■几十年来的系统基础设施和监管弱点,在与动物非洲锥虫病(AAT)作斗争的社区中,预计将创造一个促进药物滥用和耐药性风险发展的环境。这里,我们探索农村社区牲畜饲养者的做法,牲畜推广人员和药店服务员,以确定是否在施用锥虫杀虫剂和其他药物时遵循适当的做法。
■2022年在乌干达西南部进行了一项问卷调查,涉及451名饲养牛的农民,绵羊或山羊和79名“专业人员”,他们要么是牲畜推广人员,要么是药店服务员。
■受访者报告说,在过去30天内,451个农场中有80.1%使用了一种或多种类型的杀锥虫药物。约有四分之三的农场使用了双咪唑烯醋酸盐,而氯化异金属胺的使用量约为五分之一。在不到1%的农场中使用了溴化铵。与绵羊或山羊相比,牛更有可能接受锥虫杀灭剂治疗。在大约三分之二的农场,杀锥虫剂是由农民准备和注射的,扩展人员在其他三分之一的大部分地区都使用这些药物,尤其是在养牛场。几乎所有毒品都是从私人拥有的毒品商店获得的。对于用锥虫灭杀剂治疗AAT,在没有专业监督和没有明确诊断的情况下,农民通常使用处方药。虽然比农民更多的专业人员接受了更好的教育,并接受了使用锥虫杀虫剂的培训,他们正确使用这些药物的能力差异相对较小。农民比专业人士更有可能仅使用DA来治疗锥虫病,并且更有可能使用抗生素和杀锥虫药物来治疗动物。此外,他们估计,平均而言,治疗假设的400公斤牛需要两倍的推荐剂量的醋酸二烯二嗪或氯化异金属胺。少数农民和专业人士报告说,他们观察到注射杀锥虫药物后的建议戒断时间,而这两组中很少有人知道牛奶或肉类的建议戒断时间。只有六分之一的农民报告使用了这种卫生对(交替使用乙酰丙酸二那嗪和氯化异甲苯),为了降低耐药锥虫菌株出现的风险,虽然这种方法被专业人士更广泛地使用。农民报告说使用抗生素比专业人士更普遍,尤其是绵羊和山羊,引起人们对过度使用和滥用这类关键药物的担忧。除了使用锥虫杀灭剂,大多数农民还报告说,使用外用兽用杀虫剂来控制蜱和采采蝇。平均而言,农民将其收入的12.2%从牲畜销售中用于锥虫杀药。
■这项研究强调了使用药物治疗对抗AAT的复杂性。多方利益相关者运动,以提高农民的认识,药店服务员,和推广人员坚持推荐的药物剂量的重要性,使用卫生对并遵循推荐的停药指导将促进最佳实践,降低锥虫耐药菌株出现的风险,支持加强食品安全。
UNASSIGNED: Systematic infrastructure and regulatory weaknesses over many decades, in communities struggling with animal African trypanosomiasis (AAT) would be expected to create an environment that would promote drug misuse and risk development of drug resistance. Here, we explore rural community practices of livestock keepers, livestock extension officers and drug shop attendants to determine whether appropriate practice was being followed in administration of trypanocides and other drugs.
UNASSIGNED: A questionnaire-based survey was undertaken in southwestern Uganda in 2022 involving 451 farmers who kept cattle, sheep or goats and 79 \"professionals\" who were either livestock extension officers or drug shop attendants.
UNASSIGNED: Respondents reported using one or more type of trypanocidal drug on 80.1% of the 451 farms in the last 30 days. Diminazene aceturate was used on around three-quarters of farms, while isometamidium chloride was used on around one-fifth. Homidium bromide was used on less than 1% of farms. Cattle were significantly more likely to be treated with trypanocides than sheep or goats. On around two-thirds of farms, trypanocides were prepared and injected by farmers, with extension officers administering these drugs on most of the other third, especially on cattle farms. Almost all drugs were obtained from privately-owned drug shops. For treatment of AAT with trypanocides, prescription-only medicines were routinely used by farmers without professional supervision and in the absence of a definitive diagnosis. While a far greater proportion of professionals had a better education and had received training on the use of trypanocides than farmers, there was relatively little difference in their ability to use these drugs correctly. Farmers were more likely than professionals to use only DA to treat trypanosomiasis and were more likely to use antibiotics as well as trypanocidal drugs to treat the animal. Furthermore, they estimated, on average, that twice the recommended dose of either diminazene aceturate or isometamidium chloride was needed to treat a hypothetical 400 kg bovine. A minority of both farmers and professionals reported that they observed the recommended withdrawal times following injection of trypanocidal drugs and very few of either group knew the recommended withdrawal times for milk or meat. Only one in six farmers reported using the sanative pair (alternating use of diminazene aceturate and isometamidium chloride), to reduce the risk of drug resistant trypanosome strains emerging, while this approach was more widely used by professionals. Farmers reported using antibiotics more commonly than the professionals, especially in sheep and goats, raising concerns as to overuse and misuse of this critical class of drugs. In addition to using trypanocides, most farmers also reported using a topical veterinary pesticide for the control of ticks and tsetse. On average, farmers spent 12.2% of their income from livestock sales on trypanocides.
UNASSIGNED: This study highlights the complexity of issues involved in the fight against AAT using drug treatment. A multistakeholder campaign to increase awareness among farmers, drug shop attendants, and extension workers of the importance of adherence to recommended drug dosing, using the sanative pair and following recommended drug withdrawal guidance would promote best practice, reduce the risk of emergence of resistant strains of trypanosomes, and support enhanced food safety.