Delivery of the Contagious Bovine Pleuropneumonia
Vaccine in Garissa, Northeastern Kenya
Elizabeth Waithanji, Nadhem Mtimet and Pauline Muindi
Livestock, Gender and Impacts seminar series, January 29
2015, ILRI, Nairobi, Kenya

Presentation outline
• Operational definitions
– CBPP disease
– vaccine delivery
• Objective of study and research
questions
• Methodology
• Key scientific findings
• Implications for development
2

Operational definitions: CBPP
and Vaccine delivery
3

Contagious Bovine
pleuropneumonia (CBPP)
• Highly contagious
• Affects cattle and buffaloes
• Caused by a bacterium – Mycoplasma mycoides
mycoides small colony biotype (MmmSC)
• Spread through contact with cough droplets from
infected animals
• Can be acute, sub-acute or chronic – main sign is
a deep cough
• Mainly controlled through vaccination, and
quarantine
4

Vaccine delivery
• The vaccine movement processes beginning at
release of the vaccine by the manufacturer to a
private or public market and ending at the
consumer who uses it
– The term delivery is all encompassing
– The term adoption infers uptake by the end user
• Past studies on delivery have mainly focused on
adoption
5

Study Objective and Research Questions
6

• Objective:
– To understand CBPP vaccine delivery processes in order to
develop strategies to enhance efficiency and effectiveness
• Research questions
– What delivery mechanisms exist for the CBPP vaccine in
Ijara sub-county in Garissa county, Kenya?
– What are the opportunities and challenges of the current
vaccine delivery?
– How does CBPP vaccine adoption by men and women
compare, and if different, what is the difference and what
causes it?
7

Methodology
8

Sampling frame: Map of Ijara sub-
county, Garissa County, NE Kenya
9

Sampling strategy
• Inventory of all seven locations made
• Removed from sample, Masalani, the sub-county
headquarter (with a low cattle population) and all sub-
locations in conflict
• One sub-location from each of the remaining location
selected through stratified random sampling
• Chiefs requested to select at least 12 women and 12 men
from cattle owning households
• Women and men selected from different households
10

Data analysis
• Qualitative date
– Inductively – patterns identified and categories of
patterns made and theories formulated
– Using NVivo word clouds (NVivo 10® software)
• Quantitative data – STATA software used
– Descriptive statistics
– Linear regression
11

Study Sites
Sub-location Location Main clan (>50%)
Alijarare Kotile Abdallah
Sangole Ijara Abdallah
Ruqha Ruqha Rer-Mohammed
Falama Hulugo Abdallah
Gedilun Sangailo Abdallah
Ruqha
Bullaqalanqala
Ruqha Rer-Mohammed
12

Sample composition
Focus group discussant
composition
Name of
location
Number of
women
Number of
men
Gedilun 12 11
Sangole 8 12
Alijarere 9 12
Falama 12 8
Ruqha 10 11
Ruqha
(Bullaqalan
qala) 10 12
Total 61 66
Key informant composition
Qualificatio
n
Duty
County/
Sub-county
Sex
CAHW Sangailu M
CAHW Sangailu F
CAHW Sangole M
CAHW Alijarere M
CAHW Masalani M
CAHW Masalani M
CAHW Masalani M
Veterinarian Former DVO
Ijara
M
Veterinarian KEVEVAPI M
13

Conceptual framework
14

Vaccine
delivery
Consumer centered
(adoption)
• Accessibility
• Affordability
• Acceptability
Policy centered
• Political processes
• Vaccine priority and policies
• Supply versus demand driven
• Perceptions of affordability
• Unanswered technical questions
• Advocacy
Market centered
• Vaccine type
• Vaccine industry
• Market decisions
• Sales forecasting
15
Institutional and consumer adoption aspects of vaccine delivery

Results 1: Institutional aspects
16

CBPP Vaccine delivery scenarios
Future?
??? ideal:
Commercialization?
Capacity, e.g.
GALVMed
KEVEVAPI
Government: Conducive policies
Veterinarians, paravets,
(Agrovets, chemists
etc.)
Cattle
owners
Before:
Delivery via
government
led vaccination
campaigns –
public good,
supply driven
KEVEVAPI Government
Free
Cattle
owners
Currently:
Government
controlled, private
good, demand
driven
KEVEVAPI
Ksh
15 -25
Cattle
owners
Govt
Ksh
6
Government vets and
paravets
permit
Ksh ??

Vaccine delivery opportunities
Proportio
n (%) of
populatio
n
depende
nt on
cattle
Minimum
number
of cattle
required
for a HH
to trade
in
livestock
Average
number
of cattle
per HH
Proportio
n (%) of
human
populatio
n that
vaccinate
against
CBPP
Proportio
n (%) of
cattle
vaccinate
d against
CBPP
Livestoc
k
personn
el
average
76 175 48 96 83
Livestoc
k
personn
el range
40 – 100 20 – 500 15 – 100 80 – 100 75 – 100
Chiefs’
averages
72.5 175
Chiefs’
range
70 – 80 150 –
200
• > 70% of the population
depends on cattle as a
livelihood source
• 96 % of the cattle
owning population
vaccinate their animals
• 83% of the cattle
already vaccinated
• Current vaccine costs
KSh 15 – 20 (USD 0.17 –
0.23) per dose in the
field and KSh 6 at
KEVEVAPI
18

Vaccine delivery constraints
19

Delivery constraints cont…
• Identified by manufacturer and
field personnel
– Government control of CBPP
vaccine delivery
– shortage of veterinary personnel
in areas where CBPP vaccination is
allowed
• Identified by field personnel
– Poor roads
– the need for refrigeration of the
vaccine 20
Photo:
Mustafa
Maalim
ILRI
2014
Photo:
Mustafa
Maalim
ILRI
2014

Results 2: Vaccine adoption by men
and women in household – gender
analysis
21

Women are remarkably more than men
The men:women ratio of 41:59, deviates
remarkably from the national 50:50.
Deviation associated with:
• More girls being born
• Polygamy with more women being
brought into community
• Men and boys migrate from
community but women rarely do
• More men than women die in conflict
22
Index mundi 2013
(male/female ratios -
Kenya)
• at birth: 1.02
• 0-14 years: 1.01
• 15-24 years: 1
• 25-54 years: 1.02
• 55-64 years: 0.82
• 65 years and over: 0.79
• total population: 1
Implication for development and policy:
Feminization of pastoralism due to male outmigration calls for
the need to actively and deliberately engage women in livestock
matters if interventions will work

Women own less cattle wealth than men
23
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Men only FGD Women only FGD
Male Headed Households
Proportion cattle owned by children
Proportion cattle owned by women
Proportion cattle owned by men
MHH FHH
Men FGD (n=5) 39.25 5.25
Women (n=6) 82 36
Household ownership of cattle (number)
Household cattle ownership distribution by gender
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Men only FGD Women only FGD
Female Headed Households
Proportion cattle owned by children
Proportion cattle owned by women
Proportion cattle owned by men

Data on men and women
interviewed in the study
• Proportion piling results:
– Women from FHH own between 21 and 32% of the cattle in
these HH less than a third
– Women from MHH own between 11 and 17% of the cattle in
male headed households (MHH) less than a fifth
24
• Study participant men owed an average of 20.8 cattle
and women an average 4.4 cattle (P<0.01)
• Most of these women are married and belong to MHH

There is minimal joint ownership of cattle
Women’s perspectives
Four out of six women-only focus groups said
that in MHH men own the cattle and there is
no joint ownership
Explanations:
• “Even when you are told that they (cattle)
belong to both of you, you soon realize that
it is a situation of nishikilie tu, which
means “hold onto this one for me” … “Men
are wealthier than women, so they own
cattle because they bought them” … “Men
own cattle, women access them but do not
make decisions – men make the final
decisions on the cattle” … “Man is the
household head so he owns and decides on
cattle.” Four women focus group
participants, Ijara
Men’s perspectives
Three out of five men-only focus
groups agreed that there was no
joint ownership on cattle in MHH.
Explanations:
• “Joint ownership ni ya mdomo
tu, meaning that “this is lip
service rendered to the
women” … “Women own
everything at night, but in the
day they own nothing – we try
to avoid being shown the back
at night.” Two male focus
group participants, Ijara
25
Only 2 % men and women
interviewed owned cattle only
jointly and 21% as both
individuals and jointly (n=109)

Time use and roles by gender
Boys and men only: Herding, vaccination,
branding, castration, hoof trimming, pasture
investigation, counting cattle
Girls and women only: Milking, selling milk,
feeding calves, fencing calf enclosure (boma),
fetching water for cattle, cleaning the main
animal enclosure (boma)
Roles by men, women, boys and girls: Removing
thorns, taking care of sick cattle, treatment,
dipping/spraying, building the boma, and
separating calves
Men spent 49% and women 28% of their time
on cattle related activities
Men spent most of this time herding and
women milking, feeding and watering calves
and sick animals
Women activities more labor intensive
men women
unaccounted time 9 6
non-livestock
activities
12 37
livestock activities 49 28
rest 4 6
sleep 26 23
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Proportion
(%)
of
time
spent
on
activity

Knowledge of clinical signs of CBPP by gender
Clinical signs of CBPP-Men FGD Clinical signs of CBPP-women FGD
• Women seemed to know more, and earlier, clinical signs of CBPP
than men
• Signs like fever and reduced milk easier for women than men to
remember because of their gender roles e.g. milking

Desirable characteristics of an ideal CBPP vaccine
according to women and men
Men FGD Women FGD
In order of frequency of mention, the most preferred
characteristics were:
• Men: efficacious and safe
• Women: safe, cheap and efficacious:

Willingness to pay for vaccine by gender
29
Key:
1-men
2-women
Bidding game contingent
valuation method
More men than women were
willing to pay sh200 and above
for a vaccine with desirable
characteristics
Women were willing to pay
significantly less Sh 174.5
/dose/year than men’s Sh 227.8
(P<0.1)
If made to women and men’s
specifications, the new vaccine
might have a high potential for
commercialization if retailed at
sh 174 or less per dose per year
Group Mean Minimum Maximum Standard
deviation
Men
(n1=60)
227.8a* 0 660 101.3
Women
(n2=49)
174.5* 40 440 86.0
All
Group
203.8a 0 660 98.0
0
.002
.004
.006
0 200 400 600 0 200 400 600
Women Men
Density
normal WTP
WTP(KSh)
Graphs by Gender

Factors affecting WTP: Linear regression
Variables Coefficient
s
Standar
d Error
Constant 113.31*** 38.94
Gender 52.77*** 17.39
Number of
children in HH
3.84 3.39
Number of adults
in HH
12.01* 7.14
Income -4.2 10-6 3.62 10-5
Joint ownership 46.01** 19.37
Alijarere 37.74 28.46
Bullaqalankala 19.75 29.31
Falama 15.30 31.02
Gedilun -103.38*** 29.60
Sangole 10.55 27.42
R2 = 0.30; Adj. R2 = 0.23; F(10,98) = 4.16***
30
A respondent’s gender significantly
(p<0.01) affects his/her WTP with
men are on average willing to pay
53 KSh more than women
Number of adults in the household
significantly (p<0.1) affects WTP
positively; more adults in a
household may generate
additional income increasing its
purchasing power
Owning cattle jointly with another
person (generally from the same
family) increased the WTP
significantly (P<0.05) by 46 KSh
Gedilun community was still
recovering from RVF outbreak

Recommendations for policy
• A thermostable, more efficacious and safer CBPP
vaccine than the current one has a great potential for
commercialization
– Men and women are willing to pay a much higher price for such a
vaccine if it is made available
• Successful delivery of the CBPP vaccine can be
accelerated by removing the current government
control
– Government control shall be rendered unnecessary once a safe and
thermostable vaccine affordable to men and women cattle owners
becomes commercially available
31

Recommendations cont…
• County government can achieve more success in CBPP vaccine
delivery by:
– improving road infrastructure
– employing veterinarians from the area – likely to be more committed to stay in the area
• Actors in livestock development (Government, NGOs, private
practitioners and communities) should include women as relevant
stakeholders in the cattle industry
– Women will be ultimate livestock managers with feminization of pastoralism
• CBPP surveillance system can be established and or strengthened by:
– including women’s reports on detection of early symptoms of the disease (disease
early warning system)
– Early detection combined with quarantine and ring vaccination in order to contain, and
prevent spread of the disease
32

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