Knowledge and practices on Rift Valley fever among livestock farmers and animal health professionals in Nyandarua County, Kenya

¹Department of Medical Microbiology and Immunology/Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya, ²Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi, Kenya, ³Department of Veterinary Surgery, Theriogenology and Medicine, Egerton University, Nakuru, Kenya, ⁴Department of Nursing Sciences, University of Nairobi, Nairobi, Kenya, ⁵Department of Public and Global Health, University of Nairobi, Nairobi, Kenya, ⁶Emergency Preparedness and Response Program, World Health Organization (WHO), Nairobi, Kenya

^&Corresponding author
James Wanjama Kabugu, Department of Medical Microbiology and Immunology/Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya

Introduction    

Rift Valley fever (RVF) is an arboviral zoonosis caused by a Phlebovirus of the family Phenuiviridae and transmitted primarily by the Aedes mosquito. The RVF virus (RVFV) infects domestic animals (cattle, sheep, goats, and camels) [1]. Rift Valley fever (RVF) was first identified in 1931 in sheep with hepatic necrosis and fatal abortions in Naivasha, Kenya [2]. The disease is endemic in tropical Africa and the sub-tropical climates of Madagascar, and the Arabian Peninsula. The epidemics and epizootic are mostly confined to East and South Africa with Kenya experiencing RVF outbreaks in endemic areas in 1968, 1978/79, 1997/98, and 2006/2007 [3,4]. Transmission of RVFV by mosquitoes affects ruminants and causes spontaneous abortions in pregnant females, mortality in young susceptible ruminants, icterus, and hemorrhagic disease [5]. In Kenya, RVF is among the priority zoonotic diseases (PZD) due to its high public health, and socioeconomic impacts [6]. The socioeconomic impacts are attributed to livestock mortality, trade disruptions, and high intervention costs through vaccinations [7,8]. Nyandarua, a previously RVF low-endemic area, experienced livestock abortions, anaemia, diarrhea, and death of young livestock in late 2018 and early 2019. These symptoms suggestive of RVF were reported in the sub-counties of Ol Kalou, Kipipiri, and Ndaragwa [9]. Due to RVF's socioeconomic and public health impacts, studies have been conducted to assess the knowledge and practices related to RVF in other counties, but not in Nyandarua [10-13].

The approaches to preventing and controlling RVF disease and vectors require information on knowledge and practices derived from surveys that utilize qualitative and quantitative methods [14]. Most practices are associated with knowledge and information within the community [15]. The knowledge available on RVF improves the prevention and control policies [16]. Strategies and preparation for future RVF outbreaks and control have been documented by evaluating barriers to livestock vaccination in Kenya and Uganda [17]. Despite reporting of RVF cases in Nyandarua and other low-endemic areas in Kenya, little is documented about the community´s understanding of the potential risk of transmission, vectors, and control of RVF in new areas [18]. The lack of knowledge on causation, risk, and RVF transmission may lead to the high burden of RVF in vulnerable populations who continue to consume animal and animal products from uninspected sick and dead animals [19]. Therefore, there is an urgent need to raise public awareness of the risk of RVF, prevention, and control measures. These will reduce the burden of infection in humans and animals. Hence, the emphasis is on increasing the knowledge and awareness of livestock keepers in low-endemic areas. This will lead to effective community-based early warning systems and prompt outbreak response on RVF and other zoonotic diseases. This study assessed the knowledge and practices of livestock farmers and animal health professionals in Nyandarua regarding RVF prevention. By evaluating the knowledge gaps and practices of livestock farmers and AHPs. The findings will inform targeted interventions to empower the community to protect themselves and their livestock from RVF.

Methods     

Study area: the study was conducted in Nyandarua County which is located in the central region of Kenya, and lies between latitude 0°80´ to the North and 0°50´ to the south and between 35°13´ East and 36°42´ west. In Nyandarua, rainfall is well distributed throughout the year, with a cool and temperate climate. In a typical year, Nyandarua experiences two rainy seasons; long rains from March to May (maximum rainfall of 1,600 mm) and short rains from September to December (maximum rainfall of 700 mm). The average annual rainfall is 1,500 mm. The temperature is moderate. The high temperatures are low compared to the national average mainly occurs from December to March, and the lowest in July. December has the highest temperature with a mean average of 21.5°C, and July has the lowest with 7.1°C. Nyandarua borders 5 counties, Laikipia on the north, Nyeri to the northeast, Murang´a to the east, Kiambu to the south, and Nakuru to the west. The human population density is 194 individuals per square kilometre and 89.6% of the population, lives in rural areas. Agriculture is the backbone of the county´s economy and most residents are involved in farming activities, both in the rearing of livestock and cultivation of crops. Most livestock farmers in Nyandarua practice a small-scale production system with an estimated population of 433,309 cattle, 442,433 sheep, 89,972 goats, and 6,913 donkeys in the whole county.

Study design and sampling: a cross-sectional study was conducted between July 2020 and January 2021 where data was collected through interviews using semi-structured questionnaires. A purposive sampling strategy was employed to select homesteads where livestock had experienced abortions in Ol Kalou, Kipipiri, and Ndaragwa sub-counties, and the consenting household heads were interviewed. In total 57 livestock farmers were interviewed and the inclusion criteria were at least ownership of ruminant livestock, being the carer for the livestock, and being at least 18 years of age. An online questionnaire was shared with 31 animal health professionals practicing in Nyandarua County and attending a continuous professional development (CPD) program. The inclusion criteria were AHPs currently working in Nyandarua, attending the workshop, and with valid and up-to-date registration by the Kenya Veterinary Board (KVB).

Study tools: the semi-structured questionnaire had 30 questions categorized into four sections; i) demographics, ii) livestock farmer details, farm location, iii) characteristics of the farm, and iv) observation by the researcher for mosquito breeding. Mosquitoes were key observations as they are vectors of the RVF virus and play a role in maintaining transmission in animals and transovarial transmission in the Aedes offspring. Epicollect5 questionnaires were pre-tested before being integrated and uploaded as a mobile phone application software Epicollect. The questions required binary responses, (yes/no) and some with selection options. Follow-up questions were asked to livestock farmers to verify if they had noted the presence of mosquitoes and breeding sites, their knowledge and practices against mosquito bites, animal vaccination, and cases of sick and dead animals. The second questionnaire was developed for the animal health service providers including veterinarians and Animal Health Paraprofessionals from the county. The objective was to gather information including challenges in RVF prevention and control. Using a semi-structured Google form questionnaire survey, data on RVF knowledge and prevention practices were collected among the professionals attending a continuous professional development (CPD) workshop. Each respondent had confidentially received the questionnaire and filled it out before the workshop day. The questions asked sought to check whether the professionals had similar or variant views with those of the farmers interviewed.

Statistical analysis: data from Epicollect5 and Google Forms were downloaded as CSV files in Microsoft Excel 2021 (Microsoft Corporation, Redmond, Washington, USA). All qualitative responses to the questions were copied and analyzed. The descriptive statistics were calculated using Excel. The proportions of the various variables; sex, age, location, knowledge, and practices were analyzed.

Ethical considerations: study approval was obtained from the Ethics Review Committee of the Kenyatta National Hospital and University of Nairobi (KNH-UON ERC), Ref: KNH-ERC/A/373. The authorization was obtained from the National Director of Veterinary Services (DVS) and the Nyandarua County animal health authorities to engage the livestock farmers and professionals in the survey. Participation in the study was voluntary and informed consent was obtained from all respondents before data collection. All information was kept confidential.

Results     

Participant demographics: in this study, 57 livestock farmers were interviewed, of which 30 (52.6%) were males and 27 (47.4%) were females. Most livestock farmers (42%) were aged between 34 and 49 years, while (28.2%) were aged 50 -65 years old. The farmers primarily reared cattle and sheep (50.9%) versus other ruminants´ goats and donkeys. More than half (61.40%) of the livestock farmers had attained a primary level of education, and the majority were small-scale farmers (96.50%) located in Wanjohi (47.40%). Of the 57 farms visited, 3 (5.3%) were commercial farms. Of the 31 animal health professionals interviewed, 24 (77.4%) were males and 7 (22.6%) were females. Most AHPs (64.50%) were qualified in Animal Health Management (1 Degree, 12 Diploma and 7 certificate). The remaining 35.5% had a Bachelor in Veterinary Medicine. In total 12 (38.7%) of AHPs had 5-10 years of work experience and were based in Olkalou (41.9%) (Table 1).

Livestock farmers practices: of the 57 livestock farmers interviewed, 56 (98.2%) had reported the presence of mosquitoes, and 49 (86.0%) had reported an increase in their homestead. The most preferred practice by farmers to prevent human mosquito bites was the use of mosquito nets 37 (64.9%), followed by spraying insecticide 14 (24.6%) while 17 (29.8%) used no measure. There were several mosquito breeding sites within different homesteads that were visited. The natural water ponds were within and around 43 (75.4%) farms while 3 farms (5.3%) had none. Most farmers vaccinated their animals against Foot and Mouth Disease (FMD) (66.7%) followed by Lumpy Skin Disease (LSD) (57.9%). Only 2 (3.5%) farmers had vaccinated their livestock against RVF (Table 2).

Knowledge of animal health professionals on RVF: all the 31 professionals interviewed had good knowledge of notifiable diseases and acknowledged that RVF should be reported to the veterinary office. Among them, 30 (96.8%) had good knowledge about RVF prevention and 27 (87.1%) on the use of RVF vaccines. Only 16 (51.6%) of the AHPs had suspected RVF cases in animals during their practice. Although all had encountered cases of abortion in livestock, 26 (83.9%) had related frequent abortion to RVF. Only 28 (90.3%) of the AHPs knew that mosquitoes transmitted the RVF virus, either genus Aedes 24 (77.4%) or Culex 13 (41.9%). All AHPs identified correctly the risks of RVF, control measures, and their responsibility to report to the County Veterinary office, and 30 (96.8%) referred to the RVF disease as a serious problem. AHPs played a key role in vaccination against RVF, with 20 (64.5%) informing the farmers and being part of the team and 8 (25.8%) only Informing farmers about vaccination campaigns (Table 3).

AHPs´ Practices on the prevention and spread of Rift Valley fever: of the interviewed AHPs, 20 (64.5%) assisted in livestock birth without wearing gloves, and 4 (12.9%) used gloves when attending to sick animals. Twenty-seven (87.1%) AHPs handled aborted materials with gloves, while 4 (12.9%) used gloves when available. However, 26 (83.6%) AHPs reported suspected cases of RVF in livestock immediately to the county veterinary office. On the other hand, only 5 (16.7%) AHPs collected blood for laboratory analysis to confirm RVF in livestock (Table 4).

Discussion     

The livestock farmers were purposively selected from farms that reported abortions in livestock suspected to be caused by RVF. The largest percentage of the farmers interviewed were between 34 and 49 years and half focused on rearing cattle and sheep. More than half of livestock farmers had completed the basic primary school as their highest level of education. The majority of the farmers, were small-scale farmers, with a small percentage operating commercial farm. Geographically, almost half of the farmers interviewed resided in the Wanjohi ward. The animal health professionals (AHPs) comprised a higher percentage of men compared to women. The majority of AHPs qualified in Animal Health Management and the majority were males, while a smaller percentage had a Bachelor of Veterinary Medicine degree. A considerable number of professionals had work experience of between 5-10 years and were mainly stationed in the Olkalou subcounty. The demographic data is a useful starting point for understanding the livestock farmers and AHPs knowledge and practices on RVF prevention [12,15]. With all this background information, tailor-made intervention practices can be devised to effectively address RVF prevention in Nyandarua County.

Mosquitoes play a major role in the primary transmission of RVF to animals. Therefore, mosquito breeding should be monitored to reduce the population and bites [20,21]. The study observed a higher occurrence of mosquitoes in the majority of livestock farmers' homesteads (98.2%). Enhanced and effective mosquito bite control strategies are needed in humans and animals [22]. Although mosquito nets were the most common preventive measure (64.9%) for mosquito bites, a substantial share of farmers (35.1%) lacked this protection. Addressing the gap is crucial to reducing mosquito bites and potential RVF transmission through bites to humans [23-25] and animals [26]. The presence of natural water ponds within or around most farms (75.4%) presents a significant risk of mosquito breeding [27,28]. Most AHPs knew that RVF is transmitted by mosquitoes. However, the knowledge of the specific mosquitoes that transmit the RVF virus, Aedes, and Culex was lower. Training in RVF transmission, prevention, and control strategies is necessary. Public health interventions should focus on sensitizing farmers about managing these water ponds to minimize stagnant water which are potential for mosquito breeding. This should be implemented by introducing mosquito control measures like the use of larvicides or the introduction of mosquito-eating fish [29-31].

The study documents a high acceptability of livestock vaccination practice among farmers against different animal diseases. Livestock were highly vaccinated against Foot-and-mouth disease (FMD) as the vaccine was readily available [32]. However, there is a critical gap in RVF vaccination, with a small number of farmers vaccinating their livestock against RVF [33]. This shows a critical knowledge gap regarding RVF prevention. The low percentage suggested a lack of awareness or accessibility to RVF vaccines. However, most AHPs knew about RVF (96.8%) and played a key role in vaccination, with a good percentage (64.5%) actively participating in RVF vaccination campaigns. Nevertheless, among the AHPs was limited knowledge of the RVF vaccine and its availability involving a small number of the AHPs. Although a small proportion of AHPs are affected, this knowledge gap could hinder effective vaccination and implementation. The cases of sickness and abortion in livestock, particularly cattle and sheep were alarming. This raised great concern as RVF has the potential to have an economic impact on livestock farmers [8,34]. The situation was made worse when only half (51.6%) of AHPs competently suspected the cases of RVF, despite all encountering livestock abortions. This suggests a limitation in recognizing RVF clinical signs or a lack of diagnostic confirmation [18].

In general, this study highlighted the need for improved knowledge and practices on RVF prevention among livestock farmers in Nyandarua County [35]. Existing vaccination practices for other diseases provide an encouraging basis for RVF prevention [36]. Targeted campaigns that promote RVF awareness and vaccination are essential to promote the uptake of vaccine by farmers [37,38]. Based on the study, there is a need for more RVF awareness campaigns to educate farmers on RVF transmission, symptoms, and importance of vaccination. Public health initiatives should also empower livestock farmers in Nyandarua County to protect themselves, their livestock, and their livelihoods from the threat of RVF [39]. There seems to be a potential disconnect between existing practices and comprehensive RVF prevention strategies. Although there are some positive practices, such as the use of mosquito nets, significant gaps remain in RVF vaccination and in addressing mosquito breeding grounds [40]. These gaps necessitate targeted interventions to improve livestock health, and farmers' knowledge, ultimately reducing the risk of RVF transmission and outbreaks.

All AHPs understood the importance of reporting notifiable diseases to veterinary authorities [41]. This is a solid foundation for detection and control. A higher percentage (96.8%) of AHPs were aware and in a position to diagnose RVF. All AHPs had encountered cases of livestock abortions and a large percentage (83.9%) had linked the cases to RVF [42,43]. All AHPs knew the risks of RVF and their responsibility to report RVF cases to the county veterinary office. This is important for RVF early detection to ensure proper notification channels exist for timely responses. While AHPs know RVF, there are crucial areas for improvement. This could be achieved through targeted training programs focused on RVF vaccination, clinical signs, diagnosis, and mosquito vectors. This training will improve the ability of AHPs to detect, report, and participate in effective RVF transmission control strategies. It is important to improve the communication channels between AHPs and farmers on RVF prevention measures [44]. By addressing these knowledge gaps, AHPs can become even more effective allies in protecting animal and public health and preventing RVF transmission and outbreaks in Nyandarua County [45].

The practices of AHPs when related to RVF prevention revealed a disturbing disconnect between knowledge and action. While there are some positive behaviors, there were significant gaps that could contribute to the transmission and spread of RVF. Unsafe practices such as assisting livestock births, and handling sick animals without gloves by AHPs pose a high risk of transmission of the RVF virus [18]. Only a minority of AHPs collected blood samples from suspected animals for laboratory confirmation of RVF. This hinders timely RVF diagnosis, spread, and outbreak control measures. However, most AHPs (83.6%) reported suspected RVF cases to the veterinary authorities, which could allow faster investigation and intervention. There is a need for comprehensive sensitization campaigns focused on safe animal handling practices among AHPs to prevent RVF transmission [46]. There should be consistent use of gloves when assisting with livestock birth, handling sick animals, and disposing of aborted materials. Additionally, promoting the importance of collecting samples for diagnosis to aid in controlling RVF transmission and outbreaks. The limitation of the study was that the questionnaire did not analyze the attitude of the respondents during the survey.

Conclusion     

The level of knowledge and reported practices suggest a need for multifaceted interventions to improve RVF prevention practices among farmers and AHPs. Sensitization campaigns that promote consistent glove use, proper handling of aborted tissues, and the importance of sample collection to rule out RVF are essential for AHPs. Ensuring the availability and affordability of PPE will contribute to safer practices too.

Competing interests     

The authors declare no competing interests.

Authors' contributions     

James Wanjama Kabugu, Gabriel Aboge, Caroline Muneri, Angeline Chepchirchir, and Mark Nanyingi conceptualized the work and designed the survey tool. James Wanjama Kabugu led the analysis of data and drafted the work. All authors were involved in revisions of the work and approved the submitted version.

Acknowledgments     

The authors acknowledge the support from Nyandarua County, and the community for their consent and financial support from the Kenya Agriculture Climate Smart Project (KCSAP). We thank Dr. Edward Kanyari, and Wilberforce Kahiga for their support. We acknowledge the training and support from the University of Nairobi´s Building Capacity for Writing Scientific Manuscripts (UANDISHI) Program at the Faculty of Health Sciences. This work was funded in part through the ADVANCE program at IAVI. This work is made possible by the support of the American People through the U.S. President´s Emergency Plan for AIDS Relief (PEPFAR) through the United States Agency for International Development (USAID). The contents of this study are the sole responsibility of the authors and do not necessarily reflect the views of PEPFAR, USAID, or the United States Government.

Tables     

Table 1: demographic-socio-economic variables of farmers and animal health professionals from Nyandarua, Kenya

Table 2: practices associated with livestock farmers in preventing mosquitoes and animal diseases in Nyadarua (n=57)

Table 3: knowledge about RVF among animal health professionals in Nyandarua, Kenya (n = 31)

Table 4: practices and preventive measures on RVF among animal health professionals in Nyandarua, Kenya (n = 31)

References