Understanding Antimicrobial Use and Resistance in Ethiopian Livestock: Towards Prudent Prescribing Through Evidence and Digital Innovation

Antimicrobial resistance (AMR) is a growing global health crisis that threatens public health, food security, and economic sustainability. The widespread and often inappropriate antimicrobial use (AMU) in livestock plays an important role in the development of AMR. This thesis employed a multidisciplinary approach across five empirical studies to evaluate AMU and AMR within diverse Ethiopian livestock systems, and to develop evidence-based interventions that promote prudent AMU and mitigate AMR risks in resource‑limited settings. The first study (Chapter 2) explored veterinary medicinal product usage and pharmacy practices. It revealed widespread misuse, poor storage, and dispense of prescription-only antimicrobials by untrained personnel or informal vendors without prescriptions. Farmers use the same antimicrobials for various diseases, administer them without professional consultation, and use improper dosing; 43% reported no clinical improvement following antibiotic use, underscoring the consequences of poor practices. Chapter 3 assessed farmers’ disease management practices and their knowledge, attitudes, and behaviors (KAB) regarding AMU, residues, and AMR. Results showed extensive AMU practices with large proportions of farmers exhibited poor knowledge (94%) and unfavorable attitudes (97%). On the other hand, 80% of the farmers showed good behavioral scores. Negative AMU behavior was strongly associated with higher education, multi‑species farming, and frequent disease occurrence, reflecting the complex socio‑ecological drivers of AMU behavior. Chapter 4 analyzed a large database of 12,438 veterinary clinical case records to evaluate antimicrobial prescribing practices and adherence to stewardship principles. Findings showed that 75% of all prescriptions were antimicrobials, mainly oxytetracycline and penicillin-streptomycin (penstrep). Almost all prescriptions (97%) lacked a laboratory confirmed diagnosis, and a substantial proportion was prescribed for presumed viral and other non-bacterial conditions, resulting in 19% non-prudent use. These inappropriate prescribing practices were linked to specific clinics, clinical signs, and viral infections, emphasizing the urgent need for improved diagnostics and stewardship in veterinary care. Chapter 5 examined the contribution of AMU to resistance in Escherichia coli isolates from 83 dairy farms. This study confirmed widespread use of oxytetracycline, penstrep, sulfonamides, and penicillin. Isolates exhibited high resistance to tetracycline (65%), streptomycin (56%), and sulfisoxazole (43%), including resistance to cephalosporins and fluoroquinolones. Nearly half of the isolates (46.5%) were multidrug resistant, with AMU history and geographic location identified as key drivers, necessitating locally tailored stewardship interventions. In Chapter 6, a smartphone‑based application, “EDDiE,” was developed and evaluated to support small ruminant disease diagnosis and prudent antimicrobial use, based on 2,687 cases. The app demonstrated moderate diagnostic agreement with clinicians (62.3%) and substantially improved prudent prescription of antimicrobials, with only 3.1% of the cases classified as non‑prudent. Prescribing practices varied significantly across agroecological zones and regions and aligned with the national guidelines. However, antibiotic prescribing practices for viral diseases in those guidelines are inconstant with the WOAH recommendations on AMU, revealing gaps in alignment with international stewardship standards. Overall, this thesis provides robust evidence, practical interventions, and digital innovations to support veterinary decision‑making in resource-limited settings. The results emphasize the urgent need for antimicrobial stewardship to safeguard animal health, productivity, and public health. By harnessing digital tools like EDDiE and integrating One Health strategies, Ethiopia can strengthen prudent AMU, contain AMR, and contribute to sustainable livestock production.