Cultural Drivers of Brucellosis and Treatment Pathways for Febrile Illnesses Among Agro Pastoralists in Kilombero District, Tanzania

Abstract

Cultural Drivers and Treatment Pathways for Brucellosis in Kilombero District, Tanzania In livestock, brucellosis leads to losses in domestic animals and chronic disease in humans. It has been prioritized for control in Tanzania. Low awareness and risky behavior can hamper the efforts to control this disease. This disease mostly affects agro pastoralists because of their close interaction with livestock, consumption of raw animal products and the handling of aborted material. This study examined the awareness, perceptions, knowledge and behaviour related to brucellosis in Kilombero district guided by the Socio-ecological model. The study was cross sectional with agro pastoralists, local livestock, public health and wildlife officials participating. Quantitative data were collected through 333 structured interviews while qualitative data were collected through 39 in depth interviews, 16 key informant interviews and 7 focus group discussions. Quantitative data was analysed through summary and inferential statistics. Thematic analysis was conducted for the qualitative data. In this study, only 7.2% of respondents had ever heard of brucellosis in livestock and none had ever heard of the disease in humans. Most of the participants had no knowledge about the disease, its causes, signs and risk factors for humans and domestic animals. The study found that the symptoms associated with brucellosis infection are recognized but are attributed to trypanosomiasis and supernatural reasons instead. Culturally acceptable practices like drinking unpasteurized milk, consuming raw blood, handling aborted material and living in close proximity to livestock are considered normal and are not at all associated with the risk for brucellosis. Communities lack knowledge and have misconceptions regarding this zoonotic disease. Herbs, over the counter drugs were used as an initial course of action during a febrile illness. Traditional healers were used for repeated episodes of febrile illness usually after the use of conventional treatment. Formal healthcare was not used initially unless in cases of severe disease or for little children and older people. In conclusion, there is low awareness, inadequate knowledge, misconceptions and behaviour risking transmission with brucellosis in Kilombero district among the agro pastoralists. The pluralistic approaches in health care seeking for febrile illnesses can lead to misdiagnosis and inadequate treatment leading to chronic illness, poor productivity and death. This study xiii proposes regular sensitisation and engagement with the community so as to address these issues in ways that can eventually lead to behaviour change and the adoption of safer practices. This study also suggests that close collaborations between communities, policy makers and scientists are enhanced so that culturally relevant and sustainable brucellosis control programs are implemented. Publications Publication 1: Title: Lay attitudes and misconceptions and their implications for the control of brucellosis in an agro-pastoral community in Kilombero district, Tanzania. Authors: Caroline M Mburu, Salome A Bukachi, Kathrin H Tokpa, Gibert Fokou, Khamati Shilabukha, Mangi Ezekiel, Bassirou Bonfoh, Rudovick Kazwala, Katharina Kreppel. Journal: PLOS Neglected Tropical Diseases Year of Publication: 10th June 2021 Link: https://doi.org/10.1371/journal.pntd.0009500 Publication 2: Title: Determinants of treatment-seeking behaviour during self- reported febrile illness episodes using the socio-ecological model in Kilombero District, Tanzania. Authors: Caroline M Mburu, Salome A Bukachi, Khamati Shilabukha, Kathrin H Tokpa, Mangi Ezekiel, Gibert Fokou, Bassirou Bonfoh, Rudovick Kazwala. Journal: BMC Public Health Year of Publication: 5th June 2021 Link: https://doi.org/10.1186/s12889-021-11027-w