Antimicrobial stewardship and infection prevention and control in Asian swine, poultry, and aquaculture sectors: A scoping review and situational analysis.

Abstract

Antimicrobial resistance (AMR) presents a significant global health challenge, with antimicrobial stewardship (AMS) and infection prevention and control (IPC) identified as key strategies under the WHO Global Action Plan. This study aimed to identify the types of AMS and IPC interventions shown to be effective and synthesize the enabling conditions and challenges associated with their implementation in nine Asian countries. A mixed-methods approach was applied, combining a scoping review following PRISMA-ScR guidelines (2011-2022), online questionnaires, and expert interviews. Intervention strategies were categorized using the Behaviour Change Wheel (BCW) framework, and the Capability, Opportunity, Motivation - Behavior (COM-B) model was applied to identify facilitators and barriers to intervention implementation. A total of 42 interventions were identified from 45 documents and 11 interviews with 20 participants across 7 countries, with Vietnam [26 % (11/42)] and Bangladesh [24 % (10/42)] most represented. Most interventions targeted poultry [62 % (26/42)], followed by swine [19 % (8/42)], aquaculture [12 % (5/42)], and mixed species [7 % (3/42)]. Education and training were the most frequently applied BCW functions, with training and stakeholder education reported in 55 % (23/42) of interventions. Among the 36 interventions with outcome data, 50 % (18/36) reported improved knowledge and perceptions, and 63.9 % (23/36) reported behavior change. More specifically, 47.2 % (17/36) showed better herd health management, and 22.2 % (8/36) reduced antimicrobial use. Improvements in disease management were observed in 41.2 % (15/36) of interventions. Additional reported success included increased productivity [36.1 % (13/36)], economic gains [30.6 % (11/36)], scaling up and institutionalization [25 % (9/36)], environmental and social impacts [25 % (9/36)], and strengthened stakeholder collaboration [13.9 % (5/36)]. Opportunity-related factors were most prominent: barriers centered on limited resources, disease outbreaks, and weak government engagement, while facilitators included cross-sector collaboration, peer learning, and improved service access. Motivation factors, such as benefit-oriented communication and belief in improved practices supported change. Capability-related barriers reflected frequent knowledge gaps. Further research is needed to generate more evidence on the feasibility, effectiveness and sustainability of interventions to improve practices and promote responsible antimicrobial use in Asia.