Comparison of knowledge, attitude, and practices of animal and human brucellosis between nomadic pastoralists and non-pastoralists in Kenya

Mapping brucellosis risk in Kenya and its implications for control strategies in sub-Saharan Africa

In Sub-Saharan Africa (SSA), effective brucellosis control is limited, in part, by the lack of long-term commitments by governments to control the disease and the absence of reliable national human and livestock population-based data to inform policies. Therefore, we conducted a study to establish the national prevalence and develop a risk map for Brucella spp. in cattle to contribute to plans to eliminate the disease in Kenya by the year 2040. We randomly generated 268 geolocations and distributed them across Kenya, proportionate to the area of each of the five agroecological zones and the associated cattle population. Cattle herds closest to each selected geolocation were identified for sampling. Up to 25 cattle were sampled per geolocation and a semi-structured questionnaire was administered to their owners. We tested 6,593 cattle samples for Brucella immunoglobulin G (IgG) antibodies using an Enzyme-linked immunosorbent assay (ELISA). We assessed potential risk factors and performed spatial analyses and prevalence mapping using approximate Bayesian inference implemented via the integrated nested Laplace approximation (INLA) method. The national Brucella spp. prevalence was 6.8% (95% CI: 6.2-7.4%). Exposure levels varied significantly between agro-ecological zones, with a high of 8.5% in the very arid zone with the lowest agricultural potential relative to a low of 0.0% in the agro-alpine zone with the highest agricultural potential. Additionally, seroprevalence increased with herd size, and the odds of seropositivity were significantly higher for females and adult animals than for males or calves. Similarly, animals with a history of abortion, or with multiple reproductive syndromes had higher seropositivity than those without. At the herd level, the risk of Brucella spp. transmission was higher in larger herds, and herds with a history of reproductive problems such as abortion, giving birth to weak calves, or having swollen testes. Geographic localities with high Brucella seroprevalence occurred in northern, eastern, and southern regions of Kenya all primarily characterized by semi-arid or arid agro-ecological zones dominated by livestock pastoralism interspersed with vast areas with mixed livestock-wildlife systems. The large spatial extent of our survey provides compelling evidence for the widespread geographical distribution of brucellosis risk across Kenya in a manner easily understandable for policymakers. Our findings can provide a basis for risk-stratified pilot studies aiming to investigate the cost-effectiveness and efficacy of singular and combined preventive intervention strategies that seek to inform Kenya's Brucellosis Control Policy.

Low Immunization Completion among Under-Five Children: Are Underserved Nomadic and Farming Communities in a North Central State of Nigeria doing Better?

Background

The recent drop in immunization coverage in Nigeria has left more than 3.25 million children unimmunized and has risen concern over immunization completion among the under-five children. More so among underserved communities of pastoralist nomads and farmers that were isolated from immunization services because of operational and sociocultural factors.

Materials and Methods

A cross-sectional analytical (comparative analysis) study was carried out among 550 eligible caregivers of under-five children in nomadic and farming communities in Niger State, Nigeria. The mothers and caregivers paired with under-five children were recruited into the study using a multistage sampling technique. Data was collected using a validated interviewer-administered questionnaire. Data was analyzed with the statistical software package (version 23).

Results

More than half of the under-five children studied were males in both the nomadic (57.5%) and farming (52.0%) communities. The aggregated score of immunization knowledge was significantly (P < 0.001) better (Good 44.4%; Fair 49.8%) among farmers compared to their nomads' counterpart (Good 21.1%; Fair 43.6%). Conversely, almost all the respondents (98.2%) in nomadic community significantly had a good overall perception of childhood immunization compared to 77.1% in the farming community. More farmers' children (99.6%) had received immunization compared to 92.4% of the nomads' children. About 87.3% of farmers compared to 76% of the nomads' (76.0%) children reported immunization completion. About 50.5% of the farmers' and 41.4% of the nomads' children have achieved immunization on card inspection.

Conclusion

This study revealed that average immunization completion reported among under-five children in both farming and nomadic communities is higher than the national average. It is recommended that more strategies are needed to intensify immunization campaigns targeted at populations in Nigeria.

Knowledge, attitudes, and practices regarding brucellosis among general population: A cross-sectional study from Jazan Province, Saudi Arabia

Objective

Brucellosis is an endemic zoonotic infection in Saudi Arabia, including Jazan Province, and epidemiological reports about this disease are limited. In this study, we aimed to investigate knowledge, attitudes, and practices regarding brucellosis among the general population of Jazan Province, southwestern Saudi Arabia.

Materials and Methods

This is a cross-sectional study conducted using a pretested questionnaire that assessed the level of knowledge, attitudes, and practices toward Brucellosis. The calculated sample size was 384, and 1,055 participants were included representing various genders, ages, and levels of education. Data were collected between March and April 2022 and analyzed using descriptive, chi-square, and t-test analyses.

Results

Only 50% of the included participants have heard about Brucellosis. Among those who had heard about Brucellosis, 70% had a good knowledge about Brucellosis and that was significantly associated with male gender, being healthcare workers (HCWs), and having a higher level of education. Participants who directly involved in animal care represented 9%, and attitudes and practices regarding brucellosis were varied from average to unsatisfactory. This variation was significantly affected by the level of knowledge.

Conclusion

About 50% of the general population of Jazan Province had never heard about Brucellosis, in a region found prevalent for this disease. Good knowledge was recorded in 70% of those who were aware of Brucellosis, which was significantly associated with the male sex, job as being HCW, and having a higher level of education. These results necessitate public awareness campaign activities to improve knowledge and practices, especially among women, the younger generation, and individuals with limited educational backgrounds. This action could reduce the burden of the disease.

Knowledge, attitudes, and practices on camel respiratory diseases and conditions in Garissa and Isiolo, Kenya

Background

Livestock farmers' attitudes, practices, and behaviors are major factors in infection prevention and control of animal diseases. Kenya has the fourth largest global camel population, and the industry has grown over the last two decades, transforming beyond the traditional camel-keeping areas to include peri-urban camel trade and value chain growth. The dromedary camel is resilient, and it is a preferred species in the arid and semi-arid areas (ASALs) of Kenya. However, it still faces many health and production challenges; to identify infection drivers and risky behaviors for camel respiratory illnesses and conditions in Kenya, we conducted a knowledge, attitudes, and practices (KAP) survey.

Method

Using a set of tools (questionnaires, key informant interviews, and focus group discussions), we interviewed camel owners, herders, agro-veterinary outlets, and other relevant value chain stakeholders in Garissa and Isiolo counties (n = 85). Data were analyzed using descriptive and analytic statistics.

Results

Most camel owners/herders are male and most are relatively uneducated (85.5%). The camels were used primarily for milk and meat production, income generation, and transport. Larger herd sizes (&gt;30 camels) and owner/herder's lack of formal education are risk factors for owner-reported respiratory illnesses in camels. Major clinical signs of respiratory conditions were coughing (85.7%), nasal discharge (59.7%), and fever (23.4%). Diseases, lack of feeds, theft, and marketing challenges are the major constraints to camel production in Kenya. Owners-herders use drugs indiscriminately and this may contribute to antimicrobial resistance challenges.

Conclusion

Practitioners in the camel value chain want more commitment from the government and animal health officials on support services and access to veterinary services. Watering points, grazing areas, and marketing points are the primary areas for congregating camels and have a significant potential for disease spread. Kenya camels have a massive capacity for rural and ASALs' livelihoods transformation but the identified health challenges, and other issues must be addressed. Further studies on the Kenyan camels' respiratory microbial ecology are important to understand microbial risks and reduce the burden of zoonotic infections. Intensification of risk communication and community engagement, and messaging targeted at behavior change interventions should be directed at camel value chain actors.

Sero - epidemiology of brucellosis in people and their livestock: A linked human - animal cross-sectional study in a pastoralist community in Kenya

BACKGROUND

Brucellosis is associated with massive livestock production losses and human morbidity worldwide. Efforts to control brucellosis among pastoralist communities are limited by scarce data on the prevalence and risk factors for exposure despite the high human-animal interactions in these communities. This study simultaneously assessed the seroprevalence of brucellosis and associated factors of exposure among pastoralists and their livestock in same households.

METHODS

We conducted a cross-sectional study in pastoralist communities in Marsabit County - Kenya. A total of 1,074 women and 225 children participated and provided blood samples. Blood was also drawn from 1,876 goats, 322 sheep and 189 camels. Blood samples were collected to be screened for the presence of anti-Brucella IgG antibodies using indirect IgG Enzyme-Linked Immunosorbent Assay (ELISA) kits. Further, Individual, household and herd-level epidemiological information were captured using a structured questionnaire. Group differences were compared using the Pearson's Chi-square test, and p-values < 0.05 considered statistically significant. Generalized mixed-effects multivariable logistic human and animal models using administrative ward as the random effect was used to determine variables correlated to the outcome.

RESULTS

Household-level seropositivity was 12.7% (95% CI: 10.7-14.8). The individual human seroprevalence was 10.8% (9.1-12.6) with higher seroprevalence among women than children (12.4 vs. 3.1%, p < 0.001). Herd-level seroprevalence was 26.1% (23.7-28.7) and 19.2% (17.6-20.8) among individual animals. Goats had the highest seroprevalence 23.1% (21.2 - 25.1), followed by sheep 6.8% (4.3-10.2) and camels 1.1% (0.1-3.8). Goats and sheep had a higher risk of exposure OR = 3.8 (95% CI 2.4-6.7, p < 0.001) and 2.8 (1.2-5.6, p < 0.007), respectively relative to camels. Human and animal seroprevalence were significantly associated (OR = 1.8, [95%CI: 1.23-2.58], p = 0.002). Herd seroprevalence varied by household head education (OR = 2.45, [1.67-3.61, p < 0.001]) and herd size (1.01, [1.00-1.01], p < 0.001).

CONCLUSIONS

The current study showed evidence that brucellosis is endemic in this pastoralist setting and there is a significant association between animal and human brucellosis seropositivity at household level representing a potential occupational risk. Public health sensitization and sustained human and animal brucellosis screening are required.

Assessment of knowledge, attitudes and practices relating to brucellosis among cattle farmers, meat handlers and medical professionals in Namibia

BACKGROUND

Brucellosis is a re-emerging zoonosis of significant socio-economic, animal and public health importance. It is principally a foodborne or occupation-associated infection of humans, whose effective control depends on maximum cooperation of high-risk populations.

OBJECTIVES

The study assessed knowledge, attitudes and practices relating to brucellosis among cattle farmers (communal and commercial), meat handlers (abattoir and butchery workers) and medical professionals (nurses and doctors) in Namibia.

METHODS

Between June 2019 and September 2020, self-administered questionnaires and questionnaire interviews were carried out in cattle farmers (n = 264), meat handlers (n = 143) and medical professionals (n = 124) in Namibia.

RESULTS

Overall, 43.50% (231/531) of respondents were aware of brucellosis, with the highest awareness among medical professionals (73.39%, 91/124) and the least in meat handlers (13.99%, 20/143). Awareness of brucellosis was associated with tertiary education (p < 0.001) and the medical profession (p < 0.001). However, most medical professionals (98.39%, 122/124) did not consider brucellosis as a differential diagnosis in cases of persistent febrile illness. A proportion of communal (85.60%) and commercial (71.00%) farmers; abattoir workers (44.40%); butchers (53.50%); nurses (55.60%); and medical doctors (28.00%) consumed raw milk.

CONCLUSIONS

The study identified the purchase of animals of unknown health status; assisting cow delivery; handling of aborted fetuses with no protective wear; consumption of raw milk, homemade cheese, cattle testes and undercooked livers, as risk factors for Brucella infection in cattle and humans. Thus, intensified risk communication, including public health education, is recommended, in particular, among meat handlers and communal farmers, to promote awareness and discourage risky practices.

From policy to practice: An assessment of biosecurity practices in cattle, sheep and goats production, marketing and slaughter in Baringo County, Kenya

Globally, biosecurity is instrumental in prevention, control and management of livestock diseases and protection of human health. It is defined, prescribed, adopted and enforced through global, regional and national frameworks, laws, policies and strategies. There is more biosecurity practice research conducted in developed countries than developing ones. Consequently, the gap between the ideals recommended in biosecurity frameworks and what is practical in under-resourced rural settings is poorly understood. This anthropological study sought to assess adoption of biosecurity practices across a cattle, sheep and goat value chains continuum to demonstrate where risks lie. The cross-sectional mixed-methods study took place in Baringo County, Kenya. Qualitatively, it utilized 26 focus group discussions with community members and 10 observational interviews with slaughter facility workers. Quantitatively, it included a household survey with 560 community members and a separate survey with 231 livestock traders. Results show that producers, traders and slaughter facility workers did observe some biosecurity practices but not others due but not limited to personal preference, limitations in veterinary service delivery and enforcement of some biosecurity measures, and lack of requisite infrastructure. The study concludes that the implementation of biosecurity measures in rural settings is more complex than envisioned in biosecurity policies and frameworks. It can be hampered by resource limitations, poor enforcement, and contestations with cultural practices. The study recommends that further studies on willingness to adopt biosecurity measures targeting community members in under-resourced settings be conducted to identify possible critical points of intervention at county and national levels.

Brucellosis in Ethiopia: A comprehensive review of literature from the year 2000-2020 and the way forward

Brucellosis is a zoonotic disease of considerable economic and public health significance globally. Despite the limited bacteriological evidence, a large number of serological works revealed that it is prevalent both in livestock and humans in Ethiopia. The current comprehensive review was carried out to provide apparent pooled seroprevalence (APS) estimates at individual animal and herd levels in livestock, and identify factors causing variability between studies conducted over the last two decades, show the spatial distribution, as well as summarizes Brucella species reported from livestock. It also provides APS of brucellosis in humans and evaluates the public health awareness of zoonotic brucellosis. In this review, systematic and synthetic review approaches were followed to summarize the available information. For the systematic review and meta-analysis, articles were selected based on predefined criteria. Data extracted from these articles were analyzed using meta-analytical approaches to provide APS estimates and in-between study variations for humans and all livestock species considered. Sensitivity analyses and bias assessments were conducted using influence plot analysis and, Egger's and Begg's statistics along with funnel plots, respectively. Synthetic review approaches were used to summarize data on isolates and public health awareness. Pooled seroprevalence estimate of brucellosis at national level was 2.6% (95% CI, 2.2-3.0) in cattle, 4% (95% CI, 3.1-5.1) in goats, 3% (95% CI, 2.3-3.9) in sheep and 3% (95% CI, 2.4-3.7) in camels. At a herd level, 16.3% (95% CI, 12.9, 20.5) of cattle, 12.1% (7.1, 19.9) of goat, 13.3% (7.6, 22.1) of sheep and 19.7% (13.8, 27.4) of camel herds in the country had at least one seropositive animal. Cattle in the pastoral/agropastoral production systems had significantly higher (p < 0.05) APS compared to mixed crop-livestock and urban/peri-urban dairy production systems. Pooled seroprevalence of brucellosis in small ruminants (8.3%, 95% CI, 6.3, 10.8) and camels (4.4%, 95% CI, 3.5, 5.6) in Afar were significantly higher (p<0.05) than in other regions. Reports conducted using ELISA and serial Rose Bengal plate test (RBPT)-ELISA had higher (p<0.05) APS estimates than serial RBPT and complement fixation test. Brucella melitensis and B. abortus were reported from goats and cattle, respectively, from three available reports. The APS of brucellosis in humans was 5% (95% CI: 3.3, 7.3). Public awareness of brucellosis was low (18.4%), while, practices that expose humans to Brucella infection were high. Scenario-based control interventions on regions and production systems using one health approach are suggested. This article is protected by copyright. All rights reserved.

Family socioeconomic status and child telomere length among the Samburu of Kenya

Previous research in high-income countries suggests that children from families with lower socioeconomic status (SES) tend to have shorter telomere length - a biomarker of stress and cell aging - than children from families with greater social and economic resources. However, little is known about predictors of child telomere length in low-income settings. Data for the current study are from a sample of 214 Samburu children aged 1-9 years. The Samburu are semi-nomadic pastoralists who live in the Rift Valley of north-central Kenya. Samburu livelihood is based primarily on livestock, and polygynous marriage is common. Drawing on prior ethnographic research, we measured 14 culturally relevant indicators of family SES, including mother's education, head of household's education, whether the child is currently attending school, household spending, mother's employment history, head of household's employment history, mother's perceived wealth, whether the child lives in a modern house, livestock holdings (total, cows, sheep/goats, and camels), mother's wife number, and whether the child lives in a polygynous household. Telomere length was measured in salivary DNA by the quantitative polymerase chain reaction (qPCR) method. Using latent class analysis, we identified four groups of children that are similar based on the 14 indicators of family SES: Lower SES; Middle SES, Traditional; Middle SES, Modern; and Higher SES. SES classes were not significantly associated with child telomere length. In models examining individual indicators of SES, we found that telomere length was 0.57 standard deviations greater for children who lived in families in the lowest quartile of total livestock holdings compared to those in the highest quartile (b = 0.57, p = 0.03). While additional research is needed to identify the mechanisms underlying this counterintuitive finding, the current study highlights the importance of cultural context in shaping the social gradient in health.

Tokpa K, Fokou G, Shilabukha K, Ezekiel M, Bonfoh B, Kazwala R, Kreppel K. Lay attitudes and misconceptions and their implications for the control of brucellosis in an agro-pastoral community in Kilombero district, Tanzania

Brucellosis is a priority zoonotic disease in Tanzania that causes ill-health in people and affects livestock productivity. Inadequate awareness and behavior risking transmission can impede control efforts. We conducted a cross-sectional survey of 333 livestock owners in three villages in the Kilombero district, Tanzania, to understand their awareness, knowledge and behavior associated with brucellosis. Six Focus Group Discussions (FGDs), two in each village, were conducted, as well as an additional FGD with male herders from one of the villages. Factors associated with knowledge on brucellosis, food consumption and animal husbandry behavior risking transmission of this disease, were identified using generalized linear models. Predictors for knowledge of brucellosis were being male and having a higher educational level, while age was positively associated with a higher level of knowledge. Faith and ethnicity were associated with the performance of practices risking transmission. Following traditional religion and belonging to the Wamaasai ethnicity significantly increased the odds of carrying out these practices. Qualitative analysis gave insight into risk practices and reasoning. Of the 333 respondents, 29% reported that they had experienced abortions in their herds, 14% witnessed retained placentas, and 8% had seen still-births in their cattle within the previous year. However, survey results also showed that only 7.2% of participants had heard about brucellosis as a disease in livestock. Of those who had heard about brucellosis in livestock, 91% associated abortions with it and 71% knew that humans can get infected through raw milk consumption. People overwhelmingly attributed symptoms and transmission of brucellosis in livestock to infection with trypanosomiasis and to supernatural reasons instead. In the community, consumption of raw milk was valued and handling of aborted material was not considered a risk for infection. This agro-pastoralist community holds on to long-held beliefs and practices and lacks understanding of the biomedical concept of brucellosis. Transmission routes and symptoms of brucellosis in humans and livestock are completely unknown. The disparity between risk perception and actual transmission risk related to animal handling and consumption of animal products presents a challenge for disease awareness communication. This study recommends focused community engagement and sensitization to address the limited awareness and misconceptions among agro-pastoralists.

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INTRODUCTION

Brucellosis, the most common zoonosis globally, is considered a major public health problem.

OBJECTIVE

A retrospective study was carried out over 21&#160;years (1998-2018) to determine the epidemiological features of human brucellosis in the province of El-Oued (south-eastern Algeria).

RESULTS

1,832 confirmed cases of human brucellosis were reported during the study period, with an average incidence rate of around 12.26&#160;cases per 100,000&#160;inhabitants. The annual distribution of the incidence was characterized by an increasing trend and a strong fluctuation&#160;; its values ranged between 2.27 and 24.96 per 100,000 inhabitants. The monthly distribution showed that the highest incidence rates were recorded from mid-February to July, with a peak of 2.74&#160;cases per 100,000&#160;inhabitants in April.Human brucellosis has affected all municipalities. The highest incidence rate was observed in border municipalities such as Ben&#160;Guecha and Oum Tiour (89.76 and 66.14 per inhabitants, respectively).The incidence in the male population was higher than that of the&#160;female at 14.63 versus 9.83 per 100,000&#160;inhabitants, respectively, noting that it increases with age. Individuals over 65&#160;years are the most at risk, with an incidence rate of 22.32 per 100,000&#160;inhabitants.

CONCLUSION

Along with strengthening preventive measures in the population, eliminating brucellosis in animals is the most effective method to protect humans against infection.

Seroprevalence and Molecular Identification of Brucella spp. in Bovines in Pakistan-Investigating Association With Risk Factors Using Machine Learning

Bovine brucellosis is a global zoonosis of public health importance. It is an endemic disease in many developing countries including Pakistan. This study aimed to estimate the seroprevalence and molecular detection of bovine brucellosis and to assess the association of potential risk factors with test results. A total of 176 milk and 402 serum samples were collected from cattle and buffaloes in three districts of upper Punjab, Pakistan. Milk samples were investigated using milk ring test (MRT), while sera were tested by Rose–Bengal plate agglutination test (RBPT) and indirect enzyme-linked immunosorbent assay (i-ELISA). Real-time PCR was used for detection of Brucella DNA in investigated samples. Anti-Brucella antibodies were detected in 37 (21.02%) bovine milk samples using MRT and in 66 (16.4%) and 71 (17.7%) bovine sera using RBPT and i-ELISA, respectively. Real-time PCR detected Brucella DNA in 31 (7.71%) from a total of 402 bovine sera and identified as Brucella abortus. Seroprevalence and molecular identification of bovine brucellosis varied in some regions in Pakistan. With the use of machine learning, the association of test results with risk factors including age, animal species/type, herd size, history of abortion, pregnancy status, lactation status, and geographical location was analyzed. Machine learning confirmed a real observation that lactation status was found to be the highest significant factor, while abortion, age, and pregnancy came second in terms of significance. To the authors' best knowledge, this is the first time to use machine learning to assess brucellosis in Pakistan; this is a model that can be applied for other developing countries in the future. The development of control strategies for bovine brucellosis through the implementation of uninterrupted surveillance and interactive extension programs in Pakistan is highly recommended.