Mapping the flow of veterinary antibiotics in Kenya

Alexina K Morang'a; Dishon M Muloi; Simon M Kamau; Joshua O Onono; Peter B Gathura; Arshnee Moodley

doi:10.3389/fvets.2024.1304318

Mapping the flow of veterinary antibiotics in Kenya

Front Vet Sci. 2024 Apr 5:11:1304318. doi: 10.3389/fvets.2024.1304318. eCollection 2024.

Authors

Alexina K Morang'a^{1

2}, Dishon M Muloi^{1

3}, Simon M Kamau^{1

2}, Joshua O Onono², Peter B Gathura², Arshnee Moodley^{1

4}

Affiliations

¹ Animal and Human Health Program, International Livestock Research Institute, Nairobi, Kenya.
² Department of Public Health, Pharmacology and Toxicology, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya.
³ Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.
⁴ Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark.

Abstract

Introduction: To effectively regulate and reduce antibiotic use, in the livestock sector, a thorough understanding of the flow of veterinary antibiotics will help to identify key nodes in the chain for targeted interventions. The aim of this study was to understand the flow of antibiotics from import to end-user, and identify relevant governance mechanisms.

Methods: A mixed methods approach was used to collect data in three Kenyan counties (Nairobi, Kiambu, and Kajiado). Focus group discussions (n = 23), individual interviews (n = 148), and key informant interviews (n = 10) were conducted.

Results: The key actors identified include primary wholesalers, secondary wholesalers, retailers, animal health service providers (AHSPs), and farmers. Kenya imports 100% of its veterinary antibiotics: primary wholesalers legally import antibiotics as finished pharmaceutical products (90%) or active pharmaceutical ingredients (10%) after approval by the Veterinary Medicines Directorate. Secondary wholesalers play a major role in the distribution of antibiotics (60% of antibiotics) from importers to farmers, AHSPs, and retailers. Some of the illegal sources of antibiotics include unlicenced/unauthorized middlemen and online platforms that sell directly to retailers, AHSPs, and farmers.

Discussion: Despite the presence of various laws and regulations governing the antibiotic value chain, implementation has been a challenge due to financial and human resource constraints. This contributes to over-the-counter sale of antibiotics without prescription, unlicensed businesses selling antibiotics, illegal importation, and presence of poor-quality drugs. There is a need to review the applicability of existing policies and address policy gaps (e.g., product containing antibiotic combinations, and use of human critically important antibiotics) to ensure the prudent sale and use of antibiotics, pharmacovigilance, antimicrobial use surveillance, and developing a business model that aligns with antibiotic stewardship. Additional interventions include awareness raising and capacity building of the different stakeholders along the antibiotic distribution chain to reduce antibiotic mis- and overuse.

Keywords: Africa; LMIC; antimicrobial; distribution; governance; policy; supply chain.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was funded by the German Federal Ministry for Economic Cooperation and Development (BMZ) through the One Health Research, Education and Outreach Centre in Africa (OHRECA) led by ILRI, and the CGIAR Initiative-Protecting human health through a One Health approach. We also acknowledge the CGIAR Fund Donors: https://www.cgiar.org/funders/.