Using participatory epidemiology to investigate women's knowledge on the seasonality and causes of acute malnutrition in Karamoja, Uganda

The Karamoja region of northeast Uganda had been characterized by high levels of acute malnutrition (AM) for decades, despite substantial aid investment in nutrition programmes. Participatory epidemiology (PE) was used to understand the seasonality of child AM from the perspective of women agro-pastoralists and understand their knowledge and prioritization of the causes of child AM. Women provided highly plausible descriptions and analysis of monthly variations in the occurrence of AM, livelihood factors related to the temporal variation in AM occurrence, the root causes of AM and relationships between these causes. Overall, AM was strongly attributed to declining livestock ownership and access to cow milk and normalized gender discrimination. Monthly calendars revealed important monthly patterns in AM, births and women's workload that had not been previously reported. There was significant agreement (p < 0.01) between independent women's groups (n = 16) for the monthly calendars and causal diagrams, indicating strong reproducibility of the methods. Triangulation indicated good validity of the monthly calendar method. The PE approach demonstrated that agro-pastoralist women with limited formal education could describe and analyse the seasonality of AM and related factors and identify and prioritize the causes of AM. Indigenous knowledge should be valued and respected, and nutrition programmes should shift the emphasis towards far more participatory and community-based approaches. The timing of conventional nutrition surveys in agro-pastoral settings should be based on an understanding of the seasonality of livelihoods.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s13570-023-00269-5.

Participatory epidemiology: Reviewing experiences with contexts and actions

This paper reviews experiences with participatory epidemiology (PE) and focuses in pastoralist areas of Africa where much of the early development and institutionalization of PE occurred. The paper discusses the importance of context when designing PE activities and framing study questions, and uses the example of changing livelihoods in pastoralist areas, and marked wealth and gender differences within communities. By reference to a recently proposed definition of PE that includes community empowerment, the paper describes the marked socio-economic and gender differentiation in pastoralist communities. In these contexts, questions of "disease control for who?" and "empowerment for who?" arise, as does the need to move beyond the concept of communities as homogenous social and economic units. By reference to the persistent complex emergencies and other humanitarian crises, the paper discusses community participation and how functional participation in programmes and PE can contribute to successful livestock disease control. In contrast, empowering forms of participation are difficult to achieve in humanitarian contexts and might not be needed to achieve effective livestock disease control. In non-humanitarian contexts, and secure countries with stable governments, national control programmes for important transboundary or zoonotic diseases usually require control strategies that can be applied consistently across areas, and with disease policy, funding, coordination and implementation controlled centrally. In contrast, empowerment in PE implies local, community-level decision-making and control of resources. The paper also discusses importance of designing PE studies that focus on action, and participatory evaluation of new or adapted disease control methods with communities.

The futures of pastoralism in the Horn of Africa: pathways of growth and change

This paper reviews pastoralism in the Horn of Africa region with reference to the basic socio-economics of pastoralism, and the use of mobile livestock production to generate income and food for human consumption. The paper also examines long-term trends in pastoralist areas which, at first sight, appear to be contradictory. The first trend is the growth of a substantial domestic and export trade in livestock and meat across the region, driven largely by supplies from pastoralist areas and local and international demand. This trend indicates robust and responsive livestock production and marketing in pastoralist areas, despite recurrent drought, conflict and weak governance. In contrast, the second trend sees increasing levels of poverty and destitution in pastoralist areas, and continued high levels of human malnutrition. The co-existence of economic growth and increasing poverty in 'high-export' areas is explained by human population growth, drought, and the private control of pastures and water by wealthier producers. All of these factors combine to push poorer producers out of pastoralism. In areas with lower market orientation, other forms of declining land access are often evident, including the appropriation of land for mechanised farming, hydroelectric schemes, and bush encroachment. These changes, plus population growth and drought, also push people out of pastoralism. In all areas, pastoralism will continue to be the main economic activity but, at the same time, increasing numbers of people are seeking other livelihoods.

Livestock mortality in pastoralist herds in Ethiopia and implications for drought response

Participatory epidemiology methods were employed retrospectively in three pastoralist regions of Ethiopia to estimate the specific causes of excess livestock mortality during drought. The results showed that starvation/dehydration accounted for between 61.5 and 100 per cent of excess livestock mortality during drought, whereas disease-related mortality accounted for between 0 and 28.1 per cent of excess mortality. Field observations indicate that, in livestock, disease risks and mortality increase in the immediate post-drought period, during rain. The design of livelihoods-based drought response programmes should include protection of core livestock assets, and it should take account of the specific causes of excess livestock mortality during drought and immediately afterwards. This study shows that, when comparing livestock feed supplementation and veterinary support, relatively more aid should be directed at the former if the objective is to protect core livestock during drought. Veterinary support should consider disease-related mortality in the immediate post-drought period, and tailor inputs accordingly.

Impact of drought-related vaccination on livestock mortality in pastoralist areas of Ethiopia

Under a national Livestock Policy Forum in Ethiopia the impact of livestock vaccination during drought was assessed in order to inform the development of a best-practice guideline. For each of the different types of vaccine used during drought years there was no significant difference in livestock mortality, for any species, in vaccinated compared with non-vaccinated herds. The limited impact of vaccination on livestock mortality was attributed to weaknesses in the design and implementation of vaccination programmes, including use of inappropriate vaccines, low vaccination coverage, problems with vaccine dosing, incorrect timing of vaccination and problems with vaccine storage. If these weaknesses could be overcome vaccination could be a useful means to protect livestock assets, with considerable benefit-cost ratios. Vaccination should be conducted as a standard preventive measure during normal years, and programme design should be informed by participatory epidemiological studies.

Impact of a commercial destocking relief intervention in Moyale district, southern Ethiopia

A commercial destocking intervention was piloted in southern Ethiopia during the drought of early 2006. The intervention led to the purchase of an estimated 20,000 cattle valued at USD 1.01 million. On average, destocked households received USD 186 from the sale of cattle--approximately 5,405 households were involved. In terms of aid investment, the approximate cost-benefit ratio was 41:1. During the drought, income from destocking accounted for 54.2 per cent of household income (n = 114 households), and was used to buy food, care for livestock, meet various domestic expenses, support relatives, and either pay off debts or augment savings. Seventy-nine per cent of the income derived from destocking was used to buy local goods or services. Expenditure on livestock care amounted to 36.5 per cent of local spending, and included the private transportation of livestock to better grazing areas. The buoyant livestock export trade was considered to be an important driver of commercial destocking, demonstrating a positive link between livestock and meat exports, and pastoral vulnerability during drought.

The socio-economic impact of important camel diseases as perceived by a pastoralist community in Kenya

This paper presents the results of a study conducted in a pastoral community in Kenya using participatory appraisal approaches. The objective of the study was to assess the socio-economic impact of camel trypanosomosis (surra) according to the perceptions of the pastoralists. Four livestock grazing units were conveniently selected and in each of them, three groups of key informants comprising five to eight persons were selected for the participatory exercises. Five camel diseases were listed in order of importance according to their severity and frequency of occurrence including trypanosomosis, mange, non-specific diarrhoea, tick infestations and haemorrhagic septicaemia. The losses listed as incurred due to the five diseases were: losses in milk, meat, blood, fats and hides, dowry payments, and depreciation in sale of animals, losses due to infertility and abortions, and losses due to the cost of treatment. There was good agreement (P < 0.05) between the informant groups on the losses incurred as a result of the diseases for all the selected loss indicators. Surra and mange were given high median scores on all the indicators while non-specific diarrhoea, tick infestations, and haemorrhagic septicaemia received moderate median scores. Based on the study findings it is concluded that the camel plays a central role in the lives of Turkana pastoralists and that surra has a devastating social and economic impact. There is a need for veterinary and policy decision-makers to focus more attention on the control of surra in this arid and semi-arid area of Kenya.

Certification for regional and international trade in livestock commodities: the need to balance credibility and enterprise

The current system for the certification of internationally traded animal commodities can act as a barrier to developing countries accessing high-value international markets. In this Viewpoint article, Gavin Thomson and colleagues discuss the situation as it stands and identify inconsistencies with respect to the certification process. They suggest ways to address the lack of capacity for credible certification in some developing countries that will encourage market access for livestock commodities. They emphasise the role of mechanisms other than demonstrating that an area of production is free from a range of animal diseases, arguing that this could be of significant benefit to developing regions and countries, but that a reliable and independent system of certification based on international standards is essential.

Use of participatory epidemiology to compare the clinical veterinary knowledge of pastoralists and veterinarians in East Africa

Because of severe resource and logistical constraints in large areas of Africa, disease surveillance systems need to maximize the use of information provided by livestock keepers and make correct interpretations of indigenous livestock knowledge. This paper describes the use of participatory epidemiology (PE) to compare the names, clinical signs and epidemiological features of cattle diseases as perceived by pastoralists and veterinarians. Using results from two previous studies with pastoralists in southern Sudan and Kenya, provisional translations of local disease names into modem veterinary terminology were used to develop a matrix scoring method for use with veterinarians. Matrix scoring data from pastoralists and veterinarians were then compared using simple visual comparison of summarized matrices, hierarchical cluster analysis and multidimensional scaling. The results showed good agreement between pastoralists' and veterinarians' disease names and diagnostic criteria. The matrix scoring method was easy to use and appropriate for use in under-resourced areas with minimal professional support or laboratory services. Matrix scoring could be used to assist livestock disease surveillance workers to design surveillance systems that make better use of pastoralist's indigenous knowledge and correctly interpret local disease names. The method should be combined with conventional veterinary investigation methods where feasible.

The use of community-based animal health workers to strengthen disease surveillance systems in Tanzania

An 18 month trial was conducted in three districts of Arusha region, northern Tanzania, to assess the use of community-based animal health workers (CAHWs) in an official disease surveillance system. Disease reports provided by CAHWs were assessed using six indicators for effective disease surveillance, i.e. sensitivity, specificity, timeliness, representativeness, simplicity and acceptability. To assess sustainability issues and determine the incentives required by CAHWs to report disease, three different incentive models were tested in the trial. None of the incentive models involved direct payments to CAHWs. Before involving CAHWs in disease surveillance in the three trial districts, disease case reports as a proportion of cattle population were 0.13%, 0.20% and 0.12%. During the trial, disease case reports as a proportion of cattle population increased to 5.0%, 5.6% and 6.3%. The CAHWs also improved the spatial and temporal coverage of the disease surveillance system and provided timely reports. During the trial, national-level disease reporting in Tanzania increased by 17% owing to the sensitisation and support activities of the Pan African Programme for the Control of Epizootics in Tanzania. In Arusha region, disease reporting increased by 118%, and 49% of this improvement was attributable to increased reporting in the three trial districts. Reporting from these districts far exceeded that from any other district in Tanzania. Veterinarians confirmed the CAHWs' clinical diagnosis in 88% of the 170 clinical cases examined. The increase in disease reporting resulting from CAHW activities was sufficient to enable the national epidemiology unit to achieve its target in relation to World Organisation for Animal Health (OIE) guidelines. The authors conclude that the use of CAHWs should be promoted in the national strategy for disease reporting. Additionally, CAHWs must be brought under the control of the Tanzanian veterinary authorities, a process that will include appropriate legislative reform.

Community Perceptions of Important Camel Diseases in Lapur Division of Turkana District, Kenya

This paper presents the results of a study conducted in Lapur Division of Turkana District, Kenya, to estimate the incidence and mortality of camel trypanosomosis using participatory methods. Four livestock camps ('adakars') were conveniently selected for the study. Four informant groups comprising 6 8 key persons were used for the participatory exercises. The camel diseases identified by the pastoralists in their order of importance according to annual incidence were: trypanosomosis (11.4%); mange (10.8%); tick infestation (7.9%); haemorrhagic septicaemia (7.7%); and non-specific diarrhoea (7.6%). Almost half (49.3%) of the camel population suffered from at least one disease over the previous year. The annual incidence and mortality rates of trypanosomosis were estimated at 15%, and 9.9%, in adult camels and 6.9% and 5.2%, in young camels, respectively. There was a seasonal occurrence of trypanosomosis, with most cases reported in the dry season. The prevalence levels of the disease reportedly declined from about 100%, in 1978 to an almost stable state of about 15% in 2002. This study revealed that camel trypanosomosis is still an important disease in Turkana District, exacting a heavy toll in terms of morbidity and mortality. The economic losses due to the disease were likely to have been great owing to the central role the camel plays in this arid district of Kenya.

Impact assessment of a community-based animal health project in Dollo Ado and Dollo Bay districts, southern Ethiopia

Participatory methods were used to assess the impact of a community-based animal health worker (CAHW) project in two remote pastoralist districts of Ethiopia. The CAHW project had been operating for 3 years at the time of the assessment. Participatory methods were standardized and repeated with 10 groups of informants in the project area. The assessment showed significant reductions in disease impact for diseases handled by CAHWs compared with diseases not handled by CAHWs. In camels, there was significant reduction (p < 0.001) in the impact of mange, trypanosomosis, helminthosis, anthrax and non-specific respiratory disease. In cattle there was a signficant reduction (p < 0.001) in the impact of blackleg, anthrax and helminthosis. In sheep and goats there was a sign reduction (p < 0.001) in the impact of mange, helminthosis, contagious caprine pleuropneumonia, orf and non-specific diarrhoea. In order of importance, these reductions in disease impact were attributed to (1) increased use of modern veterinary services provided by CAHWs, (2) vaccination campaigns involving CAHWs, (3) good rainfall and availability of grazing and (4) decreased herd mobility. Decreased herd mobility was also associated with negative impact of tick infestation. Community-based animal health workers were considered to be highly accessible, available, affordable and trustworthy relative to other service providers. They were also perceived to be suppliers of a good quality service. Specific types of positive impact attributed to CAHW activities were increases in milk, meat, income and draught power.

A model of lineage-1 and lineage-2 rinderpest virus transmission in pastoral areas of East Africa

The development of a stochastic, state-transition model of rinderpest transmission dynamics is described using parameter estimates obtained from both laboratory and participatory research. Using serological data, the basic reproduction numbers for lineage-1 rinderpest virus in southern Sudan and for lineage-2 rinderpest virus in Somali livestock were estimated as 4.4 and between 1.2 and 1.9, respectively. The model predictions for the inter-epidemic period in Sudan and Somalia (1.2 and 4.2 years, respectively) were in agreement with analysis of livestock-owner reports (1-2 years and 5 years, respectively).

Participatory diagnosis of a heat-intolerance syndrome in cattle in Tanzania and association with foot-and-mouth disease

A heat-intolerance (HI) syndrome in cattle in Tanzania was suspected to be associated with previous, clinical foot-and-mouth disease (FMD). A participatory appraisal (PA) method called "matrix scoring" was used to explore livestock-keeper perceptions of association between HI and cattle diseases. A PA method called 'proportional piling' was used to estimate herd incidence of FMD and other diseases, herd incidence of HI, and association between HI and other cattle diseases. Use of matrix scoring and proportional piling with pastoral Maasai informants demonstrated association between FMD and HI. With agropastoral Sukuma informants, the matrix-scoring method did not indicate an association between FMD and HI, whereas the proportional piling method indicated a weak association. Results were supported by calculation of positive predictive values for herder diagnosis of HI and FMD. Clinical examination of cattle by veterinarians was used to confirm HI cases and detection of antibody to non-structural proteins of FMD virus was used to confirm previous clinical FMD.

Para-veterinary professionals and the development of quality, self-sustaining community-based services

Livestock are a major asset for rural households throughout the developing world and are increasingly regarded as a means of reducing poverty. However, many rural areas are characterised by limited or no accessibility to veterinary services. Economic theory indicates that primary level services can be provided by para-veterinary professionals working as private operators and as an outreach component of veterinary clinics and pharmacies in small urban centres. Experience from the development of community-based animal health worker (CAHW) systems indicates that these workers can have a substantial impact on livestock morbidity and mortality through the treatment or prevention of a limited range of animal health problems. Factors for success include community involvement in the design and implementation of these systems, and involvement of the private sector to supply and supervise CAHWs. Examples of privatised and veterinary supervised CAHW networks are cited to show the considerable potential of this simple model to improve primary animal health services in marginalised areas. An analysis of constraints indicates that inappropriate policies and legislation are a major concern. By referring to the section on the evaluation of Veterinary Services in the OIE (World organisation for animal health) Terrestrial Animal Health Code, the paper proposes guidelines to assist governments in improving the regulation, quality, and co-ordination of privatised, veterinary supervised CAHW systems.

Participatory analysis of seasonal incidences of diseases of cattle, disease vectors and rainfall in southern Sudan

During an investigation into a chronic wasting disease in southern Sudanese cattle, a participatory appraisal method called a 'seasonal calendar' was used to understand local perceptions of seasonal variations in cattle diseases, disease vectors, intermediate hosts and rainfall. Repetition of a standardized seasonal calendar with Dinka informants demonstrated good reproducibility of the method. Comparison of rainfall data produced by seasonal calendars and objective measures of rainfall demonstrated good validity of the seasonal calendar method. Subjective assessment of seasonal calendar scoring patterns by veterinarians indicated that herders' perceptions of seasonal populations of biting flies, ticks and snails were similar to modern veterinary knowledge. The uses of seasonal calendars in veterinary epidemiology are discussed.

Participatory investigations of bovine trypanosomiasis in Tana River District, Kenya

Participatory research on bovine trypanosomiasis was conducted with Orma pastoralists in Tana River District, Kenya. The use of participatory methods to understand local perceptions of disease signs, disease causes, disease incidence by cattle age group, seasonal patterns of disease and preferences for indigenous and modern control methods are described. Results indicated that local characterization of diseases called gandi and buku by Orma pastoralists was similar to modern veterinary knowledge on chronic trypanosomiasis and haemorrhagic trypanosomiasis (due to Trypanosoma vivax), respectively. The mean incidence of gandi varied from 10.2% in calves to 28.6% in adult cattle. The mean incidence of buku varied from 3.1% in calves to 9.6% in adults. Pearson correlation coefficients for disease incidence by age group were 0.498 (P < 0.01) and 0.396 (P < 0.05) for gandi and buku, respectively. Informants observed cases of trypanosomiasis in 24.1% of cattle (all age groups); these cases accounted for 41.8% of all sick cattle during the preceding 12-month period. Eight indigenous and three modern trypanosomiasis control methods were identified. Results indicated that an integrated approach to trypanosomiasis control based on private, individual action was well established in the assessment area. When presented with four different trypanosomiasis control methods, community representatives selected 'better use of trypanocides' as the most preferred intervention and 'community-based tsetse control' as the least preferred intervention. This finding prompted researchers to modify the original project activities. Constraints facing the sustainability of community-based tsetse control are discussed.

Participatory diagnosis of a chronic wasting disease in cattle in southern Sudan

In southern Sudan, livestock keepers identified a chronic wasting disease in adult cattle as one of their most-serious animal-health problems. Participatory-appraisal (PA) methods and conventional veterinary-investigation methods were used to characterise the chronic wasting disease and identify linkages between indigenous knowledge and modern veterinary knowledge. The local characterisation of chronic wasting encompassed trypanosomosis, fasciolosis, parasitic gastroenteritis and schistosomosis (as both single and mixed infections).A standardised PA method called matrix scoring had good reproducibility when investigating local perceptions of disease-signs and disease causes. Comparison of matrix-scoring results showed much overlap with modern veterinary descriptions of cattle diseases and the results of conventional veterinary investigation. Applications of PA methods in remote areas with very limited veterinary infrastructure are discussed. The validation of data derived from PA is discussed by reference to the low sensitivity of 'field-friendly' diagnostic tests for important cattle diseases.

Community participation and the delivery of veterinary services in Africa

Community participation is now widely promoted as an important feature of aid projects in less-developed countries. However, definitions, uses and expectations of community participation vary considerably among professionals (including veterinarians). A lack of common understanding of community participation hinders the comparison of experiences between projects and can lead to false hopes regarding how community participation should be used and what it might deliver. This paper provides an overview of experiences with community participation in animal-health service development and research in Africa. By examining two types of community-based animal-health intervention, the paper also describes how community participation can vary in veterinary projects and relates this variation to project impact and sustainability. Projects that encourage types of community participation such as interactive participation and self-mobilisation are most likely to result in sustained benefits for livestock keepers.

The use of participatory appraisal by veterinarians in Africa

The term 'participatory appraisal' refers to a range of methods for data collection, learning and facilitation, which enable local people to play an active role in defining, analysing and solving their problems. A questionnaire survey was used to obtain information on the use of participatory appraisal (PA) from veterinarians working in Africa. A low overall response rate of 28.6% was achieved. Within Africa, response rates varied from 15.6% from government veterinarians to 47.6% from veterinarians working with non-governmental organisations. Information is presented on preferred methods, specific uses, levels of training and perceived advantages and disadvantages of PA. While PA was considered by many informants to be a valuable approach to working with communities to analyse and solve local animal health problems, respondents also identified constraints to the wider use of PA. These constraints included lack of financial resources, low availability of relevant training courses and materials, lack of time to attend training courses, and negative attitudes among colleagues. The author concludes that greater institutional awareness of the role of PA in the development of Veterinary Services is required. Such awareness might be achieved by wider dissemination of experiences related to the use of PA and the development of veterinary-orientated training courses for centrally-based personnel and workers in the field. The latter should include attention to appropriate attitudes and behaviour for veterinary professionals who are attempting to develop services according to the priorities and capacity of the community.

Haematology of clinically normal and sick captive reindeer (Rangifer tarandus)

A retrospective analysis of haematological values from clinically normal captive reindeer (Rangifer tarandus) showed that the red cell count, haemoglobin level, packed cell volume and lymphocyte count were higher and the erythrocyte sedimentation rate and eosinophil count were lower in juveniles than in adults. Newborn animals were anaemic compared with juveniles and adults and had high reticulocyte counts. The values from healthy reindeer were used to identify abnormal haematological variations in a number of sick animals. It was shown that reindeer exhibit similar haemopathological responses to those of other artiodactyla, with increases in the erythrocyte sedimentation rate and fibrinogen level being of particular diagnostic significance. Eosinophilia was the only abnormal haematological finding in individuals with subclinical infections of intestinal parasites.