Awareness and Attitude Toward Zoonoses with Particular Reference to Anthrax Among Cattle Owners in Selected Rural Communities of Zimbabwe

Introduction

I n Zimbabwe, anthrax, brucellosis, rabies, bovine tuberculosis (bTB), trypanosomiasis, and cysticercosis are known to occur in animals (Chambers 1989, Bingham et al. 1999, Van den Bossche et al. 2001, Pfukenyi et al. 2009, de Garine-Wichatitsky et al. 2010, Matope et al. 2010, Chikerema et al. 2012, Gomo et al. 2011), and all of these are among the 7 diseases that have been categorized as “neglected zoonoses” in Africa (WHO 2005, 2007). The occurrence of rabies, brucellosis, and anthrax in humans has also been documented (Anonymous 1957, Nass 1992, Mwenye et al. 1996, Bingham et al. 1999, Pfukenyi et al. 2007, Gombe et al. 2010). The impact of anthrax on animal and human health can be devastating (Hugh-Jones 1999). Anthrax occurs endemically in Zimbabwe, and over 10,000 human cases secondary to unprecedented outbreaks in cattle and 182 human deaths were reported during the civil war between 1979 and 1980 (Lawrence et al. 1980, Davies 1982, Nass 1992). Recently, anthrax in humans has been reported from several districts dotted countrywide, including Gokwe (64 cases) (DVS 2007), Mbire (43 cases), and Mt. Darwin (33 cases) (Anonymous 2011).

Human behavior, such as skinning and cutting meat of infected carcasses, not using protective clothing, eating contaminated meat, and belonging to a religious sect that allows eating of meat from animals that have died of unknown causes, have been reported to be important risk factors contributing to frequent outbreaks of human anthrax in Zimbabwe (Mwenye et al. 1996, Chirundu et al. 2009, Gombe et al. 2010). It has been reported elsewhere that this human behavior is partly influenced by lack of awareness (Mosalagae et al. 2011), perceptions, and attitude (Opare et al. 2000, Shirima et al. 2003, John et al. 2008), and/or misconceptions (Webb 2003) about zoonoses. Hence, it is important for cattle owners to acquire a certain degree of awareness of livestock diseases in their areas, the risks they pose, and possible transmission routes to humans, if they are to make informed decisions on diseases suspected to have zoonotic potential. Studies on awareness of pet (Pfukenyi et al. 2010) and milk-borne (Mosalagae et al. 2011) zoonoses have been conducted in urban/periurban areas and commercial and smallholder dairy farms, respectively, but they have not been carried in the rural communities of the country. Although a few relevant studies in communal areas have focused on risk factors in the face of human anthrax outbreaks (Mwenye et al. 1996, Gombe et al. 2010), information is not available regarding the level of public awareness and the risk of anthrax in these rural communities. Thus, the objective of this study was to assess cattle owners' awareness, perceptions, and attitudes toward zoonoses with particular reference to anthrax in low-, medium-, and high-anthrax (Chikerema et al. 2012) outbreak settings. It is envisaged that the baseline information generated will facilitate the development of effective guidelines and policies for controlling anthrax outbreaks.

Materials and Methods

Study location and selection of study sites

The study was conducted in rural communities of 7 districts in Zimbabwe for the period February to November, 2010. On the basis of the mean number of outbreaks per district, mean number of years of occurrence, and mean number years of recurrence of cattle anthrax outbreaks over a 40-year period (1967–2006), administrative districts in Zimbabwe have been classified as high-, medium-, and low-risk anthrax districts (Chikerema et al. 2012) (Fig. 1). On the basis of this classification, three high-, two medium-, and two low-risk districts were randomly selected, giving a total of 7 study districts. The selected high-risk districts were Chegutu, Murewa, and Lupane in the central, northeastern, and northwestern parts of the country, respectively. Gutu and Makoni were the selected medium-risk districts, whereas Chiredzi and Gwanda were the selected low-risk districts (Fig. 1).

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FIG. 1.

High-, medium, and low-anthrax-risk districts for the period 1967–2006. (Color images available at www.liebertpub.com/vbz).

In Zimbabwe, animal health regulations compel cattle owners in rural communities to dip their cattle weekly during the rainy season and fortnightly during the dry season for control of ticks and tick-borne diseases. Considering that over 90% of cattle owners dip their cattle (DVS Annual Reports), dipping attendance was believed (by us) not to be a significant source of selection bias for the farmers. Hence, due to easy access to cattle owners during the dipping sessions, dip tanks were selected as the study sites for focus group discussions with cattle owners and animal and human health workers. Two dip tanks were randomly selected from each district, giving a total of 14 study sites. Due to logistical constraints, households nearest to the selected dip tanks were visited for a one-on-one questionnaire survey of the cattle owners. A written ethical approval to carry out the study was obtained from the Department of Veterinary Services and the Ministry of Health.

Results

Discussion

Consistent with earlier observations on pet owners' (Pfukenyi et al. 2010) and dairy farmers' (Mosalagae et al. 2011) general knowledge on zoonoses in the country, most rural cattle owners knew rabies, anthrax, and brucellosis as zoonoses. Similar findings have been reported in Tanzania (Kambarage et al. 2003, Shirima et al. 2003, Swai et al. 2010). High awareness of anthrax (as confirmed by focus group discussions) and rabies by farmers could probably be attributed to periodic vaccination campaigns launched by the Department of Veterinary Services in the farming areas of the country. The other reason could be that the most named zoonoses cause great losses in animals in terms of morbidity and mortality and also pose a threat to public health. Diseases such as anthrax, brucellosis, and rabies are potentially devastating and impair production and reproduction in livestock and are also a danger to the health of the human population (Shirima et al. 2003).

In Zambia, the awareness of bTB was observed to be lower in low-prevalence settings compared to high-prevalence settings (Munyeme et al. 2010). Similarly, Brook and McLachlan (2006) also indicated that the level of disease awareness among farmers in North America is related to the prevalence of the disease. Findings of this study also concurred with this observation because a higher awareness of anthrax was noted in those districts with a higher outbreak incidence. However, despite being classified as a low-risk anthrax district, cattle owners in Chiredzi district were relatively aware of anthrax. Since 1967, the first reported cattle anthrax outbreak in the district was in 2005, but no human outbreaks have yet been reported. Between August and November, 2004, a massive outbreak of anthrax occurred in wildlife (Clegg et al. 2007) in the Malilangwe Wildlife Reserve located in Chiredzi district resulting in the death of almost all of the reserve's estimated 500 kudu (Tragelaphus strepsiceros). Cattle owners in Chiredzi district named the kudu as another animal species affected by anthrax. Hence, the recent wildlife and cattle anthrax outbreaks in the district have probably increased their awareness. In contrast, in Gwanda, another low-anthrax-risk district, cattle outbreaks were last reported in 1987 with no human outbreaks reported and this could probably account for their low awareness. Recent studies on bTB (de Garine-Wichatitsky et al. 2010, Gomo 2011), brucellosis (Gomo et al. 2011), and Rift Valley fever (de Garine-Wichatitsky et al. 2011) in cattle and wildlife at a wildlife/livestock interface in the southeast lowveld of Zimbabwe, where the Chiredzi district is located, could probably account for the high awareness of these diseases by cattle owners in this district.

Despite a high awareness of anthrax, its clinical features in animals and humans, routes of transmission, and preventive measures, results of the present study showed that people in rural communities would still consume carcasses suspected to have died of anthrax for various reasons. The importance of cattle to rural communities cannot be underestimated. They are a source of food and draught power, are a cash buffer, and provide organic fertilizers in addition to various uses in cultural and social roles. Currently, a cow in Zimbabwe sells at a market price of US $300 to US $500 and, hence, understandably poor rural families are reluctant to bury or burn the family cattle. Similar observations have been reported in Haiti (Peck and Fitzgerald 2007). The practice of salvaging meat from carcasses and slaughter of moribund cattle of unknown causes for household consumption and sale to the unsuspecting public contributes significantly to human anthrax outbreaks. In spite of religion forbidding consumption of meat from animals that die of unknown causes, the practice of slaughtering moribund animals makes belonging to a restrictive religion a nonprotective factor, as was also observed earlier by Gombe et al. (2010).

In countries where anthrax is endemic, 95–99% of all human cases are cutaneous (Swartz 2001), and during the present study most respondents mentioned skin lesions as indicative of human anthrax. Previous human outbreak studies in the country (Mwenye et al. 1996, Gombe et al. 2010) and elsewhere (Woods et al. 2004, Peck and Fitzgerald 2007) have shown the cutaneous form to be more prevalent than the inhalational and gastrointestinal forms; clinical signs such as diarrhea and vomiting were mentioned by a very low proportion of cattle owners. Cutaneous anthrax has been reported to have a very low case-fatality rate <1% when treated early and appropriately (Christie 1973). Low case-fatality rates have been reported in human anthrax outbreak investigations in the country (Mwenye et al. 1996, Takawira et al. 2004, Chirundu et al. 2009, Gombe et al. 2010). Other literature also confirms low case fatality rates with treatment (Lakshmi and Kumar 1992, Kumar et al. 2000, Woods et al. 2004). In the present study, a significant proportion of the respondents would send a sick family member who had consumed an anthrax carcass to the hospital rather than to the traditional healer. Similar findings have been reported in other studies (Opare et al. 2000). Because of the strong desire to salvage something from the animal coupled with the knowledge of treatment efficacy and at times having forgotten about anthrax, cattle owners are reluctant to bury/burn the carcass and expose themselves to anthrax infection. However, in Haiti (Peck and Fitzgerald 2007) and Turkey (Kaya et al. 2002), cutaneous anthrax was associated with significant morbidity and mortality due to asphyxiation from edema of the neck with tracheal compression and concurrent gastrointestinal anthrax.

As observed earlier in Ghana (Opare et al. 2000) and in Zimbabwe (Gombe et al. 2010), another reason for eating meat from anthrax-suspect carcasses is the belief that drying, overcooking, and cooking the meat with herbs will prevent anthrax. However, only a small proportion of the respondents had such a belief, and during focus group discussions most cattle owners overwhelmingly disagreed with such beliefs.

In support of earlier observations on cattle anthrax outbreaks in Zimbabwe (Chikerema et al. 2012), cattle owners indicated that anthrax is a hot-season disease. Focus group discussions revealed cattle owners' observations on an increased trend of cattle anthrax outbreaks, which they attributed to cessation of government-sponsored annual cattle vaccinations that used to be conducted by the government. Temporal distribution of the disease in cattle showed a reduction in outbreaks during the period 1982–1996, and this was attributed to mass annual vaccinations done during that period (Chikerema et al. 2012). However, a gradual increase in outbreaks was demonstrated from 1997 to 2006, and this was attributed to vaccinating in the face of an outbreak and also due to budgetary constraints faced by the country in the 2000s (Chikerema et al. 2012).

The results of this study demonstrated that anthrax awareness among cattle owners is high, but it differs depending on incidence of the disease in a particular area. Efficacy of human anthrax treatment, slaughtering of moribund cattle, selling meat from cattle that died of unknown causes to unsuspecting community members, and having forgotten about anthrax were found to be major reasons for consumption of anthrax-infected carcasses. This was further revealed during focus group discussions. By targeting some of the practices that encourage the transmission of the disease through public health education initiatives, human anthrax could be preventable in the studied areas. In many developed countries, human anthrax has been virtually eliminated because of effective control measures, including human and animal vaccination, veterinary supervision of animal slaughter, and quality control of animal products (Turnbull et al. 1999). Given that cattle owners would not consume meat from animals that died of unknown causes as a discouragement from veterinary officials, introducing veterinary-supervised meat inspection services is likely to have a positive impact in preventing human anthrax outbreaks. Also encouraging was the fact that awareness of animal vaccination and disposal of anthrax-infected carcasses was high. During focus group discussions, annual vaccination of cattle with cost recovery, introducing meat inspection services, prompt reporting of cattle deaths to the veterinary department, continued education, and awareness and collaboration between human and animal health workers were considered to be important in combating the disease. In addition, continued education on existing guidelines for the slaughter, disposal, and quarantine of domestic animals suspected to have anthrax and for those that have been exposed to anthrax would be beneficial. Furthermore, given the frequency of cutaneous anthrax, a simple intervention would be to wear gloves during high-risk activities of slaughtering and butchering livestock, as highlighted by human health workers during focus group discussions.