The qualitative coding procedure described above identified four key dimensions relevant to the use of antimicrobials by backyard food animal producers: (i) scale of operation, (ii) use of antimicrobials, (iii) knowledge of antibiotic resistance and its consequences, and (iv) government policies.
Scale of operation
Participants in the producer FGDs explained the characteristics of backyard food animal production and how they differ from commercially oriented small-, medium-, and large-scale production. First, according to FGD participants, and confirmed by KII participants and structured observation, backyard producers most commonly keep one of more of the following: between five and 20 chickens and/or guinea pigs and one or two sheep or pigs. Only a few participants reported that they have cows because most do not have enough land to sustain them. Second, they invest little in infrastructure such as coops or fences, often using recycled or left-over materials such as boards and metal sheeting. Third, as discussed in greater detail below, they rarely use antimicrobials or any other veterinary products--and many reported that they never do.
Producer FGD participants explained their management practices in terms of motivation for engaging in backyard production. First, their principal interest is not profit; backyard production is sold only sporadically if there is a special need for income in addition to what household members earn outside of the home or when the number of animals exceeds available resources—especially space. Rather, food animals are kept for household consumption as an important complement to household cash income, which is generally limited, the minimum wage in Ecuador being about $400 per month. For the same reason, available resources are often used to feed backyard animals and poultry rather than relying exclusively on purchased animal feed.
Poultry production is almost universal since it requires very little investment or space and because meat and eggs are produced relatively quickly. Producer FGD participants also reported that they occasionally give chickens to family members, friends, or neighbors or may trade them for something of equivalent value. Larger species such as pigs are kept for longer periods and are often consumed during year-end celebrations. Participants in the veterinarian FGDs confirmed that for backyard producers, the major reason for keeping animals is household consumption. They also confirmed, as discussed below, that veterinarian services are rarely requested by backyard food animal producers.
FGD participants explained that in contrast to their backyard production, some small-scale producers have a more commercial orientation. While the cutoff point between backyard- and commercial small-scale operation is blurry, the major difference is that the latter invests more in infrastructure even though operations are not large, and in order to maximize production, they may seek the services of veterinarians and use veterinary products, including antimicrobials. One veterinarian explained the difference in this way:
… it is customary for our people to have their animals in a feeding system of between five and 20 birds, as what we call backyard birds. Small producers are people who have small sheds and a fully developed infrastructure, but who are ultimately engaged in chicken production as a business or as a way of subsisting.
More commercially oriented small-scale operators may consume part of what they produce, but that aspect is incidental to sales, which are the primary or only source of household income.
Participants in the veterinarian FGDs were more familiar with practices of medium- and large-scale food animal producers. Medium scale producers were described as having businesses that are large enough to provide sufficient household income without having to recur to other sources, but with modest investments in infrastructure or salaries. In contrast, large-scale producers maintain a larger number of animals (for example, more than 1,000 chickens), and substantial investment is dedicated to salaries, infrastructure, and veterinary products including antimicrobials, which are used for disease prevention and control as well as growth promotion. One veterinarian explained the difference between these levels of production:
there are certain definitions or parameters that you must use to define the small-, medium- or large-scale producer of animals. A small-scale producer, I do not have the exact data, but a small producer is one who has a livelihood and something to live on. A medium-scale producer is one who has a business established and lives on his milk or meat production. A large-scale producer is one that already produces thousands of animals.
In sum, backyard food animal producers are similar to small-scale subsistence agricultural producers, who are also found throughout the Ecuadorian highlands. In both cases, the essential characteristic of production is household subsistence, which necessarily must be supplemented by some source of cash income.
Few participants reported using antimicrobials to prevent or cure disease or to promote growth, and none on a regular basis. The producer KI reported that she has never purchased or used veterinary products of any kind; the only chemical that she has used is household repellant to rid coops of fleas and other insects. She keeps fewer than a dozen chickens and ducks and a few rabbits almost exclusively for household consumption. She sells or trades a single chicken, duck, or rabbit or a few eggs on an irregular basis, often upon request from neighbors or family members. She works as a maid for the minimum wage, and can neither afford inputs nor think they are necessary. With few exceptions, producer and veterinarian FGDs concurred with this view.
Backyard food animal producers identified two principal factors that contribute to or inhibit the use of antibiotics in backyard production. First, given their limited household cash incomes, the cost of these products is often prohibitive. Second, from the perspective of scale of production and the reasons for engaging in backyard production, an empirical cost-benefit analysis reveals that buying antimicrobials does not make sense because a single diseased animal can be slaughtered and consumed immediately and because there is no reason to promote accelerated growth. A veterinarian FGD participant explained that:
… one of the great advantages of backyard poultry production is that there is no pressure… to grow at 65 grams per day or have 14 to 15 birds per square meter. So, these are birds that do not have production stress and therefore they are animals that are not very challenged., so in short, the consumption of antibiotics at this level is very limited …
Second, some producers explained that they abstain from using antibiotics on their animals because they believe them to be harmful for their animal’s health and, ultimately, for the health of the humans (including themselves), who consume those animals. Similarly, veterinarian FGD participants explained that backyard producers rarely seek professional advice largely because of the cost and because these producers feel they do not need advice as they prefer to rely on their own experience or advice from friends or neighbors.
Finally, producer FGD participants reported that another common consequence of antibiotic use is that the use of medicine or chemicals are changes the meat’s flavor. Moreover, participants believe that when animals have received a lot of medication, their meat cannot be consumed at all. They further explained that consuming a “poisoned animal,” that has received too much medication, could lead to illness for themselves and their families.
As an alternative to administering antimicrobials, it is common--and nearly universal—that backyard producers use traditional home remedies for disease prevention and control. Producer FGD participants described using chili pepper, onion, garlic, or lemon juice mixed with water and applied in drops. As one female participant explained, “I put lemon in [the water] with chili and with that, the flu is gone.” These practices are shared among family members, friends, and neighbors, and only when traditional remedies do not achieve the expected results did participants report that they might use “modern” medicines, and in these cases, they rely on personal experience and recommendations from friends and family to choose—usually the least expensive option.
Sure, you buy the least expensive option because buying eighty or a hundred [doses] already costs more money, so you only buy twenty (female producer, Checa).
In contrast, veterinary FGD participants reported that commercially oriented medium- and large-scale producers are characterized by the indiscriminate use of antimicrobials. As one explained:
People buy a box of a hundred chickens and ask for vitamins and antibiotics and they are told that they do not need them, but no ... There are even people who buy vaccines and an antibiotic for the chicken flu as soon as it is sold. So, we usually tell [customers] that if their poultry doesn’t have the flu, why should they medicate? And they usually medicate after 28 days or in the fourth week. There are people, … if you don't sell it, you go to another store and buy.
Knowledge of antibiotic resistance and consequences
Producer FGD participants demonstrated that they possess a certain level of understanding about antimicrobial resistance, which informs their decision to use those products or not. Some participants perceived that excessive use leads to “intoxication” as discussed by one female backyard producer who said that when an animal is “intoxicated. … you can die with too much medicine,” so that traditional or “natural” alternatives are administered. Additionally, it was thought that antimicrobial resistance leads to the use of stronger “chemical” products. Interestingly, few participants remembered where they had heard about antimicrobial resistance, while some reported that this phenomenon had been discussed with neighbors or veterinarians.
Finally, the backyard producers mentioned that one of the most important consequences of overusing antimicrobials is that when a product is no longer effective, stronger alternatives have to be used, which in turn obviates human consumption.
[An animal] is already resistant to the medication you give him. For example, once you get sick with the flu and you use the same medicine and another time the same and the same … the same as a person (female producer, Yaruquí).
Veterinarian FGD participants reported that antibiotic resistance is a serious problem in Ecuador and that they have begun to witness cases in which infections in food animals are resistant to commonly used antimicrobials, which results in the use of increasingly stronger alternatives that can be harmful to human health. In this sense, the development of antimicrobial resistance is due mainly to the indiscriminate use of antibiotics in animals for human consumption since they are often used for growth promotion and disease prevention in commercially oriented food animal production. This problem also goes hand in hand with a lack of awareness among agricultural and veterinary shop owners, who are also responsible for the increase in antimicrobial resistance because they are willing to sell antibiotics with little control, often without prescription . Additionally, failure to use best practices may lead to overuse of antimicrobials and subsequent resistance. As one veterinarian FGD participant explained:
Among large-scale producers where [veterinarians] have gone to give advice, it has been seen that [producers] do not use the full dosage. And when we do the calculations [we find that] they do not use even half the dose, and many times they want their birds to be healthy in two or three days. So they continually change antibiotics. They are on sulfa and they change to quinolones and that’s how they change, until there are three or four antibiotics for the same disease, and logically it is because they do not dose well and do not leave enough time for the birds to be cured.
Participants in the veterinarian FGDs confirmed the indiscriminate use of antimicrobials among commercially oriented medium- and large-scale food animal producers for disease prevention and control and to promote growth. They attributed this growing problem to lack of information by producers and even veterinarians as well as incomplete government control. As one veterinarian explained, the consequences have already been noted, but alternatives are not yet readily apparent.
I believe that there should definitely be more control, but many technicians and producers lack awareness of the impact of [antibiotic resistance]. Perhaps one of the disadvantages of indiscriminate or irresponsible use of antibiotics is that we run out of tools or strategies that could work in other conditions using an antibiotic responsibly, because I think that eliminating the use of an antibiotic by itself does not make sense because then how can we treat a disease that absolutely needs an antibiotic?
Another veterinarian commented that government agencies are actually part of the problem:
No, I think that it is necessary to point out that the indiscriminate use of antibiotics that has been taking place and is being regulated. It is generated from the state agency that now gives away kits of antibiotics and medications, where antibiotics, antiparasitics, hormones … are gifts to the producer without absolutely any control and without any explanation of how or when they should be used.
The key informant from the Ministry of Agriculture and Livestock had a contrasting viewpoint, reporting on a government plan to address the problem of antibiotic resistance by regulating sales and monitoring, while admitting that the latter is a piecemeal effort because of limited resources. She also confirmed that the sale of Colistin, an antibiotic that had been widely used for growth, had been banned since the beginning of 2020. Finally, she believes that there is increasing recognition in government circles that antimicrobial resistance is an important problem in Ecuador and must be systematically addressed:
As for whether we are aware of the importance of antimicrobial resistance at the national level, that is why as a country we are obliged and had promised that in 2017 we were going to implement a national plan to mitigate antimicrobial resistance. However, this plan, being national, had to link several ministries, the Ministry of Health, the Ministry of Agriculture, [the Secretariat of Science and Technology], the Ministry of the Environment, and other entities. The signing was delayed but in August of (2019), we had a national plan that involves (those) ministries.