Consumption Trends in Antibiotics for Veterinary Use in Rwanda: A Retrospective Study between 2019 and 2021

doi:10.21203/rs.3.rs-1807218/v1

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Consumption Trends in Antibiotics for Veterinary Use in Rwanda: A Retrospective Study between 2019 and 2021

https://doi.org/10.21203/rs.3.rs-1807218/v1

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Background

Estimation of antibiotic consumption in animals is very important to guide decision-making and research related to the control of emergences and spread of antibiotic-resistant bacteria in humans, animals, and the environment. This study aimed at to establishing consumption trends of antibiotics for veterinary purpose in Rwanda between 2019 and 2021. Data were collected from the Rwanda Food and Drugs Authority’s database. Quantities of imported antibiotic active ingredients were computed using the information extracted from the issued import licenses. These quantities were subsequently adjusted per animal biomass.

Results

In total 35 291.39 kg of antibiotics were consumed in Rwanda between 2019 and 2021 with an annual mean of 11 763.80 ± 1 486.91kg. The adjustment of imported quantities of antibiotics per animal biomass revealed that 29.82mg/kg and 25.22 mg/kg were consumed in 2019 and 2020 respectively. A decline in antibiotic consumption was noted in 2020 (p-value > 0.05). Most of the imported antibiotics were indicated for food-producing animals (35 289.36 kg or 99.99% of the imported antibiotics). Tetracycline (17 768.65 kg), followed by sulfonamides (7 864.99 kg) and aminoglycosides (4 071.12 kg) were the most imported antibiotics over the studied period. It was noted that 78.93% of the imported antibiotics were categorized as highly important antimicrobials for human medicine.

Conclusion

This study establishes a generalized overview of the consumption of antibiotics for veterinary use in Rwanda. Results can serve as guidance to control antibiotic misuse and to make correlation between antibiotic consumption and occurrence of antibiotic resistance.

Antimicrobial Use

Antimicrobial Consumption

Antimicrobial Resistance

Veterinary use

Rwanda

Antibiotics have made a substantial contribution to the management of infectious diseases in humans and animals since their discovery in the twentieth century. Unfortunately, since then, the number of disease-causing agents (pathogens) resistant to common antimicrobials has not stopped increasing. Antimicrobial-resistant bacteria have emerged and spread over the world, posing a global danger to the control of infectious diseases in humans and animals (1). The World Health Organization (WHO) describes antimicrobial resistance (AMR) as a phenomenon that happens when antimicrobials, such as antibiotics, become ineffective vis a vis to microorganisms (such as bacteria), whereby infection persists in the body (2). According to the world bank, if no action is taken, in worst-case scenario, the world will lose 3.8% of its annual Gross Domestic Product with millions of deaths every year by 2050 and low-income countries will suffer most (3). Irrational and overuse of antimicrobials are cited as significant factors in the selection and emergence of antimicrobial-resistant bacteria (4–7). Hence, the control and prudent use of antibiotics should be encouraged to decrease the occurrence and emergence of antimicrobial resistance. In different countries, the promotion of careful use of antimicrobials in animals has been linked to a decrease in the occurrence of antimicrobial-resistant bacteria (8–10).

In Rwanda, the 2018 year report for a joint external evaluation of International Health Regulations (IHR) core capacities of Rwanda conducted by WHO, identified antimicrobial resistance as a major public health problem with high levels of inappropriate use of antimicrobials in the human and animal sectors (11). Like many other African countries, Rwanda has developed and endorsed a national action plan on antimicrobial resistance in line with the global action plan on AMR promoted by the tripartite of the Food and Agriculture Organization of the United Nations (FAO), the World Organization for Animal Health (WOAH founded as OIE) and the WHO (2). The fourth strategic objective of the Rwandan national action plan on antimicrobial resistance aims to optimize the use of antimicrobial agents in Human and Animal Health through the tracking of antimicrobial consumption and the promotion of the prudent use of these molecules to preserve their sustainable efficacy (12). The national action plan was approved in the middle of 2021. However, its implementation is still at its early stage. Besides, although some studies have highlighted a high occurrence of antimicrobial-resistant bacteria in humans (13–15) and animals (16, 17), no comprehensive studies have been conducted to estimate the antimicrobial consumption in animals in Rwanda. Baseline information on antimicrobial consumption in animals is important for guiding decision-making on the development of specific, objective, and evidence-based interventions to promote prudent use of antibiotics in animals and control the emergence and spread of antimicrobial-resistant bacteria. In addition, such data are helpful when assessing trends in the occurrence of antimicrobial resistance in a country (18).

This study was retrospectively conducted to gather information on the national consumption of antibiotics for veterinary use in Rwanda to generate the evidence needed for the development, implementation, and evaluation of novel ways to optimize the use of antimicrobial drugs for animals.

Antibiotics were ranked among the most frequently imported veterinary medicinal products in Rwanda. In total 1 574 permits were issued between 2019 and 2021 to import veterinary medicinal products to Rwanda. Anthelmintic products represented the majority of imported veterinary medicinal products followed by antibacterial products while antipsychotics were rarely imported during this period (Table 1).

Table 1

Frequencies of imported Veterinary Medicinal Products per year of importation
	Frequencies of imports of veterinary medicinal products
Category of Veterinary Medicinal Products	2019	2020	2021	Grand Total
Anthelmintic	136	210	146	492
Antibacterial	147	138	168	453
Ectoparasiticides	46	53	37	136
Antiprotozoal	36	43	46	125
Vitamin supplements	33	33	28	94
Hormones	36	6	16	58
Endectocide	13	14	24	51
Anti-inflammatory	12	14	17	43
Analgesics	7	7	21	35
Mineral supplements	8	13	11	32
Corticosteroids	4	8	11	23
Minerals and vitamins supplements	5	4	4	13
Hypnotics and sedatives	1	2	3	6
Anesthetics	0	3	1	4
Antihistamines	1	0	2	3
Diuretics and Antioxidants	1	1	0	2
Herbal oil	0	1	1	2
Anticholinergics	0	1	0	1
Antipsychotics	0	0	1	1
Grand Total	486	551	537	1 574

1. Antibiotics For Veterinary Use Imported Into Rwanda Between 2019 And 2021

In total 453 antibacterial veterinary products equivalent to 35 291.39 kg were imported between 2019 and 2021 (Fig. 1). The annual mean of imported antibiotics was 11 763.80 ± 1 486.91 kg. The consumption of antibiotic APIs was found not statistically different between the three years of importation (p-value = 0.54).

In each year, antibiotic importation per month was statistically significant (Fig. 2). In 2019, high consumption of antibiotics was noted in September (p-value = 0.02), in 2020 most of the antibiotics were imported in October (p-value = 0.0001), and in 2021, the majority of antibiotics were imported in June (p-value = 0.0005).

The majority of imported antibacterial products were intended to be used in food-producing animals (p-value = 0.000) through the Parenteral route of administration (p-value = 0.000) as presented in Table 2.

Table 2

Imported antibiotics (kg of active pharmaceutical ingredients) per target animal and route of administration
Route of Administration (p-value < 0.05)	kg of APIs (p-value < 0.05)
Route of Administration (p-value < 0.05)	Companion and Food producing animals	Companion animals	Food-Producing Animals	Grand Total
Parenteral	3.46	0.00	18 912.63	18 916.09
Oral	0.00	2.03	16 207.13	16 209.16
Other Routes	0.00	0.00	84.55	84.55
Topical	32.15	0.00	49.44	81.58
Grand Total	35.60	2.03	35 253.76	35 291.39

Other routes of administration include among others the intramammary route and intrauterine route. The Differences in kg of active pharmaceutical ingredients per targeted animals and per route of administration are statistically significant. The first column “Companion and Food producing animals” represent antibiotic APIs that can be used in both companion and Food producing animals.

Antibiotics for animal use imported into Rwanda were dominated by tetracycline followed by sulfonamides and aminoglycosides (Table 3). No statistically significant trend in the importation of antibiotic APIs per year was observed.

Table 3

Quantities of imported antibacterial active ingredients by antibiotic class and year importation
				Quantities of antibiotic active pharmaceutical ingredients imported in Kg
Class of Antibiotics	Antibiotic Active Ingredient	ATCvet Code	2019		2020		2021		Correlation coefficient Rho (p-Value)			The total quantity of API	Total quantity by Class of Antibiotic
Tetracycline	Oxytetracycline	QJ01AA06	5 321.09		5 201.43		6 628.62		0.03(0.511)			17 151.15	17 768.65
	Tetracycline	QJ01AA07	4.00		28.00		30.50		0.57(0.220)			62.50
	Doxycycline	QJ01AA02	249.32		102.80		202.88		-0.01(0.718)			555.00
Sulfonamides	Sulfadimidine	QJ01EQ03	2 717.41		2 530.65		2 449.23		0.01(0.694)			7 697.29	7 864.99
	Sulfadoxin	QJ01EQ13	21.10		38.38		67.14		-0.00(0.885)			126.62
	Sulfamethoxazole	QJ01EQ11	12.00		7.20		13.00		-0.00(0.9087)			32.20
	Sulfadiazine	QJ01EQ10	0.00		2.88		6.00		0.03(0.440)			8.88
Aminoglycosides	Dihydrostreptomycin	QJ01GA90	1 472.74		799.98		1 326.72		-0.11(0.01)			3 599.44	4 071.12
	Streptomycin	QJ01GA01	34.14		21.96		215.98		0.02(0.589)			272.07
	Gentamicin	QJ01GB03	9.60		21.74		83.08		0.07(0.108)			114.42
	Neomycin	J01GB05	55.43		19.88		9.88		-0.05(0.270)			85.19
Beta-Lactams	Penicillin G	QJ01CE01	890.78		483.76		912.21		-0.08(0.06)			2 286.75	2 779.45
	Amoxicillin	QJ01CA04	164.137		106.37		191.415		-0.03(0.465)			461.922
	Amoxicillin-CLA	QJ01CR02	0.00		1.2		0.832		0.05(0.265)			2.032
	Ampicillin	QJ01CA01	0.00		0.23		0.00		-0.00(0.932)			0.23
	Cloxacillin	QJ01CF02	7.33		12.84		8.35		-0.07(0.106)			28.52
Macrolides	Tylosin	QJ01FA90	648.04		221.17		334.14		-0.03(0.424)			1203.35	1 296.14
	Erythromycin	QJ01FA01	33.60		21.00		37.80		0.00(0.87)			92.40
	Spiramycin	QJ01FA02	0.00		0.39		0.00		-0.00(0.904)			0.39
Polypeptides	Colistin	QJ01XB01	340.87		89.38		335.87		-0.03(0.519)			766.11	766.11
Fluoroquinolones	Enrofloxacin	QJ01MA90	90.20		169.93		96.26		0.04(0.299)			356.39	356.39
Nitrofurans	Furazolidone	QJ01XE90	75.00		225.00		50.00		-0.00(0.894)			350.00	350.00
Trimethoprim	Trimethoprim	QJ01EA01	6.62		9.69		17.23		0.00(0.919)			33.54	33.54
Pleuromutilins	Tiamulin	QJ01XQ01	0.00		5.00		0.00		0.03(0.447)			5.00	5.00
Grand Total				12 153.40		10 120.87		13 017.13		− 0.00(1)	35 291.39			35 291.39

ATCVet: Anatomical therapeutic chemical classification system for veterinary medicine

The results show that 78.93% of the imported antibiotics for animal use are classified as highly important for human medicine while 19.7% are critically important antibiotics for human medicine (Fig. 3).

1.1. Adjustment On Quantities Of Antibiotic Apis By Total Animal Biomass

The total animal biomass in 2019 and 2020 is equivalent to 407 501 036.25 kg and 401 202 107.80 kg respectively. In 2019 and 2020, the total animal biomass was dominated by cattle followed by goats (Fig. 4).

The adjustment of quantities of antibiotics for food-producing animals imported to Rwanda showed that the mg of antibiotics per kg of animals slightly decreased between 2019 and 2020. Table 4 presents the quantities of antibiotic APIs imported in Rwanda adjusted by total animal biomass.

Table 4

Quantities of antibacterial actives ingredients imported to be used in food-producing animals adjusted by total animal biomass
	Year of importation
	2019	2020
Quantity of antibiotics imported for food animal (mg)	12 153 397 960	10 119 670 530
Total Animal biomass (kg)	407 501 036.25	401 202 107.80
Adjusted Quantities of antibiotics (mg/kg)	29.82	25.22

This study aimed to establish trends in the consumption of antibiotics for veterinary use in Rwanda. With no pharmaceutical industries for veterinary antibiotic manufacturing in the country, all antibiotics used in animals in Rwanda are solely imported. Hence, the results of this study reliably portray the consumption of most of antibiotics for veterinary use in Rwanda.

It was noted that anthelmintic and antibacterial products are the major veterinary medicinal products imported and this may inform on the animal diseases most frequently encountered in animals in the country (parasitic and bacterial infections). Disease control strategies should be emphasized to minimize the use of these veterinary medicinal products and preserve their efficacy.

A difference between quantities of antibiotic active ingredients for veterinary use imported into Rwanda and quantities imported in other countries in the region was noted. It was not possible to find data on the consumption of antibiotics for veterinary use in Uganda, Burundi, South Sudan and Republic Democratic of Congo. However, compared to data on antibiotic consumption in Tanzania and Kenya, quantities of antibiotics consumed in Rwanda are relatively quiet minimal. In Tanzania, it was reported that between 2010 and 2017, 12 147 491.49 kg of antibiotics were consumed with an annual mean of 1 518 436.44 kg of antibiotics for veterinary use (19). In Kenya, the mean annual antimicrobial consumption was estimated to be 14 593.66 kg between 1995 and 1999 (20). The annual consumption of antibiotics for veterinary use in Rwanda appears to be low compared to the consumption in two countries (Kenya and Tanzania) in the East of Africa. This can be explained by the fact that the antibiotic consumption is proportionate to a country's animal population (21). In fact, the animal population of Rwanda is relatively low when compared to Tanzania and Kenya (22). For instance, Tanzania and Kenya are among the countries with the largest cattle population in sub-Saharan African countries (23). On the other hand, in Cameroon, on average 36 280 kg of antibiotics are imported annually to be used in food-producing animals (24). In South Africa, 1 000.5 kg and 1 638 kg of antimicrobials for animal use were imported into the country in 2014 and 2015 respectively (25).

A decline in antibiotic consumption was observed in 2020 due to the pandemic of Covid-19 that impacted many areas including animal health. In each year, the importation of antibiotics was statistically different between months. Results show that months with high and low importation differ per year. Hence, there are no specific trends in the importation of antibiotics for veterinary use within a year. Each year is unique.

Most of the antibiotics imported for veterinary use are intended to be used in food-producing animals. This correlates with the report of WOAH where most of the African countries that managed to distinguish antimicrobial quantities by animal groups provided data for antibiotics used in food animals (26). This represents an area of vigilance as food-producing animals can be incubators and spreaders of antimicrobial-resistant bacteria if the antibiotics are not rationally used in these animals (27).

Contrary to the situation in Cameroon (24), most of the imported antibiotics are indicated to be used via the parenteral route of administration. This implies that most imported antibiotics are for systemic treatment that leads to a distribution of antibiotics in muscle, milk, and other consumed parts of an animal. Residues of antibiotics in food products can be anticipated. Antibiotic residues in food for human consumption are a public health concern, as these residues at a sub-therapeutic dose can promote the selection and emergence of antibiotic-resistant bacteria in humans (28). Therefore, it is crucial to emphasize awareness campaigns to sensitize the respect for the withdrawal period in food-producing animals.

Tetracycline followed by sulfonamides and aminoglycosides were the most imported antibiotics for veterinary use in Rwanda. Tetracycline antibiotics remain reported as the most frequently consumed antibiotics for veterinary use. This is true in Tanzania (19), Kenya (20), Cameroon (24), in South Africa (25) and many other African countries as well as the rest of the world (26). According to the WOAH, some African countries explained that tetracycline is the major class of antibiotic used in animals because of its low cost (26).

The elevated consumption of tetracycline in food-animal can explain the high level of prevalence of bacteria-resistant to tetracycline reported in different food-producing animals in Rwanda (29).

The categorization of imported antibiotics based on the WHO levels of importance of antimicrobial for Human Medicine (30) showed results similar to results reported in Cameroon (24). The majority of imported APIs, such as tetracycline, sulfonamides, and penicillin, were classified as highly important antibiotics for human medicine. But some of the imported antibiotics as such as all imported aminoglycoside, erythromycin, or Colistin were classified as critically important antibiotics for human medicine. This trend is also reported in other countries where highly important antibiotics for human medicine such as tetracycline and penicillin are widely used in food-producing animals (31). Cases of using critically important antibiotics for human medicine have also been reported in several countries (32). The WHO recommended a reduction of using medically important antibiotics in food-producing animals (33). This recommendation was well received by different stakeholders in the industry of food animals (34).

For a better comparison between quantities of antibiotic APIs for veterinary use consumed in Rwanda and quantities of antibiotic APIs consumed globally or in other countries, quantities were adjusted by animal biomass. It was noticed that 99.9% of imported antibacterial products were intended to be used in food-producing animals. Cattle, goats, pigs, sheep, and chickens are the main food-producing animals in Rwanda (35) and after noticing that most of the imported antibiotics were indicated to be used in these animal species, they were the only species included in the calculation of the total animal biomass.

Quantities of antibiotics adjusted by the total animal biomass were found not different from the data reported by WOAH for the Africa region. The fifth report on antimicrobial agents used in animals showed that for the 24 African countries that participated in the data collection, the estimated total animal biomass was dominated by bovine followed by sheep and goats (26). In this study, the total biomass was dominated by cattle followed by goats, pigs, and sheep.

The WOAH report states that for the African region the number of antibiotics consumed adjusted by animal biomass ranged between 32.72 and 25.93 mg/kg between 2014 and 2017 (26). Results obtained from this study (29.82 and 25.22 mg/kg) fall in the WOAH reported range. However, these results remain very low compared to other regions of the world where adjusted antibiotics quantities vary between 57.42 mg/kg in Europe and 192.24 mg/kg in Asia (26). In 2015, Van Boackel and collaborators reported that in Africa the only remarkable spots of consumption of antimicrobials in food-producing animals were in the Nile Delta and South Africa (36). In 2017, it was estimated that the African consumption of antimicrobials for food animals will increase by 37% in 2030 (37). Hence, surveillance of antimicrobial consumption is very encouraged to control the overuse of these medicinal products.

The foremost limitation of this study is that analysed date were obtained from the national import records which cannot give a clear picture of how these antibiotics were used in animals such as the respect to the indicated dose, the duration of treatment, use in the right animal species, use of antibiotics for therapeutic, for prevention or growth promotion, and so on.

Additionally, only legally imported antibiotics were covered by the study. However, as the country is enforcing, among others, the implementation of high standards and efficient control of veterinary medicines on the market, there may be some antibiotics imported through unofficial circuits, whose data if included would change the results.

Quantities of antibiotics imported in Rwanda were not adjusted by each animal species biomass because some antibiotics are indicated to be used in more than one animal species. Hence, the quantities of antibiotics imported were adjusted by the total animal biomass of food-producing animals without any stratification in specific animal species.

Quantities of antibiotics imported in 2021 were not adjusted by animal biomass because only data for 2019 and 2020 were available in the FAOST database.

This study establishes a baseline of imported antibiotic consumption in animals in Rwanda. Besides, this study is the first of its kind in the country to offer information on animal antibiotics intake. It forms a basis for future research, such as establishing a link between antibiotics use in animals and the occurrence of antibiotic-resistant bacteria in both animals and people. This study generates data that will assist in the promotion of antibiotics stewardship in animals and the control of antibiotic resistance in the country.

1. Source of data

Retrospective data on imported veterinary medicinal products in Rwanda were collected from database of Rwanda Food and Drugs Authority (Rwanda FDA), in the division of Food and Drugs Import-Export Control. Import permits issued by Rwanda FDA between 2019 and 2021 January to December period were screened to extract information on imported veterinary medicinal products. The date of importation, the brand name of the product, the active pharmaceutical ingredients (APIs), the pack size, and the number of imported products were extracted from import permits. Additional information such as target species, the strength of APIs, the route of administration, and the dosage form was obtained from the Rwanda FDA list of authorized veterinary medicinal products (38), summaries of product characteristics, and manufacturers’ product catalogs.

2. Estimation of Animal Biomass and Adjustment of Antibiotic quantities by Animal Biomass

To be able to make comparisons between the consumption of antibiotics for animal use in Rwanda and the consumption of antibiotics in other countries, the imported amounts of antibiotics were adjusted to the total animal biomass.

A focus was put on food-producing animals, as according to the collected data, most antibiotics imported into Rwanda are intended to be used in food-producing animals. Only cattle, sheep, goats, pigs, and chickens were considered in this study. Poultry was narrowed to chicken as they represent the majority of poultry species reared in Rwanda. Rabbits were excluded because, based on the collected data, antibiotics intended to be used in rabbits in Rwanda are very few.

The animal biomass is defined as the total weight of live domestic animals in a given area and year, that is used as a proxy to represent animals that are likely exposed to the amounts of antibiotics reported (26). The Animal Biomass was calculated following the method described by the WOAH (26). For that, data on the census population of animals, quantity of meat production/year, and heads of animals slaughtered/year were retrieved from the FAOSTAT database (39). Only data for 2019 and 2020 were used in this study as data for 2021 were not available in the FAOSTAT database.

3. Data Analysis

Data were compiled in Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington, USA). Only quantities of antibiotic active ingredients were considered in this study.

The quantity of antibiotic APIs in each product was calculated in milligrams (mg) by multiplying the strength of the API by the pack size of the products, and by the total number of imported products. Where strengths were given in International Unit (IU), %W/W, or % W/V, the latter were converted in mg using the conversion factors as per the WOAH’s guidelines (26). The total quantities of imported antibiotic APIs obtained in mg was finally converted into kilograms (kg).

Adjustment of Antibiotic quantities by Animal Biomass was done using the formulas below.

$$\text{Carcass Weight} \left(\text{kg}\right)\text{=}\frac{\text{Weight of species slaughtered} \left(\text{kg}\right)}{\text{Number of species slaughtered} \left(\text{Heads}\right)}$$

$\text{Live Weight }\left(\text{Kg}\right)\text{= }\frac{\text{Carcass weight }\left(\text{kg}\right)}{\text{Conversion Coefficient K}}$

Conversion Coefficients K were extracted from the Eurostat Estimates (40).

$$\text{A}\text{n}\text{i}\text{m}\text{a}\text{l} \text{B}\text{i}\text{o}\text{m}\text{a}\text{s}\text{s} \left(\text{K}\text{g}\right)=\text{L}\text{i}\text{v}\text{e} \text{W}\text{e}\text{i}\text{g}\text{h}\text{t} \left(\text{k}\text{g}\right) \text{x} \text{C}\text{e}\text{n}\text{s}\text{u}\text{s} \text{A}\text{n}\text{i}\text{m}\text{a}\text{l} \text{P}\text{o}\text{p}\text{u}\text{l}\text{a}\text{t}\text{i}\text{o}\text{n}$$

$$\text{Total Animal Biomass=Cattle biomass + Goats Biomass + Pigs Biomass+ Chickens Biomass}$$

To calculate the quantities of antibiotic APIs imported in Rwanda adjusted to the total animal biomass, the formula below was used.

$$\text{A}\text{d}\text{j}\text{u}\text{s}\text{t}\text{e}\text{d} \text{q}\text{u}\text{a}\text{n}\text{t}\text{i}\text{t}\text{a}\text{t}\text{i}\text{v}\text{e} \text{d}\text{a}\text{t}\text{a} \text{o}\text{n} \text{i}\text{m}\text{p}\text{o}\text{r}\text{t}\text{e}\text{d} \text{a}\text{n}\text{t}\text{i}\text{b}\text{i}\text{o}\text{t}\text{i}\text{c} \text{A}\text{P}\text{I}\text{s}=\frac{\text{Q}\text{u}\text{a}\text{n}\text{t}\text{i}\text{t}\text{y} \text{o}\text{f} \text{A}\text{n}\text{t}\text{i}\text{b}\text{i}\text{o}\text{t}\text{i}\text{c} \text{A}\text{P}\text{I} \left(\text{m}\text{g}\right)}{\text{T}\text{o}\text{t}\text{a}\text{l} \text{A}\text{n}\text{i}\text{m}\text{a}\text{l} \text{B}\text{i}\text{o}\text{m}\text{a}\text{s}\text{s} \left(\text{k}\text{g}\right)}$$

Imported antibiotic APIs were grouped into antibiotic classes based on the World Health Organization Anatomical Therapeutic and Chemical for veterinary medicines system (WHO ATCvet) (41). Furthermore, imported antibiotic APIs were classified based on the WHO levels of importance of antimicrobials for Human Medicine (30).

Microsoft Excel 2016 (Microsoft Corporation, Redmond, Washington, USA) was used to perform descriptive statistics. R 4.1.3 (R Foundation, Boston, Massachusetts, USA) was used to perform the Kruskal – Wallis test to assess the trends of importation of antibiotic APIs according to the month of importation while the Spearman correlation test was performed to compare the quantities of imported antibiotics per year of importation. Statistical significance was defined as a p-value of less than 0.05.

Ethics approval and consent to participate

Not applicable

Consent for publication

Not applicable

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This study was not funded by any governmental, private, or non-profit funding bodies.

Authors' contributions

The study conceptualization: RM, RH, AS, CK. Data collection: NB. Data analysis: RM. Writing, reviewing, and editing the manuscript: RM, RH, IEM, AS, TH, JK, VH, CK, EB. Approval: EB

Acknowledgements

Not applicable

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Consumption Trends in Antibiotics for Veterinary Use in Rwanda: A Retrospective Study between 2019 and 2021

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Abstract

Background

Results

Conclusion

Figures

Background

Results

1. Antibiotics For Veterinary Use Imported Into Rwanda Between 2019 And 2021

1.1. Adjustment On Quantities Of Antibiotic Apis By Total Animal Biomass

Discussion

Conclusion

Methods

1. Source of data

2. Estimation of Animal Biomass and Adjustment of Antibiotic quantities by Animal Biomass

3. Data Analysis

Declarations

References

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