Participatory Epidemiological Methods Research Articles

Community Conversations: A Tool in Improving Health Outcomes and Reducing the Burden of Visceral Leishmaniasis (Kala-azar) in Isiolo County, Kenya

Visceral Leishmaniasis (Kala-azar) is a neglected tropical disease (NTD) caused by Leishmania species that affects human. Transmission is through the bite of Phlebotomus sandflies. Globally, WHO ranks Kala-azar as the second largest parasitic killer after Malaria. The disease poses a threat to more than a billion people on almost every continent. Approximately 90% of Kala-azar global burden is found in Africa. Major endemicity is documented in Eastern Africa (Kenya, South Sudan, Sudan, Ethiopia, and Somalia). Accurate burden of the disease in Kenya is unknown attributable to inadequate information on disease prevalence, diagnostic challenges, and spatial distribution. Additionally, morbidity and mortality levels from the disease in the Country are unknown ascribable to a low index of suspicion by healthcare workers, diagnostic challenges, and case management. An example of diagnostic challenges is a reported outbreak of ‘unknown disease’ akin to Kala-azar in Marsabit County in May 2023 where nine people were confirmed dead and over 80 hospitalized. This study aimed to analyze community’s prioritization of causes of Kalaazar as well as community awareness of disease prevention and control. Quantitative data were collected using Participatory Epidemiology methods in purposively selected study villages. Qualitative data were collected through semi-structured interviews. Study findings indicated that 97.2% of respondents had heard about Kala-azar. Despite the awareness, a broad gap between knowledge and practice of prevention and control strategies of the disease was evident. Kala-azar was associated with human behaviour like preferences for traditional and alternative treatment approaches (45.2%), evening outdoor practices before going to bed (99.6%), sleeping outdoors (60.1%), occasional bed nets use (69.2%), and availability of domestic animals and wild animals within house yards (54.6%). Cultural beliefs and practices were noted to play a key role in augmenting the disease burden, where most cases had burn scars from traditional healers’ therapeutic burns. As a consequence, they sought medical help after onset of complications, which ranged from increased severity to fatalities. Community engagement was minimal in prevention and control. In this participatory research, we propose behaviour change communication activities for the elimination of Kala-azar as a public health problem. This article serves as a base for future studies aimed at giving voice to communities while enhancing their understanding of causes of diseases, the possibility of enhanced early diagnostic techniques, and options for prevention, control, and surveillance which in turn is translated to action.

Combining conventional and participatory approaches to identify and prioritise management and health-related constraints to smallholder pig production in San Simon, Pampanga, Philippines

Pork is the main meat produced and consumed in the Philippines. The majority of pigs are raised by smallholders who experience a range of constraints to their pig production. This study presents the findings of the first part of an overarching project that used an Ecohealth approach and aimed to improve the production and competitiveness of the smallholder pig system in an area of the Philippines. A participatory approach was embraced, combining conventional and participatory epidemiology methods followed by a stakeholder discussion. The first aim was to identify management and health-related constraints to pig production among smallholder famers in San Simon, Pampanga, Philippines. The second aim was for the project team and stakeholders to jointly prioritise activities for the immediate future to address these constraints. Key management and health-related constraints identified included inadequate water supply to pigs, particularly lactating and gestating sows, and a range of feeding-related issues. Diarrhoea was recognised as the disease syndrome of highest priority and limited record keeping meant that farmers were unable to assess the productivity and profitability of their pig farming enterprises. Actions jointly prioritised by stakeholders and the project team were: the appointment of a project coordinator within each barangay; conduct two sets of seminars, the first covering water and nutrition and the second piglet management and diarrhoea, to be delivered by technical experts but with farmer “trusted sources” also sharing their experiences; development of easily understandable leaflets and posters covering key technical information; promotion of nipple drinkers attached to five-gallon water containers and creep boxes for piglets, and conduct of a record keeping workshop with a small group of innovative farmers to develop a useful and usable tool for record keeping. The use of multiple approaches to data-gathering enabled triangulation of study findings. Without any one of these components the understanding of the pig production system would have been less complete and it is possible that the proposed actions would not have been as well-tailored to the needs of the farmers. The participatory approach, in particular the stakeholder discussion, provided the opportunity to embrace the “deciding together” and “acting together” stances of participation rather than the lower “information giving” stance, thereby giving stakeholders greater ownership of the future activities of the overarching project and beyond.

Analysis of the benefits and production challenges of working donkeys in smallholder farming systems in Kenya.

Aim:The aim of the study was to determine the benefits of keeping donkeys and associated production challenges under a smallholder farming system in Kenya.Materials and Methods:A descriptive study was conducted with smallholder farmers keeping donkeys in 13 administrative locations in Kirinyaga County. Data were collected using a questionnaire guide in 13 focus group discussions (FGDs) using participatory epidemiological methods. The FGDs comprised 8-12 participants who were donkey owners. Data were collected through listing, pair-wise ranking, and probing on the benefits of keeping donkeys, challenges faced by working donkeys and the common diseases that affect donkeys in these farms. Data analysis was performed using Kruskal–Wallis non-parametric method to test whether median ranks were significantly different. Other farm level data were also collected using the structured questionnaire and these were analyzed using descriptive statistical methods.Results:The identified benefits included income obtained from the use of donkeys in transportation (Z=5.80) and manure production (Z=3.47), which enabled the farmers to participate in trade activities and improve crop farming. The identified challenges included theft for slaughter (Z=5.99), disease incidence (Z=3.03), road accidents (Z=2.83), and malicious cutting (Z=2.32). Some of the diseases identified were tetanus (Z=5.35), hoof problems (Z=4.55), helminthiases (Z=3.10), and mange (Z=2.24). Participants ranked diseases based on their effects on work output for the donkeys, reducing productivity and often causing death. Addressing these production challenges would optimize donkey use among smallholder farmers.Conclusion:The results presented can be important for policymakers and extension agents regarding the health and welfare of donkeys kept under similar settings.

Identification of Peste des Petits Ruminants Transmission Hotspots in the Karamoja Subregion of Uganda for Targeting of Eradication Interventions.

This paper describes an assessment of the patterns of peste des petits ruminants virus circulation in the Karamoja subregion of Uganda conducted to identify the communities that maintain the virus and inform the development of a targeted vaccination strategy. Participatory epidemiological methods were used to develop an operational hypothesis for the patterns of PPR in Karamoja that was subsequently validated through outbreak investigation and genomics. The participatory epidemiological assessment included risk mapping with livestock owners, community animal health workers and veterinarians and indicated there were two critical foci of virus transmission on the Uganda-Kenya border. One was located in two adjacent subcounties of Kotido and Kaabong Districts in northern Karamoja and the other in Loroo subcounty of Amudat District in southern Karamoja. Participants reported that these were locations where outbreaks were usually first observed in Karamoja and subsequently spread to other areas. Following the participatory assessment, surveillance activities were implemented across the Karamoja subregion in 2018. Three outbreak were detected, investigated and sampled. Two outbreaks were located in the northern and one on the southern focus of transmission. No Outbreaks were diagnosed in Karamoja outside of these foci during 2018. Genomics indicated different clusters of viruses were associated with the northern and southern foci that were more closely related to other East African isolates than to each other. This indicates these are two separate systems of virus circulation which should be explicitly addressed in eradication as separate cross-border systems that require integrated cross-border interventions.

Indigenous knowledge, practices and preferences in control of gastrointestinal nematodes in Bonga and Horro sheep of Ethiopia

Gastrointestinal nematodes (GIN) remain one of the main health and production constraints of sheep globally. Considering alternatives to anthelmintics in control of GIN of sheep has become important mainly due to development of anthelmintic resistance. In this study, we used a questionnaire survey in combination with participatory epidemiology methods, ranking and scoring, with the objectives of (1) understanding local sheep disease problems related to GIN in community-based breeding programs (CBBP) in Bonga and Horro of Ethiopia, compared to neighboring communities not involved in CBBP, and (2) assessing current practices and preferences in control of GIN of sheep in both types of communities. The most important disease conditions of sheep in Bonga CBBP with weighed ranks of 1 to 3 were coenurosis, diarrhea and coughing. The corresponding sheep disease conditions in Horro CBBP were coughing, diarrhea and bottle jaw. Diarrhea and bottle jaw presumably are related to gastrointestinal nematodes. Ethnoveterinary medicinal plants are widely used in Bonga while the knowledge is at risk of loss in Horro. Respondents in non CBBP and CBBP communities did not differ (p > 0.05) regarding most of the plant species used frequently in control of GIN in Bonga. There was significant difference (p < 0.001) in frequency of anthelmintic use between CBBP and non CBBP communities for each of the two locations, Bonga and Horro. In Horro, CBBP farmers considered anthelmintics as more sustainable GIN control option than non CBBP farmers (p < 0.001). This can be attributed to lack of awareness pertinent to development of anthelmintic resistance. In conclusion, local knowledge, practices and preferences of farmers should be considered when designing and implementing control programs for gastrointestinal nematodes.

A participatory epidemiological study of major cattle diseases amongst Maasai pastoralists living in wildlife-livestock interfaces in Maasai Mara, Kenya

Livestock-wildlife interactions promote the transmission of a wide range of infectious diseases that constraint livestock production. We used a participatory appraisal approach to find out and rank infectious diseases of concern to pastoralists in a zone of intense wildlife-livestock interaction and another zone with limited interactions. Four villages were selected purposively in areas with intensive cattle-wildlife interactions (zone 1), and another two in areas with low to moderate cattle-wildlife interactions (zone 2). Data were collected in focus group discussions (FGDs) using participatory epidemiological methods (PE); each group had 8–13 participants. Results of impact matrix scoring from all sites indicated that malignant catarrhal fever (MCF), anthrax, foot and mouth disease (FMD), contagious bovine pleuropneumonia (CBPP), east coast fever (ECF) and African animal trypanosomiasis (ATT), in decreasing order, had the highest impact on livestock production. A Kruskal–Wallis test revealed a significant difference in FMD annual prevalence between cattle age groups (p < 0.001) and was the highest in animals > 4 years (median score of 32.5, range, 10–50). FMD had the highest impact on milk production, but based on veterinary costs (treatment costs), it was ranked second to CBPP. The study provides information on disease priorities that occur in the target zones in Mara ecosystem and which the local pastoralists must consider when accessing key ecosystem services such as water and pasture.

Social transitions in the Savannah

PurposeThe purpose of this paper is twofold: first, to explore social risk management strategies amongst Fulani in the subhumid zone of Nigeria; and second, to determine current status and nature of reciprocal exchange networks, risk pooling and social support for pastoral livelihoods in North-Central Nigeria.Design/methodology/approachSurveys of cattle productivity and pastoral livelihoods were carried out amongst Fulani pastoralists on the Jos Plateau: between 2008 and 2013 using participatory epidemiology methods and the sustainable livelihoods framework. Qualitative and quantitative data on livelihood activities, knowledge, attitudes and practices of animal husbandry and disease control, wealth grouping, herd entries and exits was gathered to determine the current state of cattle productivity and pastoral livelihoods in the study area.FindingsResults show that reciprocal exchange networks for risk management have mostly disintegrated and patron-client relationships have become an important social risk management strategy.Practical implicationsThis research has significant implications for sustainability of Fulani livelihoods and communities: decreased social risk-management strategies and increased self-reliance means that the most vulnerable households will find it more difficult to withstand shocks and climb out of poverty. Wealthier households may cope better with high incidence/low severity shocks like but are more vulnerable to low incidence/high severity shocks. Likewise, decreased social cohesion reduces the ability of communities to mobilise and act collectively in the face of community-level shocks. This is very important for engagement with the state – a crucial process, given current levels of acrimony and conflict.Originality/valueGiven the high levels of farmer-herder conflict and civil unrest in this region over the past 15 years this research is valuable in providing insights into economic drivers of conflict, current dynamics of pastoral livelihoods and social cohesion within and between communities.

English

Participatory epidemiological methods were used to establish local perceptions and livestock owner’s knowledge, attitudes and practices (KAPs) of risk factors that impacts of climate variability and the seasonal variations in incidences of livestock diseases, disease vectors, intermediate hosts and rainfall in pastoral Rift valley of Kenya. The interaction of the molecular biology of the pathogen itself; vectors (if any); farming practice, land use; zoological and environmental factors; and the establishment of new microenvironments and microclimates were important in forecasting how contagious caprine pleuronemonia, enterotoxaemia and sheep and goat pox occurred. Thus, the future for traditional pastoralists is depressing if they depend on an environment that may no longer support them. A risk assessment framework is proposedwas used, to examine factors based on modules that accommodate these factors. Risk assessments focused on examining the combinations of factors directly affected by climate change or indirectly by human activity, such as land use (e.g. deforestation), transport and movement of animals, intensity of livestock farming and habitat change and their relationship with should be done. This used to screen for the emergence of unexpected disease events. The present study recommended implementing disease management practices and policy measures to mitigate the impact of climate variability on the spread of livestock diseases. Key words: Climate change, participatory epidemiology, incidences of small ruminant diseases, pastoral areas.

Participatory epidemiology at the neotropics: study of diseases of backyard livestock and description of hunting patterns in Uaxactún, Maya Reserve Biosphere, Guatemala.

BackgroundThe intention of the following study was to describe the interrelationship between villagers, domestic animals and wildlife at the Community Forestry Concession of Uaxactún, Guatemala by means of participatory epidemiological methods. The main focus was generating information regarding different livestock diseases considered important by villagers and their relevance, as well as obtaining knowledge concerning hunting activities and cooking methods to gain a better understanding of the interrelationship of people and animals and the diseases of their animals.ResultsFor poultry, an overall prevalence of 41 % of Newcastle disease was found by means of the ELISA test by antibody detection, chicken being the most affected species in the village. No samples were positive to avian influenza with the HI test. No virus was isolated by means of the tracheal or cloaca swabbing of ducks.For huntingAll species could be hunted by chance at any time of the year. There was a difference in species hunted between seasons, peccaries being more frequently hunted during the dry season and in contrast, deer and wild avian during the rainy season.For cookingVillagers did not consume any raw meat. The cooking methods depended on the species. Stewing was the most favoured method for peccaries, wild birds, tepezcuintle and domestic poultry, whereas grilling was preferable for deer, roasting for armadillos and marinating for pork.ConclusionAccording to the generated information, the most important domestic livestock species in the village are chickens and pigs, chickens being the most affected by diseases. No evident health problems on pigs were observed in this study. Hunting was shown as an activity enhanced by poverty and the lack of employment opportunities in the village and was mostly directed at larger species such as deer and peccaries. From the viewpoint of a transmission of zoonoses from animals to humans cooking methods mostly reflected a protective factor as no raw meat was eaten, stews and broths being the most common forms of cooking, involving an exposure of meat to high temperatures. Nonetheless, both agricultural and hunting activities represent a risk factor for the spread of diseases as hunters may act as mechanical vectors for different pathogens within domestic and wild animal populations.

Perceptions of zoonotic and animal diseases in the Van Gujjar community of North India

Humans living in and around forest areas are at increased risk of zoonotic disease transmission. The transhumant Van Gujjars of North India are one such population, but there is an absence of health data, including evidence of zoonotic diseases, in this community. Pastoral communities can have a wide breadth of knowledge of livestock diseases, but not necessarily of human diseases. This study investigated the perceptions that the Van Gujjars have specifically of zoonotic diseases, using participatory epidemiological methods, including semi-structured interviews, ranking, proportional piling, transect walks and direct observation, triangulated by informal interviews with local veterinarians. The community did not have a wide appreciation of zoonotic diseases, apart from rabies and potentially zoonotic skin diseases. In contrast, animal diseases were of much greater concern to the community; the locally-named surra (trypanosomiasis), ajar, khuriya (foot-and-mouth disease), dakhutra, gheru, taku, and ‘blood in urine’ (possibly babesiosis), being of most concern. A participatory epidemiological approach was found to be an effective method of data collection and analysis; and the findings suggest that access to health services, particularly veterinary health services, should be improved for Van Gujjars.

Investigation of major cattle production constraints in Kembata Tambaro zone of Southern Ethiopia using participatory epidemiology methods

Ethiopia has enormous livestock resources from which rural households derive their livelihoods. A cross-sectional study based on participatory appraisal methods was conducted in Kembata Tambaro zone to assess major constraints to livestock production and major diseases of cattle and their treatment options. Four districts were selected purposively for this study, and 18 peasant associations were randomly sampled from the selected districts. Focus group discussion, semistructured interviews, simple ranking and scoring, proportional piling, pairwise ranking, and matrix scoring were the participatory epidemiological tools used in the study. Feed and free grazing land shortages and diseases were found to be the major constraints to cattle production in the area. Mastitis was ranked as the most serious disease of cattle. Modern veterinary treatments are used alongside traditional herbal remedies. Matrix scoring showed strong agreement between focus groups in identifying the major diseases using their indicators (clinical signs). Hence, it was concluded that indigenous knowledge complemented with participatory methods and approaches allow community and field researchers to jointly study specific livestock problems and help identify appropriate solutions.

The Perceived Value of Passive Animal Health Surveillance: The Case of Highly Pathogenic Avian Influenza in Vietnam.

SummaryEconomic evaluations are critical for the assessment of the efficiency and sustainability of animal health surveillance systems and the improvement of their efficiency. Methods identifying and quantifying costs and benefits incurred by public and private actors of passive surveillance systems (i.e. actors of veterinary authorities and private actors who may report clinical signs) are needed. This study presents the evaluation of perceived costs and benefits of highly pathogenic avian influenza (HPAI) passive surveillance in Vietnam. Surveys based on participatory epidemiology methods were conducted in three provinces in Vietnam to collect data on costs and benefits resulting from the reporting of HPAI suspicions to veterinary authorities. A quantitative tool based on stated preference methods and participatory techniques was developed and applied to assess the non‐monetary costs and benefits. The study showed that poultry farmers are facing several options regarding the management of HPAI suspicions, besides reporting the following: treatment, sale or destruction of animals. The option of reporting was associated with uncertain outcome and transaction costs. Besides, actors anticipated the release of health information to cause a drop of markets prices. This cost was relevant at all levels, including farmers, veterinary authorities and private actors of the upstream sector (feed, chicks and medicine supply). One benefit associated with passive surveillance was the intervention of public services to clean farms and the environment to limit the disease spread. Private actors of the poultry sector valued information on HPAI suspicions (perceived as a non‐monetary benefit) which was mainly obtained from other private actors and media.

Economic losses associated with Peste des petits ruminants in Turkana County Kenya

Peste des petits ruminants is a major economic disease affecting the pastoral herders in Kenya, with outbreaks in Turkana County having devastating effects on the Turkana livelihoods. Turkana County is a region associated with natural and manmade disasters, poor infrastructure and insecurity. There is limited essential data on livestock diseases and economic analysis. This study has attempted to estimate the direct economic loses occasioned by outbreaks of Peste des petits ruminants (PPR) based on perceived loss of benefits experienced by the Turkana people. Parameters for the analytical model were derived from secondary data, informal interviews and focused group discussions using participatory epidemiology methods. Results shows that losses due to PPR were estimated at US$ 19.1 million and mortality of small stock due to PPR constituted the greatest economic loss valued at US$ 16.8 million being 88% of the total losses. Other losses due to lost milk and weight loss constitute approximately 12% of the total losses. PPR has serious economic impacts on pastoral livelihoods, and previous estimation of PPR losses in Kenya was grossly undervalued. This study strengthens the basis for developing a system for the economic assessment of livestock diseases in areas with scanty data based on parameters derived from participatory epidemiology approaches for use in the mathematical model.

Livestock mortality in pastoralist herds in Ethiopia and implications for drought response.

Participatory epidemiology methods were employed retrospectively in three pastoralist regions of Ethiopia to estimate the specific causes of excess livestock mortality during drought. The results showed that starvation/dehydration accounted for between 61.5 and 100 per cent of excess livestock mortality during drought, whereas disease-related mortality accounted for between 0 and 28.1 per cent of excess mortality. Field observations indicate that, in livestock, disease risks and mortality increase in the immediate post-drought period, during rain. The design of livelihoods-based drought response programmes should include protection of core livestock assets, and it should take account of the specific causes of excess livestock mortality during drought and immediately afterwards. This study shows that, when comparing livestock feed supplementation and veterinary support, relatively more aid should be directed at the former if the objective is to protect core livestock during drought. Veterinary support should consider disease-related mortality in the immediate post-drought period, and tailor inputs accordingly.

Animal health studies using participatory epidemiology in the Mandrare Valley, Madagascar

Pastoral herders in Madagascar have limited access to animal health workers and veterinary medicines, and more information on their livestock diseases is needed, so that effective animal health programmes can be implemented. In this study, participatory epidemiology methods were used to gather such information in the Mandrare Valley. These included pair-wise ranking and matrix scoring. Eleven diseases were deemed to be priorities by pair-wise ranking. Matrix scoring and characterisation showed that the informant groups associated many disease syndromes with the same diseases, indicating agreement and understanding of the key diseases. The Malagasy-named syndromes, Soko, Besorko and Mamany lio, which are gastrointestinal parasitism, clostridial disease and babesiosis, respectively, were identified by every informant group. A greater sample size may be needed to characterise the diseases precisely with matrix scoring because, in this study, the matrices' scores had wide confidence intervals.

Foot-and-Mouth Disease Vaccination in South Sudan: Benefit-Cost Analysis and Livelihoods Impact

A benefit-cost analysis of vaccination for foot-and-mouth disease (FMD) was conducted in an area of South Sudan, which due to chronic conflict, had been subject to large-scale humanitarian assistance for many years. The study used participatory epidemiology (PE) methods to estimate the prevalence and mortality of acute and chronic FMD in different age groups of cattle, and the reduction in milk off-take in cows affected by FMD. The benefit-cost of FMD vaccination was 11.5. Losses due to the chronic form of FMD accounted for 28.2% of total FMD losses, indicating that future benefit-cost analyses for FMD control in pastoral and agropastoral areas of Africa need to consider losses caused by chronic disease. Participatory epidemiological methods were also used to assess the importance of milk in the diet of Nuer agropastoralists, and seasonal variations in diet in relation to cattle movements and FMD outbreaks. Marked seasonal variation in diet included a 'hunger gap' period during which households were highly dependent on milk as their main source of food. Outbreaks of FMD occurred immediately before this period of milk dependency, with chronic losses extending through this period and affecting human food security. The paper discusses the need and feasibility of mass vaccination and strategic vaccination for FMD in South Sudan. The paper also discusses the value of combining conventional benefit-cost analysis with livelihoods analysis to inform disease control efforts and funding commitments in humanitarian contexts.