Contribution of livestock marketing chains and role played by stakeholders’ knowledge, attitude and practice in spreading cystic hydatidosis to Busia Town, Kenya, 2018

Background Cystic hydatidosis (CH), a neglected parasitic zoonosis, is endemic in many parts of Kenya and could be spread along livestock marketing chains. Poor knowledge, attitude and practices (KAP) enables this spread in remote areas with inadequate public health services. We estimated prevalence, identified possible origin of CH to Busia, Kenya and assessed KAP among cattle owners and abattoir workers. Methods and Principal Findings We conducted a cross-sectional study on slaughtered livestock and interviewed their owners and abattoir workers in Busia in May–June 2018. We used visual observation, palpation and incision to identify cysts. Polymerase chain reaction (PCR) was used for confirmatory diagnosis. Epi Info 7 was used to calculate descriptive and associative statistics. Of 302 carcasses inspected, cysts were visualized in nine (2.98%, 95% Confidence Interval (CI): 1.46–5.78). Fourteen samples were collected and 13 (92.86%) were positive on PCR (sensitivity=92%, specificity=95%). All carcasses with cysts were from West Pokot County, which borders Busia to the north. We interviewed 310 participants: 260 were males (83.87%, 95% CI: 79.19 – 87.69); median age was 41 years (range=21-69). Dogs were kept by 221 (71.99%, 95% CI: 66.55 – 76.87), of which 83 (37.56%, 95% CI: 28.33 – 48.52) improperly disposed of dog faeces. Home slaughtering was practiced by 196 (63.23%, 95% CI: 58.78-69.80), of which 115 (58.67%, 95% CI: 51.44-65.64) were not inspected and 85 (43.37%, 95% CI: 36.32-50.62) fed raw organs to dogs. Adequate knowledge was associated with butcher ownership (P-value = 0.002), age ≥35 years (P-value = 0.002) and higher literacy level (P-value <0.001). Conclusions and Significance There is non-negligible risk of CH in Busia communities which might worsen with time given that the county is connected to endemic areas through livestock trade. Poor KAP by the people on the disease calls for need to implement information, education and communication campaigns to improve KAP on CH in the area. Author summary Cystic hydatidosis is a globally neglected parasitic zoonosis which is endemic in many parts of the world including Kenya. It is majorly a problem among pastoral communities where there is close contact between human, livestock and dogs. Busia County, in Western Kenya is part of a livestock marketing chain between Kenya and Uganda. Animals from high endemic regions in Uganda and Kenya can easily spread the parasite to Busia through improper disposal of their infested organs. Non-pastoral communities like Busia may not have much cumulative experience about the disease though their practices may contribute to the perpetuation of the parasite in their environment. The parasite is gradually spreading to new areas and it is very important to the public health players in Kenya to take action so as to prevent further spread of this disease. Findings from this study show that the disease is no longer limited to pastoral communities only. There is need for the implementation of information, education and communication campaigns to improve the knowledge, attitude and practices of Busia community and other non-endemic regions on the disease.


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Hydatidosis is a neglected parasitic zoonotic disease caused by larval stage of Echinococcus and 99 affects mostly dogs, livestock and humans [1,2]. The parasite has four species, but only two are

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The samples were gradually frozen to -20°C, kept for one month then processed and stored in 172 70% ethanol. For DNA extraction, up to 20 mg of tissue samples was excised and placed in a 173 nuclease-free microfuge tube. We added 300 microliters (μL) of digestion buffer A to the tissue 174 and 12 μL of proteinase K and left to incubate at 55°C for 1.5 hours. We then added 300 μL of 175 buffer SK to the lysate and mixed by vortexing and then added 300 μL of 100% ethanol. A micro 8 176 spin column with a provided collection tube was assembled and up to 600 μL of the mixture was 177 applied to the spin column assembly. The unit was capped and centrifuged for three minutes at 178 8,000 rotations per minute (RPM). After centrifugation, we discarded the flow-through and 179 reassembled the spin column with its collection tube. This was repeated until all the lysate had 180 passed through the column. To wash the bound DNA, we applied 500 μL of wash solution A to 181 the column and centrifuged the unit for one minute at 14000 RPM. After centrifugation, we 182 discarded the flow-through and reassembled the spin column with its collection tube. We applied 183 500 μL of wash solution A to the column and centrifuged the unit for two minutes at 14000RPM.

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The spin column was detached from the collection tube and discarded the collection tube and 185 flow-through. We assembled the spin column with DNA bound to the resin with a provided 1.7 186 mL elution tube. Two hundred microliters of Elution Buffer B was added to the center of the 187 resin bed then allowed to stand for 10 minutes. It was then centrifuged for one minute at    Knowledge, attitude and practices 209 We used a pre-tested questionnaire with open ended and closed-questions for interviews. The while an incorrect or "I don't know" response scored a zero (0). Adequate knowledge was 218 considered as a total score above or equal to half (≥5) of the overall score (10). We used

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Majority of the carcasses inspected, 144 (47.68%) were aged between 4-6 years and 18 244 (5.96%, 95% CI: 3.67-9.42) were aged above nine years. Hydatid cysts were visualized in nine 245 (2.98%) of the inspected carcasses. Among these, eight were female (Table 1).     The study found that there is a risk of cystic hydatidosis spreading to Busia town via cattle trade an average age of four years [9]. This could explains why most of the slaughtered cattle at the 326 two abattoirs were between 4-6 years old.

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The reported prevalence of 3% in this study shows the extent to which the infestation can 328 easily spread over time from its known endemic areas. The possibility of spread is very 329 important to the public health stakeholders in the country to take action so as to avoid the spread  communities [19,22].

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The prevalence which has been estimated by this study might be lower than expected due to 386 failure to include cattle whose owners could not be traced and therefore not having a chance to establish 387 their infestation status and so the actual risk may be higher than reported. Failure to get positive results 388 on PCR in two occasions might be explained by the fact that using strains to characterize 389 Echinococcus is essential to establish a preventive and control strategy in every endemic area,