An assessment of the impact of emergency de-worming activities

Final report – DRAFT

FAO Reference: OSRO/KEN/104/EC - FAOR/LOA NO. 008/2012 Provided by The Royal Veterinary College, University of London (RVC) in partnership

with The Participatory Epidemiology Network for Animal and Public Health (PENAPH).

Date: 11th June 2012

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Table of contents List of abbreviations ........................................................................................................................... 3 Executive Summary ............................................................................................................................. 4 Introduction .......................................................................................................................................... 6 Background to study area.................................................................................................................. 6

Marsabit ............................................................................................................................................................................... 6 Isiolo ...................................................................................................................................................................................... 6

The emergency response and the role of mass anthelmintic distribution .......................... 7 Operational strategies ........................................................................................................................ 8

Isiolo ...................................................................................................................................................................................... 8 Marsabit ............................................................................................................................................................................... 9

Monitoring, evaluation and impact assessments ......................................................................10 Aims and objectives...........................................................................................................................10

Aim ...................................................................................................................................................................................... 10 Objectives......................................................................................................................................................................... 10

Methods ................................................................................................................................................11 Study areas, study population and sampling .............................................................................11

Sampling of primary units....................................................................................................................................... 11 Sampling of secondary units .................................................................................................................................. 12

Data collection ....................................................................................................................................12 Introduction to methods used .............................................................................................................................. 12 Semi-structured interviews ................................................................................................................................... 12 Participatory rural appraisals ............................................................................................................................... 12 Household semi-structured interviews ........................................................................................................... 14

Data recording and analysis ...........................................................................................................15 Use of ranked data....................................................................................................................................................... 15 Statistical analysis ....................................................................................................................................................... 16

Results ...................................................................................................................................................17 Study area ........................................................................................................................................................................ 17 Study population .......................................................................................................................................................... 17

Main Findings.........................................................................................................................................20 Indicators of livestock output and household wellbeing that can be used to assess the effect of deworming ....................................................................................................................................................................... 20 Factors that affect livestock output and the perceived relative importance of internal parasites ............................................................................................................................................................................ 23 Changes in the perceived importance of internal parasites relative to other causes of morbidity throughout the drought ....................................................................................................................... 27 How livestock owners prevent internal parasites, stakeholders involved in this and the place of the emergency response ....................................................................................................................................... 27 Perceived change in output attributable to the provision of dewormers in the emergency drought response .......................................................................................................................................................... 28

Discussion ............................................................................................................................................30 Limitations of study design .................................................................................................................................... 30 The effect of the decision making process and operational strategies ............................................ 30

Discussion of major findings...........................................................................................................32 References ...........................................................................................................................................37

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List of abbreviations CBAHW Community-based animal health workers DSG District Steering Group DVO District Veterinary Officer HHI Household interview IP Implementing partner LEGS Livestock Emergency Guidelines and Standards KII Key informant interview NGO Non-governmental organisation OFDA Office of US Foreign Disaster Assistance PRA Participatory rural appraisal SAAL’s Semi arid and arid lands SSI Semi-structured interview

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Executive Summary There are estimated to be over one million ruminant and camelids within the counties of Isiolo and Marsabit in Northern Kenya. 90% of the population are reliant on these livestock as a daily nutritional source for household members and the economic viability of households is dependent on the morbidity and mortality of these animals. The dry climatic conditions of the SAALs of these two counties mean other agricultural activities are limited and the areas have been repeatedly affected by periods of drought in recent times. There have been an increasing number of livestock based interventions carried out as part of the emergency drought response. These projects are frequently used as technical sections of emergency programmes that aim to protect the livelihoods and household well being of livestock owners. The goal of such programmes is to provide sustainable food security during and after the drought period and aid recovery of households. Maintaining animal health is a key component of this process. Internal parasites are found to be a significant determinant of the productivity of ruminant species in the tropics. Widespread anthelmintic provision has become a predominant activity used by implementing partners (IP’s) in the emergency response based on this evidence and the belief that maintaining the health and food conversion efficiency of livestock is vital to animal health when pasture is scarce. However, monitoring and evaluation of such projects rarely extends beyond an activity assessment of operations and the impact of these provisions on animal health or household food security is unknown. This study used participatory methods to carry out a retrospective study amongst livestock owners in Isiolo and Marsabit. The study aimed to ascertain the perception of the effect of internal parasites on livestock, the capacities of livestock owners to treat and prevent parasites and the role of the emergency response and the impact of anthelmintic administration on livestock output and household wellbeing in the drought response in 2011. The study found a difference in the history of anthelmintic provision and perception towards the procurement of anthelmintics within the two counties. The overall relative effect of internal parasites compared to other diseases was uniform in the study population but the reasons for considering other diseases of greater importance was very different. It is hypothesised that there is a difference in the epidemiology of internal parasites in the two areas that may explain this difference. These key differences in effect and capacity to prevent or treat parasites did not cause a difference in the perceptions of the effect of anthelmintic use on livestock output. However they did suggest the value of anthelmintic provision needs to be further evaluated in both areas. There was clear evidence that administration within the drought itself was perceived to have little to no effect on livestock output. Although there was perceived to be an improvement in output after administration during the rains it was not possible to attribute changes to anthelmintic use because of the improvement in concurrent pasture quality and water availability.

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Whilst the methods allowed exploration of these issues, further work is needed to quantify these changes and provide a robust evidence basis for future decision-making. The study highlighted that to do this and ascertain an effect at a household level requires an in depth knowledge of the demographic of the livestock populations owned by households and an understanding of the risk factors to disease that affect each demographic throughout the drought. When the economic and nutritional contribution of each population to the household has been found and difference in the risk of disease ascertained the household impact and the cost-benefit of the response can be found. With this knowledge strategic inclusion of anthelmintics could be used in future emergency response programmes.

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Introduction

In 2008 – 2009, at least 474 livestock-based interventions were carried out in six counties of Kenya - Kajiado, Isiolo, Samburu, Laikipia, Turkana and Marsabit - in response to the ongoing drought (de Leeuw et al., 2011). The main aim of livestock-based projects is to protect the health and viability of livestock, drawing on five key technical areas: provision of feed, provision of water, provision of animal health packages, destocking and restocking. Meeting these requirements is intended to improve the livelihood status and food security of livestock owners (Watson et al,. 2008; Aklilu et al., 2002; Young et al., 2001). This study investigated the perceived impact of one of the most prevalent animal health interventions used in emergency drought responses – mass deworming activities – to assess the perceived contribution to animal health and productivity and subsequent household wellbeing. The study assessed activities carried out by four implementing partner (IP) organisations in 2011 and 2012 in the counties of Isiolo and Marsabit, focusing on those of the two main IPs in each of the study areas.

Background to study area

Marsabit Marsabit county covers approximately 66 000 km2. The dry and arid landscape supports the large livestock population which is estimated at almost 700 000 small stock, 281 000 cattle and 69 000 camels (Njanja et al., 2003). Mobility is fundamental to ensuring adequate vegetation is sought to meet their nutritional requirements.

The Gabra community is the predominant community of the far north of the county where this study was carried out. The estimated 35 000 Gabra pastoralists (Munyao etal.,, 2007) are solely reliant on livestock-based products as a source of independently generated food. Whilst in the majority of pastoral areas the direction of grazing patterns is to temperate highland areas in dry periods, the Gabra seek permanent water sources found in the lowland areas of the Chelbi desert. In the rainy season livestock are moved to take advantage of the temporary water availability in the areas of the Hurri hills (Munyao et al., 2007).

Increasing settlement near central locations has occurred to access basic services (Weiss, 2004). Whilst inter-community conflict occurs in Marsabit it was not considered as a primary hazard in the study area. Drought was considered the principle disaster in the study area.

Isiolo Isiolo county covers approximately 26 605 km2 with its highest point at 300m above sea level at the Merti plateau. Whilst multiple communities are present in Isiolo, the study concentrated on the Borana and Turkana communities along the eastern finger of the Ewaso Nyiro river which provides water for the main grazing grounds for pastoralists in the dry period. In addition, eight household interviews were conducted in the Samburu community of Oldinyiro.

The pastoral communities in the districts of Merti and Garba Tula have seen an increasing pattern in sedentary behaviour (Jillo et al., 2006), hypothesised to be a result

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of the “shifta” war of the Northern provinces in the 1960s which resulted in exceptionally high losses of livestock as a result of conflict, drought and disease in the area (Hogg, 1980). However, nomadic pastoralism is still regarded as the major economic source for the county (Weiss, 2004).

The diversity of communities and increased pressure on resources from increased population size, poverty and sedentary behaviour has resulted in inter-community fighting within the county (IRIN, 2012) with implications for livelihoods and accessibility of assistance. Insecurity and drought are the principle hazards of the study areas in this region. The emergency response and the role of mass anthelmintic distribution In both counties included in the study, food safety nets provided by the Government of Kenya have become a permanent source of food to the pastoral population. Emergency and development programmes include targeted nutritional supplementation, human health care provision and livelihood support.

Livelihood-based projects initiated in the emergency phase of a response aim to protect the livelihood of livestock owners through improved food security and economic recovery in the preceding and proceeding times after rain has fallen. The activities strategy is to provide animal health care and additional nutritional and economic support to livestock owners. The intended output of these projects is to protect and improve livestock health with a subsequent increase in their output. Concurrent provision of an alterative source of nutritional and economic support prevents the need for sale of remaining livestock to meet basic needs in the homesteads. Maintaining viable levels of healthy livestock ownership improves the stability and recovery of households highly dependent on them as a nutritional and economic source.

Helminths are ubiquitous to ruminants and non-ruminants in Africa (Hansen,J. et al 1999) (Craig, 1999) and are considered to contribute to poor feed conversion efficiency and overall productivity (Odoi, et al 2008). Strategic control can have significant cost benefits in ruminant species (Zinstaag, et al 1997.

Providing for livestock health and specifically anthelmintics is therefor frequently used as a technical component of multi-tiered projects carried out by implementing partners. Four implementing partners were involved in the distribution of anthelmintics as part of the OFDA-funded programme (OSRO/KEN/104/USA) of which the beneficiaries of the provisional services of two were the focus of this study.

The integrated framework of both national and external stakeholders in the decision making process behind anthelmintic use as part of the animal health provision is shown in Figure 1. Whilst proposals are made from implementing partners a collaborative balance with the priorities of national services is also taken into consideration. Both of these should account for the needs of the affected populations but regional and national priorities may influence the decision-making process. One of the two main IPs reported “usually” carrying out some form of needs assessment although no details were provided whilst the other main IP referred to informal communications with? the DVO to aid decision-making (it should be noted this process was under review at the time of the study).

LEGS guidelines were used to support the proposed intervention by one main IP. LEGS provides guidelines for the decision-making process in livestock interventions but

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importantly focuses on providing a framework for initial assessment that will lead to appropriate responses that supporting existing strategies (Watson et al., 2008). There is little evidence of its uptake in decision-making processes in emergency situations.

Figure 1 Framework of information flow and key actors

Operational strategies The main IPs- in the respective counties used two different operational approaches. Figures 2 and 3 outline the operational strategies and actors involved in deworming activities. Both partner organisations sought to inject local economy by procuring anthelmintics used in the programmes from local providers.

Isiolo Private licenced franchises (agro-veterinary stores) identified by the DVO were invited to enter into a tenure for a predetermined quantity of 10% albendazole that was to be administered by the operations team. The providing source was the franchise that could provide the quantity of required drugs for the lowest price in the time required. The activities were carried out in collaboration with the local DVO and an integrated local operations team that included up to 6 animal health assistants who were responsible for administration of anthelmintics to beneficiary livestock. The IP was responsible for the acquisition of logistical support and materials to carry out the operations. In addition, a member of the IP was part of the operational team and responsible for record keeping and accountability of activities carried out. Inhabitants of locations were mobilised by the sub-location chief and a blanket administration approach was taken; all livestock that were present at a predetermined location received anthelmintics. The deworming activity was carried out in December 2011 and January 2012 and had also been implemented in the previous year. The DVO informed us that acaricidal pour-on and basic primary animal health care, including antibiotic

FAODirector of veterinary services

District Steering GroupIncl. Dept. heads; including head

of water & district veterinary officer

Partner organisations –Regional Office

Nairobi

Livestock Production

Officer

Beneficiary population

LEGS guidelines

District Veterinary

Officer

Rapid Needs Assessment

Directorate of veterinary services

Technical advice Technical advice

Partner organisations –

Field office

Funding body

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administration, were provided at the same time. A high number of animals with clinical signs of mange and foot-rot were reported by the DVO. The DVO reported working with similar IPs to distribute anthelmintics and vaccinations in the preceding years. Activities were coordinated by the DVO as part of the district steering group.

Figure 2 Operational strategy in Isiolo

Marsabit Anthelmintics were pre-purchased from two private agro-veterinary stores within the Dukana district (Dukana and El Hade). The IP confirmed the quantity and quality assurance of drugs to be used. A targeted approach was taken to the allocation of anthelmintics to be distributed. Following an inception workshop with the county livestock officer, DVO, livestock production officer and meat inspector the following criteria to identify vulnerable households were created: (i) female-headed households (ii) child-headed households (iii) households owning less than 50 small ruminants; or (iv) households with adults with HIV/AIDS heading the household. The communities themselves were responsible for identifying households that met the selection criteria. A list of beneficiaries was provided to CBAHWs who were responsible for the distribution of vouchers. These vouchers were then exchanged for 3 ml of 10% albendazole as distributed by the CBAHW. The vouchers were distributed in February 2011 and redeemed in May 2011. Although the DVO was not contactable, CBAHWs involved in the process reported no other treatments were provided at the same time as the anthelmintic provided. They also reported no other externally provided animal health service had been carried out since PPR vaccination in 2009.

District Veterinary Officer

Operational teamLivestock health assistants

Community animal health workers (CAHWs)

VSF representative

AnthelminticsAcaricidesPrimary

animal health care

Imp

lem

enti

ng

par

tner

1 –

fiel

d t

eam

Local procurement of anthelmintics

Sup

po

rt a

nd

acc

ess

Provision of vehicles

Personnel / supervision

Provision of fuel

Additional programme

implementationActivities

Cash for work

Meat distribution

Restocking

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Figure 3 Operational strategy in Dukana district, Marsabit

Monitoring, evaluation and impact assessments Monitoring and evaluation was carried out by both focus organisations. However, these were activity-based assessments as frequently found in other studies (Catley et al., 2008). There is little evidence of the impact of livestock interventions on animal health or the subsequent effect on livelihood status and food security despite these being the main objectives of the programmes shared by implementing organisations (O’Dea and Marsland, 2011). This study aimed to meet some of these shortcomings by using participatory methods to assess livestock owners’ perceptions of the impact of emergency anthelmintic distributions.

Aims and objectives

Aim “To assess how emergency anthelmintic provision met the needs of livestock species and livestock-owning households and the effect on animal health, livelihood and recovery that was attributed to deworming during the emergency drought response.”

Objectives The specific objectives of the project were: 1. To identify indicators of livestock output and household wellbeing that can be used

to assess the effect of deworming. 2. To identify factors that affect livestock output and the perceived relative

importance of internal parasites. 3. To identify if the perceived importance of internal parasites relative to other causes

of morbidity altered throughout the drought.

Community animal health workers

Implementing Partner 2 - field team

Community committee of

elders

Local agro-veterinary

stores

Voucher distribution

Procurementof

anthelmintics

Beneficiary “vulnerable” households

Voucher/ anthelmintic

exchange

Beneficiary list distribution

Voucher/ anthelmintic

exchange

Payment onreceipt of vouchers

Identification

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4. To identify how livestock owners prevent internal parasites, stakeholders involved in this and the place of the emergency response.

5. To measure the difference in livestock output and household well being (and recovery from the drought) in beneficiary and non-beneficiary households.

6. To assess if participants perceive the change in output to be attributable to the provision of dewormers in the emergency drought response.

Methods

Study areas, study population and sampling The study took place in the Merti, Central and Garba Tula districts of Isiolo and the Dukana and North Horr districts of Marsabit. The administrative structure of Kenya is such that each district is divided into sub-locations. Locations within the sub-location are centres of either permanent or temporary residence of communities. The chief of the sub-location is the administrative head of all locations and populations within it.

In districts and sub-locations where there are high levels of movement, sporadic occurrence of small temporary locations results. Accountability of these locations, in a one-off time period, from a sub-location chief can be difficult.

A two-stage sampling technique was used. The primary unit was the sub-location and individuals involved in the PRA and household SSI were the secondary unit.

Sampling of primary units The locations and corresponding sub-locations of the deworming activity were identified from records at the regional office of the main IP. Interviews with the DVO, or a delegate, provided information on all locations in the district where deworming activities by any IP, and the approximate date, were carried out. The sub-locations of these were then stratified according to when deworming interventions had been carried out. The following inclusion criteria were then used to generate a sampling frame of sub–locations:

Accessibility, including distance from where team stayed Security concerns that inhibited movement to and from the sub-location

A random sample of sub-locations in the sampling frame was selected from each stratum. Convenience sampling was then used to select one location for the site of the assessment, based on likelihood of residence of livestock owners at time of study and presence of geographical features – e.g. watering point, petty trade – that meant that a representative sample of inhabitants of the sub-location was likely to be available on the day of data collection.

In Marsabit, all locations and the concurrent sub-locations where deworming had been carried out were included in the study. The location and sub-locations of deworming activity, the IP and timing of the intervention were identified from the regional office of the main IP. Stratification of sub-locations in the study was done according to the timing of the intervention that occurred.

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Sampling of secondary units The sampling frame in all sub-locations included all households and household members that had owned livestock at the time of the deworming activity, including beneficiaries and non-beneficiaries.

A meeting was held with the chief of each sub-location. The purpose of the impact assessment and methods to be used were discussed. Participants to take part in the participatory rural appraisal (PRA) were then identified by the chief. The study population of household interviewees was selected by the research team according to the availability and consent of the head of the households identified.

Data collection

Introduction to methods used In each sub-location, one PRA and up to 6 household semi-structured interviews (SSIs) were carried out.

A team comprising of 2 local facilitators, 2 translators in Isiolo central and a primary researcher from the Royal Veterinary College, University of London, carried out the assessment in each location. One facilitator, a veterinarian trained in participatory methods and fluent in both Borana and Gabra, led all PRAs to ensure standardisation of methods used. The primary researcher was responsible for recording results. A second facilitator (who spoke the community language, had experience in SSI techniques and was familiar with animal health) was employed separately in each county and responsible for carrying out the semi-structured household interviews.

In the sub-locations of Isiolo central, 2 translators fluent in Turkana and with experience in the participatory methods used joined the team. An orientation day was organised to familiarise each facilitator with both the PRA and SSI. The 2 primary facilitators were responsible for guiding the participatory work and interviews through the translators.

Semi-structured interviews Semi-structured interviews were carried out with the chiefs of the sub-locations to ascertain general demographic information at a sub-location level. This included specific agro-ecological information, the number of households, number owning individual livestock species and the movement patterns of livestock species in dry and rainy seasons. Open-ended questions guided information produced on the number of NGOs (international, national and regional) and concurrent emergency programmes that had been running in the locality. Additional key informant SSIs were carried out with 3 DVOs, 6 agro-veterinary/pharmacy owners who were identified by participants as the source of drugs purchased, 4 CBAHWs who carried out the deworming activity, participants of the PRA with specific information of interest, and a slaughter slab worker from North Horr.

Participatory rural appraisals A pilot study was carried out to ascertain livestock owners’ perceptions of the effects of internal parasites that could be used to guide the structure of the PRAs and household interviews.

A series of open questions, formulated from the pilot study, was used to guide the structure of the appraisal. The participatory methods used and trialled in the pilot study

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included ranking, seasonality calendars, proportion piling and before and after scoring. Once participants had disclosed information of interest, closed questions were used to elicit particular information relevant to internal parasites and the objectives of this study.

The appraisal began with participants defining the meaning of household wellbeing, contributing factors and the importance of livestock in this respect. Participants listed the livestock species that were owned within the location and discussed the products from each livestock species that contributed to their household wellbeing. They then ranked the outputs according to their importance to household wellbeing and openly discussed the net effect of each output.

A seasonality calendar was created to assess the change in each of the 3 most important outputs throughout the drought in the preceding years. Starting with present time, participants identified the last substantial period of rainfall that had ended the drought – October 2011. From this point they were able to identify the time of the rain before the drought period began. Using these 2 points, participants created a transect line. Five photos of different grass quality were then provided. The appraisal facilitator ensured that the groups were in agreement about the interpretation of each photo and the association of each with the temporality of rain. Participants then placed the photos along the transect line in an order that represented the increasing time without rain. This method was used to divide the transect timeline into 5 stages, present day being the 6th division.

Taking each output defined by the PRA participants respectively (milk, weight and sale of animals), proportion piling was used to show the change in output at each of the stages on the timeline. Ten counters were provided as the maximum possible output at each stage and the number of counters placed at each stage therefore showed the output relative to the maximum possible output.

Due to the high level of ownership, the exercise focussed on small ruminants in all appraisals. Key informants that owned cattle and camels were asked to identify any differences in the pattern of output between species and repeated the exercise for these species accordingly.

Participants discussed the reasons for the change in outputs of all livestock species in an open discussion. The facilitator then used guiding questions to focus discussion on diseases that affected the outputs of each livestock species. Local names for disease and conditions were cross checked with the clinical signs that were seen and the facilitator used his clinical knowledge to confirm the disease or condition that was being discussed. Closed questions were used to confirm that the clinical signs of each disease had occurred throughout the drought cycle.

For each species, the conditions that affected them were then ranked according to the perceived effect they had on the outputs of individual animals. Using the timeline, participants discussed and placed coloured markers representing each disease along the transect line at times when they saw the greatest number of animals displaying clinical signs. This exercise was used to indicate any changes in the seasonal incidence of clinical disease.

An open discussion was used to generate information on the prevention and treatments used by livestock owners for each disease. In appraisals where internal parasites had not been perceived to have an effect on output, participants were asked to list all animal

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health treatments their livestock received. The mention of anthelmintic provision initiated discussion about reasons for its use and the perceived effect of internal parasites.

In appraisals where no anthelmintics were mentioned, closed questions were used to ascertain if anthelmintics were available, were acquired and if internal parasites were perceived to affect their livestock. The facilitator also used closed questions to ascertain where and when any preventive or curative animal health products were obtained. Frequently, groups discussed the free provision of some of these items and these discussions were guided to ascertain the role of free provisions in maintaining animal health.

Finally, before and after scoring was used to assess the perceived difference in livestock outputs after receiving any anthelmintics provided and additional factors that affected this difference were discussed.

Household semi-structured interviews The household interviews contained questions overlapping with those in the PRA to triangulate the data collected. The interview was also designed to triangulate the information provided within it.

Basic demographic information of interviewees, livestock ownership and household income was gathered using closed questions.

Semi-structured interviews guided discussion around conditions and diseases perceived to affect livestock output. Livestock owners were then asked directly if they perceived their animals to be affected by internal parasites, the species and demographic of animals that were affected. Further closed questions were used to ascertain clinical signs that livestock owners attributed to internal parasites and if there were particular times when more animals displayed these clinical signs.

The perceived effect of internal parasites on all livestock species was ascertained by providing ten counters to each interviewee, representing the output of a healthy animal. They were then asked to represent the relative outputs of an animal affected by internal parasites. This provided a method of ascertaining the perceived burden of internal parasites. Where interviewees could not quantify the effect, any effect discussed was noted.

Data on methods of prevention and treatment and the timing and source of anthelmintics administered to livestock at a household level were captured. Interviewees were asked to recall the last time that they provided anthelmintics to their animals and the source of this anthelmintic. This exercise was repeated for up to 3 recall periods of anthelmintic use – i. e., the time and source of up to the last 3 times anthelmintics had been administered to their livestock.

Before and after scoring – as in the PRA – was used to ascertain the perceived effect of anthelmintic treatments on the output of all livestock, although interviewees focussed on that of small ruminants. Qualitative data around factors that affected this difference were also collected. Both the household interviews and PRAs identified locations of any anthelmintics purchased. A brief SSI using closed questions was carried out with the owner of identified franchises. The type of anthelmintic sold, price, demographics of people who

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bought the anthelmintic and time of year when the greatest quantity of anthelmintics was sold was ascertained.

Data recording and analysis Participatory appraisals were voice recorded where possible with a digital dictaphone. The primary researcher was responsible for recording the quantitative data generated throughout the appraisal. General discussion around the key topics was monitored and chaired by the facilitator. Whilst PRA participants reached consensus, the facilitator relayed to the primary researcher individual differences of opinion that were transcribed at the time. Key informant interviews were carried out when new pieces of information were generated to capture the differences in perceptions.

The interviewer transcribed the SSIs at the time of the interview.

The primary researcher kept a logbook of observational information specific to the locations visited to gain a better insight into the social and cultural differences of areas that may influence the perceptions and views of informants.

The mean proportion (score/10) of each output across all groups at each stage of the drought and the corresponding standard deviations were calculated using Microsoft Excel and used to assess the change in livestock species output throughout the drought cycle.

The percentage of appraisals and household interviews that mentioned internal parasites as having an effect on livestock outputs unprompted was noted. The percentage of household interviews that considered internal parasites as a cause of decline in output in open discussion was compared to the percentage that then answered affirmatively to a closed question of the presence of internal parasites in their livestock.

Use of ranked data The ranking of each disease in each group was converted into a score using the following formula:

Scij = Nij – rij + 1

Scij = Score for the jth disease in the ith group

Nij = The number of diseases identified by group i

rij = The rank given to disease j by the group i

Where the disease had not been voluntarily mentioned by the group it was assumed to not be perceived to have an effect on output and therefor denoted the score 0.

The individual scores for each disease were standardised to be comparable using the following formula:

STScij = Scij / Nij x 10

STScij = Standardised score for the jth disease in the ith group

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Scij = Score for the jth disease in the ith group

Nij = The number of diseases identified by group i

Statistical analysis Due to the non-parametric nature of the data the median of the standardised scores and the respective interquartile ranges are presented to compare the scores of diseases perceived as affecting outputs by different groups. Friedman’s test was used to test the null hypothesis that there was no difference in the standardised scores of all the diseases. A Wilcoxon rank sum test was then used to test the null hypothesis that there was no difference between the scores of each disease and internal parasites when individually compared.

As a result of the normal distribution but equal variance of the data, an independent Welch t–test, to account for unequal variance, was used to ascertain if there was statistical evidence of a perceived difference in outputs after anthelmintic administration, both in dry periods and following the rains, using data gathered from the PRAs. A Wilcoxon rank sum test was used to assess if there was a difference between the perceived change in output as a result of internal parasites between beneficiary and non-beneficiary households, households that self-administered anthelmintics and those that did not, and households from Marsabit and those from Isiolo. A Wilcoxon signed rank test was then used to test the hypotheses that there was no perceived change in the weight and milk output of livestock before and after deworming, using data from the HHIs. A Chi-squared test was used to assess if there was a difference between beneficiary and non-beneficiary populations in the proportion of household SSI’s that self-administered anthelmintics to their livestock. The results were further investigated to assess for a difference in self–administration between the two counties.

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Results

Study area The history of deworming activity varied between the districts within Isiolo. In Merti district 2 strata were identified; deworming activity in December 2011 and February 2012 carried out by two IPs. A third IP had distributed anthelmintics in June 2011.

In Garba Tula all but 2 sub-locations in the district that met the selection criteria had been reached by the main IP in December 2011. Sporadic deworming by other IPs had been carried out from April-June 2011. In Central district insecurity had limited the geographic distribution of activities. Information on the sub-locations of activity from the main IP was used. High levels of displacement that had resulted in conjugation of several locations across the sub-locations further influenced the sampling frame.

There was a less obvious history of deworming activity in Marsabit county. Participants, sub-location chiefs and CBAHW’s of the Dukana district reported that no deworming had occurred since 2009. In North Horr district concurrent deworming was carried out by a national NGO. There was no evidence that the area of activity distribution was coordinated with the DVO of the area.

Figure 5 Spatial distribution of centre of districts and sub-locations included in the study

Key: District centre and site of agro-veterinary store, shop (Dukana) and CBAHW’s

(North Horr) used in KII’s. Sub-location study site (2 sites omitting from Garba Tula district)

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Study population The study took place in 23 locations in Gabra (Marsabit), Borana (Merti and Garba Tula) and Turkana (Isiolo Central) communities between March and April 2012. Twenty-three PRAs including 265 participants (30% female) and 112 household interviews were conducted (Tables 1 & 2). In addition 6 KII with agro-veterinary and shop(Dukana) owners and 2 CBAHW’s who were identified as the source of anthelmintic procured, were carried out. The spatial distribution of study locations and proximity to these resources is shown in figure 4.

Each study site comprised of between 4-14 central and satellite settlements. Government food aid was distributed to 100% of the study population. According to sub-location chiefs the number of households owning no livestock was between 0–22% in Marsabit and 15–60% in Isiolo. Alternative income and food sources for homesteads included livestock loaned by neighbours and extended family members (Marsabit), attempting to farm the land for crops (Merti), petty trade, brew making and charcoal burning (Isiolo Central and Garba Tula). Additional programmes that had or were being carried out as part of the emergency response in the sub-locations included supplementary feeding programmes, voucher distribution for purchase of non-food items, cash for work, meat distribution and water management programmes. The availability of a cash economy varied according to accessibility; locations within Garba Tula and Isiolo Central had the shortest distance and therefore presumed access to small markets and towns (Isiolo).

Table 1 Household semi-structures interview study population

District Total number

HHI’s (% of total)

No. of HHI’s which were beneficiaries

(%)

Female respondents (%)

Merti 27 (22.5) 17(63) 13 (48)

Garba Tulla 22 (18.3) 8 (36) 13 (59)

Central(Oldinyiro) 24 (16.7) 12 (50) 6 (25)

Dukana 26 (21.6) 14 (54) 11 (42)

North Horr 23 (19.2) 14 (60) 14 (61)

Total 120 (100) 61 (50.8) 64 (53)

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Table 2 Sub-location deworming information and PRA study population

Sub - Location Date of deworming activity Number participating in

PRA Merti District

Bisan Biliquo Nov / Dec 2011 15 Bulesa Nov / Dec 2011 8 Goba Nov / Dec 2011 18

Mackagala Feb 2012 12 Biliqui Feb 2012 10 Saletti Feb 2012 7 Total 70

Isiolo - Garba Tulla District Kula Mawe Nov / Dec 2011 11

Boji Nov / Dec 2011 9 Barambate Non - Benefic 11 Malka Daka Non - Benefic 11

Tanna Nov / Dec 2011 14 Total 56

Isiolo District -Central Division Chumvi Nov / Dec 2011 14

Lawangelo Nov / Dec 2011 12 Dabba Nov / Dec 2011 12 Chokka Nov / Dec 2011 11 Total 49

Marsabit - Dukana Dukana May 2011 14 Garwole May 2011 12

Sorru May 2011 9 El Hadi May 2011 14 Total 49

Marsabit – North Horr Awana/ Huwara Feb/ March 2012 11

Barambate Feb/ March 2012 10 Malibot Feb/ March 2012 9 El Gadi Feb / March 2012 11 Total 41

Total participatory study population 265

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The livestock ownership of households in the study population is shown in Table 3. The median number of small ruminants and camels per household was greatest in Marsabit but cattle ownership was greatest in Merti district of Isiolo where shoat numbers were lowest. The average number of inhabitants per household was 7.9 (95% CI 6.9 – 8.8) and 30% of the households were female-headed.

All PRA participants were shoat owners and females accounted for 30% of the study population. Key informants who owned cattle and camels were identified in 14 and 10 appraisals respectively.

Main Findings

Indicators of livestock output and household wellbeing that can be used to assess the effect of deworming Factors used to describe the meaning of household wellbeing by participatory groups included availability of food (78%), absence of disease in people and livestock (30%) and absence of conflict (21%). The following are examples of key phrases summarising the definitions of household wellbeing:

“Having basic needs – food and health”

“Having good food for living for animals and humans”

“An absence of conflicts and our animal are doing well”

“When we have livestock and have full stomachs”

Almost all (22/23) participatory groups identified livestock ownership as the principal contributor to household wellbeing followed by peace as the second most important factor.

All groups identified milk as the most important output of all livestock species (except donkeys) as it was produced every day and therefore provided a constant source of nutritional intake for all household members, resulting in strength and good health of household members. Sale of livestock to generate cash to meet basic needs such as purchase of clothes, food when necessary and pay school fees of children was regarded as the second most important output from livestock species. Meat for consumption and occasionally sale was the third most important output. When using the condition score or weight of animals as proxy for the amount of meat on an animal slaughtered, these criteria all corresponded with the factors affected by internal parasites as recorded in informal interviews in the pilot study. Assessment of the change in these factors and any amount attributed to internal parasites or treatment thereof was assumed to have direct consequences for household wellbeing.

The seasonal timelines created by the groups were very similar. All identified a period of up to 3 years where no rainfall was seen between April 2008 and October 2011. As the study occurred in March, all appraisals noted the dry period and impending expected rainfall and marked present day to the last rains as the 6th stage of the timeline.

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Table 3 Livestock ownership (numbers) in household population.

*

Number owning

Median (IQ range)

Number owning (%)

Median (IQ

range)

Number owning (%)

Median (range)*

District Small ruminants Cattle Camels

Merti 25 14

(6.5 – 47.5) 20

4 (0.5 – 10)

2 0

(1 – 4)

Garba Tulla

21 30

(20 – 40) 6

0 (0-1)

4 0

(3–35)

Central 16 18

(11.5-30.3) 11

2 (0–5.25)

1 0

(1)

Isiolo 62 20

(10-40) 37

2 (0-5)

7 0

(0 – 35)

Dukana 26 30

(15.5- 75) 17

2 (0 – 6.75)

16 2

(0 – 40)

North Horr

22 45

(30 – 50) 5

0 (0 – 0)

21 9

(0 –100)

Marsabit 48 35

(20 – 60) 22

0 (0 – 5)

37 5

(0 -100)

Total 110 30

(14 – 50) 59

1 (0 – 5)

44 0

(0–100)

Minimum and maximum range

A “normal” year was considered as one month of rainfall (March/April) followed by one month of post-rains grass. A 5-month period of dry weather would follow this before 2 months of heavy rains (November/December). A period of drought was recognised as the period from where the second long rains should have occurred until the next rainfall.

Table 4 shows the perceived change in the milk and weight of each species respectively, and the change in the price and number of livestock sold collectively, relative to the absence of rain and subsequent decline in grass quality throughout the drought period. It should be noted that this information was provided for the average live animal within the herd. All appraisals noted that the number of live and viable animals reduced throughout the period, affecting the total output of their herds. A number of appraisal groups discussed how any animals remaining after the drought were weakened and no longer milking. Conception, birth and return to milk took time and accounted for the perception of lower levels of output per average animal than before the drought.

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Table 4 Relative proportion of output at each stage of drought

Mean proportion

(SD)

1

2

3

4

5

Present

Milk

Small ruminants

9.56 (1.00)

6.04 (1.59)

3.06 (1.61)

0.84 (0.61)

7.84 (3.3)

3.8 (1.66)

Cattle 9.29

(0.92) 6.15

(1.63) 3.07

(1.86) 0.39

(0.49) 7.14

(3.84) 3.79

(2.29)

Camels 8.6

(3.1) 6.9

(1.66) 4.7

(2.3) 2

(0.94) 8.7

(1.95) 5.4

(2.46)

Weight

Small ruminants

8.5 (1.95)

7.87 (2.03)

4.87 (2.05)

1.39 (0.94)

7.21 (3.14)

5.87 (2.40)

Cattle 8.1

(2.03) 8.56

(1.81) 6.44

(1.59) 1.22

(0.44) 6.11

(3.52) 7.78

(2.33)

Camels 9.71

(0.76) 7.86

(2.12) 6.14

(2.79) 3.57

(2.23) 8.71

(1.70) 6.86

(2.85)

Number of heads sold

Small ruminants and cattle

2.13 (1.67)

3.13 (1.86)

4.56 (1.71)

7.69 (1.66)

1.69 (1.41)

3.56 (2.03)

1 = 2008 rains and immediately after 4 = drought after long rains failed 2 = initial dry season 5 = rains October2011 3 = end of dry season 6 = dry seasons to present day

All PRA participants believed that the rate of reduction in output was lower in camels that retained a higher proportion of their original weight and milk output. The rate of reduction in weight and milk was greatest in cattle that were reported to subsequently lose their value at the fastest rate. Due to the high volume of milk they produced they were also the most important species to those that owned them when not in the drought. Camels were rarely slaughtered or sold due to their milking capacity in the drought and small ruminants were seen as an essential asset for quick sale when basic goods were needed.

The number of heads of small ruminants and cattle sold was proportional to the reduction in milk output from small ruminants or cattle if owned. The initial increase in the sale of either of these species through the extended dry period was “because we

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became hungry” and to provide a means to alternative food sources. In the drought period the predominant reason for sale changed; livestock were perceived to be unlikely to survive and “any price was sought for salvage”.

Factors that affect livestock output and the perceived relative importance of internal parasites All appraisal groups attributed the lack of rain and subsequent lack of pasture and water as the primary contributing factor to the decline in milk and weight of animals throughout the drought period. An increased incidence of disease was considered the second most important factor followed by loss from conflict that increased throughout the drought period.

The diseases perceived to contribute to the loss in production in all species and the number of appraisal groups that voluntarily mentioned the disease in question are shown in Table 5. The median standardised score and corresponding interquartile range show the comparative prioritisation of these diseases relative to their perceived effect on output. Factors affecting participant decisions on the appointed rank (and subsequent score) included the frequency of occurrence of clinical diseases, the number of livestock affected and the ability of the livestock owner to prevent or treat the disease. There was good evidence to support the assumption that there was a difference in the scores between diseases in all species (Friedmans P <0.001, <0.001 and 0.006 for x, y and z respectively). There were significant differences between standardised scores for internal parasites and for some of the other diseases, internal parasites were considered to affect output less than the following diseases: (i) small ruminants - CCPP (P = 0.008); “gid” cyst (P = 0.015) (ii) cattle - FMD (P = 0.001); (iii) camels - Trypanosomes (P = 0.02). The effect of internal parasites was considered overall as the condition with 4th, 3rd and 5th greatest effect on the output of small ruminants, cattle and camels, between groups respectively.

Whilst 74% of all groups identified internal parasites as a cause for production loss in small ruminants (and subsequently in other livestock species owned as it was considered to affect all) unprompted, this proportion differed between the 2 counties. 86% of PRA groups in Isiolo considered internal parasites as a cause of lowered weight and milk output in open discussion and 100% were affirmative that it affected the output of their livestock on direct questioning. However, only 44% of appraisal groups in Marsabit considered internal parasites as a cause of reduced output in open discussion and 90% on direct questioning.

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Table 5 Recognised conditions affecting output, median score and relative P- value

Condition

Number identifying

unprompted (%)

Median Score (Standardised)

Inter quartile

range

Z -score*

(P value)

Small ruminants (n=23) ** <0.001

CCPP 21 (91) 8.4

5.31 – 10

3.361 (0.008)

“Gid’cyst 14 (61) 6.67 0 -8 2.415

(0.015)

Pox 15 (65) 5.78 0 – 7.88 1.47

(0.14)

Internal Parasites 17 (74) 2.91 0.4 – 4.3 na

Ectoparasites 11 (48) 1 0 – 5.75 -0.172 (0.87)

“Quando” 11 (48) 0.83

0 -5

0.243 (0.87)

PPR 7 (30) 0

0 – 7.78 -0.79 (0.45)

Footrot 11 (48) 0

0 – 3.95 -1.107 (0.27)

Enterotoxaemia 7 (30) 0

0 – 3

-2.83 (0.0045)

Mange 9 (39) 0

0 – 2 -1.4

(0.15)

Jaagsiekte 2 (9) 0

0 – 0 -2.69

(0.0070)

Cattle (n=21) ** <0.001

FMD 20 (95) 8.3 14 – 10 3.24

(0.0012)

Trypanosomes 11 (52) 2 0 – 3.33 0.29

(0.78)

Internal Parasites 12 (60) 1.6 0 – 4.29 na

CBPP 9 (43) 0 0 – 6.67 0.547 (0.58)

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Ectoparasites 7 (33) 0 0.0 – 5.0 0.14

(0.89)

ECF 6 (29) 0 0 – 0.143 -0.86 (0.34)

LSD 5 (23) 0

0 – 0 -1.132 (0.26)

Ephemeral fever 4 (19) 0

0.00 – 0 -2.16 (0.03)

“Quando” 3 (14) 0 0.0 – 0.00 -1.043 (0.30)

Blackleg 4 (19) 0 0 – 0 -1.55 (0.12)

Camels (n=13)

**0.006

Trypanosomes 13 (100) 8.57 6 – 10 -2.33

(0.019)

Pneumonia 7 (54) 4 0 – 6.67 -1.22 (0.23)

Mange 5 (38) 3.33 0 – 6.67 -1.25 (0.21)

Abcesses 5 (38) 3.33

0 - 5 0.67(0.5)

Internal Parasites 4 (31) 0 0-2

na

Orf 3 (23) 0 0-0 1.41(16)

n= Number of PRA’s contributing *Wilcoxon signed – rank test ** Friedman test of equal scores of all diseases

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The reasons for not including internal parasites as a disease or condition initially, provided by PRA’s in Isiolo were;

“Disease you may not see specific signs of…. poor coat and weight loss

….but always there”

“Not considered as a disease as there all the time in all animals and they carry on.”

In Marsabit the reasons provided were;

“No signs are seen…. told that they cause emaciation but not observed.” “Some may see in intestines on slaughter but no signs when alive.”

In household SSIs 40% considered internal parasites a cause of declining output of all livestock species unprompted and 86% on direct questioning. All interviewees that did not perceive internal parasites to be present at all or responsible for clinical signs in their animals were from North Horr district; 50% of these interviewees reported signs in slaughtered animals that were not attributed to any in living animals and 50% reported no pathological or clinical signs. The clinical signs associated with infection can be seen in Table 6 with the results of 3 KII demonstrating the intra-sublocation differences in perception of clinical effect of internal parasites.

Table 6 Clinical signs of internal parasites and intra sub-location differences in signs

District Clinical signs

Merti ad Garba Tula

Weight loss, poor condition, rough coat, lowered milk production

Central

Weight loss, rough coat, swelling around the jaw, small white grains in faeces, diarrhoea

Dukanna No signs in live animals, Loss of weight, diarrohea small white eggs in

faeces,

North Horr Emaciation and lowered production, no signs seen when alive, see small

worms in intestines on slaughter, eggs in faeces like rice grains

Three KII’s Barambate, Marsabit.

Elderly man within appraisal

“Causes loss of body weight and condition and milk decreases and poor amount of meat.”

Female -SSI “Occasionally see eggs in livestock grazing near homestead but not a cause of other signs.”

Herder from satellite village

“No signs when alive…. Occasionally see small round worms on slaughter but not associated with signs in live animals.”

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Changes in the perceived importance of internal parasites relative to other causes of morbidity throughout the drought All PRA groups claimed that there was no change in the order of importance of diseases mentioned throughout the drought period in the timeline.

The majority of participants (52%) that could attribute particular signs to internal parasites claimed a higher clinical incidence was seen in the extended dry or drought period. Two (4%) of the appraisal groups reported an increased incidence after the rains season had occurred and the remaining 9 (39%) appraisal groups did not perceive there to be an alteration in the frequency of clinical signs seen between seasons.

Of household respondents, 40 (38%) perceived there to be a higher incidence of signs of internal parasites in the extended dry seasons or drought whilst 46 (46%) perceived this to be greatest in the rainy season. Five per cent perceived there to be no difference in incidence between the rain or dry periods and 4.5% could not say.

How livestock owners prevent internal parasites, stakeholders involved in this and the place of the emergency response There were regional differences in the historical presence of anthelmintic distribution by external agencies. This was demonstrated by the ability of household interviewees to recall the last 3 administrations of anthelmintics. Beneficiary interviewees in Isiolo were able to recall 3 points of administration by external providers at 6-month intervals. In Marsabit, interviewees were able to recall the previous anthelmintic distribution but no other.

All appraisal groups and household interviews within both counties identified salt water or grazing areas where the ground was salty as preventive of internal parasites. In Isiolo, all appraisal groups were able to identify anthelmintics as a treatment for internal parasites and an agro-veterinary store or pharmacy where community members were able to purchase anthelmintics. Whilst accessibility to the facilities was confirmed there was discrepancy between the ability of community members to purchase anthelmintics according to their economic viability. Whilst no quantitative data were collected on these differences and the effects on individual purchasing power, PRA participants identified those that could afford dewormers as purchasers whilst those that could not would “occasionally receive some form of external assistance”.

Participants of the PRA and household SSI of Isiolo were able to provide detailed accounts of the type of anthelmintic that they would preferably purchase at different seasonal times. During dry season or drought, levamisole and 2.5% albendazole were preferred whilst 10% albendazole was used immediately after the rains.

In Marsabit there was a greater variation in responses within and between appraisals on the use and purchase of anthelmintics. In 3 appraisals the majority of the group claimed that people in the community did not purchase anthelmintics. Reasons included that they did not know which drugs to buy and they did not perceive internal parasites as needing treatment. The participants in these groups all purchased other drug types including drugs to treat trypanosomes, oxytetracycline and acaracides demonstrating that lack of access to facilities to procure anthelmintics was not a limiting factor.

62% of all household interviewees had administered anthelmintic to their livestock that they had procured themselves, 90% of which recalled doing so in the last year and 99% and done so in the last two years. In Isiolo only, a higher percentage of the study

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population (71%) had purchased and self-administered anthelmintic but a far lower percentage (42%) had done so in Marsabit.

The distribution of those self-purchasing dewormers between beneficiary and non-beneficiary populations of the total study population is shown in table 7. Whilst 74% of those that did not self-administer anthelmintics were receiving dewormers as beneficiaries, 47% were both self-administering and receiving dewormers as beneficiaries of the programmes ( P-value = 0.004). Only 10% of the total study population did not receive anthelmintic through any means

When the results are stratified; a higher proportion of the non self- administering population were beneficiaries in Isiolo (81%, P-value 0.02) whilst there was a lower proportion in Marsabit (70%, P-value 0.80). As a result a higher proportion of the study population in Marsabit did not receive or administer anthelmintic through any means, 18%, in comparison to only 4% of the study population of Isiolo.

There was an intra-appraisal difference in the purchasing behaviour of the tudy population as summarised by 2 KII in table. The source of anthelmintics self- purchased by household interviewees was agro-veterinary stores and pharmacies – Isiolo and CBAHW’s and “Duka’s” (small shop unofficially selling human and animal drugs) in Marsabit. In both counties a small number of respondents acquired anthelmintic from a neighbour or friend.

Table 7 Distribution of self-administrating population of household SSI's amongst the beneficiary and non-beneficiary population.

Beneficiary Non-beneficiary Total Total Study Population

Self-Admin. = Yes 33 (47.1) 37 (52.9) 70 (62) Self-Admin. = No 32 (74.4) 11 (25.6) 43 (38)

Total 65 (57.2) 48 (42.3) 113 (100) Chi squared value = 8.11; P – value = 0.004

Perceived change in output attributable to the provision of dewormers in the emergency drought response The mean proportion and corresponding confidence interval of milk output and condition score in all livestock species before and after deworming activity in the drought itself show considerable overlap (Table 8). The results of the t-test show that there is no evidence that there is a difference in the perceived change of either output (P = 0.31 for milk output and P = 0.34 for condition score). However, there was good evidence of a difference in the mean perceived proportional output of milk (P = 0.001) and body condition score (P < 0.001) before and after deworming carried out after the rains. Table 9 shows the perceived median change in output in the HHI study population. There was no difference in the perceptions amongst different groups of the household study population. All groups perceived a generalised change in both outputs after anthelmintic use. However, qualitative data collected concurrently showed that household interviewees also perceived a difference in the effect of anthelmintic when given at different times and that this difference was not apparent when dewormers were given in the dry period.

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Major factors attributed to the changes seen included increased grass and water availability that occurred concurrently to anthelmintic administration. This means that attributing absolute change to any dewormer used was not possible for participants of either PRAs or household SSIs. Although they did consider anthelmintic administration to contribute to perceived changes in output, quantifying its independent effect was not possible.

Table 8 Mean before and after deworming output score in two seasons and corresponding Welch t-test

Before After Score (P-value)

Dry

Milk 1.925 (1.38 – 2.47)

2.32 (1.68-2.97)

0.99 (0.34)

Condition score 2.08 (1.51 – 2.65)

2.5 (1.85-3.1)

1.03 (0.31)

Rains

Milk 5.56 (4.50 – 6.68)

8.41 (7.62–9.21)

4.35 (0.001)

Condition Score 5.13 (4.24 – 6.01)

8.19 (7.33–9.04)

5.3 (<0.001)

* Welch* Paired T-Accounts for unequal variance

Table 9 Perceived change in output with internal parasites and before and after deworming – HHI study population.

Status (n)

Beneficiary Self-administration County

Status (n)

Y (49)

N (38)

Y (47)

N (37)

Isiolo (45)

Marsabit (39)

% Change milk

Median and IQR

50 (30–50)

35 (20 –50)

40 (30 -50)

50 (20 – 50)

40 (30 – 50)

50 (30 – 50)

Z score (P- value)

1.38 (0.17) 0.300 (0.76) 1.06 (0.29)

% Change weight

Median and IQR

44.2 (15.6)

44.1 (14.8)

41.2 (15.3)

46.4 (15.0)

50 (40 - 50)

40 (40- 50)

*Z score (P- value)

0.33 (0.74) -1.49 (0.14) 0.86 (0.39)

Before and After milk

**score (P-value)

4.77 (<0.001)

3.34 (0.008)

3.93 (0.001

4.26 (0.001

4.79 (<0.001)

3.41 (0.0006)

Before and after

Weight

**Score (P-value)

4.66 (<0.001)

3.75 (0.002)

4.05 (<0.001)

4.39 (<0.001)

4.82 (<0.001)

3.52 (0.0004)

*Rank sum ** Wilcoxon rank score

30

Discussion Participatory methods were used to collect information about factors surrounding internal parasites in a non-biased way by eliciting information about the perceptions relative to other diseases. This prevented the relative effect of internal parasites on output being greater than truly perceived. These methods were also chosen to allow intra-appraisal differences in perceptions to be explored. The data from household SSI’s triangulate this information and both inter and intra-district differences were observed. The distribution of anthelmintics by IPs other than those of focus, the procurement of anthelmintics by livestock owners and the relative lack of sensitivity of measuring the changes in output throughout the period of interest meant that no comparison of change between beneficiary and non-beneficiary sub-locations could be made. However, differences in the perception of the effect of internal parasites, anthelmintic purchase, use and the role of external provision between districts were evaluated.

Limitations of study design Whilst the study sought to include a representative sample population for each sub-location, the study design is likely to have resulted in a bias towards a sedentary household study population. The points in the sub-locations where the studies were carried out were settled locations of varying size (with one exception). Whilst geographical features within these sites meant that members of peripheral locations were present, daily duties and travel time are likely to mean that participation in PRAs was lower than static contemporaries. Creating a sampling frame in each sub-location or location that accounted for all satellite households was particularly hard in Marsabit where a higher proportion of the population was mobile and had temporary residence. Communication to sub-location chiefs prior to the study was not possible. Identification of temporary households in the short time period of the study was hard to ascertain and a greater amount of time would be required to create a sampling frame and representative study population of each sub-location. It is likely that the study population in all sub-locations had a greater access to resources and services that will have influenced their knowledge base and perceptions than the population of the districts they represent. No information was available from sub-locations inaccessible as a result of compromise to security. PRA’s and SSI’s drew on open questions for nonbiased information, direct questions had to be increasingly used to ascertain information specific to internal parasites and their control. Such questioning techniques are also likely to have introduced information bias. Responses regarding the effects of internal parasites or anthelmintics will be influenced by the expectations of future work as a result of the appraisal. (Mosse, 1994). Whilst the research team tried to mitigate this by providing a full explanation of their purpose it cannot be excluded as an influencing factor of response.

The effect of the decision making process and operational strategies Whilst it was reported by the IP field teams that the DSG carried out rapid needs assessments, proposals from FAO were based on needs assessments from the Kenya Food Security Steering Group (KSSG). Methods used in this included discussion with the DSG, transect drives and limited community interviews. Whilst livestock mortality and morbidity is reported by the KSSG, causes of mortality and morbidity are not presented.

31

It is unclear what methods or if standardised guidelines – i.e. LEGS - were used to carry out these appraisals. As decision-making occurs away from the beneficiary population it is unclear what needs of theirs were included in the decision-making process. This is important when considering the empowerment of beneficiaries and determining appropriate provisions to their needs are received. The operational strategies and historical nature of the IPs in the study areas will also have influenced the perceptions of the study population. In Merti and Garba Tula districts in Isiolo there was a long history of anthelmintic provision in the study areas and frequent access to information and knowledge imparted by the DVO and operational teams may influence livestock owners. Use of knowledge of the effects of internal parasites rather than perceptions as a result of experience may have guided the answers provided. This will exaggerate the perceived effects of internal parasites and anthelmintics used. In addition primary animal health care was carried out concurrently to anthelmintic administration. This dichotic approach will increase the chance of a positive opinion towards activities by beneficiaries. A comparative top down approach was used in Marsabit. Communities saw self-identification of ‘vulnerable’ households as inappropriate. By May 2011 inhabitants of sub-locations commented that the selection criteria were no longer suitable as the drought had affected all households indiscriminately. This resulted in all available households claiming they had 50 small ruminants regardless of the number owned or present. Data collected from SSI demonstrated that tension occurred amongst CBAHWs as a result of by-passing the DVO in operations. No chain of command was present to negotiate grievances about the payment per dose they administered and the viability of the voucher-based system used. Reports were that by the time of administration livestock had moved away from distribution areas. CBAHWs then distributed one litre of 10% albendazole to 6 households (regardless of the actual number of livestock owned) on the assumption that each household owned 50 small ruminants, as recorded for voucher distribution. Distribution means that there is no accounting for the administrative use of the drug amongst beneficiaries. Knowledge transfer the role of internal parasites will have not occurred and if the perceptions of the study population are representative of their needs, a drug was distributed to treat a condition not perceived to have an effect. Free provision of a service of neutral impact in a critical time results in removing decision-making from the beneficiary population and is indicative of provision of an inappropriate resource – both of which are contra-indicated in standardised guidelines (LEGS). The contrast in these 2 operational strategies demonstrated that the operational approach is an important factor. Relationships with providers concurrent service provision influence perception of effect. In Isiolo the operations process was positive for all stakeholders but the perceived effect of any deworming activity are likely to be confounded by the concurrent treatments received.

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Discussion of major findings This study sought to study the impact of internal parasites on the output of all livestock species but due to the high levels of ownership and household dependency participants focussed on the effect on small ruminants. The effect of internal parasites on the condition score and milk production of livestock species is well documented (Scheurele, 2009; Perry, et al., 1999) justifying the indicators used to assess the importance of internal parasites and impact of anthelmintic used on animal health. Some assumptions of the household economic and nutritional impact of anthelmintics can be made from these results based on the importance of livestock species and specifically small ruminants to household wellbeing throughout the drought. As all PRAs considered livestock species to be the primary contributor to household wellbeing – as defined, as food and economic security - an increase in mortality and morbidity of any cause will affect nutritional and economic security. The effect of internal parasites must be considered relative to the loss from lack of pasture and water identified by all participants. However these conditions exacerbate concurrent infection as acknowledged by the study population. Assuming that clinical signs are diagnostic of the diseases mentioned, based on evidence of a statistical difference between scores, the effect of internal parasites is considered third to CCPP and Coernus Cerebralis (Gid cysts). Other studies have found similar findings of the importance of CCPP (Njanja et al., 2003) to pastoralists in Northern Kenya. Whilst these findings place internal parasites relative to other health needs, quantifying the subsequent effect at household level requires further information beyond the scope of this study. Information on the demographic of the household livestock population is needed to ascertain the nutritional and economic importance of these losses. These will be influenced by age and sex of species owned. This study also assessed the change in the “average” animal and did not account for the differences in intra-household livestock populations throughout the drought that were recorded at the time of the study. The majority of the animals owned were moved increasing distances away from the homesteads to access available pasture during the dry periods and drought. A number of small ruminants (approximately ten per 2 homesteads) were usually left at the locations for the homestead members to use as a food source. These patterns imply that maintaining the economic and nutritional value of the livestock owned and the contribution of this to household wellbeing involves two different livestock populations. The treatment of each will have different household effects. These were not accounted for in this study that assumed every animal had an equal nutritional and economic value. The difference in response by participants of PRA’s and SSI’s in open and direct discussions on issues surrounding internal parasites raises significant points for discussion. The reason for the difference in response were very different in the two study counties and raise important issues about the inter district differences in the epidemiology of internal parasites.

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In Isiolo the reasoning was consistent with internal parasites being perceived as a condition that was always present and whilst causing some clinical signs these were not comparable to the mortality and morbidity seen with other diseases mentioned. The sudden onset of more sever clinical signs of other diseases resulted in the perception of risks of the disease being far greater. The inability of livestock owners to predetermine or control for these alternative conditions also influenced response. This suggests a perception of an endemic but controllable condition. In Marsabit county the reasons provided were very different and centred around no signs or effects on output being observed in livestock owned. This hypothesis supports the evidence from the SSI with a slaughterhouse worker in North Horr who reported no evidence of internal parasites in the gastro-intestinal tract of slaughtered animals. Previous studies have shown mixed infection of species of Trichostrongyloidae parasites the most prevalent species in the tropics and responsible for clinical signs that are consistent with those listed (with the exception of “eggs in faeces”). Haemonchus Contortus is the predominant species of gastro-intestinal parasites in small ruminants in (Fagbemi et al 1982) (Githiori et al,. 2005). It is therefore assumed that these are the prevalent parasites of these areas. The description of “eggs/ rice grains in faeces” is consistent with tapeworm infection, Moniezia spp., that would also result in clinical signs that consistent with those observed (Scheurele,2009) The nematode parasites have a direct life cycle involving a period of larval development on the ground before the infective L3 stage is ingested. This maturation period requires optimal conditions of temperature and humidity (Scheurele, 2009) The change in morphology can be stalled by high temperatures but once the third larval stage is reached infective larvae survive for longer in dry conditions (Craig, 1999). However, the high temperatures will inhibit any movement of surviving L3 larvae onto surrounding herbage where they may be consumed. Faecal pats will therefore be the most important reservoir of infective L3 (Chiejina, et al. 1989). In extensive grazing systems – such as those practiced by all pastoralists – livestock should have a low parasitic burden as they have less contact with reservoir faecal pats. Observatory data from the borders of the Chalbi desert, where these sub-locations reporting no effects are located showed large areas of salt deposits on the ground surface (see cover photo). These observations are supported by the findings of ecological studies in the area which report “extensive salt crusts at the surface” and that the salinity levels of the area even reach toxic level for some non-indigenous shrubs (Olukoye, et al, 2003). These observations may be connected with the result from all PRA’s and SSI’s;- access to salt water and ground salt is a method of preventing internal parasites. As a result of the difference in perceptions of internal parasite infection in the two counties, the unanimous perceptions of salt as a preventative for internal parasite infection and the observed geographical features in the area, it is hypothesised; that the life cycle of any internal parasites in North Horr is interrupted as a result of salinity levels of the area that inhibit any L3 survival (Craig, 1999). In Isiolo the increased stocking density as livestock graze around remaining water sources may increase the

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risk of infection. Anthelmintic use in Marsabit would therefore be contraindicated but further study of the epidemiology of internal parasites in these regions is needed. Intra sub-location differences in the perceived effect of parasites indicate that differences in livestock keeping systems of small ruminants may affect infection levels. Livestock kept close to the homestead will have a limited distance they can move for pasture. A more rapid decline in pasture levels and nutritional status are factors known to increase the risk of parasite infection in wild ruminants (Ezenwa, 2003) and may be of equal importance to domesticated species whose risk of infection increases with the subsequent increase in stocking density of available grazing areas. These findings suggest sedentary livestock populations have a different risk of internal parasite infection to the mobile herds counterparts. The difference in self- purchase of anthelmintic in the study populations reflects the perception of internal parasite risk between the two districts; higher in Isiolo (71%) than Marsabit (42%). The source of anthelmintics acquired in the two districts suggests that there is a greater access to permanent trading centres with permanent private franchises – agro-veterinary stores and pharmacies – in Isiolo than in Marsabit. This is consistent with the spatial distribution of franchises identified by the study population. There was a greater dependency on CBAHW’s and “Duka’s” (shops unofficially selling animal and human drugs) in Marsabit district. That none of the study population reported government led veterinary services as a reliable service for animal health provision demonstrates its limited capacity within these areas. Evidence suggests there is at most 1 government vet per 13,000Km2 and 140000 small ruminants in the county of Marsabit (Munyua, et al 1999). This is likely a result of the limited infrastructure, roads, settled population and high mobility of the population - factors that limit the economic potential of static services (Catley et al,. 2004). Observations at the time of the study support this information as two private franchises in two of the locations in Dukana district had closed in the last year. There is therefore a high dependency on CBAHW’s in Marsabit for provision of services. However, accessibility to CBAHW’s on which livestock owners were dependent for anthelmintic is dependent on a reliant supply of drugs to these areas for them sell and that they move with the livestock herds (Catley et al,. 2004). However reporting of purchase of antibiotics (oxytetracycline, penicillin) acaracide’s and anti-trypanosome drugs suggests that accessibility to animal health services may not be a limiting factor in the provision of anthelmintic. The intra-appraisal differences in purchasing behaviour suggest that economic differences may determine purchasing power. These effects are likely to be heightened during and after the drought period (Swift et al,. 2002). Increased sale of livestock to feed family members demonstrates that priority purchases to meet basic needs will be made with available cash in the face of the drought. Sale for salvage will result in a lesser amount of money that is unlikely to meet these basic needs reducing the purchasing power for animal health goods in households. Free provision of animal health services in these times would therefor be of benefit but anthelmintic use in dry or drought times is contrary to the behavior of livestock owners who perceived no effect from anthelmintic use at this time. Trends in sales of anthelmintic provided by agro-veterinarians and CBAHW’s support this.

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The results of the before and after scoring in rainy times and concurrent qualitative data suggest there is evidence that anthelmintic use has a positive effect on livestock output when used at this time. However, due to the nature of the data collected there is no evidence that the improvement can be attributed to drug use and it is highly likely that the effect is a partial. The main contributory effect was the concurrent improvement in grazing quality and available water. However, the evidence that livestock owners choose to procure anthelmintic at this time suggest that livestock owners consider the economic benefits from improved output to justify the costs of purchase. Although there is a small (but not significant) perceived improvement in output after anthelmintic use in the drought period this effect should be interpreted with caution. Participants were cautious that the high levels of livestock loss negated any effects to the herd at the time, that any improvement was temporary because of the lack of pasture and that inadequate pasture and outbreaks of other disease of greater significance were of greater concern at this time. Whilst the objective of this project was to assess the impact of deworming by the difference in output between beneficiary and non-beneficiary responses, this was not possible. The methods used were not sensitive enough to detect these changes and there was a far more complex relationship between implementing partners of the emergency response, local service providers and livestock owners that prevented this comparison.

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Conclusions This study provides evidence of the perceived effect of internal parasites in two counties where drought is a primary hazard that initiates an emergency response. There were historic differences in the role of anthelmintics in this response and clear differences in the planning and operational strategies of the two IP’s of focus. Whilst not of direct focus the study also demonstrated the high number of IP’s that implement anthelmintic provision as part of their response programmes. The study clearly demonstrates that the use of anthelmintics is perceived (and likely) to be greatest when provided after the rains proceeding the drought and that administration during the drought itself is considered untimely and of limited benefit. The actions by livestock owners procuring anthelmintic after the rains suggest that the greatest cost-benefit of administration is perceived at this time as well. Further study is required to quantify the benefits that are attributable to anthelmintic use and not to the concurrent improvement in grazing quality. In addition further information on the relative use anthelmintics to improve fertility recovery times were not investigated in this study and may be of benefit to the recovery of households. Whilst the study provides evidence of the perception of the relative effect of internal parasites to animal health a more detailed study of the risks to different demographic groups of each livestock species is needed. The intra-household division of livestock species may result in differences in the risks of infection to livestock, differences in the accessibility to animal health services to meet health needs and ultimately a difference in the value of the emergency response in maintaining the health of each population respectively. Further information on the contribution of each demographic sector of livestock to the nutritional and economic wellbeing of households is also needed to assess the impact of livestock health programmes at a household level. The epidemiology of internal parasites within the SAAL’s is hypothesised to be different in these two districts but further work is needed to support this theory. These findings could have considerable implications on the evidence basis for future decision-making on strategic and responsible role of anthelmintic use in these areas. Whilst the free provision of animal health services and the cash injection to local franchises during and proceeding the drought is supported by the findings of this study, the provision of resources otherwise not available to livestock owners that will prevent diseases considered of greater risk to the health of livestock may be considered of greater value. However there is a clear disparity in the socio economic status within sub-locations demonstrating that some will benefit from all animal health service provision. There was a difference in animal health providers themselves they too will encounter concurrent challenges during the drought that may impede service delivery.

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