In Nepal, a recent study with a mixed approach of knowledge, attitude and practice (KAP) and behavioural science among the poultry farmers on antimicrobial use has helped researchers gather data that will help them understand not only where there are gaps in knowledge around antimicrobial resistance (AMR), but also the influences on relevant behaviours that will help authorities support farmers and veterinarians to work towards good practices.

The study was carried out under the Action to support implementation of Codex AMR texts (ACT) project, which aims to help countries contain the spread of foodborne AMR, an issue that is contributing to overall AMR cases and threatening the life and health of millions around the world.

The control of foodborne AMR can only happen if antimicrobials in the food supply chain are used only when needed and in a strictly responsible and prudent way. In a three-pillared approach, the ACT project is supporting six countries (Bolivia (Plurinational State of), Cambodia, Colombia, Mongolia, Nepal and Pakistan) to

• improve capacities to continuously gather and analyse data on foodborne AMR
• identify and address legislative gaps relating to antimicrobial use
• raise awareness about the threat of foodborne AMR

Responsible and prudent use of antimicrobials will only come about when those on the frontline of animal source food production understand what AMR is, their role in it and how and why they are the key to controlling the development of AMR.

This study was carried out in Nepal’s southern Chitwan district over a two-month period (November 2024–January 2025) on small- and medium-sized poultry farms. The study was executed through three data-gathering phases: a pre-study, qualitative data collection phase through two focus group discussions (FGDs); based on these FGDs, interviews with 100 farmers to collect economic, behavioural and attitudes data on KAP, regarding AMR; and, thirdly, a two-fold approach involving interviews with 20 farmers and five community veterinarian practitioners, and four FGDs conducted among five participating farmers. This last phase focused on capacity, opportunity and motivation for behaviour change on antibiotic use.

The study allowed researchers to understand how they use antimicrobials and the level of awareness about related issues. For example, almost half of the study participants - 48 percent - have treated poultry with antimicrobials without veterinary supervision, and 44 percent have bought antimicrobials without a prescription. These data suggest that while there was some understanding about AMR, this did not lead to behaviour change or a reduction in antimicrobial use, suggesting that more effort is required to explain the underlying causes of AMR. This also underscores the importance of having regulations in place, effective enforcement and tailored support and incentives that considers both the economic pressures farmers face and the importance of timely and routine veterinary consultation. The qualitative dimension of the study gave valuable insights into motivations and the factors that create barriers to reducing antimicrobial use. “Engaging with farmers helped me understand the practical challenges they face, such as the lack of knowledge on alternatives to antibiotics, limited regulatory enforcement, and the economic pressure to maximize poultry production,” says Babita Neupane from the Central Department of Microbiology at Tribhuvan University, Nepal, a participating partner. Neupane’s observations reinforced the importance of the ACT project’s three-pronged approach: “I observed that many farmers purchase antibiotics directly from the agents supplying feed and chicks or pharmacies without veterinary prescriptions, highlighting the gaps in monitoring and regulation. The absence of strict policies and enforcement mechanisms has led to the unregulated sale and misuse of antibiotics, increasing the risk of antimicrobial resistance. While some guidelines exist, the level of awareness and compliance among farmers was notably low. Strengthening regulatory frameworks and establishing monitoring systems could help ensure the responsible and prudent use of antibiotics while providing safer alternatives to farmers.”

The insights provided by this study can now inform ACT activities going forward, and awareness raising, generating evidence-based AMR data, and legislative approaches on the part of the Nepali authorities.

“It is important to understand what works – and what doesn’t – within each country’s unique context when addressing AMR,” said Myoengsin Choi, ACT Project Coordinator. “This KAP study helped us identify where actions are most needed in Nepal and how we can best support that effort.”

Looking ahead

The study revealed that farmers with more knowledge or more cautious attitudes towards AMR were found to be not necessarily more likely to engage in better practices than those with no knowledge or who did not have a cautious attitude.

“To achieve sustainable change, in addition to streamlining the regulatory framework, the government could support farmers in the implementation of biosecurity/hygiene measures,” said Sakar Shivakoti, ACT Nepal Project Coordinator. He added that “Additionally, knowledge-based information, education and communication strategies need to be complemented by behaviour-based strategies to promote sustainable behavioural change among the poultry farmers for responsible and prudent use of antimicrobials to support the containment and reduction of foodborne AMR in Nepal.” 

Details about the publication of this study will be released separately.

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ACT in Nepal
The ACT project

Photo © Chris Steele-Perkins/Magnum Photos for FAO