Awareness and attitudes towards anthrax and meat consumption practices among affected communities in Zambia: A mixed methods approach

<div><p>Background</p><p>In Zambia, human anthrax cases often occur following cases of animal anthrax. Human behaviour has been implicated in this transmission. The objective of the study was to explore human behavioural patterns that may contribute to outbreaks of anthrax among affected communities.</p><p>Methods</p><p>A mixed methods study was conducted in four districts of Zambia from November 2015 to February 2016. A cross sectional survey involving 1,127 respondents, six focus group discussions and seven key informant interviews with professional staff were conducted. Descriptive statistics on socio-demographic characteristics, awareness of anthrax, attitudes towards cattle vaccination and risk factors for anthrax and vaccination practices were run using STATA 12 for analysis.</p><p>Results</p><p>Overall, 88% of respondents heard about anthrax, 85.1% were aware that anthrax is transmitted by eating infected meat and 64.2% knew that animals and humans can be infected with anthrax. However, qualitative data suggested that awareness of anthrax varied across communities. Qualitative findings also indicated that, in Western and Muchinga provinces, human anthrax was transmitted by eating infected beef and hippo <i>(Hippopotamus amphibious)</i> meat, respectively.</p><p>Although survey data indicated that 62.2% of respondents vaccinated their animals, qualitative interviews and annual vaccination reports indicated low vaccination rates, which were attributed to inadequate veterinary service provision and logistical challenges. While 82% of respondents indicated that they reported animal deaths to veterinary officers, only 13.5% of respondents buried infected carcasses. Majority (78.1%) of respondents either ate, sold or shared meat from dead animals with other community members. Poverty, lack of access to meat protein and economic reasons were cited as drivers for consuming infected meat.</p><p>Conclusions</p><p>Health education campaigns must be intensified to reduce the risk of human exposure. Veterinary extension services should be strengthened and cold chain facilities decentralized in order to improve accessibility to anthrax vaccine. It is also important to involve the affected communities and collaborate with other disciplines in order to effectively tackle poverty, improve veterinary services and address inherent meat consumption practices within the communities.</p></div

Distinct patterns among staphylococci (panel A), enterococci (panel B) and streptococci (panel C) following RAPD genotyping.

<p>One isolate per lane.</p

Prevalence and Antimicrobial Susceptibility Patterns of Bacteria from Milkmen and Cows with Clinical Mastitis in and around Kampala, Uganda

<div><p>Background</p><p>Identification of pathogens associated with bovine mastitis is helpful in treatment and management decisions. However, such data from sub-Saharan Africa is scarce. Here we describe the distribution and antimicrobial susceptibility patterns of bacteria from cows with clinical mastitis in Kampala, Uganda. Due to high concern of zoonotic infections, isolates from milkmen are also described.</p><p>Methodology/Principal Findings</p><p>Ninety seven milk samples from cows with clinical mastitis and 31 nasal swabs from milkmen were collected (one sample per cow/human). Fifty eight (60%) Gram-positive isolates namely Staphylococci (21), Enterococci (16), Streptococci (13), Lactococci (5), Micrococci (2) and Arcanobacteria (1) were detected in cows; only one grew <i>Staphylococcus aureus</i>. Furthermore, 24 (25%) coliforms namely <i>Escherichia coli</i> (12), <i>Klebsiella oxytoca</i> (5), <i>Proteus vulgaris</i> (2), <i>Serratia</i> (2), <i>Citrobacter</i> (1), <i>Cedecea</i> (1) and <i>Leclercia</i> (1) were identified. From humans, 24 Gram-positive bacteria grew, of which 11 were Staphylococci (35%) including four <i>Staphylococcus aureus</i>. Upon susceptibility testing, methicillin-resistant coagulase-negative staphylococci (CoNS) were prevalent; 57%, 12/21 in cows and 64%, 7/11 in humans. However, methicillin-resistant <i>Staphylococcus aureus</i> was not detected. Furthermore, methicillin and vancomycin resistant CoNS were detected in cows (<i>Staphylococcus hominis</i>, <i>Staphylococcus lugdunensis</i>) and humans (<i>Staphylococcus scuiri</i>). Also, vancomycin and daptomycin resistant Enterococci (<i>Enterococcus faecalis</i> and <i>Enterococcus faecium,</i> respectively) were detected in cows. Coliforms were less resistant with three pan-susceptible isolates. However, multidrug resistant <i>Klebsiella</i>, <i>Proteus</i>, <i>Serratia, Cedecea</i>, and <i>Citrobacter</i> were detected. Lastly, similar species grew from human and bovine samples but on genotyping, the isolates were found to be different. Interestingly, human and bovine <i>Staphylococcus aureus</i> were genetically similar (spa-CC435, spa-type t645 corresponding to ST121) but with different susceptibility patterns.</p><p>Conclusions/Significance</p><p>CoNS, Enterococci, Streptococci, and <i>Escherichia coli</i> are the predominant pathogens associated with clinical bovine-mastitis in Kampala, Uganda. Multidrug resistant bacteria are also prevalent. While similar species occurred in humans and cows, transmission was not detected.</p></div

Antimicrobial resistance among staphylococci from cows (panel A) and milkmen (panel B).

<p>Details in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0063413#pone.0063413.s001" target="_blank">Tables S1</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0063413#pone.0063413.s002" target="_blank">S2</a>.</p

Additional file 1: of Prevalence, antimicrobial susceptibility and risk factors associated with non-typhoidal Salmonella on Ugandan layer hen farms

Questionnaire used for study data collection. (DOCX 33 kb

Antimicrobial resistance patterns among coliforms (n = 24).

<p>AMP, Ampicillin; AMO; Amoxicillin-Clavulanate; SXT, trimethopprim-sulfamethoxazole; COL, Colistin; IMP, imipenem; CEF, Cefoxitine; CFT, Cefotaxim; CEP, Cephalothin; CFU, Cefuroxime; CFP, Cefepime; AZT, Aztreonam; ERY, Erythromycin; NTR, Nitrofurantoin; PIP, Piperacillin-Tazobactum; ERT, Ertapenem.</p><p>In boldface type are isolates found to be multi-drug resistant (MDR).</p

Comparison of socio-demographic characteristics of respondents between Western and Muchinga provinces.

<p>Comparison of socio-demographic characteristics of respondents between Western and Muchinga provinces.</p

Comparison of awareness of anthrax among respondents in 2 provinces, given as numbers (%).

<p>Comparison of awareness of anthrax among respondents in 2 provinces, given as numbers (%).</p

Map of Zambia showing study sites.

<p>Green color is Western province with Nalolo, Limulunga and Mongu districts. Purple color is Muchinga province with Chama district.</p

Knowledge on Ebola and Marburg viral diseases and their modes of transmission.

<p>Knowledge on Ebola and Marburg viral diseases and their modes of transmission.</p