Abstract
Antimicrobial resistance (AMR) is a growing global public health problem, particularly in low- and middle-income countries, including Malaysia. Understanding risk perceptions on antimicrobial use (AMU) in food-producing animals from the general public perspective is an essential component in addressing AMR. However, little is known about public risk perceptions of AMU and AMR in food-producing animals in Malaysia. The objectives of this study were to assess the level of awareness, risk perceptions, and behaviour regarding antibiotic use in food-producing animals and antimicrobial resistance and to examine the factors associated with risk perceptions and the relationship between knowledge, awareness, risk perceptions and behaviour among the general public in Malaysia. A cross-sectional survey was used. Both descriptive and analytical statistics were used to analyse data and present results. Correlation and regression analyses were conducted to examine the factors associated with risk perceptions and the relationship between risk perceptions and behaviour. A total of 416 individuals participated in the study. The majority of the participants (69.2%) had low knowledge of antibiotics and antibiotic use in food-producing animals. The levels of awareness of antibiotic use and the perceived route of antibiotic resistance transfer were moderate. Participants had a high level of general risk perception (GRP) of antibiotic use, a moderate level of personal-level risk perception (PRP) of antibiotic resistance transmission, and a high level of societal-level risk perception (SRP) of antibiotic resistance transmission. Awareness of antibiotic use was a significant predictor of GRP (β = 0.27, 95%CI: 0.12-0.31, P < 0.001). Awareness of route of resistance transfer was a significant predictor of PRP (ẞ = 0.54, 95%CI: 0.32-0.44, P < 0.001) and SRP (β = 0.47, 95%CI: 0.32-0.46, P < 0.001). PRP is the only significant predictor of behavioural changes towards antibiotic use and antibiotic resistance (OR = 1.45 [1.02–2.07], P = 0.041). Overall, there is a general lack of knowledge and little awareness of antibiotic use and antibiotic resistance in food-producing animals in Malaysia. Risk perceptions were moderate to high and were significantly predicted by awareness of antibiotic use and route of resistance transfer. Personal-level risk perception was a significant predictor of behavioural changes aimed at reducing the risk of AMU and AMR. It is imperative to raise public awareness and understanding of the risks associated with AMU in food-producing animals. Risk communication should be emphasised to ensure the translation of public risk perceptions into behavioural changes.
Generated Summary
This cross-sectional study investigated public awareness, risk perceptions, and behavior related to antibiotic use in food-producing animals and antimicrobial resistance (AMR) in Malaysia. The study employed a web-based questionnaire survey to gather data from 416 adults. The research aimed to assess the levels of awareness, risk perceptions, and behavior concerning antibiotic use in food-producing animals, examine factors associated with risk perceptions, and analyze the association between knowledge, awareness, risk perceptions, and behavior. Descriptive and analytical statistical methods were used to analyze the data, including correlation and regression analyses to explore the relationships between different variables. The study’s focus was on understanding the general public’s perspective on AMR in the context of food production, a critical component for addressing the growing global health problem of AMR.
Key Findings & Statistics
- A total of 416 individuals participated in the study.
- The majority of participants (69.2%) had low knowledge of antibiotics and antibiotic use in food-producing animals.
- Awareness of antibiotic use was a significant predictor of GRP (β = 0.27, 95%CI: 0.12-0.31, P < 0.001).
- Awareness of route of resistance transfer was a significant predictor of PRP (ẞ = 0.54, 95%CI: 0.32-0.44, P < 0.001) and SRP (β = 0.47, 95%CI: 0.32-0.46, P < 0.001).
- PRP is the only significant predictor of behavioral changes towards antibiotic use and antibiotic resistance (OR = 1.45 [1.02–2.07], P = 0.041).
- In Malaysia, the prevalence of AMR in food-producing animals is a major problem.
- A recent review of AMR in food animals in 38 low- and middle-income countries found that Malaysia had the highest median multiple antibiotic resistance (MAR) index of 0.69, well above the 0.2 threshold.
- One major contributor to the increase in AMR in Malaysia is the misuse and overuse of antibiotics in food-producing animals.
- For example, a study among ruminant farmers in Malaysia found that 67% of them stored antimicrobials in their farms and less than half (46%) obtained veterinarian prescriptions prior to antibiotic use.
- In 2017, AMU in animals accounted for 73 % of all antimicrobials used worldwide.
- Global antimicrobial usage in food-producing animals was 99,502 metric tonnes in 2020 and is expected to rise by 8.0% to 107,472 metric tonnes by 2030 based on current trends.
- Overall, the mean score of participants awareness of antibiotics and antibiotic use in food-producing animals was 3.59 (SD = 0.87) based on a 5-point Likert scale, indicating a moderate level of awareness.
- The mean score of participants awareness of route of antibiotic resistance transfer in food-producing animals was 3.00 (SD = 0.99) based on a 5-point Likert scale, indicating a moderate level of awareness.
- The mean score of participants general risk perception of antibiotic use was 3.77 (SD = 0.70) out of 5, indicating a high level of general risk perception.
- The mean score of participants personal-level risk perception of transmission of antibiotic resistance was 2.85 (SD = 0.70) out of 5, indicating a moderate level of personal-level risk perception.
- The mean score of participants societal-level risk perception of transmission of antibiotic resistance was 3.17 (SD = 0.81) out of 5, indicating a high level of societal-level risk perception.
- Overall, 238 (57.2%) of the 416 participants did not take any action regarding antibiotic use and resistance in food-producing animals, while 178 (42.8%) did.
- The study found that GRP had a significant positive correlation with participants age (P = 0.022), education level (P = 0.016), monthly household income (P = 0.002), race (P = 0.045), exposure to information about antibiotic resistance in humans (P = 0.023), ever thought resistance to antibiotics in food-producing animals may have an impact on human health (P < 0.001), knowledge of antibiotics and antibiotic use (P = 0.003), antibiotic use awareness (P < 0.001), and antibiotic resistance route of transfer awareness (P=0.047).
- Awareness of antibiotic use in food-producing animals is a significant predictor of GRP (β = 0.27, 95%CI: 0.12-0.31, P <0.001).
- PRP (P = 0.002) and SRP (P = 0.037) were significantly related to the likelihood of taking action towards antibiotic use and antibiotic resistance in food-producing animals, but knowledge, awareness, and GRP did not (P = 0.206).
- PRP was the only significant predictor for taking an action (OR = 1.45 [1.02–2.071], P = 0.041).
Other Important Findings
- Participants showed a moderate level of awareness regarding antibiotic use and the route of antibiotic resistance transfer.
- Participants demonstrated a high level of general risk perception of antibiotic use and a moderate level of personal-level risk perception.
- The study revealed a general lack of knowledge and limited awareness of antibiotic use and antibiotic resistance in food-producing animals in Malaysia.
- Risk perceptions were significantly predicted by awareness of antibiotic use and the route of resistance transfer.
- Personal-level risk perception was a significant predictor of behavioral changes aimed at reducing the risk of AMU and AMR.
- The majority of participants (63.2%) often or always thought that resistance to antibiotics in food-producing animals may have an impact on human health.
- The mean inter-item correlation values for the awareness of antibiotics and antibiotic use in food-producing animals and the awareness of the route of antibiotic resistance transfer scales were 3.6 and 3.0, respectively, indicating optimal reliability of the scales.
- The mean inter-item correlation value for the general risk perception scale was 3.8, indicating an optimal reliability of the scale.
- The mean inter-item correlation values for the personal-level risk perception scale was 2.9, indicating an optimal reliability of the scale.
- The mean inter-item correlation values for the societal-level risk perception scale was 3.2, indicating an optimal reliability of the scales.
- The most frequent action taken was to look for information on antibiotic resistance in farming, with 103 (28.9%) participants indicating this action.
- This is followed by changing eating habits, 97 (27.2%) and talking to family and friends about resistance to antibiotics in farming, 79 (22.2 %).
Limitations Noted in the Document
- The study’s reliance on a web-based questionnaire survey, particularly during the COVID-19 pandemic, may have excluded individuals without internet access or the necessary digital literacy, potentially leading to under-coverage.
- The study’s sample might not fully represent the general population due to differences in gender proportions and a self-selection bias.
- The study did not gather information on the professional and occupational backgrounds of participants, which could have provided a more comprehensive understanding of the factors influencing their responses and behaviors.
- The non-probability convenience sampling method may limit the generalizability of the findings.
Conclusion
The findings of this study emphasize the critical need to improve public understanding of the risks associated with antibiotic use in food-producing animals and antimicrobial resistance in Malaysia. The study revealed a significant gap in knowledge and awareness, highlighting the importance of raising public awareness to ensure the translation of public risk perceptions into behavioral changes. The study showed that personal-level risk perception was the only significant predictor for taking action to reduce the risk of AMU and AMR. This indicates that focusing on personal relevance might be crucial in influencing behavioral changes among the general public. Raising awareness and understanding of AMU and AMR in the general public in order to increase risk perception, and potentially contributing to positive behaviour regarding antibiotic use in food-producing animals is important. The public should have a high level of societal risk perception. Intervention strategies to improve behavioural changes regarding AMU and AMR among the general public should be focused more on influencing personal-level risk perception. This could be accomplished more effectively through interpersonal communication channels such as friends, family, neighbours, physicians, veterinarians, pharmacists, and social networks. It is imperative to raise public awareness and understanding of the risks associated with AMU in food-producing animals. Risk communication should be emphasized to ensure the translation of public risk perceptions into behavioral changes.