The risk of antimicrobial resistance and zoonotic diseases in India's dairy value chain, and how we can mitigate the public health threat through interventions

India is the world's largest producer of milk and milk products with small-scale farms dominating the dairy industry. The infrastructure is inadequate, and quality control is minimal. India has a high burden of infectious and zoonotic diseases due to a lack of awareness, poor hygiene practices, poverty, and limited access to medical services. There is however unrestricted access to medicines. Antibiotics are widely used in dairy animals for therapeutic and prophylactic purposes and are sometimes given in large quantities to prevent diseases. This thesis assessed knowledge, attitude, and practices (KAP) regarding antibiotics, antimicrobial resistance (AMR), milk safety, and zoonotic diseases. Surveys among dairy farmers and milk vendors were conducted to assess their knowledge and practices regarding milk safety, antibiotics, and milk handling. Milk samples from dairy farms were analyzed for antibiotic residues and milk samples from vendors were analyzed for antibiotic-resistant bacteria. Veterinary practitioners were interviewed to understand their knowledge and perceptions. Interventions were carried out to raise awareness and a follow-up survey was conducted to assess knowledge change. The knowledge of dairy farmers related to antibiotics, AMR, and zoonotic diseases was quite low. There were 5.9% positive samples with antibiotic residue levels over the maximum residue limit. Farmers admitted using antibiotics without a veterinarian's approval and reported a lack of veterinarians. Milk vendors were unaware of antibiotics and AMR. They knew very little about milk hygiene and sold raw milk. Most (64.5%) vendor milk samples had antibiotic-resistant bacteria. Due to a lack of diagnostic facilities, veterinarians gave antibiotics based on their knowledge of diseases and symptoms without testing. A follow-up study found that farmers who attended intervention training showed an improvement in their knowledge level. This thesis offers a glimpse of the many factors that are contributing to the inappropriate use of antibiotics in the livestock industry of India. The level of knowledge can be improved with regular discussions. In addition to improving veterinary facilities, stakeholders in the informal dairy value chain should get frequent training