1. The Role of Veterinary and Medical Personnel in the Control of Zoonoses in Urban Settlements on the Shores of Lake Victoria, Kenya. Kanyari, PWN, Department of VPM&P, Faculty of Veterinary Medicine, University of Nairobi, Kenya Kagira JM, IPR, Nairobi, Kenya. Presented at the Association of Institutes of Tropical Veteriary Medicine Conference, Bangkok, Thailand in 23 rd -26 th August 2010.

2. Introduction ◆ Zoonoses are diseases transmitted between man and animals directly or indirectly as for rabies and cystercosis respectively. ◆ In developing countries, rapid urbanization and the close interaction between man and animals has been implicated in the emergence and spread of zoonoses. ◆ This is more so for populations living in the slum areas with compromised sanitation.

3. Introduction-continued ◆ This is further complicated by the fact that, such populations are usually high and lack adequate medical facilities for disease diagnosis and management ◆ Additionally, there is little interaction between medical and veterinary personnel in knowledge sharing to control these zoonoses. ◆ This study was done to establish the roles played by the two professionals in zoonoses management.

4. Materials and Methods ◆ The study was conducted within Kisumu municipality with a population of 500,000; 60% of these live in slums. ◆ These areas have a low human development index characterised by poor sanitation, infrastructure and health facilties and also a high level of poverty. ◆ These communities keep and interact with domestic ruminants, donkeys, pigs, poultry and also dogs and cats.

5. KISUMU CITY

6. Materials and Methods-Continued ◆ Study Design: ◆ A questionnaire designed in line with that by Grant and Olsen(1999) was conducted among the Medical and Veterinary personnel involved in service provision in Kisumu Municipality. ◆ The questions required the frequency and types of zoonoses encountered, animals with the highest risks, advice offered to the patients, role played by different disciplines and communication between disciplines.

7. Data Analysis ◆ Data was entered into Ms Excel data sheets and then exported to Ms Statview® for analysis. ◆ Frequency data were analyzed using likeli- hood ratio chi-square to compare responses of the two types of personnel. ◆ A p-value of less than 0.05 was considered to be significant.

8. Results ◆ The veterinary personnel who participated were 15 and 9 for human physicians. ◆ Zoonoses cases were observed by both the veterinary and medical personnel ◆ Veterinary personnel reported the following zoonoses from cattle: Cysticercosis (10/15), Hydatidosis (8/15), Rabies (10/15), Brucellosis (6/15), Anthrax (2/15), Tetanus (1/15), Dermatophytosis (1/15), Colibacillosis (1/15) and Salmonellosis (1/15).

9. Results-Continued ◆ From small ruminants, Veterinarians reported: ◆ Hydatidosis (3/15), Rabies (2/15), Tapeworms (2/15), Mycobacteriosis (1/15), Tetanus (1/15), and Colibacillosis (1/15). ◆ From pigs, anthrax was the only zoonoses recorded as having been observed by the Veterinarians (3/15). ◆ All the Veterinarians indicated that the most common zoonosis in dogs was rabies..

10. Results-Continued ◆ Other zoonoses in dogs, were dermatophytosis, tapeworms, hookworms, colibacillosis and salmonellosis. ◆ The Physicians observed among human patients:Hydatidosis (2/9), Brucellosis (5/9), Toxoplasmosis (3/9), Rabies (4/9), Anthrax (1/9), Ticks (2/9), Hookworms (1/9), Pneumocytis carinii pneumonia (1/9), Bronchitis (1/9). ◆ Overall, the veterinary personnel significantly (p=0.04) encountered the more zoonoses cases compared to the human physicians.

11. Results-Continued ◆ The animals with the highest risks according to the veterinarians were dogs and for physicians it was the cattle. ◆ There was a significant difference (p<0.05) in the proportion of veterinary and medical personnel who considered cattle and chicken to be of high risks. ◆ Physicians highlighted the following as important responsibilities for vets: general maintenance of animal health, screening for zoonoses in animals, zoonoses education for patients and consulting physicians.

12. Results-Continued ◆ Veterinary personnel either sought or gave advice to human physicians on rare occasions (47%). ◆ Human physicians had sought (11%) or rarely give (22%) advice to veterinary personnel. ◆ Only the veterinary personnel (47%) were aware of existence of official communication between veterinary and medical offices; and this was only in cases of rabies control.

13. Discussion ◆ This study has for the first time documented the veterinary and medical perceptions on the occurrence and control of zoonoses in an urban locality in Kenya. The findings here could be quite representative of other urban dwellings in the region. ◆ Practicing graduate vets were fewer than human physicians. Urban livestock keeping is important in this town and considering the critical role played by vets in animal and public health, deployment of more vets is emperative to impart effectively in the disease control.

14. Discussion-Continued ◆ The veterinarians were widely involved in meat inspection hence were more familiar with diseases such as bovine cysticercosis and hydatidosis compared to the physicians. Kenya reports high prevalences of cysticercosis and hydatidosis in such rural areas as Narok and Turkana (Onyango-Abuje 1996; Ndirangu 2001). ◆ Epidemiological determination of these diseases in Kisumu and other urban centres would help in devising effective control strategies and reduce human infections some of which can be fatal

15. Discussion-Continued ◆ Physicians ranked cattle as the highest zoonoses risks, possibly presumming them to be main reservoirs of brucellosis. ◆ Due to the high occurence of dog bites, and possibly rabies in Kisumu, dogs were also ranked high by both the veterinary and medical personnel ◆ In contrast to a significant proportion of physicians who indicated that chicken could be of high zoonoses risk, all the veterinarians indicated that chicken were of low zoonosis risk.

16. Discussion-Continued ◆ Chicken have been associated with zoonoses such as toxoplasmosis, salmonellosis and bronchitis pneumonia (Trevejo et al. 2005; Dubey et al. 2005). ◆ This study supports recent calls for inter- disciplinary discussions and collaborative ventures in control of zoonoses through the “One health, One medicine” approach (Cripps 2000; WHO 2007). ◆ This call which should be emphasized and up- scaled for wider appreciation.

17. Acknowledgement ◆ The authors are very grateful to Lake Victoria Research Initiative (VicRes) for providing financial support to carry out the study. ◆ We also highly appreciate the CTA Office for International Cooperation[BIC], Utrecht for covering the cost of Travel and Accommodation. ◆ Thank you for your attention