Social determinants of human anthrax transmission in Zambia.

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Sitali, Doreen Chilolo
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The University of Zambia.
Zambia has experienced an unprecedented increase in the number of human anthrax outbreaks in the Western Province where cycles of epidemic outbreaks commonly occur at the onset of rains after prolonged dry periods and frequent outbreaks occur in Chama District of Muchinga Province. Epidemics are triggered by an interplay of environmental and human activity factors. Notwithstanding that ecological and epidemiological factors have been researched to some extent, there is insufficient information concerning the social factors that influence human behavior associated with anthrax transmission in Zambia. The study was set to explore the socio-economic, cultural and political determinants associated with human anthrax transmission in Zambia. The study was conducted in the Western and Muchinga Provinces of Zambia. A convergent parallel mixed methods design was used to collect both quantitative and qualitative data. A questionnaire survey involving 1,127 respondents, six focus group discussions, and eight key informant interviews were conducted to collect data. The respondents included cattle farmers as well as those who are in contact with animals. Descriptive statistics of quantitative data and thematic analysis of qualitative data were run concurrently but separately. The use of matrices facilitated interpretation of both quantitative and qualitative results. Many of the socio-demographic and socio-economic characteristics of respondents suggested that the majority were living below the poverty datum line. A larger proportion (85%) of respondents never attended school. The study also found that most of the respondents in both regions (76%) in Western and (51%) in Muchinga respectively, had no access to safe drinking water and sanitation facilities. The study further established that, though the majority (88%) of respondents were knowledgeable about anthrax and knew that vaccination was a useful preventive measure, they had negative attitudes towards most control measures due to low perceived efficacy of the vaccine and lack of trust of professional staff. Also, 78.1% of those interviewed ate, sold or shared meat from dead animals suspected to have died of anthrax. A large proportion (68%) of respondents participated in slaughtering moribund animals, and only 13% had their cattle incinerated or buried when they died of disease. Based on the study findings, it can be argued that poverty; cultural practices such as mafisa (a traditional practice common in the Western Province where a cattle owner entrusts his cattle to another herder to reduce risk of losing all the animals), gender roles and responsibilities, and socio-economic factors are fundamental drivers influencing human anthrax transmission. Also, lack of community involvement, inadequate collaboration among veterinarians, ecologists, medical professionals, and social scientists, and inadequate logistical support adversely affects the control of anthrax in the communities affected. Lastly, geographical remoteness of the two regions compromised the effective monitoring and control of the disease by veterinary staff. Based on the study’s findings, government needs to provide funding for anthrax control and tackle poverty. Collaboration with ecologists, medical professionals, and social scientists within the One Health framework is essential to effectively tackle the socio-cultural issues surrounding cattle rearing and meat consumption beliefs. There is need to conduct a comparative random sampling based study that will allow for generalization of findings and provide a comprehensive understanding of how different factors shape anthrax transmission.
Thesis of Doctor of Philosophy in One Health (Public Health).