Awareness and attitudes towards anthrax and meat consumption practices among affected communities in Zambia: A mixed methods approach.

BACKGROUND: In Zambia, human anthrax cases often occur following cases of animal anthrax. Human behaviour has been implicated in this transmission. The objective of the study was to explore human behavioural patterns that may contribute to outbreaks of anthrax among affected communities. METHODS: A mixed methods study was conducted in four districts of Zambia from November 2015 to February 2016. A cross sectional survey involving 1,127 respondents, six focus group discussions and seven key informant interviews with professional staff were conducted. Descriptive statistics on socio-demographic characteristics, awareness of anthrax, attitudes towards cattle vaccination and risk factors for anthrax and vaccination practices were run using STATA 12 for analysis. RESULTS: Overall, 88% of respondents heard about anthrax, 85.1% were aware that anthrax is transmitted by eating infected meat and 64.2% knew that animals and humans can be infected with anthrax. However, qualitative data suggested that awareness of anthrax varied across communities. Qualitative findings also indicated that, in Western and Muchinga provinces, human anthrax was transmitted by eating infected beef and hippo (Hippopotamus amphibious) meat, respectively. Although survey data indicated that 62.2% of respondents vaccinated their animals, qualitative interviews and annual vaccination reports indicated low vaccination rates, which were attributed to inadequate veterinary service provision and logistical challenges. While 82% of respondents indicated that they reported animal deaths to veterinary officers, only 13.5% of respondents buried infected carcasses. Majority (78.1%) of respondents either ate, sold or shared meat from dead animals with other community members. Poverty, lack of access to meat protein and economic reasons were cited as drivers for consuming infected meat. CONCLUSIONS: Health education campaigns must be intensified to reduce the risk of human exposure. Veterinary extension services should be strengthened and cold chain facilities decentralized in order to improve accessibility to anthrax vaccine. It is also important to involve the affected communities and collaborate with other disciplines in order to effectively tackle poverty, improve veterinary services and address inherent meat consumption practices within the communities.

Primary school children's perspectives on common diseases and medicines used: implications for school healthcare programmes and priority setting in Uganda.

BACKGROUND: Existing school health programmes in Uganda target children above five years for de-worming, oral hygiene and frequent vaccination of girls of reproductive age. OBJECTIVE: To assess primary school children's perspectives on common diseases they experience and medicines used in order to suggest reforms for school healthcare programmes and priority setting. METHODS: Rapid appraisal approaches, triangulated with a survey, using a semi-structured questionnaire with 80 children aged 8-15 years, were used in data collection. This was done during a three months fieldwork in one primary boarding school in Kampala. An investigation was made into perspectives of children on their recent illness experiences and medicines they used to recover. Other techniques in data collection included participant observation and eliciting children's narratives of diseases they experienced in a two weeks recall. Key informants, who included school teachers, a nurse, 2 paediatricians, 4 matrons and private health service providers in the vicinity of the school, were approached to validate children's narratives. RESULTS: Children named and ranked malaria as the most severe and frequently experienced disease. Other diseases mentioned included diarrhoea, skin fungal infections, flu, and typhoid. The symptoms children recognised in case of illness were high body temperature, vomiting, headache, weakness, appetite loss and diarrhoea. Children were either given medicines by the school nurse or they self-medicated using pharmaceuticals including chloroquine, panadol, flagyl, fansidar, quinine injections, capsules (amoxicillin and ampicillin) obtained from the clinics, drug shops, pharmacies, and other unspecified indigenous medicines from their home and markets. CONCLUSION: The healthcare needs and priorities of children in primary school are infectious diseases which they could readily identify.