 Felly, mae'n gweithio i fynd i bobl i gyda Doc Katie Hamilton, gyda paracetologi yma yma yma yma ym Mhwnghyslwynt Llyfrgell mor Llyfrgell, i fynd i ddweud i'n mynd i ddigonwys adenrhyw ym Mhwnghyslwynt Llyfrgell a'r Llyfrgell Ibnbhyslwyr. Dnid ei ffyswyr, Katie. Dnid ei ffyswyr. Ond y gallwn yma Llywodraeth, rwy'n dechrau ond rhywbeth y byddwch yn fwy o'r ddeud o gael ar gyfer onlin, i'r holl ar gyfer y rhumion a'r holl yma, yn Llywodraeth Aelodau Cymru yn y Llywodraeth ym Mwysgrifedig. Mae'r holl o'r rhumion yn y rhumion yn ychydig gyda'r holl yn un helyn, ond rwy'n dechrau â'r holl, ond byddwch yn mynd i, mae'n oeddo i'r holl o ffoch i gyrtig y ffrwd chain, a ddau'r hunan yng Nghymru, y dynach, y dynch, y dynch, y dynch a'r dynch arfer o gyllid yw'r rhwng yn busg. Oherwydd mae'n gweithio wahanol a'r dynch yw'r rhwyfyr yn cyffredinol i'r rhwyfyr, y dynch, y ffungig, oedd ymryd yn ei ddweud ac yn olygu o'r meddwl, ddweud o'r rhan ffordd, oed o'r tyn a chyfnodol o'r risg o ddysgu'r hyn sy'n ei ddweud. Mi oeddydu yma Icholi i'r cywlau am ymgledwyr hyn sydd yn gweithio'r cael oherwydd rhoi y imagin yn ei gwybod, oherwydd roedd yn sgwrs, oherwydd ei gwybod â'r wahanol. Roedd yn gweithio gyda ar y cwmffiniaeth successes, a y gallwch chi gweithio gweithio cyfnodol, sydd wedi bod gyntaf i hanfrewdol, i gweithio gweithio i gweithio i gweithio i gweithio i gweithio i gweithio i gweithio i gweithio i gweithio i gweithio i gweithio. o'r cyfnod bwysigol ar gyfnod o'i gwybodaeth bwysigol ar gyfer y gweithredu agorodau. Ysgolau yn unig o'r gwyfodaeth ar gyfer y gweithredu ac amser y pryd. Gwylio'r cyfnod yn dweud o'r cyfnod wedi'u cyfan ar gyfer y gweithredu, ymgyrch, ac yma'r acrydd ar gyfer y gweithredu. Mae'r cyfnod o'r gweithredu, yma'r gweithredu a'r cyfnod o'u gweithredu. dwi'n meddwl y leidio i'r hollwch iawn, felly rydyn ni'r hollwch iawn sy'n meddwl y maen nhw'n ei hwn. Mae'n meddwl i'r hollwch iawn, a dysgu'n meddwl gyda'i amser y maesafol, a ddidio'r ffordd yn gwneud yn hyn yn ymddangos, oherwydd, mae'n meddwl i'r hollwch iawn. Ysgol ysgol ysgol iawn yn gwneud yn rhan o'r mychafolodrach o'r hollwch iawn ar y sylwf iawn. A oedden nhw'n ddweud o'r rai o bobl yn amdano. The ultimate goal of the project was to obtain a baseline study of the AMR landscape within the slaughterhouse setting and to then use this information to develop relevant AMR educational material. Now our study was part of a much larger study called Zoolink and Zoolink went out to do a surveillance study for emerging zoonoses and they have set up 12 Sentinel sites within three counties within western Kenya. Now each of these Sentinel sites had to have a livestock market two or three slaughterhouses and a hospital nearby. As you can see we wanted to study slaughterhouses and the top picture shows an informal slaughter slab and the second one below shows a more organized larger slaughterhouse and these are the types of slaughterhouses we were working with. For the microbiological assessment, we took biological samples from each slaughterhouse. We sampled the floor using the boot socks in the first picture. We sampled the equipment that was used in the slaughterhouse. We took swabs from the inside of the dress carcass and the outside of the dress carcass. We took some water that was used for washing. We asked the slaughterhouse workers if they would mind if we took a handprint, and we also sampled the meat box, which is where the carcass on the slaughterhouse gets carried and delivered to the butchers. During the same time, we also held stakeholder discussions. We first held a focus group discussion with the county veterinary officers, the sub county veterinary officers and the meat inspectors. During these discussions, we explored stakeholders involved in antimicrobial resistance within the slaughterhouse context, factors driving the AMR and the challenges dealing with the AMR. We next organized a series of workshops for the slaughterhouse workers in the three counties. With them, we explored which drugs they commonly use, why they use them and had they ever experienced treatment failure, and if so, why do they think this had happened? So now the results of the biological sample. We collected 193 samples from 13 slaughterhouses, nine of those were ruminant and four of those were pig in 11 of the Sentinel sites. We identified isolates in just over half of the samples. There really appeared to be no difference between the pig and the ruminant slaughterhouse samples, and the highest proportion of isolates in the samples came from the carcass, the boot sock and the meat box. Then we went on to do antimicrobial susceptibility testing on 98 of the isolates, 21 of those were from pig and 77 of those were from ruminant. On average, the isolates were resistant to three of the 14 of antibiotics tested. The results indicated that the isolates were most most commonly resistant to streptomycin and facillin, tetracycline and trisulfa. Multiple drug resistance is when an isolate is resistant to three or more classes, and in this case, over 51% of the isolates tested were. Again, there was no significant difference between the isolates from the ruminant and the pigs slaughterhouse samples. And the highest portion of multiple drug resistant isolates were again from the meat, from the boot sock. Extended spectrum beta-lactamase are enzymes that confer resistance to most beta-lactam antibiotics, including penicillins and cephalosporins. We found this expressed in 16.3% of the isolates tested. The samples with the most ESBLs were the boot sock and also the meat box. Now the boot sock represents the environment within the slaughterhouse. So this is significant. I mean, some of these slaughterhouses, it gives an indication of what is going on within the slaughterhouse. But there was no difference between ruminant or pig. So it's as if there's one large soup just mixing around within the environment. Through the focus group discussions that we held, we identified the stulk stakeholders that really play a role in antimicrobial resistance within the slaughterhouse setting and how they relate to each other. Now butchers emerged as prominent stakeholders as they are often the ones who bring the animal to the slaughterhouse and then again take the carcass to the butchers. Butchers emerged as one individuals can exert a lot of pressure to the point where some individuals complained that they couldn't actually do their work properly due to the pressure that the butchers are putting on them. We believe that we can use the butchers influence and leverage it to positively influence and educate other stakeholders. The inadequate use of drugs was recognised as a reason for the increase in driving resistance. This included the under overdosing of animals, not respecting respecting withdrawal periods and the indiscriminate prescription by professionals such as medics and vets. And this was highlighted by one participant who said, if we vets also continue looking at all animals like very antibiotic deficient, that is the disease we treat this problem will continue to escalate. Major challenges in dealing with AMR within the slaughterhouse setting is related to the limited staff and the inadequate funding, which leads to under investment in the infrastructure and the equipment. Many of the individuals who work in the slaughterhouse, they don't have any protective clothing of any sort. There is limited availability of water, the perimeter fence, which is important for biosecurities, often missing, and waste disposal is sometimes indiscriminate to spread into the environment. When we queried what the workers thought of AMR situation in the slaughterhouse, they said they have no idea as there was no laboratory capacity to detect or surveillance to detect any changes in AMR. Everyone did agree that antimicrobial resistance requires a multi-sectorial approach involving many stakeholders. This can be very challenging to coordinate, but they did appreciate that the medics should be involved for public sensitisation, as they're the ones that carry so much respect within the community. A national action plan on prevention and containment of antimicrobial resistance was launched in 2017. The results, and part of this national policy, is to involve all stakeholders. The results from our stakeholder meeting indicated there needs to be a better coordination with the people who are trying to introduce the action plan to the people on the ground to ensure that there is a proper implementation and control of antimicrobial resistance. When we spoke to the slaughterhouse workers regarding drugs and what they take, they admitted quite freely that they often just use self-diagnosis and only go to hospital or seek medical advice if there's any case of complications. They admitted that they had experienced drug failure in humans, mostly antimilareals, and in animals, ectoparasitic and helmetic drugs haven't worked. Drugs are freely available on the markets, in the streets and in the small corner shops. That fact, coupled with the lack of formal advice, needs to an unquantifiable amount of use of antibiotics in animals and humans. One of the most popular antibiotics purchased for humans was in Moxicillin, and for animals, Xalamysin. When we queried the reasons for resistance, the slaughterhouse workers knew that there was a germ that causes disease and it is transmitted. They were also aware that they needed to take the drugs, but the reasons why they never finished the courses was lack of money, incorrect drug use and fear of side effects. And also the fact that they were feeling better, so why do I bother finishing my course? As one individual said, sometimes you visit the chemist or clinic where a dose is prescribed for you, but you don't have enough cash, so maybe the drugs cost like 600 and you have 200. So because the doctor wants money, they tell you to go with a little drug and ask after how many days will you get the money? You tell them tomorrow. You take the drugs for a few days and notice a change then stop, which also contributes because you have not finished the dose. We found that many people who worked in the slaughterhouse were aware that they were at a risk with the work that they do to disease transmission. As one slaughterhouse worker said, so maybe there are diseases that affect the animals and his undergoing treatment. The animal was taken to the slaughterhouse without completing the treatment. When slaughtering the animal, there is the interaction between human and the animal. In case there are injury to the human, there may be mixing of blood of the animal and human blood, and hence we can also be affected. Hygiene was an area that the slaughterhouse workers were completely aware was important in dealing with resistance. Both personal hygiene, for example washing hands and clean clothes and at the workplace. They recognize the importance of education in understanding and mitigating the risk, as can be seen by the quote on the slide. Educate us on how we would be handling maybe the meat before it reaches. Which other ways are we handling where? Educating us on getting a knife, cutting meat, how to hang the meat so that it doesn't get bacteria from the ground. Like you said, dust usually contains bacteria, so you educate us before undertaking the work. As part of the study, we developed an educational video that we produced and shared with all the participants taking part in the study. The video was so well received that the Government of Kenya endorsed it by including their coat of arms at the end of the video. Public health messages are important and our work we are doing here directly informs the implementation of the national strategy. I would just like to say thank you very much to Erecha for organizing this and allowing me to highlight my work and all the people who are involved in the study and everyone who funded it. Thank you very much. So I would firstly like to thank you for that great presentation, but secondly put you on the spot a little like I did to George earlier and just ask you about some of your experiences working in a multi-disciplinary team and anything that you would like to tell the participants about how best to undertake one health research. I think with our one health research, because as I said at the very beginning it incorporated the food systems as well, so I've added another factor to it. I think that we were very lucky, everyone was very keen and wanted to be involved, but there were key players who we missed out. And I think when you undergo research in a one health situation like we all should do, you have to do your groundwork and make sure that nobody's missed out. By that I mean we should have incorporated the butchers when we were doing our stakeholders meetings, but the key person wasn't highlighted as an individual of prominence until we started discussing, so it's slowly slowly build, build, build. So I think that's your question. That's great. So there was a sort of iterative nature in building your research question and the people you were working with. That's great. And thank you very much for highlighting the educational video. I would like to ask if you could put the link to that in the chat so that everybody can easily access that. That would be wonderful. Thank you so much. Okay, another round of applause for Katie. Thank you.