Divergent stakeholder perspectives on antimicrobial resistance and One Health in Ghana: a qualitative study.

Abstract

Background: Antimicrobial resistance (AMR) is a global threat to human, animal, and environmental health driven by natural processes and human practices. One Health, originating from biomedical concerns about zoonoses, links human, animal, and ecosystem health and frames AMR as a systemic issue.

Methods: This qualitative study, conducted in the Asante Akim North Municipality of Ghana, aimed to assess how community members, farmers, and institutional actors across animal, environmental, and human health sectors understand AMR and One Health in the context of AMR. Data were collected between November 2021 and October 2023 through ethnographic fieldwork (participant observation, unstructured and in-depth interviews) and socio-epidemiological methods (key-informant interviews, customer-exit interviews). Data were analysed using thematic analysis in NVivo 14, with integration through collaborative cross-coding and interdisciplinary team review.

Results: A total of 103 participants were included. Three overarching themes emerged: divergent awareness of AMR, contrasting explanatory models of antibiotic ineffectiveness, and uneven recognition of cross-sectoral health interconnections. Community members and farmers had little known prior exposure to AMR, and thus rarely perceived it as a problem. After the concept was explained, they drew on experiential models that attribute antibiotic ineffectiveness to physiological differences such as blood-drug incompatibility or the body "getting used" to drugs. Institutional actors framed AMR as an urgent global health threat with health and economic consequences, using language closely aligned with international policy discourse, yet reported limited personal experience of it. Regarding cross-sectoral dimensions of AMR, community members and farmers described links between health, animals, and environments through everyday concerns about hygiene, close contact with animals, and disease transmission. These insights resonate with One Health principles without using the term itself. Institutional actors strongly endorsed One Health at the policy level but described fragmented implementation and the persistent marginalisation of the environmental health sector.

Conclusions: These contrasting explanatory models carry implications for AMR intervention design. Integrating pluralistic explanatory models may strengthen the contextual relevance and sustainability of One Health-based AMR interventions.