| Summary: | The cage aquaculture industry in Lake Victoria, Kenya is growing explosively to meet increasing demand for fish, yet large-scale fish mortalities are prevalent and pose economic shocks with catastrophic livelihood impacts. To gain a more comprehensive understanding of fish health in Lake Victoria, our study applied: (1) survey of cage farmer accounts, perceptions and responses to fish kill events; (2) rapid-response investigation to a significant tilapia mortality event; (3) active disease surveillance; and (4) antimicrobial resistance (AMR) testing of bacterial pathogens via disk diffusion. There were 82 fish kills recalled from 2020 to 2023 with total mortalities exceeding 1.8 million tilapia; yet, only 39% of farmers reported to Kenyan institutions and 17% of farmers attempted medical treatment. Low dissolved oxygen (DO) levels and the isolation of <i>Aeromonas jandaei</i>, <i>Enterobacter hormaechei</i> and <i>Staphylococcus epidermidis</i> were implicated as suspected causes for a recent tilapia mortality event. Active disease surveillance detected trichodinids and monogeneans as common external parasites and identified an additional six bacterial species in tilapia (<i>Acinetobacter soli</i>, <i>Bacillus cereus</i>, <i>Kocuria rhizophila</i>, <i>Micrococcus luteus</i>, <i>Plesiomonas shigelloides</i>, <i>Staphylococcus sciuri</i>) previously published as fish pathogens. Furthermore, we identify AMR patterns that will support the development of host- and pathogen-specific thresholds.
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