Antibiotic stewardship challenges in Madagascar’s poultry sector: informality, knowledge gaps, and market constraints

Antibiotic resistance (ABR) is a major global public health threat, largely driven by the overuse and misuse of antibiotics. Tackling its animal health component is particularly difficult in low- and middle-income countries, where data and resources are limited. This qualitative study aims to explore antibiotic use (ABU) and its underlying drivers in poultry farms in Analamanga, Madagascar's region with the highest poultry density. In April 2023, we conducted semi-structured interviews with 79 poultry farmers (13 backyard and 66 semi-intensive), 10 animal health professionals, and 10 agrovet shop sellers. Thematic analysis was used to examine farm characteristics, poultry health management, veterinary medicine supply and use, and interactions with poultry production stakeholders, in order to identify antibiotic stewardship challenges in Madagascar's poultry sector. Backyard and semi-intensive farmers shared several features: informality (absence of farm registration, rare cooperative membership, limited training), irregular profitability, easy access to antibiotics, recurrent antibiotic misuse (for example use in poultry viral infection treatment, first-line fluoroquinolone treatments), and limited veterinary inspection by competent authorities. However, the two farmer groups differed, as semi-intensive farmers had slightly greater knowledge of ABU and ABR than backyard farmers; they primarily consulted chick and feed suppliers for health advice and medicine purchase; and they widely perceived antibiotics as essential to maintaining poultry health and productivity. Practical roadblocks to invest in preventive measures or adopt effective antibiotic stewardship (ABS) were their narrow profit margins, limited access to credit, and weak bargaining power towards poultry product buyers. Tailored approaches such as supporting professionalization of poultry sector, building capacity of chick and feed suppliers to provide training in appropriate ABU and management of flocks, flock vaccination, deworming schedules, treatment record keeping and ABS principles may enhance antibiotic usage in the Madagascar poultry sector. Future research should build on this exploratory study, which used a convenience sample of stakeholders, by examining ABU trends and drivers in Analamanga with representative sampling and rigorous quantitative validation across Madagascar's poultry sector.