Promoting prudent pharmaceutical usage in Bangladesh Aquaculture.

Principal Investigator: Dr Kelly Thornber, Department of Biosciences; and Co-Investigators: Professor Charles Tyler, Department of Biosciences and Professor Steve Hinchliffe, Department of Geography (July 2020 – Mar 2022).

Background

The Bangladesh aquaculture industry sustains the livelihoods of an estimated 15 million people and provides over 60% of the population’s animal protein. It is currently undergoing intensification in order to meet local and global demand, yet in most cases this may not be sustainable, given the current high use of pharmaceuticals and other chemicals to compensate for poor water quality and prevent / treat the ever-increasing threat of disease. There is also an important risk to food safety and human health, with reports of fish contaminated with high levels of various harmful chemical and pharmaceutical residues. High levels of chemical (including pharmaceutical) use in the aquaculture industry can also have significant negative impacts on the local environment and communities living downstream.

The Bangladeshi Government’s Department of Fisheries has few resources to provide advice and implement regulations on pharmaceutical sales and usage. As a result, there are many thousands of farm supply shops selling treatments to aquaculture farmers with little or no oversight in terms of appropriate uses, and environmental or health impacts. There is also a network of small and large pharmaceutical companies who currently lead the distribution and marketing of pharmaceuticals in aquaculture. They exert pressure on shop owners and farmers to adopt treatments with often inexpert guidance on their prudent and effective use.

For the past seven years we have been working with in-country partners on projects aimed at increasing the sustainability of Bangladesh aquaculture. As part of this work, we have identified farm supply shops and their value chains as a crucial and often overlooked entry point for interventions to promote safer, more prudent and efficient pharmaceutical usage. However, there is currently a lack of knowledge on the socio-economic profiles of farm supply shop owners and the roles different stakeholders in this value chain play in the awareness, access to, and adoption of, pharmaceutical usage by finfish farmers. Thus, in order to promote more responsible chemical and pharmaceutical usage across the industry, there is a need to understand the value chain and identify pragmatic opportunities for intervention.

About the Project

This project sought to first understand the different stakeholder groups and their roles within the aquaculture pharmaceutical value chain in the rural Mymensingh region of Bangladesh. Mymensingh is one of the major finfish production regions, where there is a large number of fish hatcheries, feed companies, drugs and chemical companies. Working with key stakeholders, the project then aimed to explore tangible solutions to improve the sustainability of pharmaceutical usage across the industry.

The outputs of the project should lead to greater understanding on ways to improve food safety and reduce the human and environmental health risks from pharmaceutical use in the aquaculture industry in Bangladesh. In turn, this will help to ensure a more sustainable future for the aquaculture industry, thereby improving the livelihoods of those who directly rely on aquaculture farming for employment and income, as well as increasing the quality and economic competitiveness of the industry.

Key aims of the Project

01.

To carry out stakeholder mapping of the pharmaceutical value chain within the Mymensingh region of Northern Bangladesh, to identify the key stakeholder groups involved in the sales and usage of pharmaceuticals to the aquaculture industry.

02.

To gather information from key stakeholder groups, to understand their roles within the value chain, their practices, knowledge / attitudes and behaviours / drivers of pharmaceutical sales / usage.

03.

To conduct a literature search and contact organisations who have trialled or implemented prudent pharmaceutical use schemes in other Lower middle income countries (LMICs), to inform discussions on potential interventions that could be trialled in Bangladesh.

04.

To engage with stakeholders to widely disseminate the project outputs and seek feedback on the acceptability and accessibility of potential interventions.

05.

To work with stakeholders to co-develop plans and a funding application for a future pilot scheme to promote prudent pharmaceutical usage in the Mymensingh area of Bangladesh, with a view to expanding it nationally if successful.

A typical aquaculture drug shop in the Mymensingh region of Bangladesh.

Gender

Women are thought to have a key role in maintaining the productivity of the aquaculture industry in Bangladesh, accounting for 60% of the workforce, however this is often not represented in official statistics and their working conditions, pay and hours are significantly worse than those of men.

This is largely driven by socio-cultural factors, notably attitudes towards gender equality in the family and society. In the project, we will ensure female representation amongst stakeholders when collecting data for the situational analysis and in the dissemination of outputs.

We sought to ensure that women were included in community workshops and that their voice was heard when discussing future interventions to promote prudent pharmaceutical usage. We invited gender equality experts (e.g. from international development organisations such as BRAC [Building Resources Across Communities]) to our workshops, to ensure that plans for follow-on studies actively promote and support gender equality.

About the Project partners

Professor Mahfujul Haque co-designed this project, and led all of the in-country work in Bangladesh. His team at BAU were responsible for collecting information from different stakeholder groups from the aquaculture pharmaceutical value chain, through interviews, focus groups and structured surveys. They then worked in close collaboration with the UK team to analyse and disseminate the data outputs. Professor Haque is a leading expert in aquaculture practice and has worked with rural aquaculture communities, private companies, government and non-governmental organisations in the Mymensingh area and other parts of Bangladesh for over 20 years. He has been working in partnership with our UK team for seven years, providing invaluable insight into the Bangladesh aquaculture industry and supporting projects seeking to improve industry sustainability.

Mr Jérôme Bossuet worked with the project team in planning the collection, analysis and dissemination of data. He is an international development practitioner with over 15 years’ experience of strategic communication of agricultural research for development in LMIC’s. Mr Bossuet’s knowledge and expertise was of great value in ensuring that the international development work is as effective as possible.

Key activities which took place

The project collected in-depth data from different stakeholder groups within the aquaculture pharmaceutical value chain, to get a comprehensive insight into the power, influence and authority underlying pharmaceutical supply and demand.

Key stakeholder groups were identified as farmers, shop owners, pharmaceutical company agents and Upazila Fisheries Officers (employed by the Government). Focus group discussions engaged representatives from these stakeholders. Feedback from the focus groups was very positive, with participants commenting on the novelty of both the topic (pharmaceutical misuse) and of the inclusive, participatory approach in engaging with stakeholders. New data provides clear evidence of the very strong influence of the pharmaceutical industry over the entire value chain, and highlights the urgent need for independent, robust information on pharmaceutical sales / usage for farmers and shop owners.

Our dataset has been very well-received by both stakeholders within the industry and international academic audiences, and this will be presented to a range of stakeholders and decision makers through a workshop in March 2022. During the workshop we will seek feedback on the acceptability and accessibility of potential intervention strategies. The data will be collated into a manuscript for scientific publication.

The project received further funding from DEFRA, which allowed additional data to be collected specifically on addressing antimicrobial misuse and antimicrobial resistance in Bangladesh aquaculture; this has been prepared as a full manuscript is under review at a leading international scientific journal.

Outcomes and impact

01. Situational analysis of the value chain and stakeholder networks underpinning pharmaceutical usage in aquaculture in the Mymensingh region of Bangladesh.

The situational analysis of the Bangladesh aquaculture pharmaceutical value chain has produced very interesting and novel data on the heavy influence of the private sector and limited provision of independent advice within the value chain. The main factors enabling this were i) the novelty of the transdisciplinary, participatory approach, and ii) the pre-established relationship between the UK and Bangladeshi partners and experience of working in this region. This enabled us to co-develop a context-specific project plan, identify appropriate stakeholders to engage with, and assess the most effective way of doing this.

02. Review of global interventions aimed at promoting the prudent and safer use of pharmaceuticals in rural communities in other low- and middle-income countries (LMICs).

This was used to inform the workshops and will be incorporated into the proposed manuscript.

03. Engaged value chain stakeholders.

a) Focus groups facilitated inclusive discussion between different stakeholder groups, ensuring that each could participate free of intimidation or other social pressures. Mixed focus group discussions were held, with groups working together on separate tables; this worked very well in giving each group a voice in the discussion, with an open and amicable environment. Encouraging women’s participation in the workshops was very difficult since the industry is so male-dominated and we had to minimise the number of focus group participants due to Covid-19 restrictions.

b) Dissemination workshops: Four workshops were held. One was held on the campus of our collaborators at Bangladesh Agricultural University and consisted of representatives from the Government (Fisheries Officer / Farm Managers, Local Extension Fisheries Agents), Pharmaceutical Shop Owners and other relevant stakeholders (NGOs, Social Leaders, etc). The other three workshops were held in the local Mymensingh communities where we have been collecting data, and consisted of farmers and local pharmaceutical company agents. Participants were presented with the project outputs, and discussed and gave feedback about how representative these findings were of the wider community. We also presented potential intervention strategies, and facilitated a discussion on the accessibility and acceptability of these across all stakeholders groups.

04. Additional outcomes.

New data highlights the urgent need for independent information on pharmaceutical sales / usage for farmers and shop owners. From this work, the team will produce a manuscript and (if time and resources allow) a policy brief recommending government officials be allowed to provide independent advice on all pharmaceuticals; currently they are only permitted to provide prescriptions on antibiotics, which means that they cannot prescribe other, possibly more appropriate treatments, and provides an opening for non-independent sources (i.e. pharmaceutical companies) to dominate this field.

Stakeholders focus group discussion.

Lessons learned and next steps

Translation involves effective engagement with stakeholders, and this takes a lot of time, both on the ground and in the planning / management.

From a project management perspective, the main factor underlying the project successes has been the effective partnership established between the UK and Bangladeshi teams, which builds upon an existing relationship and has enabled us time to understand the local context and co-develop an appropriate project. Furthermore, through this project the Bangladesh team increased their knowledge of the development and analysis of quantitative data collection and the UK team benefitted from an increased understanding of the issues and sensitivities of different stakeholder groups.

Covid-19 impacted the project through: i) Increased workload of the University staff and caused delays to partner meetings; ii) Delayed start to the project; iii) Reduced sizes of focus group discussions, to adhere to Covid-19 guidelines. These impacts were minimised by the efficiency and capability of the Bangladesh team, and effective communication between the UK and Bangladesh teams. A three-month project extension allowed all project outcomes to be realised, except the production of training materials.

The success of the project attracted further funding from DEFRA to investigate the aspects of pharmaceutical misuse related to antimicrobials (antibiotics and antifungals) and antimicrobial resistance within these farming systems.

Ultimately, we are actively looking for funding to build upon this work in several ways:

  • Working with stakeholders to further understand the most effective routes to improve the flow of pharmaceutical information amongst stakeholders, and, importantly, co-creating these.
  • Working with stakeholders to trial interventions that could address pharmaceutical misuse in the industry more widely, for example finding ways for the private and public sectors to work in partnership for a more sustainable industry.
  • Developing accessible and effective training systems for all stakeholder groups, not just in pharmaceutical use but also in best management practices more widely, which is a key driver of drug and other chemical misuse.

Lessons learned and next steps

As previously reported, the most significant challenge throughout this project has been the time needed for Dr Thornber to run the project, which far exceeded the time covered.

Furthermore, maintaining a social media presence was key to making new contacts. The University of Exeter and Plymouth Marine Laboratory were asked to join Sargasso Sea Commission following an article in the Guardian. Writing, blogs / interviews / stories for the PhycoMex website on our interactions gave people a voice which we believe they felt empowered by. By ensuring our interactions were a two-way process, people felt they became a part of our community.

The key barriers and challenge to progress the project are around further funding availability. However, we are engaging with a variety of stakeholders including Innovate UK, Venture Philanthropists, Philanthropists, Governmental Organisations, Digital Technologists to drive this research forwards. One ambitious step we are pursuing is to create a seaweed focused Doctoral Training Program (at least 30 PhD students working on multiple aspects of the problem / opportunity) with a unique applied focus and unique cooperative commercialisation model.

This project has also led to interest and funding from the Newton Fund. Arturo Mendoza, Head of NF in Mexico will present Allen’s plans to develop a sustainable process for remediation of problematic Sargassum biomass to SENER (Minister of Energy), Nayeli Mayorga working on the Policy for Climate and Energy issues at the Mexican Embassy, Ministry of Tourism and Mexican Navy in Mexico in April.

Although going forward there may be competition for biomass from plastics manufacturers and mass carbon capture and sequestration activities as more people are moving into the field of identifying uses for macroalgae. Thankfully, Sargassum is a plentiful biomass source and we expect the innovation in this space to continue.

Biorganix will continue testing the extracts provided by the partners on small scale field trials during 2022.

Links

Steve Hinchliffe, Andrea Butcher, Muhammad Meezanur Rahman, Guilder James, Charles R. Tyler, David Verner-Jeffreys (2020). Production without medicalisation – socio-economic drivers of disease and antimicrobial uses in aquaculture. Geographical Journal DOI: 10.1111/geoj.12371

Thornber, K., Huso, D., Rahman, M.M., Biswas, H., Rahman, M.H., Brum, E., Tyler, C.R. (2019) Raising awareness of antimicrobial resistance in rural aquaculture practice in Bangladesh through digital communications: a pilot study, Global Health Action, 12:sup1, DOI: 10.1080/16549716.2020.1734735

Stentiford, G.D., Bateman, I.J., Hinchliffe, S.J., Bass, D., Hartnell, R., Santos, E.M., Devlin, M.J., Feist, S.W., Taylor, N.G.H., Verner-Jeffreys, D.W., van Aerle, R., Peeler, E.J., Higman, W.A., Smith, L., Baines, R., Behringer, D.C., Katsiadaki, I., Froehlich, H.E., Tyler, C.R., 2020. Sustainable aquaculture through the One Health lens. Nature Food 1, 468–474. https://doi.org/10.1038/s43016-020-0127-5

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Thornber, K., Bashar, A., Ahmed, M.S., Bell, A., Trew, J., Hasan, M., Hasan, N.A., Alam, M.M., Chaput, D.L., Haque, M.M., Tyler, C.R. Antimicrobial resistance in aquaculture environments: unravelling the complexity and connectivity of the underlying societal drivers. In Review

Hasan, N. A., Haque, M. M., Hinchliffe, S. J., Guilder, J. 2020. A sequential assessment of WSD risk factors of shrimp farming in Bangladesh: Looking for a sustainable farming system. Aquaculture, 526: 735348. https://www.sciencedirect.com/science/article/abs/pii/S0044848619333460?via%3Dihub

Heal, R.D., Hasan, N. A., Haque, M.M. 2021. Increasing disease burden and use of drugs and chemicals in Bangladesh shrimp aquaculture: A potential menace to human health. Marine Pollution Bulletin, 172: 112796. https://www.sciencedirect.com/science/article/abs/pii/S0025326X21008304?via%3Dihub

Heal, R.D., Haque, M.M., Hasan, N.A., Nagoli, J., Arifuzzaman, S., Tyler, C., Bass, D. 2021. Understanding the economic and farming practices driving species selection in aquaculture within the Mymensingh division of Bangladesh, Aquaculture International, https://doi.org/10.1007/s10499-021-00818-y