Formal and informal antimicrobial trade and usage in farmed animals of the urban area of Lomé, Togo

Abstract

Inappropriate antibiotic use in livestock is a key driver of antimicrobial resistance. Surveillance and prevention efforts in low-income countries are challenged by widespread informal sales and administration. We investigated the antibiotics trade network for farm animals and farmers' antibiotic purchasing and usage behaviors in an urban region with high human and animal population density and prevalence of antimicrobial resistance. We conducted semi-structured interviews with 116 farmers in Lomé, Togo, in areas where multidrug-resistant bacteria had been identified. Using multiple-factor analysis and hierarchical clustering, farmers were categorized based on their livestock production, antibiotic purchase and usage patterns, and alternative disease management strategies. Additionally, 44 antibiotic distributors were interviewed using snowball sampling, allowing us to reconstruct the distribution network and its key actors. Commercial poultry and dog farmers exhibited significantly higher antibiotic consumption per unit of livestock biomass than other farmers, seeking to secure their production. Smallholders used antibiotics less frequently, often replacing them with phytotherapy to minimize costs. Large-scale farmers sourced antibiotics from legal distributors, whereas smallholders combined legal and illegal sources. Market wholesalers and retailers, mostly women, were central to the illegal antibiotic trade, primarily supplied through cross-border smuggling. Our findings highlight the need for antimicrobial resistance prevention programs that consider farmers' specific antibiotic use behaviors and motivations. Addressing the illegal antibiotic trade requires a gender-sensitive approach, as women dominate informal distribution networks. Understanding these dynamics is crucial to designing effective interventions to curb antibiotic misuse and mitigate risks of antimicrobial resistance.

Keywords: Antibiotic trade, one health, informal distribution; Antimicrobial resistance; Antimicrobial usage; Antimicrobials; Livestock production.

Fig. 1

Characteristics of livestock and livestock farmers in the five clusters identified on the basis of survey data from the urban area of Lomé (February 2023–March 2024): animal species present (A); Total livestock biomass (TLU = tropical livestock unit) (B); Antibiotic usage and expenditures: Frequency of reasons for antibiotic usage by farmers (C) and boxplot representation of the cost of antibiotics per unit of biomass (D) in the five clusters of farmers identified on the basis of survey data from the urban area of Lomé (February 2023–March 2024).

Fig. 2

Antibiotic and advice sources by cluster: Frequency of sources of antibiotics (A) and sources of advice on health management (B) among livestock farmers in the five clusters identified on the basis of survey data from the urban area of Lomé (February 2023–March 2024).

Fig. 3

Alternatives: Alternatives to antibiotics known (A) and used (B) by farmers and reasons (C) and obstacles (D) to them in the five clusters of farms identified with the survey data from the urban area of Lomé (February 2023–March 2024). The number of farmers aware of the existence of alternatives to antibiotics is 9 (16.7 %) in cluster 1, 28 (93.3 %) in cluster 2, 2 (28.6 %) in cluster 3, 15 (78.9 %) in cluster 4, 2 (40.0 %) in cluster 5.

Fig. 4

Antibiotic distribution circuit supplying the farmers in the clusters identified on the basis of survey data from the urban area of Lomé (February 2023–March 2024). Diagrams A and B describe the supply of antibiotics to farmers in clusters 1 and 2 and to farmers in clusters 3, 4, and 5 respectively. Categories of distributors involved in the antibiotic supply are displayed with boxes with colors indicating the actors belonging to the formal veterinary (green), human health (yellow), or informal (red) sector. The width of the arrows indicates the relative quantitative importance of the flows of antibiotics between the categories of actors and the fractions of antibiotics distributed to farmers transiting through each category are indicated in percentage on the right of the category concerned. *Animal health expert: includes livestock veterinary auxiliaries (LVAs), veterinarians, and animal health technicians. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)