Knowledge of pastoralists on livestock diseases and exposure assessment to brucellosis within rural and peri-urban areas in Kajiado, Kenya

Study design and area

This was a descriptive study that examined knowledge, attitudes and practices of the pastoralist community living within selected rural areas in Kajiado and another group who were living within the peri-urban areas. The study was carried out in August 2015. These communities were selected to compare the risk practices of exposure to zoonoses between those who still practiced pastoralist livelihoods system within the county, and another who had transitioned to peri-urban livelihoods systems, but were still bound by cultural ties based on the community customs and traditions. Kajiado County is predominantly inhabited by the Maasai community, which still have members who practices nomadic pastoralism. However, there are immigrants from other communities in the county, with different cultural orientations from those of the Maasai. These have mostly inhabited the peri-urban areas within the county.

Kajiado County has two main livestock production systems: nomadic pastoralism and mixed livestock and crop farming systems (agro-pastoralism) practiced around up-coming urban centers. The county was therefore stratified in two strata, based on these livelihood systems. The study sites were selected through a two-stage sampling process. The sub-counties where the study was carried out were first selected purposively due to available logistical arrangements for accessing the pastoralists, and administrative wards where interviews were carried out were selected from these sub-counties through a random selection process using a lottery method where all wards in each sub county were listed in different pieces of paper, which were then rolled up and placed in a box. From each box two pieces of paper were drawn sequentially, and names of the selected wards recorded. For each of the selected sub-counties, all administrative wards had an equal opportunity of being selected to be included in the study through a process of sampling without replacement. The process was guided by the research team with assistance from a local government extension agent in Kajiado who was familiar with geography of the area and Maasai culture and language. Two sub-counties were selected from this process: Kajiado Central representing the nomadic pastoralism system and Kajiado East representing the peri-urban communities (Figure 1). In both sub-counties, the number of administrative wards were five. The wards included Purko, Ildamat, Matapato South, Matapato North and Dalalekutuk in Kajiado Central sub county, while for Kajiado East, these were Poka, Imaroro, Kaputei North, Kitengela and Oloosirkon/sholinke wards. Two wards were selected from each of the two sub counties. For Kajiado Central, the selected wards were Matapato North and Matapato South, while in Kajiado East; Kitengela and Kaputei North wards were selected.

Figure 1. Map of Kenya showing administrative regions in Kajiado County.

Selection of study subjects

Administration officers (village elders) from each of the selected wards were recruited to help with mobilization of study participants to attend focus group discussions. The participants who were invited to the group discussions were drawn from different parts of the wards where the village elders represented. Each group comprised of between 8 to 11 participants who were identified by village elders to have lived in the area for several years, and who were either of male or female gender were recruited for the study, while anyone who was non-Maasai speaking were not invited for the discussion. This was considered to comply with group composition description of 6–12 participants for a group discussion as was described by Dilshad & Latif (2013), where individuals with a certain characteristics are brought together by a researcher to explore attitudes, perceptions, feelings and ideas about a topic. The local veterinary personnel were also recruited to the study to serve as key informants as well as in assisting during the focus group discussion sessions to triangulate the information on livestock diseases that participants identified. A total of six groups comprising both male and female participants and two groups comprising each gender separately were conducted to explore any differences in household and farm practices with regard to handling livestock and their products which could be gender specific, especially for a patriarchal society like the Maasai.

Data collection

Two focus group discussions were conducted in each selected ward led by a member of the research team with support from local government extension personnel who was conversant with the Maasai culture and language. The group discussions were held in homesteads of local village elders where community leaders would always meet to resolve communal problems or under makeshift structures which were also used as places of worship by the community. Secondary data on the other hand, was obtained through a review of surveillance data from previous published studies and grey literature sources. Published participatory methods including proportional piling, pair wise ranking and disease matrix scoring were used for data collection during the focus group discussions (Catley, 2006; Catley et al., 2012). Briefly, pairwise ranking is a structured method of prioritizing a list of factors for decision making through consensus, where each box on a matrix represent an intersection of two constraints. For each pair of listed diseases, participants determined which of the two was most important through consensus and the important disease was marked in the appropriate box. The procedure was repeated until all boxes in the matrix were filled. Diseases were then ranked according to number of times they appeared in the matrix. Proportional piling involve allocating percentage scores to identified list of factors that have been identified by a group of people through consensus. Disease impact matrix scoring employed proportional piling method to estimate effects of livestock diseases on production parameters as perceived by pastoralists. For this case a total of 100 beads representing different weights for impact of livestock diseases were applied. Production parameters assessed included weight loss, mortality, loss in milk yield, and abortion rate. This was based on how participants perceived the disease to impact on these production parameters. The production parameters were entered on the left column of the matrix, while diseases were entered on top of the matrix. The next step involved allocating scores to diseases according to how pastoralist perceived them to impact on each production parameter. This was done sequentially focusing on one production parameter each time by allocating scores across the disease columns until all the rows of the matrix were filled. The scores allocated for each production parameter were then summed to give an overall score. The results obtained were probed to obtain reasons for the observed pattern.

The guiding questions during these sessions included: list of livestock diseases in order of their perceived importance, and what is the effect of listed diseases on livestock production parameters including milk yield, mortality rates, morbidity rates, and abortion rates. For the risk assessment, both primary and secondary data were collected through use of the questionnaire guide during the focus group discussions, and through a review of published and grey literature sources (see extended data (Onono et al., 2019)). Primary data were collected on participants’ knowledge on brucellosis in animals and humans, modes of transmission of brucellosis from animals to man and the potential exposure factors contributing to spread of brucellosis in man. The data were recorded in flip charts, while the research assistant would take additional notes that participants provided to support their argument on the types of choices they made during discussions. The participants were asked whether they knew about brucellosis in animals and in man, what were the symptoms of brucellosis in animals, the ways through which people could acquire brucellosis, factors that contributed to spread of brucellosis in man, disease management in animals and what were their perceptions on the impact of human brucellosis. The factors identified were useful in exposure assessment and estimation of risk of brucellosis infection among the population under study. The literature review was based on studies that had reported presence of the disease (hazard identification) through detection with either immunological or molecular methods within pastoral herds and flocks in Kajiado and neighboring pastoral areas. The search was done in electronic databases including PubMed, Medline and CABI direct, and the search terms included “brucellosis, Brucella & melitensis, Brucella & abortus, livestock, Kenya”. Data were also obtained from grey literature sources including published thesis and reports. The inclusion criteria for studies were those which were conducted across all farming systems in Kenya, while exclusion criteria was any other study on brucellosis which was not done in Kenya. Hazard characterization was based on the livestock species from which the hazard was detected in biological samples through either immunological or molecular methods. Before the focus group discussions were conducted, participants were asked if they accepted to participate in the study through a written consent statement which was read to them, and those who accepted to participate were asked to provide their written consent by signing an attendance form. Further ethical clearance for the study was obtained from the University of Nairobi, Faculty of Veterinary Medicine ethics and biosafety committee (FVM: BAUEC/2015/138).

Data management and analysis

Data on scores and ranks obtained during focus group discussions were entered in Microsoft Excel software version 2010. Data for various questions which were obtained from the focus group discussions were analyzed using descriptive statistical methods and results presented as frequencies, while scores were analyzed through non-parametric methods using GenStat Statistical package 13th edition (VSN International, 2011). For the scores, the analysis aimed at measuring the level of agreement amongst groups of the FGDs using Kendall’s coefficient of concordance, while Kruskal Wallis One Way Anova was also used to test whether the average scores obtained for each disease as ranked by participants were significantly different from zero. The impact of the listed diseases on the various production parameters: herd/flock milk yield, abortion rates, growth rates (weight gain), and mortality rates were presented as averages.

Qualitative risk assessment was done according to the CODEX Alimentarius guidelines (FAO & WHO, 2009). The exposure assessment to infection with brucellosis through the various pathways was determined based on the scores allocated for the likelihood of occurrence of these events in the community by the participants. A high risk score of 5 was allocated when the event occurred very often in the surveyed community; medium risk score of 4 was allocated if the event occurred regularly; low risk score of 3 was allocated if the event ever occurred but was very rare; very low risk score of 2 was allocated if the event was very rare but could not be excluded and a negligible risk score of 1 was allocated if the event was so rare and it did not merit consideration. Risk estimation was achieved by summation of the scores obtained for each exposure factor across the groups for both peri-urban and rural areas. If the summed scores for a risk practice was between 1 and 4, then the risk was considered negligible, between 5 and 8 very low risk, between 9 and 12 low risk; between 13 and 16 medium risk and between 17 and 20 high risk.

Description of respondent’s demographics

Amongst the rural pastoralist category, a total of 38 respondents participated, and out of this number, 32 % were female. Of these respondents, 47 % of participants were between 25–30 years of age, 34 % were between 31–40 years and 19 % were above 40 years. With regard to the level of education, 45 % of the respondents had attained primary school education, 21 % had obtained secondary school level of education, and 3 % had tertiary education, while 31 % had no formal education. The peri-urban group of agro-pastoralists attracted 33 respondents, of which 46 % were female. Of these respondents from peri-urban areas, 15 % were between 25–30 years of age, 52 % between 31–40 years and 33 % were above 40 years. About 18 % of the respondents had primary school education, 49 % had secondary school level of education while 33 % had obtained tertiary level of education (see underlying data (Onono et al., 2019)).

Prevalent livestock diseases affecting herds in Kajiado County

A total of 11 livestock diseases were listed from all the eight groups of participants. There were more similarities on the livestock diseases suggested by the groups of rural pastoralists when compared to those within the peri-urban groups. However, only two of the peri-urban groups mentioned brucellosis among livestock diseases that affected their flocks and herds and none from rural pastoralists ever mentioned brucellosis. According to these pastoralists, livestock diseases which were most prevalent included contagious caprine pleuropneumonia, lumpy skin disease, and foot and mouth disease and these diseases were described to have a high impact on livestock production (Z > 1.96) (Table 1). Amongst all listed livestock diseases, zoonoses (Anthrax and brucellosis) were ranked low, which could be due to the fact that these groups of pastoralist lack knowledge and awareness of the impact of these livestock diseases on their wellbeing and health. The level of agreement across these groups of pastoralists on rank orders for the livestock diseases based on their impact of wellbeing and health was considered weak, with the calculated Kendall’s coefficient of concordance ‘W’ estimated at 0.007. The high impact of these livestock diseases on mortality was reported for East Coast fever and contagious caprine pleuropneumonia, while milk yield was mostly affected by foot and mouth disease, lumpy skin disease, heart water, East Coast fever and diarrhea. Increased incidences of abortions were due to infection with foot and mouth disease, lumpy skin disease, contagious caprine pleuropneumonia and East Coast fever. The pastoralists from peri-urban areas associated brucellosis with an increased level of abortions in herds and flocks while anthrax was associated with high morbidity rates in livestock herds. Rank orders for livestock diseases according to pastoralists are presented as underlying data (Onono et al., 2019).

Qualitative risk assessment for pastoralists’ exposure to brucellosis

Hazard identification was achieved through review of published literature under the different farming systems in Kenya (see underlying data (Onono et al., 2019)). Various Brucella species had been detected in livestock raised in different farming systems in Kenya, and also in humans through serological tests (Table 2). Antibodies of B. abortus had been detected in bovine milk through milk ring tests and Elisa test (Kang’ethe et al., 2004). According to a recent review by Njeru et al. (2016), B. abortus and B. melitensis had been isolated in cattle and humans and B. suis in rodents. Pastoralists listed various practices which may act as possible exposure factors for transmission of brucellosis from livestock to members of the community. These included handling birth products without protective gear while assisting livestock during birth process and consumption of unpasteurized milk, which were associated with high risk of exposure by household members to brucellosis among the rural pastoralists. These practices would increase exposure to Brucella pathogens and therefore increasing the risk of its transmission from livestock to household members. Within the rural community, young children were often drinking fresh raw milk and colostrum which were perceived to enhance their immunity against infections, which is also a potential risk factor for infection.

Within the peri-urban group, the risk associated with exposure to brucellosis through handling of birth products without protective gear and drinking of raw fresh milk was considered to be low. These peri-urban pastoralists kept only a few livestock and they did not keep mixed livestock species. Moreover, the majority also relied on professional veterinary services during delivery or treatment of sick livestock, hence they were less exposed to brucellosis infection through handling of infected birth products. Besides, these pastoralists often used pasteurized milk, while others would always boil the raw milk from their livestock but for those households who did not own livestock, they often boiled the milk they would purchase from local shops or neighboring farms before using it within the household.

Consumption of raw meat and blood were associated with medium risk of brucellosis infection among the rural pastoralists. Consumption of raw blood was often practiced during traditional ceremonies like marriage and rites of passage when young Maasai boys are initiated to adulthood, during which time livestock were slaughtered at home. Pastoralists reported that kidneys from livestock and occasionally the liver would be consumed in their raw state during slaughtering process. This practice of home slaughter was prevalent amongst rural pastoralists due to a lack of established slaughter premises where they lived, and the long distances they would have to walk to get to the nearest marketplaces where slaughter facilities were established. The risk of exposure to brucellosis was, however, ranked low because only a few people within households were engaged in drinking the raw blood or eating the raw meat from kidneys and the liver.

Based on the risk estimation criteria, the risk of exposure to brucellosis was categorized as high amongst the rural pastoralists when compared to peri-urban pastoralists. This was due to cultural practices around consumption of fresh raw milk, raw blood and meat, and handling of birth products without protection while assisting livestock during delivery. Based on the criteria for risk estimation, consumption of fresh raw milk had a score of 19 for the rural pastoralists group and only 10 for the peri-urban group; eating of raw meat had a score of 14 for rural pastoralists and 7 for the peri-urban group; drinking of raw blood was scored 15 for the rural pastoralists and only 6 for the peri-urban group; and finally, handling of birth products without gloves while assisting livestock delivery was scored 20 for the rural pastoralists and 11 for the peri-urban group (Table 3). Based on this criterion, risk of brucellosis infection in the rural pastoralists was high for handling birth products without protectives and drinking of fresh raw milk; while the drinking of blood and eating raw meat were rated to be of medium risk. For pastoralist within the peri-urban areas, handling of birth products and consumption of raw milk were ranked as low risk, while for consumption of raw meat and blood the risk was ranked as very low.

Underlying data

Figshare: KNOWLEDGE OF PASTORALISTS ON LIVESTOCK DISEASES AND EXPOSURE ASSESSMENT TO BRUCELLOSIS WITHIN RURAL AND PERI-URBAN AREAS IN KAJIADO, KENYA. https://doi.org/10.6084/m9.figshare.9848168.v5 (Onono et al., 2019)

Extended data

Figshare: KNOWLEDGE OF PASTORALISTS ON LIVESTOCK DISEASES AND EXPOSURE ASSESSMENT TO BRUCELLOSIS WITHIN RURAL AND PERI-URBAN AREAS IN KAJIADO, KENYA. https://doi.org/10.6084/m9.figshare.9848168.v5 (Onono et al., 2019)

Data are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).