DAR ES SALAAM, Tanzania—At a smoky kitchen in the port city of Dar es Salaam, none of the customers jostling to place their orders knows that the irresistibly tasty roast chicken may be harbouring bacteria that could make them sick.

“I don’t think poultry farmers would do anything likely to cause harm,” said 34-year-old Lilian Kiswale a regular customer at this popular fast-food joint.

However, what is not clear to Kiswale, is that strains of bacteria that are resistant to antibiotics have repeatedly been found in chickens at farms where city’s street kitchens source their poultry products.

“None of our customers has ever complained about the smell of antibiotics in the food we have prepared,” said Kelvin Massawe who works as a chef at the chicken restaurant that is a culinary delight in the neighbourhood. 

But it’s not about antibiotics ruining the taste of roast chicken. The antibiotic-laced food that poultry farmers in Tanzania give to their birds, ostensibly to increase muscle weight quickly and keep infections at bay, poses a threat to humans as well.

According to a recent study by Tanzania’s Muhimbili University of Health and Allied Sciences (MUHAS), excessive amounts of antibiotic residue had been found in broiler chicken tissues – a perfect condition for antimicrobial resistance (AMR).

Using the liver samples of 84 commercial broiler chickens, the researchers found that 100% had the antibiotic tetracycline – and 90% at levels that exceeded acceptable daily limits. In addition, 21.4% of the samples also had sulphonamide, although this was within the maximum limit, according to the study, which was published in the journal, Antibiotics.

Worse still, researchers say that poultry farmers have unrestricted access to prescription-only antibiotics including tetracycline, sulphonamides, penicillin, aminoglycosides and macrolides.

This was confirmed by shop owner Jesca Anthony, who said that she sells antibiotics, without prescriptions to farmers.

“Random use of antibiotics in animal feeds heighten the risk of drug resistance not just to animals but in humans as well,” Professor Mecky Matee, head of microbiology at MUHAS and the study’s lead author, told Health Policy Watch.

“The use of antibiotics as growth promoters for chicken should be banned,” Matee stressed.

Antibiotics are losing their power

When an antibiotic is used, it wipes out susceptible bacteria, leaving behind resistant ones. These resistant bacteria can grow and become dominant, and pass from chicken products to humans who eat or handle the meat. Once inside a person, these resistant bacteria can take over the colon, which is then unable to fight infections.

Antibiotics are increasingly losing their efficacy due to indiscriminate use in humans and for stimulating animal and birds’ growth.

The rise in drug-resistant bacteria has the potential to inflict a devastating human and economic toll globally, according to the United Nations.

According to the most comprehensive estimate of the global impact of antimicrobial resistance (AMR), published in The Lancet in January 2022, an estimated 1.2 million people died in 2019 from antibiotic-resistant bacterial infections – more deaths than those from HIV/AIDS or malaria.

“Many types of common antibiotics are no longer effective enough to treat bacteria, in many cases patients need hospitalisation,” said Hellen Sabuka, a senior epidemiologist at Shree Hindul Mandal Hospital in Dar es Salaam.

Sabuka urged Tanzania’s health authorities to adopt strict regulations and control on the use of antibiotics in animal production.

Although Tanzania has policies and guidelines for the use of antibiotics in animal feed, such policies are poorly enforced due to weak systems for food and agricultural productions.

In Dar es Salaam, one of Africa’s fastest-growing cities and home to 5.8 million inhabitants, poultry farmers routinely mix an array of human antibiotics into chicken feed to try to ensure they grow faster and don’t get sick.

It is a humid Sunday evening at Kibamba, a suburb in the western part of Dar es Salaam, and Salma Libuhi is busy mixing a concoction of medicines into rice husks to feed her caged chickens.

Amid smouldering heat, she methodically mixes in a cocktail of three antibiotics— oxytetracycline, doxycycline and enrofloxacin – and sets the food in cans.

“When they eat this food, they grow faster,” she told Health Policy Watch. For the 38-year-old mother of four, poultry farming is her livelihood. In 2017, quit her job as a teacher and ventured into entrepreneurship.

“Raising chicken is very profitable,” she said.

To educate herself about animal husbandry, Libuhi joined a whatsapp groups where she gets all the information about diseases and antibiotics.

“I never consulted a vet. The information I get from the group is enough,” she said.

 At Libuhi’s farm, broiler chickens usually take six weeks to reach market weight. Once they’ve reached the proper size and weight she catches each chicken by hand and transfers them to holding cages ready to be sold.

Unlike wild chickens that traverse a range of habitats as they forage for seeds, insects and fresh leaves, broiler chicken are often kept in overcrowded, poorly ventilated and unhygienic shacks.

Lack of controls in Africa

Across Africa, antibiotics are heavily in the farming of cows, pigs and chickens to fight infections and promote growth. With the indiscriminate use of antibiotics, particularly in agriculture for stimulating animal and birds’ growth, these essential medicines are losing their efficacy.

“Many types of common antibiotics are no longer effective enough to treat bacteria, in many cases patients need hospitalisation,” said Hellen Sabuka, a senior epidemiologist at Shree Hindul Mandal Hospital in Dar es Salaam.

Sabuka urged Tanzania’s health authorities to adopt strict regulations and control on the use of antibiotics in animal production.

While over-use of antibiotics as growth promoters is not a new phenomenon, global experts think preventing drug-resistant bacteria that kill millions of people every year, requires a coordinated approach.

Mohan P. Joshi, technical lead for antimicrobial resistance and global health security at the non-profit, Management Sciences for Health, said the overuse of antimicrobials in animals, especially as growth-promoters in food-producing animals, is common in many countries.

 “In some countries, the proportion [of antibiotics] used in the animal sector is as high as 80% of the total antimicrobials consumed. Alternatives such as good animal husbandry, vaccinations, and biosecurity measures including hygienic practices are critical farming approaches that can help reduce antimicrobial use in animals raised for food,” he said.

While 144 countries have national plans to combat AMR, according to a 2021 World Health Organization (WHO)  report, Joshi says sectors differ in the amount of progress they’ve made, with the human health sector generally making the most progress and the animal sector lagging.

“We need collaborative, multisectoral coordination to address public health threats at the intersection of humans, animals, and the environment. A One Health-focused approach is the only way to effectively address this widespread issue,” Joshi said.

According to him, the fight against AMR needs coordinating bodies with adequate funding, political support and authority to act.

“Countries need to establish functional multi-sectoral task forces to contain AMR that include high-level government officials and stakeholders from both human and animal health, along with the agricultural, environmental and food sectors, and ensure that such bodies are effectively facilitating One Health coordination, helping build capacities of local stakeholders, and mobilising diversified funding,” he said

In 2019, five million human infections were associated with bacterial antimicrobial resistance worldwide, including more than 1.2 million human deaths attributable to bacterial AMR. The burden was highest in sub-Saharan Africa and South Asia, with children below five years of age the most affected.

Pushed by the rising demand for cheap poultry products, the broiler value chain in Tanzania, is a big user of antibiotics. Most poultry farmers in Tanzania treat chicken with a concoction of antibiotics often without consulting veterinary doctors.

Despite the growing adversity, global experts are cautiously optimistic about prescription-only system where veterinarians will have the upper hand in dispensing drugs used in animal production.

Thomas Van Boeckel, from the public research university, Zurich ETH, said the best way to curb antibiotic use in animals is to move to a prescription only –system where only trained veterinarian would be authorized to sell the antibiotics rather than retail shop owners.

“However, even in Switzerland where such a system is in place, this does not resolve all problems because vets may still have a financial conflict of interest in prescribing for profit,” Boeckel said.

He says that a better solution would be to “remove the profit margin from vets on drug prescription,” as is the case in Sweden.

Meanwhile, Emma Berntman, senior engagement specialist at FAIRR initiative, said low and middle-income countries, including Tanzania have the largest share of global antimicrobial consumption in animals and agriculture, due to the routine use of antimicrobials in farming for growth promotion and prophylaxis.

She blamed the countries’ lack of checks and balances and low awareness on overuse of antibiotics.

“Tanzania is no exception to this. The country lacks regulation that is sufficient to adequately address the issue of excessive antimicrobial use and antibiotic are cheap and widely available,” said Berntman. FAIRR is an investor-run initiative to address threats to the global food supply.

According to her, even when regulation exists in the emerging market, it can be hard to enforce when there is a lack of access to veterinarians and poor awareness of the impacts of overusing antibiotics.

“On-the-ground initiatives are needed to help support farmers to reduce their dependence on these drugs,” she stressed.

Growing appeal of organic products

Although Switzerland launched an AMR strategy in 2015, FAIRR experts say the highest priority critically important antibiotics (HPCIAs) including fluoroquinolones, are still excessively used in farms, notably in broiler production, with authorities warning of high levels of resistance.

“These antibiotics are deemed ‘the last line of defence’ in human medicine and are the only antibiotics available to treat certain bacterial infection. If they become ineffective, it poses a significant threat to human health,” Berntman said.

“Resistant bacteria developed in broilers can spread to humans through direct contact with the birds, eating chicken or via the environment. There is also a risk to flock health due to the reduced efficacy of antimicrobials used to treat them.”

Despite the growing threat, experts see glimmer of hope in reducing the use of antibiotics in broiler farms and other antibiotics used in human medicines.

“The government can support reductions by further restricting the use of antibiotics in animals in line with the latest EU regulations, so that antibiotics can only be used to treat infections and routine use is prevented,” Berntman said.

Moreover, Berntman said the government can facilitate antibiotic stewardship activities to support the adoption of alternatives to antimicrobials including vaccination programmes and improved nutrition.

According to Berntman the rising awareness of the risk of AMR in Europe and North America has triggered a surge in demand for products associated with or lower antibiotic use.

“Many consumers are willing to pay a price premium to purchase organic chicken or chicken raised without antibiotics,” she said.

Approximately 60% of broilers in the US are now raised without antibiotics, according to Berntman. Moreover, the number of broiler chicks receiving antibiotics in the hatchery has dropped by 90% to nearly zero.

 “It is important that poultry producers improve animal welfare, vaccinate their flocks, and implement routine health monitoring programmes to meet consumer demand for broilers raised with less or no antibiotics while simultaneously creating environments where healthy flocks can be raised no antimicrobials required without impacting animal welfare,” Berntman said.

But for chicken lovers in Dar es Salaam, antibiotic-free roast chicken meat is probably a distant dream.

Image Credits: Peter Mgongo.