Effect of Phone Text Message Reminders on Compliance with Rabies Post-Exposure Prophylaxis following Dog Bites in Rural Kenya.

The prompt administration of post-exposure prophylaxis (PEP) is one of the key strategies for ending human deaths from rabies. A delay in seeking the first dose of rabies PEP, or failure to complete the recommended dosage, may result in clinical rabies and death. We assessed the efficacy of short message system (SMS) phone texts in improving the adherence to scheduled PEP doses among bite patients in rural eastern Kenya. We conducted a single-arm, before-after field trial that compared adherence among bite patients presenting at Makueni Referral Hospital between October and December 2018 (control) and between January and March 2019 (intervention). Data on their demographics, socio-economic status, circumstances surrounding the bite, and expenditures related to the bite were collected. A total of 186 bite patients were enrolled, with 82 (44%) in the intervention group, and 104 (56%) in the control group. The odds of PEP completion were three times (OR 3.37, 95% CI 1.28, 10.20) more likely among patients who received the SMS reminder, compared to the control. The intervention group had better compliance on the scheduled doses 2 to 5, with a mean deviation of 0.18 days compared to 0.79 days for the control group (p = 0.004). The main reasons for non-compliance included lack of funds (30%), and forgetfulness (23%) on days for follow-up treatment, among others. Nearly all (96%, n = 179) the bite patients incurred indirect transport costs, at an average of USD 4 (USD 0-45) per visit. This study suggests that the integration of SMS reminders into healthcare service delivery increases compliance with PEP, and may strengthen rabies control and elimination strategies.

Utilizing milk from pooling facilities as a novel approach for foot-and-mouth disease surveillance.

This study investigated the potential of pooled milk as an alternative sample type for foot-and-mouth disease (FMD) surveillance. Real-time RT-PCR (rRT-PCR) results of pooled milk samples collected weekly from five pooling facilities in Nakuru County, Kenya, were compared with half-month reports of household-level incidence of FMD. These periodic cross-sectional surveys of smallholder farmers were powered to detect a threshold household-level FMD incidence of 2.5% and collected information on trends in milk production and sales. FMD virus (FMDV) RNA was detected in 9/219 milk samples, and using a type-specific rRT-PCR, serotype SAT 1 was identified in 3/9 of these positive samples, concurrent with confirmed outbreaks in the study area. Four milk samples were FMDV RNA-positive during the half-months when at least one farmer reported FMD; that is, the household-level clinical incidence was above a threshold of 2.5%. Additionally, some milk samples were FMDV RNA-positive when there were no reports of FMD by farmers. These results indicate that the pooled milk surveillance system can detect FMD household-level incidence at a 2.5% threshold when up to 26% of farmers contributed milk to pooling facilities, but perhaps even at lower levels of infection (i.e., below 2.5%), or when conventional disease reporting systems fail. Further studies are required to establish a more precise correlation with estimates of household-level clinical incidence, to fully evaluate the reliability of this approach. However, this pilot study highlights the potential use of this non-invasive, routinely collected, cost-effective surveillance tool, to address some of the existing limitations of traditional surveillance methods.

Efficacy of Sulphachloropyrazine, Amprolium Hydrochloride, Trimethoprim-Sulphamethoxazole, and Diclazuril against Experimental and Natural Rabbit Coccidiosis.

There are no anticoccidial drugs labelled for rabbits in Kenya and those available are used as extra labels from poultry. The drugs are used in rabbits with limited knowledge of their efficacy and safety. The aim of this study was to determine the efficacy of sulphachloropyrazine, amprolium hydrochloride, and trimethoprim-sulphamethoxazole relative to diclazuril when used curatively against experimental and natural rabbit coccidiosis. In a controlled laboratory trial, sixty (60) rabbits were randomly allocated to six treatment groups, namely, 1A, 2B, 3C, 4D, 5E, and 6F, each with 10 rabbits. Groups 2B, 3C, 4D, 5E, and 6F were experimentally infected with mixed Eimeria species while group 1A served as uninfected-untreated (negative) control group. Four of the infected groups were treated with sulphachloropyrazine (5E), amprolium hydrochloride (2B), trimethoprim-sulphamethoxazole (6F), and diclazuril (4D) using dosages recommended by manufacturers. Group 3C served as infected-untreated (positive) control. A field efficacy trial in naturally infected rabbits was then undertaken. The results revealed that sulphachloropyrazine and diclazuril were effective against rabbit clinical coccidiosis by significantly reducing oocyst counts from 149.00±110.39 x 104 to 3.31±0.86 x 104 Eimeria spp. oocysts per gram of feces (opg) and 59.70±12.35 x 104 to 0.0±0.0 x 104 opg, respectively, in the laboratory trial. Similarly, sulphachloropyrazine and diclazuril recorded reduced oocyst counts in the field trial from 280.33±44.67 x 103 to 0.44±0.14 x 103 opg and 473.44±176.01 x 103 to 0.0±0.0 x 103 opg, respectively. Still, sulphachloropyrazine and diclazuril showed superior efficacy by registering lesion scores and fecal scores close to those of uninfected untreated control group. Trimethoprim-sulphamethoxazole recorded a satisfactory efficacy in the field trial by recording reduced oocyst counts from 266.78±37.03 x 103 to 0.75±0.11 x 103 opg but was not efficacious in the laboratory trial. Amprolium hydrochloride was not efficacious against clinical coccidiosis in both the experimental and field trials.

Pig traders' networks on the Kenya-Uganda border highlight potential for mitigation of African swine fever virus transmission and improved ASF disease risk management.

We applied social network analysis to pig trader networks on the Kenya-Uganda border. Social network analysis is a recently developed tool, which is useful for understanding value chains and improving disease control policies. We interviewed a sample of 33 traders about their experiences with trade and African swine fever (ASF), analyzed the networks they generated in purchasing pigs and selling pork and their potential contribution to modulating dissemination of the ASF virus (ASFV). The majority of the traders were aware of clinical signs of ASF and the risk of trade transmitting ASFV. Most said they avoided buying pigs from ASF outbreak villages or sick pigs but their experiences also indicated that inadvertent purchase was relatively common. Traders had early knowledge of outbreaks since they were contacted by farmers who had heard rumours and wanted to sell their pigs to avoid the risk of them dying. Individual traders bought pigs in up to nine villages, and up to six traders operated in a village. Although each trade typically spanned less than 5km, networks of the various traders, comprising movements of pigs from source villages to slaughter slabs/sites and retail outlets, and movement of pork to villages where it was consumed, linked up indirectly across the 100km×50km study area and revealed several trade pathways across the Kenya-Uganda border. ASF could potentially spread across this area and beyond through sequential pig and pork transactions. Regulation of the pig and pork trade was minimal in practice. The risk of ASFV being spread by traders was compounded by their use of poorly constructed slaughter slabs/sites with open drainage, ineffective or non-existent meat inspection services, lack of provision for biosecurity in the value chain, and sales of pork to customers who were unaware of the risks to their own pigs from contact with ASF infected pork. More effective regulation is warranted. However, limitations on government capacity, together with the strong self-interest that established traders have in reducing the disruption and financial losses that outbreaks cause, highlight the importance of governments and traders co-developing an approach to ASF control. Formation of trader organizations or common interest groups warrants government support as an important step in engaging traders in developing and implementing effective approaches to reduce the risk of ASF outbreaks.

Social network analysis provides insights into African swine fever epidemiology.

Pig movements play a significant role in the spread of economically important infectious diseases such as the African swine fever. Characterization of movement networks between pig farms and through other types of farm and household enterprises that are involved in pig value chains can provide useful information on the role that different participants in the networks play in pathogen transmission. Analysis of social networks that underpin these pig movements can reveal pathways that are important in the transmission of disease, trade in commodities, the dissemination of information and the influence of behavioural norms. We assessed pig movements among pig keeping households within West Kenya and East Uganda and across the shared Kenya-Uganda border in the study region, to gain insight into within-country and trans-boundary pig movements. Villages were sampled using a randomized cluster design. Data were collected through interviews in 2012 and 2013 from 683 smallholder pig-keeping households in 34 villages. NodeXL software was used to describe pig movement networks at village level. The pig movement and trade networks were localized and based on close social networks involving family ties, friendships and relationships with neighbours. Pig movement network modularity ranged from 0.2 to 0.5 and exhibited good community structure within the network implying an easy flow of knowledge and adoption of new attitudes and beliefs, but also promoting an enhanced rate of disease transmission. The average path length of 5 defined using NodeXL, indicated that disease could easily reach every node in a cluster. Cross-border boar service between Uganda and Kenya was also recorded. Unmonitored trade in both directions was prevalent. While most pig transactions in the absence of disease, were at a small scale (<5km) and characterized by regular agistment, most pig sales during ASF outbreaks were to traders or other farmers from outside the sellers' village at a range of >10km. The close social relationships between actors in pig movement networks indicate the potential for possible interventions to develop shared norms and mutually accepted protocols amongst smallholder pig keepers to better manage the risk of ASF introduction and transmission.