Sandra Nohrborg

I'm a veterinarian and doctoral student at the Department of Clinical Sciences since 2020. My research relates to antimicrobial resistance (AMR) in livestock production in low- and middle-income countries. More specifically I work with AMR in Vietnamese small- and medium-scale poultry farming. My thesis defense will take place in November 2025.   

Understanding antimicrobial resistance and its drivers in Vietnamese small- and medium-scale chicken farming for successful interventions

Vietnam has undergone a massive economic development the past decades, with a subsequent increased demand for animal-source foods. This has led to a great expansion of the livestock sector, especially in poultry, and a trend towards larger farms is currently seen. Keeping more animals is often associated with a higher disease pressure, and with that higher antibiotic use, especially if biosecurity measures are insufficient. There is also a considerable risk for antibiotic misuse since access to over-the-counter antibiotics is widespread, often in combination with low access to animal health services and diagnostics, especially among small-scale farmers. Taken together, these circumstances have led to several areas in Vietnam becoming “hotspots” for antibiotic use and resistance and alarmingly high levels of resistance have been reported from the human and livestock sectors. 

The Vietnamese government has high ambitions when it comes to dealing with antimicrobial resistance (AMR), mainly through legislations regarding antibiotic use and sales. However, the implementation of these regulations is still insufficient. Therefore, there is a need to combine such top-down approaches with bottom-up approaches to achieve a change from farm level.

The purpose of the research project is to map the AMR situation in small-scale chicken farms in one province in Northern Vietnam (Thai Nguyen), and to understand what drives antibiotic use, in order to facilitate the development of targeted, and effective, interventions to reduce the development of AMR in Vietnamese livestock production. The project is a collaboration between Swedish and Vietnamese partners from SLU, Uppsala University, International Livestock Research Institute (ILRI) and National Institute of Veterinary Research (NIVR).

Specific objectives are to:

• Describe farm characteristics and management routines in Vietnamese small- and medium-scale chicken farms
• Investigate, and evaluate, Vietnamese small- and medium-scale chicken farmers’ knowledge and practices related to antibiotics and AMR
• Evaluate which farmer demographics and farm characteristics that influence chicken farmers’ AMR-related knowledge and practice levels
• Assess AMR in commensal E. coli from healthy poultry in Vietnamese small- and medium-scale chicken farms
• Explore possible associations between farmers’ AMR-related knowledge- and practice scores, and AMR in commensal E. coli in their farms
• Understand, and evaluate, veterinary drug shop workers' knowledge regarding antibiotics and AMR, as well as their routines when selling antibiotics to farmers

The research project includes three studies:

1. A questionnaire-based study to understand poultry producers’ knowledge and practices related to antibiotics and AMR, and which farm(-er) variables that affect those
2. A microbiology study to investigate resistance to different antibiotic substances in commensal E. coli bacteria from chickens/hens in the same farms as in Study 1
3. A questionnaire-based study to understand the knowledge and routines regarding antibiotics among veterinary drug shop workers (the main source of antibiotics to small-scale farmers in Vietnam)

Methods applied

Laboratory methods:

• Standard methods for bacterial culturing
• Bacterial identification with MALDI-TOF MS
• Antibiotic susceptibility testing via disc diffusion
• Antibiotic susceptibility testing via broth microdilution

Statistical methods:

• Descriptive statistics
• Two-sample test of proportions
• Two-sample t-test
• Logistic and linear multilevel mixed-effects regression
• Item response theory
• Classical test theory
• Pairwise correlation analysis
• Map generation with ArcGIS

Supervisor group

Professor Ulf Magnusson, Department of Clinical Sciences, Swedish University of Agricultural Sciences (SLU) 

Professor Sofia Boqvist, Department of Animal Biosciences, Swedish University of Agricultural Sciences (SLU) 

Professor Josef Järhult, Zoonosis Science Center, Department of Medical Sciences, Uppsala University 

Johanna Lindahl, Department of Animal Health and Antimicrobial Strategies, Swedish Veterinary Agency (SVA) 

Collaborators

International Livestock Research Institute (ILRI), Hanoi, Vietnam. Website: https://www.ilri.org/where-we-work/east-and-southeast-asia/vietnam

National Institute of Veterinary Research (NIVR), Hanoi, Vietnam

Funders

The work was financially supported by the Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning, Formas.

2009 – 2015: Degree of Master of Science (MSc) in Veterinary Medicine, SLU, Uppsala, Sweden  

2015 – 2017: Small animal clinician at Djursholm Veterinary Clinic and Gärdet Veterinary Clinic, Stockholm, Sweden

2017 – 2019: Research assistant, Department of Clinical Sciences, SLU 

Responsibilities: Collection, processing and analysis of data regarding the animal welfare control system in Sweden. Production and administration of a Massive Open Online Course (MOOC) on antibiotic use and antimicrobial resistance (AMR) in livestock production. Organization of international workshops on antibiotic use in livestock production in collaboration with the Food and Agricultural Organization of the United Nations (FAO). Development of a university course on One Health and sustainable livestock production. Work for the platform SLU Future Animals, Nature and Health.

2019 – 2020: Lecturer, Department of Clinical Sciences, SLU 

Responsibilities: Administration of a Massive Open Online Course (MOOC) on antibiotic use and antimicrobial resistance (AMR) in livestock production. Course leader and lecturer for a freestanding course on One Health and sustainable livestock production. Lecturer in epizootiology for veterinary students. Administrative work for the international program Agriculture for Food Security 2030 (AgriFoSe2030) at SLU Global.

2020 – in progress: PhD student in Veterinary Medicine, Department of Clinical Sciences, SLU. Planned thesis defense November 2025.

Research papers

Nohrborg S, Dione MM, Winfred AC, Okello L, Wieland B, Magnusson U. Geographic and Socioeconomic Influence on Knowledge and Practices Related to Antimicrobial Resistance among Smallholder Pig Farmers in Uganda. Antibiotics (Basel). 2022 Feb 15;11(2):251. doi: 10.3390/antibiotics11020251. 

Nohrborg S, Nguyen-Thi T, Xuan HN, Lindahl J, Boqvist S, Järhult JD, Magnusson U. Understanding Vietnamese chicken farmers' knowledge and practices related to antimicrobial resistance using an item response theory approach. Front Vet Sci. 2024 Apr 5;11:1319933. doi: 10.3389/fvets.2024.1319933. 

Nohrborg S, Nguyen-Thi T, Xuan HN, Hai YLT, Lindahl J, Boqvist S, Järhult JD, Magnusson U. Understanding veterinary drug shop workers' knowledge and practices to identify drivers of antibiotic use in Vietnamese livestock farms. Vet Med Sci. 2024 Jul;10(4):e1502. doi: 10.1002/vms3.1502. 

Other

Post-conference brief, Uppsala Health Summit, Managing Antibiotic Resistance Through Behaviour Change, 2021: Why not practice knowledge? Authors: Ulf Magnusson, Anni McLeod, Leif Östman, Sandra Nohrborg, Christina Greko, Birgitta Lytsy, Cortney Price https://www.uppsalahealthsummit.se/digitalAssets/547/c_547164-l_1-k_why-not-practise-knowledge-post-conference-brief.pdf

Post-conference brief, Uppsala Health Summit, Healthy Lives from Sustainable Food Systems, 2022: Tackling Antimicrobial Resistance for Sustainable Food Systems – How to Address the Knowledge, Practice, and Governance Gaps. Authors: Marmar Nekoro, Justine Alinaitwe, Ulrika Bergström, Krister Halldin, Ulf Magnusson, Sandra Nohrborg, Kristina Osbjer, Julaporn Srinha https://www.uppsalahealthsummit.se/digitalAssets/547/c_547164-l_1-k_22-0481-uhs-post-conference-report-2022_i_digital.pdf