The unregulated use of antibiotics is linked with intensive poultry farming in developing economies. In low-and middle-income countries, the dissemination of antimicrobial resistance (AMR) has also been attributed to contamination, poor public health infrastructure and inadequate waste disposal practices. There are limited data on hygiene and waste disposal practices in small-scale commercial and household poultry farming and market sales in Bangladesh. Our objective was to explore human exposures, hygiene and waste disposal practices in poultry raising and processing to identify probable pathways for transmission of AMR bacteria.

We employed mixed methods approaches of in-depth interviews and structured observations to assess exposures, hygiene behaviours and waste-disposal practices relating to poultry production in Bangladesh. Interviews (n = 18) were conducted with commercial poultry farmers, backyard poultry owners, and live poultry market workers. Structured observations were conducted for 6-h in five households, five commercial farms and five urban live bird markets to assess the frequency of transmission/exposure events in these settings.

Interviews highlighted existing practices that can contribute to transmission of antimicrobial resistant bacteria from poultry to humans. In households and farms, untreated poultry waste and carcasses were disposed of on agricultural fields and in water bodies which may contaminate surface water and soil with poultry faeces. Biosecurity precautions were not used, and hands were rarely washed with soap after handling poultry. In urban markets, live poultry slaughter and processing was done on site with bare hands which were subsequently rinsed in water stored in containers without soap. Solid waste from poultry processing was disposed into municipal waste disposal stations and liquid waste was discarded into open drains.

Structured observations revealed that workers in live poultry markets had the highest direct contact with poultry and poultry waste, almost tenfold higher than those working in poultry farms or with domestic poultry (59 vs 544 observed direct poultry exposure events) placing them at particularly high risk of exposure to faecal bacteria. Biosecurity measures were limited; in some cases, workers in commercial farms and urban markets had gloves and masks but often did not use them. In 88% (606/689) of exposure events no handwashing took place. Eating and drinking after handling poultry and without washing hands was observed in all three settings. These data suggest effective intervention strategies to reduce environmental contamination and to decrease risks of transmission should be prioritized. Data on prevalence of risk behaviours and AMR transmission to humans along environmental pathways can inform policy and intervention strategies.

抗生素的无管制使用与发展中经济体的集约化家禽养殖有关。在低收入和中等收入国家，抗微生物药耐药性的传播也归因于污染，公共卫生基础设施薄弱和废物处置做法不足。在孟加拉国的小型商业和家禽养殖场和市场销售中，有关卫生和废物处置做法的数据有限。我们的目标是探索家禽饲养和加工过程中的人类接触，卫生和废物处置方法，以找出可能传播AMR细菌的途径。

我们采用了深度访谈和结构化观察的混合方法，以评估与孟加拉国家禽生产相关的暴露，卫生行为和废物处置做法。与商业家禽养殖者，后院家禽所有者和家禽活体市场工作者进行了访谈（n = 18）。在五个家庭，五个商业农场和五个城市活禽市场中进行了6小时的结构化观察，以评估在这些环境中传播/接触事件的频率。

访谈重点介绍了可能有助于将抗微生物耐药性细菌从家禽传播给人类的现有做法。在家庭和农场中，未经处理的家禽废物和屠体被丢弃在农田和水体中，这可能会污染家禽粪便的地表水和土壤。没有使用生物安全预防措施，处理家禽后很少用肥皂洗手。在城市市场上，用裸手现场宰杀活家禽并进行加工，然后将其用没有肥皂的容器中的水冲洗。家禽加工产生的固体废物被送入市政废物处理站，液体废物被排入露天排水沟。

结构性观察表明，活家禽市场中的工人与家禽和家禽废物的直接接触率最高，几乎比在家禽农场或家禽中的工人高十倍（观察到的直接家禽接触事件为59 vs 544），这使他们处于特别高的患病风险中。暴露于粪便细菌。生物安全措施有限；在某些情况下，商业农场和城市市场的工人戴着手套和口罩，但常常不使用它们。在88％（606/689）的暴露事件中，没有洗手。在所有三种情况下均观察到处理家禽后没有洗手的饮食。这些数据表明，应优先考虑采取有效的干预策略以减少环境污染并降低传播风险。