Undernourishment and poverty remain dominant health and social issues in rural areas of LMICs. According to SOFI, climate change and the forced displacement of people due to armed conflicts are the main threats to food security in these settings, which also severely undermine the livelihood and income of small-scale food producers. These phenomena also inflate the prices of agricultural goods, hitting the rural poor who are usually food producers, not buyers. The SOFI members have called for further investment in rural areas to increase the productive scale of the agricultural and livestock systems and to promote innovation and connections with markets as a means to alleviate poverty and undernourishment.
However, while the intensification of small-livestock systems may help combat undernourishment, this may also increase the systematic prophylactic, therapeutic and growth promotion (mis)use of antimicrobials in livestock. In 2015, an ILRI6 review of the current evidence on antimicrobial use in LMICs found there is a dearth of data on their use (type, dose and treatment duration) and the state of antimicrobial resistance. ILRI reports that the use of antibiotics is more prominent in animals than in humans and that the rapid intensification of the livestock systems is an underlying driver of antimicrobial resistance in LMICs. Given that the same classes of antimicrobials are used to treat infections in humans and animals, antimicrobial misuse in livestock is a One Health problem that undermines both animal and human health.
Pharmaceutical misuse is not exclusively linked to intensive systems, though. The dispensing of antimicrobials in small-scale systems can be common in some settings. Chicken production systems, which play a crucial role in alleviating poverty, food insecurity and reducing gender gaps in rural settings of LMICs, might be particularly sensitive to pharmaceutical misuse. For instance, a study from Bangladesh reports that veterinary officials seem to focus on large animals, leaving the chicken producers with less formal animal health assistance which usually results in inadequate antimicrobial prescription. Other types of pharmaceutical misuse in this country include dispensing contraceptive pills to chickens to treat Avian Influenza and Newcastle disease. The problem, however, is global. The administration of penicillin, tetracycline, sulfonamide, trimethoprim, enrofloxacin, doxycycline, among other antimicrobials, has been extensively reported in small-scale chicken systems of Latin-America, Africa and Asia.
While rigorous epidemiological data remain limited to estimate the attributable fraction of antimicrobial resistance in humans due to antibiotic use in small-scale livestock systems, behaviour and closeness between people and their animals may drive and facilitate the exchange of resistant pathogens. Low-cost husbandry practices aimed to protect livestock in food insecure settings (e.g. allowing chickens to sleep in baskets under the bed) may contribute to emerging antimicrobial resistance in these settings.