Alex Muriithi Gateri

• Gateri, Alex Muriithi (2025). Beyond behavior: Rethinking antimicrobial resistance through emic accounts from rural farm lives in Tanzania. Full text in Research Archive
• Gateri, Alex Muriithi (2024). Understanding Antimicrobial use in animal production in rural Moshi, Tanzania: A One Health Approach. Full text in Research Archive
• Gateri, Alex Muriithi (2024). Socioeconomic and material conditions for Antibiotic use in Kilimanjaro Region of Tanzania. Full text in Research Archive
• Gateri, Alex Muriithi (2024). Antimicrobial use in animal production in rural Moshi, Tanzania: A One Health Approach. Full text in Research Archive Show summary

  Background: Antimicrobial use (AMU) is on the rise in animal production particularly in sub-Saharan Africa. The trend is associated with a risk of antimicrobial resistance (AMR): a global public health threat. In the context of One Health, there is notable concern about pathways of resistance between animals and humans, soil and water. In this context too, studies of AMU and AMR have gone beyond biomedical, behavioral and knowledge deficit models to incorporate social science perspectives. Using a One Health approach, we sought to describe the socioeconomic and material conditions for AMU in livestock farming in rural Moshi, Tanzania. Methods: We conducted ethnographic fieldwork in rural Moshi in intensive livestock production settings. Using participant observation and repeated informal interviews, we interacted with smallholder farmers, veterinarians and agrovet operators for 12 months. Data were documented using field notes and recorded interviews while constant comparative method was used to organize data thematically. Results: Farmers face a perpetual risk of disease that prompt use of antimicrobials as they experience practical difficulties to adopt biosecurity protocols. Antibiotics are often used to compensate for this biosecurity lapse. Commercial and intensive livestock production is characterized by high investment and need for returns. Antibiotics come in as a protector of return on investment and support quick cost-effective fixes. Due to economic interests, farmers find it difficult to adhere to mandatory withdrawal periods for milk, meat and eggs. Antibiotics are readily available in loosely regulated markets. Veterinarians face unending client demand to use antibiotics for rapid outcomes. Conclusion: Social science methods augment understanding of AMU and have potential to understand resistance pathways. The ethnography helped understand community and individual practices, experiences and motivations of AMU. These can be contextually adapted to tailor bespoke interventions for optimal AMU and help tackle the risk of resistance for animals and humans.

• Gateri, Alex Muriithi; Fjeld, Heidi; Prince, Ruth Jane & Lie, Anne Kveim (2024). Understanding antimicrobial use in livestock production to promote food safety and security: Ethnographic insights from rural Moshi, Tanzania. Full text in Research Archive Show summary

  Background: Livestock production contributes significantly to household income and direct food resources in Tanzania. This contribution is however threatened by food safety concerns occasioned by high use of antimicrobial agents. Consequently, there is a risk of contamination of animal products with antimicrobial residues. There is also a risk of antimicrobial resistance (AMR) circulating in humans, animals, and the environment through food and waste. It is thus imperative to optimize antimicrobial use (AMU) in livestock production. The roadmap to such optimization must bear research-based evidence on conditions of use. Purpose: Behavioral and knowledge deficit models have dominated AMU and AMR studies. This has (in)advertently precluded the influence of collective structures accounting for AMU. Using a One Health approach, we sought to describe the social, economic, and material conditions for AMU in livestock farming in rural Moshi, Tanzania. Methods: Data were collected qualitatively using an ethnographic approach between May 2022 and April 2023. Participant observation and repeated interviews were conducted with people who come into contact with and use antibiotics for animals. We followed veterinarians, smallholder farmers, and agrovet operators in their daily lives, conducting observations and informal interviews on how and why they use antibiotics. Field notes were used to document and organize data while constant comparative method was used to sort and organize data thematically. Findings: Facing existential disease risk, farmers use antibiotics for infection prevention and treatment in commercially driven intensive livestock production. Antibiotics come into use to support return on investment as farmers compensate for poor adoption of biosecurity protocols with antibiotic use. Based on economic interests, farmers find it difficult to adhere to withdrawal periods for animal products. Further, there is crossover use of human antibiotics in poultry as farmers strive for cost-effective production. The circulation and sale of antibiotics for veterinary use are not well regulated as various antimicrobial agents are handled and sold by informal vendors. Most agrovet operators dispensing animal medicines including antibiotics have not met threshold qualifications. Veterinarians report unending client pressure to use antibiotics for rapid production outcomes. Conclusion: Antimicrobial use in animals takes place in an inclusive infrastructural context, with a risk of contamination and resistance. Antimicrobials are seen as protectors of investments in intensive commercial livestock production settings. Available in loosely regulated markets, antimicrobials help compensate for low biosecurity adoption. Antimicrobial use and optimization need to be understood in this wider context to promote food safety and security.

• Gateri, Alex Muriithi (2024). Medical Anthropology in Global Health: Reframing Antibiotic Use for optimization using a One Health, ethnographic approach. Full text in Research Archive Show summary

  A One Health approach has often been used in many Global Health practices, programs, research, and debates. It recognizes the interconnectedness of health where humans, animals, and the environment are considered as whole than separable entities. Another dimension of One Health is multidisciplinarity where the pursuit of optimal health for all invites multiple disciplines. This latter dimension has recognized the malleable nature of health- not only the absence of disease but as an aggregate result of socioeconomic, material, and political configuration. The studies and debates around antibiotic use (AMU) and antimicrobial resistance (AMR) have remarkably integrated disciplines beyond medicines and health sciences. While AMR is a biological process, it is woven into a complex web of realities that go well beyond biomedicine. This has placed the phenomenon at the intersections of epistemological positions of positivistic and interpretivist epistemology on one hand and objectivist and constructivist ontologies on the other hand. The place of social science methods, particularly medical anthropology, has been made visible in AMR research and debates. In the context of AMR and AMU, utilization of antibiotics has often been termed as "over-use, misuse, or irrational use" and therefore contributing to the global and public health threat of resistance. Approaches have also assumed a behavioral and individual responsibility while (in)advertently ignoring the macro context. As such, behavior and knowledge deficit models have been applied resulting in approaches such as behavior change of users and prescribers and imparting "knowledge". However, social science methods such as ethnography have revealed that AMU realities are more than lack of knowledge and inappropriate behavior. In our ethnographic fieldwork in rural Moshi, Tanzania, we found that AMU has socioeconomic and material connotations and embedded in the everyday life of users, with multiple meanings. Interested in the everyday realities of lives and livelihoods, we sought to understand how and why smallholder livestock farmers interact with and use antibiotics. We found that AMU makes sense in the users' livelihoods, challenging the labels of "misuse, overuse, and irrational use." Antibiotics are tools of care in livestock production in settings where zoonoses are endemic. In intensive commercial livestock production, antibiotics are protectors of returns on investment among vast unemployed rural population whose livelihoods depend on optimal production. The antibiotics are circulated in loosely regulated markets, mainly in private and informal channels. In the local pharmaceutical market, animal antibiotics operate on business models and market forces associated with profit maximization. Our research has highlighted the need for an anthropological approach to understanding contextual AMU. The existing AMU practices reflect contextual needs, demands, and influences. The local realities make AMU rational. This understanding invokes an important question of how the local conditions can be tuned to align with the prudent and optimal use of antibiotics. Approaches must be responsive to and adaptable to local realities that implementing generic and one-size-fits-all approaches and labels that may not add value to the overall outcomes. The ethnography makes visible how antibiotics are entangled in everyday life and influenced by socioeconomic and material frames.

• Gateri, Alex Muriithi (2023). Social economic and material conditions for antimicrobial use among farmers in Kilimanjaro region of Tanzania. Full text in Research Archive Show summary

  Introduction Antimicrobial use (AMU) is a major subject in global health topics, including antimicrobial resistance (AMR). There has been greater focus, however, on human health sector yet AMU in animal health is at the core of One Health and with observable spillover on humans. Understanding the conditions for antimicrobial use among farmers contributes to strengthening of measures to optimize antimicrobial use in animal health. Method We conducted an ethnographic study in Moshi rural district in Kilimanjaro region of Tanzania. For 11 months, the ethnographer lived and interacted with livestock farmers in the area, making observations and interviews while studying the daily rural lives. Observations and interviews were also conducted among the veterinarians and agrovet operators. Participant observation helped understand daily lives of persons who come into contact with antibiotics and why they use them the way they do. Results Livestock and poultry keeping is part of the daily social lives in Moshi rural district embedded in livelihoods as a major income generating activity for the vast rural population with no ‘formal’ employment. There is high demand for animal and poultry products in the growing urban population and changing lifestyles. The farmers are often in the entanglement of optimizing production and reducing cost of production amid risk of diseases and other environmental uncertainties such as drought. The entanglement also occurs under the backdrop of waning livestock extension services in the privatized sector. To maintain balance in the fast-paced modernity, farmers turn to antibiotics that seem to offer guarantee of returns, help manage risks, and provide last-line defense against uncertainties. Antibiotics are thus used as protectors of investment through prophylaxis, growth promotion, and for therapy while compensating for poor livestock production practices and gaps. Discussion and Conclusion Socioeconomic and material factors must be considered and accounted for in the description of the AMU in animal health. Laboratory studies have shown consistency in the presence of antibiotic residues in meat and eggs in Tanzania and elsewhere; pointing to increased and unnecessary use of antibiotics in animal production. The study describes the underlying factors leading to this trend with implication for AMR and One health. AMU in animal health happens in a complex context that must be unpacked by understanding the multiple role of antibiotics in social lives.

• Gateri, Alex Muriithi (2022). An Overview of Sociocultural, Economic and Political Dynamics in the Consumption of Antibiotics. Full text in Research Archive
• Gateri, Alex Muriithi (2022). Understanding antimicrobial use in rural Moshi in Tanzania: A one Health, ethnographic study. Full text in Research Archive Show summary

  Africa’s growing problem of antimicrobial resistance (AMR) is accountable for high mortality rates and risks undoing advances in health systems. Like elsewhere in the world, antimicrobial use (AMU) is a great factor associated with AMR. Antimicrobial use for human and animal health has been on steady increase in many African countries, including Tanzania, with associated AMR risk. Optimizing AMU has mainly targeted health facilities (hospitals) and providers owing to their contribution in dispensing antimicrobials. Largely, this might preclude AMU in animal health. Most of AMU occurs in communities among humans and animals. Using a One Health approach, the ongoing ethnographic study seeks to describe the socioeconomic and material conditions of AMU among farmers, their livestock and their families in Kilimanjaro region, Tanzania. We have been following farmers, veterinarians and agrovet operators in their day-to-day life in the actual settings where AMU takes place. As points of access, the health facility and community pharmacies, Accredited Drug Dispensing Outlets (ADDOs) are involved in the study. Observations and interviews confirm availability and use of a wide range of antimicrobials in both human and animal health. Practices of unprescribed medication, over-the-counter sale of antibiotics, half-dose and incomplete medication are confirmed. The practices however are woven in a complex socioeconomic and material fabric with a set of sustaining networks and relationships. The risk of disease inclines farmers to use antibiotics for prophylaxis and therapy while the need for return on investment is an incentive for use of antibiotic growth promoters e.g. in poultry production. Animal husbandry is organized within rural subsistence livelihoods including intensive animal care in zero grazing settings that necessitate practices with fundamental AMU outcomes. There is an observable crossover of human antibiotics in animals (poultry). ADDOs’ and agrovets’ ease of access, ease of negotiating half-doses, perceived resource friendliness, client demand and retention, reputation and business continuity (profits) account for the observed practices. We conclude that AMU is dynamic and complex in the communities with unique set of enablers that need to be focus of study and intervention. While prudent prescription of antimicrobials is emphasized, the consumption patterns need to be contextually understood and accounted for optimal AMU. Multi-faceted approaches including One Health approach and community approaches are imminent in optimizing AMU. Key words: Antimicrobial use, animal and human health, antibiotics,

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