1. HUMAN BRUCELLOSIS: AN INVESTIGATION OF KNOWLEDGE AND PRACTICES IN A RURAL COMMUNITY IN KAJIADO COUNTY, KENYA. Presented by: Agnes G. Maina (MPH Student, Moi University) Supervisors: Professor P.M. Gatongi, PhD (Moi University) Dr. Purity Nguhiu, PhD (Dept. of Vet. Services) Amref Health Africa International Conference November 25, 2014.

2. Introduction Human Brucellosis is a zoonotic disease by Brucella spp. Key Human Brucellosis risk factors; - Consumption of un-boiled dairy products. - Contact with infected animal abortive material via broken skin. Global prevalence: 0.89-4.10% (Gul & Khan, 2007). Local prevalence: 12% (Maichomo, 1997). Incidence: 500,000 infections/year (Franco et al., 2007). Problem Statement There is inadequate awareness of brucellosis and its preventive measures, especially among communities where disease burden is highest.

3. Objectives. General Objective To investigate the link between knowledge and practices related to human brucellosis in a rural community in Kajiado County. Specific Objectives To describe the community’s knowledge regarding brucellosis. To describe the practices that predispose the community to brucellosis. To assess the link between the practices and knowledge related to human brucellosis in the community.

4. Study Methodology Cross-sectional study in Ewaso Kedong, Kajiado County. Systematic random sampling, 384 community members. 18 – 55 years, male and female. Study Instruments: Interviewer schedule and guide. Dependent Variable: Practices Independent Variables: Sociodemographic factors, Knowledge. Data analysis : - Descriptive and analytical statistics (Quantitative data). - Organized thematically (Qualitative data). Ethical considerations : IREC approval, Informed consent.

5. Results Sociodemographic Characteristics 75% were male,25% female. 91.7% were married, 8.3% not married. 52.1% had formal education, 47.9% no formal education. Age: Median 40; Mean 39.94; SD 9.25; Range 20-55(35). Community’s Knowledge Regarding Brucellosis.(Objective 1). 70.6% knew pre-purchase livestock exam was important, 71% knew purpose was health status ascertainment. 49.5% did not know purpose of protective items at livestock delivery. Only 32.8% knew livestock abortions lead to human disease. 98.4% knew boiling milk made it safe.

6. Results Cont..d Community’s Practices Regarding Brucellosis (Objective 2). 98.4% requested for livestock exam., only 3.9% from AHWs. 98.2% assisted in livestock delivery, none used protective wear. Only 54.2% sought AHW assistance when livestock aborted. Only 12.8% burnt/buried animal abortive material. 100% boiled milk before consumption. Link between Community’s Knowledge and Practices (Objective 3). Those without formal education, half as likely to undertake brucellosis preventive practices ; {p value = 0.002, OR 0.451 [0.272,0.749]}. Knowledge of breeding soundness purpose, twice as likely to undertake brucellosis preventive practices; {p value =0.007, OR 2.013 [1.207,3.356]}. Knowledge that livestock abortions lead to human illness, likely to undertake brucellosis preventive practices; {p value = 0.027, OR 1.783 [1.070,2.974]}.

7. Discussion Community’s Knowledge regarding brucellosis. Most knew importance of livestock exam.; similar to USA study. Minority knew purpose of protective items; unlike Egypt study. Minority knew livestock abortions lead to human illnesses; like Tanzania study. Majority knew boiling milk made it safe; similar to Tanzania study. Community’s Practices regarding brucellosis. Minority consulted AHWs before livestock purchase; similar to Palestine study. None used protective items at livestock delivery; like Egypt study. Majority undertook poor measures of aborting animal and abortive material management; like in Egypt, unlike Palestine. All boiled milk; unlike Kyrgyzstan(only half boiled the milk).

8. Discussion Cont..d Link between knowledge and practices related to human brucellosis in the community. Education status predicted practice; similar to Malawi study. Knowledge of breeding soundness importance predicted practice; similar to USA study. Knowledge that livestock abortions lead to human illness predicted practice; similar to Tanzania study.

9. Conclusion Knowledge on all risk factors except purpose of boiling milk were low to average, hence placing the community at risk. All practices except milk safety measures were low to average, hence placing the community at risk. Knowledge and sociodemographic determinants of practices; - Respondent’s education status. - Knowledge of pre-purchase livestock examination for breeding soundness. - Knowledge that livestock abortions lead to human disease.

10. Recommendations 1. AHWs and Public Health Workers should sensitize community on; - Importance of pre-purchase livestock examination. - Possibility of human diseases owing to livestock abortions. 2. Community members should always; - Ensure pre-purchase livestock examination is conducted by an AHW. - Use protective items at livestock delivery. - Seek AHW assistance when livestock abort. - Burn or bury livestock abortive material.

11. Acknowledgements Moi University, AMREF Lecturers and Staff Prof. William MacLeod, Ms. Corey Haley-Boston Univ. Research Assistants : -Willy Mutinda (Dept. of Veterinary Services) - James Meritei (Dept. of Veterinary Services) Family Friends God.

12. The End Thank you.