Formal and informal antimicrobial trade and usage in farmed animals of the urban area of Lomé, Togo.

Inappropriate antibiotic use in livestock is a key driver of antimicrobial resistance. Surveillance and prevention efforts in low-income countries are challenged by widespread informal sales and administration. We investigated the antibiotics trade network for farm animals and farmers' antibiotic purchasing and usage behaviors in an urban region with high human and animal population density and prevalence of antimicrobial resistance. We conducted semi-structured interviews with 116 farmers in Lomé, Togo, in areas where multidrug-resistant bacteria had been identified. Using multiple-factor analysis and hierarchical clustering, farmers were categorized based on their livestock production, antibiotic purchase and usage patterns, and alternative disease management strategies. Additionally, 44 antibiotic distributors were interviewed using snowball sampling, allowing us to reconstruct the distribution network and its key actors. Commercial poultry and dog farmers exhibited significantly higher antibiotic consumption per unit of livestock biomass than other farmers, seeking to secure their production. Smallholders used antibiotics less frequently, often replacing them with phytotherapy to minimize costs. Large-scale farmers sourced antibiotics from legal distributors, whereas smallholders combined legal and illegal sources. Market wholesalers and retailers, mostly women, were central to the illegal antibiotic trade, primarily supplied through cross-border smuggling. Our findings highlight the need for antimicrobial resistance prevention programs that consider farmers' specific antibiotic use behaviors and motivations. Addressing the illegal antibiotic trade requires a gender-sensitive approach, as women dominate informal distribution networks. Understanding these dynamics is crucial to designing effective interventions to curb antibiotic misuse and mitigate risks of antimicrobial resistance.