Dairy farmers' levels of awareness of antibiotic use in livestock farming in Pakistan

The paper frames antimicrobial resistance arising from irrational antibiotic use in livestock as a critical but under-emphasized food security issue in Pakistan, where public focus tends to be on food quantity rather than safety and nutrition. Antibiotics are widely used in livestock for disease prevention, treatment, and growth promotion, contributing to environmental contamination and resistance. Farmer pressure can influence veterinary prescribing, and farmer knowledge and perceptions are pivotal to rational antibiotic use. The study addresses a gap in research focused on dairy farms, aiming to assess Lahore dairy farmers’ knowledge, attitudes, and perceptions regarding antibiotic use and misuse, and to link these practices to potential risks for food safety and broader food security. The research question centers on how informed Lahore dairy farmers are about antibiotic use and resistance, what their practices are, and how these factors might drive antimicrobial resistance and impact the safety dimension of food security.

The authors note that most studies on self-medication and antibiotic resistance focus on hospitals, universities, and communities rather than dairy farms. Prior work highlights extensive antimicrobial use in animal agriculture in low- and middle-income countries and calls for action to protect antibiotic efficacy while safeguarding food security. Literature also shows that farmer expectations and pressure can shape veterinary prescribing; effective stewardship requires engaging all stakeholders (farmers, veterinarians, medicine and marketing companies, inspectors, and policymakers). Evidence from other settings indicates prevalent self-medication, saving and sharing leftover antibiotics, incomplete courses, and reliance on non-professional advice, all contributing to resistance. This study builds on these insights by examining farmer-centered practices in Lahore’s dairy sector, a previously under-studied context.

Study area and sampling: Lahore (Punjab, Pakistan) was selected. Survey locations were randomly chosen in urban and suburban areas. Farms were included if they had more than 15 animals, were small/congested, reported a high disease burden, and frequently used antibiotics. Data collection took place in 2019–2020. Sample size and participation: A total of 285 dairy farms agreed to participate; 270 interviews were completed (94.73%) and included in analysis; 5.27% were excluded for non-compliance with key variables. A pilot study with randomly selected farmers tested feasibility before the main survey. All interviews were conducted at the respondents’ workplaces. Instrument and measures: A structured questionnaire (developed with expert input and adapted from related instruments) comprised two parts and 18 questions. Reliability and internal consistency were verified using Cronbach’s alpha (per Cronbach, 1951). Part 1 captured demographics (age, education, location, income per animal per day, household size). Part 2 assessed knowledge, attitudes, and perceptions related to antibiotic use, including: frequency of animal sickness; perceived efficacy of antibiotics vs home remedies; consultation and satisfaction with veterinarians; adherence to dosage instructions and discontinuation when symptoms subside; handling of leftover antibiotics; whether the same protocol consistently works (proxy for awareness of resistance); reliance on non-veterinary advice; awareness of dangers of misuse (side effects, delayed recovery, inconsistent effectiveness); and perceived cost-effectiveness of antibiotic use (yes/no). Ethics and consent: Respondents were informed of the study’s purpose and confidentiality; ethical approval was obtained from the Board of Studies (0006-MPHILL-ENV-16) of SDSC, GCUL. Statistical analysis: Data were analyzed using SPSS v16. Descriptive statistics (frequencies, percentages) summarized perceptions and attitudes; bar graphs were used for comparisons. Pearson correlations and ANOVA explored associations among variables (e.g., overcrowding, integrated disease management, cleanliness, education, location, sickness frequency).

Demographics and farm characteristics (n=270): - All respondents were male. Age distribution: 20–30 (14.1%), 31–40 (41.9%), 41–50 (27.0%), 51–60 (14.4%), 61–70 (2.6%). - Education: Illiterate (23.3%), under matric (24.4%), matric (25.6%), intermediate (20.4%), graduate (4.1%), masters (2.2%). - Residence: Urban (41.9%), suburban (58.1%). Income per animal/day: 400–500 PKR (43.0%), 501–600 (25.2%), 601–700 (30.0%), 701–800 (1.9%). Household size: 5–7 (35.6%), 8–10 (51.5%), 11–13 (10.7%), 14–16 (2.2%). - Farm area: <0.05 ha (35.9%), 0.05–0.1 (31.1%), 0.1–0.2 (23.0%), >0.2 (8.9%). Number of animals: <5 (3.0%), 5–10 (7.0%), 10–15 (11.9%), 15–25 (51.9%), >25 (22.6%). Cleanliness: very poor (6.7%), below average (12.2%), average (61.1%), above average (14.1%), very good (5.2%). Overcrowding: yes (63.0%), intermediate (23.7%), no (—). Integrated disease management: no (58.9%), yes (38.9%). Antibiotic-related practices and perceptions: - Perceived efficacy: 63.7% think antibiotics work more efficiently than home remedies; 36.3% prefer home remedies. - Veterinary consultation: 78.5% prefer to consult a veterinarian; 21.5% do not. Satisfaction with veterinarians: 71.5% satisfied. - Dosage adherence: 68.1% follow correct dosage; 31.9% do not. Discontinuation when symptoms subside: 61.5% yes; 38.5% no (i.e., many stop early). - Consistency of protocols: 45.2% say the same antibiotic protocol always works; 54.8% say it does not (suggesting awareness of resistance or treatment failure). - Non-veterinary advice: 43.3% have used antibiotics recommended by non-veterinary advisors. Peer recommending: 36.3% have recommended antibiotics to others. - Awareness of dangers: 60% report awareness; 40% do not. Among specific perceptions: side effects (29.3%), same treatment does not always work (17.0%), longer time to subside symptoms (13.7%). - Leftover antibiotics handling: throw in bin (41.9%), save for future use (35.2%), give to other farm owners (20.7%), flush or discard in water (2.2%). - Cost perceptions: Only 9.6% find antibiotic use economical; 90.4% do not (perceiving self-medication or incomplete courses as cheaper than veterinary care). - Disease burden: Animals’ sickness in last year—once (24.8%), twice (23.7%), three times (31.1%), more than three times (20.4%). Comparative analyses (selected correlations, Table 4): - Overcrowding negatively correlated with use of integrated disease management (r = -0.84, p < 0.05). - Number of animals positively correlated with general cleanliness (r = 0.36, p < 0.05). - Overcrowding negatively correlated with location of residency (r = -0.43, p < 0.05). - Handling of leftovers correlated with location of residency (r = -0.18, p < 0.05).

Findings indicate substantial gaps in dairy farmers’ knowledge and practices regarding antibiotics in Lahore: reliance on non-veterinary advice, frequent discontinuation of treatment when symptoms subside, and saving or sharing leftover antibiotics are common. Despite most respondents believing antibiotics are effective, many do not consistently follow correct dosage or complete courses, which can foster antimicrobial resistance. Economic constraints strongly shape behavior; most farmers consider full courses and veterinary consultations unaffordable, encouraging self-medication and peer reliance. Mistrust of veterinarians and perceptions of pharmaceutical influence further drive non-rational use. The observed inconsistency in treatment effectiveness and reported awareness of risks suggest partial recognition of resistance, yet this does not translate into best practices. These patterns directly address the research question by demonstrating low awareness and non-scientific practices that jeopardize animal health and the safety dimension of food security. The results underscore the need for multi-stakeholder interventions: farmer education and awareness campaigns, strengthened veterinary-farmer relationships, improved public infrastructure and affordability of services, promotion of integrated disease management and farm hygiene, and policy measures to regulate antibiotic dispensing and usage. Together, these strategies aim to reduce misuse, slow resistance development, and protect food safety within the dairy supply chain.

The study establishes a link between misuse of antimicrobials in dairy farming and risks to food security in Pakistan, emphasizing that safety and nutrition must complement food availability. Many dairy farmers are less educated, face financial constraints, and display low trust in veterinarians, contributing to self-medication, incomplete courses, non-adherence to dosage, and reliance on non-professional advice. These behaviors promote antibiotic misuse and resistance, threatening the safety of dairy products. The authors call for comprehensive awareness campaigns, integration of food security and sustainability principles in dairy policy, stricter regulation of antibiotic dispensing, promotion of integrated disease management and farm hygiene, and measures to reduce financial barriers to veterinary care. Coordinated action by policymakers and stakeholders is essential to foster rational antibiotic use and safeguard the food supply.

- Sampling frame unknown: the exact number of dairy farms/farmers in Lahore is unreported; participation was limited to 285 willing farms with 270 completed interviews, potentially limiting representativeness. - Single-city, cross-sectional design limits generalizability beyond Lahore and precludes causal inference. - Self-reported practices may be subject to recall and social desirability biases. - All respondents were male, limiting gender perspectives. - Resource constraints and focus on descriptive analysis mean some associations may be exploratory; detailed microbiological or residue testing was not conducted.