Knowledge and risk factors for foot-and-mouth disease among small-scale dairy farmers in an endemic setting

Foot-and-mouth disease (FMD) is a highly contagious viral infection of cloven-hoofed animals. In Kenya, the disease is endemic with outbreaks typically occurring throughout the year. A cross-sectional study was undertaken in Nakuru County to investigate farmer knowledge and risk factors for clinical disease. Semi-structured interviews were conducted on 220 smallholder farmers, selected using random spatial sampling. The majority of respondents (207/220 [94.1%]) knew of FMD and 166/207 (80.2%) of them could correctly identify the disease based on their knowledge of the clinical signs. Forty-five out of 220 farmers (20.4%) vaccinated their livestock against FMD in the previous 6 months, although of those who knew of FMD only 96/207 (46.4%) perceived it as a preventive measure undertaken to reduce the risk of disease in their farm. FMD had occurred in 5.9% of the surveyed farms within the previous 6 months (from May to November 2016). Using multivariate analysis, the use of a shared bull (OR = 9.7; p = 0.014) and the number of sheep owned (for each additional sheep owned OR = 1.1; p = 0.066) were associated with an increased likelihood of a farm experiencing a case of FMD in the previous 6 months, although the evidence for the latter was weak. This study reports risk factors associated with clinical FMD at the farm level in a densely populated smallholder farming area of Kenya. These results can be used to inform the development of risk-based strategic plans for FMD control and as a baseline for evaluating interventions and control strategies

Rabies elimination in rural Kenya:Need for improved availability of human vaccines, awareness and knowledge on rabies and its management among healthcare workers

BACKGROUND: In Africa, rabies causes an estimated 24,000 human deaths annually. Mass dog vaccinations coupled with timely post-exposure prophylaxis (PEP) for dog-bite patients are the main interventions to eliminate human rabies deaths. A well-informed healthcare workforce and the availability and accessibility of rabies biologicals at health facilities are critical in reducing rabies deaths. We assessed awareness and knowledge regarding rabies and the management of rabies among healthcare workers, and PEP availability in rural eastern Kenya. METHODOLOGY: We interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties, Makueni County, Kenya in November 2018. Data on demographics, years of work experience, knowledge of rabies, management of bite and rabies patients, and availability of rabies biologicals were collected and analyzed. RESULTS: Rabies PEP vaccines were available in only 5 (12%) of 42 health facilities. None of the health facilities had rabies immunoglobulins in stock at the time of the study. PEP was primarily administered intramuscularly, with only 11% (n = 8) of the healthcare workers and 17% (7/42) healthcare facilities aware of the dose-sparing intradermal route. Less than a quarter of the healthcare workers were aware of the World Health Organization categorization of bite wounds that guides the use of PEP. Eighteen percent (n = 13) of healthcare workers reported they would administer PEP for category I exposures even though PEP is not recommended for this category of exposure. Only one of six respondents with acute encephalitis consultation considered rabies as a differential diagnosis highlighting the low index of suspicion for rabies. CONCLUSION: The availability and use of PEP for rabies was sub-optimal. We identified two urgent needs to support rabies elimination programmes: improving availability and access to PEP; and targeted training of the healthcare workers to improve awareness on bite wound management, judicious use of PEP including appropriate risk assessment following bites and the use of the dose-sparing intradermal route in facilities seeing multiple bite patients. Global and domestic funding plan that address these gaps in the human health sector is needed for efficient rabies elimination in Africa

Sero-prevalence and risk factors for human brucellosis in Marsabit county, Kenya (2014)

Introduction: brucellosis is among the world's most widespread zoonotic diseases which is recognized as a public health concern in both developed and developing countries. It is endemic in Kenya's pastoral communities where it is associated with significant economic losses due to decreased animal productivity and high burden in humans. The objectives of this study were: i) To estimate the sero-prevalence and determine the risk factors of brucellosis in humans ii) To assess the knowledge attitude and practices (KAP) of a pastoral community in relation to brucellosis transmission and control. Methods: cross-sectional survey was conducted within the pastoral ecosystem of Marsabit County. A total of 227 households were randomly selected. Blood samples were aseptically drawn from the selected humans and tested for Brucella immunoglobulin G (IgG) antibodies. Questionnaires were administered via personal interviews to the head of each study household to assess risk factors of transmission. Univariate and subsequently multivariate logistic regression analysis were performed examine the factors independently associated with Brucella seropositivity after adjustment for the effects of other explanatory variables. Results: the individual Brucella sero-prevalence was estimated at 44% (332/755) and that of the household at (73.13%). Although the majority (85.5%) of the respondents had heard of brucellosis, only a few could identify the disease by clinical signs in both humans and animals. The majority (88.5%) engaged in practices that were likely to enhance Brucella transmission and thus spread. Being a male herder increased the risk of infection by almost twice (OR=1.8136) compared to females. People who were either students, farmers, skilled or non-skilled off farm workers were less likely (OR=0.3053, 0.9038, 0.7749 and 0.2010 respectively) to be infected with brucellosis than housewives. Households where milk was boiled before consumption were less likely (OR=0.404) to have a higher rate of brucellosis infection than those who consumed raw milk. Households that used milk from their own animals were much less likely (OR= 0.1754) to have infection than those that use milk from other sources. Households that kept sheep and those that had members who assisted animals during delivery were more likely to have higher rates of brucellosis than those who never kept sheep and those who never assisted in delivery respectively. Conclusion: brucellosis is endemic in Marsabit County despite the low levels of knowledge and good control practices by the community. Consumption of raw milk and close contact with animal, particularly sheep are the highest risk factors There is a need for implementation of effective prevention strategies and advocacy practices like targeted livestock vaccinations and public education