Interventions for reducing antimicrobial resistance in livestock in sub Saharan Africa: systematic review

Animals are considered key contributors to the development and spread of antimicrobial resistance (AMR). However, little is known about the existing AMR interventions in the animal sector. This scoping review examines the existing evidence on AMR interventions aimed at livestock, animal health professionals (AHPs), and farmers, while reviewing their impact, limitations, gaps, and lessons for future use. The scoping review was conducted following guidelines from the PRISMA-ScR checklist. The databases, Web of Science, Scopus, PubMed, and international organisations' websites (WHO, FAO, WOAH) were searched for articles reporting interventions targeting livestock, farmers, and AHPs. Interventions were categorised based on seven pre-defined primary measures including: change in antimicrobial use (AMU) practices; change in the uptake of antimicrobial stewardship (AMS); change in development of AMR; change in knowledge of appropriate AMU practices, AMR, and AMS; change in attitudes and perceptions concerning AMU, AMR, and AMS; and surveillance strategies. In total, ninety three sources were included: 66 studies, 20 reports, and 7 webpages. The reviewed interventions focused mostly on AMU practices (22/90), AMS uptake (8/90), and reduction of bacterial or resistant strains (30/90). Changes in knowledge (14/90) and attitude (1/90) were less frequently assessed and were often implicit. Most interventions were conducted within a select country (83/90) and 7/90 were at a global level. Only 19% (16/83) of interventions were implemented in low- and middle-income countries (LMICs) and most were at herd level with many self-reporting changes. Most of the interventions that focused on surveillance strategies (30/83) were implemented in high-income countries (62/83). Only one study investigated the financial implications of the intervention. The study findings provide an overview of existing AMR interventions and insights into the gaps which can be addressed to guide future interventions and research. A focus on developing, implementing and evaluating interventions in LMICs coupled with the use of objective outcome measures (e.g., measurable outcomes vs. self-reporting) will improve our understanding of the impact of interventions in these settings. Finally, assessing the financial benefits of interventions is necessary to inform feasibility and to encourage uptake of interventions aimed at reducing AMR in the animal health sector.

Equine Veterinary Journal has an established commitment to promoting antimicrobial stewardship; it was the first journal, worldwide, to develop specific author guidelines for authors publishing research where the highest priority critically important antimicrobials are used or investigated 1, 2. This aims to ensure that published research promotes responsible use of such products in clinical practice. To date, one other veterinary journal has come close to replicating this policy by requiring discussion of ‘off-label’ use of medicines 3. This month, Equine Veterinary Journal has compiled an online collection consisting of articles relating to antimicrobials drawn from recent issues, released to coincide with ‘European Antibiotic Awareness Day’ 4. The collection is free to all readers and aims to highlight the current state of understanding of equine antimicrobial resistance (AMR) and look to ways that the profession can enhance its guardianship of these essential medicines. As equine veterinary surgeons, our priorities when using antimicrobials are primarily focused on the individual horse under our care and achieving the best outcome for that animal, while also being mindful of the implications regarding the impact of the treatment on the wider population. Our empirical choice of antimicrobials will be based upon experience of likely bacterial populations and their likely sensitivity. Therefore, an understanding of changing trends in bacterial populations and the development of resistant bacteria is essential to the equine practitioner. These changes also indicate the impact of antimicrobial use on the development of antimicrobial resistance. In a key article within the collection, the changes in bacterial populations in foals with sepsis are presented, representing almost 600 foals from just over 30 years of a single hospital population in the USA 5. This study shows a dramatic increase in the prevalence of sepsis caused by Gram-positive bacteria in these foals, especially in the most recent period of the study. Of particular note is the increase in Enterococcus spp. in this time period. This mirrors a shift in bacterial sepsis in human patients, where Gram-positive sepsis has become more common than Gram-negative sepsis 6. One possible explanation for this temporal change proposed by the authors is the widespread prophylactic use of antimicrobials with Gram-negative activity in foals during the 1990s in the USA, resulting in a selection pressure for Gram-positive bacterial proliferation. Alternatively, this could represent the development of resistance in populations of Gram-positive bacteria, especially among Enterococcus spp. The same authors have also investigated changes in bacterial sensitivity over the same time period 7 and show changes in numbers of susceptible bacteria and changes in minimum inhibitory concentrations (MIC) over time, representing shifting patterns in antimicrobial resistance. In particular, identifying an increasing in resistance by Enterococcus spp. to imipenem, despite being rarely used in the hospital. A trend for reduction in susceptibility to ampicillin was also reported, but not significantly different, which is surprising since emergence of resistance to the carbapenems would be expected to affect all β-lactam Antimicrobial. The emergence of resistance to an antibiotic that was not widely used in equine veterinary medicine is unexpected and could suggest that the emergence of resistance is a result of antibiotic use in human patients, with nosocomial spread from human handlers to these foals. In a second series of studies included in the online collection, the prevalence of methicillin resistant Staphylococcus aureus (MRSA) and faecal carriage of antimicrobial resistant Escherichia coli is evaluated from horses in the community within the UK 8. As has been reported elsewhere, nasal carriage of MRSA in nonhospitalised horses is uncommon and, as covered in the review by the same author 9, is most commonly associated with surgical site infections or with acquired wounds 10. However, antimicrobial resistant E. coli was common in normal horses in the community. A further study identifies risk factors for carriage of resistant E. coli, showing recent hospitalisation as well as impact of housing with other horses or farm animals on the carriage of resistant bacteria. This suggests transmission of resistant bacteria from animals receiving antimicrobials, or receiving antimicrobials may result in carriage of bacteria 11 by in-contact animals. Although E. coli is rarely pathogenic, it may act as a reservoir for resistance genes within the bacterial population and therefore should not be ignored as insignificant. Transmission of resistant E. coli, as with imipenem resistant Enterococcus spp. warrants further investigation to identify methods to control the spread of resistant bacteria. The mechanisms by which bacteria acquire resistance in E. coli and other pathogens is further reviewed by Maddox 10. While the impact of antimicrobial use on resistance is clear, the study by Barr and colleagues 12 reinforces the need for judicious use of antimicrobials since they can induce potentially fatal diarrhoea. Although the prevalence of Antimicrobial associated diarrhoea (AAD) was low (0.4%) the mortality rate was high (18%). Antibiotic associated diarrhoea was associated with all classes of Antimicrobial in the horse, such that these should not be considered as benign drugs and used without due consideration. Interestingly oxytetracyline, previously associated with AAD 13 was not reported to cause diarrhoea in this study, although doxycycline was. Appropriate use of antimicrobials is covered by further studies that investigate both prescribing practice in the UK 14 and the impact of antimicrobial use on infection and pyrexia in hospitalised horses 15. The former study investigated theoretical selection and use of antimicrobials based on case scenarios commonly seen in equine practice. This demonstrated that few practitioners would have chosen fluoroquinolones or cephalosporins, although when presented with a scenario representing recurrent airway obstruction over 50% of respondents would have selected antimicrobial therapy indicating excessive use of antimicrobials. Doses of antimicrobials determined by respondents were most frequently in excess of the dose stated in the Summary of Product Characteristics (SPC). This apparent overdosing reflects the frequent variation between licenced doses and the dose recommended in the literature based upon pharmacokinetic studies. When antimicrobial use was evaluated in horses undergoing emergency coeliotomy 15 several factors related to dosing were also identified. Animals receiving preoperative antimicrobials within 30 min of the first incision did not have episodes of post operative infection. Furthermore, animals receiving antimicrobials for less than 36 h did not have any more episodes of infection than those receiving longer term antimicrobials. The authors also highlighted that few horses received a second dose of i.v. penicillin within two half-lives of the drug (80–100 min) as would be recommended in human medicine. Finally, the occurrence of pyrexia was not always associated with any recognised infection. The study by Skärlina and colleagues 16 provides evidence that reducing bacterial numbers can be achieved without antimicrobials. Wound lavage and debridement is widely used for the management of equine wounds; however, the use of hydrosurgical debridement reduced bacterial numbers in an open wound model by 99.7%: more than sharp debridement and saline irrigation. These findings and observations suggest that there are opportunities for more targeted, ‘smart’ use of antimicrobials in the perioperative period, rather than simply more antimicrobials. All of these studies identify methods for enhancing antimicrobial stewardship, through selection, dosing and timing of antimicrobials in equine practice. They should form the basis by which clinicians can change their clinical practice, to use fewer antimicrobials or more targeted therapy. Any change in antimicrobial use could impact on our primary priority, the clinical outcome of animals under our care. The final study in this online collection develops a model to audit clinical outcomes using syndromic surveillance. This uses clinical complications as a proxy to laboratory methods of confirming bacterial infection 17. It provides a low-cost method to monitor healthcare associated infection that can be instituted in any clinical practice. Importantly it creates a realistic benchmark against which other hospitals may compare their rate of healthcare associated infections, and monitor any changes with interventions in antimicrobial use policies. Equine Veterinary Journal has also commissioned 3 editorials for the online collection and included in this issue commenting on the overall situation of antimicrobial resistance (AMR) in the horse 18, the specific situation relating to antimicrobials and surgical site infection 19, and the political situation relating to AMR 20. It still remains to be determined how big a problem AMR will be for the equine veterinary profession, either through greater difficulties in effectively treating horses with bacterial infections, or through political pressure externally to restrict veterinary access to antimicrobials. The potential tensions in this subject are illustrated by the single-centre study by Jago and colleagues included in the current issue which identifies that in that hospital population altering routine surgical antimicrobial prophylaxis from sodium benzyl penicillin to the fluoroquinolone enrofloxacin led to a reduction in post anaesthetic colic 21. It is open to conjecture whether such freedom to prescribe for the benefit of our patients will be a freedom which will be allowed by society in the future.

Antimicrobial resistance (AMR) in bacteria is the end result of a multitude of factors. Some of the key factors beyond innate resistance include antimicrobial selective pressure (1–5), acquisition of a foreign genetic resistance element(s) (1–5), clonal dissemination (1) and new mutations (2,3,5); factors vary for different species and geographical locations. Increased global antimicrobial use is the foremost reason for the spread of AMR in the community setting (1). Social networks of individuals (households, schools and child care facilities) have served both as a reservoir for these bacteria and as a common route for their transmission. Similarly, hospitals, nursing homes and long-term care facilities have also served as reservoirs for antibiotic-resistant organisms, and the discharge of patients from these facilities contributes to the spread of resistance within communities. In addition, the use of antimicrobials in food animals has been an important contributing cause (1).

Antimicrobial resistance (AMR) is a complex, inter-sectoral and international problem. Economic evaluation (EE) methods offer systematic, evidence-driven approaches to inform policy decisions about which AMR interventions to fund. EE of AMR interventions is complicated owing to diffuse effects, complex mechanics of the problem and high levels of uncertainty. Current AMR EE literature restricts the analytical scope, potentially resulting in omissions of effects that may limit the utility of EE to inform policy decisions. We aimed to systemise the key evolutionary and ecological processes of AMR to elucidate the paths through which AMR interventions impact population health and healthcare costs to support EE design and to support decision makers in understanding the limitations of EE evidence for decision-making. A conceptual map and a corresponding tool were developed on the basis of a literature review in consultation with experts across the relevant disciplines of molecular biology, infectious disease modelling, health economics and ecology. The AMR development map: (1) distils the key AMR processes and process drivers behind AMR development and maps the available types of AMR interventions to AMR process drivers; (2) proposes a way to conceptualise the spatial scope of analysis through considering the connectivity of the wider ecosystem and (3) outlines the key dimensions that AMR burden and intervention effects could be measured across. An AMR development map tool was developed to support conceptual modelling, with the focus on the choice of scope in the EE of AMR interventions, and an illustrative case study was provided. This work summarises the key underlying biological principles of AMR development to provide mechanistical grounding for considering the scope of effects of AMR interventions and the appropriate system of analysis to support conceptual modelling in EE of AMR interventions. In addition, this map can facilitate the identification of effects that cannot be considered or quantified, thus enabling transparency about these omissions within decision-making.

Antimicrobial stewardship (AMS) remains a cornerstone of efforts aimed at improving antimicrobial-related patient safety. It slows the development and spread of antimicrobial resistance (AMR), while helping clinicians to improve clinical outcomes and minimise harm by improving antimicrobial prescribing. AMS programmes (ASPs) are driven through various processes and people. An AMS structure comprises the core elements that should be in place to support the ASP including the AMS team, treatment guidelines, and surveillance of AMR and antimicrobial use (AMU). This manual aims to provide a practical guide to health care facilities in Nigeria and other low-and- middle-income countries, for establishing, implementing and sustaining ASPs, and is structured into 14 sections. Section 1 introduces the subject matter and gives background information on the current situation of AMS in Nigeria. It describes the efforts of the National Antimicrobial Stewardship Working Group (NASWOG), an arm of the Clinical Microbiology and Infectious Diseases Society of Nigeria (CLIMIDSON), in identifying the AMR issues in health care facilities in the country and providing evidence-based recommendations for ASPs. Section 2 describes the goals of AMS and core elements which must be in place for successful and sustainable ASPs. Section 3 presents how a health care facility could start an ASP depending on the size, highlighting the important role of point prevalence survey (PPS) in obtaining baseline data on AMU and prescribing practice in health care facilities, which is useful in developing an action plan. Although management support is key for a successful ASP, the governance of the programme rests with the AMS committee, which composition and size will depend on the level of health care facility. Section 4 describes AMS strategies, which include the core and supplemental strategies. Every hospital should aspire to do at least a core strategy, although it may be convenient to start with other stewardship activities and supplemental strategies. Section 5 describes the antibiotic policy and guidelines, which provide the framework for all AMS activities, and is an effective means of changing behaviour in antimicrobial prescribing. The guidelines should be written by a multidisciplinary team and due consideration must be given to the local antibiotic susceptibility data and the common infectious disease syndromes in the facility or region. Dissemination of the policy and guidelines should be given wide publicity. At the primary health care facilities, where there may be no doctors to prescribe, “standing orders” are used to guide antibiotic prescribing. Section 6 describes the critical importance of stakeholder engagement to a successful ASP. If stakeholders are more informed about AMR issues and ASP, they are better able to positively support the programme. AMS stakeholders will differ from facility to facility but generally include health care facility management, clinicians, pharmacists, nurses, infection prevention and control (IPC) practitioners, clinical microbiologists, other relevant laboratory staff, and patients. The importance of education and training to the successful implementation of AMS is presented in section 7. Health care facilities should provide induction and in-service training to all staff on AMS and IPC. Training objectives should be clear and targets of education and training should include AMS committee and team(s), clinicians, pharmacists, nurses and other health care staff, patients and caregivers, and advocacy and community campaigns. Sections 8 and 9 explain how monitoring and evaluation (M&E) of ASP, and feedback to stakeholders are conducted. Monitoring and evaluation are critical to identifying the impact of intervention measures and opportunities for improvement. This involves the evaluation of the structures, processes and outcomes of ASPs. Sections 10 and 11 delved into the roles of clinical microbiology laboratory support for AMS, and diagnostic stewardship as well as information and communication technology (ICT) in ASPs. The clinical microbiology laboratory should provide quality antibiotic susceptibility testing data, and standard antibiograms periodically to the AMS committee. Sections 12, 13 and 14 enumerated the core elements of outpatient ASP, institutional mentoring in AMS, and system building approach to sustainability of ASP. The recommendations for outpatient AMS in this document apply to either stand-alone clinics and casualties or those located in secondary or tertiary hospitals.

Background/Objectives: Antimicrobial resistance (AMR) is one of the greatest health threats affecting humans, animals and the environment. Antimicrobial use (AMU) in the livestock sector contributes to the development and spread of AMR, highlighting the need to understand the current situation, to target knowledge gaps and non-prudent practices with tailored interventions, and improve antimicrobial stewardship. This is especially important in low- and middle-income countries (LMICs), where data on AMU and AMR are currently limited. This study assessed knowledge, attitudes and practices (KAP) among farmers, veterinarians, veterinary pharmacy personnel and feed mill personnel related to AMU (particularly considering the use of antibiotics) and AMR in seven former Soviet countries, Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine. Methods: Face-to-face interviews were conducted between 2020 and 2025 with 3012 participants, with results analyzed using an aggregated regional approach. Results: The interviews revealed common regional knowledge gaps and practices among livestock sector stakeholders related to antimicrobials, AMR, antimicrobial residues, and prudent AMU. Non-prudent practices, such as the purchase of antimicrobials without a prescription, the use of antimicrobials as growth promoters, the inappropriate disposal of antimicrobials, and the frequent use of highest priority critically important antimicrobials (HPCIAs) were reported. Another factor that may hinder prudent AMU was the limited access of veterinarians to diagnostic laboratories. Conclusions: Despite significant global efforts to tackle AMR, there is an ongoing need to address knowledge gaps and non-prudent practices of livestock sector stakeholders in former Soviet countries. The findings highlight the importance of antimicrobial stewardship interventions that address system-level drivers of improper AMU beyond stakeholder trainings.

Antimicrobial resistance: time to repurpose the Global Fund

Exposure factors associated with antimicrobial resistance and identification of management practices for preharvest mitigation along broiler production systems: A systematic review

1The Review on AMR was an expert panel commissioned by the UK Government in 2014 tasked with analysing the economic and social impacts of AMR and proposing solutions to these. 2NICE is a UK non-departmental public body that sponsored by but separate from the Department of Health that produces evidence-based guidance for health practitioners. 3NHS England is a non-departmental public body sponsored by the Department of Health that oversees planning and delivery of health services in England. 4Note that circulation of the News of the World ceased in July 2011; the Sun on Sunday was launched by the same newsgroup in 2012, but is unavailable on the Nexis database.

Antimicrobial resistance (AMR) is an economic, food security, and global health threat accelerated by a multitude of factors including the overuse and misuse of antimicrobials in the human health, animal health, and agriculture sectors. Given the rapid emergence and spread of AMR and the relative lack of development of new antimicrobials or alternative therapies, there is a need to develop and implement non-pharmaceutical AMR mitigation policies and interventions that improve antimicrobial stewardship (AMS) practices across all sectors where antimicrobials are used. We conducted a systematic literature review per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify peer-reviewed studies that described behavior-change interventions that aimed to improve AMS and/or reduce inappropriate antimicrobial use (AMU) among human health, animal health, and livestock agriculture stakeholders. We identified 301 total publications– 11 in the animal health sector and 290 in the human health sector–and assessed described interventions using metrics across five thematic areas- (1) AMU, (2) adherence to clinical guidelines, (3) AMS, (4) AMR, and (5) clinical outcomes. The lack of studies describing the animal health sector precluded a meta-analysis. Variation across intervention type, study type, and outcome precluded a meta-analysis for studies describing the human health sector; however, a summary descriptive analysis was conducted. Among studies in the human health sector, 35.7% reported significant (p<0.05) pre- to post-intervention decreases in AMU, 73.7% reported significant improvements in adherence of antimicrobial therapies to clinical guidelines, 45% demonstrated significant improvements in AMS practices, 45.5% reported significant decreases in the proportion of isolates that were resistant to antibiotics or the proportion of patients with drug-resistant infections across 17 antimicrobial-organism combinations. Few studies reported significant changes in clinical outcomes. We did not identify any overarching intervention type nor characteristics associated with successful improvement in AMS, AMR, AMU, adherence, nor clinical outcomes.

Antimicrobial resistance (AMR) is an economic, food security, and global health threat accelerated by a multitude of factors including the overuse and misuse of antimicrobials in the human health, animal health, and agriculture sectors. Given the rapid emergence and spread of AMR and the relative lack of development of new antimicrobials or alternative therapies, there is a need to develop and implement non-pharmaceutical AMR mitigation policies and interventions that improve antimicrobial stewardship (AMS) practices across all sectors where antimicrobials are used. We conducted a systematic literature review per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify peer-reviewed studies that described behavior-change interventions that aimed to improve AMS and/or reduce inappropriate antimicrobial use (AMU) among human health, animal health, and livestock agriculture stakeholders. We identified 301 total publications- 11 in the animal health sector and 290 in the human health sector-and assessed described interventions using metrics across five thematic areas- (1) AMU, (2) adherence to clinical guidelines, (3) AMS, (4) AMR, and (5) clinical outcomes. The lack of studies describing the animal health sector precluded a meta-analysis. Variation across intervention type, study type, and outcome precluded a meta-analysis for studies describing the human health sector; however, a summary descriptive analysis was conducted. Among studies in the human health sector, 35.7% reported significant (p<0.05) pre- to post-intervention decreases in AMU, 73.7% reported significant improvements in adherence of antimicrobial therapies to clinical guidelines, 45% demonstrated significant improvements in AMS practices, 45.5% reported significant decreases in the proportion of isolates that were resistant to antibiotics or the proportion of patients with drug-resistant infections across 17 antimicrobial-organism combinations. Few studies reported significant changes in clinical outcomes. We did not identify any overarching intervention type nor characteristics associated with successful improvement in AMS, AMR, AMU, adherence, nor clinical outcomes.

Antimicrobial resistance (AMR) is currently one of the twenty-first century's biggest threats to public health. Addressing AMR is often operationalized as requiring 'behavior change' of clinicians and patients and improving the drug development pipeline. Few studies and interventions have approached AMR as a challenge fundamentally embedded within the cultural fabric of modern societies and their varied economic, social and political organizations. This systematic review aimed to gather and review the available data on the behavioral and socio-economic determinants of AMR in sub-Saharan Africa (SSA). Articles were sourced from PubMed using search terms across five domains: "Antimicrobial resistance", "Sub-Saharan Africa", "Behavioral", "Socio-economic", and specific SSA country names. References were also reviewed for relevant data. This systematic review included original studies published in English between 2015 and 2023, focusing on behavioral and socio-economic factors influencing AMR in human populations in SSA, with AMR as a key outcome. This systematic review identified 30 studies, with 83% (n=25) focusing on self-medication and antibiotic use practices, 67% (n=20) on healthcare providers' practices and knowledge, and 60% (n=18) on community knowledge and perceptions of AMR while 50% (n=15) of studies explored various socio-economic factors. The common themes that emerged from these studies included inadequate evidence-based prescription practices (63%, n=19), financial barriers to accessing antibiotics (50%, n=15), poor community awareness of AMR (53%, n=16), regulatory challenges in antibiotic sales and distribution (47%, n=14), and healthcare infrastructure limitations, including deficient diagnostic capabilities and antimicrobial stewardship programs (40%, n=12). This review's findings provide crucial insights into the behavioral and socioeconomic patterns influencing AMR in sub-Saharan African populations. For AMR interventions to be effective, there is a need for a thorough understanding of people's behaviors and practices about AMR knowledge and antimicrobial use which will help in developing more targeted interventions and policies to address inappropriate antimicrobial use and the spread of AMR.

The global rise in antimicrobial resistance (AMR) is claiming the lives of more than 1.2 million people each year. According to the World Health Organization (WHO) this global health crisis is particularly acute in Africa, largely due to fragile and underfunded health systems. Efforts to combat this public health threat have led to the implementation of health system interventions worldwide aimed at managing and containing the spread of AMR. However, the literature on the real time impacts and the barriers that hinder the implementation of these interventions in the African context is limited. The objective of this scoping review was to identify AMR interventions in African health systems, their impact, and the challenges of the implementation. Drawing on Muka and colleague’s 24 step approach for scoping reviews, two major public health databases (PubMed and Global Health) were searched for articles in accordance with the PRISMA guidelines resulting in 4,783 records. Screening and retrieval of articles was done using Rayyan software based on specified inclusion criteria and 36 articles included in the final list. These articles were synthesized after extracting specific data on AMR interventions and their impact on African health systems. The review identified four broad impacts of AMR interventions including 1. Reduction in antibiotics use, 2. Increased adherence to guidelines and protocols, 3. Enhanced laboratory-based AMR surveillance, 4. Development of antimicrobial stewardship (AMS) Action Plans and Teams. However, challenges such as poor laboratory infrastructure, logistical challenges, poor financial commitment and inadequate education and training were identified as challenges impeding the successful implementation of AMR interventions in Africa. Our findings reveal a range of successful AMR interventions in African health systems although infrastructural and financial challenges remain. Better standardization and reporting of AMR diagnosis while leveraging the available information is needed to improve the optimization of treatment guidelines across Africa.

Pharmacists critical to managing antimicrobials, developing infection control procedures

Antimicrobial use (AMU) in animals, including poultry, can contribute to antimicrobial resistance (AMR) in humans. With a rising middle class and demand for meat in sub-Saharan Africa's second largest poultry producer, Nigeria, AMU in food-producing animals is predicted to continue rising. Interventions to reduce AMR and AMU are limited in low- and middle-income countries, including Nigeria. This study aimed to understand the current AMU practices, challenges and motivators and barriers to adopting AMR interventions in the Nigerian poultry sector. Qualitative semistructured interviews (n = 22) were conducted in Nigeria consisting of poultry farmers, animal health professionals and other related key players. Thematic analysis identified three themes surrounding barriers and challenges: (i) ‘issues of access' relating to time, money, laboratories and expertise, (ii) ‘lack of knowledge' due to lack of training and poor relationships between farmers and animal health professionals and (iii) ‘taking responsibility' with participants describing a lack of responsibility from both the government and other animal health professionals, para-professionals and farmers and how social responsibility was key to motivating people. Overall, the results from this study highlighted the wide range of barriers to engaging animal health professionals and farmers in AMR interventions and improving AMU practices in sub-Saharan Africa. If interventions are to succeed, they need to reflect a collaborative and multifaceted effort from all invested parties.