# Exploring the Current Situation and Developing Strategies for Behavior Change to Improve Antibiotic Use in West Africa: Protocol for a Multidisciplinary Interventional Research Project

## TL;DR

This study explores antibiotic use and resistance in West Africa and develops strategies to change behaviors using a multidisciplinary approach.

## Contribution

The novel aspect is combining design thinking with One Health perspectives to create a tailored, participatory intervention for AMR in low-resource settings.

## Key findings

- Baseline data on AMR pathogens will be collected in Burkina Faso and Ghana.
- Perceptions and antibiotic use will be assessed among healthcare workers, communities, and farmers.
- A multidisciplinary intervention will be developed using a design thinking approach.

## Abstract

Antimicrobial resistance (AMR) is recognized as a global concern, with particularly severe consequences in low- and middle-income countries. Although it may occur naturally, it is also an anthropogenic problem linked to the irrational use of antibiotics in humans and animal husbandry and the use of pesticides in plant agriculture. Generally, data on AMR and evidence of effective and feasible multifaceted interventions are limited in many African countries.

This study aims at (1) assessing baseline data on AMR pathogens in Burkina Faso and Ghana; (2) understanding perceptions and quantifying use of antibiotics among health care workers, communities, and livestock farmers; and (3) defining and refining an AMR intervention using a design thinking approach.

This multidisciplinary study will be conducted in two rural districts and will consist of two phases. First, baseline data will be collected on AMR pathogens along dominant food production chains. extended-spectrum beta-lactamase (ESBL)–producing Escherichia coli and Klebsiella pneumoniae will be selected as indicator mechanisms for AMR because of their high occurrence among animals and humans. The perception and understanding of AMR and antibiotic use among different stakeholders and community members will be assessed using epidemiologic and socio-anthropological methods. Qualitative methods will include participant observations, in-depth and key informant interviews, and focus group discussions. The quantitative part will consist of the development of an inventory of circulating antibiotics and a household survey. Second, key informant and in-depth interviews will be conducted with One Health stakeholders in preparation for the intervention development. Subsequently, multidisciplinary “design teams” will develop ideas for an intervention on AMR using a design thinking approach.

Data collection started in April 2022. The analysis of microbiological, anthropological, and socio-epidemiological data is ongoing in both countries. The intervention development has been initiated in Ghana but has not started yet in Burkina Faso. All results are planned to be submitted to peer-reviewed journals by December 2025. First, manuscripts will be published for each discipline. Afterward, the results of the 3 disciplines will be combined in multidisciplinary papers, and a publication of the evaluation of the intervention will follow.

Owing to the multifactorial nature of AMR, different perspectives need to be considered to develop a holistic context-based intervention that is tailored to local needs. This study stands out in its combination of different disciplinary and epistemological perspectives following the One Health paradigm and taking a design thinking approach to develop an intervention. Thereby, collaboration across disciplines and social levels and a participatory bottom-up approach will be promoted to achieve a common understanding of problems and needs and to develop an accepted and efficacious intervention. The national AMR networks and policymakers will be continuously involved in the project.

DERR1-10.2196/66424