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

该研究伙伴关系涉及一项为期两年的工作计划，重点关注快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（LMIC）塑造农业中抗生素使用/滥用的方式，以及应对全球抗菌素耐药性（AMR）健康挑战的影响。AMR，或通俗地说，耐药性感染，是世界卫生组织（世卫组织）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，如果这一挑战得不到解决，预计在未来30年内，全球范围内由AMR导致的死亡人数将达到每年约1000万人。农业和食品系统中的抗生素耐药性是一个令人关注的关键领域，越来越多的病例报告了大肠杆菌、弯曲杆菌和沙门氏菌等细菌菌株对特定抗生素产生耐药性的情况。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使用不当和不成比例，从而减少了人类的可用性，并催化了耐药性。研究伙伴关系的第一个目标是评估改变城市饮食，增加肉类消费，改变粮食系统和农业中使用/滥用抗生素之间的关系。鉴于肯尼亚和马拉维的家禽生产和消费迅速增加，生产中抗生素的使用增加，但管制不力，因此将重点关注这两个国家的家禽部门，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，非洲大陆的AMR死亡率最高。第二个目标是在这些背景下，以改善政府AMR国家行动计划实施的方式，为抗生素减少和管理举措制定文化和地理敏感的方法。这项研究的前提是，减少农业中抗生素滥用的政策和目标，虽然由世卫组织和“一个健康”议程制定，但如果其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，限制和机会，则最有可能有效。该合作伙伴关系汇集了肯尼亚，马拉维和英国的跨学科团队和更广泛的研究人员和政策制定者网络。核心小组代表了内罗毕的非洲人口和健康研究中心、马拉维大学、纽卡斯尔大学、南安普顿大学和伦敦大学学院。该伙伴关系的合作涉及地理学、历史学、流行病学、医学、人类学、微生物学和艺术学科之间的对话，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/滥用不可分割。该合作伙伴关系还包括其顾问委员会中有影响力的AMR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合作伙伴。伙伴关系的模式包括一个相互交织的范围界定研究方案，涉及在肯尼亚和马拉维收集二级和初级数据，以及在伦敦、内罗毕和利隆圭举办三个密集讲习班。研究将发展对抗生素使用的嵌入性和AMR意识在日常文化和生计和商业农业实践中的理解。根据这项研究，将向肯尼亚和马拉维的AMR政策制定者提出关于抗生素管理的文化敏感和有效方法的建议。

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.