Presented by Kang'ethe, E., Nyangaga, J. and Grace, D. at the PENAPH First Technical Workshop, Chiangmai, Thailand, 11 – 13 December 2012.

1. Participatory planning, implementation
and evaluation of a zoonosis control
project in Kenya
Erastus Kang’ethe, Julius Nyangaga, Fred Unger and Delia Grace
PENAPH First Technical Workshop, Chiangmai, Thailand, 11-13
December 2012

2. Presentation outline
•Objective
•Methods
• Cross-sectional surveys
• Outcome mapping
•Findings
• Prevalence and risk factor studies
• Development of messages
• Participatory impact assessment
•Conclusion

3. Background
•Cryptosporidiosis an important emerging disease worldwide
•Many species of Cryptosporidium but 2 account for most
infections in people: non-zoonotic C. hominis and zoonotic C.
parvum.
•Ruminants are the most important non-human reservoir for
zonotic C. parvum
•A major risk factor for human zoonotic disease is contact with
cattle or their feces.
•In cattle, 4 species of Cryptosporidium are found: zoonotic C.
parvum and non-zoonotic C. bovis, C. andersoni, and C. ryanae.
•Cryptosporidiosis is especially important in dairy calves up to 30
days of age.Other risk factors for increased shedding include
husbandry and hygiene practices.

4. Background:
Milk very popular in Nairobi.
Most produced from peri-urban dairies.
Concern over health risks.

5. Objective
A trans-disciplinary process of co-generating,
sharing and evaluating evidence-based
messages for reducing the risk from
cryptosporidiosis and other zoonoses in an
urban and peri-urban community in Nairobi

6. Methods
Cross sectional survey of prevalence & risk
factors
•Cattle-owners
•Non-cattle keeping neigbours
•Cattle
•People living with HIV
Outcome mapping or research into use
•Defining boundary & strategic partners
•Identifying “Outcome Challenge”, markers and strategies
•Measuring progress

7. Findings: prevalence and risk factors
Prevalence
•Dairy households ~ 4%
•Non-dairy neighbours ~ 5%
•People with HIV 4.5%
•Cattle ~13%
Discussion
•Dairy not a prima facie risk
•Having HIV not necessarily leading to increased risk

8. Findings: Risk factors allow evidence based messages
Prevalence
•Dairy households ~ 4%
•Non-dairy neighbours ~ 5%
•People with HIV 4.5%
•Cattle ~13%
Discussion
•Dairy not a prima facie risk
•Having HIV not necessarily leading to increased risk

9. Messages 1: Television show
“By peppering the drama-infused lives of its
characters with demonstrations of agricultural
practices, trips to the doctor for tuberculosis tests,
and Kenyan history, Makutano Junction serves to
both entertain and provide reliable information for
families throughout sub-Saharan Africa. This is soap
opera drama that people can actually relate to—and
learn from.”

10. Messages 2: Cartoons

11. Messages 3: Crypto – campaigners
• Resource people, selected by their communities, received special training to
help them share information.
• A brochure was developed with detailed information about zoonoses
transmission, vulnerability, knowledge, practices, economic contribution of
urban dairying to households and mitigation measures.
• The brochure was given to the resource people for use while educating the
communities on cryptosporidiosis prevention.
• Knowing is not enough.
• Many conventional public health programs are based on the mistaken
assumption that people will change their behaviour if informed of the health
benefits of so doing.
• We found basing messages on social norms, such as the wish to appear a
good parent or to avoid a practice that evokes disgust, are more effective at
changing behaviour

12. Participatory Impact Assessment

13. Conclusions 1 – Assessing risk of Crypto
• First reported study to simultaneously survey livestock,
livestock keepers and their non-livestock-keeping neighbours
for cryptosporidiosis.
• We found no difference between cattle keeping and non-
cattle-keeping, no overall association between infections in
cattle and people; the prevalence in people living with HIV
was no higher than in the general community.
• Taken together, these suggest no evidence that zoonotic
cryptosporidiosis is not important overall in this community.

14. Conclusions 2 – better managing zoonoses in urban settings
• Key elements of the approach were: identifying groups within
the community adjusting messages to norms and values of
that group; an emphasis on evidence-based messages
developed in and with the community rather than generic
health and hygiene advice; use of social incentives (such as
the desire to be seen as a good parent); using multiple
channels (including television); and active involvement of
community and policymakers in the development and
dissemination of messages.
• This offers a model for improving health extension for
zoonoses management, which can be further developed and
evaluated.

15. International Livestock Research Institute www.ilri.org