Behavioral and economic drivers of antimicrobial use in commercial poultry farms in Bangladesh: A qualitative study.

Antimicrobial resistance (AMR) is an emerging public health challenge globally, with poultry production recognized as a major contributor due to widespread and often indiscriminate use of antimicrobials. In Bangladesh, limited evidence remains on the social, economic, and behavioral factors shaping antimicrobial use at the farm level. Hence, this study aimed to explore the underlying drivers of antimicrobials in commercial poultry farms and to understand farmers' perceptions and decision-making process in antimicrobial use. We conducted an explorative qualitative study among poultry farms across three districts of Bangladesh between July and December 2021. Data were collected from 60 poultry farmers through in-depth interviews. Interviews were audio recorded with consent, transcribed verbatim in Bangla, and analyzed using inductive thematic coding based on the grounded theory approach. Farmers commonly reported administering antimicrobials for perceived illness without prior disease diagnosis or veterinary consultation. They believe that antimicrobials have no harmful side effects and do not pose a risk of residues being transmitted to humans through poultry products. Antimicrobials were routinely used throughout the production cycle, often within 14 days before data collection. Antimicrobial use was strongly influenced by economic and relational factors, particularly farmers' reliance on poultry dealers who supplied chicks, feed, and medicines on credit. These credit-based arrangements created economic dependency, requiring farmers to sell poultry back to the same dealers and granting dealers substantial influence over decisions regarding the choice and frequency of antimicrobial use. Commercial influence from pharmaceutical representatives further shaped antimicrobial practices through product promotion and brand-driven recommendations. Additionally, veterinarians, including those affiliated with pharmaceutical companies, occasionally visited farms and prescribed multiple medicines, further influencing antimicrobial use practices. Farmers' self-belief and experiential confidence also contributed to the continued use of multiple antimicrobials, despite awareness of potential risks. This study reveals prevalent and largely unregulated antimicrobial use in commercial poultry farms in Bangladesh, driven by farmer perceptions, economic dependency on dealers, and limited veterinary oversight. Addressing AMR in poultry production will require coordinated One Health interventions, including strengthened regulation of antimicrobial distribution and access, improved veterinary services, and targeted farmer education to promote responsible antimicrobial use and protect animal and human health.