COMMUNITY KNOWLEDGE, PERCEPTIONS AND PRACTICES ABOUT ANTHRAX IN KASESE AND RUBIRIZI DISTRICTS, SW UGANDA

UVA and UMA One Health Conference, 15 February 2013

Conservation Through Public HealthSteven Rubanga, Joseph Byonanebye, Dr. Gladys Kalema Zikusoka,

Lawrence Zikusoka, Wilson Kagoro (QEPA CCW)

Presentation Outline

• Background• Participatory epidemiology study• Community involvement in reducing negative

impact of anthrax outbreak

Background• Queen Elizabeth Protected Area (QEPA) reported an

unusually high mortality of hippos June 11, 2010

• National Anthrax Task Force developing out break response strategies including community mobilisation

• The objectives of the taskforce - containment of the outbreak, prevention of transmission to other animals and humans, and building capacity for outbreak response.

• Members: UWA, MAAIF, MOH, MTWH,CDC, USAID RESPOND , AFENET, CTPH, WHO and FAO.

Anthrax Disease Outbreak and Risk to Park Communities

Community Sensitization

Community Workshops

Participatory Epidemiology Study

• A Participatory Epidemiology (PE) and Participatory Disease Surveillance (PDS) study was carried out in Kyambura, Katunguru and Kasenyi areas in Kasese and Rubirizi districts

• To determine knowledge, perceptions and practices about anthrax and the preferred channel of information regarding anthrax

• Information generated from this rapid assessment used for implementation of Information Education and Communication for Behavior Change regarding anthrax

Materials and Methods• 7 villages were purposefully and conveniently selected • One semi-structured interview involving 10 – 15

participants was held with each community/village • key informant interviews involving local leaders and

animal health service providers were conducted before and after the group sessions

• PE techniques: participatory mapping, simple ranking, proportional pilling/morbidity and mortality, seasonal calendars, transect walk, disease matrix impact scoring, and pair wise ranking

Materials and Methods• Study area – Queen Elizabeth National Park in areas surrounding Kazinga

channel and Lakes George and Edward • Sampling of villages = 7: Kyenzaza , Mirarigye, Kafuro, Kashaka,

Kyambura , Kasenyi, Katunguru • Data collection- involvement in the study through the local

mobilisers/leaders • Participants were asked

– knowledge of community about anthrax – list of the diseases they thought could be acquired by wildlife, livestock

and humans and to rank them– health seeking practices – preferred channel of information about anthrax– impact of nomadic pastoralists/grazing, hunting, crop farming on

occurrence of anthrax – Seasonality of anthrax– Community-UWA relationships

Results• The common animal-human diseases problems – Anthrax, Worms, Foot & mouth Sleeping sickness, Big

head, TB, Brucellosis and “others” – Anthrax was relatively more common and was of

importance in all the villages visited than any other disease followed by “other diseases”

– Anthrax was in particular perceived to be more important especially in the villages of Kafuro, Kashaka and Kasenyi.

– The reasons given for relative frequency and importance of anthrax • Hippos come out of water and graze with their animals; • They use water in which sick animals die • More difficult to treat than malaria.

Results

• The perception of community about anthrax • Women perceived themselves to be at risk of

anthrax from their spouses as they are hunters and pastoralists

• The practices of community about anthrax • significant shift in preference towards the formal

health services as opposed to the traditional healers • Severity was a factor associated with seeking

immediate care

Preferred source of health information

• Most preferred channels of communication: social mobilization, social institutions and radio

Radio

Phone

social mobilisation

social institutions

Poster

TV

0 5 10 15 20 25 30 35 40 45

Prefered channel of communication

Community-UWA relationships

• Consensus in Kasenyi, Kahaka and Kafuru- community were not happy with the UWA.

• UWA mind about “their” animals and not them, the human beings; they harass them, and do not mobilize and educate them in case of anthrax outbreaks.

• “the park officials brought anthrax,… just as they brought for us crocodiles. For example, some respondents do not want to participate when it came to community-UWA issues, when they realize UWA personnel was present”. KI Kashaka vilage

Conclusion

• Level of knowledge, perception, and practices about anthrax varied according to proximity to the park

• Social mobilization, institutions and radio were the preferred method for behaviour change communication messages

Follow Up• Facilitated formation of 30 community

conservation health volunteers to collect data and educate communities:

- Consumption of bush meat from unknown sources and Poaching

- Better health seeking behaviour- Hygiene and sanitation- Drinking water from the lake- Cattle sharing drinking sources with wildlife- Cattle grazing with wildlife

• Disease outbreaks website - www.diseaseoutbreaks.ug• Toll free hotline (0800200300)• Sms short code (6969).• Over 10,000 people called the toll free hotline in 5months• Program was hosted on national TV. • CCHWs visited 3,170 households• CCHWS gave 1,094 village health talks • 278 households were shown sms disease alerts• 1,541 listened to radio talk shows about anthrax. • The positive impact - all suspected cases investigated• No cases of people or cattle that have died of anthrax. • Runners Up in 2010 Health Category of Annual Uganda

Communications Commission Award

CTPH Communication Strategy

Recommendations

• Reinforce community knowledge about anthrax

• Strengthen community/local surveillance network for future disease outbreaks

• Explore the use of mobile phones to continue to collect data and link with other projects in QEPA such as PREDICT animal mortality monitoring

Acknowledgements• National Anthrax Task

Force• MAAIF• MOH• MTTI/UWA/QEPA• Kasese and Rubirizi

Districts• CDC• AFENET• WHO

• Donors• MacArthur Foundation• USAID• Emerging Pandemic

Threats/RESPOND• Uganda

Communications Commission

THANK YOU