Mapping the flow of veterinary antibiotics in Kenya.

Introduction: To effectively regulate and reduce antibiotic use, in the livestock sector, a thorough understanding of the flow of veterinary antibiotics will help to identify key nodes in the chain for targeted interventions. The aim of this study was to understand the flow of antibiotics from import to end-user, and identify relevant governance mechanisms. Methods: A mixed methods approach was used to collect data in three Kenyan counties (Nairobi, Kiambu, and Kajiado). Focus group discussions (n = 23), individual interviews (n = 148), and key informant interviews (n = 10) were conducted. Results: The key actors identified include primary wholesalers, secondary wholesalers, retailers, animal health service providers (AHSPs), and farmers. Kenya imports 100% of its veterinary antibiotics: primary wholesalers legally import antibiotics as finished pharmaceutical products (90%) or active pharmaceutical ingredients (10%) after approval by the Veterinary Medicines Directorate. Secondary wholesalers play a major role in the distribution of antibiotics (60% of antibiotics) from importers to farmers, AHSPs, and retailers. Some of the illegal sources of antibiotics include unlicenced/unauthorized middlemen and online platforms that sell directly to retailers, AHSPs, and farmers. Discussion: Despite the presence of various laws and regulations governing the antibiotic value chain, implementation has been a challenge due to financial and human resource constraints. This contributes to over-the-counter sale of antibiotics without prescription, unlicensed businesses selling antibiotics, illegal importation, and presence of poor-quality drugs. There is a need to review the applicability of existing policies and address policy gaps (e.g., product containing antibiotic combinations, and use of human critically important antibiotics) to ensure the prudent sale and use of antibiotics, pharmacovigilance, antimicrobial use surveillance, and developing a business model that aligns with antibiotic stewardship. Additional interventions include awareness raising and capacity building of the different stakeholders along the antibiotic distribution chain to reduce antibiotic mis- and overuse.

Consumer preferences and willingness to pay for safe pork products in rural Kenya.

Designing interventions to support the safe development of rapidly growing livestock value chains in sub-Saharan Africa requires a clear understanding of consumer demands. This study aimed to determine purchase patterns, consumers' preferences, and willingness to pay for safe pork attributes; specifically, the presence of a veterinary inspection stamp and the cleanliness of the butchery. A discrete choice experiment-based survey was used to investigate the purchasing behavior of 401 pork consumers: 253 buying raw pork for household consumption, and 148 buying cooked pork for out-of-home consumption. The study findings indicate that the average quantity of pork purchased by consumers was approximately 0.4 Kg per transaction, with the majority of consumers making several purchases per week. The average price per Kg of pork was KES 310 (Approx. 2.60 USD) at the time of the study. Data from the choice experiment showed that consumers were willing to pay a price premium of KES 245 (Approx. 2.1 USD) and KES 164 (Approx. 1.4 USD) per Kg for evidence of better veterinary meat inspection and higher butchery hygiene respectively; further, these were the two most important attributes they considered while making a pork purchase decision. These findings highlight the potential to leverage consumers' willingness to pay to improve the food safety within pork value chains in this context. Investing to increase consumer awareness on food safety issues should be considered to generate an effective market demand, especially in rural areas with relatively lower literacy levels.

Economics of East Coast fever: a literature review.

East Coast fever (ECF) is a cattle disease caused by a protozoan parasite called Theileria parva (T. parva). Theileria parva is transmitted among cattle by ticks. It is endemic in parts of central, eastern, and southern Africa and imposes an economic burden through illness and death of approximately a half of a billion U.S. dollars annually. This paper reviews existing science on the economics of ECF. We utilize a conceptual model that defines primary categories of economic costs due to ECF and use it to organize a synthesis of the literature on aggregate and micro level direct costs of the disease and the costs and benefits related to various ECF management strategies. We then identify knowledge gaps to motivate for future research.

Mapping, intensities and future prediction of land use/land cover dynamics using google earth engine and CA- artificial neural network model.

Mapping of land use/ land cover (LULC) dynamics has gained significant attention in the past decades. This is due to the role played by LULC change in assessing climate, various ecosystem functions, natural resource activities and livelihoods in general. In Gedaref landscape of Eastern Sudan, there is limited or no knowledge of LULC structure and size, degree of change, transition, intensity and future outlook. Therefore, the aims of the current study were to (1) evaluate LULC changes in the Gedaref state, Sudan for the past thirty years (1988-2018) using Landsat imageries and the random forest classifier, (2) determine the underlying dynamics that caused the changes in the landscape structure using intensity analysis, and (3) predict future LULC outlook for the years 2028 and 2048 using cellular automata-artificial neural network (CA-ANN). The results exhibited drastic LULC dynamics driven mainly by cropland and settlement expansions, which increased by 13.92% and 319.61%, respectively, between 1988 and 2018. In contrast, forest and grassland declined by 56.47% and 56.23%, respectively. Moreover, the study shows that the gains in cropland coverage in Gedaref state over the studied period were at the expense of grassland and forest acreage, whereas the gains in settlements partially targeted cropland. Future LULC predictions showed a slight increase in cropland area from 89.59% to 90.43% and a considerable decrease in forest area (0.47% to 0.41%) between 2018 and 2048. Our findings provide reliable information on LULC patterns in Gedaref region that could be used for designing land use and environmental conservation frameworks for monitoring crop produce and grassland condition. In addition, the result could help in managing other natural resources and mitigating landscape fragmentation and degradation.

Non-typhoidal salmonella contamination along the pork value chain in a rural East African setting: a cross-sectional study.

BACKGROUND: Non-typhoidal Salmonella (NTS) is a serious foodborne pathogen that has previously been isolated from pigs presented for slaughter in a rural pork value chain in western Kenya. METHODS: To understand varying NTS contamination along the value chain we assessed prevalence at slaughter, transport and retail. Suspect isolates from culture were confirmed using matrix-assisted laser desorption-ionization time of flight mass spectrometry. RESULTS: Prevalence on pig carcasses, meat transportation containers, retailed raw and cooked pork and accompanying side salads was 18.1%, 23.9%, 28.0%, 1.9% and 8.6%, respectively. CONCLUSION: NTS contamination is propagated along the pork value chain in rural western Kenya, demonstrating the need for improved hygiene measures to prevent human exposure.

Antimicrobial Use by Peri-Urban Poultry Smallholders of Kajiado and Machakos Counties in Kenya.

Antimicrobial use (AMU) is a major driver of antimicrobial resistance (AMR). An understanding of current practices can lead to better targeting of AMU-reducing interventions. An analysis of the distribution and current usage of veterinary drugs in peri-urban smallholder poultry systems in Kenya was undertaken. A survey among poultry farmers and key informant interviews with agrovet operators and other players in the value chain was conducted in Machakos and Kajiado counties. Interview data were analyzed using descriptive and thematic approaches. A total of 100 farmers were interviewed. The majority (58%) were > 50 years old, and all kept chickens, while 66% kept other livestock. Antibiotics constituted 43% of the drugs reportedly used on the farms (n = 706). These were mostly administered by the farmers themselves (86%) through water (98%). Leftover drugs were stored for later use (89%) or disposed of (11%). Incineration was the main method for the disposal of leftover drugs and empty containers. As described by the key informants (n = 17), the drug distribution chain relied on agrovet shops that were supplied by local distributors and pharmaceutical companies, which, in turn, supplied drugs to the farmers. Farmers reportedly purchased drugs without prescriptions and rarely observed the withdrawal periods. Drug quality was a concern, especially for products requiring reconstitution.

Assessment of community perceptions and risk to common zoonotic diseases among communities living at the human-livestock-wildlife interface in Nakuru West, Kenya: A participatory epidemiology approach.

BACKGROUND: Zoonoses account for most of the emerging and re-emerging infections in Kenya and in other low to medium-income countries across the world. The human-livestock-wildlife interface provides a nexus where transmission and spread of these zoonotic diseases could occur among communities farming in these areas. We sought to identify perceptions of the community living near the Lake Nakuru National Park in Kenya. METHODS: We used participatory epidemiology techniques (PE) involving Focus Group Discussion (FGD) among community members and Key Informant Interviews (KII) with the health, veterinary, and administration officers in July 2020. We used listing, pairwise matching, and proportional piling techniques during the FGDs in the randomly selected villages in the study area from a list of villages provided by the area government officers. Kruskal-Wallis test was used to compare the median scores between the zoonotic diseases, source of information, and response to disease occurrence. Medians with a z-score greater than 1.96 at 95% Confidence Level were considered to be significant. Content analysis was used to rank qualitative variables. RESULTS: We conducted seven FGDs and four KIIs. A total of 89 participants took part in the FGDs with their ages ranging from 26 to 85 years. Common zoonotic diseases identified by participants included anthrax, rabies, and brucellosis. Anthrax was considered to have the greatest impact by the participants (median = 4, z>1.96), while 4/7 (57%) of the FGDs identified consumption of uninspected meat as a way that people can get infected with zoonotic diseases. Community Health Volunteers (Median = 28, z = 2.13) and the government veterinary officer (median = 7, z = 1.8) were the preferred sources of information during disease outbreaks. CONCLUSION: The participants knew the zoonotic diseases common in the area and how the diseases can be acquired. We recommend increased involvement of the community in epidemio-surveillance of zoonotic diseases at the human-wildlife-livestock interface.

Prevalence of gross lesions and handling practices in pigs and their association with pork quality, Kiambu, Kenya.

Pre-slaughter handling of pigs has been documented to affect the quality of meat though no studies have investigated this relationship in the Kenyan context. This study aimed to determine the prevalence of gross lesions and practices related to sub-optimal welfare in pigs presented for slaughter while analyzing the relationship between occurrence of these lesions and meat quality. A cross-sectional study was conducted at a medium scale, non-integrated pig abattoir supplying to the Nairobi market, with a capacity to slaughter approximately 40 pigs a day. Data on welfare-associated lesions and handling practices were obtained from 529 pig carcasses and traders respectively. 387 pork samples were collected, and their quality evaluated by measuring their pH, meat color and drip loss. These three parameters were used to classify pork into four recognized categories namely: Red, Firm, Non-exudative (RFN), Pale Soft Exudative (PSE), Dark Firm Dry (DFD) and Red Soft Exudative (RSE). Almost all pigs were inefficiently stunned as evidenced by the presence of consciousness post-stunning. The majority of pigs (82.97%) having one or more welfare-associated gross lesions. Other animal welfare malpractices observed were high loading density and inadequate rest periods between transport and slaughter. A quarter of the pork samples were of sub-optimal quality including: RSE (11.36%), PSE (2.58%) and DFD (2.58%). Multinomial logistic regression revealed that pork originating from pigs transported at a high loading density had increased odds of being classified as DFD (OR 13.41, 95% CI 2.59-69.46). The findings indicate the need to educate stakeholders in the pork value chains on improved pig handling before and during slaughter to enhance pig welfare pre-slaughter and pork quality post-slaughter. Animal welfare legislation enforcement and implementation was observed to be insufficient. There is a need to educate key stakeholders on its importance of being put into practice both from economic and welfare perspectives.

Assessment of Milk Quality and Food Safety Challenges in the Complex Nairobi Dairy Value Chain.

Food networks present varying food safety concerns because of the complexity of interactions, production, and handling practices. We investigated total bacteria counts (TBCs) and total coliform counts (TCCs) in various nodes of a Nairobi dairy value chain and identified practices that influence food safety. A value chain analysis framework facilitated qualitative data collection through 23 key informant interviews and 20 focus group discussions. Content thematic analysis identified food safety challenges. Cow milk products (N = 290) were collected from farms (N = 63), collection centers (N = 5), shops/kiosks (N = 37), milk bars (N = 17), roadside vendors (N = 14), restaurants (N = 3), milk vending machines (N = 2), mobile traders (N = 2) and a supermarket (N = 1). Mean values of colony-forming units for TBC and TCC were referenced to East African Standards (EAS). Logistic regression analysis assessed differences in milk acceptability based on EAS. The raw milk from farms and collection centers was relatively within acceptable EAS limits in terms of TBC (3.5 × 105 and 1.4 × 106 respectively) but TCC in the milk from farms was 3 times higher than EAS limits (1.5 × 105). Compared to farms, the odds ratio of milk acceptability based on TBC was lower on milk bars (0.02), restaurants (0.02), roadside vendors (0.03), shops/kiosks (0.07), and supermarkets (0.17). For TCC, the odds that milk samples from collection centers, milk bars, restaurants, roadside vendors, and shops/kiosks were acceptable was less than the odds of samples collected from farms (0.18, 0.03, 0.06, 0.02, and 0.12, respectively). Comparison of raw milk across the nodes showed that the odds of milk samples from restaurants, roadside vendors, and shops/kiosks being acceptable were less than the odds of samples collected the farm for TBC (0.03, 0.04, and 0.04, respectively). For TCC, the odds of raw milk from collection centers, restaurants, roadside vendors, milk bars, and shops/kiosks being acceptable were lower than the odds of acceptability for the farm samples (0.18, 0.12, 0.02, 0.04, and 0.05, respectively). Practices with possible influence on milk bacterial quality included muddy cowsheds, unconventional animal feed sources, re-use of spoilt raw milk, milk adulteration, acceptance of low-quality milk for processing, and lack of cold chain. Therefore, milk contamination occurs at various points, and the designing of interventions should focus on every node.

Developing and validating a rapid assessment tool for small ruminant reproduction and production in pastoralist flocks in Kajiado, Kenya.

The collection of production performance data in small ruminants pastoralists flocks is essential to evaluate their efficiency and assess how different challenges, such as diseases, droughts or changes in land use, affect their sustainability. Although different methodologies exist, capturing these data is difficult, particularly in nomadic pastoral flocks. In this study, a method for rapid assessment of flock production performance based on farmer recall was designed, implemented and tested. Through literature review and consultation with pastoralists and key informants, a questionnaire was developed to capture small ruminant flock data disaggregated by age (≤2 years old and >2 years old), species and sex. Data on flock dynamics and on reproduction parameters were collected for a period of 12 months. A survey of 130 pastoralists with medium to large flocks was then conducted in Kajiado County (Kenya). Values were calculated for 12 reproduction performance indicators and 7 additional production performance indicators. In addition, a flock efficiency indicator (FEI) is proposed that classifies mixed flocks (i.e., with sheep and goats) into low, medium or high efficiency. Results showed that in flocks with low efficiency, the median value for net fecundity rate was 0.43 lambs/ewe (range 0.08-1.00) and 0.41 kids/doe (range 0.07-0.73), and the median production rate was 6% (range [-47%] to 20%) for sheep and 11% (range [-38%] to 0.21%) for goats. In flocks with high efficiency the median net fecundity rate was 0.77 lambs/ewe (range 0.48-2.73) and 0.88 kids/doe (range 0.49-1.80), and the median production rate was 25% (range 11-47) for sheep and 28% (range 15-46) for goats. Sixty-two (47.7%) of the pastoralists surveyed reported usually buying animals into their flocks, and, consequently were considered as 'pastoralists and traders'. Their flocks had significantly lower FEI scores (median = 7.5, interquartile range [IQR] 6-9), compared with "pastoralists only" flocks (median = 8, IQR 6-10, Kruskal-Wallis rank sum test, p-value <0.001). Since this method is based on pastoralist recall, values obtained should be considered as approximations. Nonetheless, the proposed assessment tool can be used by individuals with low resources or recording capacity, and in large scale programmes to monitor pastoralist flock dynamics, set-up benchmarking programmes, estimate the impact of diseases and shocks, identify those flocks which are most vulnerable to these shocks and evaluate the effectiveness of policies and interventions on herd performance.

Understanding what shapes disease control: An historical analysis of foot-and-mouth disease in Kenya.

Interpreting the interplay between politics, social demographics and epidemiology is essential for understanding how a disease's occurrence and control evolve over time. Foot-and-mouth disease (FMD) virus was first detected in Kenya in 1915 and serotyped in 1932. This review aims to describe and appraise initiatives to control FMD in Kenya since its independence from British rule in 1964, using information from the scientific literature. We describe the historical dynamics of FMD epidemiology in the country and determine socio-political factors that have shaped the control strategies used. PubMed, Scopus, CAB abstracts, Science Direct, Web of Science and Google Scholar were used to search and retrieve papers, using predetermined search criteria encompassing FMD, Kenya and disease control programme descriptors. In total 1234 papers were identified and screened for relevance using the World Health Organization's guidelines for rapid review. Ultimately 69 references from this search were included, and information extracted and consolidated. These papers highlight that following independence, there was a structured effort to control FMD consisting of a compulsory subsidised vaccination programme in the Rift Valley with movement controls and quarantine when outbreaks occurred. This programme led to an initial decrease in recorded FMD outbreaks. However, endemic circulation continued and this programme was discontinued due to multiple factors, including political deprioritisation and changes in the structure of veterinary services. Only low levels of active surveillance have been applied since 1964; most surveillance is passive and relies on outbreak reports. Currently control focuses on outbreak management and a mixture of public- and privately-funded vaccination. This review highlights critical drivers influencing disease control programme implementation including veterinary service structure, the active participation of stakeholders with farming systems and availability of affordable and matched FMD vaccine. Additionally, it appraises the availability of historical information and draws attention to gaps in the historical record.

Analysis of the benefits and production challenges of working donkeys in smallholder farming systems in Kenya.

AIM: The aim of the study was to determine the benefits of keeping donkeys and associated production challenges under a smallholder farming system in Kenya. MATERIALS AND METHODS: A descriptive study was conducted with smallholder farmers keeping donkeys in 13 administrative locations in Kirinyaga County. Data were collected using a questionnaire guide in 13 focus group discussions (FGDs) using participatory epidemiological methods. The FGDs comprised 8-12 participants who were donkey owners. Data were collected through listing, pair-wise ranking, and probing on the benefits of keeping donkeys, challenges faced by working donkeys and the common diseases that affect donkeys in these farms. Data analysis was performed using Kruskal-Wallis non-parametric method to test whether median ranks were significantly different. Other farm level data were also collected using the structured questionnaire and these were analyzed using descriptive statistical methods. RESULTS: The identified benefits included income obtained from the use of donkeys in transportation (Z=5.80) and manure production (Z=3.47), which enabled the farmers to participate in trade activities and improve crop farming. The identified challenges included theft for slaughter (Z=5.99), disease incidence (Z=3.03), road accidents (Z=2.83), and malicious cutting (Z=2.32). Some of the diseases identified were tetanus (Z=5.35), hoof problems (Z=4.55), helminthiases (Z=3.10), and mange (Z=2.24). Participants ranked diseases based on their effects on work output for the donkeys, reducing productivity and often causing death. Addressing these production challenges would optimize donkey use among smallholder farmers. CONCLUSION: The results presented can be important for policymakers and extension agents regarding the health and welfare of donkeys kept under similar settings.

Assessment of Phenotypic Characteristics and Work Suitability for Working Donkeys in the Central Highlands in Kenya.

The study aimed to assess the phenotypic characteristics of donkeys and their suitability for work. Data were collected on age, sex, coat color, height at withers, body length, and heart girth from 360 randomly sampled donkeys raised in a highland agroecological system in Kenya between the months of June and September 2018. Data were analyzed using descriptive statistics and ANOVA with the sex of the donkey and age group treated as sources of variation. The weight of donkeys was estimated using a formulae incorporating body length and heart girth. The study reveals that the average weight of the working donkey in the central highlands of Kenya was 155.5 kgs ± SE 1.71. Their height at withers was 99.7 cm ± SEM 0.50, with a heart girth of 113.7 cm ± SEM 0.43 and a body length of 113.2 cm ± SEM 0.58. All these body measurements varied significantly by sex and age group (P < 0.001). Therefore, donkeys raised in Kenya had the same height but heavier, with longer body lengths and heart girth measurements when compared to other domesticated working donkeys in different parts of the world indicating genetic diversity, differences in ecogeographical conditions and husbandry practices. The majority (86%) of the donkeys were in good welfare conditions with moderate to ideal 86% body condition scores, minimal body lesions 5%, and lameness 18%. The results are useful for extension agents and donkey users when estimating optimal pack or cart loads in line with their welfare. The findings provide opportunities for future research on the reasons for phenotypic diversity between donkeys raised in Kenya and other parts of the world.

Risk factors for the incursion, spread and persistence of the foot and mouth disease virus in Eastern Rwanda.

BACKGROUND: Identification of risk factors is crucial in Foot-and-mouth disease (FMD) control especially in endemic countries. In Rwanda, almost all outbreaks of Foot-and-Mouth Disease Virus (FMDV) have started in Eastern Rwanda. Identifying the risk factors in this area will support government control efforts. This study was carried out to identify and map different risk factors for the incursion, spread and persistence of FMDV in Eastern Rwanda. Questionnaires were administered during farm visits to establish risk factors for FMD outbreaks. Descriptive statistical measures were determined and odds ratios were calculated to determine the effects of risk factors on the occurrence of FMD. Quantum Geographic Information System (QGIS) was used to produce thematic maps on the proportion of putative risk factors for FMD per village. RESULTS: Based on farmers' perceptions, 85.31% (with p < 0.01) experienced more outbreaks during the major dry season, a finding consistent with other reports in other parts of the world. Univariate analysis revealed that mixed farming (OR = 1.501, p = 0.163, CI = 95%), and natural breeding method (OR = 1.626; p = 0.21, CI = 95%) were associated with the occurrence of FMD indicating that the two risk factors could be responsible for FMD outbreaks in the farms. The occurrence of FMD in the farms was found to be significantly associated with lack of vaccination of calves younger than 12 months in herds (OR = 0.707; p = 0.046, CI = 95%). CONCLUSIONS: This is the first study to describe risk factors for persistence of FMDV in livestock systems in Rwanda. However, further studies are required to understand the role of transboundary animal movements and genotypic profiles of circulating FMDV in farming systems in Rwanda.

Risk Factors for Outbreaks of Lumpy Skin Disease and the Economic Impact in Cattle Farms of Nakuru County, Kenya.

Lumpy Skin Disease (LSD) is an emerging disease of cattle that causes substantial economic loss to affected regions. However, factors favouring transmission under field conditions and farm-level impacts are poorly quantified. This was a retrospective case-control study of cattle farms in Nakuru, Kenya to determine risk factors associated with lumpy skin disease and the farm-level economic impacts of an outbreak. Data were collected using questionnaires administered through personal interview. Collected data included herd sizes, age, and sex structures, breeds, sources of replacement stock, grazing systems, and costs (direct and indirect) incurred when LSD outbreaks occurred. Farm-level risk factors were examined through univariable and multivariable logistic regression and a final model built using backward stepwise regression and likelihood ratio tests. The factors associated with LSD outbreaks on univariable analysis included breed (exotic vs. indigenous, OR = 15.01, P = 0.007), source of replacement stock (outside the herd vs. within the herd, OR = 8.38, P < 0.001) and herd size (large [>10 cattle] vs. small [1-3 cattle], OR = 3.51, P = 0.029). In the multivariable logistic regression model, only breed (exotic vs. indigenous, OR = 14.87, 95% CI 1.94-113.97, P = 0.009) and source of replacement stock (outside the herd vs. within the herd OR = 8.7, 95% CI 2.80-27.0, P < 0.001) were associated with outbreaks. The economic impact was compared between farms keeping purely indigenous (n = 10) or exotic (n = 29) breeds of cattle which indicated mean farm-level losses of 12,431 KSH/123 USD and 76,297 KSH/755 USD, respectively. The mean farm-level losses from reduction in milk yield and mortality were estimated at 4,725 KSH/97 USD and 3,103 KSH/31USD for farms keeping indigenous breeds whilst for farms keeping exotic breeds the equivalent losses were 26,886 KSH/266 USD and 43,557 KSH/431 USD, respectively. The indirect losses from treatments and vaccinations were proportionately much higher on farms with indigenous breeds at 4,603 KSH/46 USD making up ~37% of the total costs compared to ~8% (5,855 KSH/58 USD per farm) of the total costs for farms with exotic breeds. These findings indicate that LSD caused significant economic losses at the farm level in Nakuru County. This justifies implementation of disease control measures including quarantine of cattle post-purchase and the need for effective vaccinations of susceptible cattle herds.

Investigation of the governance structure of the Nairobi dairy value chain and its influence on food safety.

The dairy value chain of Nairobi is comprised, in its majority, of small-scale independent enterprises that operate within a complex interlinked system. In this complexity, the coordination and power structures of the system may have major influences on the management of dairy food safety. Therefore, the aim of this study was to investigate the governance structure and challenges faced by stakeholders throughout the Nairobi dairy value chain and assess their potential implications on food safety. Qualitative data were collected through focus group discussions and key informant interviews based on a dairy value chain mapping framework previously developed. Thematic analysis enabled identification of governance themes, key challenges and analysis of their implications on food safety. Themes were organized depending on their association with farmers (informal settlement or peri-urban), dairy cooperatives, dairy traders, processing companies, retailers or government officers. The identified governance themes included: i) weak linkage between government and farmers, ii) inadequate compliance with government regulations by traders and retailers, iii) emphasis on business licenses and permits for revenue rather than for food safety, iv) multiple licensing resulting in high business cost and lack of compliance, v) fragmented regulation, vi) unfair competition and vii) sanctions that do not always result in compliance. The key challenges identified included, among others: i) inadequate farmer support, ii) harassment of traders and retailers and iii) high business costs for traders, retailers, dairy cooperatives and large processors. The implication of governance and challenges of food safety were, among others: i) inadequate extension services, ii) insufficient cold chain, iii) delivery of adulterated and low milk quality to bulking centers, iv) inadequate food safety training and v) lack of policies for management of waste milk. The range of issues highlighted are based on stakeholders' perceptions and reflects the complexity of the relationships between them. Many of the governance themes demonstrate the linkages that are both beneficial or confrontational between the formal and informal sectors, and between industry and regulatory authorities, with possible direct food safety consequences. Findings obtained provide indications to decision-makers of potential governance areas that could help improve efficiency and food safety along the dairy value chain.

Assessment of structure and performance of cattle markets in western Kenya.

Cattle markets play a major role in economic empowerment among cattle-keeping communities in developing countries. The objective of this study was to assess the structure and performance of selected cattle markets in western Kenya. Data was collected using a semi-structured questionnaire administered to livestock traders who visited markets and by conducting focus group interviews. Data was collected on availability of market information, price setting behavior, marketing costs, practices of traders on livestock movements, sources of working capital, and characteristic of respondents. A total of 252 questionnaires and six focus group discussions were conducted for the study. Cattle market concentration indices were analyzed by calculation of Gini coefficient and plotting of Lorenz curves. Additionally, gross marketing margins were calculated to evaluate market performance. The results from this study showed a positive marketing margin in study markets for all cattle categories, the relatively high Gini coefficient of 0.65, and Lorenz curves revealing that in some markets 20% of traders control about 48% of the market share which is an indication of high market concentration. The high Gini coefficient and positive marketing margin obtained imply that study markets were highly concentrated but profitable which is an indication of inequality in the markets. The main barriers to entry in these livestock markets included lack of adequate market information, high operational capital requirements, and high costs of transporting animals. In conclusion, cattle marketing within western Kenya is profitable. However, the high concentration index in markets and presence of entry barriers including lack of flow of information on sources of livestock for trade, mechanism of price setting within markets' high capital outlay, may encourage poor trade practices which may compromise biosecurity standards within markets, and hence necessitating increased risk for spread of livestock diseases and even zoonoses to connected farms and systems.

Management and cost of snakebite injuries at a teaching and referral hospital in Western Kenya.

Background: Data on the cost of snakebite injuries may inform key pillars of universal health coverage including proper planning, allocation, and utility of resources. This study evaluated the injuries, management, and costs resulting from snakebites at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kenya.  Methods: In total, medical records of 127 snakebite victims attending JOOTRH between January 2011 and December 2016 were purposely selected and data on the age, gender, type of residence (urban or rural), part of the body bitten, time of bite, injuries, pre-hospital first aid, time to hospital, length of stay, treatment, and costs were collected. Regression analysis was used to predict the total indirect cost of snakebite injuries and p≤ 0.05 was considered significant. Mortality and loss of income of hospitalized victims were considered as direct costs. Results: It was found that 43 victims were 13-24 years of age, 64 were female, 94 were from rural areas, 92 were bitten on the lower limbs, 49 were bitten between 6.00 pm and midnight, 43 attempted pre-hospital first aid, and the median time to hospital was 4.5 hours. Antivenom, supportive therapy, antibiotics, antihistamines, corticosteroids, analgesics, and non-steroidal anti-inflammatory drugs were used. Cellulitis, compartment syndrome, gangrenous foot, psychiatric disorder, and death were the main complications. Most victims spent 1-5 days in hospital and the median cost of treating a snakebite was 2652 KES (~$26). Drugs, ward charges, and nursing procedures were the highest contributors to the total indirect cost. Victims hospitalized for 6-10 days and >10 days incurred 32% and 62% more costs, respectively, compared to those hospitalized for 1-5 days.  Conclusions: The longer snakebite victims are hospitalized, the higher the cost incurred. Continuous medical education on the correct management of snakebites should be encouraged to minimize complications that may increase hospital stays and costs incurred.

Knowledge of pastoralists on livestock diseases and exposure assessment to brucellosis within rural and peri-urban areas in Kajiado, Kenya.

Background: Livestock diseases impact the livelihoods of pastoralists. Brucellosis, a neglected zoonotic disease is highly prevalent in this system with an estimated 16% of livestock population in sub-Saharan Africa infected with the disease. The objective of this study was to assess knowledge of livestock diseases and the risk of exposure to brucellosis among pastoralists living in Kajiado County of Kenya. Methods: The study sites included pastoralist communities living in rural and peri-urban areas within the County. Both primary and secondary data were collected using participatory methods including pairwise ranking, proportional piling and probing and a review of the published literature. Exposure risk assessment was conducted according to the CODEX Alimentarius framework: Hazard identification, hazard characterization, exposure assessment and risk estimation. Results: According to pastoralists, livestock diseases that frequently occurred in their flocks and herds were contagious caprine pleuropneumonia, lumpy skin disease and foot and mouth disease; but zoonoses, including anthrax and brucellosis, were also mentioned during focus group discussions. Potential pathways of exposure to brucellosis and other zoonoses included consumption of unpasteurized milk, handling infected aborted materials without protective measures and consumption of raw meat and raw blood. Consumption of unpasteurized milk and handling infected aborted materials without protectives were linked with high risk of exposure to household members living in rural areas, with the risk level within the peri-urban areas ranked very low to low for most of these risk practices. Conclusions: The results call for enhanced public education targeting vulnerable groups to mitigate risks of disease spread and other impacts of brucellosis within the affected pastoralist production systems.

Acute Poisonings at a Regional Referral Hospital in Western Kenya.

The emergency department (ED) of the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) handles many cases of poisoning. However, there is scant information on the factors, agents, and outcomes of poisoning at the hospital. The aim of this work was to determine the factors, agents, and outcomes of poisoning at JOOTRH. Records of patients who presented to JOOTRH with symptoms of poisoning between January 2011 and December 2016 were retrieved. Data on age, gender, offending agents, time, and season of exposure were collected. Information on the route of exposure, motive, and clinical symptoms of poisoning was also included. Other information included the laboratory evaluation, first aid measures, period of hospitalization, and outcome of poisoning. Mean, standard deviation, frequencies and bar graphs were used to describe the demographic factors of the study population. Multivariate logistic regression was used to determine the strength of association between risk factors and outcome of poisoning among patients. The level of significance for inferential analysis was set at 5%. There were 385 cases of poisoning: 57.9% (223/385) were male, 31.9% (123/385) were 13⁻24 years of age, and 83.9% (323/385) of exposures were in Kisumu County. The peak time of exposure was 6:00⁻00:00, and 23.6% (91/385) presented 1⁻4 h after exposure. About 62.9% (242/385) of the cases were due to accidental poisoning. Snakebites and organophosphates (OPPs) contributed to 33.0% (127/385) and 22.1% (85/385) of all cases, respectively. About 62.1% (239/385) of exposures were oral, and 63.9% (246/385) of all cases occurred in the rainy season. Additionally, 49.2% (60/122) of intentional poisoning was due to family disputes, and 16.1% (10/62) of pre-hospital first aid involved the use of tourniquets and herbal medicine. About 28.6% (110/385) of the victims were subjected to laboratory evaluation and 83.9% (323/385) were hospitalized for between 1⁻5 days. Other results indicated that 80.0% (308/385) responded well to therapy, while 7.3% (28/385) died, 68% (19/28) of whom were male. Furthermore, 39.3% (11/28) of the deaths were related to OPPs. Our findings suggest that the earlier the victims of poisoning get to the hospital, the more likely they are to survive after treatment is initiated. Similarly, victims of poisoning due to parental negligence are more likely to survive after treatment compared to other causes of poisoning, including family disputes, love affairs, snakebites, and psychiatric disorders. The management of JOOTRH should consider allocating resources to support the development of poison management and control.