Assessment of community knowledge, attitude and practices for sustainable control of tsetse and tsetse-borne trypanosomosis in Meatu district, Tanzania

D J Malulu^1,2, E N Kimbita², H N Tuntufye², S Kinung’hi³, H S Nyingilili¹, E Lyaruu¹, T Mbilu⁴, J K Sahani⁴ and I I Malele¹

¹ Vector and Vector Borne Disease Institute (VVBD), P.O. Box 1026, Tanga, Tanzania
maluluone@hotmail.com
² Department of Microbiology, Parasitology and Immunology, Sokoine University of Agriculture (SUA),P O Box 3015 Chuo Kikuu Morogoro, Tanzania
³ National Institute for Medical Research (NIMR), Mwanza Centre, P O Box 1462, Mwanza, Tanzania
⁴ National Institute for Medical Research (NIMR), Tabora Centre, P O Box 482, Tabora, Tanzania

Abstract

This paper reports the knowledge, attitude and practices of respondents in selected villages of Meatu district on trypanosomosis collected through a cross-sectional study which involved 306 participants. Tsetse was well known vector of trypanosomosis by about 70 % of participants. Animal African Trypanosomosis (AAT) was known by 90.2 % (259) while Human African Trypanosomosis (HAT) was known by 40.3 % (123). Seventy percent of respondents knew the correct clinical signs of HAT while 68.6 % (177) knew the clinical signs of AAT. The use of trypanocidal drugs was up hazard with only 5.2 % observed recommended veterinary drug use and 46.4 % could not recall how they used drugs in treating AAT. The awareness on HAT trend has shown to be increasing in recent years compared to previous years with school and health centres playing a front role. Since HAT health services are inaccessible and current trypanosomosis control techniques are not sustainable an integrated approach involving community is essential.

Keywords: community, nagana, sleeping sickness

Introduction

Trypanosomosis is a neglected tropical disease that continues to be a constraint to livestock-development in about 38 African countries and causing a fatal human disease (Allsopp, 2001). Tsetse borne sleeping sickness and nagana seriously impede agricultural sector development which employs about 80 % of rural people in the country. It threatens hundreds of lives the productive force resulting into gravely economic losses.

The tsetse borne trypanosomosis is mainly managed through vector control and/or parasite control. Vector control is done by use of traps and Insecticide treated targets (ITTs) the main technique employed in national parks, game reserve and areas adjacent to reserved areas (Daffa et al 2003). Insecticides application utilizes synthetic pyrethroids which are available through government subsidy (URT 2011; URT, 2016). Hand spraying and dipping constitute major control methods. The application of Sterile Insect Technique (SIT) led to eradication of Glossina austeni in Zanzibar (Msangi et al 2000) and has not been extended in other parts of the country due to several constrains, including cost. Parasite control is done through the application of chemotherapy and chemoprophylaxis. The dependence on trypanocidal drugs alone is not sustainable because of prohibitive prices, unreliable supply and the risk of emergence of trypanosome resistant strains (Matovu et al 2001).

Attitude and knowledge plays a significant role in practices taken towards any disease trypanosomosis inclusive. At community the knowledge, attitudes and practice on trypanosomosis have been inherited, acquired and shared within the community for thousands of years and through all these years the community has evolved a way of surviving in the deadly environment. Though assessment on community Knowledge Attitude and Practice (KAP) on the vector and the diseases have been conducted in Tanzania (Kinungh’i et al 2006; Byamungu et al 2016) their application in tsetse control is limited leading to re-infestation of tsetse in controlled areas. In most cases communities are implementers of the projects activities ignoring the fact that the vector and diseases have evolved within the community for years. Double control costs emerge as a result of non integrative and non participatory approaches. Entomological as well as parasitological surveys when coupled by a study on the community KAP gives an immense understanding of the community, disease and vector therefore increases advantages of intervention success.

This paper presents knowledge, attitude and practices of four villages (Buganza, Mwanyahina, Makao and Mwangudo) of Meatu district on tsetse borne diseases with a view to adding to how the information could be best tapped, addressed and integrated in the control.

Methodology

Study area

The study was conducted in Meatu district located between longitude 34°8' and 34.49"E and between latitude 2°57' and 4.9"S in two wards (Mwanyahina and Mwangudo) in their four villages namely Mwanyahina, Buganza, Mwangudo and Makao (figure 1). The district is among five districts of Simiyu region. The district has the size of about 8 871 km ² and a population size of about 296 616 people according to the 2012 Tanzania National Census (URT, 2012). Meatu experience a uni-modal rainfall which usually starts from October up to May. The average annual rainfall ranges from 400 mm to 900 mm. Its vegetation is mainly open bush savannah dominated by acacia species. The district borders Maswa Game reserve to the North and Ngorongoro Conservation Area (NCAA) on the North eastern part. These wildlife conservation areas are active source of tsetse infestations and hence making the district a viable candidate for the study.

Sampling techniques and data collection

Purposive sampling technique was used in the wards and villages selection. The relative position to Game reserve and National Parks and cattle population were the criteria. A cross sectional study was conducted in September 2015 to assess community’s knowledge, attitude and practice on tsetse borne trypanosomosis using semi structured questionnaire. The questionnaire was addressed to subjects regardless of gender to respondents aged 18 years and above. A pre-test and introduction of the study objectives to the village leaders were done before the study was conducted. Oral consent was obtained before a questionnaire was administered to an individual. Sample size of 306 respondents was interviewed.

Data management and analysis

Data was entered, coded and summarized using Microsoft Excel (2007) spreadsheets and then analysed by using Epi info 7 software (CDC, 2014). The coding involved assigning codes to open ended responses after structuring them. Descriptive analysis concentrated on frequencies and percentages.

Results

Socio-demographic characteristics

Information on Knowledge, Attitude and Practice (KAP) was collected from 306 respondents from the selected two wards covering four villages. Table 1 summarizes socio-demographic information. Makao village contributed 46.4 % of all respondents followed by Mwanyahina, Buganza and Mwangudo. Among respondents 52.3% were females and males constituted 47.7 %. The largest group of the respondents aged 19-29 years (32.7 %) while the least group had 40-39 years (21.6%). Seventy percent of the respondents were literate where by 60.1 % (184) had attained primary education, 8.17 % secondary education while 2.61% were college graduates. Three major means of livelihood in descending order were agro-pastoralism, pastoralism and other activities (of bee-keeping, retail shops) corresponding to 74.2 %, 11.8 %, and 6.54 % respectively. Women aged 18-29 years contributed a fairly large proportion of agro-pastoral. Pastoralism in contrast was a male’s activity.

Livestock management and awareness of animal trypanosomosis

Two livestock management system were distinct; crop-livestock and pastoral system the previous being dominant than the latter. Table 2 illustrates livestock possession whereby owning more than one livestock species was common (98.4 %). Cattle were kept by 10.1 % of respondents whereas the largest group (37.3 %) of respondents kept cattle, goat, sheep and dog followed by cattle, goat and dog (16.9 %), cattle and dog (13.4 %), cattle and goat (10.5 %). Least groups were cattle and sheep and sheep, goat and dog 1.31 % each.

Knowledge on bovine trypanosomosis

Table 3 below illustrates knowledge about nagana/bovine trypanosomosis. The disease was mainly referred to as “Bhusatu bho ngi” (66.0 %) word equivalent to fly disease by kisukuma language (a largest proportion tribe found in the area). Eight percent referred it as “ndorobo” a Kiswahili word meaning tsetse fly so they literally meant tsetse fly disease. About 8.95 % referred it as “ngaroti” a Kimasai word meaning diarrhea disease and 18.5 % did not know the local name . Tsetse was known as the source of nagana (77.6 %) though other still believed it is associated with witchcraft (3.60 %).

Figure 1 illustrates bovine diseases of economic importance in Meatu where bovine trypanosomosis was ranked the first in respect to other diseases followed by East coast fever (ECF).

Figure 1. Cattle disease of economic importance in Meatu by village

Clinical signs and perceived impact of the disease are shown in figure 2, the first recognized signs by respondents were emaciation and starry hair coat, abortion and anemia while a proportion of respondents did not knew the signs. Respondents associated nagana with abortions and still births, weight loss and increased treatment costs while high mortality was ranked the last.

Figure 2. Clinical signs and perceived impact of Nagana

The drugs for treatment of nagana are shown in figure 3. It was observed that Berenil (Diminazene aceturate) was widely used for treatment against AAT, followed by Oxy tetracycline (OTC), Samorin (Isometamidium chloride) and Novidium (Homidium chloride). A proportion followed the instruction recommended for veterinary drug use with the majority could not recall which drugs were used in livestock and some of the respondents reported once to twice per week drug administration.

Figure 3. Drug use and drug use frequency by village

Awareness of sleeping sickness and risk perception

Sleeping sickness was known to 40.3 % (123) of the respondents while 70.2 % (87) mentioned sleeping sickness symptoms; fever (37.9 %), swelling of the lymph nodes (14.5 %), headache (9.68 %), abnormal appetite (5.65 %) and general body malaise (2.42 %) while 29.8 % did not know the symptoms of sleeping sickness (Figure 4).

Figure 4. Sleeping sickness awareness and clinical signs

Figure 5 indicated the trend by which the information on sleeping sickness was delivered. The information on the disease revealed to be increased in 2000s (48.6 %), followed by early 1960-1989 (32.7 %) and 1989-1999 (18.7 %). Health centres and schools (53 %) play a half role in dissemination information, followed by friend relative or friend (24.8 %), radio (16.5 %) and newspaper (5.79%).

Figure 5. Source of sleeping sickness information and year

Table 4 summarizes further HAT information collected in the area. About 11.4 % respondents reported sleeping sickness to be the problem whereas 2.44 % did not know whether sleeping sickness was a problem and 84.8 % reported that sleeping sickness was not a problem. About 70.9 % of the respondents identified tsetse as source of sleeping sickness, 20.2 % respondents reported mosquito, 2.42 % associated it with witchcraft, 0.81 % other parasite and 5.65 % did not know the source.

Identified sleeping sickness risk areas included bush/forest (62.3 %), grazing areas (17.2 %), at home (6.56 %) and in the bush roads (4.10 %) and 9.84 % did not knew. Eighty percent of diseased people are sent to hospital, 3.54 % are sent to traditional healers while 2.65 % did nothing, while 13.3 % did not knew what to do. Sleeping sickness treatments were not easily accessible in the area (89.7 %) and there are no sustainable tsetse control activities in place (72.6 %). The ongoing tsetse control methods reported by 27.4 % of the respondents were insecticides spraying of livestock, 55.9 % bush clearing and 44.1 % bush fire. (Measures suggested by respondents included tsetse control (29.0 %), disease surveillance (25.8 %), building of health centres and staffing (12.9 %), avoid tsetse (12.9 %), accessible health services (drugs and vaccine) 8.06 % (Figure 6).

Figure 6. Current and perceived sleeping sickness control measures

Discussion

Knowledge

Community is aware that tsetse is the source of trypanosomosis where bush /forest and grazing land are most risky areas. Awareness on AAT is high compared to HAT. This may be due to the pathogenicity observed in cattle and the understanding that bush and forests which they are near to are the sources of infection. Game reserves and wildlife management areas offer alternative sources of pastures to their animals during drought despite strict bylaws and penalties that prohibit animals from grazing. Poor awareness of HAT on the other hand is attributed to reduced cases of HAT in the area which may be due to high use of Diminazene aceturate (Figure 3) which reduced Trypanosoma brucei rhodesiense circulation in livestock and vector in Uganda (Matovu et al 1997; Fevre et al 2001). However, reduced HAT awareness may be contributed by under reporting which results from shared clinical signs with other fever causing diseases (Kennedy 2012). Furthermore, contents of text books describe poor sleeping sickness disease while their availability in schools especially in remote areas (where HAT is also endemic) significantly affect teaching resulting to poor awareness of HAT to students. Therefore, there is a need to improve and create new HAT awareness channels such as the use of social media (Olet and Othieno 2015) which their use among youth is increasing. The use of social media in awareness creation has proved useful in cancer awareness (Laponte et al 2014). Leaflets and pamphlets could convey information directly to the users if they will be made available. Moreover, Schools can serve as a reliable information source if sleeping sickness clubs will be formed to schools found in endemic areas and number of science text books will be made available to schools. These would increase awareness and subsequent reliable information disseminated to others.

Attitude

Community views AAT and HAT as important diseases. This is vivid from positive disease control efforts and medical seeking behavior the community has. Nevertheless the community view trypanosomosis control in a multidimensional approach rather than unidirectional (Figure 6). In this way the community is prepared to participate in tsetse and trypanosomosis control which will be advocated their area.

Practice

Livestock keeping is a source of livelihood in Meatu district for many of its residents where the practice of keeping more than one livestock species seems to be a way of diverging income sources. While the challenge of bovine trypanosomosis was high, the chances of contracting sleeping sickness are high as well due to ownership of different domestic species (Ruiz et al 2015). The mixed management systems (pastoral and agro pastoral) present a threat of distribution of resistant strains (Selby et al 2013). Grazing livestock in the protected parks (game reserve) during drought increases chances of contracting trypanosomes as well as other parasites and vectors harboured in wildlife (Auty et al 2012). Competition for available water sources with other uses during dry season limit insecticide application (both spraying and dipping) and cause dependency on chemotherapy only for control which can lead to drug resistance strains emergency (Matovu et al 2001; Kibona et al 2006). The application of insecticide pour on technique could help in minimizing the effects during drought (Rowlands et al 2001). Since farmers treatment regimes is based mostly on clinical signs which are shared by other diseases there is need for strategic education in specific nagana clinical signs and proper drug use. While the utilisation of trypanotolerant livestock in Tanzania is limited (Mutayoba et al 1989) their use could ease trypanosome control challenge to farmers (D'leteren et al 1998). Livestock intensification and use of prophylactic than chemotherapy would reduce the costs which farmers do not see (FAO, 1998).

The ongoing vector control interventions are not environmental friendly because they are associated with vegetation destruction which can reduce tsetse belt in a while but contributing to climatic change in the long run (Malele et al 2011).

Conclusion

• The awareness of AAT is higher than HAT among village residents; new awareness dissemination means need to be instituted.
  
  
• Since chemo treatment plays as main trypanosomosis control which is a risk factor for emergency of resistant strains, prophylactic use should be promoted.
  
  
• Training and advocacy of integrative and participatory tsetse and trypanosomosis control approaches following what is perceived important by community are is essential for realization of control success.

Conflict of Interest

The authors declare that there is no conflict of interest regarding the publication of this paper.

Acknowledgement

We acknowledge financial support provided by the Tanzania Commission for Science and Technology (COSTECH) GRANT NO: CST/RA.56/1426/2013, and for this we are grateful and appreciative. We also sincerely thank the District authorities for Meatu district and the village authorities and communities for agreeing to participate in this study.

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Received 20 January 2017; Accepted 26 February 2017; Published 1 May 2017

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