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

抗菌素耐药性(AMR)将与气候变化相抗衡，成为21世纪健康和福祉的最大障碍之一(Aarestrup，2015；O‘Niel，2015；Woolhouse等人，2015)。与气候变化一样，AMR可能会对穷人社区产生优先影响(Heffernan，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，尽管全球2/3的贫困人口是畜牧业者(Lin和Heffernan，2009a，2010)，但人们对促进这一群体中的AMR的因素知之甚少。然而，我们确实知道，AMR出现在疾病和治疗所处的社会、文化和行为环境中。在这种情况下，也就是牲畜生产的环境。因此，该项目的目的是探索三个相互关联的驱动因素：社会、行为和环境因素，这是导致依赖牲畜的穷人的两个社区--肯尼亚的马赛牧民和印度奥里萨邦自给自足的奶制品生产商--出现AMR的主要原因。这两个社区都参与了1999年由英国国际发展部资助的关于提供动物保健服务的大规模研究(Heffernan和Misturelli，2000；Heffernan，2001)。通过这种方式，这项研究将利用历史数据集来比较对AMR的出现至关重要的各种参数。从动物保健寻求行为/偏好，到以牲畜为基础的生计，到获得服务提供者的机会，到农民了解疾病病因，以及获得牲畜药物和抗生素使用的机会，包括17年期间的剂量和时机，这些都是一系列的问题。因此，这项研究提供了一个独特的机会来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：第一，可以衡量这些力量对AMR出现的强度和方向性，从而更好地理解；第二，分析为支持基于证据的决策提供了一个独特的机会。AMR迅速崛起为全球威胁的风险在于，发展界将在证据薄弱的基础上制定政策。同样有问题的是，目前探索AMR的大部分研究都侧重于一次性的生物勘探。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。以这种方式，相关决策支持工具预测变化的能力将受到支撑数据的单一、确定性性质的限制(Heffernan和Yu，2010；2007；Yu和Heffernan，2009)。为了解决这个问题，该项目将创建并提供一个基于纵向数据集的简单易用的排名和权重框架“AMR预测者”。其目的是使政策制定者、研究人员和从业人员能够使用这个简单的在线工具来评估有关社区中出现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势在必行的(O‘Neil，2015；Woolhouse等人，2013；2015)。先前的研究表明，儿童可以成为社区一级牲畜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龄儿童传播关于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转移。

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.