Abstract
BACKGROUND: Mastitis is a common driver of antibiotic use in dairy farms and is exacerbated in low-income settings by the lack of diagnostics and treatment strategies. We assessed the decision-making process of animal health providers (AHPs) in managing mastitis in small-holder dairy farms in Kiambu County, Kenya. Data were collected from 114 AHPs and using item response theory, scales were developed to measure attitudes toward udder health, and multivariable linear regression was used to analyse demographic factors associated with these attitudes. RESULTS: Overall, 90% of AHPs diagnose clinical mastitis based on clinical symptoms such as visible udder signs and milk changes, with little diagnostic testing support. Antibiotic treatment was initiated immediately after clinical examination by all, 80% and 50% of AHPs in severe, moderate, and mild mastitis cases, respectively. β-lactams (namely penicillins) and aminoglycosides which were administered mostly parenterally, were the frequently reported antibiotic classes used in treatment of mastitis irrespective of the severity. AHPs with a larger farmer client base and those who did not treat mild mastitis cases with antibiotics had significantly higher mean attitude scores. Treatment of mastitis is primarily based on clinical judgment, with limited microbiological diagnostic support, and parenteral antibiotics are used empirically as first-line therapy. CONCLUSIONS: We recommend development of mastitis management support tools such as treatment guidelines and advocate for adoption of routine on-farm rapid testing supported by bacterial culture to guide treatment decision making and antibiotic choice.