Evaluating Methods to Explore Antibiotic Use on Smallholding Pig Farms in Peri-Urban Kenya

Understanding patterns and practices of antibiotic use in livestock at the farm level is crucial to make informed recommendations for improved antibiotic stewardship and to measure the impact of interventions aimed at reducing inappropriate antibiotic use. Trends in antibiotic use practices are rooted in economic, regulatory and clinical/animal health contexts, making the development of a unified tool for determining farm-level antibiotic use problematic. To advance the understanding of methodological approaches used to explore antibiotic use, we evaluated the strengths and limitations of four different methods on smallholding pig farms in a peri-urban area of Nairobi, Kenya. Methods were trialled in parallel over one month on 13 farms. We evaluated four methods for their success in collecting instances of antibiotic use and facilitating 2 further exploration of antibiotic use practices using qualitative discussion. Methods were: waste bucket analysis; medicine-recording sheets; weekly semi-structured interviews; and the 'Drug Bag' medicine sorting technique. We found no single method captured all likely or reported instances of antibiotic use. Waste bucket analysis collected the lowest number of instances of reported antibiotic use. The 'Drug Bag' collected the highest number of instances of reported antibiotic use but risked over-reporting due to misrecognition, duplication and recall errors. Our results highlight the challenges of gathering farm-level antibiotic use data. We suggest that future research into antibiotic use must consider methodological suitability when planning data collection and triangulation of methods should be used where possible. Our study also provides further evidence that comparative analyses between antibiotic use studies should be carefully structured to account for methodological but also contextual variation and we suggest methodological suitability statements should be included in publications of future studies.