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

Abstract

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.

1. Introduction

Poultry meat production has risen significantly in South and Southeast Asia over recent decades [1]. In Bangladesh, poultry products account for 20% of total protein consumption, with chickens comprising 90% of the poultry population [2]. Bangladesh has two main poultry production systems: commercial and backyard. Commercial poultry farming, which includes broiler (meat) and layer (egg) production, is expanding rapidly to meet rising demand [3]. The primary challenge faced by commercial poultry producers is the prevalence of diseases [4]. Avian influenza, in particular, had a severe impact on commercial poultry production in Bangladesh, leading to a reduction in the number of commercial poultry farms from 115,000 in 2007 to 55,000 in 2013 [5]. Hence, effective commercial poultry production demands thorough animal husbandry practices, incorporating antimicrobial therapy and vaccinations [[6], [7], [8]].

While antimicrobials have reduced animal mortality. However, excessive and inappropriate use of antimicrobials, in this era, is considered a major public health concern globally. [9]. Farmers are more likely to use antimicrobials for therapeutic purposes and growth promoters without veterinary supervision [10]. Misuse drives antimicrobial resistance (AMR), causing treatment failures in both animals [11] and human [12], and is a growing global threat, including in Bangladesh [13]. Contributing factors include irrational drug use, incomplete courses, and limited awareness [14].

The poultry industry often underestimates long-term consequences, while human health costs are treated as externalities [15], leading to significant public health and economic burdens such as prolonged illness, extended hospital stays, and transmission of resistant pathogens [16]. Multidrug-resistant bacteria in various poultry samples, such as feces, meat, and eggs, revealed a significant use of antimicrobials in poultry production [17]. Findings from Iran [18] suggest that antimicrobial-resistant bacteria could potentially be transmitted to humans through the consumption of eggs containing these multidrug-resistant strains. Around 47.9% of farms administer antimicrobials via water and feed for therapeutic or prophylactic purposes [19] and the widespread over-the-counter availability of antimicrobials further drives misuse [20].

Despite a limited understanding of the impact of excessive and prophylactic use of antimicrobials on AMR emergence, feed dealers and drug sellers frequently encourage farmers to use antimicrobials [21]. Client-patron relationship between dealers and farmers played a significant role in influencing farmers to use antimicrobials for poultry production [10]. Farmers depend on dealers or agents who provide a credit system to facilitate their procurement needs [22].

The sale and promotion of antimicrobials through poultry dealers and pharmaceutical representatives reflects weak governance in Bangladesh [10]. As of now, Bangladesh lacks a comprehensive national drug policy or clear guidelines specifically governing the prudent use of antimicrobials in food-producing animals. Although the “Bangladesh Fish Feed and Animal Feed Act 2010” prohibits the inclusion of antimicrobials, growth hormones, steroids, and insecticides in animal feed during manufacturing [23] enforcement at the farm level remains limited. As a result, there is no comprehensive regulatory framework effectively overseeing veterinary drug use in poultry production, and antimicrobials remain widely accessible without prescription [24]. Furthermore, existing evidence indicates that farmers frequently deviate from recommended dosage and treatment duration [25].

Although previous studies have examined antimicrobial use in broiler and layer farms [26], there remains limited understanding of antimicrobial use practices across all major commercial poultry production systems and geographic regions, particularly regarding the social and economic factors that shape the farmer behavior. Addressing this gap is critical for designing targeted interventions to reduce AMR risks at the human-animal environment interface. From a One Health approach, understanding how social, economic, and governance factors influence antimicrobial use in poultry production is critical to safeguarding animal health, public health and environmental health [26].

Therefore, the study was designed to explore the social and economic driving forces that contribute to the widespread and indiscriminate use of antimicrobials in commercial poultry production in Bangladesh and to gain an in-depth understanding of farmers' perceptions and decision-making processes related to antimicrobial use in poultry production.

2. Methodology

2.1. Study design and setting

We conducted an exploratory qualitative study in three districts of Bangladesh over a six-month period, from July 2021 to December 2021. The study was carried out in Dhaka, Manikganj, and Narayanganj, Bangladesh, which were purposively chosen as the study sites (Fig. 1). These districts were purposively selected due to the high density of small and medium commercial poultry farms in this region [27]. Furthermore, these districts were selected due to their central location and high population density, resulting in a significant demand for poultry meat and subsequent growth of poultry production. Previous studies also showed that these districts were recognized as the primary hub for poultry sales, predominantly because of their significant population density and the economic independence of their inhabitants [28]. We purposively selected 18 farms from Dhamrai and Savar in Dhaka district, 21 from Singair and Saturia of Manikganj district, and 21 from Sonargaon and Araihazar in Narayanganj district.

Fig. 1.

Geographic location of the three study districts in Bangladesh (Dhaka, Manikganj, and Narayanganj), where commercial poultry farmers were included in the in-depth interviews.

2.2. Ethics approval

The study received approval from the ethical committee of Chattogram Veterinary and Animal Sciences University (Memo no: CVASU/Dir (R&E) EC/2020/241(5), Date:15/04/2021) and in accordance with the guidelines and regulations in the Declaration of Helsinki. Informed consent was obtained by study staff after discussing the informed consent form with each participant. The study was conducted by trained field anthropologist who had completed formal ethical training in human subjects' research through the Collaborative Institutional Training Initiative (CITI Program), including modules on public health research ethics, responsible conduct of research in social, behavioral, and biomedical sciences, and best practices for social and behavioral research in clinical settings.

2.3. Participant recruitment and data collection procedures

A total of 60 poultry farms were purposively selected for this study [29], where most farms raised Sonali (n = 36) and broiler (n = 10), primarily intended for meat production, and layer (n = 14), which specializes in egg farming. We selected one poultry farmer from each farm as the study participants, typically the owner or primary decision-maker, who were deliberate, recognizing their pivotal role in the decision-making and execution of antimicrobial usage in their respective farms. Eligibility criteria required that farmers had direct responsibility for daily farm management, decision-making authority regarding veterinary care, and antimicrobial use (AMU) practices within their farms.

Data were collected through in-depth interviews (IDI), with informed written consent obtained from all participants before the interviews. A semi-structured IDI interview guide comprising open-ended questions was developed to minimize interviewer confirmation bias and social desirability bias (Supplementary Table 1). The semi-structured interview guide consisted of five core thematic areas: (1) farming practice and management, (2) raising practices, (3) use of antibiotics and decision-making, (4) knowledge and perception of poultry diseases, and (5) knowledge and perception of antibiotics. Within those thematic areas, the researchers conducted the interviews, focusing on the questions and asked necessary probing questions related to farmers' beliefs, social relationships, and economic dependencies that influence decision-making around antimicrobial use in poultry farms. We conducted one IDI from each selected poultry farm, with interviews lasting approximately 40 minutes on average. The interview enabled an in-depth exploration of their perspectives, attitudes, and behaviors related to antimicrobial use in commercial poultry production.

2.4. Qualitative data analysis

All interviews were conducted in the local Bengali language and audio-recorded with participant consent. Audio recordings were transcribed verbatim and translated into English. Subsequently, the narrative data were analyzed by experienced anthropologists. We developed thematic codes from the data for analysis based on the grounded theory approach [30]. An inductive coding framework was developed directly from the data. Codes were iteratively grouped into categories and refined into broader themes through team discussions. Data collection continued until thematic saturation was reached, ensuring no new codes or insights emerged. Data management and analysis were conducted using MAXQDA qualitative data analysis software [31].

3. Results

3.1. Demographic characteristics of the participants

The poultry farmers were predominantly males, ranged in age from 18 to 75 years, with the majority falling between 35 and 44 years old (Table 1). Their experience in poultry farming, with a significant portion (n = 33) having relatively short tenures, primarily between 0 and 5 years. Among the farmers, most of them (n = 44) had completed secondary education or higher level. All participants engaged in poultry farming as their main source of income; however, some of them (n = 22) earned alongside several other sources like agricultural farming, large animal farming, businesses, and dealerships.

Table 1.

Socio-demographic characteristics of farmers.

Characteristics	Total n = 60
Age group (years)
18–24	5
25–34	13
35–44	21
45–54	17
>55	4
Years of poultry farming experience (years)
0–5	33
6–10	17
>10	10
Educational attainment
No academic education	5
Primary	11
Secondary	24
Higher secondary	16
Graduate or above	5
Formal Training in poultry farming
No	52
Yes	8

Most of the participants (n = 52) did not receive any formal training in poultry farming. Instead, they primarily relied on self-teaching and observed practices from neighboring farmers. Very few farmers received training primarily on biosecurity practices, provided by government agencies, such as the Department of Livestock Services (DLS), Open University, and various private organizations. However, there was a notable lack of awareness or training regarding the appropriate use of antimicrobials, including their administration and adherence to specialized protocols.

3.2. Thematic results: Behavioral and economic drivers of antimicrobial use

3.2.1. Farmers' knowledge and perceptions regarding antimicrobial use in poultry farming

The first theme highlights the routine and preventive use of antimicrobials influenced largely by their knowledge, perceptions and beliefs about disease prevention and human health risk. Farmers reported administering antimicrobials to healthy chickens preventively, often without a veterinarian's prescription or disease diagnosis. They believe that antimicrobials do not lead to adverse effects on poultry or transmission of antimicrobial residues from poultry to humans.

3.2.1.1. Antimicrobials used as preventive measures

In poultry farming, farmers adopted the practice of administering antimicrobials to healthy chickens as a proactive measure to prevent the occurrence of diseases. This preventive approach involved the administration of antimicrobials to chickens before the manifestation of any signs or symptoms of illness. Most farmers administered antimicrobials during the production cycle, often within 14 days before data collection, mainly using fluoroquinolones, tetracyclines, sulfonamides, and penicillin, with common agents including amoxicillin, doxycycline, neomycin, colistin, erythromycin, enrofloxacin, and ciprofloxacin.

“Medicines were given so that the chickens eat properly, stay well and healthy... don’t have any sickness and stay disease-free.” (Farmer, Manikganj).

Out of the 60 farmers interviewed, more than two-thirds (n = 41) of the farmers prescribed antimicrobials without a veterinarian's prescription and sometimes, even in the absence of any evident illness. Furthermore, they have been administering drugs to their poultry without completing the dose and storing the remaining medications for future use.

3.2.1.2. Perceptions of antimicrobial side effects and human health risks

Farmers expressed mixed views regarding the potential side effects of antimicrobials. Nearly half (n = 26) believed that antimicrobials do not cause any harmful side effects, and residues are not transmitted to humans through poultry products, and that there is no health risk for both animals and humans.

“Antibiotics don't have any side effects. Antibiotics remain in the bird for a few days, but when the poultry meat is consumed, it doesn't transfer to humans. It doesn't cause any harm to humans if the poultry are cooked.” (Farmer, Narayanganj).

In contrast, some farmers acknowledged that unnecessary use of antimicrobials could be harmful for both animals and humans. Despite this knowledge, they continued increased use of antimicrobials because they believe that the antimicrobials increase poultry production and growth.

“Antibiotics are just how humans consume it, if you think about it like that, it can be considered harmful. Even if it benefits the chickens, it may be harmful to us. Sometimes, I see on the mobile and books that it is harmful to humans, so, actually, we are still giving it, knowing everything.” (Farmer, Manikganj).

Several farmers stated that, given the widespread food adulteration in Bangladesh, any additional potential harm from antimicrobials was perceived as negligible.

“Yes, it (antibiotics) causes harm, then again there's no harm because everything is adulterated” (Farmer, Dhaka).

3.2.2. Economic dependency on poultry dealers driving antimicrobial use in the farm

This theme highlights how poultry dealers emerged as key actors influencing antimicrobial use decisions at the farm level. Farmers often trust dealers, viewing them as reliable advisors or even medical professionals because of their frequent involvement in poultry health management. Dealers supplied chicks, poultry feed, and medicine on credit, and farmers repaid these inputs by selling their poultry back to the same dealer. This arrangement created economic dependency and positioned dealers as central decision-makers in antimicrobial use.

3.2.2.1. Trust in poultry dealers influencing antimicrobial decisions

Farmers reported that dealers played a significant role in determining which antimicrobials to use and how frequently they should be administered. Twenty-two farmers reported buying antimicrobials from dealers. Notably, dealers were viewed as responsible and dependable individuals, with some even being perceived as medical professionals or doctors by certain individuals.

“If there is a problem with the poultry, then the doctor comes. Otherwise, the dealer gives medicine as he is also kind of a doctor.” (Farmer, Narayanganj).

Dealers were categorized based on selling medicine, feed, or chicks, though some sold both feed and medicine. They provide valuable guidance, and farmers often seek their advice for minor poultry health issues, relying on their expertise. For severe illnesses or mortality, farmers turn to veterinarians.

“Feed dealer helps me regarding farming by giving suggestions, as they know about farming too. If chickens have a mild sickness, then I will take suggestions from the dealer. I take suggestions from the doctor only if the chickens have severe sickness or start dying.” (Farmer, Narayanganj).

“This morning, he (dealer) called me and asked me about my poultry. He enquires about my poultry often. He’s a good man.” (Farmer, Dhaka).

However, some farmers questioned dealers' advice, particularly when antimicrobials were recommended preventively in the absence of illness.

“The dealer gives all kinds of advice; give this, give that, give some vitamins, give some antibiotics. He even gives antibiotics to the chickens before they get sick. Why give antibiotics when chickens are not sick? It's not necessary. Dealers just want to be on the safe side all the time.” (Farmer, Dhaka).

3.2.2.2. Debt-based dependency reinforces antimicrobial use

Farmers were trapped in a cycle of dependency on dealers for both purchasing and selling poultry. Farmers described being economically dependent on dealers through credit-based arrangements. They obtained chicks, feed, and antimicrobials on credit, often repaying exclusively to the same dealer, sometimes using assets like land to secure loans. This financial dependence compelled farmers to follow dealers' advice on antimicrobial use.

“If I don't pay in cash, the dealer makes a profit of 300 taka per sack of feed and 12,000 taka for 60 sacks of feed. If I pay in cash, I could earn 12,000 taka myself. Nowadays, farmers who are doing business with dealers on credit are even mortgaging their land.”(Farmer, Manikganj).

These arrangements created power imbalances that shaped antimicrobial decision-making, influencing routine and sometimes unnecessary use of antimicrobials in poultry production.

3.2.3. Role of pharmaceutical representatives in shaping antimicrobial use in poultry farms

The third theme describes how interactions with pharmaceutical representatives from multiple companies played a prominent role in influencing antimicrobial use in poultry farms through aggressive marketing practices of their products, emphasizing benefits and downplaying drawbacks. Farmers often obtained medications from multiple sources, perceiving all products as effective, which created brand bias based on representatives' recommendations.

3.2.3.1. Promotion of medicine as a superior product

Farmers reported that pharmaceutical representatives from various companies asserted that their products were the most effective, while rarely discussing limitations or potential drawbacks. Consequently, farmers acquired medications from multiple sources since none of them is deemed inferior. Thus, farmers were influenced by decision-making regarding the usage of antimicrobials by pharmaceutical representatives.

“No matter which company they come from, all pharmaceutical representatives claim that their medicine is the best. No one says it is bad, so I buy medicine from all.” (Farmer, Manikganj).

3.2.3.2. Commercial interest of pharmaceutical representatives influencing recommendations

Farmers perceived that pharmaceutical representatives' recommendations were often driven by commercial incentives, with a tendency to promote potential brand bias. Several farmers noted that newly established companies aggressively marketed lower-priced products, which further motivated purchasing decisions.

“Pharmacy representatives offer medicine from their companies. He will suggest antibiotics from the company from which he benefits the most.” (Farmer, Dhaka).

3.2.3.3. Interaction of pharmaceutical representatives during veterinary consultation

Farmers noted that pharmaceutical representatives were sometimes present during veterinary consultations and encouraged consideration of specific medicines. These interactions occasionally involved discussion of prescriptions and promotion of alternative products, which some farmers found confusing. These representatives engaged in arguments over prescriptions, even going as far as photographing them, and persistently push for the sale of their own medicines. These interactions influenced farmers' decision-making and, in some cases, contributed to uncertainty.

“When we go to see the doctor, the pharmaceutical representatives are often present. They question and want to see the prescription, take photos of the prescription, and then request us to buy their medicine.” (Farmer, Manikganj).

These commercial pressures from pharmaceutical representatives influenced antimicrobial use practices at the farm level and, in some cases, encouraged brand-driven rather than need-based decision-making.

3.2.4. Role of veterinarians in influencing antimicrobial use in poultry farms

This theme highlights how the role of veterinarians influenced the use of antimicrobials in poultry farming. Farmers reported that veterinarians often prescribed antimicrobials for poultry from specific companies, sometimes resulting in the use of multiple medications. Several farmers mentioned that some private veterinarians were hired by pharmaceutical companies and routinely visited farms as part of their duties. These visits usually involved providing poultry health advice and prescribing medicines without charging a consultation fee, which further stimulated farmers to follow their suggestions and to use medicines from pharmaceutical companies.

3.2.4.1. Veterinarians' preference for specific pharmaceutical brands

One-fifth of the farmers (n = 12) stated that veterinarians often aligned their prescriptions with recommendations from pharmaceutical companies, motivated by incentives or professional benefits. Such practices were perceived to impact overall transparency and trust in the veterinary services. Farmers believed that company-appointed veterinarians tend to prioritize their own products, regardless of comparative effectiveness.

“There is a doctor nearby who writes medicine suggested by the pharma company. The pharma company gives doctors benefits, so he (doctor) prescribes accordingly.” (Farmer, Manikganj).

Although most farmers followed these recommendations, a few farmers stated that they individually verified prescriptions and compared products from different companies before providing antimicrobials.

“Pharma company affiliated doctors want to prescribe their own company medicine, whether it works or not. They only prescribe that medicine and say that it will work. But when we don't get the expected result, we don't use it. I take a prescription, and I try to understand the diagnosis, then I verify and see which one is the best company of all and give that medicine. I don't rely solely about on what the company doctor prescribes.” (Farmer, Dhaka).

3.2.4.2. Confusion arising from multiple antimicrobial prescriptions

Farmers frequently expressed their uncertainty when veterinarians prescribed multiple antimicrobials without a clear indication or explanation regarding diagnosis, purpose of the treatment. Farmers reported the lack of detailed guidance on specific reasons for the prescriptions left them puzzled and concerned about their appropriate use.

“I don't know for what problem the antibiotic was given. When we think there's a problem, we call the doctor. A veterinarian from a pharmaceutical company prescribed 4-5 antibiotics altogether. But I didn't use those to my poultry. I went to another private doctor, and he prescribed fewer antibiotics.” (Farmer, Dhaka).

3.2.4.3. Influence of veterinary advice on farmers' treatment decisions

Farmers also described situations in which veterinarians often visited farms and strongly recommended medicines from specific companies. When farmers declined these suggestions, they expressed dissatisfaction, which discouraged farmers from questioning their advice. In such situations, farmers often felt obligated to comply with the veterinarian's recommendations due to professional authority and the need to maintain access to veterinary support.

“Some doctors visit our farms and give medicines from specific companies, and if I don't use them, they (doctors) will get upset. They also call the shop and ask about the medicines. We face problems because of this, and most of the time well-recognized doctors do this. as a result, I cannot give the medicine that we prefer, because I need to give medicine which is recommended by them. And if I need to call them for advice, they tell me, ‘Why do I need advice now? I am the jack of all trades!” (Farmer, Manikganj).

3.2.5. Farmer self-belief and experiential confidence influencing antimicrobial use

This theme captures how farmers' personal beliefs and accumulated farming experience shaped their decisions to use antimicrobials. Farmers often justify antimicrobial use by drawing comparisons with other well-known health risks, such as smoking, and by expressing confidence with their own judgement and experience. They also believed that if chicken meat is properly cooked, it is harmless to consume it. They assumed the heat would neutralize antimicrobials by cooking, just as it can neutralize poison.

3.2.5.1. Questioning choices and perceived risk

The farmer raised an important and thought-provoking question about the choices people make regarding the use of antimicrobials. By drawing a parallel comparison between the antimicrobial use and the habit of smoking, the farmer highlighted the well-known health risks associated with smoking and the widespread awareness of its adverse effects. Despite this knowledge, people continue to smoke, which perplexes the farmer. They also believed that antimicrobials were destroyed by heat.

“If chicken meat is cooked properly, antibiotics will be destroyed by heat because even poison becomes water by heat. So will antibiotics too.” (Farmer, Manikganj).

The farmer also believed that if the antimicrobials were genuinely harmful, the significant amount of usage of antimicrobials would have caused widespread casualties. The farmer argues that if antimicrobials truly transferred to humans and caused harm, thousands of poultry farmers would not continue raising poultry in the current manner.

“If antibiotics were really transferred to humans, then thousands of poultry farmers wouldn't raise chickens like this. If an antibiotic is given to the chicken and if that antibiotic is transferred to the human body and if it really harms people, then it (antibiotics) would've stopped being given.” (Farmer, Narayanganj).

3.2.5.2. Confidence based on the farming experiences

Experienced farmers asserted their strong confidence in their ability to manage poultry health and administer medications without formal training. Years of hands-on experience have equipped them to manage poultry health independently, reinforcing their belief in their ability to care for their flock effectively without external advice.

“I don't need training because I am experienced enough, and I can provide training to others. I can identify problems of the poultry by myself.” (Farmer, Dhaka).

However, a few farmers acknowledged limitations in their knowledge and practices and expressed a need for formal training, recognizing that their current approaches to poultry health management may not be optimal.

4. Discussion

Our study revealed that farmers commonly reported using antimicrobials prophylactically in healthy poultry to prevent disease outbreaks and minimize production losses, a practice similarly reported in commercial poultry farms in China [32]. The use of antimicrobials for prevention was also reported on large poultry farms in other developing countries, such as Vietnam and Thailand [33,34]. Although international guidelines from the World Organization for Animal Health (OIE) and World Health Organization (WHO) discourage the routine use of antimicrobials to healthy food-producing animals as a precautionary measure to mitigate the development and proliferation of antibiotic resistance [35,36]. Farmers in this study experienced a conflict between knowing the harmful effects of antimicrobials, yet continued their use due to fear of losses, uncertainty about disease prevention, and perceived inevitability of antimicrobial use within the production system. Farmers also expressed frustration over improper practices observed elsewhere, leading to a cycle of blame in which responsibility for antimicrobial misuse is often displaced onto veterinarians, farmers, doctors, pharmaceutical suppliers, and antimicrobial users, with little accountability at the individual level [37].

Our study revealed a crucial connection between poultry dealers and farmers, as dealers provide essential credit that influences farmers' livelihoods and antimicrobial use. Financial dependence on dealers, who also sell antimicrobials, encourages farmers to purchase them. Similar findings reported that these dealers played a key role in poultry operations and contributed to irrational and indiscriminate antimicrobial practices and often breached antimicrobial guidelines by recommending incorrect dosage, duration, or withdrawal periods, contributing to the escalation of AMR in poultry [10]. Other research has also shown that the actual appropriate use of antimicrobials was largely unknown [38]. Farmers often bought chicks and feed on credit from poultry dealers and repaid them by selling their poultry back to them. They were typically obligated to sell exclusively to these dealers, a practice also reported in other studies [39].

Our study also highlighted the interconnected roles of farmers, dealers, and pharmaceutical sales representatives in poultry rearing. Consistent with previous research, representatives aggressively market their products, emphasizing benefits and downplaying drawbacks, while prioritizing sales targets set by their company [10]. This influence of the commercial target and interests of representatives often results in recommendations being closely associated with specific brands or companies, potentially leading to bias towards those products. Previous research on antimicrobial resistance has shown that the global pharmaceutical industry plays a significant role in driving antimicrobial use in livestock and food production, rather than the practices and knowledge of end-users, such as farmers [40].

Veterinarians often base prescriptions on pharmaceutical company recommendations, influenced by benefits and perks. Companies maintain market presence by offering discounts to dispensers and rewards to doctors. The persistence of these practices reflects inadequate monitoring and regulation of antimicrobial production, prescription, and use in Bangladesh [13]. Veterinarians often deliver medicines from specific companies and may express displeasure if farmers decline, effectively obligating farmers to follow their recommendations. Previous studies documented similar findings, showing that pharmaceutical companies use aggressive marketing tactics, pressuring veterinarians through incentives, emotional manipulation, or personal connections to promote their products [41]. Farmers in this study were often uncertain about the purpose of multiple antimicrobials received from veterinarians, and were sometimes provided limited information on withdrawal periods, a finding that has also been reported in previous research [42]. Prior research also found that farmers opt for antimicrobials that facilitate rapid recovery [43], placing pressure on veterinarians to meet these expectations. This can lead to prescribing multiple doses, as prolonged recovery may increase farmers' financial burden and affect the veterinarian's reputation [44].

This study provides insights into drivers of irrational antimicrobial use in commercial poultry farms in Bangladesh, but several limitations exist. It was conducted in only three districts, which may limit generalizability. In addition, reliance on self-reported practices may introduce recall or social desirability bias. However, the consistency of findings across participants and the use of in-depth qualitative methods strengthen the credibility of the results.

Despite these limitations, the findings have important implications for policy and practice. They can inform targeted interventions, such as farmer training programs, stricter prescription regulations, and awareness campaigns, to promote prudent antimicrobial use. The findings also underscore the need for a One Health approach, that integrates human, animal, and environmental health perspectives to address antimicrobial resistance in poultry farming and beyond. These insights can inform future research aimed at designing interventions to reduce inappropriate antimicrobial use and mitigate the risk of antimicrobial resistance.

5. Conclusions

The findings of this study demonstrate that antimicrobial use in commercial poultry farms in Bangladesh is widespread and frequently used as a preventive measure in healthy chickens, often occurring in the absence of veterinary consultation. Although some farmers recognize the potential health risks, misconceptions about antimicrobials being harmless, combined with strong economic pressures and social dependencies, contribute to their continued misuse. Poultry dealers, pharmaceutical representatives, and veterinarians play influential roles in shaping antimicrobial practices within a weakly regulated production system. Importantly, this study shows that antimicrobial use is not driven solely by individual knowledge gaps but is embedded within interconnected economic incentives, social relationships, and supply chain dynamics. By highlighting how multiple actors collectively influence farmers' decisions, the findings shift the focus from individual blame to structural determinants of antimicrobial misuse.

Reducing antimicrobial resistance in poultry farming requires a coordinated One Health approach that recognizes the interconnectedness of human, animal, and environmental health systems and addresses these structural drivers. Key strategies include raising awareness among farmers, enforcing regulations to prevent indiscriminate antimicrobial use, and promoting responsible farming practices. Training programs for farmers, feed dealers, and drug sellers can further strengthen knowledge and encourage prudent antimicrobial use. Beyond awareness, strengthening veterinary oversight, regulating pharmaceutical distribution channels, and improving accountability across the poultry production network are essential components of an effective One Health response. Continued surveillance and research on antimicrobial use and resistance across human and animal populations will be critical for informing evidence-based interventions and safeguarding public health.

Funding

This work was partially supported by the Bangladesh Bureau of Educational Information and Statistics (BANBEIS) for MMH, Conservation, Food, and Health Foundation (CFHF), Training Hub promoting Regional Industry and Innovation in Virology and Epidemiology (THRIIVE) and Biosecurity Research program Through Charles Sturt University for A. Islam.

Ethics approval

The study received approval from the ethical committee of Chattogram Veterinary and Animal Sciences University (Memo no: CVASU/Dir (R&E) EC/2020/241(5), Date:15/04/2021) and in accordance with the guidelines and regulations in the Declaration of Helsinki. Informed consent was obtained by study staff after discussing the informed consent form with each participant. The study was conducted by trained field anthropologist who had completed formal ethical training in human subjects' research through the Collaborative Institutional Training Initiative (CITI Program), including modules on public health research ethics, responsible conduct of research in social, behavioral, and biomedical sciences, and best practices for social and behavioral research in clinical settings.

CRediT authorship contribution statement

Nabila Nujhat Chowdhury: Writing – review & editing, Writing – original draft, Methodology, Investigation, Formal analysis, Data curation. A.K.M. Dawlat Khan: Writing – review & editing, Writing – original draft, Validation, Methodology, Investigation, Formal analysis, Data curation. Md. Arif Khan: Writing – review & editing, Validation, Methodology, Investigation, Data curation. Md. Zulqarnine Ibne Noman: Writing – review & editing, Validation, Methodology, Investigation, Data curation. Monjurul Islam: Writing – review & editing, Visualization, Software, Investigation, Data curation. Abdullah Al-Mamun: Writing – review & editing, Validation, Investigation, Data curation. Md. Mehedi Hasan: Writing – review & editing, Validation, Methodology, Investigation, Data curation. Shusmita Dutta Choudhury: Writing – review & editing, Validation, Investigation, Data curation. Mohammad Mahmudul Hassan: Writing – review & editing, Validation, Resources, Methodology, Funding acquisition. Jade K. Forwood: Writing – review & editing, Supervision, Resources, Funding acquisition. Tahmina Shirin: Writing – review & editing, Supervision, Resources, Project administration, Methodology, Data curation. Ariful Islam: Writing – review & editing, Writing – original draft, Supervision, Project administration, Methodology, Funding acquisition, Data curation, Conceptualization.

Declaration of competing interest

We have no financial and personal relationships with other people or organizations that could inappropriately influence (bias) our work.

Appendix A. Supplementary data

Supplementary material

Data availability

Data will be made available on request.