1. Introduction
Ghana’s tilapia and catfish aquaculture industry are crucial for economic growth, contributing about 5% to GDP. Cage aquaculture systems in Ghana consist of small-, medium-, and large-scale farms, accounting for approximately 90% of farmed fish, with the remaining 10% coming from other culture systems like ponds and tanks. The industry has experienced rapid growth in cage farming on Lake Volta, with an annual increase of 73%, making it the fastest-growing aquaculture industry in Ghana [
1]. However, in late 2018, a disease outbreak caused by the infectious spleen and kidney necrosis virus (ISKNV) and bacterial infections resulted in substantial mortality of fish in cage farms in Lake Volta, followed by a decline in aquaculture production from 65,000 metric tons to 52,000 metric tons in 2019 [
2]. The following burden of disease outbreaks, disease diagnosis, and the overall fish health management practices were mostly handled independently by the farmers and lacked a collaborative approach established by fish health authorities in Ghana on the Volta Lake [
3].
It has been documented in many Asian aquaculture-intensive countries that aquaculture farmers use antibiotics and antibiotic-formulated feeds to treat and prevent all kinds of infections in fish farming as well as promote the fast growth of fish, boost fish immunity, and increase the survival of fish to maximize profit [
4,
5,
6,
7,
8,
9]. A review revealed the wide use of tetracyclines, oxolinic acid, sulfonamides, and erythromycin antibiotics in aquaculture production [
5,
8,
10,
11,
12]. However, the use of antibiotics in animal feeds varies across geographic regions depending on the local food regulatory authorities, antibiotic usage profiles, monitoring systems, and even regulatory frameworks governing the use of antibiotics [
13,
14,
15]. There has been an indication of the use of antibiotics in earthen and concrete fish ponds in Ghana [
16,
17,
18]. A recent article revealed the presence of antibiotic residues in water and soil sediments sampled from cage farms of Volta Lake, Ghana [
19,
20]. Antibiotics, in general, are mostly limited to water solubility and resilience to deterioration and biodegradation [
5]. Unregulated antibiotic use in fish culture has the tendency to increase resistant traits to both animal and human pathogens, affecting food quality and its safety by leaving residues in food products and, as well as its effect on organs like the liver, has become a major threat to public health and general animal welfare [
5,
20,
21,
22]. The One Health concept stresses reducing antibiotic resistance concerns at the human–animal–environment interface, with the goal of improving control mechanisms and addressing the complicated issue regarding antibiotic overuse in aquaculture [
23,
24,
25,
26,
27]. Furthermore, occupational health hazards of aquaculture workers and human health risks connected with recreational waters posed by antibiotic resistance have been emerging issues but have been scarcely evaluated [
28,
29]. Some pathogenic bacteria, such as Aeromonas, play an important role in the human–animal–environment interface, and their ability to transmit tetracycline resistance under oxytetracycline stressors has been investigated [
30,
31]. Given the significance of cage fish farming to the local and national economy and the increasing call for ecologically friendly fish farming methods, antibiotic use, mode of application, and withdrawal period, as well as the role of stakeholders in the use of pharmaceuticals in fish farming on the Volta Lake needs to be evaluated and documented. This study, therefore, seeks to address the gaps in knowledge by examining the knowledge, attitude, and practices of cage farmers on antibiotic use and the role of stakeholders in regulating antibiotic use in cage aquaculture on the Volta Lake.
3. Discussion
Global aquaculture has considerably increased the availability of fish for human consumption, reduced pressure on natural stocks, and employed many trained and unskilled individuals across the value chain [
13]. However, it has also had a detrimental influence on the environment and public health, including disease outbreaks, environmental pollution, and residues of antibiotics in products [
7,
9,
32,
33,
34]. Certain antibiotics are permitted and used in some countries either for the purpose of treating or preventing diseases in aquaculture [
6,
7,
12,
35,
36]. Recent research revealed Vietnam as the top user of antibiotics in aquaculture between 2008 and 2018 [
37], while Chile was deemed the country with the most significant antibiotic use per ton of fish harvested [
38]. It is necessary to better understand the status of antibiotic use in all aquaculture systems, especially in cage aquaculture since the use of antibiotics in aquaculture varies between regions, countries, species, production phases (hatcheries, nurseries, and grow-out), and farming systems [
6,
7,
27,
39,
40]. Little or no attention has been given to the assessment and effects of antibiotic use on freshwater cage aquaculture fish species for domestic trade. Cage aquaculture farms contribute to local and international food security, sustainable rural and urban development, job creation, and water efficiency. Antibiotic residues have been found in water and sediment samples from cage farms [
20]. Similarly, antibiotic-resistant
A. hydrophila and
Streptococcus spp. strains have been reported in aquaculture systems in Volta Lake [
24,
41]. These secondary data support our findings in the current study, which show that antibiotics are widely used in cage aquaculture in Ghana.
Misuse and lack of antibiotic awareness endanger antibiotic-resistant microbes, environmental and farmed fish residues, and human food security [
7,
9,
12,
38]. According to the survey, most fish farmers have been in the profession for 16 years or more and have an average income of 10,000 USD earned per year. Feed expenses, fingerling costs, mortality, and disease outbreaks are all issues that must be addressed as the significant challenges farmers face. On the other hand, most cage farmers believe that antibiotics can be used to treat any infections caused by any microorganism and that they may also be used to fatten fish quickly. A possible reason could be ascribed to the cheap and initial effectiveness of antibiotic application in disease control, and the general animal welfare and the tenacity of farmers to raise fish and to make a profit by all means within the shortest period. A similar study has been reported on freshwater fish and giant prawn (
Macrobrachium rosenbergii) farmers in southern Vietnam, where these farmers reportedly use antibiotics for treating diseases and for prophylaxis purposes without any prior diagnostic tests [
42,
43]. The study revealed that a number of the farmers had been exposed to the tetracycline group of antibiotics, with the majority of them admitting to having learned about antibiotic usage from friends. These antibiotics increase survival, boost immunity, lower mortality, promote growth, improve digestion, and cure wounds. Common diseases caused by ISKNV and streptococcus predominantly affect most cage farms. The survey recorded the ineffectiveness of treatment and even death of fish due to inappropriate application of antibiotics by farmers. Despite this, farmers use or overuse antibiotics in cage aquaculture. The main reason could be a lack of information, training or access to alternative treatments or management practices as a replacement for antibiotics for treating infectious diseases in fish, in the form of vaccination, probiotics, or herbal/plant extracts. Also, other treatments, such as vaccination and probiotics, which have proven promising candidates to replace antibiotics, are also not specific to fish species and are costly. It was also revealed that there is no diagnostic center around the Lake that could respond to farmers in times of difficulty. Moreover, in the local environment, farmers tend to believe in the experience of friends in a related field rather than consulting experts on a particular issue regardless of its consequences. In a related study, it was noted that Vietnamese farmers reported treatment failure and poor response due to inappropriate antibiotic dosage, demonstrating a lack of awareness about the hazards of antibiotic usage in marine fish and lobster cage farming [
39].
The survey revealed that fish farmers obtain either human or animal antibiotics through personal encounters without appropriate monitoring or regulation. Reducing antibiotic use in fish farming can be accomplished by lowering stocking density, avoiding overfeeding, providing quality feed, and minimizing stressful activities. Most farmers have worked in the aquaculture business on the Volta Lake for more than 16 years and they might have come across these drugs through personal experience. Some also indicated that they had worked on people’s farms before establishing their own farms. All these could influence their exposure and experience to antibiotic use in fish culture [
39]. Most respondents believe all antibiotics, be they for human or veterinary use, have an essential role in overall fish health management. Antibiotics have been tested and proven effective for therapeutic, metaphylaxis, and prophylaxis purposes both in humans and in animals. Other studies have shown that human-use antibiotics in aquaculture fields have increased and proven effective due to their efficacy, low cost, and availability [
39,
42,
44]. With these findings considered, researchers, fish farmers, and stakeholders would need to study, collaborate, and share practical alternative approaches to disease outbreaks, treatment, and the development of a dependable and trusted replacement for these antibiotic compounds in order to reduce their use in aquaculture successfully. These issues appear to be more challenging in cage and open aquaculture systems since it is more complicated, as well as significantly more expensive to apply biosecurity and meet the requirement of Good Aquaculture Practice (GAD) standards [
6,
42,
43]. The government must continue to support novel research and educational programs on antibiotic use and its effects. To address these concerns, there is need to work collaboratively to improve advisory services and give training on the responsible use of antibiotics, as well as alternative disease prevention and mitigation techniques.
Moreover, respondents utilize veterinary medications without a prescription when there is a sudden change in fish behavior and for any purposes concerning fish health management. According to the survey, most cage farmers base their drug effectiveness decisions on recommendations from friends who have used them before, with a lot revealing the level of infection and route of antibiotic administration as grounds for antibiotic inactivity. Caged farmers also agreed to combine or switch to different antibiotics when they did not obtain satisfactory results after their application. They also typically acquire drugs from street sellers for any purpose in fish farming. This was attributed to the fact that diagnosing a disease that usually delays and no diagnostic center even to carry out a simple diagnosis, as well as no specific antibiotics for fish, are significant reasons why farmers depend on other farmers for the type, timing, and to judge the effectiveness of the antibiotic application. Easy and cheap access to medications from roadside sellers without interrogation also influenced farmers’ desire to acquire drugs from these areas rather than buying from veterinary shops which are usually occupied by veterinary protocols. This study agrees with other surveys conducted by [
45,
46]. It has been reported that farmers in the Mekong Delta of southern Vietnam who use higher doses of antibiotics do so based on personal experience rather than instructions [
42,
43]. Antibiotic usage in Ghana is primarily due to availability, convenience, and cost and is mostly for human and animal use. Therefore, governments and stakeholders of concern must impose more robust monitoring and restriction of antibiotic sales for aquaculture and for food producing animal users in general. Different nations have different distribution and registration systems and upper-middle- and high-income countries require veterinarian antibiotic prescriptions on antibiotic application [
6,
47].
Previous research has identified a knowledge gap in antibiotic misuse in resource-constrained aquaculture businesses and areas, with demographic factors significantly influencing knowledge, attitudes, and practice [
6,
39]. Previous studies discovered that age, education, farm type, and farm size were significant determinants of farmers’ KAP for antibiotic use in aquaculture farms [
6,
39]. According to the present study, age, level of education, and number of cages significantly (
p < 0.05) influence proper knowledge of antibiotics use in cage aquaculture, while age, role on the farm, years in farming, and number of cages significantly (
p < 0.05) influenced “desirable” attitudes in antibiotic use. Age, level of education, and number of cages significantly (
p < 0.05) the odds of having “better” practice towards antibiotics use. The findings of several studies [
48,
49,
50] are consistent with the current survey results. Regardless of their level of knowledge, attitudes, and practices, respondents engaged in inappropriate use of antibiotics in fish culture due to less supervision and surveillance [
15]. The study finds a substantial relationship between farmers’ age and knowledge, attitudes, and practices on antibiotic use, with those farmers aged 51 years and above having better practices than younger farmers. This could be a result of the eagerness of the young generation to make a profit at all costs, thereby not following good husbandry practices, a conclusion comparable to a Bangladeshi study [
44]. To combat the rate of antibiotic use in fish culture, human behavior and educational level are crucial [
51]. In addition, to enhance the proper use of antibiotics, farmers must have a high level of education and adopt certain behaviors [
52]. A farmer’s educational status is substantially linked (
p < 0.05) with knowledge and practices regarding the general use of antibiotics [
53]. The study also found that farmers with tertiary education showed better KAP responses toward antibiotic use, similar to a Turkish study emphasizing higher education about antibiotic usage [
54]. Highly educated farmers have access to veterinary services, farm management, biosecurity measures, and a better grasp of antibiotic use and withdrawal times [
55]. According to the study, farmers with low knowledge ratings were more likely to apply antibiotics inappropriately, which is similar to the findings of a study in Cameroon and Bangladesh, where farmers with lower knowledge were more likely to be untrained in poultry farming and therefore will not adhere to antibiotics protocols [
56,
57] and with drug and feed sellers reporting that farmers who received training had appropriate practices regarding AMU and AMR, respectively. The present study advocates that farmers be encouraged to participate in antibiotic training programs to create a baseline of knowledge. Educational campaigns, seminars, and mass media communications should be organized to train fish farmers with the assistance of physicians and veterinarians [
51,
56]. High costs of veterinary services, animal healthcare, feeding, and animal loss may promote negative attitudes and practices toward proper animal husbandry [
58,
59].
To reduce antibiotic use in cage aquaculture, farmers and stakeholders must have access to affordable disease diagnostic services closer to Volta Lake and be better informed about antibiotic resistance and other risks. Improving farm biosecurity can help avoid the possibility of disease outbreaks while also managing environmental cleanliness and water quality, particularly on Volta Lake [
20]. Pre- and probiotics are widely used in aquaculture systems worldwide, particularly in intensive and superintensive forms, to prevent and manage disease outbreaks while maintaining water quality [
60,
61]. Vaccination has also proven beneficial in lowering antibiotic use in aquaculture [
38,
62,
63]. Ghana’s tilapia and cage culture systems are still in the early stages of development compared to European countries due to a lack of appropriate systems to check vaccines, delivery systems, and costs. Corporate–public collaborations between the government, academia, and the corporate sector can help to provide low-cost and customized immunizations that can all help to reduce antibiotics in cage aquaculture.
4. Materials and Methods
4.1. Ethical Consideration and Approval
All ethical clearance and consent were sought and obtained concerning the present study from the University for Development Studies and the Ministry of Fisheries and Aquaculture Development, Ghana (REF. NUMBER FC 0.5/9)
4.2. Study Area
Sampled cage farms in stratum II of the Volta Lake within the Akosombo Dam at 6°17′57.7″ N 0°03′19.6″ E is designated as upstream, through the area between the Akosombo Dam and Kpong Dam at 6°07′12.4″ N 0°07′31.4″ E is designated as midstream, and after the Kpong Dam at 6°06′02.3″ N 0°09′26.2″ E through to the Akuse area is designated as downstream. These demarcations are the original sections of the stratum II of the Volta Lake, which were the sampled areas for the study (
Figure 12) [
64].
4.3. Development and Pretesting of Research Instrument
A multidisciplinary group of aquaculture professionals, environmental scientists, drug producers, pharmacists, food scientists, water quality experts, fish farmers, and consumers collaborated to design a questionnaire on antibiotic use in cage aquaculture systems. The questionnaire focused on farmers’ demographic characteristics, level of experience in fish farming, knowledge, attitude, practice, personal experience, and some recommendations on the use of antibiotics in fish farming, as well as the role of veterinarians and government fisheries officials in the use of antibiotics in fish culture on the Volta Lake. The questionnaire was complemented by physical observations of antibiotic application and practice in cage farms to obtain more in-depth information about the study. The questionnaire was pilot-tested between October and November 2023 with a sample of the target group. Appropriate measures were taken to preserve and maintain confidentiality, anonymity, and voluntarism throughout the study.
4.4. Sampling Techniques and Design
Purposive sampling was used in choosing fish farmers along the strata for the study, from December 2023 to February 2024. In each designated site, ten (10) or eleven (11) small-scale (i.e., farms with cage dimensions 5 m × 5 m × 5 m), medium-scale (i.e., farms with cage dimensions 6 m × 6 m × 6 m), and large scale (i.e., farms with cage dimensions 12 m × 12 m × 12 m) individual cage fish farms with a general stocking density between 6000–200,000 fingerlings/grow out per cage. In all, a total of 91 (30 small-scale, 30 medium-scale, and 31 large-scale farms) individual cage fish farms were sampled.
4.5. Data Analysis
All data obtained from the field, including demographics, level of experience in fish farming, knowledge, attitude, and practice about antibiotic use, were coded into a computerized database and analyzed using STATA software version 17. In all, 91 cage fish farmers of valid data cases were incorporated and analyzed, and the results were presented as frequencies and percentages in tables and charts. Pearson’s chi-square test was used to determine whether the observed variables are related to each other, Spearman’s correlation was used to assess the strength and direction of the tested variables, logistic regression was used to analyze the relationship between the tested variables, and validity and liability tests were done by using Cronbach’s alpha to check for internal consistency which was all performed using STATA. In contrast, Kendall’s coefficient of concordant was carried out using SPSS version 24 to rank the challenges faced by farmers.