The effectiveness of community-based animal health workers, for the poor, for communities and for public safety

Knowledge, attitude and practices study of acaricide usage and tick control in South Omo Zone pastoral areas, South-Western Ethiopia

Although acaricide chemotherapy is widely used to control tick infestation in Ethiopia, its effectiveness is uncertain due to misusage by herdsmen. Currently, there is no study being conducted in the South Omo Zone of Ethiopia which shows the knowledge, attitude, and practice (KAP) and associated factors of acaricide usage by herdsmen. Therefore, this study was conducted to assess KAP of 120 (83 male and 37 female) pastoralist and agro-pastoralist of Bena-Tsemay district through structured questionnaire survey. Accordingly, Ivermectin was the most preferred acaricide by majority (62.5%) of the herdsmen. Half (50%) of the herdsmen confessed that price of acaricide is the defining variable for acaricide preference in their location where 60.83% of them obtain acaricides from private drug shops. Majority (60%) of the respondents said that they obtain information about acaricide usage from drug sellers in the vet drug shops. According to 72.50% of the respondents, acaricide application/injection on the infested herd was conducted by the herdsmen. A 95.83% of our interviewee revealed that there was no training or awareness creation being given on how to inject or apply acaricide on tick infested animals. Moreover, all responders (100%) confessed that they didn't have a practice of weighing animals and measuring acaricide dosage prior to injection/application. The incidence of acaricide poisoning on animal and personnel was reported by 19.17% and 22.5% of respondents, respectively. Simple logistic regression analysis revealed that gender (OR = 5.09, OR 95% CI = 2.30-11.72), practice of acaricide rotation (OR = 3.22, OR 95% CI = 1.41-7.64) and personnel preference for acaricide application (OR = 2.66, OR 95% CI = 1.18-6.15) were significantly (P < 0.05) associated with the knowledge score of the respondents. On the other hand, respondent's attitude score was significantly (P < 0.05) associated with their acaricide rotation practice (OR = 3.20, OR 95% CI = 1.39-7.53) and personnel preference for acaricide application (OR = 6.61, OR 95% CI = 2.78-16.93). Similarly, practice of acaricide rotation (OR = 5.31, OR 95% CI = 2.26-12.96) and personnel preference for acaricide application (OR = 7.21, OR 95% CI = 3.03-17.99) were significantly linked with the practice score of the respondents towards acaricide usage. In conclusion, ticks are the major challenge in the study area despite widespread usage of acaricides. Because of extensive misusage of available acaricides, awareness creation should be applied to narrow KAP gaps and to conserve the efficacy of these chemicals. Furthermore, acaricide efficacy investigation (in vitro and in vivo) should be conducted to know the status of commonly used acaricides in the area.

Access to Veterinary Drugs in Sub-Saharan Africa: Roadblocks and Current Solutions

Background

Access to veterinary drugs for livestock has become a major issue over the last decade. Analysis has tended to focus on the demand for these products, while studies looking at the drivers behind their use generally focus on farmer behavior and interactions between veterinarians and farmers. However, the use of drugs also depends on structural factors that determine the functioning of the drug supply chain and farmers' access to the drugs. This article presents an overview of the factors that limit access to veterinary drugs in sub-Saharan Africa (SSA) as well as the international policy tools and arrangements that claim to improve it.

Methods

We have conducted a scoping review of the scientific and grey literature as well as the publicly-available data from both the animal health industry and international organizations. We aimed to gather information on the veterinary drugs market in SSA as well as on the international norms, recommendations, guidelines, and initiatives that impact SSA farmers' access to these drugs.

Findings

We highlight numerous barriers to veterinary drug access in SSA. The SSA market is highly dependent on imports, yet the region attracts little attention from the international companies capable of exporting to it. It suffers from a high level of fragmentation and weak distribution infrastructures and services, and is driven by the multiplication of private non-professional actors playing a growing role in the veterinary drug supply chain. The distribution system is increasingly dualized, with on the one hand the public sector (supported by development organizations) supplying small scale farmers in rural areas, but with limited and irregular means; and on the other side a private sector largely unregulated which supplies commercial and industrial farming systems. Different innovations have been developed at the international and regional levels to try to reduce barriers, such as homogenizing national legislations, donations, and vaccine banks. Alongside decades-old inter-state cooperation, many new forms of public-private partnerships and other hybrid forums continue to emerge, signaling the private sector's increasing influence in global governance.

Conclusions

Policies on animal health would be bolstered by a better understanding of the drivers behind and the components of access to veterinary drugs in different regional and national contexts. Inequalities in drug access need to be addressed and a market-driven approach adopted in order to strengthen our understanding of what determines veterinary drug use at the farm level. Policies should balance the interests of the various stakeholders, being careful not to reinforce bias toward certain diseases deemed "interesting" and neglect others that could prove to be highly important for veterinary public health.

Contributions of village animal health workers to foot-and-mouth disease control in Cambodia

Local animal health services in rural communities in Cambodia are mainly provided by village animal health workers (VAHWs), although the participation and contribution of VAHWs to livestock disease prevention are uncertain. The participation of the VAHWs as identified by their 'dropout rate' was examined in a desktop review in December 2020 of the national data on VAHWs recorded between 2011 and 2020. The contribution and involvement of VAHWs in disease prevention programmes were examined in a survey conducted between February and March 2014, then analyzed in the context of other surveys of VAHW knowledge, attitudes and practices. The survey involved guided group discussion with VAHWs (n = 198) from the two Cambodian provinces of Kampong Cham and Pursat. This study identified that VAHWs generated less than 22% of their annual household incomes from animal health services. Less than one-third had vaccinated livestock against foot-and-mouth disease (FMD), with none having vaccinated cattle every 6 months during the study period, and nearly half of the VAHWs having never vaccinated their own cattle against FMD. As no privately provided FMD vaccination services occurred in these communities, with all vaccines delivered through the government-subsidized programme, the findings confirmed that VAHWs only vaccinated animals against FMD when vaccines were made available by the Government. The desktop review found that the number of VAHWs in 2020 declined by more than 24% since 2017, and the proportion of female VAHWs was consistently low, with a mean of 8.26 (±1.019). These findings confirm findings from previous studies that identified considerable weaknesses in the VAHW system in Cambodia, particularly in contributing to FMD control. Cambodian animal health authorities require more effective policies to strengthen the current VAHW system, improving their services delivery; their retention as 'active'; their development of more sustainable roles with lower 'dropout' rates and the prolonged gender inequity. With the limited availability of government-subsidized FMD vaccination currently, extension programmes that engage VAHWs and farmers in seeking privately funded and delivered FMD vaccination that incorporates appropriate multivalent FMD serotype vaccines of high quality, delivered in small dose vials from a robust cold chain, is suggested. This strategy would assist VAHWs to contribute to the provision of private livestock vaccination services that are likely essential for sustainable FMD prevention and control in Cambodia.

Knowledge, Attitude, and Practices on Antimicrobial Use and Antimicrobial Resistance among Poultry Drug and Feed Sellers in Bangladesh

Poultry production has boomed in Bangladesh in recent years. The poultry sector has contributed significantly to meet the increased demand for animal source proteins in the country. However, increased use of antimicrobials appeared to be a significant threat to food safety in the poultry sector. The poultry drug and feed sellers are at the frontline position involving selecting and delivering the antimicrobials to the poultry farmers. Studies assessing the poultry drug and feed sellers’ knowledge, attitudes, and practices (KAPs) are limited. The current study aimed to assess the community poultry drug and feed sellers’ KAPs of antimicrobial use (AMU) and antimicrobial resistance (AMR) in some selected areas of Bangladesh. We determined the respondents’ (drug and the feed sellers) KAPs of AMU and AMR using a tested and paper-based questionnaire. The study demonstrated that most respondents have insufficient knowledge, less positive attitudes, and inappropriate practices regarding AMU and AMR. The factor score analysis further showed that the type of respondents and their years of experience, level of education, and training on the drug were the significant factors impacting the current knowledge, attitudes, and practices of AMU and AMR. The adjusted logistic regression analysis revealed that the drug sellers who completed their education up to 12th grade and had training on the drug had adequate knowledge of AMU and AMR. The data also showed that the drug sellers belong to the age group 31–35 and 36–40 years and who completed 12th grade had good attitudes on the same. Likewise, the analysis further determined that drug sellers belonging to the age category 18–25 and 26–30 years, and interestingly, the respondents who completed education up to 12th grade, had better practices. Spearman’s rank-order correlation revealed a positive association between each pair of the KAPs scores for the respondents. The correlation was fair between knowledge–attitudes, knowledge–practices, and attitudes–practices. Based on the current study results, we recommend educational interventions and appropriate training for the poultry drug and feed sellers to raise awareness and to upgrade their current knowledge on the appropriate use of antimicrobials. This will ultimately lead to reducing the chances of developing AMR in the poultry sectors of the country.

Can improving animal health and biosecurity knowledge of para-veterinarians in Cambodia assist in addressing challenges in smallholder livestock farming?

Para-veterinarians are crucial in providing front-line veterinary care and advice to smallholder farmers in countries with under-resourced national veterinary services. Many of these individuals undergo basic training with minimal monitoring and evaluation of performance and knowledge levels. To identify the knowledge, attitudes and practices of Cambodian para-veterinarians a cross-sectional survey (n = 80) of Village Animal Health Workers (VAHWs) was conducted during August 2018 in the provinces of Tbong Khmum and Takeo in southern Cambodia. Descriptive statistics indicated that VAHWs had a high level (mean score 86%) of animal health and biosecurity knowledge. As the Royal Government of Cambodia continues to move towards commercial agricultural value chains, VAHWs are crucial to ensuring the safety and sustainability of these systems. Binomial logistic regression modelling found the length of employment (p = .003), reporting of pig diseases (p = .007), recommending the quarantine of newly purchased animals (p = .008), treatment of cases of haemorrhagic septicaemia with antibiotics (p = .032) and washing footwear with water when entering or leaving a farm (p = .008) were all positively associated with a higher (≥92%) animal health and biosecurity knowledge score. These results demonstrate the correlation of positive biosecurity and disease reporting behaviours with high levels of knowledge, providing evidence that improved training of VAHWs can ensure they remain important in supporting the under-resourced national veterinary services. Regular monitoring and evaluation of training programmes for VAHWs will likely further strengthen the livestock sector in Cambodia.

The Impacts of Animal Health Service Providers on Antimicrobial Use Attitudes and Practices: An Examination of Poultry Layer Farmers in Ghana and Kenya

International organizations and governments have argued that animal health service providers can play a vital role in limiting antimicrobial resistance by promoting the prudent use of antimicrobials. However, there is little research on the impact of these service providers on prudent use at the farm level, especially in low- and middle-income countries where enforcement of prudent-use regulations is limited. Here, we use a mixed-methods approach to assess how animal health-seeking practices on layer farms in Ghana (n = 110) and Kenya (n = 76) impact self-reported antimicrobial usage, engagement in prudent administration and withdrawal practices and perceptions of antimicrobial resistance. In general, our results show that the frequency of health-seeking across a range of service providers (veterinarians, agrovets, and feed distributors) does not significantly correlate with prudent or non-prudent use practices or the levels of antimicrobials used. Instead, we find that patterns of antimicrobial use are linked to how much farmers invest in biosecurity (e.g., footbaths) and the following vaccination protocols. Our results emphasize that more research is required to understand the interactions between animal health service providers and farmers regarding antimicrobial use and antimicrobial resistance. Addressing these gaps will be crucial to inform antimicrobial stewardship training, curriculums and, guidelines whose ultimate purpose is to limit the selection and transmission of antimicrobial resistance.

Improving Village Animal Health Worker participation in national disease surveillance systems: A case study from Cambodia

Para-veterinary systems have arisen in numerous developing countries to address the low capacity of national veterinary services in meeting livestock health demands of mainly smallholder farmers. In Cambodia, the village animal health worker (VAHW) system was established in the early 1990s, involving short training programmes to equip VAHWs to provide basic animal health services for smallholder farmers, particularly the vaccination of cattle for haemorrhagic septicaemia (HS). However, there are increasing expectations that VAHWs provide village level disease surveillance information to the national veterinary services, despite their low-level disease diagnostic skills. To identify opportunities to improve the disease reporting system in Cambodia, a closed-ended cross-sectional study of VAHWs (n = 80) from two provinces was conducted in 2015, examining their contact frequency with district and provincial animal health authorities. Ordinal logistic regression was used to determine factors associated with increased frequency of VAHW contact with the district animal health authorities responsible for national disease reporting. Positive associations between income generated from VAHW activities (p = .01) and the frequency of visiting farmers (p < .0001), with more frequent contacts with district animal health authorities, were identified. High levels of inappropriate use of antibiotics, with almost 90% of VAHW reporting they use antibiotics to treat FMD-affected animals, were reported. Although further research to increase the rates of reporting at the smallholder farmer and VAHW levels is required, increased emphasis on complying with the World Organisation for Animal Health's competency guidelines for veterinary paraprofessionals may be required if they are expected to contribute to national animal disease surveillance systems.

Participatory epidemiology of endemic diseases in West African cattle - Ethnoveterinary and bioveterinary knowledge in Fulani disease control

Fulani pastoralists in Nigeria lack adequate access to good quality veterinary services and often resort to treating their animals themselves. There are several negative aspects to this, including poor treatment outcomes, misuse of veterinary drugs and subsequent resistance, and further barriers to good relations between pastoralists and veterinary services. A participatory epidemiology survey was undertaken in Fulani communities, to examine their ability to diagnose and treat bovine diseases. Qualitative participatory epidemiology techniques including semi-structured interviews, ranking and participant and non-participant observations were used for data collection. Quantitative analysis to match Fulani disease descriptions to veterinary diseases was done by hierarchical clustering and multi-dimensional scaling. A concurrent parasitological survey for soil-transmitted parasites, trypanosomiasis and tick-borne diseases was undertaken to validate results. Fulani pastoralists displayed high levels of ethnoveterinary knowledge and good clinical diagnostic abilities. Diseases considered important by pastoralists included: hanta (CBPP); sammore (trypanosomiasis); boro (foot and mouth disease), gortowel (liver fluke), dauda (parasitic gastro-enteritis with bloody diarrhoea) and susa (parasitic gastro-enteritis). The parasitology survey supported the participatory epidemiology results but also showed a high prevalence of tick-borne diseases that were not mentioned by pastoralists in this study. The use of "hanta" to describe CBPP is important as the accepted translation is liver-fluke (hanta is the Hausa word for liver). Gortowel and dauda, two previously undescribed Fulfulde disease names have now been matched to liver fluke and PGE with bloody diarrhoea. Fulani showed low levels of bovine veterinary knowledge with mostly incorrect veterinary drugs chosen for treatment. Levels of ethno- and bio-veterinary knowledge and their application within pastoralist livestock healthcare practices are discussed.

Engaging research with policy and action: what are the challenges of responding to zoonotic disease in Africa?

Zoonotic diseases will maintain a high level of public policy attention in the coming decades. From the spectre of a global pandemic to anxieties over agricultural change, urbanization, social inequality and threats to natural ecosystems, effectively preparing and responding to endemic and emerging diseases will require technological, institutional and social innovation. Much current discussion emphasizes the need for a 'One Health' approach: bridging disciplines and sectors to tackle these complex dynamics. However, as attention has increased, so too has an appreciation of the practical challenges in linking multi-disciplinary, multi-sectoral research with policy, action and impact. In this commentary paper, we reflect on these issues with particular reference to the African sub-continent. We structure the themes of our analysis on the existing literature, expert opinion and 11 interviews with leading One Health scholars and practitioners, conducted at an international symposium in 2016. We highlight a variety of challenges in research and knowledge production, in the difficult terrain of implementation and outreach, and in the politicized nature of decision-making and priority setting. We then turn our attention to a number of strategies that might help reconfigure current pathways and accepted norms of practice. These include: (i) challenging scientific expertise; (ii) strengthening national multi-sectoral coordination; (iii) building on what works; and (iv) re-framing policy narratives. We argue that bridging the research-policy-action interface in Africa, and better connecting zoonoses, ecosystems and well-being in the twenty-first century, will ultimately require greater attention to the democratization of science and public policy.This article is part of the themed issue 'One Health for a changing world: zoonoses, ecosystems and human well-being'.

Bovine dermatophilosis: Awareness, perceptions and attitudes in the small-holder sector of north-west Zimbabwe

A cross-sectional study was conducted to assess cattle owners' awareness, perceptions, attitudes and drug-usage practices with regard to bovine dermatophilosis. Knowledge of these farmers' attributes is important for animal health policy makers in their endeavours to provide optimum disease control strategies that are acceptable to the communities. Data on cattle owner awareness of bovine dermatophilosis, causes, treatment practices, perceptions about its importance and potential dangers to humans were collected using an interviewer-administered questionnaire. A total of 185 stockowners and cattle herds were involved in the study, with bovine dermatophilosis determined clinically by veterinarians. The results showed that 45.4% of the herds were clinically positive for dermatophilosis, and most farmers (79.5%) were generally aware that dermatophilosis was a cattle disease. In the event of a dermatophilosis outbreak in a herd, 74.1% of the farmers treated their cattle using antibiotics; the proportion of farmers treating cattle did not differ (p > 0.05) across the diptanks. Fifty-two farmers (52/63) indicated that drugs had to be administered four to seven times before an animal recovered from infection. Tetracyclines were the antibiotics used by most farmers (79.3%) to treat dermatophilosis, with 19.1% using penicillins. Concerns were raised by farmers about the effectiveness of these drugs against bovine dermatophilosis. Across the study sites, 48.6% and 27.6% of the farmers perceived bovine dermatophilosis to be an important disease at the herd and area level, respectively. A small proportion (12.4%) of the farmers regarded bovine dermatophilosis as a potentially zoonotic disease. The high level of stockowners' general awareness, with regards to bovine dermatophilosis, sets ideal conditions for the mobilisation of farmers by animal health authorities in the control of the disease. However, further research needs to be undertaken to investigate effective antibiotic delivery protocols and the potential zoonotic impact of bovine dermatophilosis in a situation of high disease prevalence.

Household Animal and Human Medicine Use and Animal Husbandry Practices in Rural Bangladesh: Risk Factors for Emerging Zoonotic Disease and Antibiotic Resistance

Animal antimicrobial use and husbandry practices increase risk of emerging zoonotic disease and antibiotic resistance. We surveyed 700 households to elicit information on human and animal medicine use and husbandry practices. Households that owned livestock (n = 265/459, 57.7%) reported using animal treatments 630 times during the previous 6 months; 57.6% obtained medicines, including antibiotics, from drug sellers. Government animal healthcare providers were rarely visited (9.7%), and respondents more often sought animal health care from pharmacies and village doctors (70.6% and 11.9%, respectively), citing the latter two as less costly and more successful based on past performance. Animal husbandry practices that could promote the transmission of microbes from animals to humans included the following: the proximity of chickens to humans (50.1% of households reported that the chickens slept in the bedroom); the shared use of natural bodies of water for human and animal bathing (78.3%); the use of livestock waste as fertilizer (60.9%); and gender roles that dictate that females are the primary caretakers of poultry and children (62.8%). In the absence of an effective animal healthcare system, villagers must depend on informal healthcare providers for treatment of their animals. Suboptimal use of antimicrobials coupled with unhygienic animal husbandry practices is an important risk factor for emerging zoonotic disease and resistant pathogens.

The economic value of One Health in relation to the mitigation of zoonotic disease risks

The essence of One Health is an interdisciplinary approach combined with some degree of intersectoral integration that is aimed at mitigation of human and animal health risks, taking account of environmental, ecological, social and economic factors. While a large number of international stakeholders now consider the One Health approach necessary for more effective protection of the global community against health threats, there is still no systematic allocation of resources to integrated national or multinational programmes, partly due to the inertia of existing sectoral systems and the lack of convincing economic arguments in support of the approach. We propose different degrees of sectoral integration depending on system types and associated economic efficiency gains to be expected from a One Health approach. International and regional organisations have an important role in facilitating the adoption of the approach, since the costs and the benefits are often of a regional or even a global nature, such as in the case of avian influenza.

Development of a participatory tool for the evaluation of Village Animal Health Workers in Cambodia

In countries with a lack of primary care systems, health workers are of crucial importance to improving the delivery of health and animal health services at community level. But somehow they are rarely evaluated and usually with a top-down approach. This is the case in Cambodia, where thousands of Village Animal Health Workers (VAHWs) have been trained by the government, and where no standardized evaluation tool is available to accurately assess the situation. Based on methodology developed by the French NGO Agronomes et Vétérinaires Sans Frontières (AVSF) in Madagascar for farmers' association evaluation, we developed our own participatory methods to collect information about the VAHW context and build a criteria grid for their evaluation. In this framework, several participatory approaches were used such as problem trees, semi-structured interviews, pair-wise ranking and focus groups. The grid was built with the help of relevant stakeholders involved in the animal health system in Cambodia in order to (i) identify VAHW functions; (ii) set up criteria and associated questionnaires, and (iii) score the grid with all the stakeholders. The tool was divided into five categories of evaluation criteria: sustainability, treatment, production, vaccination and disease reporting. Our approach looked at local indicators of success developed and used by VAHWs themselves, which should lead to better acceptability of evaluation. This method gave priority to dialog aiming to engage decision makers and other stakeholders in a mutual learning process and could be applied in other countries to develop trust between health workers and official service representatives as well as to foster corrective action after evaluation.

Animal husbandry practices in rural Bangladesh: potential risk factors for antimicrobial drug resistance and emerging diseases

Antimicrobial drug administration to household livestock may put humans and animals at risk for acquisition of antimicrobial drug-resistant pathogens. To describe animal husbandry practices, including animal healthcare-seeking and antimicrobial drug use in rural Bangladesh, we conducted semi-structured in-depth interviews with key informants, including female household members (n = 79), village doctors (n = 10), and pharmaceutical representatives, veterinarians, and government officials (n = 27), and performed observations at animal health clinics (n = 3). Prevalent animal husbandry practices that may put persons at risk for acquisition of pathogens included shared housing and water for animals and humans, antimicrobial drug use for humans and animals, and crowding. Household members reported seeking human and animal healthcare from unlicensed village doctors rather than formal-sector healthcare providers and cited cost and convenience as reasons. Five times more per household was spent on animal than on human healthcare. Strengthening animal and human disease surveillance systems should be continued. Interventions are recommended to provide vulnerable populations with a means of protecting their livelihood and health.