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Background Raising awareness of antimicrobial resistance is a cornerstone of action plans to tackle this global One Health challenge. Tools that can reliably assess levels of awareness of antibiotic resistance (ABR) among human or animal healthcare professionals (HCPs) are required to guide and evaluate interventions. Methods We designed and tested an ABR awareness scale, a self-administered questionnaire completed by human and animal HCPs trained to prescribe and dispense antibiotics in six countries—Ghana, Nigeria, Tanzania, Vietnam, Thailand and Peru. Questionnaires also elicited demographic, practice, and contextual information. Psychometric analysis for the scale followed Rasch Measurement Theory. Bivariate analysis was carried out to identify factors associated with awareness scores. Results Overall, 941 HCPs (625 human and 316 animal) from Ghana, Nigeria, Tanzania, Vietnam, Thailand and Peru were included in the study. The 23-item ABR awareness scale had high-reliability coefficients (0.88 for human and 0.90 for animal HCPs) but performed better within countries than across countries. Median ABR awareness scores were 54.6–63.5 for human HCPs and 55.2–63.8 for animal HCPs (scale of 0–100). Physicians and veterinarians scored higher than other HCPs in every country tested. HCPs in this study reported working in contexts with limited laboratory infrastructures. More than 95% of HCPs were interested in receiving information or training on ABR and antimicrobial stewardship. Conclusion HCPs’ awareness of ABR can be reliably assessed with this validated 23-item scale within the countries tested. Using the scale alongside context questions and objective measurement of practices is recommended to inform interventions to improve antibiotic use.

Smallholder farms are the predominant livestock system in India. Animals are often kept in close contact with household members, and access to veterinary services is limited. However, limited research exists on how antibiotics are used in smallholder livestock in India. We investigated antibiotic supply, usage, and their drivers in smallholder livestock production systems, including crossover-use of human and veterinary antibiotics in two rural sites in West Bengal. Qualitative interviews were conducted with key informants (n = 9), livestock keepers (n = 37), and formal and informal antibiotic providers from veterinary and human health sectors (n = 26). Data were analysed thematically and interpreted following a One Health approach. Livestock keepers and providers used antibiotics predominantly for treating individual animals, and for disease prevention in poultry but not for growth promotion. All providers used (highest priority) critically important antimicrobials for human health and engaged in crossover-use of human antibiotic formulations in livestock. Inadequate access to veterinary drugs and services, and a perceived efficacy and ease of dosing of human antibiotics in animals drove crossover-use. Veterinary antibiotics were not used for human health due to their perceived adverse effects. Given the extent of usage of protected antibiotics and crossover-use, interventions at the community level should adopt a One Health approach that considers all antibiotic providers and livestock keepers and prioritizes the development of evidence-based guidelines to promote responsible use of antibiotics in animals.

Food systems are increasingly under threat, with climate, biological, economic or policy shocks and stressors occurring at an increasing frequency and scale. Their complex and fragile nature has become even more apparent during the COVID-19 pandemic. A systematic review of news articles published globally between December 2019 and April 2020 was conducted to describe the impacts of the COVID-19 pandemic on the chicken meat system and to identify key vulnerabilities and intervention points to build resilience. Most of the impacts identified were caused by a combination of the different mitigation measures implemented by the system actors such as movement restrictions rather than by the direct effects of the virus, thereby demonstrating the importance of interconnections and coordination in the system. Social media were found to have played a crucial role in amplifying, mitigating or mediating the impact of the pandemic. The findings highlight the importance of adopting a holistic approach that integrates the multiple dimensions of food systems for effective responses to systemic shocks.

Strategic decision making in animal healthcare involves an array of complex factors interacting for the allocation of scarce resources. Consequently, modelling techniques which consider the actions and interactions of multiple decision makers, such as game theory and agency theory, have potential to provide insight of past and future interventions and policy which seek to improve economic efficiency. This scoping review aimed to identify, describe, and synthesise literature relating to multi-actor strategic decision making in animal healthcare. Embase, Web of Science, PubMed, CAB direct, EconLit, and AnthroSource were searched for literature published until November 2020. Studies were included if they were written in English, modelled strategic decisions between multiple actors, and contained information that related to animal healthcare practices. Data were analysed within the context of a conceptual framework based on strategic decision-making literature and modelling techniques. The identified literature (n = 31) had a strong focus on livestock healthcare and particularly on cattle (n = 13). Most studies (27/31) examined decisions concerning infectious disease and seven studies used compartmental models to include disease prevalence data. Almost all the articles (n = 30) used the monetary outcome of strategic decisions as a basis for expected utility, either through direct profit maximisation or via the aversion of losses. Nine studies used discursive and conceptual models to describe the strategic decision-making process, providing a wide lens by which to view decisions and opportunity to discuss the role of behavioural contributors to utility. Twenty-two studies used formal mathematical models to describe strategic decisions and used model solutions to provide recommendations to a specific problem, ten of which were parameterised with empirical data. Consequently, 20 articles provided specific policy recommendations to improve the welfare output of a system, the majority of which suggested the need for an increased level of state intervention in the animal health sector. This review describes the range of studies which have approached strategic decision making in animal healthcare through multi-player modelling techniques. These modelling techniques provide opportunity to consider the perspectives of multiple stakeholders and to combine economic and epidemiological data which may be beneficial to the development of animal health interventions.

A variety of antimicrobials and antiparasitics are used to treat British cattle and sheep to ensure animal welfare, a safe food supply, and maintain farm incomes. However, with increasing global concern about antimicrobial resistance in human and animal populations, there is increased scrutiny of the use of antimicrobials in food-producing animals.\ud \ud This systematic review sought to identify and describe peer and non-peer reviewed sources, published over the last ten years, detailing the usage of, and resistance to, antimicrobials and antiparasitics in sheep and cattle farming systems in Britain as well as identify knowledge gaps. Applying the PRISMA review protocol and guidelines for including grey literature; Scopus, Web of Science, Medline, and government repositories were searched for relevant articles and reports. Seven hundred and seventy titles and abstracts and 126 full-text records were assessed, of which 40 scholarly articles and five government reports were included for data extraction.\ud \ud Antibiotic usage in sheep and cattle in Britain appear to be below the UK average for all livestock and tetracyclines and beta-lactam antibiotics were found to be the most commonly used. However, the poor level of coverage afforded to these species compared to other livestock reduced the certainty of these findings. Although resistance to some antibiotics (using Escherichia coli as a marker) appeared to have decreased in sheep and cattle in England and Wales over a five-year period (2013-2018), levels of resistance remain high to commonly used antibiotics. The small number and fragmented nature of studies identified by this review describing anthelmintic usage, and the lack of available national sales data, prevented the identification of trends in either sheep or cattle.\ud \ud We recommend that additional efforts are taken to collect farm or veterinary level data and argue that extraction of this data is imperative to the development of antimicrobial and antiparasitic resistance strategies in Britain, both of which are needed to reduce usage of these anti-infective agents, curb the development of resistance, and safeguard national agricultural production. Finally, metrics produced by this data should be generated in a way to allow for maximum comparability across species, sectors, and countries.

Interventions designed to reduce the burden of foodborne illness often require value chain actors to alter undesired and risky behaviours. This desired behavioural change may be supported by 'nudge theory', a sub-field of behavioural economics, which describes how individuals can be encouraged, or 'nudged', to act in ways which produce net societal benefits without restricting freedom of choice. This research aimed to investigate the use of nudges in the pork value chain in Vietnam. Key informant interviews (n = 12) were initially utilised to document the type of nudges being used within existing food safety interventions, followed by a questionnaire-based survey (n = 132) to describe the behavioural elements of pork value chain actors which could be amenable to nudging. Finally, a workshop was conducted to measure the response of stakeholders (n = 30) to various nudge elements which could be used to support future food safety interventions. Key informant interviews demonstrated that the use of behavioural nudges were a common aspect of food safety interventions in the pork value chain in Hanoi and Hung Yen Province. Survey participants reported that when considering food safety, veterinarians and actors' peers were highly trusted, and reputation was thought to be an effective incentive to illicit behavioural change. During the workshop, stakeholders appeared aware of the major slaughter and retail contamination points and cited lack of access to improved infrastructure as the limiting factor in their ability to improve hygiene. Value chain actors reported positive responses to the concept of using posters containing photographic images as nudges and stipulated that media should reflect the local context and contain language framed to suit the target audience. We suggest that the findings of this study are used to create site specific nudges for the Vietnamese pork industry targeting key value chain actors, such slaughterhouse workers and traditional retailers, which should be tested in the field to investigate their effectiveness.

Mathew has worked as a small animal vet since qualifying in 2007 and is now studying for a Diploma in Garden Design. How does he find the time?