India

No prescription, no problem! A mixed-methods study of antimicrobial stewardship relating to working equines in drug retail outlets of Northern India

Multidrug resistance (MDR) is already occurring among some equids in India. Donkeys and mules are a mobile species moving between regions and international borders, often populating areas of India where private community pharmacies, or medical stores, are the primary healthcare provider for both humans and animals. This article highlights how the capacities of drug retail outlet workers might affect their antibiotic dispensing practices, particularly in relation to donkeys and mules, in order to consider how this might impact the development of antimicrobial resistance (AMR) on a wider scale. A mixed-methods approach was implemented using patient simulation method (n = 28), semi-structured interviews (SSIs) (n = 23), focus group discussions (FGDs) with veterinary practitioners and non-governmental organisation animal health workers (n = 2 FGDs), and participant observation. Fewer than 48 per cent of drug retail outlet workers admitted to having had any formal training in pharmaceuticals at all, while 78 per cent reported having no formal training in animal-related pharmaceuticals. Moreover, 35 per cent of all participants sold antibiotics without a prescription, unprompted and without specifically being asked for antibiotics. Of the antibiotics dispensed, only 21 per cent were correctly dispensed for the symptoms presented, and all dosages dispensed were incorrect (underdosed). Furthermore, 43 per cent of drug retail outlet workers interviewed believe that some antibiotics can be legally dispensed without a prescription. Equine owners in northern India are frequently being sold antibiotics without a prescription and, in most cases, with incorrect diagnoses, treatment choice, and dosage. A substantial gap in capacities exists amongst Drug Retail Outlet (DRO) workers, with few being sufficiently qualified or trained to dispense antibiotics to animal owners. The study highlights the need for further training of private DRO workers as well as knowledge extension and awareness training for both DRO workers and animal owners regarding antimicrobial resistance and its potential impact upon livelihoods. It also illustrates the need to identify a balance whereby greater enforcement of regulation at all levels is implemented, while at the same time maintaining sufficient access to medicine for rural populations.

Journal
Volume
9
Issue
6
Start page
295
Publication date
Research output
Country

Cultural “blind spots,” social influence and the welfare of working donkeys in brick kilns in Northern India

Non-governmental organizations (NGOs) work across the globe to improve the welfare of working equids. Despite decades of veterinary and other interventions, welfare issues persist with equids working in brick kilns. Engagement with all stakeholders is integral to creating abiding improvements to working equid welfare as interventions based purely on reactive measures fail to provide sustainable solutions. Equid owners, particularly those in low to middle-income countries (LMICs), may have issues such as opportunity, capacity, gender or socio-economic status, overriding their ability to care well for their own equids. These “blind spots” are frequently overlooked when organizations develop intervention programs to improve welfare. This study aims to highlight the lives of the poorest members of Indian society, and will focus on working donkeys specifically as they were the only species of working equids present in the kilns visited. We discuss culture, status, religion, and social influences, including insights into the complexities of cultural “blind spots” which complicate efforts by NGOs to improve working donkey welfare when the influence of different cultural and societal pressures are not recognized or acknowledged. Employing a mixed-methods approach, we used the Equid Assessment Research and Scoping (EARS) tool, a questionnaire based equid welfare assessment tool, to assess the welfare of working donkeys in brick kilns in Northern India. In addition, using livelihoods surveys and semi-structured interviews, we established owner demographics, socioeconomic status, ethnicity, religion and their personal accounts of their working lives and relationships to their donkeys. During transcript analysis six themes emerged: caste, ethnicity, inherited knowledge; social status, and impacts of ethnic group and caste; social status and gender; migration and shared suffering; shared suffering, compassion; religious belief, species hierarchy. The lives led by these, marginalized communities of low status are driven by poverty, exposing them to exploitation, lack of community cohesion, and community conflicts through migratory, transient employment. This vulnerability influences the care and welfare of their working donkeys, laying bare the inextricable link between human and animal welfare. Cultural and social perspectives, though sometimes overlooked, are crucial to programs to improve welfare, where community engagement and participation are integral to their success.

Volume
7
Start page
214
Publication date
Research output
Country

The extension and education methods implemented for sustaining the health and welfare of working donkeys in India

P. R. Kumar
Presentation date

In India the majority of donkeys are used as pack animals to carry sand, gravel, debris and bricks especially in brick kilns and also goods up the hill in pilgrimage places. Like many of the developing countries the donkeys working in India suffer tremendous abuse, injury and pain. Harness wounds and lameness are common due to improper harness, overloading and lack of knowledge about care and management among the owners. This paper discusses the extension methods that were used and found to be effective with an aim to improve the condition of the donkeys, help them become wound free and prevent suffering. The donkey owners were given practical lessons on how to fit a harness properly, donuts (circular protectors), padding materials and how to make good U-shaped back protectors. A video film was made for this purpose and shown to the owners. Distributing soft cotton hobbles made from fabric waste prevented the hobble wounds. Re-homing abandoned donkeys to good owners and rewarding the owners for best-kept donkeys has encouraged the owners to keep their donkeys in good condition, wound free and fit. Distribution of hoof picks (modified screw drivers) encouraged owners to pick out donkeys' feet regularly to prevent lameness due to puncture wounds and hoof abscesses caused by thorns and sharp objects. Enthusiastic owners were picked and given training in basic donkey care. Efforts were taken to promote correct treatments and also encourage the use of readily available natural herbal products. A cartoon film, study materials in the form of pictures and cartoons were used to evoke interest among the donkey owner's children in basic donkey care. Public awareness included distributing storybooks, leaflets, organising camps at local agricultural and equine fairs and publishing articles in newspapers. A marked improvement in the donkeys' status, health, condition and owners care for their donkey has become a reality due to the implementation of extension and education activities.

Country
Published as conference proceedings
Publication date

The Donkey Sanctuary India's management of equine influenza in Noida and the neighbouring operational areas: a summary

P. Sushmita
Surajit Nath
Ganesh Murugan
Presentation date

This paper gives details of how an outbreak of equine influenza in Noida and neighbouring operational areas was managed by the Donkey Sanctuary India. It was managed by establishing a probable diagnosis, confirming the existence of an outbreak, confirmatory diagnosis, and the implementation of treatment control and preventative measures.

Country
Published as conference proceedings
Publication date
Publisher

Non Tsetse transmitted animal trypanosomosis (NTTAT) in working donkeys

Mulugeta Getachew
Presentation date

Although donkeys are considered to be more resistant to trypanosomes, they are often seen causing severe clinical disease, particularly anaemia, lethargy and boor body condition, in immuno-compromised animals due to stress from overwork, poor management practices and low quality diets. Studies made by The Donkey Sanctuary in Kenya showed a high prevalence of both tsetse and none tsetse transmitted trypanosomes. T. congolense and T. brucei sp are the most highly prevalent tsetse transmitted trypanosomes while T. vivax is the second most prevalent, next to T. congolense. Infection prevalence of T. vivax as high as 30% were diagnosed in Kenya and Ethiopia using parasitological techniques. These prevalences could have been higher had they been diagnosed using molecular techniques, as it was shown by the study made in Gambia, in which they found an infection prevalence of 87% using PCR.

Dourine is mostly diagnosed in horses from the highland regions in Ethiopia. Recent serological study made in Ethiopia, however, revealed not only in donkeys but across all agro-ecological zones. However, as the CFT does not differentiate between the infection of Dourine and Surra, it is difficult to know the true epidemiology of these diseases among equids where they both exist. Although Surra is reported in donkeys from different countries, it is not reported in donkeys in Ethiopia. However, Surra is endemic in camels in the arid and semi-arid regions of Ethiopia. The recent migration of camels to the mid-lowland areas during the dry season in search of feed might spread the disease among equids in the area.

A recent study made in Gambia by Glasgow University, funded by The Donkey Sanctuary, showed a fatal neurological syndrome among donkeys and horses caused by trypanosomosis. The aetiological agent of this emerging neurological syndrome has been established based on the presence of trypanosomes in the brain of affected animals. However, given the genetic homology between T. evansi, T. brucei brucei and T. equiperdum, it was not possible to confirm which one of these is causing this devastating condition. To solve this mystery and identify the species of trypanosome involved, study on further molecular characterization of cerebral trypanosomosis is underway in Gambia, a project funded by The Donkey Sanctuary.

The infection of trypanosomes in donkeys raises certain questions that need to be addressed. Given the high infection prevalence in the donkey population and associated diseases:

  • Are they really carriers/resistant to trypanosomosis?
  • The welfare implication of trypanosomosis in donkeys.
  • What would be the role of donkeys in the epidemiology of trypanosomosis?
  • The impact of exclusion of donkeys in the control of animal trypanosomosis?
Keywords
Not published as conference proceedings

Effect of modern drugs on the environment and the role of alternative medicine

Ganesh Murugan
Presentation date

Effect of the modern drugs used extensively for treatment of humans and animals could be detrimental on the environment. The reported near extinction of several vulture species in India and"careless and casual" use of Diclofenac sodium on livestock being attributed as the cause, shows the extent and depth of this issue. Effects of drugs like Ivermectin and organophosphates in the environment need to be understood. Traditional plants have the potential to be used as alternatives, but a lot of constraints, including a lack of hard evidence to support the use of many of them, which can raise ethical concerns in using them. Environmental impact has to be considered to especially of rarer plants. This paper aims to stress the importance of pursuing alternative medicines like herbs/plant products and constraints in using them on animals are discussed. Potential natural products that could be used in place of modern medicines wherever possible especially in mobile veterinary units are discussed.

Country
Published as conference proceedings
Publication date

Mapping the issues of Indian donkey and mule population and identify the potential intervention strategies and partners

Status
Researcher(s)
Country

It is evident from the literature that working equines contribute much to the sustainable development goals through supporting the livelihood of poorest families worldwide. They are considered source of employment in various sectors including agriculture, construction, tourism and mining sector. However, the contribution in enhancing the livelihood of poor and welfare issues especially in the case of donkeys and mules are under-acknowledged and neglected in the policies and development programmes due to lack of information and data to support their contribution. Efforts by various animal welfare organisations to improve the welfare of working equines have not achieved significant positive changes. There is need for one welfare approach where welfare of animals and human to be considered interlinked to each other, so change in human welfare will bring positive change in animal welfare and improved animal welfare will increase the productivity and household income.

Methodology

The study will follow desktop review, qualitative and quantitative data collection methods across the regions where donkey and mule populations are relatively higher.

Aims

This study is aimed to map the issues of Indian donkey and mule population and their dependents in the broader developmental context to identify the potential institutional innovations to bring positive changes in animal and human welfare.

Objectives

1) To identify the donkey and mule population, trend and their usage patterns in rural, urban and industrial development context in different regions of India. 2) To specify the communities who own the donkey and mule population in different regions of the country. Evaluate the human development indicators associated with these communities specific to different regions. 3) To identify the key challenges and opportunities that impact the welfare of human and equine populations (one health approach) in the areas where donkey and mule populations are high.

The role, importance and impact of veterinary drug retail outlets (VDRO) on the welfare of equines and their owners in India

Status
Researcher(s)
Start date
End date
Country

In spite of their official classification under “livestock”, and the significant role they play in the livelihoods of millions in the developing world, equines and those who depend upon them for their livelihoods tend to be ignored within the research agenda. It is also the case that other livestock are often valued over working equines due to their 'direct link to food and nutritional security'. Equine welfare in this case, with respect to veterinary treatment, might therefore suffer as a consequence of this placement of value. Couple this with the fact that the majority of donkey and mule owners in developing countries live in marginalised or poor communities and it becomes clear that the medicating practices of equine owners require further investigation to understand how they make decisions regarding the veterinary treatment of their animals, and who they source their medication and advice from when their animals require medications. This research will attempt to fill some of these gaps in knowledge.

Methodology

Fieldwork focussed largely on communities working in brick kilns but also incorporated some working in construction. A small proportion of the research aimed to capture any differences between sites where Donkey Sanctuary India (DSI) partners had provided veterinary interventions and advice and sites not visited by DSI. A mixed methods approach was identified as most appropriate in capturing the lived experience of donkey owners as well as members of the veterinary retail outlet workforce, and was undertaken through semi-structured interviews (enabling quantitative and qualitative data capture), focus groups, patient simulation method, knowledge assessment through the use of vignettes. Both donkey owners/users as well as a purposive sample of VDRO workforce members and veterinary service providers was recruited for participation. Equine welfare was measured using the Equid Assessment Research Scoping (EARS) tool. Videos were also taken of each equid/ group of equids for qualitative behavioural assessment. Fieldwork was carried out in February/ March due to their relative seasonal reliability in terms of weather, as well as corresponding with the early brick kiln season in the specified study location.

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