PENAPH First Technical Workshop, Chiangmai, Thailand, 11-13 December 2012

Participatory planning, implementation and evaluation of a zoonosis control

project in KenyaErastus Kang’ethe, Julius Nyangaga, Fred Unger and Delia Grace

Presentation outline

•Objective

•Methods• Cross-sectional surveys• Outcome mapping

•Findings• Prevalence and risk factor studies• Development of messages• Participatory impact assessment

•Conclusion

Background

•Cryptosporidiosis an important emerging disease worldwide•Many species of Cryptosporidium but 2 account for most infections in people: non-zoonotic C. hominis and zoonotic C. parvum. •Ruminants are the most important non-human reservoir for zonotic C. parvum•A major risk factor for human zoonotic disease is contact with cattle or their feces.•In cattle, 4 species of Cryptosporidium are found: zoonotic C. parvum and non-zoonotic C. bovis, C. andersoni, and C. ryanae. •Cryptosporidiosis is especially important in dairy calves up to 30 days of age.Other risk factors for increased shedding include husbandry and hygiene practices.

Background:Milk very popular in Nairobi.Most produced from peri-urban dairies.Concern over health risks.

Objective

A trans-disciplinary process of co-generating, sharing and evaluating evidence-based messages for reducing the risk from cryptosporidiosis and other zoonoses in an urban and peri-urban community in Nairobi

Methods

Cross sectional survey of prevalence & risk factors•Cattle-owners•Non-cattle keeping neigbours•Cattle•People living with HIV

Outcome mapping or research into use•Defining boundary & strategic partners•Identifying “Outcome Challenge”, markers and strategies•Measuring progress

Findings: prevalence and risk factors

Prevalence•Dairy households ~ 4%•Non-dairy neighbours ~ 5%•People with HIV 4.5%•Cattle ~13%

Discussion•Dairy not a prima facie risk •Having HIV not necessarily leading to increased risk

Findings: Risk factors allow evidence based messages

Prevalence•Dairy households ~ 4%•Non-dairy neighbours ~ 5%•People with HIV 4.5%•Cattle ~13%

Discussion•Dairy not a prima facie risk •Having HIV not necessarily leading to increased risk

Messages 1: Television show

“By peppering the drama-infused lives of its

characters with demonstrations of agricultural

practices, trips to the doctor for tuberculosis tests,

and Kenyan history, Makutano Junction serves to

both entertain and provide reliable information for

families throughout sub-Saharan Africa. This is soap

opera drama that people can actually relate to—and

learn from.”

Messages 2: Cartoons

Messages 3: Crypto – campaigners

• Resource people, selected by their communities, received special training to

help them share information. • A brochure was developed with detailed information about zoonoses

transmission, vulnerability, knowledge, practices, economic contribution of

urban dairying to households and mitigation measures. • The brochure was given to the resource people for use while educating the

communities on cryptosporidiosis prevention.

• Knowing is not enough. • Many conventional public health programs are based on the mistaken

assumption that people will change their behaviour if informed of the health

benefits of so doing. • We found basing messages on social norms, such as the wish to appear a

good parent or to avoid a practice that evokes disgust, are more effective at

changing behaviour

Participatory Impact Assessment

Conclusions 1 – Assessing risk of Crypto

• First reported study to simultaneously survey livestock,

livestock keepers and their non-livestock-keeping neighbours

for cryptosporidiosis.

• We found no difference between cattle keeping and non-

cattle-keeping, no overall association between infections in

cattle and people; the prevalence in people living with HIV

was no higher than in the general community.

• Taken together, these suggest no evidence that zoonotic

cryptosporidiosis is not important overall in this community.

Conclusions 2 – better managing zoonoses in urban settings

• Key elements of the approach were: identifying groups within

the community adjusting messages to norms and values of

that group; an emphasis on evidence-based messages

developed in and with the community rather than generic

health and hygiene advice; use of social incentives (such as

the desire to be seen as a good parent); using multiple

channels (including television); and active involvement of

community and policymakers in the development and

dissemination of messages.

• This offers a model for improving health extension for

zoonoses management, which can be further developed and

evaluated.

International Livestock Research Institute www.ilri.org