Beyond the Clinic: A One Health Qualitative Analysis of Antibiotic Use and Antimicrobial Resistance (AMR) in Sierra Leone

Abstract

This study utilizes a One Health framework to explore AMR drivers across human, animal, and environmental domains in Freetown. Using a qualitative exploratory design, 25 semi-structured interviews were conducted, including 17 in-depth interviews with frontline human health, animal health, and environmental professionals, and 8 key informant interviews with One Health policymakers. Data were analyzed using Braun and Clarke’s thematic framework. Over 70% of hospital antibiotic prescriptions occur without diagnostic testing, driven by drug shortages and patient demand. In the animal sector, unregulated access to human medications for livestock is prevalent. Environmental pathways, specifically untreated hospital wastewater and pharmaceutical waste, remain unmonitored. Awareness is high in medical sectors but significantly lower among environmental professionals. AMR in Sierra Leone is a multisectoral crisis exacerbated by weak governance and lack of laboratory infrastructure. Effective containment requires translating One Health policy into actionable surveillance, waste management and diagnostic capacity.

Keywords: Antibiotics, Antimicrobial Resistance (AMR), Antibiotic Stewardship, Environmental Health, One Health, Global Health Policy, Hospital Wastewater, Qualitative Research, Sierra Leone.