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Nayiga S, MacPherson EE, Mankhomwa J, Nasuwa F, Pongolani R, Kabuleta R, Kesby M, Dacombe R, Hilton S, Grace D, Feasey N, Chandler CI. "Arming half-baked people with weapons!" Information enclaving among professionals and the need for a care-centred model for antibiotic use information in Uganda, Tanzania and Malawi. Glob Health Action 2024; 17:2322839. [PMID: 38441912 PMCID: PMC10916894 DOI: 10.1080/16549716.2024.2322839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The overuse of antimicrobial medicines is a global health concern, including as a major driver of antimicrobial resistance. In many low- and middle-income countries, a substantial proportion of antibiotics are purchased over-the-counter without a prescription. But while antibiotics are widely available, information on when and how to use them is not. OBJECTIVE We aimed to understand the acceptability among experts and professionals of sharing information on antibiotic use with end users - patients, carers and farmers - in Uganda, Tanzania and Malawi. METHODS Building on extended periods of fieldwork amongst end-users and antibiotic providers in the three countries, we conducted two workshops in each, with a total of 44 medical and veterinary professionals, policy makers and drug regulators, in December 2021. We carried out extensive documentary and literature reviews to characterise antibiotic information systems in each setting. RESULTS Participants reported that the general public had been provided information on medicine use in all three countries by national drug authorities, health care providers and in package inserts. Participants expressed concern over the danger of sharing detailed information on antibiotic use, particularly that end-users are not equipped to determine appropriate use of medicines. Sharing of general instructions to encourage professionally-prescribed practices was preferred. CONCLUSIONS Without good access to prescribers, the tension between enclaving and sharing of knowledge presents an equity issue. Transitioning to a client care-centred model that begins with the needs of the patient, carer or farmer will require sharing unbiased antibiotic information at the point of care.
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Affiliation(s)
- Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Eleanor E MacPherson
- Research and Innovation Services, University of Glasgow, Glasgow, UK
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - John Mankhomwa
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | | | | | - Rita Kabuleta
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Mike Kesby
- School of Geography & Sustainable Development, University of St Andrews, St Andrews, UK
| | - Russell Dacombe
- Research and Innovation Services, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Delia Grace
- Natural Resources Institute, University of Greenwich, Chatham, UK
- International Livestock Research Institute, Nairobi, Kenya
| | - Nicholas Feasey
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
- The School of Medicine, University of St Andrews, St Andrews, UK
| | - Clare I.R. Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Kayendeke M, Denyer-Willis L, Nayiga S, Nabirye C, Fortané N, Staedke SG, Chandler CI. Pharmaceuticalised livelihoods: antibiotics and the rise of 'Quick Farming' in peri-urban Uganda. J Biosoc Sci 2023; 55:995-1014. [PMID: 36762463 DOI: 10.1017/s0021932023000019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The 'livestock revolution' has seen the lives and livelihoods of peri-urban peoples increasingly intertwine with pigs and poultry across Africa in response to a rising demand for meat protein. This 'revolution' heralds the potential to address both poverty and nutritional needs. However, the intensification of farming has sparked concern, including for antibiotic misuse and its consequences for antimicrobial resistance (AMR). These changes reflect a micro-biopolitical conundrum where the agendas of microbes, farmers, publics, authorities and transnational agencies are in tension. To understand this requires close attention to the practices, principles and potentials held between these actors. Ethnographic research took place in a peri-urban district, Wakiso, in Uganda between May 2018 and March 2021. This included a medicine survey at 115 small- and medium-scale pig and poultry farms, 18 weeks of participant observation at six farms, 34 in-depth interviews with farmers and others in the local livestock sector, four group discussions with 38 farmers and 7 veterinary officers, and analysis of archival, media and policy documents. Wide-scale adoption of quick farming was found, an entrepreneurial phenomenon that sees Ugandans raising 'exotic' livestock with imported methods and measures for production, including antibiotics for immediate therapy, prevention of infections and to promote production and protection of livelihoods. This assemblage - a promissory assemblage of the peri-urban - reinforced precarity against which antibiotics formed a potential layer of protection. The paper argues that to address antibiotic use as a driver of AMR is to address precarity as a driver of antibiotic use. Reduced reliance on antibiotics required a level of biosecurity and economies of scale in purchasing insurance that appeared affordable only by larger-scale commercial producers. This study illustrates the risks - to finances, development and health - of expanding an entrepreneurial model of protein production in populations vulnerable to climate, infection and market dynamics.
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Affiliation(s)
| | - Laurie Denyer-Willis
- School of Social and Political Science, University of Edinburgh, Scotland, United Kingdom
| | - Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Nicolas Fortané
- Institut National de la Recherche en Agriculture, Alimentation et Environnement, IRISSO (CNRS, INRAE, Université Paris-Dauphine, PSL), Paris, France
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sarah G Staedke
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Clare Ir Chandler
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Arvidsson A, Fischer K, Chenais E, Kiguli J, Sternberg-Lewerin S, Ståhl K. Limitations and opportunities of smallholders' practical knowledge when dealing with pig health issues in northern Uganda. PLoS One 2023; 18:e0287041. [PMID: 37294750 PMCID: PMC10256192 DOI: 10.1371/journal.pone.0287041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 05/30/2023] [Indexed: 06/11/2023] Open
Abstract
Pig production has a short history in Uganda. The majority of pigs are kept by smallholder farmers in rural areas where access to veterinary services is limited, and pig keeping has been suggested as a potential pathway out of poverty for smallholders. Previous research has identified the disease of African swine fever (ASF) as a major threat, causing high mortalities in pigs. With no available cure or vaccine, the only option is to implement biosecurity measures, i.e. strategies that prevent the spread of ASF. This paper draws on data from four months of ethnographic fieldwork in rural northern Uganda. Combining methods of participant observation, semi-structured interviews, focus group discussions and a survey, the aim was to improve understanding of smallholders' perceptions and responses to pig health issues such as ASF. Applying the concept of practical knowledge, this paper analyses the potential and limitations of smallholders' practice-based knowledge as a means of dealing with pig health issues. The results show that while pigs were appreciated locally for providing an income, many informants found it difficult to deal with pig diseases effectively. Consequently, informants commonly expressed a need for other kinds of knowledge in their pig production, indicating that veterinary advice can play an important role in reducing the negative impact of pig health issues. For animal health provision to have relevance in this context, however, veterinary practitioners must pay close attention to smallholders' priorities and ways of knowing in their livestock keeping. Results further show that pig health issues made some informants abandon pig production altogether. To enhance the potential of pig production as a poverty mitigation strategy in Uganda, research and policy need to focus on ways of bettering general conditions for smallholder pig keeping, including improving the quality of and access to veterinary services in rural areas.
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Affiliation(s)
- Anna Arvidsson
- Department of Urban and Rural Development, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Klara Fischer
- Department of Urban and Rural Development, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Erika Chenais
- Department of Epidemiology and Disease Control, National Veterinary Institute (SVA), Uppsala, Sweden
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, Makerere University, Kampala, Uganda
| | - Susanna Sternberg-Lewerin
- Department of Biomedical Science and Veterinary Public Health, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Karl Ståhl
- Department of Epidemiology and Disease Control, National Veterinary Institute (SVA), Uppsala, Sweden
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Chenais E, Fischer K, Aliro T, Ståhl K, Lewerin SS. Co-created community contracts support biosecurity changes in a region where African swine fever is endemic – Part II: Implementation of biosecurity measures. Prev Vet Med 2023; 214:105902. [PMID: 36966659 DOI: 10.1016/j.prevetmed.2023.105902] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
Smallholder subsistence pig production is common in Uganda and African swine fever (ASF) is endemic in the country, with its spread driven by human activities along the smallholder value chain. Previous research in the study area has revealed that many stakeholders are aware of how ASF is spread, its prevention and control, and have a generally positive attitude towards biosecurity. Despite this, even basic biosecurity is largely lacking. Costs, as well as a lack of adaptation to the local context, culture and traditions have been identified as factors hindering biosecurity implementation. Community engagement and local ownership of disease problems are increasingly recognised as important for improving disease prevention and control. The objective of this study was to investigate the capacity of participatory action at community level with broad inclusion of stakeholders to improve biosecurity in the smallholder pig value chain. Specific attention was paid to participants' perceptions and experiences of implementing the biosecurity measures included in their co-created community contracts. The study was conducted in Northern Uganda in villages purposively selected on the basis of previous occurrences of ASF. In each village, farmers and traders were also purposively selected. At a first meeting, basic information about ASF was shared and participants presented with a list of biosecurity measures adapted for farmers and traders respectively. Participants discussed each measure in farmer and trader subgroups, decided on the measures to implement for one year, and signed a community contract to this effect. The following year, interviews were again undertaken and implementation support given. Interview data were coded and thematically analysed. Each subgroup chose a minimum of three and a maximum of nine measures, with wide variations between villages in their selection of measures. At the follow-ups, none of the subgroups had fully implemented what had been agreed in their contract, but all had changed some of their biosecurity routines. Some frequently recommended biosecurity measures, such as not borrowing breeding boars, were not considered feasible. Relatively simple and cheap biosecurity measures were rejected for reasons of cost, highlighting the participants' general level of poverty and the relevance of poverty as a specific factor governing disease control results. The participatory methodology allowing for discussions, co-creation and the option to refuse measures seemed to facilitate the implementation of measures that had initially been thought to be controversial. The broad community approach was deemed to be positive for strengthening community identity, cooperation and implementation.
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Affiliation(s)
- Erika Chenais
- Department of Disease Control and Epidemiology, National Veterinary Institute, Uppsala, Sweden.
| | - Klara Fischer
- Department of Urban and Rural Development, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Tonny Aliro
- Faculty of Agriculture and Environment Gulu University, Gulu, Uganda
| | - Karl Ståhl
- Department of Disease Control and Epidemiology, National Veterinary Institute, Uppsala, Sweden
| | - Susanna Sternberg Lewerin
- Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Penrith ML, van Heerden J, Pfeiffer DU, Oļševskis E, Depner K, Chenais E. Innovative Research Offers New Hope for Managing African Swine Fever Better in Resource-Limited Smallholder Farming Settings: A Timely Update. Pathogens 2023; 12. [PMID: 36839627 DOI: 10.3390/pathogens12020355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023] Open
Abstract
African swine fever (ASF) in domestic pigs has, since its discovery in Africa more than a century ago, been associated with subsistence pig keeping with low levels of biosecurity. Likewise, smallholder and backyard pig farming in resource-limited settings have been notably affected during the ongoing epidemic in Eastern Europe, Asia, the Pacific, and Caribbean regions. Many challenges to managing ASF in such settings have been identified in the ongoing as well as previous epidemics. Consistent implementation of biosecurity at all nodes in the value chain remains most important for controlling and preventing ASF. Recent research from Asia, Africa, and Europe has provided science-based information that can be of value in overcoming some of the hurdles faced for implementing biosecurity in resource-limited contexts. In this narrative review we examine a selection of these studies elucidating innovative solutions such as shorter boiling times for inactivating ASF virus in swill, participatory planning of interventions for risk mitigation for ASF, better understanding of smallholder pig-keeper perceptions and constraints, modified culling, and safe alternatives for disposal of carcasses of pigs that have died of ASF. The aim of the review is to increase acceptance and implementation of science-based approaches that increase the feasibility of managing, and the possibility to prevent, ASF in resource-limited settings. This could contribute to protecting hundreds of thousands of livelihoods that depend upon pigs and enable small-scale pig production to reach its full potential for poverty alleviation and food security.
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Samuel M, Fredrick Wabwire T, Tumwine G, Waiswa P. Antimicrobial Usage by Small-Scale Commercial Poultry Farmers in Mid-Western District of Masindi Uganda: Patterns, Public Health Implications, and Antimicrobial Resistance of E. coli. Vet Med Int 2023; 2023:6644271. [PMID: 37122610 PMCID: PMC10139818 DOI: 10.1155/2023/6644271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023] Open
Abstract
Background Poultry production in Uganda is growing at a fast rate due to increasing demand, notwithstanding, poor husbandry practices, and diseases, prompting farmers to rear healthy productive flocks with antimicrobials. The study evaluated the knowledge and practices as regards the use of antibiotics among poultry farmers in Masindi district and determined the antibiotic susceptibility profiles of E. coli strains from chickens. Methods A cross-sectional study using a closed-end questionnaire was conducted in 140 selected small-scale commercial poultry farms in Masindi district between June and December, 2020. Analyzed qualitative data were presented as frequencies, percentages, and their 95% confidence intervals (95% CI). Fecal swabs from chickens were inoculated onto a MacConkey agar, and E. coli was confirmed by standard biochemical tests. Antimicrobial susceptibility was determined by the disk diffusion method for 7 antibiotics. Results Most farmers (74%) used antibiotics, mainly tetracycline (51.4%) and sulfonamides (28.6%), given to the chicks (45%), for both curative and prophylaxis purposes (80%), and via drinking water (67%). Farmers mainly used antibiotics recommended by the veterinarian (76.4%), more than relying on experience (10.7%), while 45% were involved in self-medicating the birds. On choosing the correct dosage, 45.7% read the instruction, and 42.9% consulted a veterinarian. Only 10.7% observed the drug withdrawal period, while 53.6% consumed eggs at home or sold eggs (35.7%) from birds under treatment. Of the 200 E. coli strains, 90 (45.0%) were resistant to one drug, 74 (37.0%) to two, and multidrug resistance to three classes of antibiotics was 36 (18.0%). Overall, E. coli resistance to tetracycline was (69.0%), ampicillin (37.0%), sulfonamides (36.0%), and to kanamycin (1.5%). Conclusions The small-scale poultry farmers frequently use antimicrobial drugs, mainly tetracycline and sulfonamides for curative and prophylaxis. Thus, enforcing measures against antibiotic use supported by a strong veterinary service sector and farmers' training on judicious use of antimicrobials are needed.
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Affiliation(s)
- Majalija Samuel
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Tony Fredrick Wabwire
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Gabriel Tumwine
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
| | - Peter Waiswa
- College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, P.O Box 7062, Kampala, Uganda
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Broz L, Keck F, Weich K. Veterinary anthropology: Samples from an emerging field. Front Vet Sci 2023; 10:1053256. [PMID: 36891467 PMCID: PMC9986252 DOI: 10.3389/fvets.2023.1053256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
We contribute to the growing field of veterinary humanities by promoting collaboration between veterinarians and anthropologists. Veterinary anthropology as we propose it analyzes the role of animal diseases in social life while questioning notions of animal health and human health. We distinguish three ways for veterinarians to collaborate with anthropologists, which more or less follow a chronological order. One form of collaboration requires anthropologists to bring risk perception or local knowledge on zoonoses identified by veterinarians. A more recent form of collaboration integrates veterinarians and anthropologists around the view of animals as actors in infrastructures of security. Finally, we suggest that, as veterinary expertise and its roles in contemporary societies is becoming an object of anthropological enquiry, a new space for collaboration is unfolding that enables veterinarians to see themselves through that reflexive lens of anthropological attention. Veterinary anthropology can therefore be defined as an anthropology of veterinarians and with veterinarians.
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Affiliation(s)
- Ludek Broz
- Czech Academy of Sciences, Institute of Ethnology, Prague, Czechia
| | - Frédéric Keck
- Laboratory for Social Anthropology, Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Kerstin Weich
- Unit of Ethics and Human-Animal Studies, Messerli Research Institute, University of Vienna, Medical University of Vienna, University of Veterinary Medicine, Vienna, Austria
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Chenais E, Depner K, Ebata A, Penrith M, Pfeiffer DU, Price C, Ståhl K, Fischer K. Exploring the hurdles that remain for control of African swine fever in smallholder farming settings. Transbound Emerg Dis 2022; 69:e3370-e3378. [PMID: 35737577 PMCID: PMC9796485 DOI: 10.1111/tbed.14642] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023]
Abstract
To honour the 100 years anniversary of the first publication about African swine fever (ASF) a webinar with a particular focus on disease control in the smallholder sector was organized. This article is based on the webinar, summarizing the early history of ASF research, reflecting on the current global disease situation and bringing forward some suggestions that could contribute towards achieving control of ASF. The first description of ASF by R. Eustace Montgomery in 1921 laid the foundations for what we know about the disease today. Subsequent research confirmed its association with warthogs and soft ticks of the Ornithodoros moubata complex. During the latter half of the 21st century, exponential growth of pig production in Africa has led to a change in the ASF-epidemiology pattern. It is now dominated by a cycle involving domestic pigs and pork with virus spread driven by people. In 2007, a global ASF epidemic started, reaching large parts of Europe, Asia and the Americas. In Europe, this epidemic has primarily affected wild boar. In Asia, wild boar, smallholders and industrialized pig farms have been affected with impact on local, national and international pig value chains. Globally and historically, domestic pigs in smallholder settings are most frequently affected and the main driver of ASF virus transmission. Awaiting a safe and efficacious vaccine, we need to continue focus on other measures, such as biosecurity, for controlling the disease. However, smallholders face specific challenges linked to poverty and other structural factors in implementing biosecurity measures that can prevent spread. Improving biosecurity in the smallholder sector thus remains an important tool for preventing and controlling ASF. In this regard, interdisciplinary research can help to find new ways to promote safe practices, facilitate understanding and embrace smallholders' perspectives, engage stakeholders and adjust prevention and control policies to improve implementation.
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Affiliation(s)
- Erika Chenais
- Department of Disease Control and EpidemiologyNational Veterinary InstituteUppsalaSweden
| | - Klaus Depner
- Institute for International Animal Health / One HealthFriedrich‐Loeffler‐InstitutGreifswald‐Insel RiemsGermany
| | - Ayako Ebata
- Institute of Development StudiesUniversity of SussexBrightonUK
| | - Mary‐Louise Penrith
- Department of Veterinary Tropical DiseasesUniversity of PretoriaPretoriaSouth Africa
| | - Dirk U. Pfeiffer
- Centre for Applied One Health Research and Policy AdviceCity University of Hong KongHong KongPR China,Pathobiology and Population SciencesRoyal Veterinary CollegeLondonUK
| | - Cortney Price
- Animal Production and Health DivisionFood and Agriculture Organization of the United NationsRomeItaly
| | - Karl Ståhl
- Department of Disease Control and EpidemiologyNational Veterinary InstituteUppsalaSweden
| | - Klara Fischer
- Department of Urban and Rural DevelopmentSwedish University of Agricultural SciencesUppsalaSweden
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