The University of Dodoma University of Dodoma Institutional Repository http://repository.udom.ac.tz
Social Sciences Doctoral Theses
2016 Supply systems and social networks determining access and use of antibiotics in livestock and their implications on antibiotics resistance in Ngorongoro district, Tanzania
Matunga, Benta Nyamanyi
The University of Dodoma
Matunga, B. N. (2016). Supply systems and social networks determining access and use of antibiotics in livestock and their implications on antibiotics resistance in Ngorongoro district, Tanzania (Doctoral thesis). The University of Dodoma, Dodoma. http://hdl.handle.net/20.500.12661/1741 Downloaded from UDOM Institutional Repository at The University of Dodoma, an open access institutional repository. SUPPLY SYSTEMS AND SOCIAL NETWORKS DETERMINING
ACCESS AND USE OF ANTIBIOTICS IN LIVESTOCK AND
THEIR IMPLICATIONS ON ANTIBIOTICS RESISTANCE IN
NGORONGORO DISTRICT, TANZANIA
By
Benta Nyamanyi Matunga
A Thesis Submitted in Fulfillment of the Requirements for the Degree of Doctor
of Philosophy of the University of Dodoma
The University of Dodoma
October, 2016
CERTIFICATION
The undersigned certify that they have read and hereby recommend for acceptance by The University of Dodoma a thesis entitled “Supply Systems and Social
Networks Determining Access and Use of Antibiotics in Livestock and their
Implications on Antibiotics Resistance in Ngorongoro District, Tanzania” in fulfilment of the requirements for the degree of Doctor of Philosophy of the
University of Dodoma.
Signature: ______
Dr. Rehema G. Kilonzo
(Supervisor)
Date: ______
Signature:
Prof. Joanne Sharp
(Supervisor)
Date: Date: 7th November 2016
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DECLARATION
AND
COPYRIGHT
I, Benta Nyamanyi Matunga, do hereby declare to the Senate of the University of
Dodoma that this thesis is my own original work and that it has not been submitted for a higher degree in any other University.
Signature ______
No part of this thesis may be reproduced, stored in any retrieval system, or transmitted in any form or by any means without prior written permission of the author or The University of Dodoma.
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ACKNOWLEDGEMENTS
I thank the Almighty God for his protection, blessings and bringing me up to this moment. I am grateful to the collaboration between University of Dodoma and
Glasgow through Antimicrobial Resistance (AMR) project for funding this work. I extend my gratitude to the National Science Foundation (DEB1216040) and
Biotechnology and Biological Sciences Research Council (BBSRC) for their support to AMR project to facilitate this study. I am also glad to express my sincere gratitude to my supervisors Dr. Rehema G. Kilonzo of the University of Dodoma whose valuable guidance, constructive criticisms and tireless efforts in giving me academic advice, something which has facilitated the completion of this work. Thanks to Prof.
Joanne Sharp of the University of Glasgow, Scotland who made efforts to build me a pathway to academic learning and logistics for funding. I thank my employer, the
University of Dodoma for granting me a study leave and support throughout this work. Special thanks should also go to the Regional Administration Secretary Office
Arusha Region and District Administration Secretary office Ngorongoro District for granting me permission to conduct research and to Dr. Miran B. Miran the District
Livestock Development Officer, Ngorongoro District for his valuable information and supportive contacts to Endulen Ward during my field work. My sincere thanks should also go to Mzee T. Sarmo and his family for support at Endulen ward also
Mr. Supuk and Mr. S. Kereto for translation and research assistance at Endulen and
Esere villages. I also thank Mr. O. Sorongo for organizing field activities and research assistance at Nainokanoka and Irkeepus villages. I thank Fr. Ngowi of
Endulen Parish and Sister Matola at Nainokanoka Dispensary for providing me with accommodation. Furthermore, I am grateful to Dr. E. Ichumbaki of Olduvai
Landscape Palaeo Anthropology Project (OLAPP) for transport support to Esere
v village during field work. My appreciation goes to Dr. P. Allando‘s family in Karatu and Dr. M. D. Matunga in Arusha for their support and encouragement during data collection.
I extend my gratitude to Dr. S. Matotola and Mr. Abdala for their support on data analysis. I also thank my friends J. Ndanga, A. M. Kitigwa, Ms. L. Bhogohe and Ms.
S. Maghashi for their encouragement, love, support and prayers throughout my study. Furthermore, I extend my special thanks to Prof. D. Mwamfupe and Dr. E.
Ngowi, for their nurturing, support, mentorship, friendship and positive criticisms that contributed to improvement and completion of this work. I also express my sincere gratitude to Prof. A. Tenge, Dr. V. George, Prof. P. Kopoka and Dr. A.
Mustafa for their valuable contributions. More special thanks go to respondents in
Enduleni, Esere, Nainokanoka and Irkeepus villages for providing crucial information for this study, village leaders and individuals consulted during the study.
Moreover, I express my sincere gratitude to all staff members of the Department of
Development Studies, School of Social Sciences, Graduate Studies of the University of Dodoma and Prof. A. Ame who provided valuable inputs and constructive criticism during the early stage of this work. I also express my thanks to all other people who, in one way or another, contributed to the success of this study. Last but not least, I express my deep and special gratitude to my beloved family members:
Sarah D. Wangwe, Haji Athuman, Richard Matunga, Emmanuel Matunga, Agnes
Daniel and my parents Mama Magdalina Naaman and Gaudensius Matunga as well as my sisters Nyanjira, Sophia, Constansia and Matilda for their prayers, love, moral support, encouragement and resilience throughout my ups and downs of the study time. Finally, all the short comings of this study remain my responsibility.
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DEDICATION
This thesis is dedicated to my loving family and friends. Also, to the inspirational memory of the late Dr. Michael Damas Matunga, my uncle who passed away towards the end of this work may his soul rest in peace. Amen.
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ABSTRACT
Antibiotics resistance is a global concern that presents a major threat to veterinary public health as it reduces the effectiveness of antibiotic treatment in livestock and people. Many studies on antibiotics resistance have been based mainly on microbiology, biomedical and veterinary sciences in laboratory test with little attention paid to social aspects. Based on pastoralist communities in Ngorongoro
District in Tanzania, the study examined how supply systems and social networks determine the access and use of antibiotics and their implications on antibiotics resistance. Specifically, the study sought to map out and examine how supply systems and social networks determine the access and use of antibiotics and to examine the implications of supply systems and social networks on antibiotics resistance.
The study used both quantitative and qualitative approaches involving survey, key informant interview, focus group discussion; participatory wealth ranking and observation methods. A sample size of 221 respondents and 21 key informants were involved in the study. Quantitative data were analysed using statistical package for social sciences computer software version 20. Qualitative data were analysed using content analysis. The findings revealed that supply systems have failed to provide adequate quality antibiotics and veterinary experts to impart proper knowledge, information, services and monitoring as well as regulatory control mechanisms for the distribution channel of antibiotics from the various sources to end users. This has forced end users to resort to strategies such as sharing antibiotics and knowledge on use of antibiotics. Among the important actors in social networks who determine access to and use of antibiotics include neighbours, friends, relatives, interest groups and traditional dealers. These actors are connected with social ties based on trust and reciprocity. However, they have limited knowledge on antibiotics handling and viii administration hence resulting into misuse of the drugs. This lack of knowledge has implications on antibiotics resistance. It is concluded that supply systems is associated with inadequate quality antibiotics, limited number of experts and limited knowledge of users of antibiotics. All these contribute to problem of antibiotics resistance. Therefore, social aspects are equally important in explaining antibiotics problem in livestock. It is therefore recommended that there should be capacity building to those who are involved in the supply systems and users on the proper access and use of antibiotics. Also, awareness creation to the public on the problem of antibiotics resistance should be part and parcel of the design and implementation of the livestock policy planning and interventions.
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TABLE OF CONTENTS
CERTIFICATION ...... i DECLARATION AND COPYRIGHT ...... iv ACKNOWLEDGEMENTS ...... v DEDICATION ...... vii ABSTRACT ...... viii TABLE OF CONTENTS ...... x LIST OF TABLES ...... xv LIST OF FIGURES ...... xvii LIST OF PLATES ...... xviii LIST OF ABBREVIATIONS OR ACRONYMS ...... xix
CHAPTER ONE: INTRODUCTION ...... 1 1.1 Introduction ...... 1 1.2 Background Information ...... 2 1.3 Statement of the Problem ...... 8 1.4 Objectives of the Study ...... 10 1.4.1 General Objective...... 10 1.4.2 Specific Objectives...... 10 1.5 Research Questions ...... 10 1.6 Rationale of the Study ...... 11 1.7 Significance of the Study ...... 12 1.8 Organization of the Work ...... 13
CHAPTER TWO: LITERATURE REVIEW ...... 15 2.1 Introduction ...... 15 2.2 Definition of Key Concepts ...... 15 2.2. 1 Antibiotic Supply Systems ...... 15 2.2.2 Social Networks ...... 16 2.2.3 Antibiotics Resistance ...... 17 2.2.4 Access to Antibiotics and Use...... 18 2.3 Theoretical Framework of the Study...... 18 2.3.1 Social Network Theory ...... 19 x
2.3.2 Social Exchange Theory ...... 23 2.3.3 Theory of Optimal Use of Antibiotics ...... 24 2.4 Empirical Literature Review ...... 25 2.4.1 Social Networks of Knowledge and Information Sharing ...... 26 2.4.2 The Importance of Social Networks at the Community level ...... 27 2.4.3 Resource Ownership, Control and Access to Antibiotics and Use ...... 29 2.4.5 Antibiotic Efficacy, Supply Systems and the Market Structure ...... 30 2.4.6 Policy and Regulations Governing the Supply Systems on Access to and Use of Antibiotics at the Community Level ...... 32 2.5 Conceptual Framework of the Study...... 35 2.6 Knowledge Gap ...... 38 2.7 Summary of the Chapter ...... 41
CHAPTER THREE: RESEARCH METHODOLOGY ...... 43 3.1 Introduction ...... 43 3.1.1 Scope of the Study ...... 43 3.2 Selection of the Study Location and Justification ...... 44 3.3 Socio–Economic Profile of the Study Area ...... 47 3.4 Research Design ...... 49 3.5 Methodological Approach ...... 50 3.5.1 Qualitative Approach ...... 51 3.5.2 Quantitative Approach ...... 51 3.6 Population of the Study ...... 52 3.7 Sampling Procedure and Sample Size Determination ...... 52 3.8 Types, Methods and Instruments for Data Collection ...... 54 3.8.1 Types of Data ...... 54 3.8.1.1 Primary Data ...... 54 3.8.1.2 Secondary Data ...... 55 3.8.2 Methods and Tools for Data Collection ...... 55 3.8.2.1 Survey Method ...... 55 3.8.2.2 Focus Group Discussion ...... 56 3.8.2.3 Participatory Wealth Ranking ...... 57 3.8.2.4 Interview ...... 58
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3.8.2.5 Observation ...... 58 3.9 Data Processing, Analysis and Interpretation...... 59 3.9.1 Analysis of Qualitative Data ...... 59 3.9.2 Analysis of Quantitative Data ...... 60 3.9.3 Validity and Reliability of the Study Instruments...... 62 3.9.3.1 Validity ...... 63 3.9.3.2 Reliability ...... 64 3.10 Ethical Considerations ...... 64 3.11 Study Limitation and Delimitation ...... 65 3.12 Summary of the Chapter ...... 67
CHAPTER FOUR: SOCIO-ECONOMIC PROFILE OF PASTORALISTS IN NGORONGORO DISTRICT ...... 69 4.1 Introduction ...... 69 4.2 Socio-Economic Profile of the Study Population ...... 70 4.2.1 Sex of the Respondents ...... 70 4.2.2 Age of the Respondents ...... 72 4.2.3 Marital Status of the Respondents ...... 73 4.2.4 Education Level of the Respondents ...... 74 4.2.5 Household Size ...... 76 4.2.6 Household Wealth Status ...... 77 4.2.6.1 Indicators Used for Wealth Status ...... 78 4.2.6.2 Household Annual Income ...... 80 4.2.6.3 Types of Livestock Herds in Ngorongoro District ...... 83 4.2.6.4 Trends of Livestock Production ...... 85 4.3 Common Livestock Diseases in Ngorongoro District ...... 87 4.4 Awareness of Users on Antibiotics Resistance in Ngorongoro District ...... 94 4.5 Indicators of Antibiotics Resistance by Users Perception ...... 96 4.6 Chapter Summary...... 107
CHAPTER FIVE: SUPPLY SYSTEMS DETERMINING ACCESS TO AND USE OF ANTIBIOTICS IN NGORONGORO DISTRICT ...... 109 5.1 Introduction ...... 109
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5.2 Types of Antibiotics Supplied to Users in the Ngorongoro District ...... 109 5.3 Sources of Antibiotics in Ngorongoro District ...... 110 5.4 Antibiotics Supply Chain in the Ngorongoro District ...... 110 5.4.1 Urban Based Suppliers of Antibiotics ...... 112 5.4.2 Rural Based Suppliers of Antibiotics ...... 113 5.5 Chapter Summary...... 124
CHAPTER SIX: SOCIAL NETWORKS DETERMINING ACCESS TO AND USE OF ANTIBIOTICS IN NGORONGORO DISTRICT ...... 126 6.1 Introduction ...... 126 6.2 Actors Determining Access to and Use of Antibiotics in Social Networks ...... 127 6.3Ties in Social Networks ...... 129 6.3.1 Friendship Ties ...... 132 6.3.2 Kinship Ties ...... 134 6.3.3 Neighbourhood Ties ...... 134 6.3.4 Trust and Reciprocity Norms ...... 135 6.3.5 Age Set Ties ...... 136 6.3.6 Ties Based on Service Provision ...... 137 6.4 Operation of Social Networks in Ngorongoro District ...... 137 6.5 Sources of Knowledge and Information on Antibiotics Availability and Usage 138 6.6 Types of Antibiotics Commonly Shared and Used ...... 143 6.7 Multiple Logistic Regression Model for the Access and Use of Types of Antibiotics ...... 153 6.7.1 Multiple Logistic Regression Model for the use of Penstrep ...... 154 6.7.2 Multiple Logistic Regression Model for the Use of Tylosine ...... 155 6.7.3 Multiple Logistic Regression Model for the use of Tetracycline and Sulpha. 157 6.8 Chapter Summary...... 159
CHAPTER SEVEN: IMPLICATIONS OF THE SUPPLY SYSTEMS AND SOCIAL NETWORKS ON ANTIBIOTICS RESISTANCE IN NGORONGORO DISTRICT ...... 161 7.1 Introduction ...... 161 7.2 Implications of the Supply Systems on Antibiotics Resistance ...... 161
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7.2.1 Lack of Implementation of By-Laws and Regulations Governing Access to and Use of Antibiotics in Livestock ...... 162 7.2.2 Limited Expert Advice ...... 163 7.2.3 Low Level of Antibiotics Supply ...... 165 7.2.4 Low Level of Awareness of Suppliers on Antibiotics Resistance ...... 168 7.3 Implications of Social Networks on Antibiotics Resistance ...... 169 7.3.1 Sharing of Antibiotics among Users ...... 170 7.3.2 Sharing of Knowledge and Information on Antibiotics Usage ...... 172 7.3.3 Self Belief and Confidence ...... 175 7.3.4 Sharing of Common Resources–Water and Pasture ...... 176 7.3.5 Sharing Livestock for Care ...... 177 7.3.6 Sharing Livestock Market ...... 177 7.3.7 Low Level of Awareness of the Users on the Problem of Antibiotics Resistance ...... 180 7.4 Chapter Summary ...... 181
CHAPTER EIGHT: SUMMARY, CONCLUSION AND RECOMMENDATIONS ...... 185 8.1 Introduction ...... 185 8.2 Summary ...... 185 8.2.1 General Summary of the Study ...... 185 8.2.2 Summary of the Key Findings ...... 189 8.3 Conclusion ...... 192 8.4 Recommendations ...... 193 8.4.1 Policy Recommendations ...... 194 8.4.2 Recommendations for Further Research ...... 195 REFERENCES ...... 197 APPENDICES ...... 215 Appendix 1: Questionnaire for Household Survey in Pastoral Community ...... 215 Appendix 2: Interview Guide for Key Informants (Village leaders and elites) ...... 228 Appendix 3: Interview Guide for Key Informants (Veterinary Experts) ...... 230 Appendix 4: Interview Guide for Key Informants (Suppliers) ...... 231 Appendix 5: Checklist for Focus Group Discussion ...... 232
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LIST OF TABLES
Table 3-1: Number of Livestock in Study the Villages ...... 49 Table 3-2: Sample Size Involved in the Study ...... 54 Table 4-1: Percentage Distribution of the Respondents by Sex, Age and Marital Status ...... 71 Table 4-2: Level of Education and Household Size by Wealth Category ...... 74 Table 4-3: Indicators for Wealth Status Based on Size of Livestock ...... 79 Table 4-4: Wealth Categories Based on Cattle Size ...... 80 Table 4-5: Annual Income and Household Expenditure in Livestock by Wealth Status ...... 82 Table 4-6: Mean, Minimum and Maximum Size of Livestock ...... 85 Table 4-7: Reasons for the Decreased Trend of Livestock Production by Type of Livestock ...... 86 Table 4-8: Common Diseases Affecting Cattle in Ngorongoro District ...... 89 Table 4-9: Proportion of Livestock which Do Not Respond to Treatment and Hence Die ...... 99 Table 4-10: Mean and 95 % Confidence Interval of Number of Cattle, Goats, Sheep and Donkeys that Do Not Respond to Treatment with Antibiotics ...... 102 Table 4-11: Mean and 95 % Confidence Interval of Number of Cattle, Coats, Sheep and Donkeys that Die after Treatment with Antibiotics ...... 104 Table 4-12: Measures Taken by Users on Non-Response to Treatment ...... 106 Table 5-1: Sources of Antibiotics in Ngorongoro District ...... 121 Table 6-1: Actors in Social Networks and Their Roles in Access to and Use of Antibiotics ...... 128 Table 6-2: Sources of Information on Antibiotics Availability in Ngorongoro District139 Table 6-3: Sources of Knowledge on Antibiotics Administration and Use ...... 143 Table 6-4: Common Antibiotics Used According to Wealth Status ...... 144 Table 6-5: Reasons for the Choice of Antibiotics by Type of Drugs ...... 147 Table 6-6: Types of Antibiotics Commonly Shared By Wealth Categories ...... 151 Table 6-7: Rate of Receiving or Giving Antibiotics to Others ...... 152 Table 6-8: Parameter Estimates, Standard Error and Adjusted Odds Ratio of the Logistic Regression Model for the Access and Use of Penstrep ...... 154
x v
Table 6-9: Parameter Estimates, Standard Error and Adjusted Odds Ratio of the Logistic Regression Model for the Access and Use of Tylosin ...... 157 Table 6-10: Parameter Estimates, Standard Error and Adjusted Odds Ratio of the Logistic Regression Model For the Access and Use of Tetracycline and Sulpha ...... 158 Table 7-1: Level of Antibiotics Supply in Ngorongoro District ...... 166 Table 7-2: Reasons for Not Seeking Veterinary Expert Advice ...... 174
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LIST OF FIGURES
Figure 2-1: Conceptual Framework on Supply Systems and Social Networks Determining Access, Use and Antibiotics Resistance in Ngorongoro District ...... 37 Figure 3-1: Map of the Greater Serengeti Ecosystem Showing the Study Villages .. 45 Figure 4-1: Level of Awareness of Users on Antibiotics Resistance ...... 94 Figure 4-2: Awareness on the Extent to Which Antibiotics Resistance Occurs in Ngorongoro District ...... 96 Figure 5-1: Supply Chain of Antibioticsi in Ngorongoro District ...... 111 Figure 6-1: Actors in Social Networks in Ngorongoro District ...... 133 Figure 6-2: Operation of Social Networks ...... 138 Figure 7-1: Implications of Supply Systems on Antibiotics Resistance ...... 167 Figure 7-2: The Rate of Combining Livestock Herds with Others ...... 176 Figure 7-3: Implications of Social Networks on Antibiotics Resistance ...... 179
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LIST OF PLATES
Plate 4-1: Interaction between Wild Animal and Livestock by Sharing Pasture ...... 93 Plate 5-1: One of the Drug Suppliers at Esere Village...... 115 Plate 5-2: Pastoralist Asking for Drugs at an Open Market in Nainokanoka Village116 Plate 5-3: A Drug Seller at Irkeepus Village Waiting for Buyers...... 117 Plate 7-1: Maasai Pastoralists Sharing Open Livestock Market in Nainokanoka Village ...... 178
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LIST OF ABBREVIATIONS OR ACRONYMS
ABR Antibiotics Resistance
CBPP Contagious Bovine Pleuropneumonia
CAHWs Community-based Animal Health Workers
DALDO District Agriculture and Livestock Development Officer
DFID Department for International Development of United
Kingdom
ECDC European Centre for Disease Prevention and Control
FAO Food and Agriculture Organization
FGD Focus Group Discussion
FSA European Food Safety Authority
GARP Global Antibiotics Resistance Partnership
GSE Greater Serengeti Ecosystem
Ha Hectares
HBS Household Budget Survey
HH Household
IRENA International Renewable Energy Agency
Kg Kilogramme
MDGs Millennium Development Goals
NBS National Bureau of Statistics
NSGRP National Strategy for Growth and Reduction of Poverty
REPOA Research on Poverty Alleviation
SADC South African Development Cooperation
Sq km Square Kilometre
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SSA Sub–Saharan Africa
SUA Sokoine University of Agriculture
TAS Tanzanian Shillings
TCU Tanzania Commission for Universities
UDOM University of Dodoma
UN United Nations
UNDG United Nations Development Group
URT United Republic of Tanzania
USAID United States Agency International Development
USFDA United States Food and Drug Administration
WB World Bank
WHO World Health Organization
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CHAPTER ONE
INTRODUCTION
1.1 Introduction
This study is on supply systems and social networks determining access, use and antibiotics resistance to livestock in Ngorongoro District, Tanzania. It is part of a collaborative research project on antimicrobial resistance involving the United
States, United Kingdom and research institutions in Tanzania, including the
University of Dodoma. The project title is ―Ecological and Socio–economic Factors
Impacting Maintenance and Dissemination of Antibiotics Resistance in the Greater
Serengeti Ecosystem‖. The long-term goal of the project is to identify the ecological and socio–economic drivers that contribute to maintenance and dissemination of information on antibiotics resistance. Specifically, the project seeks to understand how antibiotics resistance is impacted by patterns of connectivity within and between communities, arising from shared resources such as water; population density and its effect on interactions between human and livestock, as well as animal movements, via trade between communities.
The project is important in the country because it gathers the biological, epidemiological and socio-economic analyses that allow development of a framework that combines technical, economic and social outcomes of drivers that promote and maintain resistance to antibiotics.
1
The framework also, allows identification of positive, neutral and negative aspects of antibiotics use in communities to guide policy development in broader societal context of matching safe and stable food supply and sustainable livestock farming with human health as noted by Matthews (2012).
This study contributes knowledge to the project objective on socio–economic drivers for antibiotics resistance in the Greater Serengeti Ecosystem. There is a common pattern of access to and use of antibiotics in livestock without prescriptions due to limited availability of well-organized livestock health services as revealed by
Mshana et al. (2013) and Kambarage et al. (2003). This results into drug resistance problem that occurs as a natural phenomenon or due to the pattern of antimicrobial use. In the Greater Serengeti Ecosystem especially in Ngorongoro District, the problem is becoming widespread in such a way that not only livestock are affected but also human beings and wildlife. This happens due to interactions among human beings, livestock and wild animals. Many studies have been conducted based on biomedical and veterinary sciences in laboratory tests for resistance, but have ignored the social aspects such as antibiotics supply systems and social networks thus contributing to access, use and antibiotics resistance. The purpose of this study was therefore, to examine how the antibiotics supply systems and social networks determine the access and use and their implications on antibiotics resistance in
Ngorongoro District.
1.2 Background Information
Antibiotics are commonly used in animal husbandry for a number of reasons, including growth promotion, treatment of sick animals and prophylactic treatment of healthy animals during periods of stress (Millar, 2010; Kreisberg, 2009; Mathew et
2 al., 2007; Levy and Marshall, 2004; Redding et al., 2014). Currently, antibiotics have become the most necessary tool used to control many dangerous bacterial infections. However, according to WHO (2013) report on antimicrobial resistance in media centre, the more often bacteria are exposed to antibiotics, the more likely they are to survive and become resistant. In view of this, both animals and human beings are being affected due to frequent use of antibiotics.
Antibiotics resistance has become one of the global concerns and an increasing challenge to public health worldwide (Call et al., 2013). Increasing resistance to antibiotics also presents a major threat to veterinary public health as it reduces the effectiveness of antibiotic treatment, hence leading to increased illness and deaths in animals, especially livestock (USFDA, 2011; Davies, 2006; Hambly, 1996). The emergence of antibiotics resistance is largely attributed to irrational use of drugs in medical and veterinary practices, food industries, agriculture and in communities as noted by Bbosa, and Mwebaza (2013); Ilić et al., (2011). Irrational use of drugs involves misuse of drugs, including prescription at an incorrect dose, frequent use, or duration, redundant, or when such drugs have the potential for adverse interactions with other drugs as explained by Chandy (2008) in India. Although the problem of antibiotics resistance has spread all over the world, it affects especially the poor and developing nations much harder than developed ones (Okeke et al., 1999; Dungu, et al., 2013). This is because, antibiotics are much easier to obtain and use without a prescription in many of these countries therefore, revealing irrational use. On the contrary, their access and use is more limited in the developed world as revealed by
Okeke et al. (1999) and Dungu, et al. (2013). In Brazil, for example, antibiotics can be bought over-the-counter; therefore leading to self-medication and this contributes for antimicrobial resistance (Rossi, 2010). Rossi further reported that Brazil and 3
Latin American countries, in general, have higher levels of bacterial resistance among most of their key pathogens, compared with Europe and the United States.
The problem of antibiotics resistance is widespread in Africa too and, the burden of responsibility in seeking and applying technical solutions to animal health rests heavily on official livestock and veterinary services as asserted by Anteneh (1989).
Many rural areas in Africa are characterized by limited or lack of access to such veterinary services (Catley et al., 2004) as a result, prescription by health professionals is minimally done. Antibiotics are chosen based on the set criteria by the users including the place of manufacturer without proper prescription (Catley et al. 1997). In situations where there is limited access to antibiotics, livestock keepers rely on various sources of antibiotics that are within their reach. These sources include friends, relatives, neighbours and drug suppliers in their area. As such, these users do not obtain appropriate knowledge on the types of drugs, dosage and types of diseases to be treated. Inappropriate access and use of antibiotics can enhance the likelihood of adverse events associated with antibiotics, including the promotion and dissemination of bacterial resistance as argued by Colgan and Powers (2001).
In Sub–Saharan Africa, limited animal health services, associated with the scarcity of qualified livestock health experts are poorly sustained and run-down livestock health care facilities which as a result, encourage fraudulent drugs (Nweneka et al., (2009).
In places where livestock health care facilities are available, the costs involved prevent access to such services (Dungu, et al., 2013; Okeke, 2010; Byarugaba, 2004;
Levy and Marshall, 2004; Mandomando et al., 2010; Nweneka et al., 2009; Planta,
2007; Okeke et al., 1999). In addition, reliable evidence shows that many traditional healers in some parts of Africa add antibiotics to some of the local brews and the
4 residues are given to livestock as a feed (Okeke et al., 1999). The effects of such antibiotics, in combination with other ingredients accumulate in the system of the livestock, thus increasing the chances of resistance development (Okeke et al., 1999;
Okeke, 2010). Other places in Africa have the trained livestock health assistant such as community–based animal health workers (CAHWs), but livestock keepers prefer to administer drugs by themselves as revealed by Bett et al., (2008) in Kenya. This can lead to misuse of drugs such as under or over dose thus resulting into more risks of antibiotics resistance.
Chances of antibiotics resistance in Tanzania as one of the developing countries, is also high. Evidence suggests that excessive and inappropriate antibiotics access and use, which leads to drug resistance, is a widespread problem affecting both human and livestock in the country (GARP–Tanzania Working Group, 2015; Sosa et al.,
2010). The access and use of antibiotics are contributed to by unexplored social networks and supply systems at the community grassroots level.
High mortality rate has been among the factors that hinder production of livestock in the country (Dungu et al., 2013). Such levels of livestock mortality contribute to an increase in poverty and malnutrition to people whose livelihoods depend on the livestock sector. Prevention and control programmes against diseases have been set up and implemented by veterinary professionals in collaboration with private veterinarians (URT, 2011; Gustafson et al., 2015). The veterinary medicinal products most commonly used to treat these diseases are antibiotics. Hepeng (2008) reported that, any un-prescribed use of antibiotics contributes to overuse of the drug.
However, the factual concern is counterfeit drugs which have given rise to growing market for cheap generic drugs, mostly from Asia and South-East Asia with no
5 regulation of the industry in sight. The liberalization of the veterinary profession on one hand, and the low purchasing power of most livestock keepers such as pastoralists, on the other hand, have led to fraud and counterfeiting of antibiotics and their incorrect use (Viberg et al., 2010; WHO, 2007). Counterfeit or substandard drugs have penetrated many market places in Africa as reported by Kingsley (2015a) and Kingsley (2015b) in Nigeria.
In Tanzania, treatment and handling of livestock infectious diseases rests in the hands of untrained drug suppliers, pastoralists, owners of implements shops and untrained personnel (Katakweba, et al., 2012; Carlos, 2010). Studies by SUA/UCPH
(2014); Mshana et al. (2013) and Kambarage et al., (2003) in the Greater Serengeti
Ecosystem revealed that individuals buy antibiotics from private suppliers to treat their livestock without prescription from veterinarians. This is because, these livestock keepers lack access to professional veterinary services within their close proximity. In most cases, they cannot afford to pay for the services. However, above all, they are confident with the knowledge and information they acquire through social networks as it is in case of the pastoralist communities in Ngorongoro District.
In this area, it is evident that unauthorized access and use of antibiotics is common in veterinary settings. Furthermore, a study done by SUA/UCPH (2014) reveals that, selling antibiotics in livestock implements shops and livestock open markets is done by untrained personnel and suppliers who sometimes sell expired antibiotics or under dose the animals. Buyers of antibiotics in this case, pastoralists, do not receive written guidelines showing instructions for use.
Pastoralists require antibiotics for treatment and control of livestock diseases (URT,
2010). The prevalence of various diseases in the area and the limited availability of
6 livestock health services are common as revealed by Katakweba, et al. (2014). The availability and accessibility of antibiotics are determined by the antibiotics supply systems at the community level where there is no well-coordinated distribution of drugs to livestock keepers such as pastoralists. The system is driven by social networks of relationships and interactions among people at the community level who access and use antibiotics without prescriptions.
A study by SUA/UCPH (2014) also shows that, pastoralists are not aware of possible human health threats that are caused by the use of antibiotics in livestock. This can lead to an increased problem of antibiotics resistance in both animals and human beings, therefore resulting into increased mortality rates of people and livestock.
Furthermore, the major factors to ease access and use of antibiotics at the community level are associated with the supply systems and social networks that had not been explored clearly by scholars.
Social networks involve the sharing of knowledge, information and resources while connected and interacting to access and use antibiotics in livestock. Contractor
(2000) suggests that, knowledge networks are built on the existence of social networks in a community. (ibid) further argues that, each individual within the community participates in a number of social networks, which are critical resource in building teams and in transmitting and maintaining knowledge or information. Such interactions between community members with their neighbourhoods have an influence in the access to and use of antibiotics which are supplied from various sources, thus leading to the dissemination of antibiotics resistance traits at the community level. This is revealed in Ngorongoro District where the study was
7 conducted, that such inappropriate access and use of antibiotics without prescription through social networks is common. This can lead to drug resistance problem.
The problem in Ngorongoro District is widespread in such a way that not only livestock are being affected but also human beings and wildlife due to their interactions. The way these interactions encourage antibiotics resistance is not clearly known, especially in the Ngorongoro District where pastoralist communities tend to use the modern antibiotics for livestock. Therefore, this study aimed to uncover the information on how the supply systems of antibiotics and social networks determine access and use and their implications on antibiotics resistance in
Ngorongoro District.
1.3 Statement of the Problem
Tanzania, like any other countries in the developing world, has been facing the problem of antibiotics resistance following inappropriate accessibility and use of drugs in both livestock and people (GARP –Tanzania working group, 2015; Sosa et al., 2010). Studies conducted by Lembo et al. (2011) and SUA/UCPH (2014) in the
Greater Serengeti Ecosystem revealed that a high prevalence of bacteria causing diseases and resistance was recorded in livestock and people. In response to this, the government has made various efforts to address such problem including the development of the Livestock Policy (2006). One of the aims was to provide support and promote privatization of veterinary services through community-based animal health workers (CAHW). Other efforts include the formulation of the Livestock
Sector Development Strategy (2010) and Rural Development Strategy (2001) which encourage public/private investments in the livestock value chain (URT, 2001; URT,
2006; URT, 2010). Furthermore, various vaccination programmes to control
8 contagious diseases caused by bacteria in livestock have been established
(PANVAC, 2011; Mshana et al., 2013).
To a large extent, these efforts have not been successful in eradicating the problem of livestock diseases, emanating from antibiotics resistance in the country (Mshana et al., 2013). Part of the reason is that the existing channels to provide the antibiotics are not well organized. This has forced pastoralists to establish their own efforts by resorting to existing supply systems, social networks and using their own resources available to access and use antibiotics in their livestock. Through supply systems and social networks, pastoralists share knowledge, information and resources to access and use antibiotics for the purpose of treatment of livestock. This can result into more risk of antibiotics resistance at the community level and this has not been fully given attention for both investigation and interventions.
Antibiotics resistance has been explained mainly as a natural phenomenon whereby experts agree on the positive link between antibiotics use and resistance. These are based mostly on biomedical and veterinary science in laboratory tests which discover antibiotics resistance traits in livestock and wild animals but ignoring the social aspects such as the supply systems and social networks (Levy and Marshall; 2004;
Wang and Schaffner, 2011). This can be a source of the problem of antibiotics resistance in livestock.
Studies concerning antibiotics resistance problem have tended to be purely scientific, based mainly on microbiological and biomedical as well as veterinary sciences in laboratory test results which discover the antibiotics resistance traits in livestock and wild animals (Levy and Marshall, 2004; Wang and Schaffner, 2011). However, the social aspects by which antibiotics are supplied, accessed and used through the 9 supply systems and social networks, have received far less scholarly consideration and to be precise, have been ignored. This can be a source of antibiotics resistance problem to livestock that needs attention. This study, therefore, aimed at exploring and examining how supply systems and social networks determine access and use of antibiotics and their implication on antibiotics resistance in Ngorongoro District in
Tanzania.
1.4 Objectives of the Study
1.4.1 General Objective
The overall objective of this study was to explore and examine how supply systems and social networks determine the access and use of antibiotics in livestock and their implication on antibiotics resistance in Ngorongoro District.
1.4.2 Specific Objectives
This study specifically aspired to:
i. Examine how supply systems determine the access and use of antibiotics in
Ngorongoro District.
ii. Map out and examine how social networks determine the access and use of
antibiotics in Ngorongoro District
iii. Examine the implications of supply systems and social networks on
antibiotics resistance in Ngorongoro District
1.5 Research Questions
The basic questions which were addressed by the study include:
a. What are the existing supply systems and how do they determine access and
the use of antibiotics in Ngorongoro District? (The key actors in supply
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systems, sources of antibiotics, types of antibiotics supplied, antibiotic supply
chain)
b. What are the existing social networks and how do they determine access and
use of antibiotics in livestock in Ngorongoro District? (Actors and associated
ties in social networks, sources of knowledge and information; sharing of
antibiotics; sources of antibiotics; types of antibiotics shared, operations of
social networks)
c. What are the major implications of supply systems and social networks on
antibiotics resistance in Ngorongoro District? (Implications of supply systems
and implications of social networks on antibiotic resistance).
1.6 Rationale of the Study
In Tanzania, the majority of pastoralists traditionally depend on livestock keeping as one of the major economic activities. In Ngorongoro District, pastoralists and their livestock interact with wild animals. These interactions cause transmission of diseases to human beings, livestock and wildlife alike. The persistence of livestock diseases forces pastoralists to access and use antibiotics through the supply systems by obtaining antibiotics, information and knowledge from untrained personnel Also through social networks by sharing antibiotics, inappropriate knowledge and information for the treatment of their livestock without prescription. This leads to the transmission of resistant bacteria from one host to another.
Poor handling and storage of antibiotics also lead to a rapid spread of antibiotic resistant bacteria in livestock and people. Inappropriate access and use of antibiotics due to little knowledge and information without prescription from veterinary experts, including under dosage or over dosage and due to low purchasing power, results in
11 the development of resistance to drugs used. Improper use of antibiotics in livestock is evident in our country; some of the practitioners in the supply systems are not well trained and others prescribe drugs that are not related to the disease. This also serves as a source of drug resistance especially antibiotics.
Most of the studies which have been conducted involved detection of antibiotics resistance traits in livestock and human beings in the laboratory or hospital settings.
However, limited studies, if any, have been conducted to examine how the supply systems and social networks determine the access and use of antibiotics in livestock as consequence to antibiotics resistance.
1.7 Significance of the Study
The importance of this study rests on: First, providing scholarly information on how the antibiotics supply systems and social networks determine the access and use of antibiotics. Second, it contributes to scholarly literature on the theories. Third, it provides information to development policy and planners especially livestock policy as well as the veterinary sector operators, on how to address the problem of antibiotics resistance in Ngorongoro District in the Greater Serengeti Ecosystem and the country at large. Finally, an understanding of these factors facilitates more effective administration and handling of antibiotics and aid in the development interventions.
The study aligns with development of thematic priorities, especially in rural community development because the livestock sector is of critical importance to the economy and wellbeing of the people in the rural areas of Tanzania. This is also because rural community development encompasses a range of approaches or activities including livestock keeping that aim to improve the welfare and livelihoods 12 of the people living in rural areas. The study pays attention to social issues including interactions and relationships (ties) that enable them to attempt to solve their own problems. For instance, access and use of antibiotics in livestock through social networks is one of the ways in which pastoralists try to solve livestock health problems. However, the access and use of antibiotics without proper channels of prescription from livestock health experts results in more problems, not only to livestock development, but also to people and wildlife as well. Therefore, the information from the study provides the awareness through multidisciplinary approaches that should be created to all stakeholders of the livestock sector and public health on the risk associated with improper ways of antibiotic access and use in livestock in order to establish appropriate means of antibiotic stewardship to improve public health for rural development and poverty reduction.
1.8 Organization of the Work
This work is organized into eight chapters. Chapter one provides background information on the study, statement of the problem, general and specific objectives, the study questions and the significance of the study. Chapter two presents the theoretical basis for the study, empirical information, the overall framework and the knowledge gap. Chapter three covers the methodological aspects of the study which indicate how the study objectives were achieved, data collection methods and statistical procedures for the analysis. Chapter four provides a detailed description of socio-economic profile of households, addressing the ways they are related to antibiotics access and use and the implication to antibiotics resistance.
Chapter five presents the findings on how the supply systems determine access and use of antibiotics. Chapter six presents findings and discussions on how social
13 networks determine access and use of antibiotics. Chapter seven provides discussions on the implications of the supply systems of antibiotics and social networks on antibiotics resistance. Chapter eight gives the conclusions, recommendation and suggestion of areas for further study.
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CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
This chapter presents a review of theoretical and empirical literature related to the study topic. It covers the definition of key concepts and terms, theoretical framework which provides the basis to establish the conceptual framework of the study. This chapter also states the knowledge gap which the study aspired to fill, as well as the conceptual framework indicating the variables and their relationships. Finally, the summary of the discussed issues is presented.
2.2 Definition of Key Concepts
Concepts in social sciences often do not have a single meaning. Consequently, the same concept can be defined differently in different perspectives. The concepts defined in this section include antibiotics supply systems, social networks, antibiotics resistance, antibiotics accessibility and use, as well as antibiotics access and use.
2.2. 1 Antibiotics Supply Systems
Supply systems of antibiotics are the ways in which antibiotics get to people for use in livestock. People can get antibiotics from private suppliers such as drug vendors, shops, companies, the government and non–government organizations. This can be through purchasing or getting them free from others by sharing or in whatever means. The supply systems in this study also involve those who take part in the supply of antibiotics at the community level.
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In Tanzania for example, sometimes antibiotics are sold against regulations and without prescriptions in private drugstores and retail drug suppliers in rural areas in which some of them are unqualified individuals (Viberg et al. 2010). Given this reality, the study was interested to examine the nature of the supply systems in the in
Ngorongoro District.
2.2.2 Social Networks
A social network is a set of nodes (called actors) along with a set of ties of specified type (such as friendship) that link people (Borgatti and Halgin, 2011). Nodes are often individuals or collective individuals (e.g., corporate boards, families, organizations, nations). Halgin (2012) argues that, a social network is a social structure made up of individuals (or organizations) called "nodes", which are tied by one or more specific types of interdependency, such as friendship, kinship, common interest, financial exchange, dislike, sexual relationships, or relationships of beliefs, knowledge or prestige. Fesenmaier and Contractor (2001) explain that social networks are not what we know, but whom we know in the community whereas knowledge networks represent who knows what at the community level. In this case, nodes (actors) are individuals who access and use antibiotics as well as the sources of antibiotics supply. Social networks involve sharing of knowledge, information, antibiotics and experience about the access and use of antibiotics, in relation to the supply systems of antibiotics among the community members that can enhance appropriate or inappropriate use, resulting into antibiotics resistance (Sosa et al.,
2010).
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2.2.3 Antibiotics Resistance
Antibiotics are substances used to kill bacteria causing diseases or to stop them from growing and multiplying. They are commonly used in human and veterinary medicine to treat a variety of infectious diseases (Guardabassi and Kruse, 2008). The overuse or misuse of antibiotics has been linked to the emergence and spread of micro–organisms which are resistant to them, thus rendering treatment ineffective and posing a serious risk to public health (Laxminarayan and Brown, 2000).
Antibiotics resistance is the ability of bacteria to resist the effects of an antibiotic to which they were once sensitive (WHO, 2013; Davis, 2012; Millar, 2010; Sahoo,
2008; Levy and Marshall, 2004; Laxminarayan and Brown, 2000). Antibiotic resistance is when an antibiotic loses its ability to effectively control or kill bacterial growth. This causes a prolonged illness to people and livestock, meaning that antibiotics resistance can delay and hinder treatment which leads to more complicated illnesses and even death of people and livestock caused by bacterial infections. In development context, resistance also makes people use stronger and more expensive antibiotics hence resulting to poverty (IRENA and WHO, 2014;
USFDA, 2011). Antibiotics resistance can be due to misuse of antibiotics in both livestock and animals that contribute to the emergence, persistence and spread of resistant bacteria. Unreasonable use of antibiotics can also lead to antibiotics resistance (USFDA, 2011). Scientific expert bodies concluded that there is a connection between irrational use of antibiotics in animals and resistance (Chandy,
2008).
In this study, the indicators which were used to explain the antibiotics resistance problem included health status of livestock number of livestock that continue to get
17 sick (persistent ill–health) in spite of antibiotic administration and the number of livestock that died after the treatment by antibiotics.
2.2.4 Access to Antibiotics and Use
An access to antibiotic is having antibiotic medicines continuously available and affordable at the public or private health facilities or medicine outlets that are within one hour‘s walk from the homes of population (UNDG, 2003). Access to antibiotics also includes availability (physical access), affordability (economic access), geographical accessibility and acceptability (social–cultural access) crossly linked with safe, efficacious, quality and cost–effectiveness (Jacobs et al., 2011; Kabandika,
2012). The way in which pastoral communities obtain antibiotics and utilize them for various purposes such as treatment of illness, prevention of diseases or for growth promotion in livestock, is termed as access and use. The ways of obtaining antibiotics can be through sharing with friends, neighbours, relatives and from various other sources at the community level.
2.3 Theoretical Framework of the Study
This section provides background information on theories that guided the study and applied as a ―lens‖ to the understanding of the phenomenon. The theoretical framework identifies the existing gap that needs to be addressed. This is in line with
Anfara and Mertz (2006) who point out that, a theoretical framework is an empirical or quasi-empirical theory of a social process at a diversity of levels that is applied to the understanding of the phenomenon. Theory, in this study, puts together all the isolated bits of empirical data into a coherent conceptual framework of wider applicability as suggested by Cohen, et al. (2000).
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The examination of social networks comprises of the sharing of knowledge, information and resources including antibiotics through interactions associated with supply systems. This determines the access and the use of antibiotics in livestock, therefore resulting into risks of antibiotics resistance. Various theories were used as a lens to guide the study. These theories included: social network theory, social exchange theory and the theory of optimal use of antibiotics. Generally, these theories contribute to the body of existing knowledge in understanding the situation and come out with appropriate suggestions for interventions.
2.3.1 Social Network Theory
Social network theory is built on Granovetter‘s theory of strong and weak ties (1973) and Granovetter (1983) which stipulates that the degree of overlap of two individuals‘ friendship networks varies directly with the strength of their tie to one another. Granovetter (1983) argues that, weak ties are less likely to be socially involved with one another than strong ties (close friendship). Whereas strong ties tend to bind cliques1 of individuals and primarily convey within–group knowledge, weak ties bridge cliques and is, therefore, sources of new knowledge (Granovetter,
1973). Granovetter further argues that, most social network models deal implicitly with strong ties, thus confine their applicability to small well defined groups.
Granovetter (1983) stresses that, strong ties in a close network where everyone knows each other, information is shared and so potential sources of information are quickly stunned down. Thus, the network quickly becomes futile in terms of access to new information. According to (ibid), weak ties in social networks are superior to strong ties for providing support for example, in getting a job. Borgatti et al (2014)
1 A clique is defined in Social Network Analysis as a ―maximal complete sub-graph of three or more nodes, all of which are adjacent to each other, and there are no other nodes that are also adjacent to all of the members of the clique,‖ (Wasserman & Faust 1994). 19 argue that, although Granovetter‘s (1973) theory on the strength of weak ties depends crucially on the distinction between strong and weak ties, therefore, the rationale behind the theory is not so much about the type of tie as it is about the different network structures surrounding these ties.
Brass (2012), however, noted that strong ties are thought to be more influential, more motivated to provide information and of easier access than weak ties. Knowledge sharing in networks requires strong ties (Hansen, 1999; Dyer and Nobeoka, 2000). In addition, Burt (2000) argues that, information circulates more within than between groups or community. The individuals with few weak ties will be deprived of information from distant parts of the social system and will be confined to the provincial news and views of their close friends.
Brass (2012) further argues that, social networks of relationships provide opportunities and constraints that affect the outcomes of individuals and groups. The structure of social networks builds around the positions and roles of the involved actors and the ties that exist between them. An important distinction in social network theory is made between strong and weak ties, i.e. the frequency or intensity, also termed ‗quantity‘ of ties.
Granovetter (1983) further argues that, throughout their lives, people tend to form different kinds of relationships with different people, for instance, with greatest allies, closer relatives and friends. People at the community level establish strong ties that reinforce their beliefs and provide them with the support required to endure life‘s challenges. With other people, with whom they usually do not have such in-depth connections, they develop weaker ties that help to address a larger variety of perhaps more specific needs. Even though people usually do not pay much attention to weak 20 ties, some literature articulates that it is through weak ties that one normally becomes aware of new opportunities and hence broadening their perspectives (Burd, 2002).
Social networks analysis views social relationships in terms of network theory consisting of nodes and ties (also called edges, links, or connections) (Borgatti et al.,
2009; Borgatti and Halgin, 2011; Halgin, 2012). Nodes are the individual actors within the networks, and ties are the relationships between the actors (Halgin, 2012).
In social networks, the nodes represent actors who are individuals, groups and organizations. Actors can be connected on the basis of: similarities such as same location, membership in the same group or similar attributes such as gender (Bridge,
2002; Devereux and Getu, 2013). Social relations such as kinships, roles and affective relations as friendship involve interactions including talks with, giving advice to and flow of information (Borgatti et al., 2009; Halgin, 2012; Rummel,
1996). Halgin (2012) argues that, information and resources that flow through formal reporting relationships and partnerships differs from information that flows through trust ties or repeated social interactions.
According to Borgatti and Halgin (2011), there can be many kinds of ties between the nodes. Research in a number of academic fields has shown that social networks operate at many levels. These levels range from families up to the level of nations and play a critical role in determining the way problems are solved. The degree to which individuals succeed in achieving their goals is also determined by this.
Borgatti and Halgin (2011) further indicate that, the nodes to which an individual is connected are the social contacts of that individual. The network can also be used to measure social capital–the value that an individual gets from the social network
(Berhanu, 2011; Fu; 2004; Putnam, 2000).
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In addition, Wasserman and Faust (1994) affirm that, social network analysis in social network theory provides the understanding of the globalised knowledge system and gets closer to understanding the dynamics of the system. The social network analysis allows new approaches to advising the policy process in encouraging the growth of the knowledge system (Scott et al., 2005). Wasserman and Faust (1994), provide additional insights that social network analysis provides a way of quantitatively analysing relationships among people or other information– processing agents. Furthermore, in other settings, research has consistently shown that the one who knows what in social network analysis, has a significant impact on what one comes to know. As such, relationships are critical for obtaining information, solving problems and learning how to do work. However, Mejias (2006) proposes that, the social network theory undermines productive forms of sociality by over-privileging the node.
Based on the discussion, many scholars Brass (2012); Hansen (1999); Dyer and
Nobeoka (2000); Burd (2002) have supported social network theory and others such as Borgatti et al (2014); Mejias (2006) have criticized the theory. Their criticisms focused largely on the social relationships to solve the problems or not. They also argue that the theory is also silent on how actors share knowledge, information and resources. Despite these criticisms, the social network theory based on Granovetter‘s theory of strong and weak ties (1973, 1983) and social network analysis by Borgatti et al., (2009) are relevant to the current study. This is because, the study is also involved with actors (nodes) and relationship (ties) in interactions to share knowledge, information and resources including antibiotics. In this context, the ties are indicated by relationships among pastoralists in access and use of antibiotics in livestock. 22
2.3.2 Social Exchange Theory
Social Exchange Theory by Homans (1961) proposes that social behaviour is the result of an exchange process. The purpose of this exchange is to maximize benefits and minimize costs knowing whom to exchange with and what to exchange. People weigh the potential benefits and risks of social relationships. When risks outweigh rewards, people terminate or abandon that relationship2. According to Homans
(1961) social exchange is the exchange of activity, tangible or intangible and more or less rewarding or costly, between at least two persons. Cost is viewed primarily in terms of alternative activities or opportunities foregone by the actors involved.
In Social exchange theory, humans are seen as rational beings that are able to calculate the costs and rewards to be realized when engaging in a behaviour or pursuing a relationship (Heath, 1977). The difficulty with social exchange is that its central concepts such as costs and rewards are not clearly defined (West and Turner,
2004). Sabatelli and Shehan (1993) cited in West and Turner (2004), argue that, it becomes impossible to make an operational distinction between what people value, what they perceive as rewarding, and how they work in social exchange theory. The theory also argues that, people do what they can to maximize rewards and then, what people do is a rewarding behaviour. However, Heath (1977) provides different opinion that it is difficult to separate the two concepts. In this case, the theory does not consider the issue of how people do things to maximize benefit.
2 Kendra Cherry: Social exchange theory suggests that people weigh the benefits versus the costs of relationships. Costs involve things that are seen as negatives to the individual such as having to put money, time and effort into a relationship. The benefits are things that the individual gets out of the relationship such as fun, friendship, companionship and social support. Social exchange theory suggests that we essentially take the benefits and minus the costs in order to determine how much a relationship is worth. Positive relationships are those in which the benefits outweigh the costs, while negative relationships occur when the costs are greater than the benefits. Source: Academic Journalwww.iiste.org Fast Review, Publishing & Printing International Journal (US Published).
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Different scholars such as Heath (1977); West and Turner (2004), have contributed to social exchange theory by providing criticisms focused more on the rationality of individuals for cost minimization and benefit maximization in a relationship. They argue that, the theory remains silent on the nature of what is being exchanged in social relationship. Again, social exchange theory, can lead to more problems in some social aspects, such as supply systems of antibiotics. This is because some individuals concentrate on getting more benefits without consideration of the quality and quantity recommended. Despite these criticisms, the theory is relevant to the current study because it also focuses on pastoralists who are involved in the social exchange process while interacting to see whether it is for benefit maximization or cost minimization. The application of social exchange theory was based on how supply systems, particularly the market structure of antibiotics operate in the study area.
2.3.3 Theory of Optimal Use of Antibiotics
The theory of optimal use of antibiotics postulates that, the evolution of antibiotics resistance is strongly influenced by the economic behaviour of individuals and institutions. The more antibiotics are used (or misused), the greater the selective pressure placed on bacteria to evolve (Laxminarayan and Brown, 2000). The theory explains that, one ought to use less costly antibiotic to begin with and switch to the more costly antibiotic when the effectiveness of the first antibiotic is fully exhausted
(Laxminarayan and Brown, 2000).
Laximinarayan and Brown (2000) further argue that, optimal antibiotic therapy is equivalent to recommended remedy with extra requirements that recommended antibiotics are tailored to the local health care setting. Remedy is considered when it
24 is the most cost-effective of the appropriate remedies. Optimal antibiotic remedy is equivalent to recommended therapy (above), with the additional qualification that recommended antibiotics are tailored to the local health care setting (Polk, 1999).
According to Laximinara (2001), the high cost of antimicrobials has been a primary reason for concerns about minimizing the optimal use. The problem arises from the lack of economic incentives for individuals to account for the negative impact of antibiotics use on social welfare. Laxminarayan and Brown (2000) further assert that, resistance is more common in the case of hospital-acquired infections than in community-acquired infections. Laximinara (2001) considers that, antibiotic use in hospitals is relatively intensive compared to use in the community. This is because resistance bacteria are more likely to develop in hospitals areas where antibiotic use is more intensive. The likelihood that patients will be infected with resistant bacteria increases with a longer duration of hospitalization (Laximinara, 2001).
Based on the theory of the optimal use of antibiotics, it can be viewed that, antibiotic use depends on the perception on the cost involved and the effectiveness realised.
However, this is only possible if individuals use one type of antibiotic at a time without using more than one antibiotic simultaneously. It can be also possible if individuals access antibiotics from appropriate sources such as veterinary professionals and qualified suppliers to get the right knowledge and information on the use and effectiveness of antibiotics. This theory is relevant to the current study because it is also concerned with antibiotics access and use at the community level.
2.4 Empirical Literature Review
Empirical literature review examines the literature on supply systems and social networks on the access and use of antibiotics elsewhere and in the Tanzanian 25 situation. The subsection proceeds with the need for understanding the supply systems of antibiotics and social networks. This subsection also reviews widely the importance of social networks at the community, antibiotic access and use, antibiotics efficacy, supply systems and the existing market structure and finally the issue of policy and regulations governing the supply systems, access and use of antibiotics are also reviewed.
2.4.1 Social Networks of Knowledge and Information Sharing
The recent concept of social networks by Contractor et al. (2000) and Hansen (2002), indicates that the content of ties between actors (individuals) consists of some form of knowledge. The location of knowledge within a network of actors varies along a continuum, spanning from knowledge residing with one actor (knowledgeable individual) to knowledge distributed among many actors through social networks
(Monge and Contractor, 2003). Community members keep continuous interaction through networks or face to face communication, and achieve the purpose of sharing knowledge and information (Liao and Xiong, 2011). In social networks actors are bound with social ties that make them interact more to share knowledge, information and available scarce resources as reported by Gilbert and Karahalios (2009) in New
York. According to Grasswitz et al (2004)), to improve appropriate antibiotics access and use, it is necessary to attain an understanding of the knowledge on the access and use of antibiotics among specific population of pastoralists so that veterinary professionals can render effective treatment for the targeted animals. Lack of knowledge about any medication including antibiotics can increase the probability of misuse within the community.
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At individual level, actors have their own perceptions of the knowledge networks; i.e. each actor has his or her own ideas about the distribution of knowledge among actors in the network. Likewise, at the community level, individuals (actors) have their own understandings, ideas, perception, beliefs and ideas about the knowledge and information they share, especially on the access and the use of antibiotics.
Nevertheless, there is little information on how knowledge or information shared within and outside the community. Therefore, there is a need to explore this valuable information particularly on the antibiotic access and use in order to understand the social aspect of the antibiotics resistance phenomenon.
2.4.2 The Importance of Social Networks at the Community Level
Social networks are of critical importance to enable interactions since people get connected by sharing views, resources and support one another. A study by Baird and Gray (2014) in Maasai communities in northern Tanzania revealed that traditional social networks of exchange and reciprocity are critical components of household security, disaster relief, and social wellbeing, especially in rural areas.
Social networks comprise of family, clan and age-set members, as well as friends.
These are the basis of a household‘s support system and the first people to which a household will turn to when it confronts problems and need of assistance as suggested by Baird and Gray (2014) with a focus on the Maasai community in
Northern Tanzania. It is important for people to have diversified and supportive social connections in their bid to have awareness on availability of opportunities
(Burd, 2002).
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Resources and opportunities can be available but one cannot necessarily be aware of their existence, or even have direct access to them. Therefore, in those cases, knowing people from different backgrounds, grades of expertise, and social levels turns out to be essential (Burd, 2002). A study by Tarayia (2004) and Sortland (2009) in Kenya revealed that traditionally, there was a high degree of interconnectedness between every member of the Maasai community, either through birth, marriage, clan or age group that enabled them to share resources as a form of social networks.
Social networks, therefore, are one of the principal means by which people and households acquire resources—either directly, through informal exchanges, or indirectly, by providing information on how to access the services provided by governments and other institutions as suggested by Wellman (1999) in North
America; Bekure et al. (1991) and Macharia (1988) in Kenya. A study by Schnegg and Linke (2015) in pastoralists in Namibia and (Zhang and Yu, 2012 revealed the sharing and sanctioning water resources based on trust.
Furthermore, a study by Wawire (2003) in Turkana Kenya revealed that, social networks provide food, care of children and old people, medical assistance, school fees, cash and connections to employment. Furthermore, they provide moral support to those concerned and especially so to those belonging to women/youth organizations and age-sets in the case of men.
Moreover, social networks, which comprise of family, clan, and age-set members as well as friends, are the basis of a household‘s support system and the first people to which a household will turn to when it confronts problems and needs of assistance as noted by Baird and Gray (2014) with a focus on pastoral society in Tanzania, Africa.
Therefore, it is important for people to have diversified and supportive social
28 connections in order to have awareness on availability of opportunities as suggested by Burd (2002) in the context of Chicago. The support system in social networks is normally taken positively and works to sustain the community in many ways.
However, in other ways it can reveal negative impact. For instance, the sharing of antibiotics and the frequent use can lead to under dose or over dose thus resulting into antibiotics resistance.
2.4.3 Resource Ownership, Control and Access to Antibiotics and Use
Resources owned and controlled by individuals and households can contribute to antibiotics access from different sources. Resources can be in terms of income and assets that can be committed to obtain antibiotics without the proper channel of prescription. Report by USAID (2006) in Ethiopia revealed that income from sale of animal assets was used for purchasing water for livestock, medicine and veterinary drugs among others. Sometimes, an animal was exchanged with drugs or services to care for them. A study by Sekyere (2014) in Ghana found that the middle income and high income farms used more antibiotics than lower income farms due to the larger number of animals and financial ability. Thus, this reveals the importance of resource ownership in access and use of antibiotics in livestock.
The high costs faced by pastoralists in formal animal health care system encourage them to purchase antibiotics without prescription. Although this practice is common, it is not very accurate. Drug retail shops which are unlicensed and poorly managed can recommend the wrong treatment of livestock or provide incorrect dosage. People with limited resources such as income would want to purchase only part of the recommended course and can more easily negotiate this practice at local shops than in formal livestock health care facilities. GARP–Kenya Working Group (2011)
29 reported that, although access to antibiotics is related to socio–economic status, the reasons cannot be directly related to financial resources. These include low level of education, lack of nearby health facilities, inconsistent presence of medicines and health workers for both animals and humans. This contributes to the access and use of antibiotics without proper prescription hence leading to antibiotics resistance problem.
2.4.5 Antibiotic Efficacy, Supply Systems and the Market Structure
Antibiotics have been known to be used for the purpose of growth promotion, treatment and control of diseases to animals (FDA, 2009; Codex Alimentarius
Commission‘s Committee on Food Hygiene, 2001). Some reasons can also apply to antibiotic use in human beings for treatment and prevention of diseases (WHO, 2004;
WHO, 2011). A study by Baggaley et al. (2010) in Nigeria, Burkina Faso,
Cameroon and Cote d‘Ivoire in Africa depicted that diluted antibiotics were sold on the black market. The dosage taken by patients or administered to animals was often too low to be effective as noted by (Collard; 1999) in Belgian Biosafety Server on
Antibioresistance Archive. All these behaviours contribute to the development of resistant strains of infectious organisms. Therefore, it is important to appreciate the recommendations for storage of antimicrobials as suggested by Arya and Agarwal
(2008) in New Delhi, India. Studies by Bekure et al (1991) and Grandin et al (1989) in pastoralists of Kajiado and Turkana, in Kenya, respectively, reported the poor condition of the marketing structure of livestock involving mobility of Maasai pastoralists. This can also increase the problem of antibiotics due to cross contamination of diseases that promote frequent access and use of drugs in livestock.
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Most of drug suppliers are often untrained personnel and as a result, customers do not get better advice from them on the proper use of drugs as was reported by
Chandy (2008) in India. According to WHO (2004), the practice is mainly common in rural areas where also the storage systems are not in good conditions, something which lead to ineffectiveness of drugs. This results into inappropriate access and use of drugs since public health care facilities often are in short supply due to an unreliable delivery system. In response to this, the community tends to establish social networks of knowledge, information and resource sharing on how to access and use drugs, including antibiotics, based on the supply systems available.
According to Okeke et al. (1999), Okeke (2010) in Nigeria and Thriemer et al.,
(2013) in Democratic Republic of Congo revealed that other problems associated with antibiotic supply systems include health provision for both animals and human services such as retail drug suppliers for profit without regulations. However, how these supply systems have the implications on antibiotics resistance is still unclear and needs to be addressed.
Viberg et al. (2010) argue that, some of the drug suppliers in Tanzania understand that all antibiotics can be used for treating the same diseases in animals. However, all antibiotics cannot cure the same illnesses as reported by drug suppliers. On the other hand, antibiotics are significantly less often assessed as relevant compared to other drugs by drug suppliers. Furthermore, Grasswitz et al (2004) found that, there was an increased marketing effort of the pharmaceutical industry by pressuring pharmacists to use certain types and brands of antibiotics. Therefore, there is a need to train the suppliers to understand the importance of antibiotics as other drugs and understand the communities‘ supply systems and social networks that facilitate the access and use of antibiotics in a proper way. 31
A report by WHO (2000) recommended that, the public should be involved in improving access to medical services including veterinary, reducing unnecessary use of antimicrobial drugs in animals and not sharing equipment with other people.
Evidence shows that at the community level, individuals still access and use antibiotics for livestock through social networks and supply systems which also lead to antibiotics resistance as suggested by Katakweba, et al. (2014) in Tanzania.
Pastoralists obtain antibiotics from friends‘ leftovers and drug suppliers‘ retail shops without prescription. Therefore, the study sought to come out with the contribution on how the supply systems and social networks determine access and use of antibiotics far-reaching implications on antibiotics resistance. This can facilitate changing of people‘s attitudes and practices by creating awareness and improving their knowledge regarding antibiotics access and use to preserve antibiotic effectiveness and hence minimize antibiotics resistance.
2.4.6 Policy and Regulations Governing the Supply Systems on Access to and
Use of Antibiotics at the Community Level
When antibiotics are not used correctly, they fail to completely kill off the bacteria causing diseases. Many developing countries such as China, India, Kenya and Brazil, have no national policies on use of antibiotics, a result which leads to irrational and unnecessary use of antibiotics (Hepeng, 2008). (ibid) further argues that, weak government guidance on prescribing practices has major consequences that result into inappropriate prescribing practices, including the wrong choice of antibiotics with incorrect dosage and duration of treatment.
In developing countries, there are unregulated drug sales, where in most cases, people obtain drugs without any prescription from health experts. This is due to
32 various reasons including not being able to afford the prescribed drugs, lack of awareness of what causes antibiotic resistance and poor access to regulated pharmacies or hospitals including vet centres as was revealed by Hepeng (2008) in
China and India.
Bacterial resistance to antimicrobial drugs is one of the most serious problems which affect global public health. McLaughlin (2016) reported that antibiotics for human and animal use are widely available in China without any prescription, something which leads to overuse and antimicrobial resistance. Antibiotics resistance was also revealed by Rossi (2010) and Rossi et al (2008) that Latin American countries of
Brazil, Argentina and Mexico have higher levels of bacterial resistance due to self- medication compared with Europe and the United States. FDA (2009) in the US and
Muhairwa (2014) in Tanzania reported that imprudent uses of antimicrobial drugs, in both humans and animals, contribute to the development of antimicrobial resistance.
Thus, it is important to use these drugs only when medically necessary. For instance,
Kreisberg (2009) in Califonia revealed that, outside of therapeutic uses of antibiotics to treat illnesses, antibiotics also seem to stimulate growth in animals and are used for this purpose. A study by McKee and Mills (1999) in the USA indicated that, a substantial proportion of individuals obtained antibiotics through a method other than a physician prescription for the condition. Subjects not only used their own leftover medication, but they also used friends‘ and family members‘ leftover pills.
Furthermore, they obtained antibiotics directly from pharmacists or from sources outside the country without proper prescription and quality as reported by Boray et al., (1990) in New Jersey. This has been also happening in the study area where pastoralist users of antibiotics obtain antibiotics through different sources such as
33 friends, relatives and neighbours among others without prescription something that can cause danger of antibiotics resistance.
Guardabassi and Kruse (2008) in United Kingdom observed that, antibiotics use is higher in countries where antimicrobials are dispensed by veterinarians and the direct sale of drugs generates a significant part of their income. The amount of prescribed antimicrobials can be significantly reduced by eliminating the economic advantages associated with drug dispensation by veterinarians. This implies that, the problem of antibiotics resistance in animals and humans can be caused by social factors on the part of the users and economic factors on the prescribers. However, according to
Okeke (2010) in Nigeria, the threat of antibiotics resistance is growing at an alarming pace, perhaps more rapidly in developing countries in which the prescription by veterinarians is low. Therefore, it is important to realize that this problem can easily cross borders in this era of globalization to neighbourhood countries through market exchange of livestock and drugs.
In Africa, Mandomando et al. (2010) in Southern Mozambique suggested that, there was a growing concern regarding the management of community-acquired infections because of increasing prevalence of resistance to the most commonly antibiotics used in these settings and the emergence of multidrug-resistant strains. This can be caused by misuse of drugs or on the counter antibiotics access which are due to the existing supply systems and the social networks, especially in Africa, at the community level, which were explored by this study.
Although, socio–economically, antibiotics use has been known to have benefits across a wide range of human activities, including health care and farming, the use of antibiotics is leading to increasing contamination of the world with antibiotics 34 resistance bacteria in the United Kingdom and California (Millar, 2010; Wiggins et al., 1999). For instance, scientists and policymakers are giving increased attention to the large quantities of antibiotics given to farm animals, and their possible contribution to antibiotics resistance in human pathogens. Evidence by Williams
(2002) on antibiotics resistance, not just for people in California, indicates that, the two can be linked and that antibiotics lose effectiveness as a result of the frequent use in animals as well. The benefits of antimicrobial drugs including antibiotics in controlling infectious diseases in developing countries are limited by inadequate access to drugs, poor and inadequate health care systems and civil conflicts, bad governance, including corruption, unregulated dispensing and manufacture of antimicrobials as reported by Chandy (2008) in India; Byarugaba (2004) in Uganda;
Mandomando et al. (2010) in Southern Mozambique; Planta, (2007); Okeke et al.
(1999) in Nigeria and Goldman and Riosmena (2013) in Kenya. However, there are some common practices of sharing knowledge, information, experience and antibiotics. Also, the supply systems involving obtaining antibiotics from inappropriate sources at the community level, which can encourage the spread of antibiotics resistance traits.
2.5 Conceptual Framework of the Study
A conceptual framework provides an outline for analysing a large volume of data and in this study it was oriented towards establishing findings which aimed to fulfil the objectives of the study. The usefulness of conceptual framework is on its ability to serve the purpose of formulating and developing the structure of logical connection and relationships among the variables used in the study (Shajahan, 2005). The major subject matter in this study is on how supply systems and social networks determine the access and use of antibiotics in livestock thus resulting into antibiotics resistance. 35
Fig. 2-1: indicates the conceptual framework for the study. The assumption is that antibiotics resistance measured by persistence ill-health and deaths of livestock is a function of independent variables such as the supply systems of antibiotics, social networks, antibiotic access and use. Supply systems of antibiotics include availability of drug shops, distance to veterinary centres and the existing market structure. In supply systems, there are actors, sources and types of antibiotics supplied. Social networks are composed of actors and associated ties, sharing of knowledge, information and antibiotics. Antibiotic access and use include availability and affordability of antibiotics involving the purchasing power of the users.
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BACKGROUND INDEPENDENT DEPENDENT VARIABLES VARIABLES VARIABLES
Social networks Antibiotics (Actors and associated ties) resistance Demographic o Knowledge & information (Persistent ill-health & sharing and deaths in Socio -economic o Sharing antibiotics & livestock) profile resources o Sex o Age o Marital status o Level of education o Size of household o Wealth Antibiotics access & use status o Affordability -Wealth o Availability indicators -Income o Purchasing power INTERVENING -Size of VARIABLE livestock o Trend of livestock production Policy & regulations o Diseases in o Law enforcement livestock o Regulations on o Awareness antibiotics access & on use Antibiotic supply systems antibiotics o The existing market resistance structure o Knowledge of suppliers o Sources of antibiotic o Types of antibiotics
Figure 2-1: Conceptual Framework on Supply Systems and Social Networks
Determining Access, Use and Antibiotics Resistance in Ngorongoro District
Key: Relationship under normal circumstances Research gap
37
Antibiotics access and use are also determined by the independent variable affected by socio-economic profile of the population studied. This includes the back ground variables of respondents among others, sex, age, marital status, education level, types and size of livestock, income, common diseases affecting livestock and awareness on antibiotics resistance. The intervening variable, policy and regulations including law enforcement, regulations on antibiotic access and use, exist in between antibiotics access and use, and the supply systems regulating the functioning of the two.
The knowledge gap is how independent variables, the supply systems and social networks determine the access and use of antibiotics far-reaching antibiotics resistance that needs to be addressed. Therefore, antibiotics resistance needs appropriate understanding of the existing supply systems and social networks at the community level and how they link to antibiotics resistance. This requires community awareness on the consequences of the access and use of antibiotics without appropriate prescriptions. In addition, good policies and regulations are required to regulate the supply systems and create community awareness for the appropriate access and use of antibiotics. Unless these are put in place, antibiotics resistance will lead to persistent ill-health and deaths in livestock.
2.6 Knowledge Gap
Many scholars such as Brass (2012); Hansen (1999); Dyer and Nobeoka (2000);
Burd (2002) have supported social network theory and others like Borgatti et al
(2014); Mejias (2006) criticized the theory. However, they focus their criticisms of the theory largely on the social relationships to solve the problems. The theory is silent on how actors share knowledge, information and resources. However, in the context of this study, social network theory based on Granovetter theory of strong
38 and weak ties (1973, 1983) and social network analysis by Borgatti et al., (2009) is relevant to the current study. This is because, the study is also involved in actors
(nodes) and relationship (ties) in interactions to share knowledge, information and resources including antibiotics. In this context, the ties are indicated by relationships among pastoralists in accessing and using of antibiotics in livestock.
Moreover, different scholars Heath (1977); West and Turner (2004), have contributed to social exchange theory by providing criticism focused more on the rationality of individuals for cost minimization and benefit maximization in a relationship. However, the theory remains silent on the nature of what is being exchanged in social relationship. Social exchange theory, can lead to more problems in some social aspects, such as antibiotic supply systems. This is because, some individuals can concentrate on getting more benefits without consideration of the quality and quantity recommended. However, the theory is relevant to the current study because it also focuses on pastoralists involved in the exchange process while interacting to see whether it is for benefit maximization and cost minimization. The application of social exchange theory was based on how supply systems, particularly the market structure of antibiotics operates in Ngorongoro if for benefit maximization or otherwise.
The theory of optimal use of antibiotics by Laxminarayan and Brown (2000) postulates that, the evolution of antibiotics resistance is strongly influenced by the economic behaviour of individuals and institutions. The high cost of antimicrobials antibiotics included, has been a primary reason for concerns about minimizing the optimal use (Laximinara, 2001). Laximinara (2001) considers that antibiotic use in hospitals is relatively intensive compared to use in the community. Resistant bacteria
39 are more likely to develop in areas in hospitals where antibiotic use is more intensive. However, the intensive use of antibiotics not only occurs at the hospital settings but also in others such as veterinary setups at the community level. The theory further asserts that, antibiotic use depends on the perception of individuals on the cost involved and their effectiveness. This is only possible if individuals use one type of antibiotic at a time without combining different antibiotics and use at a time.
Furthermore, the optimal use of antibiotics is also realized by the knowledge and perception of individuals for the effectiveness of antibiotics. This is possible if individuals access antibiotics from appropriate sources such as veterinary professionals and qualified suppliers to get the right knowledge and information on the use and effectiveness of antibiotics. However, this theory is relevant to the current study because it is also concerned with access to and use of antibiotics in the community of pastoralists in Ngorongoro District. In addition, the theory is also applicable where the users have awareness and knowledge on access to and use of antibiotics.
Empirically, various studies have been conducted on social networks that provide easy connections and relationships among individuals which enable them to share of information at the community level (Harnneman and Riddle, 2005; Wasserman and
Faust, 1994). However, limited information is available on how these interactions facilitate the access to and use of antibiotics and the implication on antibiotic resistance. Most of the studies are based on natural sciences such as microbiological and veterinary medical approaches and least priority is put on social sciences aspects, especially on supply systems and social networks which affect the access and use of antibiotics as a function of antibiotics resistance.
40
Therefore, this study aimed at exploring and examining the supply systems of antibiotics and social networks in order to determine the access to, use and their implications on antibiotics resistance in Ngorongoro District.
2.7 Chapter Summary
This chapter has explored a number of aspects including the definition of key terms, theoretical point of view and empirical facts regarding the supply systems of antibiotics and social networks that affect the access and use of antibiotics in livestock in pastoralist communities. In this consideration, social networks theory, social exchange theory and the theory of optimal use of antibiotics have been explored in order to understand the actors and their roles, as well as the associated ties, access to and use of antibiotics at the community level in rural areas. Studies of this nature cannot be done by using a single theory alone, more than one theory are suitable to complement each other.
Empirical literature suggests that there have been a common practice of the access and use of antibiotics without prescriptions by veterinary experts in rural communities in developing countries, including Tanzania, something that has been leading to the risk of antibiotics resistance that threatens public health. However, the ways in which the supply systems and social networks determine access and use of antibiotics by pastoralists, are missing in both empirical and theoretical literature.
The main argument for the conceptual framework has been that social networks and supply systems facilitated the access to and use of antibiotics through sharing knowledge and resources. On the other hand, the access and use of antibiotics through the supply systems and social networks can result into the risk of antibiotics resistance at the community level. This has to be addressed by all potential stakeholders of both livestock and public health sectors. Social networks have been
41 viewed on positive ways in which problems can be solved at community level.
However, when used inappropriately or used to solve the problems that require a technical solution like that of antibiotics resistance, they can lead to negative outcome especially on the sharing of antibiotics. The subsequent chapter explains in details the methodological part of the study.
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CHAPTER THREE
RESEARCH METHODOLOGY
3.1 Introduction
Research methodology is the systematic way in which a particular question in the process of conducting research is dealt with (Nguyahambi, 2013). Research methodology provides detailed discussions regarding research techniques and procedures, research methods, theoretical perspective and the body of knowledge contained in the theoretical perspective (Crotty, 1998 as cited in Creswell, 2009). In general, research methodology provides a logical way in which researchers perform research.
This chapter describes the methodological aspects and procedures used in the study.
The chapter includes sections on the research design, description of the study area, the study population and sampling procedures that were used. This chapter also covers methods and instruments that were used in data collection. This chapter also discusses validity and reliability aspects in the study and the ethical considerations and procedures for data collection, processing and analysis. Lastly, the chapter discusses the challenges and limitations encountered during the study.
3.1.1 Scope of the Study
The imprudent use of antibiotics leading to a risk of antibiotics resistance is common to the population of both animals and human beings. This study focused on the antibiotic use in livestock, particularly in pastoral communities. Pastoralists occupy a large area of the Greater Serengeti Ecosystem in Northern Tanzania where there is interaction between wildlife, livestock and human beings.
43
However, this study focused only on pastoralists inhabiting Ngorongoro District due to their unique characteristics of their traditional social networks of sharing knowledge, information and resources alongside the use of antibiotics in livestock.
All these attributes made it suitable to conduct this study.
3.2 Selection of the Study Location and Justification
This study is part of a bigger and an on–going research project on Antimicrobial
Resistance whose aim is to understand how antibiotics resistance is impacted by patterns of connectivity within and between communities in the Greater Serengeti
Ecosystem. However, the study focused on examining how supply systems of antibiotics and social networks determine the access and use of antibiotics in livestock and their implications on antibiotics resistance in Ngorongoro District.
The Greater Serengeti Ecosystem is a geographical region in East Africa located in
Northern Tanzania and extends to South–western Kenya. In Tanzania, the area includes parts of Arusha, Mara and Shinyanga regions3 See Figure 3-1. The area covers an ecological system that has a growing human population alongside antibiotics use patterns and self–contained interactions among people, domestic animals and wild animals (human–animal interactions). Ngorongoro District is characterized by different topographical features, including open plains, highlands, highland plateaus and depressions. The open plains occupy vast areas of the district, including the Serengeti, Salei and Angata – Salei plains. The plains are interrupted by highlands, hills, craters and escarpments. The main highland areas are located in
3 The area covers more than 30,000km2 including Grumeti reserve, Ikorongo game reserve, Loliondo controlled area, Maswa game reserve, part of the Ngorongoro conservation area in Tanzania and Kenya‘s relatively small Maasai Mara game reserve. Source: Expert Africa: the Greater Serengeti Ecosystem. [http://www.expertafrica.com/tanzania/serengeti-migration- area]. 44 southern parts of Ngorongoro Conservation Area. See Figure 3-1 the map of the
Greater Serengeti Ecosystem showing the study villages.
Figure 3-1: Map of the Greater Serengeti Ecosystem Showing the Villages under the
Study
These highlands include the Crater highlands –a vast volcanic chain with several calderas (Ngorongoro in the central parts, Olmoti and Empakai in the eastern parts).
Other Mountains are Lemogarat and Oldeani in the central parts, while
45
Lomalmalasini and Kerimasi Mountains are located in the east. Oldonyo Lengai, an active volcanic Mountain that lies at the edge of Salei plains and the Rift valley. The main highlands in Loliondo area are the Ololoswani highlands (Potkanski, 1994).
The altitude varies from about 1,000m on the Rift valley floor (a.s.l.) to 1,500 and
1,700 m (a.s.l.) on Salei and Serengeti plains peaking to 2,100 and 2,800m (a.s.l) on the highland plateau. The crater highland records up to 3 000 m (a.s.l)
The study was carried out in Ngorongoro District, which incorporates a significant part of the Greater Serengeti Ecosystem. The district is inhabited by pastoral communities whose livelihoods depend solely on livestock keeping activity.
Ngorongoro is one of the few remaining areas in East Africa where the Maasai are still able to pursue traditional pastoralist lifestyle characterised by social networks of sharing knowledge, information and resources (Cleaveland, et al., 2014). Also, the
Ngorongoro District was selected due to interactions between livestock, wildlife and human beings with cross infections leading to high risk of antibiotics resistance (Call et al., 2013). Enduleni and Nainokanoka wards were selected purposively because they are among the list of the most populated wards in the district with 13,537 and
12,971 populations, respectively. The wards make a total of 26,508 (15.2%) out of
174,278 the total population in Ngorongoro District (URT, 2013). In addition, the two wards were selected for the study because they have large sizes of herds compared to other wards in Ngorongoro District (URT, 2013). Two villages were selected randomly from each ward, whereas Enduleni and Esere villages were selected from Enduleni ward; Nainokanoka and Irkeepus villages were selected from
Nainokanoka ward.
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3.3 Socio–Economic Profile of the Study Area
The socio-economic profile provides a brief description that summarizes the characteristics of the study areas. Ngorongoro District is among the five districts making up Arusha Region in North Eastern Tanzania. Other districts are Karatu,
Monduli, Arumeru, and Arusha urban. Ngorongoro District is located along the latitude of 2°45'0" and longitude: 35°30'0". The district borders the Republic of
Kenya in the North, Karatu District in South, Meatu and Serengeti districts in West and Monduli District in the East.
About 59% of the district's landmass falls within the famous Ngorongoro
Conservation Area which was established by the Ngorongoro Conservation Area
Ordinance of 1959 to deal with matters related to the conservation of wildlife resources, promotion of tourism and the development of indigenous Maasai pastoralists (Olengurumwa, 2009). In Ngorongoro District, the total human population according to the 2012 national census was 174,278 of which men were
82,610 and women were 91,668. Typical to the pastoral areas, Ngorongoro District is generally sparsely populated. However, of recent, it has been experiencing rapid population increase. The main ethnic groups in Ngorongoro District are the Maasai pastoralists which constitute the majority ethnic group (95%) residing in both
Loliondo and Ngorongoro areas. Others are the Sonjo agro-pastoralists (1%) restricted to Loliondo area, the pastoral Tindiga (1%) and Barbaig (3%) found in
Lake Eyasi escarpment area and the Ndorobo gatherers who have been assimilated in various Maasai sections (Runyoro, 2001 cited in Kisoza, 2007). Other ethnic groups such as Datoga and Hadzabe also live in Ngorongoro Conservation Area. Others are employees or those who retired from government service and have decided to settle
47 in the area. These are referred to as ―Waswahili‖ but are reported to have very little influence in everyday life decision making (Melita and Mendlinger, 2013).
The indigenous Maasai social and economic life centres on livestock. Cattle, sheep and goats which form the basis for their subsistence. Their pastoral economy is basically subsistence oriented and pure pastoral diet of milk, blood and meat is still highly valued. However, in practice, agricultural foods now form a very important part of the diet and replace the pastoral diet, particularly during drought and at the height of the dry season (Homewood, 2008; Galvin et al., 2004).
While the Maasai seems to constitute one group (95%), there are also differences within this group that at times becomes sources of conflicts. These differences are largely due to origin of the different Maasai groups. There are six major groupings of the Maasai, namely Purko, Laitayok, Kisongo, Loita, Salei and Sonjo (agro- pastoralists). The Purko Laitayok, Lita, Laitayok and Salei are found in Loliondo area. Kisongo Maasai are found in Ngorongoro area and are widely distributed in
Kiteto and Simanjiro districts (Runyoro, 2001 cited in Kisoza, 2007). The Loita
Maasai have immigrated from Kenya, and they are frequently involved in resource- use conflicts with other Maasai clans as well as the Sonjo who have settled in the area for a long time.
Most areas in Ngorongoro District are semi-arid plains, which cannot support crop cultivation, and only limited areas are suitable for cultivation. The main economic activity in the area is pastoralism with limited cultivation. Other economic activities include crop cultivation, tourism and handicraft. However, the area that has been converted to cultivation is on the increase. This is particularly so in the highland areas. The total arable land available is estimated to be 50,000 ha, and the total land 48 under cultivation is 10,250 ha (ARCO, 1997 cited in Kisoza, 2007); Melita and
Mendlinger, 2013).
Ngorongoro District has the largest livestock population in Arusha Region in which the largest numbers of cattle keeping households are found. About 88% of the households in Ngorongoro keep cattle (708,659 cattle, 39.1% of the total cattle in the region), goats (655,087 goats, 36% of the total goats in the region) and sheep
(599,099 sheep, 42.7% of the total sheep in the region) (URT, 2012). Livestock population in the study villages is shown in Table 3-1.
Table 3-1: Number of Livestock in the Study Villages
Livestock Village Total Enduleni Esere Nainokanoka Irkeepus Cattle 18,913 8,319 2,374 8,050 37,656 Goats 25,680 2,325 5,100 3,200 36,305 Sheep 39,900 2,745 4,000 2,100 48,745 Donkeys 200 139 80 200 619 Source: Respective village office report, 2013
Ngorongoro District, like other pastoral areas, has very limited social services like schools, health facilities and transport network. The district‘s total road length is 515 km, and road density is about 0.04 km/ km2 (ARCO, 1997 cited in Kisoza, 2007).
The roads present in most areas are dry weather tracks, which are not passable during rain seasons.
3.4 Research Design
A research design is a process by which the topic is brought to the field for test as a researchable project (Nguyahambi, 2013). In any research undertaking, research design is of paramount importance and this is essential because it facilitates the
49 smooth functioning of the various research operations, and therefore, provides a solid base for the whole research. Furthermore, a research design carries an important influence on the reliability of the results attained. Generally, a research design directs the researcher on how to move forward in doing research. The choice of a research design for this study was dictated by the nature of the study which is both qualitative and quantitative in nature.
Based on the nature of this study, an explanatory cross–sectional survey research design was adopted. This research design allows data to be collected at a single point in time and can be used for purposes of simple statistical description and for determining the relationship between variables (Bailey, 1998; Babbie, 1990; Kothari,
2004). Furthermore, cross-sectional surveys are useful in assessing practices, attitudes, experiences, knowledge and beliefs of a population in relation to a particular social, natural and health related event in their vicinity (Bryman, 2012;
Miller, 2006). This fits well in the current research theme which sought to explore and examine how supply systems and social networks determine access and use of antibiotics in livestock.
3.5 Methodological Approach
The general methodological approach for this study was a mixed method approach.
This method refers to a methodology of research that advances the systematic integration, or ―mixing,‖ of quantitative and qualitative data within a single investigation or sustained programme of inquiry (Creswell, 2009; Creswell and Plano
Clark, 2011). Mixed method of both qualitative and quantitative approaches in data collection, interpretation and analysis procedures were used to complement each other. Mixed method was employed because by mixing both quantitative and
50 qualitative research and data, the researcher gains in breadth and depth of understanding and validation, while counterbalancing the weaknesses intrinsic to using each approach by itself. One of the most advantageous characteristics of conducting mixed methods research is the possibility of triangulation to examine the same phenomenon (Creswell and Plano Clark, 2011). The details of each of these approaches are provided below.
3.5.1 Qualitative Approach
Qualitative approach is an investigation technique of understanding a social problem grounded on a multifaceted, holistic picture, moulded with words, reporting detailed views of informants carried out in a natural settings (Creswell, 2009). In this study, the qualitative approach was employed to capture the understanding of local circumstances that communities operate in. It was employed to seek comprehension of local population of pastoralists for the study in order to obtain the participants‘ and respondents‘ opinions and social contexts such as interactions and relationships in a social network.
3.5.2 Quantitative Approach
Quantitative methods determine the breadth to which observed behavioural practices, resources or problems are distributed within a population (Bailey, 1998). The method also involves gathering numerical information on instruments such as questionnaire
(Creswell, 2009). The quantitative approach was employed by this study to obtain data on demographic and socio–economic profile of the population in the form of sex, age, marital status, level of education, size of household, wealth status, trend of livestock production, diseases in livestock and awareness on antibiotics resistance.
Also, on how often the target population of pastoralists interact in a social network
51 and the extent to which the study variables link, such as how income, livestock size
(wealth status) and time reflected by distance to the source determine access and use of a particular antibiotic in livestock.
3.6 Population of the Study
Population refers to the total number of cases that can be included as research subjects (Matthews and Ross, 2010). The target population for this study included pastoralists as the main respondents, antibiotic suppliers and the livestock development service providers such as District Livestock Office, Community Based
Animal Health Workers, and Veterinary and Animal Health Officers in Ngorongoro
District as well as Policy Makers from the Ministry of Agriculture, Livestock and
Fisheries Development as key informants. The sample was drawn from suppliers of antibiotics and pastoralists whose livelihoods depend mainly on livestock keeping.
The key sampling unit was pastoralists whose sampling frame was obtained through the existing list of pastoralists in the village. Other units sampled included antibiotic suppliers, livestock development service providers such as veterinary and animal health officers and Community-based Animal Health Workers (CAHWs) and livestock policy makers who were minor.
3.7 Sampling Procedure and Sample Size Determination
Sampling procedure is a process of choosing a sub-group from a population to participate in the study. Selected individuals represent the large group from which they were selected from (Ogula, 2005). Multistage sampling techniques were employed in which purposive sampling was used to select the study area of the
Greater Serengeti Ecosystem, Ngorongoro District, Nainokanoka and Endulen wards and the study villages. A random sampling technique was employed to select the
52 respondents for household survey. The sampling frame for household survey consisted of a list of households in the village office. To calculate the sample size, the formula from Yamane (1967) was adopted as follows:
Where; = sample size, = Population size and
= the level of precision 5% at 95% level of confidence.
The exercise was done during the preliminary survey of the study area. The data from ward executive offices from Enduleni and Nainokanoka wards indicated the population = 14,630 and 15,808, respectively, thus making a total population of
29,938. This is slightly different from the URT (2013) 2012 population and housing census which was 13,357 and 12,971 for Enduleni and Nainokanoka, respectively.
With a total population of 26,508 thus, = 29,938/1+29,938(0.052) = 395. Therefore,
50% of the sample which is 198 respondents was estimated to be used for the study to cater for the representative sample of household heads. The assumption was that the other 50% of the population were children under 18 years therefore not eligible to be household heads or representatives. However, the actual data was 221 respondents. A sample size between 30 and 500 at 5% confidence level is generally sufficient for many researchers (Delice, 2010). Bailey (1998) also supports the view that the numbers of respondents more than 30 are reasonable for social science research.
Purposive sampling was further employed to obtain key informants whereby a total of 21 key informants knowledgeable and experienced in livestock development were interviewed to supplement household information. The key informants included were village elders and elites, antibiotics suppliers and livestock development service providers such as veterinary officers and CAHWs. 53
The identification of the key informants from the community started from FGDs and other key informants were obtained from village office information. Purposive sampling was employed to select participants for FGDs in each village by identifying community members who were knowledgeable on the subject under study through the help of village leaders and research assistants. The size of the groups ranged from
12 to 15 members, and this is considered adequate as suggested by Babbie (2002).
Table 3-2 gives the summary of the sample size involved in the study.
Table 3-2: Sample Size Involved in the Study
Types of respondents Endulen Esere Nainokanoka Irkeepus Total Household heads for 54 39 75 53 221 questionnaire survey Key informants: in 5 3 5 4 19 villages District livestock - - - - 2 development officers FGDs 11 10 14 13 48 Total 290 Source: Field Data, 2014
3.8 Types, Methods and Instruments for Data Collection
Based on the nature of the study, two types of data were collected. These were primary and secondary data. A combination of methods was used using assorted tools for data collection.
3.8.1 Types of Data
In this study, both primary and secondary data were collected and a detailed discussion of each type of data is provided below.
3.8.1.1 Primary Data
Primary data are first–hand information which the researcher directly collects and which have not been previously collected (Matthews and Ross, 2010; Warioba, 54
2008). The larger portion of data used for this study was from primary sources. Data were obtained from household respondents, key informants, FGDs and through observation. The information sought was on demographic and socio-economic profile of the households, antibiotic supply systems, social networks, and antibiotics access and use, as well as antibiotics resistance.
3.8.1.2 Secondary Data
The secondary data for the study were obtained through literature review from both soft and hard copy documents relevant for academic reference. Secondary information were obtained in order to complement the primary data. Secondary data was obtained from sources such as libraries, books, journals and official reports from
The Ministry of Livestock Development, NGOs, internet, Ngorongoro District offices and other institutions such as livestock development departments. All study information was obtained using the researcher‘s diary. The information sought was on social networks, antibiotic supply systems, antibiotics accessibility and use as well as antibiotics resistance.
3.8.2 Methods and Tools for Data Collection
This study employed a combination of various methods such as household survey, interview method, FGD and observation. The advantage of using different methods and tools for data collection was to ensure that the limitations of one type are balanced by the strengths of another. This was also to ensure that understanding was improved by integrating different ways of knowing as supported by Creswell (2009).
3.8.2.1 Survey Method
Survey method is often used for descriptive studies and it makes easier for the researcher to perform the analysis of different responses, which can be easily 55 compared (Kothari, 2004). As for this study, a household survey was done to obtain data from household heads on socio-economic profile of household and how social networks determine the access and use of antibiotics for livestock.
A household questionnaire was used to collect primary data from heads of households in each village. The questionnaire consisted of both open and closed ended questions. Open–ended questions gave the respondents freedom to give detailed answers or opinion while close–ended questions gave respondents alternatives and were asked to choose among them. The questions were translated into Swahili language for better understanding and conceptualization of the subject matter.
Data that were collected included household characteristics such as livestock ownership, size, other assets, annual income and proximity to veterinary/livestock service centres, availability of antibiotic shops and sources of antibiotic supply.
Training of two research assistants knowledgeable in Swahili and local language was done to assist the research in the data collection. One translator conversant in both local languages Maa and Swahili was also engaged to enhance the communication between the researcher and the respondents who were not conversant with Swahili language. Pre–testing of the questionnaire was done to improve the understanding of the questions. A total of 10 respondents were involved, these individuals were not interviewed in the actual data collection.
3.8.2.2 Focus Group Discussion (FGD)
FGDs were conducted in each village prior to the household survey in order to obtain the overview of the situation in the subject matter and the study area. FGD discussions are normally used for triangulation purposes, or in conjunction with other 56 data–gathering techniques (Cohen at el, 2007). This was also the purpose of this study. A total of four FGDs were conducted in the villages of the study whereby one
FGD in each village was conducted. The purpose was to obtain as much important information as possible on the socio-economic context of the pastoralists. FGDs were also important for the identification of the key informants from the community such as elders and antibiotics suppliers. FGDs were composed of both male and female participants with exception of one FGD from Endulen village that was composed of males only because the organization of women was very difficult due to commitments they had in the village. The information sought, among others, included data for participatory wealth ranking, types of livestock, mapping of supply systems and social networks for antibiotics accessed and used in livestock and awareness on antibiotics resistance.
The moderator introduced the topic and allowed the group members to discuss. Such conversations were held in places where the researcher and participants found appropriate. Notebooks were used to record information from the discussions. Also, a moderator with tape recorder followed a predetermined checklist with open ended questions to direct the discussions. The advantage of audio-recording is that it frees up the researchers from note–taking, thereby allowing them to concentrate on the job at hand: to listen to what is being said and prompt for further responses where appropriate (Markle et al., 2011). Thus, audio-recording is important for preserving the entire verbal part of the interview for later analysis.
3.8.2.3 Participatory Wealth Ranking
Participatory wealth ranking is a participatory poverty assessment method that uses the ratings of local reference groups concerning the relative poverty status of
57 households in their community (Zeller et al., 2006). Participatory wealth ranking was conducted during FGDs to obtain information on wealth status based on local community‘s wealth indicators. Wealth category indicators were used to determine various aspects of wealth status and antibiotics access and use from the study area; while drawing comparison among and within the wealth categories. This exercise was important because inequalities in wealth affect access to every aspect of the people‘s lives, such as veterinary services, education, food security and the ability to respond to changes (Grandin, 1983). The aim was to understand the situation of access to and use of antibiotics and the implications of antibiotics resistance in the study area.
3.8.2.4 Interview
Interviews were conducted to obtain information from the key informants using an interview guide. The reason for adopting this method was to obtain more information and facilitate respondents to make clarifications where the respondent did not understand the question well (Mellenbergh, 2008). The information was used to complement the findings from household survey. The key informants included village elders and leaders, elites, antibiotic suppliers; policy implementers such as
CAHWs, veterinary and animal health officers. The identification of the key informants started from the village office, respondents and FGD.
3.8.2.5 Observation
The study employed a participant observation method to collect additional information. For example, antibiotics were administered to livestock. The researchers interacted with the respondents by asking them questions or communicating with while recording what was happening by listening to the respondent‘s talks. This
58 method was preferred because of its advantage to eliminate subjective biases. In the process of collecting data for the present study, the researcher observed confidentiality, anonymity, safety and an informed consent of the respondents.
3.9 Data Processing, Analysis and Interpretation
Data processing involved converting raw data from the field to classify information. Data analysis is the process of transforming raw data into usable information. Data analysis and interpretation is the process of assigning meaning to the collected information and determining the conclusions, significance and implications of the findings (Minister of Industry, 2009). The primary data collected from quantitative and qualitative sources were cleaned, coded, analysed and interpreted to get the meaning to ease the comprehension of the study phenomenon.
The quantitative and qualitative data were collected and analysed differently using respective methods and techniques.
3.9.1 Analysis of Qualitative Data
Qualitative data from various sources such as FGDs, observation and key informants were analysed using content analysis technique. Content analysis can be effective in qualitative analysis–that "counts" of textual elements merely provide a means for identifying, organizing, indexing, and retrieving data. The analysis of the data was organized according to certain content elements which involved consideration of the literal words in the text being analysed, including the manner in which these words were offered (Berg, 2001; Stemler, 2001).
On the other hand, social Network Analysis was employed for the analysis of social connections after the mapping of social networks. Social Network Analysis is a method for visualizing people and connection power, and therefore being able to 59 identify how best they interact to share knowledge. It allows relationships between people to be mapped in order to identify knowledge flows and information flow. The process of social network analysis involved the use of questionnaires and/or interviews to gather information about the relationships between a defined group and networks of people (Wasserman and Faust, 1994; Hanneman and Riddle, 2005).
Mapping of social networks was done based on the highest percentage scored on multiple responses of actors depending on whom they were interacting more with. This is important in combining information on multiple types of ties
(Wasserman and Faust, 1994). Social networks mapping was employed to explain the existing social networks by tracing how knowledge, information and antibiotics were shared. Social networks mapping provided an understanding of the connection around the pastoral community (Cross et al., 2001). This involved the analysis of relationships between people to be mapped in order to identify the knowledge flows.
This involved the tracing of day to day interactions and relationships to generate the existing networks of information and knowledge as well as resources sharing.
3.9.2 Analysis of Quantitative Data
To permit quantitative analysis, data collected were converted to numerical codes representing attributes or measurements of variables (Kothari, 2004). Quantitative data from household survey were coded and subjected to analysis using the Statistical
Package for Social Sciences version 20 computer programme for descriptive statistical analysis. Frequencies, percentages, trends, multiple responses, measure of central tendency and measure of dispersion were employed to analyse descriptive data. Cross tabulation involving chi–square in categorical data was used to show the
60 associations on how the some variables determine access to and use of antibiotics.
The decision criteria were based on 95% precision.
Multiple logistic regression models were employed to find the association between various independent variables of interest and the use of antibiotics. Regression methods have become an integral component of any data analysis concerned with describing the relationship between a response variable and one or more explanatory variables. Many types of regression analysis exist and logistic regression is one of them (Hosmer and Lemeshow, 2000). When the outcome variable is dichotomous, taking value 1or 0, the logistic regression model has become the standard method of analysis (Hosmer and Lemeshow, 2000). Logistic regression is interested in studying how risk factors are associated with the presence or absence of an event. It can be used not only to identify risk factors but also to predict the probability of success (Hosmer and Lemeshow, 2000). In this study, the logistic regression model was used to find the association between various independent variables such as income, livestock size (number of cattle) and distance to the source of drugs and the use of a particular type of antibiotics identified.
In this analysis, individuals were classified according to whether they were using a particular type of antibiotics or not. That is the dependent variable, Y=1 if the individual was using such antibiotics, and Y=0 if otherwise. The independent variables were income, number of cattle and the distance from the source of antibiotics. The general multiple logistic regression model is given as:
()x logit [ ( x )] log x ...... x 1 (x ) 0 1 1 pp
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Where, ()x is the probability that individuals were using antibiotics, xsi ' are
covariates and i 's are their respective parameters.
The results of the model are presented in the form of regression parameter estimate and odds ratio. The estimated odds ratio (OR) which is determined by taking the exponent of the regression parameter estimates tells about the increased or decreased chance of using antibiotics of a given level of the independent variable while controlling for the effects of the other variables in the model. An estimate of odds ratio greater than 1.0 indicates that the risk of using an antibiotic of a given level of the independent variable is greater than that for the reference category. The estimates of less than 1.0 specify that the risk of using an antibiotic for a given level of independent variable is less than that for the reference category. The Statistical
Analysis System (SAS) statistical package version 9.3 was used for data management and statistical analysis, SPSS package version 20 was used for data entry and excels 2010 was used only for data manipulation. All the tests were done at the 5% level of significance unless otherwise stated.
3.9.3 Validity and Reliability of the Study Instruments
Validity and reliability concern with the quality of the data and appropriateness of the methods employed in conducting research. To ensure validity and reliability, a pilot study was conducted through interviewing a sampled community. The quality of questionnaires was improved after reviewing the questions and responses obtained prior to full data collections. Validity and reliability of research were conducted in order to strengthen the study. Validity emphasizes the measurement pointing a proposed research whilst reliability refers to obtaining similar results through utilizing different experiments or devices. Questionnaires were pre–tested with a 62 small number of interviews before conducting the main interviews. This helped to reveal unanticipated problems with question wording, instructions to skip questions and to see if the interviewees understood the questions and therefore be in a position to give useful answers.
3.9.3.1 Validity
Validity is concerned with whether the measurements provide the information needed to answer the research questions. It is a measure of accuracy, the degree to which a research finding reflects reality (Cooper and Schindler, 2006; Bloor and
Wood, 2006). Validity refers to the ability of scale to measure what is supposed to be measured (Babbie and Mouton, 2001). Any useful research must convince the readers that the findings are trustworthy and believable, that is, they are reliable and valid. The central aim of establishing validity is to confirm that the variables being studied; the methodology and conclusions reached can be generalized beyond the specific study. In order to achieve validity of this study, the study sample was obtained using scientific procedures. Also, multiple methods of data collection were employed to enable triangulation. These include: key informant interviews, focus group discussions, household survey and participant observation. The use of different methods helps to ensure the quality of the findings by triangulation through comparison of the content of different sources of information (Kilonzo, 2008).
According to Bloor and Wood (2006), triangulation is the systematic comparison of findings on the same research topic generated by different research methods.
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3.9.3.2 Reliability
Reliability is concerned with the repeatability of a study, that is, whether the same results can be produced if the same data collection and analysis methods are employed in a new study. It is a measure of precision, the degree to which a research finding remains the same when data are collected and analysed several times
(Robson, 2002; Bloor and Wood, 2006). Reliability is generally difficult to achieve in qualitative studies because it is difficult to replicate the identical circumstances of the original study. Thus, in order to ensure reliability of the data collected, pre- testing of data collection tools was done. A pilot survey was done in the Ngorongoro
District which allowed checking of any possible irregularities that would have mired consistency in the application and results from the study instruments.
3.10 Ethical Considerations
Research ethics are a set of values, standards and institutional schemes that help to constitute and regulate a scientific activity (National Committee for Research and
Ethics in Norway, 1993). Ethical issues were considered and the participants were assured that any information recorded would be for academic purposes and not for any other use. Fieldwork was conducted between September, 2014 and February
2015. The procedures for field work were done according to the government requirements, through the Tanzania Commission for Universities. An introductory letter from the Director of Graduate Studies, of the University of Dodoma was obtained and submitted to the Arusha Regional Administrative office for the permission letter to conduct research in Ngorongoro District. The permission letter from the Arusha regional office was further presented to the Ngorongoro District commissioner office in Loliondo headquarters for the permission to undertake the
64 field work in the district whereby all the necessary documents and permission letters were obtained.
Prior to the beginning of the survey in the villages, much care and foresight were taken to legitimize the research in the eyes of the village leaders, pastoralists and the government officials at village and district levels. Two research assistants and one translator from the study area were trained to assist the researcher in the data collection process and to guide on the local ethics, issues, culture and orders to consider while working within the community. The issue of confidentiality and privacy of the respondents was also taken into consideration, whereby all the individuals involved voluntarily in the discussions and interviews to provide the necessary and valuable information for the study.
3.11 Study Limitation and Delimitation
Some limitations encountered during the field work in the study area include: i. Language barrier: many respondents did not speak English or Swahili. Therefore,
all the study tools such as questionnaire, checklist and interview guide had to be
translated from English language to Swahili language to be understood clearly by
the research assistants and the respondents who understood Swahili language.
Also, a translator of Swahili to Maasai (Maa) language was engaged to assist in
understanding the questions by respondents and the interview using Swahili
language had to be done only to those who speak Swahili something which
delayed the field work. ii. Geographical environment and spatial distribution of households made it very
difficult to conduct household survey. The researcher had to visit on foot some
households which were easily accessible and stayed at the village centres where
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most of household heads or representatives usually came to obtain their
necessities. By the help of village leaders and research assistants, they were
sampled randomly and interviewed. Furthermore, the weather was extremely cold
and it was showering in some villages, such as Nainokanoka and Irkeepus that
the work had to start in late morning which extended the data collection time. iii. The mobility nature of pastoralists in search for water and pasture delayed data
collection due to frequent absence of heads of household who were spokesmen
on issues related to livestock production and antibiotics use. This was overcome
through visiting the nearest grazing areas such as Olmoti crater. iv. Communication networks and accommodation were not easily accessible in the
study area, especially at Nainokanoka ward. Therefore, the information was
obtained through social networks from Enduleni ward to Karatu then to
Nainokanoka ward. Also, the good relationship between the researcher and local
communities facilitated through local leaders and CAHW, who were engaged as
enumerators, made accommodation possible in Nainokanoka ward during this
study. v. Most of the pastoralists were reluctant to disclose the actual number of livestock
they owned in fear inherent in their belief that counting livestock can bring bad
luck to livestock such as increasing their deaths. They were also scared of being
forced by the local government or other stakeholders to reduce the number of
livestock they owned for fear of increasing tax. A solution to this problem was
attained through building trust with the local communities, particularly through
participatory research approaches as FGD and participatory wealth ranking which
fully engaged the community.
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vi. Women respondents were few and could not respond until they were allowed by
men and sometimes men tried to speak on behalf of women. Women respondents
were very difficult to meet. Therefore, more time was spent in explaining the
need for this research. Although male respondents dominated the study, the
researcher tried to engage few women so as to get their opinions to make sure
that the study was not limited to men only. vii. Some of the data were based on memory recall by respondents. These were
carefully considered to be a close approximation of the variables which were
envisioned to quantity. Therefore, verification of data obtained using one method
through triangulation was done to overcome this limitation.
In spite of all the limitations encountered during this study, sufficient measures were taken to overcome them. Therefore, the data obtained were adequate to allow for the inferences made from the study results.
3.12 Chapter Summary
Chapter Three presented the study location, justification for its selection and socio- economic profiles of study. Furthermore, it described the research design, data collection methods and instruments for data collection. Also, sampling procedures that were used and why each instrument for data collection was selected to be suitable for the current study. This Chapter further discussed in details the data processing and analysis methods used in this study as well as the reasons behind the use of the methods. Data analysis techniques were for both quantitative and qualitative data in order to understand the fine distinction presented in a numeric form.
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To ensure validity and reliability issues, together with the ethical considerations of the study findings, all data collection tools were designed to allow accurate and consistent results throughout. Finally, the study limitations and delimitation encountered during data collection, writing and the way they have been addressed in the thesis are presented.
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CHAPTER FOUR
SOCIO-ECONOMIC PROFILE OF PASTORALISTS IN NGORONGORO
DISTRICT
4.1 Introduction
This chapter presents a description of the socio-economic profile of the population involved in the study and their environment that enable access and use of antibiotics in livestock, hence, far-reaching implications on antibiotics resistance. The chapter is organized into four main sections. After this introduction, the chapter describes the socio-economic profile of the study population. In addition to the socio-economic profile, the chapter dwells on the common diseases affecting livestock in the
Ngorongoro District. Furthermore, the chapter discusses the awareness of users on the problem of antibiotics resistance and the indicators of the problem.
The findings presented in this chapter are based on content analysis and descriptive statistics. The content analysis involves a review of various documents from previous studies and transcription of focus group discussion and key informants‘ interviews/responses. The final section provides a brief summary of the chapter.
Information from this chapter is essential because it provides the basis for the discussion and supports the findings of the study.
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4.2 Socio-Economic Profile of the Study Population
Socio–economic profile involves household background information related to social and economic factors that are important for accessing and using antibiotics. This is in relation to antibiotic users within the supply systems and social networks being either disadvantaged or advantaged on the basis of age, sex, literacy levels and socio- economic status. The information hereunder focuses on the households with respect to sex, age, and marital status, level of education, household size and wealth status.
Although not reflected in objectives, these factors were deemed to influence the decision on the access and use of antibiotics within the supply systems and social networks that further have implications on antibiotics resistance at the community level.
4.2.1 Sex of the Respondents
The sex of individuals in a household determines gender relationships in the decision making process, particularly on the ownership and control of resources. In the context of this study, the sex of an individual influences the decision on the access and use of antibiotics. The findings as presented in Table 4-1 below indicate that very few women, accounting for 10.4% of the respondents, were involved in household survey compared to male respondents who accounted for the remaining
89.6%. Esere and Nainokanoka villages had eight female respondents each and
Irkeepus had only seven, while Enduleni village had no female respondents interviewed. The relatively low turn up of women for interview is explained by the social and cultural set-up in these pastoral societies in which women are regarded as minors. In this situation, women are rarely involved in decision making and, in the
70 event that they need to speak to strangers, they first have to seek permission from their male counter parts.
Among the reasons for women not turning up for interviews is that, like other women in rural Africa, women in Ngorongoro District are usually involved in household chores including preparing food, drawing water, building huts, milking cows, hollowing out gourds and decorating them, as well as caring for family members. A study by Odour (2011) supports this observation that a Maasai woman is faced by a
―triple burden‖ to reproduce, to produce and to bear all the other social roles. In this way, women did not want to ―waste‖ any minute in other activities that did not contribute to the family and community welfare. This explains why there were very few women involved in this study.
Table 4-1: Percentage Distribution of Respondents by Sex, Age and Marital Status
Variables Number Per cent Sex Male 198 89.6 Female 23 10.4 Total 221 100.0 Age in Years <30 Young 47 21.3 30 - 40 Young middle 62 28.1 41 - 50 Middle 57 25.8 51 - 60 Old middle 31 14.0 >60 Old 24 10.9 Total 221 100.0 Marital Status Single 8 3.6 Married 209 94.6 Widowed 4 1.8 Total 221 100.0 Source: Field Data, 2014 71
4.2.2 Age of the Respondents
The findings in Table 4-1 show that a fairly equal proportion of respondents among the young (21.3%); young middle (28.1%); and middle (25.8%) participated in the study. Those aged between 51- 60 accounted for 14% and those above 60% accounted for 10.9% of the rest. The age of the head of the household has significant influence on the decision making process to access antibiotics through social networks and supply systems, as well as livestock production and management.
The head of the household is responsible for fulfilling the household basic economic and social needs. This is because it requires a person who is mature enough to take responsibilities for the various decisions made at household level. This necessitates the household head to get involved in social networks in order to satisfy household needs which include caring for family and the livestock. Based on age-set system of pastoralists, it is the men who usually take care of the livestock whereas women take care of the family members. This is also supported by Koissaba (2013) regarding age groups and productive capacity in Maasai of Kenya that the age-set system plays an important role in the structure and social organization.
Furthermore, these age ranges are also involved in the security operations and assisting the older people in their advisory role at the community level. It was also revealed by the study that these age groups were the major decision makers, as they are old enough to be involved in social networks that enable, not only access and use of antibiotics in livestock, but also the sharing resources at the community level.
Bekure et al., (1991) hold a similar opinion, as they assert that, the age-set is an accepted and organized group consisting of persons especially male of the same age.
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In many pastoralist settings, the age-set normally consists of males who are initiated one the same time.
It is also important to note that, once a person enters a given age-set at birth or by initiation, he remains a member of the same age-set for the rest of his life and has to take up responsibilities according to the socially and administratively constructed roles, including antibiotic access and use (Bekure et al., 1991). Thus, age-sets and clans still form the most important structure, for socio-political organization in pastoral communities in which every person has well-defined roles, responsibilities, rights and obligations in relation to every other person in society. Moreover, age groups in the study area are gendered in terms of division of responsibilities. For instance, antibiotics purchase and use are normally done by men.
4.2.3 Marital Status of the Respondents
The study involved respondents with different marital statuses. The data presented in
Table 4-1 indicate that the majority (94.6%) of the respondents were married. Only a small proportion of respondents, accounting for 5.4% and 1.8% were single and widowed, respectively. One would expect that married couples would more likely to be involved in social networks to access and use antibiotics in livestock than unmarried persons. Nevertheless, marital status is not the only important factor in social networks that allows a person to assume household and the family responsibilities including livestock management. Otherwise, other aspects such as herd size are also important. The findings show that all respondents were involved in social networks associated with access and use of antibiotics in livestock, regardless of their marital status.
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4.2.4 Education Level of the Respondents
The level of education does not only empower an individual in knowing how to read and write, but also it is important for one to be informed on various developmental issues and initiatives for a better decision making. Among the respondents interviewed, 56.9% among the middle wealth category and 59.1% within the rich wealth category had attained primary education (Table 4-2).
Table 4-2: Level of Education and Household Size by Wealth Category
Wealth categories Education level Poor (n=127) Middle (n=72) Rich (n=22) Total (n=221) N % N % N % N % Informal education 63 49.6 24 33.3 5 22.7 92 41.6 Primary education 58 45.7 41 56.9 13 59.1 112 50.7 Secondary 4 3.1 6 8.3 4 18.2 14 6.3 education Post-secondary 2 1.6 1 1.4 0 0.0 3 1.4 Total 127 57.5 72 32.6 22 10.0 221 100.0 Household Size < 4 Small 32 25.2 15 20.8 3 13.6 50 22.6 4 – 7 Medium 48 37.8 26 36.1 7 31.8 81 36.7 > 7 Large 47 37.0 31 43.1 12 54.5 90 40.7 Total 127 57.5 72 32.6 22 10.0 221 100.0 Source: Field Data, 2014
The findings also show that less than 50% of the respondents in the poor wealth category had attained primary education, meaning that at least they knew how to read and write. About half (49.6%) of the respondents, among the poor wealth category, had only informal education, implying that they hardly knew how to read and write
(Table 4-2).
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The proportion of households with formal education is worth commenting on. This is lower than the national average of 91.3% of people who have primary education in
Tanzania Mainland (URT, 2014). This is typical of the pastoral communities which, due to their frequent mobility, they had no better opportunities to benefit from formal education. It is also important to note that there is no any person with post- secondary education in the rich wealth category. This implies that formal education is given an average priority despite the government‘s initiatives that emphasize on primary education attainment for all (URT, 2001). It was revealed that those who were illiterate, they were normally asking for assistance from their neighbours and suppliers for advice and instructions in using antibiotics. This means that antibiotic users depend on local suppliers for information on access and use. In most cases however, a large proportion of the local suppliers did not have adequate expert knowledge to disseminate to antibiotic users.
In addition, only a very small proportion of people (3.1%) in the poor and 8.3% heads of households in middle wealth categories had secondary education (Table 4-
2). This is because in most of the pastoral communities, formal education, especially higher education, is still given a minimal priority. This is because many people either cannot afford to pay for higher education or due to attitudes towards formal education and the culture of Maasai pastoralists to cling to their traditions. This explains why there was low turn up for secondary school education. In addition, primary education was not adequate for handling and administration of antibiotics in livestock as it results into misuse of the drugs in livestock leading to antibiotics resistance.
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4.2.5 Household Size
A household size consists of the number of persons usually residing in a household and who share the expenses (Kamuzora and Mkanta, 2000). The size of household can influence the access and use of antibiotics within a household because there is sharing of other available resources. There is also an involvement in social networks among individuals in the households, which provide them with knowledge and information to access and use antibiotics. One would expect that those households with a large number of adults would have established more social networks that enable them to share knowledge and information to access and use antibiotics in livestock.
The households in the study areas had different sizes. The data in Table 4-2 show that 25.2% among the poor households, 20.8% among the middle wealth category and 13.6% among the rich wealth category had a small household size (less than 4).
It was found that 37.8% of the respondents among the poor, 36.1% among the middle wealth category and 31.8% among the rich households had a medium household size of 4–7 individuals. It was further revealed in Table 4-2 that 54.5% of the households, among the rich, 43.1% among the middle and 37.0% among the poor wealth category had a large household size above seven individuals.
The findings further revealed that the average household size in the study area was
8.1 members. This figure is statistically higher than the one reported by URT (2013) during the population census of 2012, which was 4.5 and 4.7 for Nainokanoka and
Enduleni wards, respectively and 4.8 for Ngorongoro District. These large variations can be explained by two major reasons which are typical to pastoral communities.
First, polygamous marriages enable them to have many wives and children,
76 associated by an increased population due to high fertility and relatively reduced mortality rates. A study by Coast (2001) on Maasai Demography in Kenya and
Tanzania supports this observation that there is evidence of recent decline in mortality rates that can cause an increase in the population.
Second, the more wives and children a man has, the higher his status in the community and the ability to cope with labour demands (Tarayia, 2004; Odour,
2011). It was also observed that children, who were at the age of 7 to 10 years, normally take care of small livestock such as goats, sheep and calves for grazing and watering. The morani (youth) are normally involved in security operations for people and livestock. The elderly play advisory and keeping roles. Such division of labour also requires more household members with stronger networks who can access and use antibiotics for livestock.
4.2.6 Household Wealth Status
Household wealth status determines the access and use of antibiotics for livestock.
Wealth status was determined from participatory wealth ranking during focus group discussions. Among the variables for wealth status include: indicators used for wealth status, household annual income, size of livestock herd and trend of livestock production. Cattle are the most valuable livestock that signify wealth and confer a status than any other livestock in Ngorongoro District. In a pastoralist community, like Maasai, cattle serve as a medium of exchange they legitimize marriage and symbolize social relationships. Moreover, cattle are objects of affection and of supreme religious significance (Arkhem, 1985). Following the multiple role played by livestock in a pastoral community, the use of antibiotics in caring for livestock, especially cattle, is of paramount importance. However, this is done without
77 consultation with livestock health experts hence resulting into over use or under use, thus leading to antibiotics resistance to livestock.
4.2.6.1 Indicators Used for Wealth Status
The members of focus group discussions indicated that ownership of livestock is almost the sole indicator of wealth status. This attachment to livestock among pastoralists is not unique to Maasai pastoralists in Ngorongoro District. Other pastoralists, such as Datoga, Sangu, Juhaina Arabs and Yomut, place high value on livestock, which is the symbol of wealth status (Mulder, et al., 2010). The wealth indicators were used to determine different wealth categories and access to and use of antibiotics in the study area. A comparison among and within the wealth categories was drawn. This exercise was important because, the inequalities in wealth have effect on every aspect of the people‘s lives, such as veterinary services, education, food security and the ability to respond to changes.
It was assumed that households with differing wealth status had different problems and needs, as well as varying ability to access and the use antibiotics for livestock.
The main indicator used was the size of the livestock herd of cattle, goat and sheep.
The size of the herd of cattle was the major indicator used because, according to the focus group discussions, in all the villages in the study area, those owning large herds of cattle also owned a large number goats and sheep. On the basis of ownership of livestock, three major categories of wealth status existed in the study area. These included poor households, middle wealth households and well-off or rich households. Table 4-3 shows the indicators of wealth categories as ranked by the focus group discussions in each village in the study area.
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Table 4-3: Indicators for Wealth Status Based on Size of Livestock
Esere FGD Enduleni FGD Irkeepus FGD Nainokanoka FGD Rich Rich Rich Rich Cattle: >300 Cattle: >100 Cattle: >50 Cattle: >150 Goats &sheep: > 600 Goats &sheep: >250 Goats &sheep: >60 Goats &sheep: >200 Middle Middle Middle Middle Cattle: 50–300 Cattle: 10–100 Cattle: 10–30 Cattle 50–150 Goats &sheep: 200– Goats &sheep: 50– Goats &sheep: 20– Goats &sheep: 50- 600 250 50 200 Poor Poor Poor Poor Cattle :<50 Cattle: <10 Cattle: <20 Cattle <20 Goats & sheep: <200 Goats &sheep: <50 Goats &sheep: <10 Goats &sheep: <50
Source: FGD Field Data, 2014.
Based on the indicator and the criteria used, the data in Table 4-4 show that slightly more than half (57.5%) of the respondents from the villages in the study area were poor, owning less than 20 herds of cattle. This was followed by 32.6% of the household in the middle wealth category owning 20–100 herds of cattle and 10 % of households in the rich wealth category owning more than 100 herds of cattle. The fact that slightly more than half of the people are poor can have an impact on how to access and use antibiotics for livestock. Chi-square test statistics show that there is a significant difference in wealth status based on the size of the herd of cattle.
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Table 4-4: Wealth Categories Based on Cattle Size
Wealth status Chi- Poor (n=127) Middle Rich (n=22) Total (N=221) square Village (n=72) Value N % N % N % N % Enduleni 24 44.4 24 44.4 6 11.2 54 100.0 13.186* Esere 17 43.6 17 43.6 5 12.8 39 100.0 Nainokanoka 50 66.7 20 26.7 5 6.6 75 100.0 Irkeepus 36 67.9 11 20.8 6 11.3 53 100.0 Total 127 57.5 72 32.6 22 10.0 221 100.0 * = significant at P <0.05; N=Number; %=Per cent
Source: (Field Data, 2014)
4.2.6.2 Household Annual Income
Household annual income and the expenditure on livestock health services were considered to be among the important aspects that facilitate antibiotic accessibility and use. Income earned by households enables them to strengthen their purchasing power to access to antibiotics and other needs. It was found that the mean annual income earned by the households was TAS 2,084,398.19. The minimum and maximum annual incomes were TAS 420,000.00 and TAS 9,500,000.00, respectively, with a standard deviation of 1549063.25. The variation of income would be expected to reflect in the variation of access to and use of antibiotics, such that those with higher income were expected to have a stronger purchasing power.
These assumptions are supported by Sekyere (2014) study in Ghana who found that the middle income and high income farms used more antibiotics than lower income farms due to the larger number of animals and financial ability. As a result, the prospects of resistance to various antibiotics in bacteria in the farm environment were higher in the middle and higher income farms than in the low income farms.
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Subsequently, according to Sekyere (2014), increased veterinary attention and education should be directed more towards the middle and higher income farms than the lower income ones to minimize the practices leading to increase of antibiotic abuse and resistance.
It is worth noting that although the annual incomes vary from one household to another, indicating that some households get more than 1 USD per day while others earn less, social organization and networks of the respondents enable them to depend on others to acquire their means of livelihoods, including food security and antibiotics. In this way, antibiotic users share antibiotics and other resources, as such that, even the low income users, with few livestock, can access and use antibiotics frequently. This is further supported by findings elsewhere in Africa where Berhanu
(2011) in Southern Ethiopia, for example, revealed that social capital was a key asset of the peripheral poor pastoralists. Table 4-5 shows the distribution of annual income, expenditure in livestock health per month and the level of sufficiency of the expenditure.
The majority (77.2%) of the respondents among the poor, 95.8% among the middle and all households among the rich wealth categories, were revealed to earn more than 1,000,000 TAS as the annual income. The findings show that only 2.4% of the respondents owned less than TAS 500,000 and they were found within the poor wealth category. However, Chi-square test statistics show that there was a significant difference at p<0.01 among the wealth categories in terms of annual income gained within the wealth categories in the study area.
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Table 4-5: Annual Income and Household Expenditure in Livestock by Wealth Status
Wealth status Chi- Poor (n=127) Middle Rich (n=22) Total(n=221) square Variables (n=72) Value N % N % N % N % Level of income <500,000 3 2.4 0 0.0 0 0.0 3 1.4 17.208** 500,000 – 26 20.5 3 4.2 0 0.0 29 13.1 1,000,000 >1,000,000 98 77.2 69 95.8 22 100.0 189 85.5 Total 127 100.0 72 100.0 22 100.0 221 100.0 Expenditure in livestock health services per month <50,000 87 68.5 27 37.5 4 18.2 118 53.4 42.886*** 50,000 – 34 26.8 30 41.7 8 36.4 72 32.6 100,000 >100,000 6 4.7 15 20.8 10 45.5 31 14.0 Total 127 100.0 72 100.0 22 100.0 221 100.0 **=Significant at P<0.01; ***=Significant at P<0.001; NS=not significant P>0.05;
N=number; %=per cent;
Source: Field Data, 2014;
The significant differences were shown between those who earned less than TAS
500,000 and those who earned TAS more than 1,000,000 annually but not between the wealth categories. It is important to note that the pastoralists‘ wealth status is considered by livestock size than income.
The findings in Table 4-5 further reveal that 68.5% of households in the poor wealth category were using less than TAS 50,000 per month whereas 41.7% of households in the middle wealth category were using TAS ranging from 50,000 to 100,000 per month. Households in the rich wealth categories were spending more than TAS
100,000 per month on livestock health care. Chi-square test statistics show that there
82 is significant difference at P<0.001 among the wealth categories in terms of the expenditure in livestock health care per month. It is evident from this analysis that the differences in expenditure in livestock is due to the number of livestock to care.
For example, rich pastoralists with more livestock spend more income for livestock health services including purchase of drugs like antibiotics. Nevertheless, the variation in wealth status of the households does not hinder access and use of antibiotics in livestock because of the sharing culture among pastoralists that enable the poor also to access and use drugs frequently.
In addition, the study examined other users‘ assets which can influence access to and use of antibiotics. The assets owned by households, apart from livestock, included mobile phone (78.6%), sprayer pumps (49.3%) and radio (33.6%) of the respondents.
Other assets included wheelbarrow (2.1%) and motorcycle (0.7%). The motorcycle, which is one of the major assets in most places including urban and rural areas in the country, especially for youth, was reported by only one individual. This was because in the villages of the study in Ngorongoro District, motorcycles and bicycles are not allowed because they are prone of the risks involved with wild animals attack and accidents.
4.2.6.3 Types of Livestock Herds in Ngorongoro District
Livestock is one of the most important resources determining the wealth status of most pastoral communities in Sub-Saharan Africa and Tanzania is not an exception.
The types of livestock owned determine the economic value of the household and influence the use of antibiotics for animal health care. Pastoralists in Ngorongoro
District owned different types and sizes of livestock herd in the study area. It would be assumed that the type of livestock with more value would be frequently treated
83 using antibiotics compared to others. However, the opposite was noted whereby almost all types of livestock were treated using antibiotics.
The major types of livestock owned by households in Ngorongoro District by priority include cattle owned by 96.8%, goats (96.4%), sheep (81.4%) and donkey
(53.4%). A few households (3.2%) did not own cattle but at least owned goats or sheep or both. It was further observed that those households with more cattle also had more goats and sheep, normally combined. Donkeys were owned by few households because they were not seen to be that much valuable compared to other types of livestock. It was revealed that Donkeys were mostly owned and used by women for carrying luggage such as water, maize and food stuff from distant places.
The study by Mulder et al. (2010) supports this finding, that women in pastoral communities owned small ruminants and donkeys while men owned cattle.
Further analysis shows that the minimum and maximum numbers of cattle were 0 and 150, respectively, with a mean of 29.76 and standard deviation of 36.137. The minimum and maximum numbers of goats were 3 and 240, respectively, with a standard deviation of 31.140. In addition, the minimum and maximum numbers of sheep were 2 and 500, respectively (Table 4-6). It is important to note that, information on the size of livestock in pastoral communities needs to be treated with caution. This is because of the inherent tendency among pastoralists not to tell the exact number of livestock. Efforts by this were directed towards triangulation in order to minimize the occurring of error.
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Table 4-6: Mean, Minimum and Maximum Size of Livestock
Livestock Minimum Maximum Mean Std. Variance Deviation Number of cattle 0 150 29.76 36.137 1305.867 (N=221) Number of goats 3 240 27.05 31.140 969.719 (N=213) Number of sheep 2 500 27.34 47.799 2284.763 (N=180) Number of donkeys 1 20 3.90 3.239 10.494 (N=116) Source: Field Data, 2014); N=number; %=per cent
4.2.6.4 Trends of Livestock Production
The study further sought to find out the trend of livestock owned by the respondents over the past five to ten years, to determine the status of livestock production. The respondents provided slightly different opinions on the trend of livestock based on wealth categories. The findings show that the livestock trend over the past five to ten years had been decreasing for households in all wealth categories and for all types of livestock. This reveals that many pastoralists experienced a decrease in livestock trend regardless of their wealth status.
The respondents gave several reasons to explain the declining trends in the size of livestock herds owned at household level. These reasons are presented in Table 4-7 and they include outbreak of diseases, drought and sale of livestock to obtain household needs, and attacks of livestock by wild animals.
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Table 4-7: Reasons for the Decreased Trend of Livestock Production by Type of
Livestock
Type of Livestock Reasons for the Cattle Goats Sheep Donkeys declining trend of (n=214) (n=213 (n=178) (n=54) livestock N % N % N % N % Diseases outbreak 211 98.6 210 98.6 173 97.2 16 29.6 Drought 94 43.9 73 34.3 46 25.8 10 18.5 Increased sale to fulfil 45 21.0 43 20.1 42 23.6 2 3.7 needs Attacks by wild animals 14 6.5 7 3.3 6 3.4 26 48.1 NB: Percentages and totals are based on multiple responses.
Source: Field Data, 2014
The outbreak of livestock diseases was mentioned by 98.6% of the respondents to be among the reasons for the decline of the size of cattle herds. This was also reported as the main reason for the decline in the number of goats by 98.6%, sheep (97.2%) and 29.6% for donkeys (Table 4-7). Limited access to veterinary services was deemed the main factor contributing to high prevalence and persistence of livestock diseases.
The respondents also gave their opinions on recent changes in their communities. It was reported that there had been an increasing demand for social services such as education, health services and food. These demands led to more expenditure and an increase in selling of livestock to meet those necessities. Drought was reported by
43.9% of the respondents and this also contributed to some diseases such as solosh
(malnutrition) and general body weakness of the livestock. Solosh was not reported by any respondent from Nainokanoka and Irkeepus villages. This is because malnutrition is caused by lack of enough fodder to feed livestock. Near these villages
86 there is Olmoti crater where they find feed for livestock. They are therefore, less affected by nutritional related diseases such as solosh. It is shown in Table 4-7 that cattle were affected more by drought compared to other types of livestock. This is because cattle require more pasture and water than other types of livestock.
Galvin et al. (2004) revealed that disease epidemics and livestock starvation associated with recurring drought, among other factors, impacted on the livestock population due to livestock morbidity and mortality among the Maasai of Tanzania, therefore, putting a serious food security stress on households. Although the general trend shows that the number of livestock declined, some few numbers of participants in FGDs explained that livestock number increases. This is because livestock are a business for some of the individuals.
4.3 Common Livestock Diseases in Ngorongoro District
The prevalence of livestock diseases which have become difficult to cure were reported by pastoral respondents as one of the biggest challenges affecting livestock development in the study area and, in the country at large (URT, 2010, Gustafson, et al. 2015). This is further compounded by the limited availability of livestock health experts in the area. As a result of such limitations, access to antibiotics is done through social networks which are now found to be the main option, especially for the poor households. The major common diseases affecting livestock as reported by respondents in the study area, are presented in Table 4-8. Based on the multiple responses, the findings reveal that the most common diseases affecting cattle in the study area include, East Coast Fever (Oltikana) as reported by 97.7% of the respondents, followed by Bovine Cerebral Theileriosia (Ormilo) reported by 75.7% of the respondents and Pneumonia (Orkipei) reported by 66.4% of the people
87 interviewed. These diseases were reported to affect nearly all the villages. These common diseases were also confirmed during focus group discussions from all the villages under this study.
An interview with the Ngorongoro District Livestock Development Officer further revealed that the most common diseases in livestock among others included
Contagious Bovine Pleuropneumonia (Orkipei), Trypanosomiasis (Ndorobo), Bovine
Cerebral Theileriosia (Ormilo), Plasmosis and tick borne diseases which included
East Cost Fever (Oltikana). Trypanosomiasis was not reported by the respondents from Esere village because they had dipping facilities (to control ticks) where livestock keepers were obtaining services at low costs.
Participants in focus group discussions in Endulen village confirmed to be affected by trypanosomiasis in cattle because although there was a dipping facility run by the community, some livestock keepers were not using it because they found it to be expensive and, sometimes the facility ran out of drugs. Also, dipping facilities were located far from others villages for users to access the services. Thus, the use of hand pumps which many livestock keepers were sharing had become common.
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Table 4-8: Common Diseases Affecting Cattle in Ngorongoro District
Common Village diseases Enduleni Esere Nainokanoka Irkeepus Total n=214 affecting cattle N % N % N % N % N % East Coast Fever 52 24.3 35 16.4 70 32.7 52 24.3 209 97.7 Malignant Catarrhal 20 9.3 27 12.6 21 9.8 18 8.4 86 40.2 Fever Foot and Mouth 20 9.3 6 2.8 38 7.8 25 11.7 89 41.6 Diseases Bovine Cerebral 40 18.7 36 16.8 46 21.5 40 18.7 162 75.7 Theileriosis Brucellosis 12 5.6 10 4.7 23 10.7 12 5.6 57 26.6 Anthrax 4 1.9 12 5.6 2 0.9 0 0.0 18 8.4 Cancer 13 6.1 5 2.3 1 0.5 0 0.0 19 8.9 Worms 2 0.9 2 0.9 6 2.8 1 0.5 11 5.1 Contagious Bovine 51 23.8 35 16.4 31 14.5 25 11.7 142 66.4 Pleuropneumonia Diarrhea 8 3.7 7 3.3 12 5.6 20 9.3 47 22.0 Anaplasmosis 0 0.0 2 0.9 8 3.7 0 0.0 10 4.7 Blackquater 2 0.9 2 0.9 2 0.9 0 0.0 6 2.8 Rinderpest 3 1.4 0 0.0 3 1.4 1 0.5 7 3.3 Trypanosomiasis 24 11.2 12 5.6 0 0.0 0 0.0 36 16.8 Constipation 2 0.9 1 0.5 0 0.0 0 0.0 3 1.4 Malnutrition 5 2.3 17 7.9 0 0.0 0 0.0 22 10.3 Tuberculosis 1 0.5 0 0.0 0 0.0 0 0.0 1 0.5 Total 53 24.8 37 17.3 71 33.2 53 24.8 214 100.0 NB: Percentages and totals are based on multiple responses.
Source: Field Data, 2014
Although Brucellosis and Tuberculosis were reported by only 26.6% and 0.5% of the respondents, respectively, these diseases are fatal to both livestock and human beings. The diseases were also confirmed by the livestock officer to affect livestock in Ngorongoro District (WHO, 2006; Davies, 2006). Furthermore, rinderpest 89
(sotoka) was also mentioned by 1.4% of respondents from both Endulen and
Nainokanoka and 0.5% from Irkeepus village. However, the Ngorongoro District
Livestock Development Officer reported that rinderpest had been eradicated in the study area for almost ten years back.
“Rinderpest is no longer a threat to livestock; it was eradicated ten years back” (Livestock Officer Ngorongoro District, 2014).
This reveals that either users of antibiotics confused the symptoms of rinderpest with other diseases or the District Livestock Development Officer was not aware of the current outbreak of the disease in the area. Therefore, if the latter were true, then it further reveals the earlier observations that there is limited contact between livestock experts and livestock keepers in the study area.
The findings further revealed that most of the common diseases affecting cattle were also affecting other livestock, especially goats and sheep. The diseases of goats included Bovine Cerebral Theilerosis (Ormilo) this was reported by 89.2% of the respondents. Contagious Caprine Pleuropneumonia (Orkipei laa ndare) was reported by 93% of the respondents, slightly high incidence of the diseases was actually reported from Nainokanoka village. This is because the village has low temperature due to its proximity to Olmoti crater. Diarrhea (Engorotik) and skin conditions
(Emukuji/Olomoroj) were reported to frequently affect goats by 52.6% and 47.9% of the respondents, respectively. These diseases were also reported by pastoralists to be difficult to treat due to repeated occurrences in the livestock. The study further revealed that East-coast fever (Oltikana) and infections by worms (Enginyoot) were among the major diseases affecting sheep as reported by 47.3% and 34.2% of the respondents, respectively, compared to other livestock in the study area. It was noted
90 that occurrence of these diseases contributes to users‘ involvement in social networks to access and use antibiotics for livestock care.
This discussion on the most common livestock diseases has revealed that despite the frequent use of antibiotics obtained mostly through social networks and supply systems, it has not been possible to solve the problems of livestock diseases in the study area. This is because there is still persistence of the outbreak of diseases which compel pastoralists to continue using antibiotics and in some cases, without prescription.
It was revealed that only donkeys are the type of livestock not frequently affected by many diseases in the study area. This is because, they are more resistant to diseases and drought than other animals as explained by one of the key informants:
“Donkeys are not easily affected by many diseases because they are more resistant to drought and diseases. Also most donkeys are owned by women who do not have enough money and time to care for other animals” (Key informant Enduleni, 2014).
There were still some diseases mentioned such as Trypanosomoses
(nagana/ndorobo), reported by 42.9% of the respondents, Bovine Cerebral
Theileriosis (Ormilo) reported by 33.6%, Skin Conditions (26.2%) and worms infection (7.1%). These diseases were also mentioned to affect other livestock, thus making pastoralists find various means to access and use antibiotics for treatment.
In view of the existence of livestock diseases in the study area, various initiatives and practices have been taken by pastoralists to cope with the problem reported by the participants from all FGDs.
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“We normally shift our livestock to other places to graze away from the affected herds; sometimes we use vaccination and dipping animals” (FGD participants in all villages of the study).
Referring to the statements on the initiatives to cope with diseases, some practices such as shifting livestock to other places can lead to more contacts with other livestock, thus spreading diseases to other places.
The diseases were also due to the interaction between livestock and wild animals because livestock and wild animals share the common resources such as water and pasture. This interaction can contribute to transmission of diseases to livestock from other hosts and vice versa. Sharing resources alongside the use of antibiotics in livestock can result into antibiotics resistance that in turn affects livestock, wild animals and people. The findings revealed that the majority (95.0%) of the respondents disclosed that their livestock were interacting with wild animals several times; whereas only (5.0%) admitted that their livestock interact with wild animals occasionally. However, pastoralists took no action in most cases, as it was explained in a discussion;
“Nothing can be done for our livestock not to share water and pasture with wild animals because there are no specific places for livestock to gaze and drink. Those wild animals you see can come even to the compound of households” FGD Irkeepus (2014).
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Plate 4-1: Interaction between Wild Animal and Livestock by Sharing Pasture
Source: Field Data, 2014
The study further assessed the level of awareness of respondents on any problems that arises due to interactions of livestock with wild animals. The findings revealed that 70.1% of the respondents had a minimal awareness of the problems that could arise due to interaction between livestock and wild animal; whereas 27.6% of the respondents were not aware of any problem and only 2.3% were aware of the problems of interaction between livestock and wild animals. The problems that were mentioned to arise due to interaction of livestock with wild animals included contacting diseases mentioned by 64.5% of the respondents and attack of livestock from wild animals was mentioned by 48.5%.
Furthermore, 24.5% of the respondents revealed that the problems were not clearly known to them although they had minimal awareness. This reveals that the interaction of livestock with wild animal can cause transmission of diseases to livestock and reasonable number of pastoralists had same degree of awareness but still there was more interaction that could increase diseases in livestock. 93
The types of diseases mentioned to be transmitted from wild animals (wildebeest) to livestock (cattle) was MCF - Malignant Catarrhal Fever (Engatii). The respondents admitted that this disease had no effective cure. As a result, they were forced to shift their livestock to other places during the breeding season of the wildebeest. This finding aligns with the study by Hambly (1996) that, the Maasai had no cure for
MCF (engatii), they kept their livestock strictly away from wildebeest and from surface drinking water during their breeding season. This precautionary measure is derived from indigenous knowledge and experience shared within the community of the cause and vector of the disease. Pastoralists were convinced that the wildebeest was the silent carrier of MCF. They also believed that the disease was contained in the foetal membrane fluids of calving wildebeest.
4.4 Awareness of Users on Antibiotics Resistance in Ngorongoro District
Awareness of antibiotics resistance can shape the users‘ habit of utilization of the drugs in livestock. The level of awareness is important to show the understanding of the users on the possible risks that can be associated with an imprudent use of antibiotics. The findings in Figure 4-1 show the level of awareness of users on antibiotics resistance.
Figure 4-1: Level of Awareness of Users on Antibiotics Resistance. Sources: Field Data,
2014 94
Low level of awareness on antibiotics resistance can lead to an improper use of antibiotics in livestock. This can increase the risk of antibiotics resistance in the study area. A study by Katakweba (2014) in Mikumi in Tanzania on the awareness of risks associated with antimicrobials use and practices that contribute to selection for antimicrobial resistance in livestock was conducted. The finding obtained from that study revealed that 30% of the respondents were not aware of the problem of antibiotics resistance and 52% were not aware of the types of diseases that could be treated with antibiotics. This poses the public health at risk since pastoral community access and use antibiotics to treat livestock without prescriptions.
Further analysis shows that the pastoralists had minimal awareness on the problem of antibiotics resistance. Also the extent, to which it existed at the community, was also not known by many of them. Figure 4-2 shows that the majority (85.0%) of the respondents reported that the extent of antibiotics resistance was not known to them.
This implies that the pastoralists had minimal awareness of the risk associated with antibiotics resistance. Yet again, they were not aware of the magnitude of antibiotics resistance problem. Not knowing the magnitude of a problem and the risk factors associated with the problem, can result into imprudent use of antibiotics in livestock consequently to antibiotics resistance. Figure 4-2 indicates the users‘ awareness on the extent of antibiotics resistance in the study area.
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Figure 4-2: Awareness on the Extent to Which Antibiotics Resistance Occurs in
Ngorongoro District
Sources: Field Data, 2014
Antibiotics resistance was realised to exist in the essence that the users were in paradox of malfunctioning of drugs due to resistance or due to expired/fake
(counterfeiting) drugs existing in the supply systems. Knowing a particular problem enables individuals to make the right decision on how to minimize or to handle the situation. For example, antibiotics resistance dilemma is compounded by the prevalence of various diseases in livestock, which becomes difficult to get cured.
This was revealed by all participants in all FGDs in Ngorongoro as one of the biggest challenges affecting livestock development. Prevalence of diseases indicates either the misuse of drugs or interaction of livestock with others or wild animals resulting into antibiotics resistance.
4.5 Indicators of Antibiotics Resistance by Users Perception
Indicators are used to understand how antibiotics resistance is explained by users based on their perceptions and perspectives. This is also important to understand the measures taken to tackle the problem. The respondents mentioned multiple indicators to explain antibiotics resistance. Though the users revealed minimal awareness on
96 antibiotics resistance in the study area, they were able to give their views on indicators used to explain antibiotics resistance. These indicators include persistence of illness in livestock, the number of livestock reported not to respond to treatment with antibiotics and the number of livestock that died after treatment with antibiotics.
Concerning livestock not responding to treatment, it was revealed that illnesses were occurring due to malfunctioning of drugs as one of the most useful indicators to explain antibiotics resistance by users. This was reported by 51.2% of the respondents among the poor, 48.6% of the respondents among the middle and 54.5% among the rich wealth categories. Based on users‘ perspective, persistence of illness can occur when antibiotics are administered for treatment of non-bacterial infections.
This is because users in most cases do not consult veterinary experts for advice or prescription. Instead, they rely on knowledge acquired through social networks and self-experience, thus leading to the risk of antibiotics resistance. Furthermore, livestock not responding to treatment can be due to the use of expired drugs or counterfeit drugs therefore, making diseases untreatable. About 35.3% of the respondents did not know the indicators for drug resistance, meaning that they could not explain the incidence, as it was pointed out in the discussion:
“….Sometimes we just try these antibiotics, you buy the drug from a seller‟s shop in a village but livestock do not respond to treatment or after short time of one or two weeks, the animal falls sick again” (FGD participants, Irkeepus, 2014)
The statement supports the finding of few respondents (4.0%) who reported that repeated illness in livestock after short period of treatment could also be one of the indicators to explain antibiotics resistance. A similar situation was also noted elsewhere in the world where Kingsley (2015b) in Nigeria reported that the cattle owners had adopted a practice of testing a drug on a small number of sick animals 97 for fake drugs. Conversely, repeated illness can also be due to under dosage of livestock because of the habit of sharing drugs or it can also be due to improper administration of antibiotics.
Furthermore, the number of livestock reported to continue to get sick on treatment with antibiotics in the past six months during the study period were also indicated by users. The findings in Table 4-9 show that about 40% of the respondents in the poor and middle wealth categories reported that the number of cattle that experienced persistent illness in the past six months of the study was less than five. About 42.9% of the respondents in the rich wealth category reported more than 10 herds of cattle.
The proportion of number of livestock not responding to treatment indicates that users of antibiotics experienced persistent illness of relatively equal number of cattle regardless of their wealth categories.
The number of livestock not responding to treatment with antibiotics reveals the possible scenarios that can be explained by either the fact that there is resistance of drugs, inappropriate treatment provided to livestock such as under dosage and the use of counterfeit drugs. This can result into more problems in livestock health the consequences of which could result to deaths. Thus, users need to be aware of the causes of persistent illness in livestock in order to provide appropriate measures for proper treatment of diseases in livestock. Table 4-9 shows the proportion of livestock which did not respond to treatment and died on treatment with antibiotics in
Ngorongoro District.
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Table 4-9: Proportion of Livestock which Do Not Respond to Treatment and Die
Numbers of livestock that continue to get Numbers of livestock died after treatment with sick antibiotics Number Per cent Number Per cent Cattle < 5 80 39.2 144 71.6 5 - 10 74 36.3 35 17.4 > 10 50 24.5 22 10.9 Total 204 100.0 201 100.0 Goats < 5 44 21.6 111 54.1 5 - 10 75 36.8 34 16.6 > 10 85 41.7 60 29.3 Total 204 100.0 205 100.0 Sheep < 5 36 21.3 105 62.9 5 - 10 74 43.8 33 19.8 > 10 59 34.9 29 17.4 Total 169 100.0 167 100.0 Source: Field Data, 2014
Another indicator to explain antibiotics resistance by users was the number of livestock deaths after treatment with antibiotics. Table 4-9 indicates that more than
50 per cent of the respondents reported less than five deaths of livestock after treatment with antibiotics. Occurrence of deaths means that there are risks of antibiotics resistance incidences regardless of the number of livestock which died.
Paradoxically, not all the time the number of deaths are due to antibiotics resistance, rather the over or under dosage of drugs also can lead to deaths. Also treatment of diseases with wrong medicine or wrong diagnosis results into deaths. This was testified by some users; who pointed out that:
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“I injected Hitet drug on the muscles subcutaneously instead of intramuscular injection, within no time more than 125 cattle died. I remained with only eight cattle. This drug was supposed to be administered intramuscularly! (Participant FGD Enduleni village, 2014”
Another respondent said to have lost many goat kids following some challenges:
“to estimate the weight of livestock and the required dose is sometimes a challenge. One day I over dosed goats kids without knowing the weight, about 15 of them died.” (Respondent, Irkeepus Village, 2014)
Another respondent also shared his experience, saying:
“One day I bought livestock drugs from Nainokanoka to treat ECF after getting advice from the seller, I injected the cattle, the bull died on the spot! One cc of the drug cost TAS 5000, it was a big loss and I still don‟t know what happened”. (Respondent Irkeepus village, 2014)
All these deaths of livestock occur because of the shared knowledge, information and antibiotics in social networks. Thus, it was revealed that knowledge is very important for livestock production otherwise pastoralists will continue losing their livestock and become destitute from misuse of drugs which cause the antibiotics resistance.
Furthermore, the study was also interested to establish the extent to which the risk of antibiotics resistance problem was revealed in the study area. Table 4-10 presents the mean number of cattle, goats, sheep and donkeys that continued to get sick after treatment with specific types of antibiotics. It can been seen from the first panel of
Table 4-10 that, on the average approximately 11( CI:8.6-14.2) cattle, 11(CI: 8.2-
14.3) cattle, 11(CI:8.6-12.9) cattle, 10(CI:6.9-13.2) cattle and 11(CI: 8.2-13.6) cattle continued to get sick after being treated with OTC, Penstrep, Tylosine, Tetracycline and Supha, respectively. These results revealed that, there was no statistical significant difference in number of cattle that continued to get sick by the type of
100 antibiotic being treated with as all 95% confidence interval overlaped to each other.
This is because antibiotics are frequently used in livestock. Sometimes antibiotics are mixed together and the mixture is administered to livestock. Furthermore, these drugs are normally used interchangeably in such a way that it is difficult to note resistance to a particular antibiotic.
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Table 4-10: Mean and 95 % Confidence Interval of Number of Cattle, Goats, Sheep
and Donkeys that do not respond to Treatment with Antibiotics
Antibiotic N Mean Std Deviation 95% Confidence Limits Cattle OTC 204 11.4 20.3 8.6 14.2 Penstrep 184 11.3 20.9 8.2 14.3 Tylosine 181 10.8 14.5 8.6 12.9 Tetracycline 93 10.0 15.3 6.9 13.2 Sulpha 131 10.9 15.5 8.2 13.6 Goat OTC 204 17.0 19.0 14.4 19.6 Penstrep 180 16.7 19.1 13.7 19.5 Tylosine 181 17.3 18.5 14.6 20.1 Tetracycline 92 14.1 18.7 10.3 18.0 sulpha 128 16.5 19.3 13.2 19.9 Sheep OTC 169 17.6 32.4 12.7 22.6 Penstrep 152 18.1 33.5 12.7 23.5 Tylosin 146 17.6 30.9 12.5 22.6 Tetracycline 88 15.7 30.2 9.3 22.1 sulpha 112 17.2 29.5 11.7 22.8 Donkeys OTC 16 2.3 2.4 1.0 3.5 Penstrep 15 1.8 1.6 0.9 2.7 Tylosin 15 2.3 2.4 1.0 3.7 Tetracycline 8 2.3 2.1 0.5 4.0 sulpha 13 1.9 1.7 0.9 2.9 Source: Field Data, 2014
Table 4-11 presents the mean number of cattle, goats, sheep and donkeys that died after treatment with antibiotics. On average, approximately 11(CI: 8.6-14.2) cattle,
11(CI: 8.2-14.3) cattle, 11(CI: 8.6-12.9) cattle, 10(CI: 6.9-13.2) cattle‘s and 11(CI:
8.2-13.6) cattle died after being treated with OTC, Penstrep, Tylosine, Tetracycline
102 and Supha respectively. These results revealed that, there was no statistical significant difference in the number of cattle that died after treatment with antibiotics by the type of antibiotic being treated with since all 95% confidence interval overlaped to each other. It is important to note that death of livestock can be caused by other factors including drought and malnutrition. However, the risk of antibiotics resistance is greater due to frequent use of antibiotics in livestock in the study area.
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Table 4-11: Mean and 95 % Confidence Interval of Number of Cattle, Coats, Sheep
and Donkeys that Died after Treatment with Antibiotics
Antibiotic N Mean Std Deviation 95% Confidence Limits Cattle OTC 201 7.5 18.4 4.5 10.0 Penstrep 181 7.3 19.0 4.5 10.1 Tylosine 179 6.8 12.4 5.0 8.6 Tetracycline 92 5.8 13.1 3.1 8.5 Sulpha 129 6.7 13.3 4.4 9.0 Goat OTC 205 13.4 26.6 9.7 17.1 Penstrep 180 13.4 27.7 9.3 17.5 Tylosine 182 14.2 27.6 10.2 18.2 Tetracycline 93 11.5 34.3 4.5 18.6 Sulpha 128 13.7 31.1 8.3 19.2 Sheep OTC 167 11.3 28.9 6.9 15.7 Penstrep 150 11.5 30.1 6.6 16.3 Tylosine 144 11.7 3.0 6.8 16.7 Tetracycline 88 10.9 35.2 3.5 18.4 Sulpha 111 12.5 33.3 6.2 18.8 Donkeys OTC 8 1.4 0.7 0.8 2.0 Penstrep 7 1.1 0.4 0.8 1.5 Tylosine 8 1.4 0.7 0.8 2.0 Tetracycline 4 1.3 0.5 0.5 2.1 Sulpha 7 1.1 0.4 0.8 1.5 Source: Field Data, 2014
Furthermore, it was revealed by the study that measures taken by respondents in situation of antibiotics resistance indicators depended on specific indicators. Findings in Table 4-12 revealed that more than 80.0% of the respondents reported to change the medicine or treatment where there was persistent illness in livestock. This was
104 normally done without any advice from livestock health experts. Changing medicines or treatment explains the scenario of the risk of antibiotics resistance in the study area or misuse of antibiotics in livestock. The findings further revealed that 30.6% of the respondents consulted neighbours, relatives and friends for advice in terms of the persistent illness in livestock. The advice from non-livestock health experts resulted into an imprudent access and use of antibiotics leading to more risks of antibiotics resistance.
Furthermore, a reasonable number of respondents (28.2%) reported to repeat the dose when persistent illness was noted in livestock on treatment with antibiotics (Table 4-
12). The practice of repeating the dose indicates that livestock were normally under dosed. Under dosing the livestock leads to antibiotics resistance thus resulting into more deaths of livestock, which in turn translated into increased poverty in the rural community of pastoralists.
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Table 4-12: Measures Taken by Users on None Response to Treatment
Measures taken for the persistence illness Measures taken when livestock die N % N % Change the medicine Slaughter and eat by sharing 179 82.9 112 52.3 or treatment with other people Consult neighbours, Report the incidence to the relatives and friends 66 30.6 50 23.4 veterinary expert for advice Report to veterinary Inform relatives or 41 19.0 110 51.4 experts for advice neighbours for advice Slaughter and eat by Shift the livestock to sharing with other 22 10.2 another place to change the 44 20.6 people environment Shift livestock to another place to Report the incidence to 24 11.1 13 6.1 change the CAHWs environment Throw away the dead Repeat the dose 61 28.2 15 7.0 livestock Sell the sick livestock 12 5.6 Inform the village authority 4 1.9 Consult CAHWs for 17 7.9 Bury the carcass 2 0.9 advice Report to the village 3 1.4 Burn the carcass 3 1.4 authority Total 216 100.0 Total 214 100.0 NB: The percentages and totals are based on multiple responses;
Source: Field Data, 2014
On tackling the problem of livestock deaths, pastoralists explained some initiatives they were normally taking after the death of livestock. The initiatives taken included first, skinning and eating the dead animal by sharing it with others. This was reported by nearly half (52.3%) of the respondents. Second, inform relatives and neighbours for advice, reported by 51.4% of the respondents. Third, shifting livestock to another
106 place to change the environment was reported by 20.6% of the respondents. Fourth, reporting the incidence to veterinary expert and was reported by only 23.4% of respondents.
It is evident from findings that measures taken in handling livestock health matters are basically from users‘ perception and experience gained through social networks.
This could result into more problems because of inappropriate knowledge on handling the situation. Some of the initiatives can result into more problems not only to livestock but also to human beings and wild animals as well. For example, the slaughtering of the dead animal and getting them eaten by people can lead to risk of contamination by diseases hence resulting into serious illnesses and deaths to livestock and people.
Moreover, throwing away the carcass and shifting livestock to other places can introduce diseases to new environment thus leading to contamination of the environment. This can also affect other livestock and wild animals as well.
Therefore, proper handling of dead livestock and the rest of livestock is necessary to minimize the risk of antibiotics resistance problem. More details of the initiatives are displayed in Table 4-12.
4.6 Chapter Summary
Chapter four presented a description of socio-economic profile of the study population. The aim was to provide background information on the households involved in the study sample. Though not in the objectives, the information was deemed important since it was seen to influence the decision making process for the access and use of antibiotics in the household. It was noted from the study findings that respondents had different socio-economic profile such as age, sex, level of
107 education marital status, household size, wealth status such as income, herd size and livestock production. Household socio-economic profiles were deemed important in the decision on how to access and use antibiotics in livestock through proper channel, but the study noted the opposite.
It was further noted that, although there were variations in socio-economic profile of respondents, the difference in access and use of antibiotics in livestock was not realised. This is because of the pastoralists, Maasai culture of cooperation built around sharing of resources. The major problem facing pastoralists in Ngorongoro
District was revealed to be frequent occurrence of livestock diseases. Pastoralist households, therefore, have been trying to take their own initiatives for prevention and treatment of diseases through sharing knowledge and antibiotics among themselves without proper prescriptions regardless of their wealth status. However, insufficient prescription of drugs, can lead to misuse of drugs including under or over dosage, wrong diagnosis of diseases and wrong drug administration thus creating more risk of antibiotics resistance.
It was also revealed that the majority of users of antibiotics were not aware of the problem of antibiotics resistance and the extent to which the problem was occurring.
This can result into antibiotics resistance in the study area. Therefore, there is a need for livestock policy and planners to find a better way to empower the users to properly cope with livestock diseases.
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CHAPTER FIVE
SUPPLY SYSTEMS DETERMINING ACCESS AND USE OF ANTIBIOTICS
IN NGORONGORO DISTRICT
5.1 Introduction
This chapter presents the major findings of the study but particularly on how the supply systems determine access and use of antibiotics in Ngorongoro District. The aim was to have an understanding of the major key actors involved in antibiotic supply systems. In addition to mapping out the actors, the chapter also provides a discussion on the ties or connections associated with the key actors. Alongside this mapping, sources, types of antibiotics commonly supplied in the study area are discussed.
5.2 Types of Antibiotics Supplied to Users in the Ngorongoro District
Different types of antibiotics were being supplied to users in Ngorongoro District.
According to results of FGD in all villages and the key informant suppliers, the most common antibiotics were supplied included Oxytetracycline (OTC),
Penicillin+Streptomycine (Penstrep), Tylosine, Sulpha, Tetracycline caps and
Chloramphenicol. Despite the wide range of antibiotics being supplied to users in
Ngorongoro District, only few were commonly used in livestock. These include
OTC, Penstrep, Tylosine, Sulpha and Tetracycline caps. OTC drugs were reported by many users to be the most important antibiotics because they perceived them to be multipurpose for treating many diseases. In addition, this type of antibiotic was more easily available. OTC was not only preferable to users among the Maasai in
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Ngorongoro, because as Katakweba (2014) also reports, the antibiotic was also a most commonly used drug around Mikumi National Park in Tanzania.
5.3 Sources of Antibiotics in Ngorongoro District
There are different sources of antibiotics that are used in Ngorongoro District. These sources are discussed in terms of location and people (actors). With respect to location, there are also two types of sources-urban and rural areas. In urban areas, there are wholesale and retail shops which further supply antibiotics to smaller retailers and end users in rural areas. In addition, there are also two categories of people who supply antibiotics. First, there are wholesalers dealers in large stocks and retail shops who engage in the supply of antibiotics among others drugs as their speciality. These are mostly found in urban areas. This category also includes veterinary experts who apart from their services on the use of antibiotics, they are also engaged in selling drugs. The second category is made up of retail suppliers, drug vendors, CAHWs, and end users who also happen to play the role of suppliers in rural areas.
5.4 Antibiotics Supply Chain in the Ngorongoro District
Antibiotics pass through many hands from different sources in a form of a chain organized in a hierarchical order starting from the dealers of large stock allocated in urban areas. The major purpose of these large stock dealers is business for profit.
They supply drugs to retain traders in urban areas, which normally supply antibiotics to small retailer shops, vendors of drugs, veterinarians and CAHWs who are the major sources of antibiotics to end users at the community level. Two sub-systems were identified as the major sources of antibiotics these include: groups of suppliers located in urban areas linked to the main purpose of business for profit. Another sub-
110 system involves mainly end users in rural areas. These suppliers act as the main sources of antibiotics to end users. Figure 5-1 indicates the supply chain of antibiotics in the Ngorongoro District.
Dealers in large stocks for wholesale based in urban areas
Retail stores in urban areas
Drug Retailers Veterinaria CAHWs vendors in Retailers (shops) in ns mostly in in rural villages rural areas in urban urban areas areas centers
End users in villages (Relatives, Neighbours, Friends, Interest) groups of herdsmen)
Figure 5-1: Supply Chain of Antibiotics Ngorongoro District
Source: Developed by the Researcher (2015)
It is important to note that end users at community level do not access antibiotics directly from the wholesale suppliers in urban areas but they get them from retailers in the villages and from small urban centres in their proximity. End users also share antibiotics among themselves in form of social networks. Access to antibiotics from suppliers in the community is associated with some setbacks in the supply systems.
First, the price of antibiotics is usually high to an extent that many end users fail to access them through purchase. This is the reason for seeking for alternative sources
111 such as sharing the antibiotics as well as the knowledge on use. Second, some suppliers do not have deep expert knowledge on how the antibiotics work and as a result, there is loss of quality, information and sometimes as the drugs reach the end users the information is distorted. This results into imprudent use of antibiotics.
Leyland et al. (2014) also reported weak drug supply systems in the Horn of Africa leading livestock keepers to access drugs from improper sources.
Unexpectedly, few users from all the wealth categories of end users access antibiotics from veterinarians and CAHWs in the supply chain. These individuals have better knowledge on livestock health services yet; less people obtain antibiotics from these sources. This can be because of limited availability and the cost of service given the special distribution of households in the study area. It can also happen because of the users‘ attitudes and perception. Elsewhere in the world, slightly similar situation is also experienced. Bett et al., (2008) in Kenya reported that, most pastoralists preferred to purchase drugs from CAHWs but administered the drugs themselves to treat their livestock without proper prescription. This was done even when CAHWs were available to provide veterinary support.
5.4.1 Urban Based Suppliers of Antibiotics
Urban based suppliers of antibiotics are for business. These include the dealers in large stocks for whole sale. The major purpose of these suppliers is business for profit as postulated in the social exchange theory by Homans (1961). They sell varieties of drugs in bulk to other traders such as retail shops in urban areas. These large stock dealers do not have to provide veterinary expert knowledge to their customers on drug use. They are normally few in numbers based in urban areas and have no direct link with end users.
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Other urban based suppliers are the retail stores in urban areas. These are located in urban areas and their major purpose is business for profit. Retails stores in urban areas access antibiotics and other drugs from dealers in large stocks to supply to small retail shops allocated in the villages, vendors, veterinary officers, CAHWs and urban centres in proximity to users.
The veterinary experts also constitute the category of urban based suppliers. These are well trained professionals in animal health services. Veterinarians are also in this category but are there for the purpose of providing their services in which sometimes they sell drugs to users. These are mainly located in urban areas at the district level.
Though they are adequately trained in animal health matters, there is minimal interaction between these actors and the community because they are few and located in urban areas particularly at the district headquarters.
5.4.2 Rural Based Suppliers of Antibiotics
Rural based suppliers of antibiotics are divided into two categories, those mainly for business to obtain profit and those who are not for business. They are basically local suppliers at the community level. They sell antibiotics to end users but they also use drugs for treatment of their livestock. Those who are not for business are suppliers who are normally the end users of drugs who sometimes keep small stocks for use in their livestock in which they become sources of antibiotics to others by sharing when needs arise. This is basically based on social obligations and norms of trust and reciprocity at the community level as it was revealed by one of FGDs.
“If you don‟t support others in terms of any important needs such as drugs, it can cause bad luck to your livestock and family, likewise you will also lack support from others” (FGD participants Irkeepus village, 2014). 113
In reference to the statement, these suppliers sometimes overlap with actors in social networks at the community level. They, in most cases include relatives, friends, neighbours and interest groups, CAHWs and traditional dealers.
Community-based animal health workers (CAWHs) are trained individuals on the basic animal health handling such as vaccination and other basic animal health services. They are located at the community level in rural areas close to users. They can access drug from retailers in both urban and rural areas to provide service at the community level. These actors were expected to interact more with end users of antibiotics. On the contrary, the opposite is realised because they are few in numbers and they lack facilities to provide good services to users.
Retail shops in rural areas are normally mixed item shops in which antibiotics are one of the sold items. This was confirmed by the discussion with some drug supplies in the villages. For instance, Plate 5-1 indicates one of the drug suppliers at Esere village, who explained that she had a shop for selling other items but one of her relatives was bringing her some drugs to sell and she was getting commission. This kind of supply systems of antibiotics as one of the veterinary drugs is not unique to
Ngorongoro District but also elsewhere. A study conducted by Grasswitz et al (2004) in Kenya revealed that, the majority of animal health services were provided by the informal sector, the shops known as ‗agrovets‘ in the higher-potential areas, mixed- goods shops and informal traders in lower-potential areas.
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Plate 5-1: One of the Drug Sellers at Esere Village
Source: Field Data, 2014
I sell a variety of items in my shop, one of my relatives who works at Karatu town normally brings me some livestock drugs to sell for him with some commission” (Drug supplier Esere village, 2014)
It is clear from the statement that some of these suppliers of antibiotics are not well trained in livestock health services including handling and administration of drugs though they are the important sources of drugs to users. This leads to misuse of drugs by users due to wrong information and advice from these non-veterinary ‗experts‘.
Further evidence is provided by others supplier;
“Our husband is a small business man who brings drugs from Karatu or Arusha. Then we sell these drugs to others in the market or at home” (Drug suppliers Nainokanoka village, 2014)
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Plate 5-2 displays one of the users of drugs consulting drug suppliers at an open market in Nainokanoka village. Antibiotic suppliers use their own knowledge and experience to supply these drugs to users. For instance, according to explanation from the supplier of drugs in rural market, it was noted that some drugs cannot be displayed to avoid damage but how and why damage occurs is not known to suppliers!
“Other drugs for instance tetracycline capsules and albendazole cannot be displayed on the table to avoid damage but I do not know why!” (Drug supplier Nainokanoka market, 2014).
Lack of better knowledge on handling drugs can result into misuse of drugs that can make possible for risks of antibiotics resistance problem.
Plate 5-2: Pastoralist Asking for Drugs at an Open Market in Nainokanoka Village
Source: Field Data, 2014
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It was learnt that most of drug suppliers in rural areas are not trained and knowledgeable personnel in antibiotics handling, but they were driven by trust they had built in the supply systems. This facilitated them easy access and use of antibiotics in livestock in the community. Plate 5-3 shows a drug seller at Irkeepus village.
“My brother is working in Arusha in hotel. He normally purchases veterinary drugs and I sell them for him” (Drug supplier Irkeepus village, 2014).
This was further revealed by one of the rural suppliers who said:
“I have never attended any training on drug handling, but I have experience in selling drugs to my customers and they trust me because I normally give them good advice. For example, I tell them to know the name and quantity of the drugs they need before coming to my shop.” (Drug supplier, Esere village, 2014).
Plate 5-3: Drug Seller at Irkeepus Village Waiting for Buyers
Source: Field Data, 2014
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Drug vendors are actors located at different places in rural areas; they deliver antibiotics to where end users are found. Drug vendors access drugs from retail sellers and have moderate interaction with pastoralist end users. They sometimes use antibiotics in livestock but their major objective is for business. In most cases, they are not trained personnel on livestock drugs. They access drug from various sources including cross boarders such as Kenya.
One of the drug vendors in an open market at Nainokanoka village was of a Kuria ethnic group from Mara region. He obtains drugs from various sources including
Kenya, Loliondo, Karatu and Arusha and supplies them to users but he is not trained on livestock health services. This kind of dispensing can result into misuse of antibiotics therefore fuelling a risk of antibiotics resistance.
Urban centre sources are in proximity to end users‘ location where vendors go for drugs. Their main objective is profit oriented business and antibiotics are one of the items supplied. They do not have more interaction with end users; the relationship is only with their services and no trust ties do exist between them and their customers.
Similar situation was also observed elsewhere in the world that most customers in remote areas obtain their animal health products including antibiotics by making bus trips to urban centres in proximity to their places in South Africa (Grasswitz et al.,
2004). The price to these urban centres is slightly higher because of the transport cost involved.
End users of antibiotics (Relatives, friends, neighbours and interest groups), these are end users of antibiotics mainly for use in livestock. They can sometimes act as source of drugs to others by sharing them based on trust and reciprocity. It was noted that users prefer drugs from Kenya to those from within the country because of their 118 perception on their effectiveness. One of the respondents at Irkeepus village confirmed that,
“We prefer drugs from Kenya to those from Tanzania because drugs from Kenya are effective compared to those from Tanzania. For example, OTC 5% drug manufactured from Kenya is more effective than OTC 10% drug from Tanzania especially that made from Bajuta Company”. (Participant FGD, Irkeepus village, 2014)
Similar perception of preference was not only viewed to Maasai in Ngorongoro but also elsewhere in the world in which a study by Catley et al. (1997) reported that there were examples of herders in the Somali National Regional State, Ethiopia demanding Oxytetracycline which was manufactured in Europe rather than in other countries.
Moreover, drugs from Kenya can be accessed through exchange with livestock or paying for them in cash. For example, one of the respondents explained that two vials of OTC 5% drug from Kenya could be exchanged with one sheep or goat. The study also revealed that users set criteria to access and use antibiotics before purchase. The criteria used were normally based on their experience as following:
First, they would look at the expiry date of drugs because they believed that when drugs failed to work it was because it was its past expiry date. Second, they would also consider the percentage concentration of drugs. For instance, OTC (5%), OTC
(10%), OTC (20%) and OTC (30%) vary in effectiveness in treating livestock diseases. Third, they would consider the place of manufacture because they believed that, drugs from Kenya were more effective than those manufactured within the country. However, relying only on the set criteria without proper prescription can result into misuse of antibiotics by administering wrong dosage with wrong
119 diagnosis. A study by Hepeng (2008) in China and India and Grasswitz et al (2004) in Kenya found similar situation that even experienced clients were often unaware of more understated dosing concepts that could affect effectiveness. For instance, they would buy a 5% Oxytetracycline formulation because it was cheaper than a 10% product, yet administering the same volume and hence unintentionally giving half the recommended dose of active ingredient to the animal. Nevertheless, there is a slight difference that users in Ngorongoro were purchasing OTC 5% manufactured in
Kenya not because of the price but the perception of its effectiveness.
It is argued in this study that users can find new drugs and information as well as
knowledge concerning the use and management of livestock. Nevertheless, drugs
sold at the open markets or any other unauthorized places can compromise the
quality of the drugs thus leading to their ineffectiveness. Furthermore, suppliers of
drugs are non-veterinary experts meaning that the knowledge they share is not
appropriate to livestock health care. This can contribute to the problem of
antibiotics resistance in the study area. Therefore, there is a need to create
awareness to users of antibiotics to establish a proper channel of access to and use
of drugs for livestock.
A study by Katakweba (2014) in Mikumi Tanzania revealed that points of selling antibiotics and their prescriptions were found to be handled by agriculture and veterinary input shops, veterinarians, livestock markets and exhibition points.
However, in the current study selling of antibiotics was done mainly by drug suppliers with shops within the village and drug vendors in livestock open markets from outside the village who were not knowledgeable enough to provide appropriate information and prescription. Therefore, there is a need to provide mechanisms that
120 will help users to access drugs in a proper way and from appropriate individuals. The suppliers also get drugs from different sources and in most cases, outside the village or in the nearest town or other places.
The sources of antibiotics were also confirmed by findings reported by the users of antibiotics from the study area. Results in Table 5-1 revealed that 81.4% of the respondents were sharing or borrowing antibiotics from others in the village. This kind of communication was based on trust and reciprocity. The actors involved in these social networks were relatives, neighbours, friends and interest groups whose aim was for utilization and not for profit. These findings are also similar to the study by Katakweba, et al., (2012) in Tanzania and McKee and Miller (1999) in New York which revealed that users obtained drugs from friends and family leftovers. A closer view to Table 5-1shows that, about 89.8% of the users among the poor obtained antibiotics through sharing and borrowing from others in the village compared to
70.8% and 59.1% among the middle and the rich wealth categories, respectively.
Translated in veterinary context, this is a sign of access to antibiotics from inappropriate sources without proper prescriptions which can lead to misuse of drugs in livestock.
Findings in Table 5-1 further revealed that about 60% of the respondents were purchasing or borrowing antibiotics in the village shops. A thorough look into the
Table discloses that 77.3% of the rich were purchasing or borrowing antibiotics in the village shops compared to 66.7% and 51.6% of the middle and the poor, respectively. It was revealed that borrowing of antibiotics from the village shops was based on trust.
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Table 5-1: Sources of Antibiotics in Ngorongoro District
Wealth status Poor (n=127) Middle Rich Total Sources of antibiotics (n=72) (n=22) (n=221) N % N % N % N % Share or borrowing from others 114 89.8 54 75.0 14 63.6 182 82.4 Purchase or borrow in the village shop 68 51.6 48 66.7 17 77.3 133 60.2 Purchase in the nearest town 51 40.2 47 65.3 18 81.8 116 52.5 Obtain from vendors elsewhere 51 40.2 43 59.7 19 86.4 113 51.1 Obtain from veterinary experts 20 15.7 10 13.9 3 13.6 33 14.9 Obtain from CAHWs 19 15.0 6 8.3 2 9.1 27 12.2 NB: Percentages and Totals are based on multiple responses;
Source: Field Data, 2014
One of the FGD participants from Enduleni village explained that;
“We normally borrow drugs from the sellers then pay money later after selling livestock or we borrow antibiotics such as Oxytetracycline injection from other fellows then pay back. There is no problem, we trust each other” (FGD participant, Endulen village, 2014)
This kind of trustfulness was also confirmed by key informants who were among the drug sellers in Enduleni and Esere villages:
“Livestock keepers normally borrow drugs from my shop and pay later after selling their livestock without any problem” (Drug seller, Enduleni village, 2014).
“During bad (dry) season livestock keepers borrow drugs from my shop and pay later after selling their livestock during better (rainy) season when the price of livestock is better” (Drug seller Esere villages, 2014).
Concerning the functioning of the drugs supplied, some drug suppliers claimed that users were to blame when drugs did not give good results. One supplier had this to say:
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“Users buy poor quality drugs and use them incorrectly” (Drug vendor Enduleni, 2014)
Irrespective of the blames directed to users, vendors nonetheless used different strategies to build trust on their regular customers. The most commonly used strategy was to offer drugs on credit. This made users trust them and become the potential reliable customers. Similar findings were also noted by Kingsley (2015a) in Nigeria where blame was laid on the hands of customers to purchase poor quality drugs and use them wrongly and vendors applied various strategies including offering drugs on credit. Furthermore, sometimes access to drugs by purchasing and borrowing was not only based on trustworthiness but also on reciprocity norms on both parties of users and sellers in the village shops.
“I offer drugs on credit because if I do not help them when they are in need they will not come to my shop. New customers normally come with people whom I know and trust, to make sure that they borrow and pay in order to maintain good relationships” (Drug seller Enduleni village, 2014).
Similar findings were also revealed by SUA/UCPH (2014); Mshana et al. (2013);
Katakweba et al. (2012); Viberg (2010) and Kambarage et al., (2003) in Tanzania which explored that individuals purchased antibiotics from private drugstores and retail drug sellers in rural areas in which some of them were unqualified individuals.
Findings in Table 5-1 further indicate that slightly more than 50% of the respondents were getting antibiotics through purchase from the nearest town and from vendors elsewhere including cross boarders in Kenya. The poor revealed the lowest proportion (40%) of the users, while the rich revealed the highest proportion (81.8%) of the users who were getting antibiotics from the nearest town. This is because of the cost of antibiotics for the poor users which was high therefore hard to afford.
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This was also based on the belief on the effectiveness of drugs from other sources as it was revealed by one of the key informants:
“Livestock keepers trust antibiotics from Kenya to be more effective, they are ready to obtain them at high cost. For example, a goat costing more than 50,000/= can be exchanged with a vial of OTC costing less than 20,000/=TAS” (Key informant Irkepus, 2014).
5.5 Chapter Summary
This chapter sought to map out existing supply systems and discuss in details how the systems determine access and use of antibiotics in Ngorongoro District. This was revealed by exploring the sources of antibiotics and types of antibiotics supplied. The sources of antibiotics were mainly divided into two major categories that include urban and rural based suppliers. It was revealed that urban based suppliers do not interact directly with end users and they are engaged on business for profit. Rural based suppliers were seen to interact more with end users who were also sources of antibiotics through social networks overlap. These basically aimed for the use of antibiotics not for business. These are the major sources of antibiotic supply although they are not appropriate suppliers. It was revealed that inappropriate source of antibiotics lead to equally inappropriate use of drugs.
It can be therefore concluded that access to antibiotics from suppliers in the community can be associated with the following setbacks such as; high price of antibiotics thus making many end users not able to access them in proper channels.
Hence, they resorted to alternatives such as sharing antibiotics and knowledge on use. Also loss of appropriate experts‘ prescriptions due to limited knowledge of suppliers at the community level. This resulted into imprudent use of antibiotics.
Thirdly, the quality of antibiotics can be compromised due to poor handling. 124
The findings in this chapter on one hand support the social network theory and the theory of social exchange. This is because there are more interactions of users with those who are closer to them with strong ties than those with weak ties. Also suppliers especially those for business tend to maximize benefit and minimize cost as suggested by the social exchange theory. On the other hand, the findings are contrary to the social exchange theory that it is not all the time that individuals engage in activities or social relationship to maximize benefit while minimizing cost. This was revealed by end users who were supplying antibiotics to others through sharing as one of the social obligations.
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CHAPTER SIX
SOCIAL NETWORKS DETERMINING ACCESS TO AND USE OF
ANTIBIOTICS IN NGORONGORO DISTRICT
6.1 Introduction
This chapter presents a discussion on how social networks determine access and use of antibiotics in Ngorongoro District. This is presented through examining the actors involved in the social networks and associated ties. This was deemed important in order to understand how pastoralists in the social networks interact with each other and enable themselves to access and use antibiotics in livestock. This section covers the mapping of actors and ties determining access to and use of antibiotics, sharing of knowledge and information on access and use, sharing antibiotics for treatment of livestock diseases and types of the commonly shared antibiotics.
Mapping of social networks was done based on the highest percentage scored on multiple responses of actors depending on whom they were interacting more with.
This is important in combining information on multiple types of ties (Wasserman and
Faust, 1994). The aim is to score the strength of all of the relationships of an actor in a rank order from the strongest to the weakest, based on highest percentage rates in multiple responses. In addition, descriptive statistics and content analysis is used for analysis to draw the inference of how the social interactions determine antibiotic access and use in livestock.
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6.2 Actors Determining Access and Use of Antibiotics in Social Networks
Social networks in Ngorongoro District have several actors who constitute an important source of antibiotics to others. In this context, actors are individuals or groups of individuals (nodes) involved in social interactions and the positions they occupy. Actors who have more interactions include friends, neighbours, relatives and interest groups of herdsmen. These are end-users of antibiotics located in rural areas and found in close proximity to each other. Furthermore, these are the most important actors in social networks because, apart from being the end users of the drugs, they also supply the drugs to others through sharing. All these are the actors who are frequently consulted by end users of the drugs in case of livestock health problems, such as diseases.
The findings reveal that neighbours and friends are the most important actors for sharing the antibiotics with others as reported by 100.0% and 77.8% of the respondents, respectively (Table 6-1). Interest groups of herdsmen (51.0%) and relatives (39.1%) also play an important role of making information available to others. Other actors and their roles are shown in details in Table 6-1. Actors in social networks are bound with social ties that enable them to interact and access antibiotics and use through sharing. The sharing of the antibiotics among actors is made easier due to the geographical proximity that they enjoy. Similar findings were also revealed by Wawire (2003) in Kenya that social networks assisted residents of
Turkana District to cope with drought in the form of relatives and friends.
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Table 6-1: Actors in Social Networks and Their Roles in Access and Use of Antibiotics
Actors Roles Responses Number Per cent Friends Share antibiotics with others 172 77.8 Make information available for access and use 49 22.2 of antibiotics in the community Relatives Share antibiotics with others 142 39.1 Make information available for access and use 1 0.3 of antibiotics Neighbours Share antibiotics with others 221 100.0 Make information available for access and use 143 39.2 of antibiotics in the community Interest groups of Share antibiotics with others 167 46.0 herdsmen Make information available for access and use 184 50.5 of antibiotics Make information available for access and use CAHWs 185 51.0 of antibiotics Make information available for access and use Traditional dealers 22 10.0 of antibiotics NB: Cases are based on multiple responses;
Source: Field Data, 2014
Friends in social networks form close relationships with more interactions that enable users to share information, knowledge, experience and antibiotics. These actors can also determine access to antibiotics by borrowing antibiotics or resources to access antibiotics from each other without difficult set conditions, trustworthiness and reciprocity. This makes friends easily available for more access and use of antibiotics by users. Relatives in social networks play a major important role in making antibiotics available to others by sharing information on the available sources and antibiotics in the social networks. It is important to note that, relatives sometimes overlap with other actors in social networks. This can make most performance shift 128 to others. For instance, a relative can be a friend or a neighbour. Table 6-1 confirms this finding, where only 0.3% of the respondents reported to have had available information on access to and use of antibiotics from relatives. It is further revealed that, neighbours were sharing more antibiotics than information. This was also due to the overlapping of these actors with others, such as friends and relatives. It is also important to note that actors identified in the social networks were also involved in the supply systems of antibiotics as end users at the community level in rural areas
(Figure 6-1).
6.3Ties in Social Networks
Based on the findings of this study, three forms of multiple social ties in social networks exist in Ngorongoro District. Strong ties with more interactions, moderate ties with moderate interactions and weak ties with less interaction. These ties enable pastoral households to access not only antibiotics to use in livestock, but also other resources to fulfil social needs.
Interaction involves sharing of drugs, knowledge, seeking of information on symptoms, experience on use, prescription, sources of antibiotics, or even the price and many other forms of interactions. Rummel (1996) pointed out that social interactions are the practices of people mutually oriented towards each other's selves‘ speculations. Exchange is the most basic type of social interaction; an exchange takes place whenever people interact in an effort to receive a reward or a return for their actions. This has also been reflected in pastoral communities in Ngorongoro District in terms of interactions while sharing resources, knowledge, information, experience and exchange based on trust and reciprocity.
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The actors in social networks are bound by social ties, such as friendship, kinship, neighbourhood, age set (mates) ties, trustfulness and reciprocity, which connect them and make more feelings of one commitment to the other. These are called strong ties and involve more interactions in social networks with more trust and reciprocity.
Gilbert and Karahalios (2009) in New York assert that strong ties exist where people are more trusted and whose social circles tightly overlap with others.
For social networks to be associated with the sharing phenomenon among users is possible because of the common bond (ties) within each family and between families, households and the community as a whole. These ties sometimes overlap within social networks in such a way that an actor can be found to have multiple ties.
A study by Tarayia (2004) in Maasai of Kenya revealed that everyone belongs to a family, a clan, an age group and the community and tribe as a whole, the role of care giving was communal and the child‘s interaction was within the family and other community members. The sharing of antibiotics was common between users and relatives, friends, neighbours and interest groups. Tarayia (2004) further revealed that traditionally, there was a high degree of interconnectedness between every member of the Maasai community, either through birth, marriage, clan or age group that enabled them to share resources. These views were also noted by Koissaba
(2013) that each member of the Maasai family in Kenya is responsible for the welfare of each other and for those who live within a close proximity; they share resources and responsibilities, which include childcare. This is similar to the study findings on social networks ties that strengthen the actors‘ relationships, such as friendships, thus leading to the sharing of antibiotics that have to be noted by livestock development and public health actors.
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Figure 6-1 presents the mapping of interaction of actors in social networks and the social ties connecting them. These interactions are explained as follows: inside the boxes on the right hand side are the actors and the magnitude (percentages) of interactions with antibiotic users in the social networks. The boxes and arrows on the left hand side show the rate of interactions and social ties with users of the antibiotics social networks. The thickness of arrows indicates the intensity of social ties, whether there are moderate or less interactions that form strong, moderate and weak ties. It can be viewed that the thicker the arrows are, the stronger the ties in the networks which allow more interactions and vice versa.
Actors with strong ties are easily reached by pastoralist users of antibiotics in terms of distance, availability and willingness to share resources such as water, pasture, livestock, market and antibiotics, experience, knowledge and information. Actors with moderate interactions, such as drug vendors, can be moderately reached by users. These actors are normally found at the open market places and at the grazing areas. In contrast, actors with minimal interactions are not easily reached by users of antibiotics to access and use such antibiotics. These findings provide support in favour of Granovetter‘s (1983) argument that in social networks, weak ties are less likely to be socially involved with one another than strong ties. These include veterinary officers, CAHWs and traditional dealers and retail shops in urban areas that do not involve more interactions with end users of antibiotics.
Existing ties in social networks include friendship, kinship, neighbourhood, trust and reciprocity norms, as well as age set ties. Others include ties in service provision and exchange processes. Figure 6-1 below shows the mapping of actors (nodes) and their social ties (relationship).
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6.3.1 Friendship Ties
Friendship ties exist between users with their friends within and outside the community whom they have more interactions with. These ties find expression by sharing information, knowledge, experience and resources, including antibiotics. The study findings in Figure 6-1 show that all respondents have, at some point, consulted friends first, in case of livestock health problems. Users in most cases obtain the remaining drugs after use (leftovers) for livestock from friends. Sometimes they access drugs by borrowing from friends then pay back later. The findings revealed that sometimes friendship ties intertwined or overlapped with other ties such as neighbourhood, kinship or age set ties thus making such ties stronger but limited with expansion. Expansion means approaches for seeking new knowledge that goes beyond their close relationship when it becomes limited. A study by Hanneman and
Riddle (2005) confirmed that, if friends have many non–overlapping connections, the range of connection is expanded and vice versa. This enables the acquisition of new knowledge and information within the community.
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Implications on Risk of drug resistance
Social ties Actors
Friendship Friends (100.0%) Antibiotic Users’ Kinship Relatives (99.5%) interaction
- Share Neighbourhood Neighbours (99.1%) knowledge & information Drug suppliers‘ shops -share Ties in exchange in the village (85.1%) resources to process (trust) - Access & use antibiotics Interest group of -Based on Age set herdsmen (76.5%) trust and reciprocity
Drug vendors (64.3%) Seasonal Access antibiotics Broader Based on Veterinary health experts knowledge service Social ties (46.2%) Limited provision on service provision availability
CAHWs (33.5%) Have basic knowledge but lack facilities
Suppliers in urban centres High price (32.4%) minimal trust
Traditional dealers (17.2%) Involve more in human herbs
Retail shops in urban 8.0% Minimal interaction
Whole sale in urban No interaction
Figure 6-1: Actors in Social Networks in Ngorongoro District; Source: Field Data, 2014 Key: Indicates more interaction with strong social ties Indicates moderate interaction with moderate social ties Shows less interaction with weak social ties No interaction with users no ties
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6.3.2 Kinship Ties
Kinship ties result from closely related family members, including the extended family and in–laws. The findings in Figure 6-1 indicate that 99.5% of the respondents had at one point consulted relatives including members of the extended family when there were problems with livestock health. Sharing of knowledge, information and resources is also done among relatives. These social ties sometimes overlap with other social ties such as friendship, neighbourhood and age set to make them strong. A study by Potkanski (1994) in Ngorongoro and Salei areas, also revealed that pastoralists recognized that participation in kin-based mutual assistance networks was the best survival strategy they had at their disposal on facing unpredictable environmental conditions and the constant risk of personal misfortune.
The obligation to assist an impoverished fellow clan member is also deeply rooted in their culture through customary rules of social relations, as well as resulting from the character of property rights in livestock. Other studies in Kenya such as by Macharia
(1988) acknowledged the importance of kinship and friendship ties among pastoral communities in connecting drug suppliers to users. The importance of kinship and friendship ties also serves as a reminder to policy makers and development planners not to underestimate the existing social connections in pastoral communities when addressing livestock development.
6.3.3 Neighbourhood Ties
Neighbourhood ties exist between users and fellow neighbours. The findings in
Figure 6-1 show that 99.1% of the users were consulting neighbours in case of livestock health problems and also for obtaining antibiotics from them. A neighbourhood tie was seen as a vital component that fostered the development of
134 social networks through interaction in local public space as supported by Bridge
(2002) in UK. A study by Devereux and Getu (2013) in sub Saharan Africa also supported that Neighbourhood ties in social networks provide mutual assistance to people in the same residential nearby areas. Like kinship ties, neighbourhood ties sometimes overlap within the social networks. For instance, neighbourhood ties can overlap with friendship, kinship, age set and others thus creating a strong bond in the network. The strong bond makes it obligatory for users to share resources, knowledge, information and experience with others. This facilitates easy access and use of antibiotics by the users.
6.3.4 Trust and Reciprocity Norms
Trust and reciprocity norms play an important role in connecting community members to each other. Also they connect the users with drug supplies shops in villages, based on the exchange process. This is the strength for all to share common resources, roles and responsibilities guided by a code of ethics and beliefs entrenched in the common culture, as it was revealed by Koissaba (2013). The importance of trust in connecting community members to each other, has been long appreciated
(Zhang and Yu, 2012; Gefen et al. (2003) cited in Fu (2004); Field, 2003 cited in Fu
(2004). This was also noted in Ngorongoro District where strong ties were associated with trustworthiness and sometimes reciprocity, especially in exchange process. For instance, this study found that 85.1% of the respondents were going to shops selling drugs to obtain them as well as advice in case of livestock health problems.
Borrowing drugs was also seen to be based on trustworthiness and reciprocity norms on both parties of users and suppliers not necessarily by cash. This is exemplified by one of the drug suppliers who said:
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“I offer drugs on credit because if I do not help them when they are in need they will not come to my shop. For the new comers normally come with people whom I am familiar with and trust to make sure that the borrower pays and to maintain the good relationship already existing” (Drug supplier at Enduleni village, 2014).
Putnam (2000) further noted that social networks have value and he referred to social capital as ―connections among individuals. That is, social networks and the norms of reciprocity and trustworthiness that arise from them. (ibid) regarded trust as an essential element of the norms that arise from social networks. Putnam further argues that, dense networks in the community foster norms of reciprocity facilitate communication and strengthen trust, which result in the citizens‘ cooperation for mutual benefit.
Further emphasis on the importance of trust and reciprocity is provided by Goldman and Riosmena (2013) who revealed that relations of reciprocity coordinated access to reserved pastures by groups of households for use by calves and sick livestock
(alalili) and water resources. Goldman and Riosmena (2013) further suggested that trust and reciprocity can be thought of as an extended set of entitlements: long– reaching social relations.
6.3.5 Age Set Ties
Age set ties are found among pastoralists based on the cultural setups. A most important aspect of being a Maasai is the initiation into membership of an age-set; that is central to establishing the identity, as noted by Bekure et al., (1991) in Kenya.
Ties of age sets form the most important framework for socio-political organization.
Sortland (2009) argues that, age set ties are important; every person has well-defined roles, responsibilities, rights and obligations in relation to every other person in the
136 society. This indicates how important age set tie is in enabling access and use of antibiotics in livestock at the community level.
These ties sometimes appear to be strong depending on the level of social interactions. Again, these ties can also overlap with one or more ties, such as neighbourhood, friendship and kinship ties, thus, making a relationship stronger.
Homewood (2008) revealed that social networks and good relations among the pastoral community of the Maasai with age-mates, clan members, and traditional leaders (ilaigwenak) were essential. This was for facilitating mobility of livestock across large spatial scales in search of pasture and water which was important, particularly during droughts. Similarly, to this study finding, age set ties were found to be strong as they allowed sharing of drugs, knowledge and information on the access and use of antibiotics in livestock.
6.3.6 Ties Based on Service Provision
Ties based on service provision connect drug users with drug suppliers‘ shops in the villages, normally drug vendors at the open market places and at the grazing areas, veterinary health experts, CAHWs and traditional dealers. These involve Moderate and weak ties with moderate and minimal interactions in social networks, respectively. These ties do not involve more than trust and reciprocity, but still they can help the pastoralists to access and use antibiotics.
6.4 Operation of Social Networks in Ngorongoro District
Social networks in Ngorongoro District were seen to operate in a lateral way through interactions and thus, determining the access to and use of antibiotics in livestock at the community level. Users of antibiotics were getting access to antibiotics from different sources especially through social networks with the aim of utilizing them 137 for livestock. The users of antibiotics can also be the sources of the drugs to others in social networks, such as friends, relatives, neighbours, interest groups, and traditional dealers. These sources of antibiotics, in most cases, were the actors in social networks but they were not well trained and informed on the proper use of antibiotics in livestock. This leads to misuse of antibiotics in their livestock. Figure 6-2 indicates the operations of social networks in the study area.
Friends
Neighbours Users of Relatives antibiotics
Interest groups
Traditional dealers
Figure 6-2: Operation of Social Networks
Source: Developed by the Researcher (2015)
6.5 Sources of Knowledge and Information on Antibiotics Availability and
Usage
Sources of knowledge and information on antibiotics availability and usage in most cases are social connections involving interactions cemented with multiple ties. The major important sources of information identified included relatives, neighbours, friends, interest groups and drug suppliers‘ shops and individuals. It is important to note that the sources of information do not differ with regard to wealth categories in
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Ngorongoro District (Table 6-2). These sources can be put into four major categories. These include for example, actors in the social networks that include relatives (99.1%), neighbours (100%), friends (99.5%), traditional dealers (18.6%) and interest groups (84.2%). Drug suppliers with shops (90.5%) and livestock drug vendors (58.4%) who also form another category. Veterinary experts (48.0%) and
CAHWs (56.6%) form the last category. Table 6-2 provides a range of sources of information on antibiotic availability in Ngorongoro District.
Table 6-2: Sources of Information on Antibiotics Availability in Ngorongoro District
Wealth status Sources of information Poor Middle (n=72) Rich Total on antibiotic (n=127) (n=22) (n=221) availability N % N % N % N % Relatives 126 99.2 71 98.6 22 100.0 219 99.1 Neighbours 127 100.0 72 100.0 22 100.0 221 100.0 Friends 126 99.2 72 100.0 22 100.0 220 99.5 Traditional dealers 14 11.0 19 26.4 8 36.4 41 18.6 Interest groups 105 82.7 62 86.1 19 86.4 186 84.2 Veterinary experts 61 48.0 32 44.4 9 40.9 109 48.0 CAHWs 60 47.2 37 51.4 11 50.0 108 48.9 Drug suppliers (shops) 103 81.1 66 91.7 19 86.4 200 90.5 Drug vendors 63 49.6 49 68.1 13 59.1 125 56.6 NB: Percentages and totals are based on multiple responses;
Source: Field Data, 2014
A thorough look at Table 6-2 will show that among the three categories, the actors in the social networks (with an exception of traditional dealers) were considered to be the most important sources of information on antibiotics availability. The reasons for attaching more importance to this source of information are clear. First, these sources
(actors) were found within the villages and, therefore the users of drugs did not need to travel far to obtain information on the proper use of antibiotics. In addition, these
139 actors in the social networks were held in social ties, which bound them, to help each other in times of difficulties. This is where trust and reciprocity would tend to work for the benefit of community members. Despite the importance attached to these actors of the social networks as sources of information, one needs to note that, in most cases they lacked expert knowledge on the proper use of antibiotics. This leads to misuse of antibiotics resulting to risk of antibiotics resistance problem.
Second important category involves drug suppliers with shops. These are individuals involved in business and were residing in the village and, therefore, were closely connected to people. These were easily accessible and also connected with trust in the exchange processes within the villages where they were operating their business where users found them available for service. Livestock drug vendors, who are mobile vendors of drugs from the neighbouring villages, the nearest town and elsewhere outside the district such as Karatu, Arusha, Mwanza and Kenya, also fall under this category. These actors (drug vendors) in most cases were going where users were found. These areas included livestock open market places and in the grazing areas. They were going there to provide information on the availability, access and use of antibiotics. However, despite their importance to users in providing information, in most cases these actors were not knowledgeable enough to provide veterinary expertise knowledge in the proper use of antibiotics. This results into imprudent access and use of drugs leading to risk of antibiotics resistance. This was confirmed by a Key informant from Esere village, who was also a drug user, who said:
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“Most suppliers in the drug shops are not knowledgeable enough to give more accurate information on the use of drugs and the dates of expire. Therefore, you have to know the drugs and their use, otherwise you have to find someone to give information on the use and read the expiry date before you purchase the drug” (Key informant Esere village, 2014).
The view of above provides the clue that users do not obtain proper information from the sellers of drugs. This can explain why users rely on their own established sources of information through social networks.
The last category of the sources of information on antibiotics availability and use, includes veterinary experts and CAHWs. This category was expected to be among the most important sources of information on the proper use of antibiotics in livestock because of their rich knowledge and skills. Surprisingly, however, this was rated as a less important source of information compared to other sources. This is because, they were not closely connected to the users of antibiotics in the rural areas and they were not easily reached. The fact that nearly all of them (veterinary experts) were residing in urban areas made it difficult for antibiotic users to benefit from their expert knowledge because reaching these experts was costly. Of the four study villages, only Endulen had one livestock extension officer. Therefore, the users had to establish their own ways of accessing information on the use of antibiotics, which in most cases were not appropriate, as one of the key informants observed:
“Veterinary experts are normally not available in rural locations, except when they are engaged in special operations to vaccinate livestock experts. Also, due to the geographical location of the village, you have to pay much money for transport to where livestock are. In addition, we have only one community-based animal health worker in this ward and when you go to him you get advice but you cannot obtain drugs to purchase. You have to go to the drug sellers‟ shops or wait to 141
purchase them on market day. Therefore, one finds it worth time to go to, sellers to obtain both information and antibiotics” (Key informant Nainokanoka, 2014).
Furthermore, the findings in Table 6-3 revealed that sources of knowledge on how to administer and use antibiotics depended more on the sources of these antibiotics. The major sources of knowledge on antibiotics dosage and use in the study area included: neighbours (99.5%), friends, (97.3%), relatives (91.4%), self-experience (85.5%) and drug suppliers (71.5%) as reported by the users in all wealth categories. Therefore, importance of friends, relatives, neighbours and the use of self-experience cut across all wealth categories. This is a further indication that sharing of antibiotics for treatment of livestock took place among pastoralists in all wealth categories.
In an ideal situation, it would have been expected that veterinary experts and
CAHWs would have been an important source of knowledge on the use of antibiotics. Paradoxically, however, this was not the case. This is because, a closer look into results in Table 6-3, revealed that the major sources of knowledge on how to use antibiotics were not the veterinary experts (38.9%) or CAHWs (31.7%). The over reliance on friends, relatives, neighbours and self-experience sources of knowledge on the use of antibiotics, this tended to contribute to imprudent use of drugs, thus leading to an increase in risk of antibiotics resistance. Others are as shown in Table 6-3.
In line with the findings in Table 6-3, similar findings were also revealed by Boray et al., (1990) in New Jersey, that factors contributing to under-or overdosing and hence, to the development of resistance included illiteracy, inability to estimate livestock body weights and dilution of product. For instance, spread of a small purchase over a
142 large herd size, unfamiliarity with the product and ignorance of the consequences of misuse.
Table 6-3: Sources of Knowledge on Antibiotics Administration and Use
Wealth status Sources of knowledge Poor (n=127) Middle (n=72) Rich (n=22) Total (n=221) N % N % N % N %
Self-experience 103 81.1 66 91.71 20 90.9 189 85.5 Friends 124 97.6 69 95.8 22 100.0 215 97.3 Neighbours 127 100.0 71 98.6 22 100.0 220 99.5 Relatives 112 88.2 69 95.8 21 95.5 202 91.4 Drug suppliers shops 79 62.2 61 84.7 18 81.8 158 71.5 Drug vendors 41 32.3 35 48.6 10 45.5 86 38.9 Media 0 0.0 0 0.0 1 4.5 1 0.5 CAHWs 49 38.6 16 22.2 5 22.7 70 31.7 Veterinary experts 51 40.2 28 38.9 6 27.3 85 38.5 Interest group 59 46.5 44 61.1 14 63.6 117 52.9 Total 127 57.5 72 32.6 22 10.0 221 100.0 NB: Percentages and totals are based on multiple responses.
Source: Field Data, 2014
Moreover, in an ideal situation, access to and use of antibiotics for livestock requires a veterinary prescription. This is essential because giving high or low doses of antibiotics to livestock to treat infections actually makes some bacteria become resistant. Therefore, it is important that veterinarians exercise their medical judgment and careful oversight of antibiotic use in livestock production. While veterinary experts would have been the ideal source of knowledge and information on antibiotic access and use, they were few in number to an extent that livestock keepers opted for other sources of information and knowledge.
6.6 Types of Antibiotics Commonly Shared and Used
The types of antibiotics and their use for the treatment of a particular livestock disease determine the effectiveness of the drug to treat the intended illness. The findings in Table 6-4 show that the most commonly used antibiotics in livestock 143 include Oxytetracycline (OTC) injection which was reported to be used by all of the respondents. The users in the study area found some diseases easily treatable using the antibiotics available in their area, as one key informant put it:
"Every Maasai cattle keeper has a syringe and vial of OTC injection and administers the drug to livestock. Almost every boy over ten and adult females can inject goats, but cattle are left for adult males” (key informant Irkeepus, 2014).
Penicillin–streptomycin (Penstrep) and Tylosin were reported by more than 80% of all respondents in each wealth category and Sulphonamides (Sulpha) was reported by more than 50.0% of all of the respondents within each wealth category.
Table 6-4: Common Antibiotics Used by Wealth Status
Wealth status Most commonly Poor (n=127) Middle Rich Total used antibiotics (n=72) (n=22) (n=221) N % N % N % N % Oxytetracycline 127 100.0 72 100.0 22 100.0 221 100.0 Penstrep 110 86.6 65 90.3 20 90.9 195 88.2 Tylosin 104 81.9 68 94.4 21 95.5 193 87.3 Sulpha 76 59.8 50 69.4 18 81.8 144 65.2 Tetracycline 62 48.8 30 41.7 11 50.0 103 46.6 capsules NB: Percentages and totals are based on multiple responses.
Source: Field Data, 2014
Another common antibiotics used in livestock is Tetracycline capsules, which is normally used for treatment of human beings was reported by 48.8% of the poor,
41.7% of the middle and 50.0% of the rich households (Table 6-4). Surprisingly, tetracycline capsules are one of the antibiotics used for treatment of human beings and despite its increasing resistance to many people, but it was being used in the treatment of livestock in the study area! The study by Collard (1999) corroborates
144 this finding, that the emergence of bacterial resistance to tetracycline antibiotics has limited its use in human beings.
The wide use of antibiotics is not confined to pastoralists in Ngorongoro District only. A study done by Katakweba (2014) in Mikumi National Park and Ngorongoro
Conservation Area in Tanzania, also revealed that the most commonly used antibiotics were Oxytetracyline (62.9 %) followed by Sulphadimidine/ trimethoprim
/(STX) (23.2%), penicillin-streptomycin (13.4%) and gentamycin (0.5 %).
Katakweba (2014) further noted that only slightly more than 54% of the respondents obtained their antibiotics through prescription by veterinarians and the potential risk factors were identified to be the sources of the development of antimicrobials resistance. The sources of antimicrobial resistance included livestock management systems, antibiotics handling and types of antibiotics used in the study areas.
The explanations given by some respondents on how tetracycline capsules were being used show that the capsules were sometimes given to livestock orally after dissolving them in water or mixing them with OTC injections. The mixture was then injected into livestock intramuscularly or sometimes put in feeds and given to livestock. The knowledge of mixing these antibiotics was acquired through social networks involving sharing and trusts among the community members. This puts the public at risk of antibiotics resistance resulting into increased incurable diseases to livestock and eventually, to people. Roderick et al (2000) revealed that in a number of cases, trypanocides and antibiotics were mixed together before injection for the treatment of livestock diseases. Redding et al., (2014) also noted that the knowledge of how drugs are used can provide some measures of drug misuse, the magnitude of the risk of disease and the need to introduce other disease control methods.
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Almost all livestock keepers in Ngorongoro District were treating their livestock with antibiotics through injection and other forms of drugs and, in most cases; this was done in the absence of veterinary experts‘ supervision. They were getting their supplies mainly from local village shops, informal antibiotics traders or from nearby town shops, such as Karatu town.
It was noted that, accurate information on the dose of the antibiotics could not be obtained because it is normally obtained from unauthorized sources. However, it was noted that, in most cases, users gave a single injection rather than a course of treatment. It was learnt that necessity of treatment of diseases to maintain livestock health forced livestock owners to obtain and use drugs without veterinary supervision. Nevertheless, there were concerns with regard to the possibility of drug misuse and the development of drug resistance, as one of the key informants put it:
“Most of the pastoralists do not consult livestock health experts because they are fairly well informed on diseases problems in their local language. They are also familiar with the drugs but sometimes they try and test the drugs in livestock. Nevertheless, the issue of under or over dosage and misuse of drugs is about 90%” (Livestock Development Officer, Ngorongoro, 2014).
Furthermore, the reasons for the choice of each antibiotic were also provided by the respondents with the aim of consideration of the perception and understanding of users views. The findings in Table 6-5 show that there were different reasons for the choice of antibiotics. These include cost saving, easy availability, not trusting veterinarians, effectiveness, and lack of veterinary experts and being multipurpose.
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Table 6-5: Reasons for the Choice of Antibiotics by Type of Drugs
Antibiotic drug Reasons for OTC Tetracycline Penstrep Tylosine Sulpha choice of (N=221) (N=99) (N=196) (N=194) (N=136) drugs N % N % N % N % N % Cost saving 57 25.8 96 97.0 13 6.6 7 3.6 101 12.2 Easily 160 72.4 88 88.9 136 69.4 118 60.8 102 34.2 available Not trusting 12 5.4 5 5.1 11 5.6 10 5.2 2 2.6 veterinarians Effectiveness 112 50.7 19 19.2 138 70.4 147 75.8 27 23.9 Lack of veterinary 51 23.1 24 24.2 45 23.0 49 25.3 9 10.9 experts Multipurpose 76 34.4 5 5.1 0 0.0 0 0.0 0 16.2 NB: Percentages and totals are based on multiple responses;
Source: Field Data, 2014
The findings in Table 6-5 reveal that most of the drugs were chosen by users because of being easy to obtain them. As such, OTC was chosen by 72.4%, Tetracycline
88.9%, Penstrep by 60.4% and Tylosine by 60.8% of the users. This was due to the availability of various sources including an established open market that allows many suppliers of livestock drugs from various places. Another reason provided was the cost saving by 97.0% for Tetracycline, 25.8% for OTC and only 6.6% for Penstrep,
3.6% for Tylosine and 12.2% for Sulpha by users. The users of Tetracycline capsules explained that capsules save cost for treatment of young sheep (mbelelo) which normally get sick regularly. In view of this observation, it can be explained that most of the antibiotic drugs are costly and, for that matter, their affordability is low. When drugs are not more affordable they can lead to limited purchase, resulting into under dosage. The users can also misuse drugs by access and use poor quality drugs in order to minimize costs. 147
Moreover, the effectiveness of the drugs was also one of the reasons given by most of users for Tylosine (75.8%), Penstrep (70.4%), OTC (50.7%), Sulpha (23.9%) and
Tetracycline (19.2%). Based on users‘ opinion, it was revealed that antibiotics considered to be effective, were not much mentioned to be cost saving. This can explain the reason why the antibiotics which are frequently used are not effective.
This can lead to over use of the drugs.
The findings further show that, the choice of OTC was because it is multipurpose and can treat many diseases (34.4%). Considering OTC being multipurpose without proper knowledge whether diseases are caused by bacterial infections, can lead to the administration of antibiotics for the treatment on none bacterial infections. The use of antibiotics to treat none bacterial infection results into prolonged illness in livestock, thus leading to, not only economic loss, but also public health due to the risk of antibiotics resistance. This knowledge was revealed to have been shared among users since they depended on drug suppliers‘ knowledge and information, as an important source apart from other sources. This view was also held by Viberg et al. (2010) who found that some drug suppliers referred to antibiotics as a strong drug that treated many diseases. Katakweba (2014) also found out that 52% of the respondents were not aware of the types of diseases that could be treated with antibiotics and 40% did not know if the antibiotics used in livestock posed risk to human health in Mikumi
National Park, Tanzania.
The study further revealed that lack of veterinary experts was one of the reasons for the choice of drugs such as Tylosine (25.5%), Tetracycline (24.2%), OTC (23.1%),
Penstrep (23.0%) and Sulpha (10.9%) of the respondents. It can be observed from the findings that, the lack of experts was not mentioned by the majority to be the major
148 reason for the choice of accessing and using antibiotics for livestock. Although the lack of veterinary experts was one of the reasons for the choice of some drugs without prescription, there were some places where veterinary experts were available but not ready to respond immediately on call. Also, the high cost involved hindered access to veterinary experts as one of the key informants explained:
“Veterinary experts normally take long time to respond to an emergency call about livestock and yet, you still pay much money as costs involved to transport them and for the advice they give you. This makes pastoralists take their own initiatives to access and use the antibiotics” Key informant Nainokanoka, 2014)
Generally, the reasons for the choice of particular antibiotics also depend on the individuals‘ perception and attitude towards the drug. The reasons given for the choice of one antibiotic can be the same reasons for the choice of another different antibiotic for treatment of livestock. For instance, the ease of availability of antibiotics and their effectiveness were among the reasons for the choice of Penstrep and Tylosine antibiotics. Nevertheless, as it was revealed, all users tried to make sure that they accessed and use antibiotics for the treatment of livestock because livestock were the major means of their livelihoods, such as being source of food security and improved nutrition, income, cultural value, risk mitigation and economic, as well as, capital goods.
It is significant to note that all the antibiotics are selected due to the users‘ reasons, choice and perceptions without analysis of which diseases are to be treated with a particular type of antibiotics. For example, the ease of availability and cost saving were among the reasons provided by the respondents for the choice of some antibiotics. However, these reasons for the choice are not sufficient to access and use
149 antibiotics without prescription because it is important to have experts with appropriate knowledge of livestock diseases and treatment.
Different types of antibiotics were commonly used and shared amongst users in various wealth categories in the past six months of the study period. The findings revealed that OTC antibiotic was the most shared antibiotic reported by 47.7% of the users, followed by Tylosine antibiotic (23.5%) of users. The sharing of OTC was revealed more among users in the poor wealth categories (35.5%) than others. This is because OTC is one of the most commonly used antibiotics by the respondents in the study area. Moreover, the availability of Tetracycline is also one of the factors for its accessibility by users. In addition, OTC is considered to be multipurpose for treatment of many diseases, thus making its use be frequent in the study area. The findings further indicate that Tetracycline and Sulpha drugs were not shared with other users among the rich and middle wealth categories. Only a few respondents
(5.5%) and 3.6%, among the households in the poor wealth category, shared
Tetracycline and Sulpha drugs, respectively. This is because these drugs are affordable to many users that is, they can access them through purchase. Chi-square test statistics show that there was a significant difference at P<0.005 between the types of antibiotics shared among users in the different wealth categories (Table 6-6).
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Table 6-6: Types of Antibiotics Commonly Shared By Wealth Categories
Wealth status Chi- Shared Poor Middle (n=72) Rich (n=22) Total square antibiotics (n=127) (n=221) Value N % N % N % N % Tetracycline 38.184*** 13 5.9 3 1.4 0 0.0 16 7.2 caps Oxytetracycline 74 35.5 25 11.3 5 2.3 104 47.1 Tylosine 16 7.2 25 11.3 11 5.0 52 23.5 Penstrep 16 7.2 18 8.1 6 2.7 40 18.1 Sulpha 8 3.6 1 0.5 0 0.0 9 4.1 Total 127 57 72 32.6 22 10.0 221 100 Source: Field Data, 2014
The frequency of sharing antibiotics was also considered to be important to understand the rate of accessing and use of antibiotics in livestock. The findings revealed that all respondents admitted to receive or give antibiotics to others in the past 6 months of the study, irrespective of the users‘ wealth status. However, the frequency of receiving or giving antibiotics to others slightly differed from one user to another among wealth categories. Table 6-7 shows that 65.2% of the respondents reported to share antibiotics with others several times, 27.6% shared three times in the past six months of the study period and this was regardless of their wealth status.
Only one respondent shared antibiotics with others only once. Chi–square test statistics show that there was no significant difference at P>0.05 among users of antibiotics at the level of sharing by wealth categories. This study is of the view that, antibiotics were shared and used frequently for livestock.
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Table 6-7: Rate of Receiving or Giving Antibiotics to Others
Wealth status Chi- Poor (n=127) Middle Rich (n=22) Total (n=221) square Frequency (n=72) Value N % N % N % N % Once 1 0.8 0 0.0 0 0.0 1 0.5 2.077NS Twice 10 7.9 4 5.6 1 4.5 15 6.8 Three times 37 29.1 19 26.4 5 22.7 61 27.6 Several times 79 62.2 49 68.1 16 72.7 144 65.2 Total 127 100.0 72 100.0 22 100.0 221 100.0 NS= not significant p>0.05;
Source: Field Data, 2014; N=number; %=per cent
Sharing antibiotics among or between users in different wealth categories, for instance, the rich and the poor, contributes to frequent access and use of antibiotics in livestock. The findings further reveal that sharing was most noted among friends, relatives, neighbours and other interest groups, who were actually the important actors in social networks, bound by strong ties. A study by McKee and Mills (1999) in the USA supports this finding that a substantial proportion of individuals obtained antibiotics from friends‘ and family members‘ leftover pills or obtained antibiotics directly from pharmacists. In such situations, it is quite obvious that the way users obtain antibiotics contributes to the development of antibiotics resistance in livestock, and the situation in Ngorongoro District is not an exception.
The extent, to which actors in social networks help each other in terms of accessing antibiotics through sharing, was also determined. It was found that the majority of the respondents accounting for 89.0% among the poor; 81.9% of the respondents among the middle and 86.4% of the respondents among the rich wealth categories, admitted to have helped each other at some point in time. Helping one another
152 implies the functioning of social networks in seeking assistance to access and use antibiotics for livestock. Chi–square statistical test revealed that there was no significant difference at P>0.05, among the groups in terms of the extent of helping each other by sharing. Helping one another among the pastoral communities is not only based on livestock health care, but also includes, all the other necessary social and economic aspects, such as food, clothes, medicines and other needs. This makes the poor also get the necessary commodities for living. It was further noted that livestock keepers within the study area believed that sharing by giving medicines or assistance to the person in need, brought more blessings to people. One respondent said:
“If you don‟t help others, you can cause bad luck to your livestock and family and you will also lack support from others”, (Respondent at Esere village, 2014).
The explanation above implies the existence and functioning of social networks based on trustworthiness and reciprocity. However, access to antibiotics through sharing among users who do not have adequate knowledge of the functioning of the drugs, brings the risk of antibiotics resistance in livestock.
6.7 Multiple Logistic Regression Model for the Access and Use of Types of
Antibiotics
The study also investigated the relationships of some socio-economic variables and the types of antibiotics supplied and accessed in the study area. These variables include income in TAS, time reflected by distance in kilometres and the number
(size) of livestock to reflect the wealth status of users of these types of antibiotics.
To find the association between the independent variables of interest and the access and use of antibiotics, multiple logistic regression models were employed as stated in
153 the methodology chapter. The results of these models are presented in a series of
Tables based on each type of antibiotic used by the pastoralists in the study area.
6.7.1 Multiple Logistic Regression Model for the use of Penstrep
Multiple logistic regression models were used to find the association between the studied independent variables and the access and use of Penstrep. The results of the fitted model are presented in Table 6-8. Compared to individuals with income less than or equal to 1,000,000/= TAS, the chance of accessing and using Penstrep was significantly higher in individuals with income of more than 1,000,000/= TAS with an adjusted OR of 4.352 (p=0.0071). Penstrep is relatively costly compared to others and this was confirmed by the users who provided the reasons for the choice of drugs in which effectiveness and availability were mentioned (see Table 6-5 section 6.6).
Table 6-8: Parameter Estimates, Standard Error and Adjusted Odds Ratio of the
Logistic Regression Model for the Access and Use of Penstrep (N=194)
Parameter Estimate Standard Error Adjusted Odds Ratio P-Value Intercept 1.522 0.3612 <0.0001 Income <=1,000,000 Reference >1,000,000 0.7353 0.2733 4.352 0.0071 Number of cattle <20 Reference 20-100 0.271 0.416 1.473 0.5147 >100 -0.1545 0.5416 0.963 0.7754 Distance from source <5 Km Reference 5-10 Km 0.4477 0.3166 2.113 0.1573 >10 Km -0.147 0.3601 1.166 0.683 Source: Field Data, 2014
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The study shows that the effect of the number of cattle and the distance from the source of antibiotics were not significantly associated with access and use of
Penstrep. This is because, pastoralists did access and use antibiotics in livestock regardless of the distance to the source and the number of livestock owned. Though not significant, individuals with 20-100 cattle (OR=1.473, p=0.5147) and those who were living at a distance of 5-10 km from the source (OR=2.113, 0.1573) had higher chance of using Penstrep, as compared to peoples with less than 20 cattle and those who were living at a distance of less than 5km, respectively. This is because
Penstrep is one of the strong antibiotics sold at a higher price for people with low income to purchase. However, in the study area, people with low income could still access high costly antibiotics through social networks by sharing, as it was observed by McKee and Mills (1999) that livestock keepers used leftover and shared antibiotics with friends instead of purchasing them.
6.7.2 Multiple Logistic Regression Model for the Use of Tylosine
Regarding the association between independent variables of interest and the access and use of Tylosine, the results of the model revealed that income (p=0.0111) and distance from the source of the antibiotic (p=0.0314) were significantly associated with the individuals, access and use of Tylosine, while the number of cattle
(p=0.2414) that an individual had were not significantly associated with the use of
Tylosine. This has a similar explanation with Penstrep antibiotics. Table 6-9 shows the parameter estimates, standard error and adjusted odds ratio of the fitted model.
The results showed that individuals with income of more than one million
(OR=3.783, p=0.0111) were significantly more likely to use Tylosine compared to individuals whose income was less than or equal to one million. These individuals
155 with less income involved themselves in social networks to access antibiotics from others thus leading to risk of antibiotics resistance.
For the case of distance from the source of antibiotics, those who were living at a distance of 5-10 km (OR=0.239, p=0.0087) had a significantly lower chance to use
Tylosine in comparison to people living at a distance of less than 5km from the source. Though not significant (OR=1.237, p=0.2688), people living at distance of more than 10km from the source of antibiotics, had a higher chance to use Tylosine compared to those living at a distance of less than 5km (Table 6-9). This is because pastoralists from far distance made sure that they obtained enough stock of antibiotics such as Tylosine and used it for livestock, compared to those at close proximity. These users felt that they could obtain antibiotics at the nearby shops at any time which, however, at times they failed to get due to limited supply.
Nevertheless, distance was not significantly important for the access and use of
Tylosine antibiotics in livestock, since almost all of the respondents could access and use antibiotics in livestock through sharing, regardless of the distance from the source. This posed more risk of antibiotics resistance at the community level.
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Table 6-9: Parameter Estimates, Standard Error and Adjusted Odds Ratio of the
Logistic Regression Model for the Access and Use of Tylosin (N=194)
Parameter Estimate Standard Error Adjusted Odds Ratio P-Value Intercept 2.4232 0.506 <0.0001 Income <=1000,000 Reference >1000,000 0.6653 0.2618 3.783 0.0111 Number of cattle <20 Reference 20-100 0.2244 0.501 2.407 0.6543 >100 0.4299 0.7217 2.957 0.5514 Distance to source <5 Km Reference 5-10 Km -1.0261 0.3913 0.239 0.0087 >10 Km 0.6194 0.5602 1.237 0.2688 Source: Field Data, 2014
6.7.3 Multiple Logistic Regression Model for the use of Tetracycline and Sulpha
For the case of Tetracycline and Sulpha antibiotics, the results of the fitted model revealed that none of the independent variables (income, distance to the source, number of livestock) was significantly associated with the use of Tetracycline and
Sulpha, as shown in Table 6-10. This is because, Tetracycline capsule and Sulpha antibiotics were easily available and accessible in terms of affordability, compared to other antibiotics.
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Table 6-10: Parameter Estimates, Standard Error and Adjusted Odds Ratio of the
Logistic Regression Model For the Access and Use of Tetracycline and
Sulpha (N=194)
Parameter Estimate Standard Error Adjusted Odds Ratio P-Value Tetracycline Intercept -0.2534 0.2693 0.3468 Income <=1000,000 Reference >1000,000 -0.0957 0.2193 0.826 0.6627 Number of cattle <20 Reference 20-100 -0.0716 0.2408 0.719 0.7662 >100 -0.1867 0.3288 0.641 0.5701 Distance to source <5 Km 5-10 Km 0.3946 0.2013 2.287 0.0499 >10 Km 0.0383 0.2454 1.602 0.8758 Sulpha Intercept 0.5556 0.2791 0.0466 Income <=1000,000 Reference >1000,000 0.3194 0.2173 1.894 0.1417 Number of cattle <20 Reference 20-100 0.1069 0.2632 1.572 0.6845 >100 0.2384 0.365 1.793 0.5137 Distance from source <5 Km Reference 5-10 Km -0.0413 0.2099 0.967 0.844 >10 Km 0.0487 0.2589 1.058 0.8508 Source: Field Data, 2014
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It was revealed that the majority of the pastoralists did not use Tetracycline capsules because they were not effective in the treatment of livestock, especially for the grown up cattle, as per their perception. Nonetheless, given easy availability and low cost but not the effectiveness of these drugs, were among the reasons given by pastoralists for accessing and using Tetracycline capsules and Sulpha.
6.8 Chapter Summary
The chapter sought to map out the existing social networks and how they determined the access and use of antibiotics in Ngorongoro District. Among the important actors who determined access to and use of antibiotics were neighbours, friends, relatives, interest groups and traditional dealers. With regard to social networks, these actors had more interactions with end users and are connected with social ties based on trust and reciprocity. The ties include kinship, friendship, neighbourhood and ties based on the service provision. Social ties connecting these actors are strong ties that give more sense of social obligations to share. However, these actors had limited knowledge on antibiotics handling and administration which they were sharing within the social networks. This resulted into misuse of drugs such as under or over dosage and inappropriate diagnosis. It can be concluded that, while much of the expert knowledge on antibiotics rests with veterinary experts and CAHWs, it is least accessible to end users of antibiotics in rural areas. Therefore, stakeholders in the livestock health care services should be aware of the existing supply systems and social networks in Ngorongoro District and should focus on a proper plan to help livestock keepers on the prudent use of antibiotics.
This chapter also, covered the most commonly used antibiotics. The findings show that Oxytetracycline drug was the most commonly shared and used antibiotics, but it 159 was also the same drug which was the most commonly misused because of the belief and perception that it was a multipurpose drug. Therefore, this strongly contributes to imprudent and irrational use of antibiotics, thus leading to antibiotics resistance in
Ngorongoro District. The chapter assessed how social networks determined access to and use of antibiotics. The main findings revealed that social networks determined access to and use of antibiotics through sharing with others. It was revealed that users share knowledge and information on antibiotic availability, access and use. The major types of antibiotics shared included Oxytetracyline, Penstrep, Tylosine, Sulpha and Tetracycline capsules. These types of antibiotics were also the major antibiotics supplied in the study.
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CHAPTER SEVEN
IMPLICATIONS OF THE SUPPLY SYSTEMS AND SOCIAL NETWORKS
ON ANTIBIOTICS RESISTANCE IN NGORONGORO DISTRICT
7.1 Introduction
This chapter examines the implications of supply systems and social networks on antibiotics resistance in Ngorongoro District. The chapter is organized into five main sections. After this introduction, this chapter proceeds with a discussion on implications of supply systems on antibiotics resistance followed by a discussion on implications of social networks on antibiotics resistance. The chapter also provides a discussion on the theoretical and policy implications of the supply system and social network.
7.2 Implications of the Supply Systems on Antibiotics Resistance
The supply systems for accessing and utilization of antibiotics have strong implications on antibiotics resistance. In an ideal situation, the supply system is expected to facilitate the availability of antibiotics as well as making it possible for end users to get the required knowledge on how to administer the drugs. The findings from this study have revealed a number of shortcomings that compromise the smooth facilitation for access to and utilization of antibiotics. These drawbacks include: low level of antibiotics supply, limited availability of veterinary experts, poor implementation of by-laws and regulations governing the access and use of antibiotics and the low level of awareness of the problem of antibiotics resistance by rural suppliers and end users.
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The low level of antibiotics supply and the limited availability of veterinary experts force users to resort to their own alternative sources to access and use antibiotics something that leads to risk of antibiotics resistance. This is compounded by weak implementation and lack of regulations governing prudent access and use of antibiotics in livestock. Furthermore, most of the rural suppliers have limited knowledge of antibiotics handling and administration. As such, they provide inadequate knowledge and information to users who depend much on them. As a result, more risk of antibiotics resistance is experienced.
7.2.1 Lack of Implementation of By-Laws and Regulations Governing Access
and Use of Antibiotics in Livestock
The local suppliers of antibiotics play an important role in making the antibiotics available to different users. The fact that these are supplied without proper channels is also a source of risk of antibiotics resistance. Part of the reasons for this situation is that there is poor implementation of the regulations governing the use of antibiotics in livestock. The Tanzania Food and Drugs Authority Act (2003) 18.-(I) and 47.-(2) states that:
“No person shall manufacture for sale, sell, supply or store products regulated under this Act except in premises registered under this section for that purpose” (TFDA, 2003:18.-1) “No person shall manufacture for sale, sell, supply or dispense any drug except under the immediate supervision of a pharmacist” (TFDA, 2003:42.-2)
Despite the clarity of the regulations, this study noted that the by-laws and regulations governing the sale, access and use of antibiotics were not properly implemented at the grassroots level. As such, pastoralists accessed the antibiotics from local suppliers and used them for livestock without proper monitoring and prescriptions. This usually led to misuse of drugs, hence the risk of antibiotics 162 resistance. Lack of awareness on regulation governing the sale of antibiotics was revealed by drug suppliers in the villages as confirmed by some sellers:
“I am not aware on any regulation governing the sale of antibiotics and other livestock drugs because there is no any seminar that has been conducted in our area” (Drug supplier Endulen Village, 2014).
Another seller also said that
―I started selling the drugs according to demands of people in our villages but not aware of any regulation governing the sale” (Drug supplier Nainokanoka village, 2014).
Based on the statements, it is revealed that the by-laws and regulations are not implemented to grassroots level, thus making the users unaware of the potential problem. This was also confirmed by key informant from Ngorongoro District that,
“By-laws and regulations are generally established by Tanzania Food and Drugs Authority normally for those who handle drugs at the high levels but not at the grassroots level” (Livestock Officer, Ngorongoro District, 2014).
Improper actions for the regulations governing drug access and use was also noted elsewhere in the world in which Chandy (2008) pointed out that there had been no sufficient penalties for irrational prescription of antibiotics and minimal regulation of misuse and overuse of drugs in India.
7.2.2 Limited Expert Advice
Veterinary expert advice is important for providing information on the dosage, storage, administration of antibiotics as well as proper information on symptoms of livestock diseases. Furthermore, expert advice is important in providing knowledge and information on the threat of new diseases, new medicines and vaccination. The
163 situation in Ngorongoro District is that antibiotics users do not normally consult veterinary experts for advice in livestock health matters. This is because of limited availability of veterinary services in their area. This problem is not unique to
Ngorongoro District because the same problem is noted in many African countries as revealed in a study by Grasswitz et al (2004) that in Kenya, Uganda and South
Africa the difficulty of providing adequate animal health care is compounded by an absolute shortage of practicing veterinarians.
Findings from Ngorongoro District also reveal that although some villages had potential actors such as CAHWs who could provide the much needed knowledge, users did not frequently consult them. This is also because trained CAHWs were few in number and lack facilities to provide good services to users. In that case, they accessed and used antibiotics through self-experience and from other sources which, unfortunately were without proper knowledge and prescription. Access and use of antibiotics through experience without proper channel and knowledge result into misuse of antibiotics in livestock thus leading to high risk of drug resistance. Results from a study by GARP–Tanzania working group (2015) and Sosa et al., (2010) also revealed that resistance of antibiotics emerged from inappropriate use of the drugs.
Focus Group Discussions also revealed the seriousness of the problem of limited expert advice on usage of antibiotics as remarked by one participant that,
“We normally see veterinary experts in our village during the period when there is disease outbreak especially that can also put wild animals at risk. That is when they insist on vaccination of livestock which is also expensive. For instance, to vaccinate one cattle for ECF costs TAS 8000–10,000 depending on the types of vaccine, therefore not many people afford to vaccinate all their livestock” (FGD participant Esere village, 2014). 164
In view of the explanation above, it is confirmed that pastoralists in Ngorongoro
District have been establishing their own mechanisms to access antibiotics and use them for treatment of livestock. This is because of the limited availability of veterinary experts and the cost involved in securing the services. Provision of adequate animal health care is hampered by deficiency of practicing veterinarians in many African countries as supported by Grasswitz et al (2004) in Kenya, Uganda and South Africa. Studies by Muhairwa (2014) and SUA/UCPH (2014) support that, treatment of infectious diseases in Tanzania is mostly left in the hands of undertrained persons, such as drug sellers, livestock keepers, owners of veterinary implement shops and only rarely are veterinarians involved.
7.2.3 Low Level of Antibiotic Supply
Another problem related to the supply systems of antibiotics is the low level of supply in the study area. This problem forces many antibiotics users to seek other alternative sources of antibiotics for treating their livestock. This was one of the reasons for having various sources of antibiotics to carter for the needs of the users.
The level of antibiotics supply determines the availability of antibiotics for an easy access and use in livestock. Limited availability of antibiotics supplies can make users obtain antibiotics from improper sources including local social networks.
Furthermore, when the level of supply is low, the demand becomes higher and consequently, it forces people to find whatever means and sources as possible to access the required antibiotics.
One of the key informants confirms that;
"The drugs are expensive, especially in very remote areas with shortage of supplies. Thus users normally sell livestock to purchase enough stock of drugs such as de-wormers, tick-dips and injections including 165
antibiotics, where available as in open markets” (Key informant, Nainokanoka village, 2014).
This means that there is inadequate supply of antibiotics in the study area, which forces the pastoralists to establish their own ways, such as being involved in social networks to access antibiotics without prescription. This results into inappropriate access and use of antibiotics in livestock. Table 7-1 shows sufficiency level of antibiotics supply to serve the needs.
Table 7-1: Level of Antibiotics Supply in Ngorongoro District
Village Level of sufficiency of antibiotics supply Slightly sufficient Sufficient Not sufficient Total N % N % N % N % Enduleni 38 70.4 16 29.6 0 0.0 54 100.0 Esere 37 94.9 0 0.0 2 5.1 39 100.0 Nainokanoka 25 33.3 1 1.3 49 65.3 75 100.0 Irkeepus 8 15.1 0 0.0 45 84.9 53 100.0 Total 108 48.9 17 7.7 96 43.4 221 100.0 Source: Field Data, 2014
Furthermore, 43.4% of the respondents reported the insufficient level of antibiotics supply from the villages. A clear look at Table 7-1 shows that Nainokanoka (65.3%) and Irkeepus (84.9%) villages, revealed a higher level of insufficient level of antibiotics supply. Only 5.1% of the respondents from Esere and none from
Enduleni reported any insufficient level of antibiotic suppliers compared to others.
Therefore, it can be explained that in Enduleni and Esere villages, there were somewhat more drug suppliers‘ shops and private suppliers (vendors) compared to
Nainokanoka and Irkeepus villages. This reveals that there were slight variations in the villages regarding the sufficiency of antibiotics supply, despite the various sources of antibiotics supply through social networks. Insufficient level of supply of antibiotics prompts the users to get involved in social networks to share antibiotics. 166
In doing so, these pastoralists are likely to create more risk of antibiotics resistance.
Figure 7-1 shows the implications of supply systems on the risk of antibiotics resistance.
FAILURES IN POSSIBLE THE SUPPLY RESPONSE RISKS SYSTEMS Use own Under-dose ANTIBIOTIC Inadequate supply experience Over-dose S Expensive Own choice Wrong RESISTANC diagnosis E antibiotics of Inadequate antibiotics Wrong choice o Persistent ill- of antibiotics health knowledge & Miss-use of o Death information antibiotics
Figure 7-1: Implications of Supply Systems on Antibiotics Resistance; Source:
Developed by the Researcher (2016)
One of the objectives of the National Livestock Policy (2006) is to ensure adequate supply, accessibility and affordability of safe, quality and efficacious veterinary medicines (URT, 2006). This objective has not been fully achieved due to various challenges facing the livestock sector such as diseases as revealed by URT (2006) and URT (2001). There have been some factors contributing to livestock diseases and deaths that require attention such as the existing supply systems at the community level. Figure 7-1 shows the implications of the supply systems on the risk of antibiotics resistance in Ngorongoro District involving failures of supply systems.
It is clearly shown from Figure 7-1 that supply systems of antibiotics in Ngorongoro
District are characterized by inadequate supply of antibiotics, expensive antibiotics and inadequate information on storage, handling and use of the antibiotics. In response to these problems, pastoralists have been forced to use their own experience in handling and administration of antibiotics, as well as having their own choice of 167 antibiotics. Such responses on the part of antibiotics users have been leading to possible risks such as under-dosage, over-dose, wrong diagnosis and wrong choice of antibiotics and even misuse of the drugs. At the end of this chain of events is antibiotics resistance which is reflected in persistent ill health of livestock and, in some cases, death of the animals.
7.2.4 Low Level of Awareness of Suppliers on Antibiotics Resistance
In situations where suppliers of antibiotics especially in rural areas, are not aware of the problem, they do not adequately advice their customers on the better ways to handle and administer drugs. Instead, they continue to supply the drugs. The study further revealed that many of the suppliers are not aware of the antibiotics resistance problem and the extent of it. This was observed from the antibiotics suppliers in rural areas, who were interviewed in which it was noted that their level of awareness of antibiotics resistance was very low. One supplier revealed this by explaining that:
“I have never attended any seminar on antimicrobial resistance including antibiotics, I am not aware of anything about it. Also my customers are normally concerned about expire date and effectiveness of drugs in treatment of livestock. No one ever asked about drug resistance” (Drug seller Enduleni village, 2014)
Furthermore, one of key informants explained that he had heard that there was drug resistance and added:
“Resistance cannot be proved until scientific testing by setting experiments. Also, drug resistance depends on the kind of herd exposed to the environment with the risk of resistance” (District Livestock Development Officer Ngorongoro, 2014).
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On further interview he explained that:
―There are elements of resistance in Trypanosomiasis and some drugs such as OTC 10% not being more effective for treatment of the cattle. This has been evidenced by many pastoralists‟ complaints but no scientific proof and any initiatives that have been taken to tackle the problems”
Based on the statements above, the issue of antibiotic resistance needs to be address at all levels in order for all stakeholders in livestock sector to be aware of the problem for better actions to minimize it. Generally, it can be concluded from this section that the supply systems have implications on antibiotics resistance. This is because, the system has failed to supply adequate and quality antibiotics to access, appropriate knowledge to share such as limited availability of veterinary experts and capacity building and empowerment to CAHWs. Also, it has failed to proper monitoring and regulatory control of the distribution channel of antibiotics from whole sale to end users. All these require the stakeholders‘ attention to foresee.
7.3 Implications of Social Networks on Antibiotics Resistance
In this section, a discussion is provided on how the nature of social networks contributes to development of antibiotics resistance to livestock. The social networks among pastoralists who are characterized by sharing of knowledge, information, experience and antibiotics have implications on antibiotics resistance. Also sharing of common resources such as water and pastures, livestock and markets, all contribute to antibiotics resistance. The discussion is anchored on the reality that pastoralists in Ngorongoro District depend on their social networks because the formal supply of antibiotics is not functioning properly. This alternative however, is also marred by problems, which in turn, contribute to antibiotics resistance in livestock. 169
7.3.1 Sharing of Antibiotics among Users
One of the salient features of the social networks among pastoralists in Ngorongoro
District is the sharing of antibiotics amongst themselves. There are many reasons for this tendency including the fact that antibiotics are expensive and inadequately supplied. Respondents from nearly all the study villages reported that the majority of their people had low purchasing power to such an extent that they would lay hands on what is readily available, but which cannot be the correct drugs for some livestock diseases. Given the poor infrastructure, in terms of roads and inadequate supply of the antibiotics, the retail price of these drugs is considered higher than most people can afford. Due to their low purchasing power, most pastoralists therefore turn to themselves as friends, relatives and neighbours as alternative sources of antibiotics.
This makes antibiotics be accessed and used without prescriptions thus leading to antibiotics problem in the Ngorongoro District. GARP—Tanzania Working Group
(2015) in its recent study also reported significant rates of antibiotics resistance due to prevalent use of antibiotics in farm animals due to lack of proper prescription.
Without doubt, pastoral communities are socially differentiated, particularly in terms of household income. In view of this, one would expect that, those households with higher income would easily afford antibiotics for their livestock. In reality however, they are also engaged in sharing of antibiotics with poorer households as part of the obligation to other community members, but also under the fear that unless they contribute to good health of their neighbours‘ herds their own herds will not be safe from livestock diseases. Access and use of antibiotics through sharing can lead to misuse of antibiotics resulting into an increased risk of antibiotics resistance.
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The ways antibiotics are obtained and used also determine the effectiveness of the drug to fight a particular disease or otherwise (Katakweba, et al., 2012). Findings revealed that all the respondents admitted to have obtained and used antibiotics in livestock in the past six months for the major purpose of treatment of diseases. There were a few cases whereby antibiotics were used in livestock for other purposes:
“We use Oxytetracycline injection or capsules „rangi mbili‟ is like the way people use „panadol‟ for relieve of fever and pain, the drug is given livestock to relief fever and make livestock active when tired after long distance to the market place it can also relieve starvation to livestock‖ (FGD Nainokanoka, 2014).
In view of this statement, it is clear that the use of antibiotics depends on users‘ perceptions. This is further supported by Katakweba, et al. (2012) who revealed that livestock keepers in Tanzania were using antibiotics to treat their livestock when they got sick. This study discovered other reasons for the use of antibiotics apart from treatment such as relief of starvation which made livestock active. This can be explained by the fact that the problem of livestock diseases seems to be common in most cases where there is limited services from livestock health experts. In addition, pastoralists also have their beliefs and perceptions leading to frequent use of antibiotics in livestock; hence increasing the risk of antibiotics resistance in the study area.
Findings further confirms that 78 % of the poor, 41.7% of the middle and 18.2% of the rich households were getting antibiotics from neighbours, friends, relatives or others through sharing. Another way of obtaining antibiotics is through exchange of antibiotics with livestock as reported by 11.8% of the poor, 26.4% of the middle and
31.8% of the rich households. Although it can be seen clearly that pastoralists have multiple ways of obtaining antibiotics, most of drugs are accessed and used without
171 proper prescription from livestock health experts. This can result into more risk of antibiotics resistance at the community level.
7.3.2 Sharing of Knowledge and Information on Antibiotic Usage
In addition to sharing of antibiotics, pastoralists in Ngorongoro District also share information, knowledge and experience on the usage of antibiotics to their livestock.
Sharing of this important information is perhaps an inevitable outcome of the fact that professional knowledge from veterinary experts is very limited. This is because veterinary experts are few in terms of numbers in rural area. With a low number of veterinary experts, it becomes difficult for all pastoralists to be reached easily. This is further compounded by dispersed nature of pastoral settlements in Ngorongoro
District. While friends, relatives and neighbours are depended on as alternative source of information these sources, in most cases, they are not from livestock health experts. This contributes to under dosage, combining antibiotics with herbs, and mixing different antibiotics, over dosage, hence persistence of ill health and deaths in livestock become an inevitable outcome.
The sharing of information is also a result of the reluctance of pastoralists to seek expert advice from veterinary personnel. This study revealed that more than 70% of the users were not seeking veterinary advice before obtaining antibiotics to use them for livestock. This is because of the strongly established social connections bound with trust and reciprocity that enable them to access antibiotics and use in livestock within their communities. Respondents only seek advice when there are widespread diseases that are out of their control.
“When an extensive outbreak of livestock diseases occur pastoralists organize themselves and liaise with the government veterinary officers to vaccinate their 172
livestock; on the contrary, not all livestock are taken for vaccination” (Key informant, Enduleni village, 2014).
It was also noted that, many pastoralists do not take livestock for vaccination very often because: first, not only that the vaccines are reported to be expensive, but also they believe that vaccinated livestock will not be cured with other drugs when they become sick again. In addition, many pastoralists are not willing to expose numbers of livestock they own. This is because they believe that counting livestock can bring a bad omen to them thus increasing their deaths. Second, they are normally not sure of what purposes or intentions the size of livestock is for. This finding is contrary to that of Homewood et al. (2006) in Kenya who noted that pastoralists from all economic backgrounds viewed the livestock vaccination positively. Homewood et al further argued that, the decision to vaccinate was strongly associated with a measure of wealth that included livestock numbers and economic security.
Pastoralist in Ngorongoro District are in most cases scared that they can be forced by the government or other stakeholders to reduce the number of livestock they own thus making them scared and uncertain for their future. So no one was willing to tell the truth about the exact livestock size they own. Thus, even for the vaccination they just take few herds.
“We do not tell the truth about the numbers of livestock we own because this sometimes brings bad luck to our livestock causing more deaths. Also the government authority can ask us to reduce the number of livestock; what will we eat?” (FGD Enduleni village, 2014).
Reasons given are based on users‘ perception sometimes contribute in one way or another to not seeking advice from veterinary experts. Perception of users was not mentioned as one of the reasons for not seeking veterinary advice, but they believe 173 that veterinary officers can count and know the exact number of livestock owned by individual households that can bring bad luck. Thus, users opt for social networks for sharing knowledge, information, experience and antibiotics to use in livestock that can result into imprudent use of antibiotics. Table 7-2 provides in detail the reasons for not seeking advice for veterinary experts.
Table 7-2: Reasons for Not Seeking Veterinary Expert Advice
Wealth status Reasons for not seeking Poor Middle Rich Total(n=221) veterinary experts’ advice (n=127) (n=72) (n=22) N % N % N % N % Confident in self-knowledge and experience on the types of 67 56.3 44 63.8 15 78.9 126 60.9 diseases and treatment Lack of veterinary 16 13.4 9 13.0 4 21.1 29 14.0 professionals Consult neighbour, relative or friend who are knowledgeable 49 41.2 20 29.0 3 15.8 72 34.8 on antibiotics use Consult CAHWs 8 6.7 2 2.9 0 0.0 10 4.8 Obtain instructions from the 31 26.1 24 34.8 6 31.6 61 29.5 suppliers Total 119 57.5 69 33.3 19 9.2 207 100.0 Source: Field Data, 2014
The study further revealed that reasons provided by pastoralists for not seeking veterinary advice include having confidence in self-knowledge, experience, types of diseases and treatment. This was reported by 56.3% of the respondents within the poor wealth category. Consult neighbours or relatives or friends who are knowledgeable about antibiotics use were reported by 34.8% within the middle wealth category and 31.6% reported by the respondents in the rich wealth category.
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This implies that social connections through social ties enable users to access and use antibiotics without appropriate knowledge. This can lead to imprudent use of antibiotics thus resulting into risk of antibiotics resistance. In some point, lack of veterinary professionals was explained by few 14.0% respondents indicated that experts were available but pastoralists were not willing to consult them due to mistrust or due to the cost involved in engaging experts:
“It is very expensive to engage a veterinary expert because you need to find transport which generally, public transport is not available in our village and neither motorcycles nor bicycles are available. Veterinary experts depend on transport from NCA, which are again not reliable” (FGD participant Esere village, 2014).
7.3.3 Self Belief and Confidence
Discussions with participants from FGD in Esere village revealed that some of the users‘ self-experience was obtained through social networks. For instance, the storage of drugs was done depending on the individual‘s knowledge, experience, determination and situation. Users of antibiotics sometimes buried the drugs in the soil or put them under water in the river as a way of preserving or storing them. One participant explained,
“Drugs are wrapped in a piece of cloth, buried in the soil and then you water them every day. When livestock fall sick, you remove and draw the required amount then you keep the remaining drugs until the day you shift to other places depending on the expiring date or dig a place inside the river under water and bury them there” (Participant FGD Esere, 2014).
This kind of knowledge that originated from social networks poses the risk of inappropriate handling and administration of drugs leading to damage that can cause mal-functioning, hence risk of drug resistance. 175
7.3.4 Sharing of Common Resources–Water and Pasture
The study also revealed that herdsmen put together livestock from different places during grazing and watering. Putting many herds from different places together can result into the transmission of diseases from one herd to another, thus increasing the rate of access and use of antibiotics for treatment. This can lead to more risk of antibiotics resistance. Figure 7-2 reveals that the majority (92.8%) of the users in all wealth categories were combining their herds with others several times for water and pasture.
Figure 7-2: The Rate of Combining Livestock Herds with Others in Ngorongoro
District
Source: Field Data 2014
Users of antibiotics normally combined their herds with those of their relatives
(77.3%), friends (30.0%), neighbours (70.5%) and other herdsmen from different places (40.0%). This is because, livestock share common sources of water and pasture. Only one respondent reported not to combine livestock with others. This is because he did not own cattle and had only a few goats and sheep that were managed near the homestead. It was revealed that, pastoralists sometimes combined livestock not only for sharing pasture and water resources but also to promote friendship based
176 on trust and reciprocity for protection against enemies. Participants in all FGDs revealed this by explaining that:
“When searching for water and pastures, livestock are combined from different places. This promotes friends but also protects each other from enemies”. (FGD participants in all the study villages, 2014)
Sharing of resources such as water is not unique to pastoralists in Ngorongoro
District, but also elsewhere in the worldwide. A study by Schnegg and Linke (2015) in pastoralists in Namibia also revealed the sharing and sanctioning of water resources.
7.3.5 Sharing Livestock for Care
Sharing livestock for care is also a common practice among pastoralists in
Ngorongoro District. Those with more livestock can distribute some livestock to friends, relatives, neighbours, age mates or any other to care for them while enjoying milk and other products. This involves mixing of herds of livestock from different places based on trust and reciprocity. However, mixing of herds can transmit diseases to livestock hence leading to frequent access and use of antibiotics and eventually, promotes antibiotics resistance. Sharing of livestock among pastoralists was also reported by Bekure et al 1991 that traditionally, some East African pastoral societies have had strong redistributive mechanisms, whereby within a social group
(e.g. clan) owners of large herds were socially compelled to share with those who had few livestock.
7.3.6 Sharing Livestock Market
Pastoralists in Ngorongoro District were revealed to share the livestock market where many people and livestock came from different villages for the sale and purchase of livestock. Mixing livestock in the market for purchase or sale can also result into 177 contact of diseases which promote more of the risk of antibiotics resistance. Plate 7-
1: shows Maasai pastoralists sharing open livestock market in Nainokanoka village.
Plate 7-1: Maasai Pastoralists Sharing Open Livestock Market in Nainokanoka Village
Source: Field Data, 2014.
The common livestock market do exist among pastoralists in other places worldwide where a study by Bekure et al 1991; Grandin et al, 1989) in pastoralists of Kajiado and Turkana, respectively, became more interested in livestock marketing and gaining access to formal education to improve the market.
Generally, the implications of social networks on antibiotics resistance were revealed to emanate from various factors ranging from the policy to grassroots levels. One of the issues in the National livestock Policy is based on the premise that,
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“Livestock diseases are among the constraints limiting the development of the livestock industry. There is a high prevalence of livestock diseases in the country…” (URT, 2006).
The policy also recognizes that the constraints facing the use of veterinary medicines include their availability, high costs, poor quality, and low awareness of the stakeholders, poor distribution network and infrastructure. Moreover, one of the objectives of the National Livestock Policy (2006) is to ensure adequate supply, accessibility and affordability of safe, quality and efficacious veterinary medicines.
This objective has not been fully achieved due to various challenges facing livestock development sector such as diseases as revealed by URT (2006, 2001). Apart from the policy being aware of existing factors facing the use of veterinary medicines, there have been some factors contributing to livestock diseases and deaths that require attention and which are worth noticing, such as social networks at the community level. Figure 7-3 shows the implications of social networks on the risk of antibiotics resistance.
FAILURES IN THE SOCIAL RESPONSE POSSIBLE NETWORKS RISKS ANTIBIOTI Rely on Under-dose CS Share inadequate self- Over-dose RESISTANC knowledge and experience Wrong E Own choice o Persistent information diagnosis of Wrong choice ill-health Share inadequate antibiotics of antibiotics o Death and expensive Misuse of antibiotics antibiotics
Figure 7-3: Implications of Social Networks on Antibiotics Resistance
Source: Developed by researcher (2016)
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7.3.7 Low Level of Awareness of the Users on the Problem of Antibiotics
Resistance
The problem of antibiotics resistance develops slowly to the extent that it becomes difficult to trace its severity. Sometimes, when this problem is noted, it must have taken a long time to realise its symptoms. In situations where users of antibiotics are not aware of the initial symptoms of the problem, they take no steps to solve it and, instead, continue using the drugs. The level of awareness on antibiotics resistance provides an understanding on how well users are informed about the problem in their area. For example, if users are well informed and become aware of the antibiotics resistance problem, they become attentive and cautious of the cause of the problem and the risks associated with it. Hence, abide with the appropriate accessibility and use of antibiotics in livestock.
The study further revealed that the majority of pastoralist respondents in Ngorongoro
District had low level of awareness about the problem of antibiotics resistance. This went on contributing to the continued access and use of antibiotics without prescription by livestock health experts. This was revealed by key informants that;
“In this area, many people are not aware of antibiotics resistance problem but are aware of the use of expired drugs. That is why many people rely on information from others and the sellers of drugs before the purchase” (Key informants Esere and Irkeepus villages, 2014).
This finding further supports Muhairwa‘s (2014) that, 30% of livestock keepers in
Tanzania have never heard of antibiotics resistance. Muhirwa further noted that, the problem of antibiotics resistance is high, but not uniquely in Tanzania, compared to international reports detected in farm animals. Nevertheless, this occurrence of antibiotics resistance is worth mentioning and highly given attention before it 180 increases more threats to livestock and people. Furthermore, Muhairwa (2014) confirmed that:
“Many people in Tanzania are quick to take medication without consulting a doctor, and this applies both to human beings and livestock. “There is no policy on antibiotics use and disposal in the country” (Muhairwa, 2014).
This involves obtaining drugs from unapproved sources resulting into misuse of drugs as a result leading to risk of antibiotics resistance. Studies by Katakweba
(2014) and Viberget at al. (2010) in rural Tanzania support that, reasonable numbers of pastoralists do not obtain livestock antibiotics through prescription by veterinarians but also purchase them from private drugstores in rural Tanzania.
7.4 Chapter Summary
The overall findings indicate that supply systems and social networks have implications on antibiotics resistance. This is because, the supplies systems on one hand have made antibiotics available at the community level and on the other hand, the same supply systems failed to supply adequate quality antibiotics, knowledge and information for users to share. This failure is due to limited availability of veterinary experts and lack of capacity building and empowerment to CAHWs, suppliers and the end users of antibiotics. Also supply systems have failed to provide proper monitoring and regulatory control mechanisms for the distribution channel of antibiotics from the whole sale to end users. All these require stakeholders‘ attention to foresee.
Thus, due to failures of the supply systems of antibiotics, end users are also being involved in sharing of inadequate antibiotics, knowledge, information, resources such as water and pasture. There is sharing of livestock and the market places which 181 are inadequate to solve their problems. This proves the failures of social networks that compel users to share knowledge, information, antibiotics and other resources originating from self- experiences based on trial and error. It was observed that, pastoralists were accessing and incorrectly administering antibiotics in a variety of ways, thus causing treatment failures that are difficult to distinguish from those caused by poor drug quality or antibiotics resistance. This supports social network theory contributed by Wasserman and Faust (1994) that, the one who knows what in social network analysis, has a significant impact on what one comes to know. Also, there criticism on the social network theory those relationships are critical for obtaining information, solving problems and learning how to do work. It is true that relationships are important for obtaining information and learning to do work.
However, they do not always solve the problem. This is because, in social networks sharing inadequate knowledge, information and antibiotics, leads to more risks of antibiotics resistance problem instead of solving it.
Furthermore, social networks failures rooted in the failure of the supply systems compel users to share the scarce resources they have. It was also noted that, the regulatory bodies for the supply and use of drugs are normally implemented at the higher level, ignoring the grassroots level. This can aggravate the problem of antibiotics resistance due to the misuse of drugs. Therefore, an efficient regulatory authority is essential, if quality standards are to be achieved and enforced at all levels. Generally, based on these views, it can be argued that, sharing of knowledge, information and antibiotics with others is normally done without proper prescription.
Yet, it is the most important way in which social networks determine access and use of antibiotics in livestock with consequent implications on antibiotics resistance.
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Generally, social networks on one hand have slightly succeeded in facilitating the access to and use of antibiotics in livestock to users. That is, making the users, including the poor, access and use antibiotics through sharing, trust and reciprocity for the treatment and other purposes for livestock. On the other hand, they have not been able to solve the problems of users, such as treatment of diseases affecting their livestock. As such, users employ different responses to cope with the specific situations by sharing. This can result into risk of antibiotics resistance causing persistent ill health and deaths of livestock. Therefore, there is a need to have better understanding of existing social networks at the community level in order for them to be integrated into the development plans and policy.
This is possible because pastoralist areas have the potential of livestock wealth that can contribute to socio-economic development of the community. Social networks are also important to users (nodes) due to ties linking them at the community level.
However, due to weak capacity of these nodes in terms of knowledge, the policy fails to take advantage of the existing social networks to equip the nodes with important information and better knowledge on antibiotic access and use that can be shared to establish the basis for the development interventions.
Generally, the lack of policy on antibiotics use and disposal, can lead to a difficulty in attaining the main objective of livestock sector as stipulated in the National
Livestock Policy (2006) that,
“The livestock industry has an important role to play in building a strong national economy and in the process, reducing inequalities among Tanzanians by increasing their incomes and employment opportunities, while nurturing the natural resources…” (URT, 2006).
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Unless there is a proper channel in which livestock health problems are handled at the community level, diseases will persist. Also, knowledge and information about the diseases to be treated with antibiotics sometimes cannot be appropriate, thus leading to persistent illnesses and eventually more deaths to livestock, resulting into extreme poverty and destitution of the people.
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CHAPTER EIGHT
SUMMARY, CONCLUSION AND RECOMMENDATIONS
8.1 Introduction
This chapter presents the summary, conclusion and recommendations of the study. In essence, the chapter offers a brief description of the study while summing up the discussion regarding the topic at hand. The section on recommendations is also further divided into two subsections: policy based recommendations and the recommendations of the areas for further studies.
8.2 Summary
The findings of this study have been presented in four major areas as summarised below:
8.2.1 General Summary of the Study
The study was prompted by the consideration of livestock sector as one of the major sources of livelihood support in rural areas of Tanzania. The study aimed at examining the supply systems and social networks determining the access, use and their implications on antibiotics resistance in Ngorongoro District. The study was set to address the three specific objectives and research questions to address the general purpose.
The first objective mapped out the existing supply systems and examined how they determine the access and use of antibiotics in Ngorongoro District. The analysis was important because it provides a better understanding on how the supply systems determine the access and use of antibiotics in pastoralist communities.
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The second objective also mapped out the existing social networks and examined how they determine the access and use of antibiotics in livestock in Ngorongoro
District. The aim was to provide the understanding on how actors involved in social networks and their relationships to the access and use of antibiotics. The third specific objective examined the implications of supply systems and social networks on antibiotics resistance in Ngorongoro District. This was meant to provide an analysis of the major connotations of the supply systems and social networks on antibiotics resistance.
In order to achieve the specific objectives of this study, the following questions were enquired. First, what are the existing supply systems and how do they determine access and the use of antibiotics? Second, what are the existing social networks and how do they determine access and use of antibiotics in livestock? Third, what are the major implications of supply systems and social networks on antibiotics resistance?
In order to examine the general research problem and answer the research questions systematically, a critical review of various theories related to the current study was done. Three theories were adopted to guide the study. These included social network theory and social exchange theory and the theory of optimal use of antibiotics.
Social network theory (Granovetter, 1973) stipulates that, the degree of overlap of actors (nodes) in a social network varies with the strength of their ties to another one.
Granovetter (1983) argues that, weak ties are less likely to be socially involved with one another than strong ties (close friendship). The study also mapped out actors and their associated ties in social networks that are strong, moderate and weak.
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Borgatti and Halgin (2011) argue that, social networks operate at many levels and play a critical role in determining the way problems are solved. However, social networks cannot solve all the problems at the community especially on antibiotics resistance which require appropriate prescription and use of drugs. The study findings revealed that, users of antibiotics had less interaction with veterinary experts with appropriate knowledge on the use of antibiotics. Therefore, the findings are contrary to social network theory that focuses largely on positive side of the social relationships. Therefore, in this context, social networks do not always solve the problems to actors because they fail to provide perfect knowledge and information to them.
Social exchange theory (Homans, 1961) proposes that social behaviour is the result of an exchange process whose purpose is to maximize benefits and minimize costs knowing whom to exchange with and what to exchange. The study also revealed that actors in both the supply systems and social networks were involved in exchange process but had different purposes. Whereas in supply systems the major aim for the majority was to maximize benefit, for social networks it was for the utilization.
Social exchange theory suggests that an exchange process involves the exchange of activity, tangible or intangible between at least two persons with the aim of maximizing benefit while minimizing cost. However, the exchange of tangibles like antibiotics and intangibles such as knowledge on its use without proper prescription leads to more problems of antibiotics resistance in the community. In the current study, the exchange among users was based on trust and reciprocity, not always for benefit maximization and cost minimization but mainly due to social obligations.
Nevertheless, this theory was important to the side of urban and some rural based suppliers whose major aim was business benefit maximization in terms of profit. 187
The theory of optimal use of antibiotics (Laxminarayan and Brown, 2000) postulates that, the evolution of antibiotics resistance is strongly influenced by the economic behaviour of individuals and institutions. One ought to use less costly antibiotic to begin with and switch to the more costly antibiotic when the effectiveness of the first antibiotic is fully exhausted. This theory is essential if users obtain antibiotics through purchase in a formal channel which do not involve sharing like what was found in Ngorongoro District. Also the theory considers that antibiotics use in hospitals is relatively intensive compared to use in the community. As a result, resistant bacteria are more likely to develop in areas in hospitals where antibiotic use is more intensive. However, the intensive use of antibiotics not only occurs at the hospital settings but also in other settings at the community level. For instance, findings revealed that pastoralists use antibiotics frequently for treatment of livestock in veterinary settings. This leads to more prevalence of antibiotics resistance at the community level like in hospital settings.
In terms of methodology, the study employed explanatory cross–sectional survey research design by applying both quantitative and qualitative methodological approaches for data collection, processing interpretation and analysis. The methods of data collection comprised of household surveys, key informants interviews, focus group discussions and participant‘s observation using a semi-structured interview guide, checklist discussion guide, and questionnaire. These were supplemented with documentary reviews which helped to gather secondary data for the study. Data presentation, interpretation and analysis were thematically structured to enable smooth flow of information and arguments.
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8.2.2 Summary of the Key Findings
The summary of the key findings based on objectives were as follows:
First, based on objective one, it was revealed that the most commonly supplied antibiotics in Ngorongoro District included OTC, Penicillin+Streptomycine
(Penstrep), Tylosine, Sulpha and tetracycline caps and Chloramphenicol. The supply systems of these antibiotics were determined by users‘ preferences whereby, OTC was mostly preferred by users. Sources of antibiotics were found in both urban and rural areas. In urban areas, there were wholesale and retail shops which were further supplying antibiotics to smaller retailers and end users in rural areas. These urban sources had no direct link with end users in most cases. Veterinary experts, who apart from their services on the use of antibiotics, they were also seen to engage in selling drugs included in urban areas. The second category was made up of retail suppliers, drug vendors, CAHWs, and end users who also happened to play the role of suppliers to others in rural areas. These were seen to have direct link to end users in the supply chain.
The findings of the second objective displayed that, social networks actors interacted differently depending on their closeness. For example, actors who had more interactions included friends, neighbours, relatives and interest groups of herdsmen.
These were end-users of antibiotics located in rural areas and they found in close proximity to each other. It was also revealed that users of antibiotics interacted less with veterinary experts due to their limited availability and the cost involved in engaging them.
Based on the findings of this study, three forms of multiple social ties in social networks exist in Ngorongoro District. These are strong ties and thus involve more 189 interactions. Strong ties enable pastoral households to access not only antibiotics to use in livestock, but also other resources to fulfil social needs. Strong ties include friendship, kinship, neighbourhood; age set (mates) ties, trustfulness and reciprocity.
These ties connect actors and engender more feelings of commitment to others.
There are also moderate ties connecting actors with some rural suppliers such as retail shops where also they access drugs based on trust. Weak ties connect actors with veterinary experts and CAHWs who involve less interaction. However, they are actors who have knowledge base on the proper use of antibiotics.
Furthermore, findings revealed that social networks in Ngorongoro District were operating in a lateral way through interactions and thus, determining the access and use of antibiotics in livestock at the community level. The end users of antibiotics were also the sources of the knowledge, information and drugs to others, such as friends, relatives, neighbours, interest groups and traditional dealers. These sources of antibiotics, in most cases, were not well trained and informed on the proper use of antibiotics in livestock. This usually led to the misuse of antibiotics such as over and under dose for their livestock.
The most common types of antibiotics shared were the ones from the supply systems.
These included: Tetracycline caps, Oxytetracycline, Tylosine, Penstrep and Sulpha.
All of the respondents admitted to receive from or give (share) antibiotics to others in the past 6 months of the study, irrespective of the users‘ wealth status. As such, wealth status has got nothing to do with antibiotics access and use. Thus, enables the poor to access and use antibiotics in livestock frequently. This was due to the culture of cooperation and social commitments in terms of obligations.
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The third objective‘s findings indicated that supply systems and social networks have implications on antibiotics resistance. This is because in an ideal situation, the supply system is expected to facilitate the adequate availability, high quality of antibiotics and makes it possible for end users to get the required knowledge on how to utilize drugs. However, the system consists of drawbacks. These include low level of antibiotics supply, limited availability of veterinary experts, poor implementation of by-laws and regulations governing accessibility and use of antibiotics and the low level of awareness of the problem of antibiotics resistance by rural suppliers and end users. The low level of antibiotics supply and the limited availability of veterinary experts force users to resort to their own alternative sources to access and use antibiotic that can lead to risk of antibiotics resistance. This is compounded by weak implementation and lack of regulations governing prudent access and use of antibiotics in livestock. Furthermore, most of the suppliers have limited knowledge of antibiotics handling and administration. As such, they provide inadequate knowledge and information to users who depend much on them. As a result more risk of antibiotics resistance.
Moreover, the nature of social networks contributes to development of antibiotics resistance to livestock. Social networks among pastoralists are characterized by sharing of antibiotics, sharing of information and pastures. Also sharing of livestock and livestock market, all contribute to antibiotics resistance. The discussion is anchored on the reality that pastoralists in Ngorongoro District depend on their social networks because the formal supply systems of antibiotics are not functioning properly. This alternative however, is also marred by problems, which in turn, contribute to antibiotics resistance at the community level.
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8.3 Conclusion
Antibiotics resistance problem has been mainly addressed based on microbiological, biomedical and veterinary sciences in laboratory tests. However, minimal attention has been put on social aspects. Based on the findings from this study, a number of conclusions can be drawn. First, the nature of both the supply systems and social networks involve key actors who play important roles in the access and use of antibiotics. This has implications on antibiotics resistance. Second, the findings revealed that antibiotics pass through many hands before reaching the end users. This goes with the risk of distorted information on use, price hiking that most of the end users do not afford and inadequate antibiotics supply. Therefore, these setbacks of the supply systems contribute to antibiotics resistance.
Third, the findings also revealed that actors in social networks were bound with ties based on trust and reciprocity as they interacted to share inadequate knowledge, information, experiences and resources including antibiotics, water, pasture, market and livestock. Therefore, these have direct and indirect implications on antibiotic resistance at the community level. Fourth, from the theoretical point of view, social network theory suggests that actors in social networks involve themselves in social relationships by sharing knowledge and information helping them to solve problems.
However, not all the time this sharing can solve their problems, instead as evidenced by this study, sharing of antibiotics and knowledge on use by pastoralists lead to antibiotic resistance problem. On the other side, the social exchange theory postulates that behaviour of an individual is a result of an exchange process knowing whom and what to exchange. The aim is to maximize benefit and minimize cost.
However, findings from this study revealed that not all the exchange process can maximize benefits. For instance, the exchange of antibiotics with livestock can contribute to spread of the problem of antibiotics resistance. Also, the theory of 192 optimal use of antibiotics views that the high cost of antibiotics has been a primary reason for concerns about minimizing the optimal use of antibiotics and that resistance occurs mostly in hospital settings where there is intensive utilization of drugs. However, there is also frequent use of antibiotics in other settings such as in rural areas which do not have reliable veterinary services thus leading to antibiotics resistance with far-reaching implications that should not be ignored.
Social networks have been viewed in positive ways in which problems can be solved at community level. However, when used inappropriately or used to solve the problems that require a technical solution like that of antibiotics resistance, thus leads to negative outcome especially on the sharing of antibiotics. In addition, studies to address the occurrence of antibiotics resistance cannot be done by using a single theory alone. Furthermore, the single approach alone cannot address the problem of antibiotics resistance. Therefore, multidisciplinary approaches are required to address the problem of antibiotics resistance.
8.4 Recommendations
The study identified various issues so as to get a better understanding of how supply systems and social networks determine the access and use of antibiotics in livestock and their implications on antibiotics resistance. This is because, they largely determine the access and use of antibiotics in livestock which eventually have far- reaching implications on antibiotics resistance. This can result into problems in both public and livestock health sectors. The study, therefore, provides recommendations which can help to better address the issues of supply systems and social networks in policy planning and interventions for development.
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8.4.1 Policy Recommendations
The findings emanating from this study have potential policy relevance. Based on its findings, a number of recommendations are put forward for both policy makers and stakeholders of livestock health and public health sectors. Some of the suggestions that can be drawn from the findings of this study are as follows:
1. It was found that some rural suppliers of antibiotics did not have adequate
knowledge and information on antibiotics use and the problems of resistance.
This can lead to misuse of antibiotics that can jeopardize not only livestock
and people‘s health, but also put wildlife at risk in Ngorongoro District. It is
therefore; recommended that there should be a clear training of those actors
who are involved in the supply systems of antibiotics in order to have
appropriate knowledge to impart to users. Also users should be made aware
of the problems that arise from the misuse of drugs that they share with
others. This should be done by all stakeholders in livestock sector.
2. Capacity building to pastoralists on the access and use of antibiotics and the
public awareness of antibiotics resistance should be part and parcel of the
design and implementation of the livestock policy planning and interventions
in order for users to share appropriate knowledge and information but not to
share antibiotics.
3. It was observed that in some villages there were CAHWs who are trained on
the basic livestock health including the handling of various livestock diseases
and vaccination. However, they were not very much consulted due to being
few in numbers. This was also compounded by lack of necessary equipment
and capacity building to take part in the supply systems. Thus, there is a need
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for the government through the Ministry of Agriculture, Livestock and
Fisheries and other stakeholders in livestock sector to strengthen the
public/private partnership to build capacity of more CAHWs to take part in
the supply systems of livestock drugs including antibiotics. It is also,
recommended for the government and other stakeholders of veterinary drugs
to supply adequate experts (veterinarians) and more quality drugs to
pastoralists who depend much on livestock for their livelihoods.
4. Sharing resources such as water, pasture and market is good but when it
comes to improper handling, it can contribute to the risk of antibiotics
resistance. Therefore, there should be proper ways to improve these potential
resources for community to share without compromising the health of
livestock, people and wildlife.
5. The development, design and implementation of livestock health delivery
services need to be multidisciplinary approach so as to address the social,
microbiological, biomedical and veterinary issues for dissemination of
antibiotics resistance problem. Also, the participatory approach is important
that the suppliers and users of the services are part and parcel of the process.
This enhances the better understanding of existing social networks among
pastoralists and makes the process to be demand driven while at the same
time addressing the needs of the community in order to be integrated into the
development plans and policy.
8.4.2 Recommendations for Further Research
The scope of the study was to explore and examine how the social networks and antibiotic supply systems determine the accessibility and use of antibiotics in
195 livestock and their implications to antibiotics resistance in Ngorongoro District. The study identified three areas which could be the subject of further investigation by other researchers in the field:
i) This study was undertaken in pastoralist community of Ngorongoro District
in rural areas of Tanzania, but the study findings could be generalised to other
parts of the country with the similar characteristics. Therefore, it would be
meaningful to undertake a broader study comprising of different geographical
locations within the country so as to understand the nature of social networks
of other communities. For instance, it could be important to see if there are
similar reasons in the access and use of drugs to make the study more
comprehensible and stronger to contribute to the scholarly information.
ii) A study should be done social networks and the institutional set ups for
livestock health delivery services. This can provide contribution to find
innovative ways to monitor and regulate the supply systems of drugs at the
community level.
iii) A study should be conducted on pastoralist‘s perception and attitudes towards
willingness to transformation ways of access and use of antibiotics in
livestock. This can provide better understanding of users‘ knowledge on
livestock improvement to be accommodated in veterinary development
policy. These are important because attitudes of individuals can compromise
the efforts to improve quality such as the access and imprudent use of drugs.
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APPENDICES
Appendix 1: Questionnaire for Household Survey in Pastoral Community
Confidential for the academic purpose only Study Topic: Supply Systems and Social Networks Determining Accessibility, Use and their Implications on Antibiotics Resistance in Ngorongoro District, Tanzania.
Household Identification Ward……………...... Village………………...... No. of respondent……..Name...... Date….………...... Phone......
1.0 Socio-economic profile Social economic profile deals with demographic and socio-economic backgrounds of households
1.1 Household demographic characteristics
1. Sex: 1. Male……………...... 2. Female…………………………………….
2. Marital status 1. Single; 2. Married; 3. Divorced; 4. Widowed; 5. Separated
3. Age ...... (in years)
4. Level of education 1. Informal 2. Adult literacy 3. Primary 4. Secondary 5. Post–secondary. (Indicate the final level obtained ...... )
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5. Household size ...... Number of children¸ (<18)...... adults......
1.2 Household Socio-economic Background 1. What types of livestock do you keep? Type of livestock Number Trends over the past 5–10yrs Reasons Increase Same Decrease Cattle Goats Sheep Donkeys Others (specify)......
2. How did you obtain your initial stock? 1. Inheritance 2. Purchasing 3. Gift from a friend 4. Dowry 5. Others (specify) ......
3. Which of the above was the main way of obtaining your livestock? (Rank)
Livestock Methods of obtaining Inherited Purchased Gift Others (specify) .. Cattle Goat Sheep Donkeys Others (specify)......
4. Methods of maintaining livestock size (Rank)
Livestock Methods of maintaining Own breeding Purchase Gift Others (specify)...... Cattle Goat Sheep Donkeys Others (specify)......
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5. Where do you purchase or sell your livestock? 1. From the market place 2. From individual livestock keepers within the village 3. From individual livestock keepers outside the village
6. Besides livestock keeping, what other economic activities does your household engage in? Economic activity 1. Yes 2.No Small business Local brewing Casual labour Local midwife/traditional healing Handicraft Farming Others (specify)......
7. Indicate income from the following for the last year.
Year 2013 Enterprise Quantity sold Price/unit Amount Where sold Livestock sale Cattle Goats Sheep Donkeys Other economic activities Small business/kiosk Local brew sales Local midwife/traditional Handicraft Harvest from farming Others (specify) ......
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8. Indicate the household pattern of expenditure in the last month.
Items Slightly sufficient Sufficient Not sufficient and options Options Food Health services School fees Clothes Livestock care Others (specify) .....
9. What other assets does your household own apart from livestock and the uses?
SN Assets Uses 1. Radio 2. Mobile phone 3. Bicycle 4. Wheel barrow 5. Sprayer pump 6. Others (specify) ......
10. Indicate type of livestock, the most common diseases and methods of treatment
(Rank)
Livestock Most common diseases Methods of treatment Modern treatment Traditional therapy (Antibiotics) 1. Cattle 1 2 3 2. Goat 1 2 3 3. Sheep 1 2 3 4. Donkey 1 2 3
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11. Indicate the Effectiveness of the methods of treatment to livestock by putting a
tick
Livestock Most common Methods of Not Moderately Very diseases treatment effective effective effective 1. Cattle 1 2 3 2. Goat 1 2 3 3. Sheep 1 2 3 4. Donkey 1 2 3
2.0 Supply systems and antibiotics access and use
1. Have you ever used antibiotics to treat your livestock? 1. Yes 2. No
2. How many times did you treat your livestock with antibiotics in the past 6
months?
Type of livestock Treatment with antibiotics 1. Once 2. Twice 3. Three times 4. Several times Cattle Goat Sheep Donkey Others (specify) ......
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3. How frequently have you used the types of antibiotics to treat your animals in the
past 6 months?
Type of Antibiotic Frequency of use /indicate type of livestock (Rank) Frequently used Not frequently used Cattle Goat Sheep Donkey Cattle Goat Sheep Donkey 1. Oxytetracyclines 2. Penicillin 3. Chloramphenicol 4. Sulphonamides 5. Others (specify)
4. What were the reason(s) for the choice of antibiotics?
Reasons for treatment Livestock Cattle Goat Sheep Donkey 1. Cost saving 2. Easily available 3. Not trusting veterinarians 4. Effectiveness antibiotics 5. Others (specify)......
5. Do you seek the veterinary advice before purchasing antibiotics or you use self- experience? 1...... 2......
6. Indicate sources of antibiotics
Source Sellers Others in (specify)… Types of antibiotic Sellers village Veterinary experts urban 1. Oxytetracyclines 2. Penicillins 3. Chlorophenical/ 4. Tylosine 5. Sulphanormides 6. Others (specify)......
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7. Availability and affordability of antibiotics
Affordability Antibiotic Availability Affordable Not Within village Neighbouring Nearest affordable village town R/Av NRAv R/Av NRAv R/Av NRAv 1. Oxytetracyclines 2. Penicillins 3. Tylosine 4. Sulpha 5. Others (specify)...
8. To what extent is the level of antibiotics supplied sufficient to serve the needs of livestock? 1. Slightly sufficient 2. Sufficient 3. Not sufficient
9. In case of insufficient supply of antibiotics, what measures do you undertake? 1...... 2...... 10. Are you aware of any regulation(s) governing antibiotic access and use? 1. Yes 2. No
3.0 Social networks and antibiotics access and use in livestock
1. Indicate sources of knowledge and information on the dosage and usage of antibiotics (Rank)
1. Self-experience 2. Friends 3. Neighbours 4. Relatives 5. Suppliers of veterinary drugs 6. Private veterinary health service providers 7. Veterinary professional workers 8. Media 9. Others (specify) ......
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2. Have you ever given an antibiotic to other people in the past 6 months? 1. Yes 2. No
3. How frequently have you given antibiotics to other people in the past 6 months? 1. Once 2. Twice 3. Three times 4. Several times
4. Indicate types of antibiotics which are the most frequently used and shared.
Type of Antibiotic Frequency of use Frequently used Not frequently used 1. Oxytetracyclines (10%, 20%, 30%) 2. Penicillins 3. Tylosine 4. Sulphanormides 5. Others (specify)......
5. Indicate the role (s) played by the following actors in antibiotics access and use.
Group (nodes) Access to Information Availability of Others antibiotics on usage stock (specify).... Relatives Neighbours Friends Traditional dealers Interest groups Veterinarians Drug sellers shops Livestock open market CAHWs Others (specify) …
6. What are your major sources of information and antibiotics supply?
1. Relatives 2. Neighbours 3. Friends 4. Traditional dealers 5. Interest groups 6. Livestock keepers organizations
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7. Livestock extension staff 8. Veterinary drug shops 9. Private livestock service providers 10. Farmers exhibition day 11. Livestock open market 12. Others (specify) ......
7. What is the distance in kilometres and time taken in hours from the source of antibiotic supply? ......
8. What are your major means of communication with your suppliers of antibiotics? (Rank) 1. Face to face 2. Mobile phone 3. Internet 4. Post office/agency 9. Others (specify) ......
9. What are your major means of communication with people who need your help? (Rank) 1. Face to face 2. Mobile phone 3. Internet 4. Post office/agency 5. Others (specify) ......
10. How do you store your antibiotics before and after use?
......
11. How many times have you attended training workshops/seminars on veterinary drug use? 1. Never attended 2. Once 3. Two times 4. Three times 5. More than three times 12. Do you help each other in case of livestock problems? 1. Yes 2. No
13. To what extent do you help each other by sharing antibiotics or livestock equipment? 1. Large extent 2. Small extent 3. Do not help each other
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14. Where/whom do you go to for help or advice in case of livestock health problems
including antibiotics resistance?
Sn Actors Tick 1. Relatives 2. Neighbours 3. Friends 4. Traditional dealers 5. Interest groups 6. CAHWs 7. Veterinary professional staff 8. livestock drug shops 9. Livestock open market 10. Others (specify) ......
15. Who do you think can come to you for help or advice in case of livestock health
problems?
1. Relatives 2. Neighbours 3. Friends 4. Traditional dealers 5. Interest groups 6. Livestock keepers organizations 7. Livestock extension and veterinary professional staff 8. livestock drug shops 9. Private livestock service providers 10. Farmers exhibition day 11. Livestock open market 12. Others (specify) ......
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4.0 Awareness on antibiotics resistance
1. To what extent are you aware of antibiotics resistance? 1. Not aware 2. Very little aware 3. More aware 4. Most aware 2. How did you get information/learn about antibiotics resistance? 1. From Veterinarian 2. Livestock extension staff 3. From TV and Radio 4. From Exhibitions 5. From brochures and books 6. From seminars and workshops 7. Never heard of antibiotics resistance 8. Others (specify)...... 3. What are the indicators of antibiotics resistance problem in livestock? 1...... 2...... 3...... 4. To what extent is the rate of antibiotics resistance a serious problem? 1. Not known 2. Not serious 3. Moderately Serious 4. Very serious
5. How many livestock continued to get sick after the treatment with antibiotics? 1. Cattle ...... 2. Goat ...... 3. Sheep ...... 4. Donkey......
6. How many livestock died after the treatment with antibiotics? 1. Cattle ...... 2. Goat ...... 3. Sheep ...... 4. Donkey......
7. If it happens that livestock continue to get seriously sick or die what do you do? 1...... 2...... 3...... 8. Have you stopped using any antibiotics in livestock? 1.Yes 2. No
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9. Which antibiotics? 1...... 2......
10. What do you use instead? 1...... 2......
5.0 Livestock, wild animals and human interactions 1. Do your livestock share water and pasture with wild animals? 1. Yes 2. No. 2. Do human being, livestock and wild animals share same sources of water? 1. Yes 2. No 3. How often do livestock and wild animals interact per month? 1. Several times 2. Occasionally 3. No interaction 4. What is the distance in kilometres from the grazing area to the game reserve? ......
5. To what extent your livestock contact wild animals per month? 1. Frequently 2. Rarely 3. No contact 6. To what extent are you aware of any problems that may occur when livestock interact with wild animals? 1. Not aware 2. Little aware 3. Moderately aware 4. More aware 7. What are the challenges which may arise in livestock keeping and interaction?. 1...... 2...... 8. What measures should be taken to combat the overcome the challenges ......
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9. Who do you mix your livestock with during grazing? 1. Relatives 2. Friends 3.Neighbors 4. Interest groups 5. Others (specify) ...... 10. How do you prevent your livestock from contacting diseases? 1...... 2......
THANK YOU FOR YOUR COOPERATION
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Appendix 2: Interview Guide for Key Informants (Village Leaders, Elders and
Elites)
Village…………………….Ward………………………...... Date………………… 1. What is your designation?...... 2. How do people in this village access and use antibiotics for their livestock? 3. Who are the major suppliers of antibiotics in the village? (In terms of individuals, business companies, agents, location). 4. What are the major types antibiotics used by people in the village? (Rank) 5. To what extent do suppliers satisfy the demand for antibiotics? (Comment on the types of antibiotics). 6. What is the level of availability of antibiotics in the village? (Comment on the different types). 7. What are the other assets apart from livestock and their uses in livestock development? 8. What proportion of the village population is using antibiotics in livestock? 9. How serious is the problem of antibiotics resistance in your village? (Comment on the wider neighbourhood). 10. What are the causes of antibiotics resistance problem in your area? 11. What trend of antibiotics resistance have you experienced over the past 5 – 10 years? 12. What are your opinions on the access and use of antibiotics by people? (Give general comments on availability, affordability and knowledge of use). 13. Who and why do people in your village share antibiotics for treatment of livestock? 14. What are the major means of communication of people with their suppliers and those people whom they share information or knowledge on antibiotics? 15. How and why do livestock in the village interact with wild animals? 16. What do you think are the effects of such interactions? 17. What is the distance in kilometres from the national park to the village? 18. To what extent is antibiotics resistance a serious problem in livestock? 19. To what extent are people aware of the problems of antibiotics resistance in the villages? 228
20. In your opinion what do you think should be done to minimize the problem of antibiotics resistance? 21. Are people aware of any regulation(s) governing antibiotic access and use?
THANK YOU FOR YOUR COOPERATION
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Appendix 3: Interview Guide for Key Informants (Veterinary Experts)
Village…………………….Ward………………………...... Date………………… 1. What is your designation? ...... 2. What is your level of education? ...... 3. What is your qualification? ...... 4. How many times have you attended refresher courses training in the past ten years? 5. How long have you been providing livestock health development services in this area? 6. What are the kinds of services do you provide to the community? 7. To what extent do people come to you for the livestock health services? 8. To what extent do you prescribe or give advice for antibiotic use in livestock treatment? 9. What are the major types of antibiotics you prescribe to be used in livestock? (Rank) 10. What are the sources and availability of antibiotics you prescribe? (Comment for the different types). 11. What proportion of the village population is using antibiotics in livestock? 12. How serious is the problem of antibiotics resistance in your area? (Comment on the wider neighbourhood). 13. What are the causes of antibiotics resistance in your area? 14. What are your opinions on the access and use of antibiotics by people? (Give general comments on availability, affordability and knowledge of use). 15. Who and why do people in your village share antibiotics for treatment of livestock? 16. What are the major means of communication with the people 17. To what extent does antibiotics resistance a serious problem in livestock? 18. To what extent do people aware of antibiotics resistance in the villages? 19. In your opinion, what do you think should be done to minimize antibiotics resistance? 20. What are the challenges do you face in providing livestock health development services and how do you overcome challenges?
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Appendix 4: Interview Guide for Key Informants (Suppliers)
Village…………………….Ward………………………...... Date………………… 1. Education level ...... Qualification...... 2. Who are the major customers of livestock medicines (antibiotics)? (In terms of individuals, business companies, agents, location). 3. How do you supply medicines (antibiotics) to your customers at the community level? 4. What are the major types of antibiotics do you supply to people? 5. Where do you get antibiotics to supply? 6. How do you store the drugs? 7. What are your major means of communication with your customers and suppliers of antibiotics? 8. How do you make sure that antibiotics supplied to people are in good quality? 9. To what extent do you satisfy the demand for antibiotics by your customers? 10. How often do you attend trainings on handling the veterinary medicine? 11. To what extent are you aware of antibiotics resistance in livestock? 12. What do you think are the causes of antibiotics resistance in livestock? 13. Are you aware of any regulations governing antibiotic supply? 14. In your opinion what do you think should be done to minimize the antibiotics resistance? 15. What are the challenges do you encounter on supplying veterinary drugs? 16. How do you manage to get through the challenges?
THANK YOU FOR YOUR COOPERATION
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Appendix 5: Checklist for Focus Group Discussion 1. Access and use of antibiotics in the village - Types of livestock kept in the area (ranking). - Other economic activities in the area apart from livestock keeping - Other assets for livestock development in the area - Diseases affecting livestock (rank) according to type of livestock - Availability of shops/veterinary centres/pharmacies for livestock drugs and equipment. - How people normally obtain antibiotics in the village? - Affordability and effectiveness of the livestock medicines, equipment and services - Availability of livestock health professionals in the village. - Most frequently used antibiotics in the village and reasons for the choice - The use of antibiotics without prescription in percentage. - What factors determine the level of access to antibiotics in the village? (Availability of medicine shops, livestock diseases, distance from the drug shops).
2. Antibiotic supply - Where do people get antibiotics for use in livestock? - What is the most reliable supply of antibiotics used in the village? - Do all antibiotic suppliers have veterinary/animal health background? - What role is played by veterinary professionals in antibiotic supply? - Are there any organization/projects involved in the supply of antibiotics?
3. Knowledge and information on antibiotic access and use in livestock - How and where people acquire knowledge on antibiotic use in livestock? Rank - Who/where people normally go to for help and advice on livestock problems and why?
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- Do people share equipment, knowledge and information on antibiotic use in livestock and how? - What are the major means of communication in this village? - Awareness of the regulations governing antibiotic access and use
4. Wealth ranking - What are the indicators used in wealth ranking in the village? - What are the existing wealth categories in the village? - Estimate the size of each wealth category in terms of percentage. - Who are using antibiotic most in livestock poor/well–off and why?
5. Awareness of antibiotics resistance problem in the study area - Are you aware of antibiotics resistance problem in livestock? - What are the indicators used to identify the problem of antibiotics resistance in livestock? - What do you think are the causes of antibiotics resistance in livestock? - Effects of antibiotics resistance to the animals and household welfare? - What do you think is the solutions for antibiotic problem in livestock?
6. Livestock–wild animals interactions - What is the distance in kilometres from the grazing area to the game reserve? - What are the forms of interaction of wild animals and livestock? Sharing water & pastures, food chain and hunted animals - What problems do result from the interaction between wild animals and livestock and why? - What should be done to minimize the problem/s mentioned above?
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