Study Uncovers Sharp Divide in Ghana Over Antimicrobial Resistance Perspectives

A qualitative investigation conducted in Ghana has documented a profound divergence in how rural residents, livestock farmers, and institutional officials understand antimicrobial resistance and the interconnected health of humans, animals, and ecosystems. Fieldwork carried out across semi-urban and rural areas of the Asante Akim North Municipality established that while national and regional institutional actors conceptualize antimicrobial resistance as an urgent global crisis requiring coordinated policy, community members and poultry farmers operate largely outside of this formal biomedical framework. Instead of identifying diminished antibiotic efficacy as a collective biological threat driven by resistant pathogens, local residents and agricultural producers understand medication failure through experiential models based on personal bodily physiology, pharmaceutical strength, and individual treatment mismatches.

The study, published in BMC Global and Public Health as part of the multidisciplinary AMR-B-CHANGE project, gathered comprehensive empirical data to inform the participatory co-design of contextually grounded interventions against antimicrobial resistance. Conducted in a district covering 1,160 square kilometers with 68,186 inhabitants—where agriculture employs 72.7 percent of the workforce and poultry represents over a fifth of livestock activities—the research targeted both the semi-rural administrative capital of Agogo and the remote rural settlement of Bebome. Researchers leveraged the established infrastructure and community relationships of the Kumasi Centre for Collaborative Research in Tropical Medicine, which routinely performs hospital-based surveillance in the locality, to secure multi-sectoral access across community, agricultural, and policy tiers.

Methodologically, the authors combined long-term ethnographic fieldwork with structured socio-epidemiological approaches to triangulate observations, interviews, and analytical perspectives across 103 participants. Anthropological data collection spanned November 2021 to November 2022, during which a Ghanaian research assistant lived immersed in the community, recording daily field diaries across ordinary routines, while investigators conducted semi-structured in-depth interviews across 30 selected households comprising 30 mothers, 13 fathers, and two grandmothers. This was supplemented by extensive ethnographies across six semi-intensive poultry farms housing 500 to 8,000 birds, involving 14 interviews with farm owners and laborers. The socio-epidemiological component added 25 key informant interviews conducted between August 2022 and April 2023 with institutional actors spanning animal, environmental, and human health sectors across district, regional, and national bodies, alongside exit interviews with 11 community members and eight farmers recruited immediately following antibiotic purchases.

The collected interview transcripts and observational field records were categorized into three analytical cohorts—community members, farmers, and institutional actors—and systematically analyzed using thematic analysis across NVivo 14 projects. The integration of qualitative materials revealed that community members had virtually no prior familiarity with the specific concept or biomedical terminology of antimicrobial resistance. When the phenomenon was described using accessible phrasing conveying that an antibiotic can lose efficacy regardless of administered dosage, many participants expressed skepticism that such an issue could occur, noting that antibiotics are widely expected to work for everyone. Although institutional actors frequently positioned resistance as a prominent issue within their administrative agendas, their accounts relied heavily on global policy discourse rather than personal encounters with drug-resistant infections.

Contrasting explanatory frameworks emerged when participants accounted for why pharmaceutical treatments might fail. Community respondents frequently linked treatment failure to perceived physiological incompatibilities, such as a patient’s blood being unable to contain a particular drug, or described the human body becoming accustomed or adapted to pharmaceuticals following frequent use. These models extended beyond antibiotics to encompass medications used for chronic conditions like hypertension, diabetes, and malaria, as well as routine analgesics such as paracetamol. Rather than locating resistance within evolving microorganisms, community members situated treatment failure within an external locus of control, viewing the therapeutic outcome as a matter of individual constitution, drug compatibility, or excessive illness severity overpowering medication.

Poultry farmers exhibited a distinct hybrid explanatory model that merged practical farm management observations with terminology adopted from veterinary officers and educational workshops. While farmers recognized that administering excessive or improper dosages could lead to drugs losing effectiveness, many framed this in terms of the animal’s biological system getting used to the chemical compound or the disease proving stronger than the medicine. Several farmers described rotating or alternating antibiotic formulations as a practical strategy to restore perceived therapeutic strength. Furthermore, although farmers demonstrated widespread awareness of antibiotic withdrawal periods—the interval during which animal products should not be sold or consumed following treatment—they explained that adhering strictly to these waiting windows was frequently economically impossible due to severe financial losses incurred from discarding eggs or withholding stock from market.

In stark contrast, institutional actors across animal, environmental, and human health sectors conceptualized antimicrobial resistance through biomedical mechanisms, emphasizing overuse, underdosing, and weak regulatory enforcement. However, their narratives predominantly cast community members and farmers as responsible for resistance through indiscriminate use, unguided self-medication, and poor adherence. Human health professionals highlighted poor facility-level infection prevention and control as structural drivers while noting that prolonged illnesses caused by resistant pathogens inflict severe economic burdens through lost wages and family caregiving demands. Simultaneously, institutional actors noted that resistance remains largely invisible in clinical settings because attributing a specific death directly to resistance is complicated by underlying comorbidities, leading some officials to describe resistance as an under-prioritized threat that progresses slowly without generating the public urgency seen in other infectious epidemics.

The investigation also documented substantial differences in how stakeholders conceptualize cross-sector health connections and the framework of One Health. Community members and livestock farmers routinely recognized everyday links between human health, animal welfare, and surroundings, pointing out that close contact with livestock, exposure to animal excrement, improper cooking of meat, and unhygienic environments facilitate disease transmission. These grounded observations directly aligned with the core principles of One Health without participants using the formal terminology. Farmers, in particular, emphasized that poor environmental conditions and sanitation within animal pens negatively impacted animal growth and could generate health risks extending to humans through food consumption.

At the institutional level, while participants universally endorsed the One Health paradigm in policy discussions, they reported profound imbalances and systemic fragmentation during practical execution. Respondents revealed that national initiatives remain overwhelmingly dominated by the human health sector, leaving animal health under-resourced and environmental health persistently marginalized and underfunded. Environmental health officials felt excluded from core intersectoral planning, noting that environmental domains are frequently treated merely as passive contamination sinks rather than active arenas driving resistance. Furthermore, institutional respondents noted that national action plans and technical working groups had failed to foster meaningful cross-sectoral collaboration at the municipal and district levels, where human health, agriculture, and environmental departments continue to function in institutional silos without shared operational goals or integrated data systems.

The authors acknowledged important methodological boundaries, noting that the study was conducted within a single municipality and that its findings may not capture the full diversity of perspectives across all regions of Ghana. Additionally, because institutional participants were intentionally selected based on their formal involvement in resistance regulation, research, or management, their perspectives reflect sector-specific expertise rather than general civil service views, with some institutional accounts potentially reflecting socially desirable alignment with official international narratives. Nonetheless, the findings demonstrate that relying exclusively on top-down biomedical campaigns risks failing to achieve sustainable behavioral or systemic change. The researchers concluded that effective national interventions must integrate experiential explanatory models and engage rural communities and farmers as substantive knowledge holders rather than passive targets of external messaging.

Subject of Research: Qualitative assessment of stakeholder perspectives on antimicrobial resistance and One Health in Ghana

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

Article References: Neuerer, M., Baxerres, C., Seferiadis, A. A., Arhinful, D. K., Amponsah, A., Aglanu, L. M., Louis, V. R., Amuasi, J. H., & Souares, A. (2026). Divergent stakeholder perspectives on antimicrobial resistance and One Health in Ghana: a qualitative study. BMC Global and Public Health, 4(1), Article 82. https://doi.org/10.1186/s44263-026-00319-1

Image Credits: AI Generated

DOI: 10.1186/s44263-026-00319-1

Keywords: Antimicrobial Resistance, One Health, Public Health, Ghana, Qualitative Research, Global Health, Antibiotic Use, Veterinary Health, Divergent, stakeholder, perspectives, antimicrobial