance knows no geographical or political boundaries; it spreads quickly all over the world. So, not only the poorer human beings from underdeveloped countries suffer, these countries also become 'hot spots' of resistance generation and spread. Cambodia is the poorest country in the Greater Mekong Sub-Region and continues to recover from a prolonged civil war which saw its institutions and infrastructure destroyed, which resulted in the loss of most of its educated personnel. With support of international partners, Cambodia is rapidly developing; Cambodia was one of the countries, which achieved the millennium development goals in reducing infant and child mortality. The proposed provinces for the antibiotic resistance study and intervention are among the most remote and underserved both within the formal health and agricultural systems and rely for care on personnel who have minimal training for both care of patients and animals. When a person or animal becomes ill, medicines including antibiotics, often of dubious quality are bought from local pharmacies or market stalls and administered by the persons themselves. Human antibiotics are often given to animals and vice versa. Due to the deficit of trained health personnel, Cambodia has developed a cadre of village level healthcare workers, who have minimal training and little supervision to treat villagers or their sick animals. Little care is taken in disposing of antibiotics, which must be resulting in huge amount of residues in Cambodian environment. The proposed project will investigate and map the current status of antibiotic use, antibiotic resistance and antibiotic residues in the target area and would examine the drivers for these in these remote areas, involving various stakeholders including human and animal healthcare providers and policy makers. We would involve the newly instituted laboratory and personnel in the Royal University of Agriculture and Veterinary Medicine as well as our partners, the Ministry of Health and the Ministry of Fisheries and Agriculture. We would also seek to evaluate the efficacy of a community dialogue intervention in improving the knowledge and understanding of use, handling and disposal of antibiotics to achieve appropriate antibiotic resistance management.