UW tV fR S IT V OF O H A H A LIBRARY UNIVERSITY O F GHANA TH E BA LM E LIBRARY BAT,ME LIBRARY THESES 1. Balme Library theses are available for consultation in the Library. They are not normally available for loan, and they are never lent to individuals. 2. All who consult a thesis must not copy or quote from it without the consent o f the author and o f this University. 3. Any copying or quotation permitted should be duly acknowledged. RC121.A6 Op 1 blthr C.l G 359m The Balme Librar University of Ghana http://ugspace.ug.edu.gh KNOWLEDGE, ATTITUDES, BELIEFS AND PRACTICES OF INHABITANTS OF THE TAMALE MUNICIPALITY ON ANTRHAX: IMPLICATIONS FOR THE PREVENTION OF HUMAN ANTHRAX BY CHARLES OPARE A DISSERTATION SUBMITTED TO THE SCHOOL OF PUBLIC HEALTH, LEGON IN PARTIAL FULFILMENT FOR THE AWARD OF MASTER OF PUBLIC HEALTH OF THE UNIVERSITY OF GHANA SEPTEMBER 1999 University of Ghana http://ugspace.ug.edu.gh - 339113 R c \ ■ M O f \ \ V slS ^ 6 R p O 'w a University of Ghana http://ugspace.ug.edu.gh DECLARATION ii I declare that this dissertation has been the result o f my own field research, except where specific references have been made, and that it has not been submitted towards any degree, nor is it being submitted concurrently for any other degree. Dr. B. D. Akanmori University of Ghana http://ugspace.ug.edu.gh DEDICATION This work is dedicated to my wife Evelyn, and the children; Linda, Loreen, Alice, Emma and William, for their encouragement, support and the sacrifices they made towards it. May the Good Lord bless them . University of Ghana http://ugspace.ug.edu.gh ACKNOWLEDGEMENT “Education is expensive but ignorance is more expensive” . For this reason, I am most grateful to the Good Lord for providing me with the opportunity, strength and grace to see me through this Master’s course. I am indebted to all my lecturers for providing me knowledge which helped me at the Tamale Municipality for the production o f this dissertation. I wish to place on record the support and direction from my field supervisor, Dr. Agana Nsiire, Metropolitan Director for Health Services,Tamale. Special thanks to Drs B.D. Akanmori ,Senior Research Fellow, Noguchi Memorial Institute for Medical Research, and Bawa Awumbilla, Senior Lecturer, Department of Animal Science, University o f Ghana, for their direction, supervision and constructive contributions during the preparation and writing o f this work. I benefited from the suggestions and direction o f Dr Matilda Pappoe o f the School o f Public Health and I am very grateful.To name all the people who have contributed substantively to this work would double its length. However, to Mrs Fati Dimah, Mr N.M. Abdul -M um in and their colleagues and Miss Evelyn T. Bayon who helped in the questionnaire administration and preparation o f this work, I am very grateful. And to the communities I visited and those who consented to be interviewed, my debt and gratitude to them is not lessened. Thank you to each o f you- named or unnamed. I thank my sponsors the Ministry o f Food and Agriculture for their support. My warmest acknowledgement is reserved for my favourite critic, my exacting but enthusiastic partner, companion and friend, Abena for her contribution. Finally, I register my profound gratitude to the Director and others from the School of Public Health, the staff o f the Municipal Health Office, Tamale and all who in diverse ways helped me to get this work produced. May the Good Lord bless you all. University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS PAGE Title Page ' Declaration 11 Dedication 111 Acknowledgement 1V Table o f contents v List o f Tables and Map viii Abstract x Chapter One 1 1.0 Introduction 1 1.1 Background 1 1.2 Statement o f the Problem 3 1.3 Rationale for the Study 4 1.4 Objective o f the Study 5 Chapter Two 6 2.0 Literature Review 6 2.1 History of Anthrax 6 2.2 Anthrax as a disease in Livestock 7 2.3 Anthrax as a Human disease 8 2.4 Anthrax in livestock in Ghana 9 2.4.1 Human Anthrax in Ghana 10 2.5 Control o f Human Anthrax 10 2.5.1 Control o f Anthrax in livestock through vaccination 11 2.5.2 Control o f Anthrax in Livestock through Public Education 11 2.5.3 Prevention o f Human Infection 12 University of Ghana http://ugspace.ug.edu.gh 2.5.4 Constraints to control o f Anthrax in Ghana 12 2.5.5 Human Behaviour and Anthrax Outbreaks 13 2.6 The Conceptual Framework for the study 13 2 .6.1 Drawing on local knowledge and making locally relevant and acceptable 14 2 .6.2 Beliefs 14 2.6.3 Knowledge, Attitudes and Practices o f people in relation to disease 15 Chapter Three 16 3.1 Study Design 16 3.1.1 Variables Studied 16 3.2 The Tamale Municipality 16 3.2.1 Population and Administration 16 3.2.2 Rainfall and Vegetation 16 3.2.3 Infrastructure and Social Amenities 17 3.2.4 The Health Care System and Facilities 17 3.2.5 The Social and Political Structure o f Dagbon 18 3.2.6 Economic Activities 20 3.3 The Study Population 20 3.4 Sampling 20 3.5 Data Collection 21 3.5.1 Primary Data 21 3.5.2 Secondary Data 21 3.6 Quality Control 21 3.7 Analysis o f Data 22 3.8 Ethical Consideration 22 University of Ghana http://ugspace.ug.edu.gh Chapter Four 4.0 Results 23 4.1 Socio-Demographic Characteristics o f Respondents 23 4.2 Knowledge, Attitudes, Beliefs and Practices (KABP) o f Respondents 23 4.2.1 The Disease in Animals and its causes 23 4.2.2 Signs o f Anthrax in Animals 23 4.2.3 Vaccination against Anthrax 25 4.2.4 Causative Agent 25 4.2.5 Risk Factors 28 4.2.6 Disposal o f carcass 28 4.2.7 Prevention o f Human Anthrax 29 4.3 Distribution o f KABP on Butchers and Consumers 29 4.4 Interrelationships between Socio-Demographic characteristics and KABP 31 4.5 Focus Group Discussions (FGDs) and In-depth Interview 33 4.5.1 Focus Group Discussion Findings 34 4.5.2 In-depth interview Herbalist/Soothsayer 35 4.5.3 In-depth interview with Acting Regent 37 4.6 Discussion 38 Chapter Five 41 5.0 Conclusions and Recommendations 41 5.1 Conclusion 41 5.2 Recommendations 43 References 44 Appendix Figures Questionnaire University of Ghana http://ugspace.ug.edu.gh Table Table Table Table Table Table Table Table Table Table Table Table LIST OF TABLES PAGE 1 Distribution o f Respondents by Age, Sex, Education, Marital Status and Religion 23 2 Distribution o f Respondents by what they attribute sudden Death in cattle to 23 3 Distribution o f Respondents by their knowledge concerning Anthrax and Vaccination 25 4 Distribution o f Respondents by what they know about Anthrax And Vaccination 25 5 Distribution o f Respondents by their attitudes and beliefs on Anthrax 26 6 Distribution o f Respondents by their perceptions and practices Relating to Anthrax 26 8 Distribution o f KABP on Butchers 29 9 Distribution o f Respondents (Butchers) on what Anthrax is 29 10 Distribution o f Respondents (Butchers) on what they would do When called to butcher carcass o f cattle 29 11 Distribution o f KABP o f Consumers on Anthrax 29 12 Distribution o f Respondents (Consumers) knowledge on what Anthrax is 29 13 Distribution o f study population by religion and where to send sick member o f family 30 University of Ghana http://ugspace.ug.edu.gh Table 14 Distribution o f study population by religion and knowledge o f Local name for Anthrax Table 15 Distribution o f study population by level o f education and usage of herbs to prevent Anthrax Table 16 Distribution o f study population by age group and usage o f herbs to prevent Anthrax University of Ghana http://ugspace.ug.edu.gh DIST lidSs^ \VSANIUM/*J,'iiow N avoroogo* 1 J ^ o n g o * Zcbfla I B A W K U E A S T i BolgaUnga b o l g a t a n g a JERAPA LAMBUSSIE, BUILSA G&mhaga EAST MAMPRUSI Wakwaie • * NadowlI NADOWLI WEST MAMPRUSI. GUSHIEGU /KARAGA Cufhl'H’u • •SAVELUGl v NANTON | V S A B O B A I CHEREPONP ' Saboba«i TOLON KUM BUNGO DAGOMBA1 Yendl • ZabzuguYENDITanudeWEST GONJA ZABZUGU TA TA L E BLmbUi EAST GONJA NANUMBA NVwanta •KINTAMPO NKWAJVTA • KLnUmpo ATEBUBU JAMAN NKORANZA S U N Y A M 1 rVirman Abeokf SEKYEREEAST % Mampooc Donkokrom •HOIOFO, ANO SOUTH j AP"RAM PLAINS KWAHU SOUTH • Mpraeso A S U N A F O >H/lNT\ ?AN TEAKW , :ESO-BlA KROBt ADANSf EAST SEFWI WIAWSO jevr AdubUtsl K W A P Ij KRABOA / Jp R TH . C O A L TA B ^ S O W }// AKWAMty — / ^ \ WEST Ailm Od« \ A K IM \ i V • \ BIRIM SOUTH \ Asuni AJrropon£ Dodowa s^DANGBE DANGBEV Asankragui TEM A• Fo«rASlKU^ j?^ *fa55*S >/ ODOBEN k A G O n A ^ V f EKYA ¥ }:\ I . J i G O M U A / . WASSA-AMENFI JOMOR( NZIMA EAST lHAN T / r f o * ----------------------------------------j - 11 w LEGEND + InL B oundary _ „ ___ Regional Boundiu-y © .................- N allonaJ CapiLai * 0 . . . . . - Regional C ap ita l » _ _ _ _ . D ls lr id C ap ita l 9-00 KRACHI K eU k r ich J # Kadjebl JasQcaa* JASIKAN HOHOE . 7 W ADEDOM E A dldom e 5 / KETU^ IVnu OWIN-SUAMAN • EochJ 0°00 University of Ghana http://ugspace.ug.edu.gh ABSTRACT The study was intended to find out the knowledge, attitudes, beliefs and practices o f cattle owners, herdsmen, butchers and consumers on anthrax, its transmission, risk factors and prevention, in order to determine the human behaviour factors responsible for human anthrax outbreaks in the Tamale municipality. It was also intended that the findings would help in the control o f animal anthrax as well as the prevention o f human anthrax. A descriptive study was conducted using both qualitative and quantitative methods. Data was collected using structured questionnaire, focus group discussions and in- depth interviews. The study revealed that 96% o f the study population have knowledge o f anthrax and the signs that indicate anthrax in cattle. However, knowledge about the causative agent is poor and included links with the supernatural. This lack o f knowledge about the cause o f the disease does not encourage participation in control measures in livestock, such as vaccination and also prevention o f human disease by proper disposal o f carcasses. Eight percent o f the respondents believe that using herbs can prevent human anthrax and 9% indicated that they would send suspected anthrax patients to the herbalist. These percentages even though small, would suggest that human anthrax can persist in the areas o f these respondents. About two-thirds o f respondents are o f the view that animals which have died o f unknown causes are cut up and used because they serve as a source o f inexpensive meat for the community. Also, 16.8% o f the respondents indicated that cooking meat from carcasses with herbs could prevent anthrax. This, taken together with the low incomes o f the farmers and University of Ghana http://ugspace.ug.edu.gh cattle owners makes it very tempting to eat meat o f animals which have died o f unknown causes including anthrax. On the risk o f getting anthrax from handling or cutting meat, about 10% o f the study population indicated there is no risk. This is alarming since such views mean no compliance with the rule o f burning or burying suspected anthrax carcasses and may perpetuate human anthrax, through consumption o f infected carcasses. Based on the findings o f the study, the following key recommendations are made to the relevant authorities; 1. The Veterinary Services in collaboration with the Ministry o f Health (MOH), the Municipal Assembly and other related agencies should organise durbars to educate residents o f Tamale about the public health importance o f anthrax and in particular about the causative agent o f anthrax, how it is spread, and how this can be prevented by disposal o f cattle which have died o f unknown causes. 2. Livestock owners should be compelled by law to report all unexpected deaths in their herds. 3. Suspected anthrax cases should be confirmed by reliable laboratory tests. University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE 1.0 INTRODUCTION 1.1 BACKGROUND Anthrax (Greek: Black) is an acute infectious disease caused by the spore-forming bacterium Bacillus anthracis. It is primarily a disease o f herbivorous mammals (e.g, cattle, goats, and sheep), and pigs (Blood, et a l l 994). The disease is also an important zoonosis affecting humans as well. Anthrax causes deaths in livestock thus affecting the livestock industry worldwide. Tanzania lost 97,585 cattle through anthrax from 1981 to 1990. Similarly, Zambia lost 4000 Hippos (Hippopotamus amphibus) in 1987 due to anthrax (Turnbull, 1991). Anthrax causes morbidity and mortality in humans too. In 1979, an outbreak o f largely pulmonary anthrax occurred in Yakaterinburg (Sverdlorsk), Russia in which 66 individuals were documented to have died. Investigations disclosed that the cases occurred as a result o f a plume emanating from a Biological Research Institute and led to the conclusion that the outbreak was due to accidental aerosol generated in work related to biological warfare studies (Benenson, 1995). Human anthrax outbreaks have also occurred in Switzerland affecting 25 workers in a textile factory. The source o f infection was goats hair imported from Pakistan (Pfisterer, 1991). And in Andhra Pradesh in India 30 anthrax cases were reported as a result o f infection from eating contaminated meat (Sekhar and Singh, 1990). When material containing anthrax bacilli is exposed to the air, spores are formed which protract the infectivity o f the environment for very long periods. The spores are resistant to most external influences including the salting o f hides. University of Ghana http://ugspace.ug.edu.gh normal environmental temperatures and standard disinfectants. Anthrax bacilli have remained viable in soil stored for 60 years in a rubber-stoppered bottle, and field observations indicate a similar duration o f viability in exposed soil particularly in the presence o f organic matter, in undrained alkaline soil and in warm climate. (Schwabe, 1998) Control o f animal anthrax is through the annual vaccination o f cattle and public health education on the disposal o f carcasses. Since the spores o f the causative organism can survive for decades if the carcasses are buried, the preferable disposal technique is to incinerate the carcasses at the site o f death (Benenson, 1995). Should this method be impossible, deep burial with quicklime and decontamination of soil seeded by carcasses or discharges with 5% lye, anhydrous calcium oxide (quicklime) is an important control measure. Human anthrax is controlled through animal vaccination and educational campaigns by public health and veterinary staff aimed at educating people on the dangers o f consumption o f carcasses of animals “found dead from an unknown cause”, (Turnbull, 1991). Proper inspection o f meat before being distributed for consumption is also an important control measure. Human anthrax can also be controlled by immunization o f high risk persons with a cell free vaccine prepared from culture filtrate containing protective antigen (Benenson, 1995). This is effective in preventing cutaneous and probably inhalation anthrax, it is recommended for laboratory workers routinely working with B. anthracis and workers handling potentially contaminated industrial raw materials such as wool, hair and hides. Control o f human anthrax in Ghana is through public education and meat inspection by veterinary and health officials. Other control measures include University of Ghana http://ugspace.ug.edu.gh prohibition o f selling meat from an animal that died o f an undisclosed cause and regulations for the proper disposal o f carcasses. In the UK, the incidence o f anthrax has declined dramatically over the past century. This is due to improved factory hygiene and the development in 1937 o f an effective livestock vaccine which reduced the incidence o f the disease throughout the world and hence the level of contamination in products imported into Britain. Another factor had been the increased use o f man-made alternatives to animal products. The first stages o f the processing o f hides are now being carried out in the country o f origin instead o f Britain. The development o f a human vaccine have contributed to a reduction in industrial cases o f anthrax (Turnbull, 1991). 1.2 STATEMENT OF THE PROBLEM In Ghana, vaccination o f livestock is undertaken each year and the public is made aware o f the disease through meetings and announcements. Vaccination coverage is however not complete and nomadic Fulani herdsmen often do not have their animals vaccinated. There is therefore the potential for animal anthrax transmission. Official statistics suggest that anthrax has claimed over 1000 lives in Ghana since 1980, resulting from sporadic outbreaks. These may be due to inadequate responses or preparedness from health and veterinary services resulting in ineffective monitoring and containment (Wastling, et al. 1999). Moreover there are many outbreaks o f anthrax in animals despite the availability o f a locally produced vaccine. Most of these occur in the Northern Regions o f the country. These outbreaks of animal anthrax are unfortunately associated with outbreaks o f human anthrax University of Ghana http://ugspace.ug.edu.gh resulting in mortality or morbidity. The records available at the Veterinary Services Department Tamale, indicated at least 4 outbreaks o f animal anthrax in the Tamale Municipality from January to April 1999 while the Ministry o f Health records revealed at least 89 cases o f human anthrax in 1998, indicating that the disease is still a major problem in the area. 1.3 RATIONALE FOR THE STUDY According to Opoku-Pare, animals are a great asset and important investment for most Ghanaians so the sudden death o f cattle with no prospect o f compensation can be a financial distress. This financial loss may probably play a role in the consumption o f meat from anthrax- infected animals or exhumation o f animal carcasses for recovery o f hides, leading to the high relationship between human and animal disease (Wastling, et a l l 999). It is important to identify the real cause o f human anthrax outbreaks in general and in the Tamale municipality in particular. It is needful to find answers to why the persistent outbreaks o f both animal and human anthrax in this part o f the country despite the fact that the anthrax vaccine for livestock is produced in Tamale. Among the many reasons, human behaviour may probably play an important role in contributing to outbreaks o f human anthrax in the Tamale municipality. Indeed human behaviour patterns have been found to play important roles in the persistence o f diseases such as guinea worm, schistosomiasis and malaria (Obeng, 1997). University of Ghana http://ugspace.ug.edu.gh 1.4 OBJECTIVES OF THE STUDY The objectives o f this study are; 1. To determine the knowledge, attitude, practices and beliefs o f cattle owners, herdsmen butchers and consumers in the Tamale municipality with respect to human anthrax, and how these are related to the situation o f anthrax, in the area. 2. To identify any behaviour patterns that may contribute to human anthrax outbreaks. 3. To recommend measures to improve the control o f animal anthrax and the prevention o f human anthrax in the same area. University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO 6 2.0 LITERATURE REVIEW 2.1 HISTORY OF ANTHRAX Anthrax has been the scourge o f man and animals since first written history o f disease. It was one o f the plagues o f Egypt in the time o f Moses (cl250 BC) and it was known in Asia Minor at the time o f the siege o f Troy (cl200 BC). Accounts o f its symptoms in the writings o f Homer (clOO BC), Hippocrates (c 400 BC), Varro (116 - 27) BC, Virgil (C70-19 BC), and Galen (c-AD 200) show that it was well known to the Greeks and Romans (Turnbull, 1991). Anthrax was the first disease o f man and animals shown to be caused by a micro organism, and it was the disease on which much o f the work on bacteria and vaccines was done and from which many o f the principles o f pathogenic microbiology were derived. Robert Koch established his famous postulates in 1877 by proving that Bacillus anthracis (so named by Cohen in 1875) was the cause of anthrax. Louis Pasteur’s vaccine was used worldwide for some 50 years but many attempts at developing better alternatives were made in the 1920’s and 1930’s culminating in Sterne’s successful live spore vaccine which was largely responsible for making anthrax controllable across the world. This remains the livestock vaccine in use in most countries today (Turnbull, 1991). Anthrax occurs worldwide but it is endemic in most countries in Africa, Asia and South America. University of Ghana http://ugspace.ug.edu.gh 72.2 ANTHRAX AS A DISEASE IN LIVESTOCK Sudden death in a herbivore without prior symptoms or following a brief period o f fever and disorientation should lead to suspicion o f anthrax, and bloody fluid exuding from the nose, mouth, or anus o f the dead animal is particularly suggestive. Failure o f the blood to clot, absence o f rigor mortis and the presence o f splenomegaly are the most important necropsy findings. The disease occurs in all vertebrates but is most common in cattle and sheep and occurs less frequently in goats and horses. Predisposing causes include close grazing o f tough scratchy feed in dry times, which results in abrasions o f the oral mucosa and confined grazing on heavily contaminated areas around water holes (Benenson, 1995). At death in most susceptible species, the blood contain 107 - 109 bacilli/ml, provided the animal has not been treated. Pigs are noted for being an exception and the bacterium may be undetected in blood at death (Schwabe, 1998). The causative agent, Bacillus anthracis is facultatively anaerobic. It is a gram positive, spore- forming rod that occur in chains. Colonies on sheep blood agar are large and flat, with a ground glass appearance and comma-shaped outgrowths (Nester, 1983). Unlike most Bacillus species, it is non-motile and susceptible to a specific bateriophage. Anthrax spores are resistant to environmental conditions and remain infectious for years in soil, wool, hides and other habitats (The Merck Veterinary Manual, 1986). University of Ghana http://ugspace.ug.edu.gh In laboratory confirmation o f anthrax, the Macfadyean polychrome methylene blue stain is used. Large members o f blue-black staining bacilli, often surrounded by a clearly demarcated pink capsule is fully diagnostic. For differential diagnosis, blackleg, botulism, toxicosis (eg. toxic plants, heavy metals, snake bite) lightning strike, and peracute babesiosis may cause symptoms similar to those o f anthrax. As a control in animals penicillin injection is given to all animals showing fever after the first case is confirmed. Vaccination o f livestock in endemic areas is a prerequisite which protects them for at least one year. 2.3 ANTHRAX AS A HUMAN DISEASE Man acquires the infection by direct inoculation o f spores through breaks in the skin by inhalation o f spores or by ingestion o f contaminated meat. There may be person to person spread in particular circumstances; for example an outbreak in the Gambia was in part traced to the use o f communal loofahs when bathing and in the U.K and Russia shaving brushes have been a source. The organism may be transmitted mechanically by insects including the house fly (Turnbull, 1991). The disease in humans appears in three forms: cutaneous anthrax, inhalation and gastro-intestinal anthrax. In cutaneous anthrax, itching o f an exposed skin surface occurs first, followed by a lesion that becomes papular, then vesicular, and in 2-5 days develops into a depressed black eschar. The eschar is usually surrounded by moderate to severe and very extensive edema, sometimes with small secondary vesicles. The head, forearms and hands are common sites o f infection. Untreated cutaneous anthrax has a case fatality rate between 5% and 20% (Benenson, 1995). Initial symptoms o f inhalation anthrax are mild and nonspecific, resembling acute University of Ghana http://ugspace.ug.edu.gh symptoms o f respiratory distress. X-ray evidence indicate mediastinal widening. Fever and shock follow in 3-5 days, with death shortly after. Symptoms o f intestinal anthrax include abdominal distress which is followed by fever, signs o f septicemia and death in the typical case. Laboratory confirmation is made by demonstration o f the causative organism in blood, lesions or discharges by direct polychrome methylene blue MacFadyean stained smears or by culture. In anthrax treatment, penicillin is the drug o f choice and is given for 5-7 days. Tetracyclines, erythromycin or chloramphenicol are also effective (Benenson, 1995). 2.4 ANTHRAX IN LIVESTOCK IN GHANA Anthrax in livestock occurs countrywide but it is more concentrated in the Northern Regions o f the country. The Northern region is endemic for anthrax. Although anthrax is an old disease, records show that there have been consistent animal outbreaks every year since 1983. The number o f animals affected was 3804 and out o f this, 979 animal deaths were recorded from 1993 to 1998 (Veterinary Services, 1998). There have also been 14 confirmed anthrax outbreaks in livestock in the Tamale municipality from 1995 to April, 1999 (Veterinary Services, 1999). Anthrax outbreaks in livestock have been reported in all the districts in the Northern Region. In the Tamale municipality all the 6 subdistricts had been affected since 1993 (Veterinary Services, 1998). The various species o f livestock affected during outbreaks since 1993 were 3721 cattle, 77 sheep and 6 goats. Total deaths were 979 (Veterinary Services, 1998). Countrywide, between 1994 and 1997, 76 outbreaks were recorded involving 1216 animals; cattle 78%, sheep and goats 22% University of Ghana http://ugspace.ug.edu.gh (Veterinary Services, 1998). Anthrax is therefore a cause o f significant economic losses in livestock in the municipality, where average protein intake is already low. 2.4.1 HUMAN ANTHRAX IN GHANA Human anthrax also occurs countrywide but more often in the Northern Regions o f the Country, in association with outbreaks o f animal anthrax. A total o f 80 human deaths have been reported usually associated with the consumption o f contaminated food and meat from animals which have died o f anthrax (Veterinary Services, 1998). Ten human deaths were recorded in relation to outbreaks in livestock in the Northern Region since 1993. Eighty-nine human anthrax cases were recorded in 1998 with 5 deaths (Ministry o f Health, 1998). The highest number o f 51 cases was associated with an outbreak which occurred in the East Gonja district in September, 1998. Twenty-two human anthrax cases were recorded in Nakpanduri in the East Mamprusi district in December, 1998 (Ministry o f Health, 1998). Sixty-one persons had contact with anthrax carcass during an outbreak in March 1999 in the Tamale municipality. They were given chemoprophylaxis o f amoxicillin capsules. There have also been an anthrax outbreak in the East Mamprusi district resulting in 3 human deaths (Andane, 1999). 2.5 CONTROL OF HUMAN ANTHRAX Control or prevention of human anthrax could be achieved through public health education. Health education aimed at exposing the risk factors o f anthrax, touching on proper disposal o f anthrax carcass and education on the causative agent is a prerequisite for the control or prevention o f human anthrax. Legislation and its enforcement is also important in human anthrax control. Investigation o f contacts and source o f infection and the specific treatment o f patients University of Ghana http://ugspace.ug.edu.gh with penicillin, tetracycline or chloramphenicol are important for the control o f human anthrax. Other control measures involve the control o f the disease in livestock, reducing animal anthrax and minimizing the chances o f human exposure. 2.5.1 CONTROL OF ANTHRAX IN LIVESTOCK THROUGH VACCINATION The annual vaccination o f livestock in endemic areas is a prerequisite for the control o f anthrax in livestock. Prompt immunization o f all animals at risk during outbreaks and the treatment o f in­ contacts with penicillin or tetracycline is very important. This annual vaccination o f livestock has led to the elimination o f anthrax in some developed countries such as Britain and the United States o f America ( Blood, et al 1994). 2.5.2 CONTROL OF ANTHRAX IN LIVESTOCK THROUGH PUBLIC EDUCATION Public education on the importance o f vaccination to livestock owners is quite vital to the control o f anthrax in livestock. Also, education on the proper disposal o f anthrax carcass and the disinfection o f contact areas with formaldehyde (30%) and caustic soda (40%) are important for the control o f anthrax in livestock. Public education has played a major role in the eradication o f guinea worm in Ghana where the disease was endemic. Public education has led to fewer cases o f anthrax in Tanzania and Kenya (Titball,et al. 1991). University of Ghana http://ugspace.ug.edu.gh 2.5.3 PREVENTION OF HUMAN INFECTION One important way o f preventing human infection is by ensuring that there is no direct contact with animals which have died from the disease. This means the animals should be buried or burnt without being cut open. Prohibition o f selling meat from an animal that died o f an undisclosed cause helps in the prevention o f human infection .Education campaigns by public health and veterinary staff aimed at educating people not to eat meat from livestock not slaughtered in an approved abattoir and inspected is vital in the prevention o f human infection. With the introduction o f abattoirs in the major cities o f the country with regular meat inspection, human anthrax cases hardly occur in the major cities in Ghana. 2.5.4 CONSTRAINTS TO CONTROL OF ANTHRAX IN GHANA Lack of cooperation by some livestock farmers, and poor vaccination coverage due to lack o f education on the importance o f vaccination is a constraint to the control o f anthrax. Logistical problems faced by the Veterinary Services, inaccessibility o f certain remote areas is a constraint to the control o f anthrax.The periodic infiltration o f Fulani herdsmen with their cattle which may not be vaccinated is also a constraint to the control o f anthrax in Ghana. Other constraints include livestock owners not reporting sudden deaths in their herds to Veterinary Officials and the consumption o f uninspected meat Some traditional beliefs concerning the usage o f herbs to anthrax contaminated meat and sending anthrax patients to the herbalist instead o f a hospital may serve as constraints to the control o f anthrax in Ghana. University of Ghana http://ugspace.ug.edu.gh 2.6 HUMAN BEHAVIOUR AND ANTHRAX OUTBREAKS It is clear that human behaviour is important in the control activities against anthrax. Compliance in ensuring that cattle are vaccinated and that any deaths in cattle are reported to the Veterinary Services to ensure proper diagnosis and disposal if it is anthrax, are crucial. The socio-economic and educational levels and religious beliefs o f people will influence their decisions to a large extent. 2.7 THE CONCEPTUAL FRAMEWORK FOR THE STUDY A theoretical perspective guiding the study is the Health Belief Model (HBM).The Health Belief Model was developed by Rosenstock and Becker to explain why people did not use health services (utilization behaviour), but has been applied to many aspects o f health behaviour as well The Health Belief Model (HBM), says that if a person is to perform a particular act(Health) he/she has to believe they are susceptible, that the health problems caused affect him or her personally rather than other people or society as a whole; feel that the condition is serious; and that it can lead to death or other serious outcomes if action is not taken (Hubley,1993). The person also has to believe that the condition could be prevented, and that the benefits o f taking action will outweigh the disadvantages. When applied to the study under consideration, the questions to be asked are: ♦ To what extent does a cattle owner, herdsman, butcher or consumer in Tamale municipality consider himself susceptible to anthrax? ♦ How serious does he/she consider anthrax? University of Ghana http://ugspace.ug.edu.gh ♦ Does he/she think anthrax can be prevented? ♦ Does he/she think refraining from consumption o f suspected anthrax carcasses has more benefits than disadvantage? 2.6.1 DRAWING ON LOCAL KNOWLEDGE AND MAKING PROGRAMS LOCALLY RELEVANT AND ACCEPTABLE Communities often have detailed knowledge about their surroundings. This community knowledge includes among other things, the treatment and prevention o f diseases. It makes sense, therefore, for service providers and other development workers to involve communities in making plans because they know local conditions and the possibility for change. I f the community is involved in choosing priorities and deciding on plans, they are much more likely to become involved in the programme and make use o f the services because such programs are seen to be meeting their needs (Hubley, 1993). 2.6.2 BELIEFS Beliefs deal with a people’s understanding o f themselves and their environment. Beliefs about the different possible outcomes from performing actions are especially important in understanding behaviours. Social Science theory tells us that while some behaviours may exist on their own, others are a part o f a wider system o f belief, such as religion (Hubley, 1993). A behaviour, value or belief can be shared by a group o f people, a whole community or even a country. A person also develops beliefs from what he/she reads or hears from other persons. It is therefore important to find out how a particular belief has been acquired in order to predict how University of Ghana http://ugspace.ug.edu.gh it might be changed. According to Fishbein, whether or not a person forms an intention to perform a behaviour will also depend on the overall pressure from those around him (Hubley, 1993). 2.6.3 KNOWLEDGE, ATTITUDES AND PRACTICES (KAP) OF PEOPLE IN RELATION TO DISEASE Human behaviour arising out o f people’s knowledge, beliefs and attitudes play an important role in disease control. For example, human behaviour patterns have been implicated in the persistence o f diseases such as guinea worm and schistosomiasis. For schistosomiasis, physical contact with infected water makes a person contract the disease (Obeng,1997). Although this mode o f infection makes workers on irrigation schemes, agriculturists and fishermen vulnerable, it appears that by far the greater proportion o f infections encountered in communities is through the behaviour o f persons who use irrigation canals, ponds, streams and swamps which are transmission sites for water collection, bathing and washing and swimming (Obeng, 1997). Similarly, the behaviour patterns o f wading through infected streams and ponds for the collection o f water for drinking and domestic use brings about guinea worm infection. University of Ghana http://ugspace.ug.edu.gh 16 CHAPTER THREE METHODS 3.1.1 STUDY DESIGN This is a descriptive study using both qualitative and quantitative methods, to collect data on the level o f knowledge, attitudes, practices and beliefs o f cattle owners, herdsmen, butchers and consumers in the municipality. It was conducted over a period o f six weeks. In addition, available medical and veterinary records were also examined. 3.1.2 VARIABLES STUDIED The variables studied were: ♦ Knowledge o f cattle owners, herdsmen, butchers and consumers regarding anthrax in general, its transmission and the control o f the disease ♦ The attitude and beliefs o f cattle owners, herdsmen, butchers and consumers on anthrax and its control. ♦ The practices o f cattle owners and herdsmen in terms o f disposal o f carcasses and vaccination o f their cattle. Relationships between some Socio-demographic characteristics and some o f the independent variables were explored. The Tamale Municipal area is one of the 13 District Assemblies in the Northern Region of 3.2 THE TAMALE MUNICIPALITY 3.2.1 POPULATION AND ADMINISTRATION University of Ghana http://ugspace.ug.edu.gh sq.km making it the smallest o f all districts. It has a population density o f 276 per sq. km. and about 170 communities and villages. The Municipality is bordered to the North by Savelugu/Nanton district, to the east by Yendi and East Gonja districts and the west by Tolon/Kumbungu and West Gonja districts. The Municipal capital Tamale, (also the capital o f Northern Region), by virtue o f its strategic location plays a very important role in administration, industry, education, commerce and trade. The Municipal Chief Executive is the political head o f the municipality. He is assisted by the Municipal Coordinating Director. The Municipal Assembly constitutes the focal point in the decentralized administration. There are 13 decentralized departments under the Assembly. 3.2.2 RAINFALL AND VEGETATION The rainy season is from April to October while the dry season starts from November to March (Dickson and Benneh 1970). The average annual rainfall is about 1100 mm with the heaviest in August and September. The average sunshine is about 7.5 hours per day. High temperatures are experienced all year round. The maximum daily temperatures are between 33 and 39 degree Celsius, with minimum night temperatures between 16 and 25 degrees Celsius. The vegetation is Guinea Savanna woodland with widely spaced dawadawa, shea, baobab and neem trees mixed with perennial grass. The area is about 180 meters above sea level, fairly flat with a series o f low ridges that serve as water shed to small streams (Dickson and Benneh 1970).. 3.2.3 INFRASTRUCTURE AND SOCIAL AMENITIES Under the Tamale roads rehabilitation programme, 79 km o f roads in urban Tamale will be asphalted and the drains lined and covered. The Tamale municipality has more educational University of Ghana http://ugspace.ug.edu.gh facilities than any other district in the Northern Region. It has about 357 educational institutions, but the illiteracy rate is about 79% (Municipal Assembly Report). There is pipe borne water in the municipality but it is not reliable. About 30% o f the people get their water from ponds, wells and dams. Transportation in the municipality is quite good mostly made up o f private transport, (vehicles, bicycles and motor cycles). The main means o f transport is bicycle and motorcycles. 3.2.4 THE HEALTH CARE SYSTEM AND FACILITIES There are 18 health facilities in the Municipality, operating at the municipal level, sub-district level and at community level, providing all kinds o f health service programmes to the people. These facilities include a Regional Hospital, which is also a teaching hospital for the School o f Medical Sciences, University o f Developmental Studies, in Tamale. Other facilities include a Military Hospital, Health Centers, Private Clinics and Private Maternity Homes. There is also a well equipped Veterinary Laboratory at Pong-Tamale, 22 miles from Tamale on the Tamale- Bolgatanga trunk road. The Veterinary Laboratory apart from diagnostic activities, produces anthrax vaccines for livestock vaccination in the country. There is also a Public Health Reference Laboratory and a Private Diagnostic Laboratory in the municipality. 3.2.5 THE SOCIAL AND POLITICAL STRUCTURE OF DAGBON The indigenous people of the municipality are Dagombas. At the top hierarchy o f chiefdom is the paramout chief called the Yaa-Naa, and under him are three (3) divisional chiefs who are sons o f past Yaa Naas. These are the Kariga Chief, Savelugu Chief and Mion Chief. There are also three 18 University of Ghana http://ugspace.ug.edu.gh divisions o f Queen Mothers, whose statuses or positions are at par with the three (3) divisional chiefs mentioned above, Gundogu Lana, Kpatuya and Shilin Naa. These are all based in Yendi seat o f the Dagbon Paramountcy. In the traditional sense all towns and villages in the Dagbon traditional area are under the Yaa- Naa and as such pay allegiance to the Paramountcy. A t the village level the chief is assisted by the Wulan or the Senior linguist, followed by the Kpena-Lana, Chief Imam, Tindana and Lun- Naa. At the head o f the household or clan is the family head, who is assisted by the senior wife and NachimKpiema (eldest son). The female children in the house are in charge o f domestic chores: cooking, washing o f cooking utensils, fetching firewood etc whilst the boys are in charge o f farming, sweeping, clearing o f weeds around the compound, herding cattle and taking care o f fowls, goats and sheep. The Dagombas in general are polygamous in nature. The system o f marriage in the past was through betrothal, elopement and confiscation o f women by chiefs, opinion leaders and rich men. With modernity, religion has influenced the system o f marriage and hence people either marry in the Moslem or Christian way. The Dagombas constitute a structured society. Apart from formal education, one is either bom into a “Nakoha” family (Butcher), Blacksmith family, Wanzam family etc. the Wanzam performs duties such as barbering, circumcision and other minor surgical interventions. Language o f the Dagombas is Dagbani, however, Hausa is spoken by a large section o f the University of Ghana http://ugspace.ug.edu.gh inhabitants. There are three religions dominating in Dagbon:- these are Islam, Christianity and the Traditional Religion. 3.2.6 ECONOMIC ACTIVITIES The main economic activities are farm ing petty trading and light industry. There are few agro­ based industries in the municipality. These are the rice mills, vegetable oil mills and cotton ginneries. Other activities are processing and exportation o f shea nuts and livestock. During the dry season the people hunt. Farming is the main activity for most o f the people. The crops produced are maize, groundnuts, yams, guinea com, millet, rice, cassava, soya beans and pigeon peas. The main livestock reared are cattle, sheep and goats. The poultry industry is at its infant stage. Collection o f sheanuts is a major activity for the women during its season. 3.3 THE STUDY POPULATION The study population o f 250 (males and females) comprised o f cattle owners, herdsmen, butchers, and consumers who live in the urban, sub-urban and rural communities. They are made up of peasant farmers, traders, artisans and other vocations.In the rural communities, they live mostly in mud huts thatched with grass as shown in Figs (1,2,3 and 4) 3.4 SAMPLING Cattle owners, herdsmen, butchers and consumers were randomly selected for interview from a sample frame o f a list o f cattle owners/herdsmen and butchers using an estimated sample o f size 250 based on the population o f Tamale Municipality 290,538 (MOH, 1998). An assumed anthrax awareness frequency o f 10% and a worst acceptable anthrax awareness frequency o f 15% was University of Ghana http://ugspace.ug.edu.gh used. A breakdown o f the sampling size was assumed as follows; Cattle owners 20%, Herdsmen 20%, Butchers 10% and consumers 50%. This came up to cattle owners 50, herdsmen 50, butchers 25 and consumers 125 as the number o f persons to the interviewed. 3.5 DATA COLLECTION 3.5.1 PRIMARY DATA Data was collected through a structured questionnaire by trained interviewers (Figs 1 and 2). The questionnaire were pre-tested on the staff o f the Municipal Health Office. Also, the interviewers were trained for 2 days in order to minimize errors. Focus group discussions and In-depth interviews were also employed. The actual data collection was carried out over a period o f five weeks. An In-depth interview o f a Herbalist/Soothsayer was also conducted (Fig 3). 3.5.2 SECONDARY DATA Secondary data were obtained from existing records at the Ministry o f Health and at the Veterinary Services, at Tamale. 3.6 QUALITY CONTROL Spot checks for quality control and completeness o f information collected were made. Completed questionnaires were collected each day and cross checked with the interviewer. University of Ghana http://ugspace.ug.edu.gh 3.7 ANALYSIS OF DATA Data were analyzed using the EPI Info Software. Frequencies o f respondents knowledge, attitudes, beliefs and practice about anthrax and its control were done. The chi square test o f association o f some o f variables were also done. P value less than 0.05 was considered significant. 3.8 ETHICAL CONSIDERATION Permission was sought from the Tamale Municipal Assembly, the chiefs, the land lords in the community before entry and administration o f questionnaires. The study was explained to the people in the local language, and those who agreed to participate were included. University of Ghana http://ugspace.ug.edu.gh CHAPTER FOUR 4.0 RESULTS 4.1 SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS Out o f the 250 respondents 218 were males (87.2%) and 32 females (12.8%). This is in line with the fact that the livestock industry in the country especially large ruminants is dominated by men. Sixty percent o f the respondents were above 35 years and nearly 40% o f the respondents have some form o f education (Table 1). More than 80% o f the respondents were Moslems and 10.4% were Christians. 4.2 KNOWLEDGE, ATTITUDES, BELIEFS AND PRACTICES (KABP) OF RESPONDENTS 4.2.1 THE DISEASE IN ANIMALS AND ITS CAUSES The study revealed that 96% o f the study population knew about anthrax and could mention the local names such as ‘yogu’ in Dagbani and ‘Cepha’ in Hausa both major languages spoken in the Municipality (Table 4). On attribution to sudden death 22.8% o f the study population said they would attribute sudden death in their herd to snake bite and 33.6% indicated anthrax. At least a third o f the respondents know that anthrax causes sudden death (Table 2).. 4.2.2 SIGNS OF ANTHRAX IN ANIMALS On the signs that suggest anthrax 33.2% o f the respondents settled for “Blood from the natural Orifices” 47.6% for “flies do not settle on blood” and 12% for “Blood will not clot”. Majority o f the respondents totaling 96.8% know about some signs that may suggest anthrax (Table 3). University of Ghana http://ugspace.ug.edu.gh 24 Table 1 Distribution of Respondents by Age, Sex, Education, Marital Status and Religion CHARACTERISTIC FREQUENCY PERCENTAGE A se Under 18 3 1.2 1 8 -3 5 97 38.8 above 35 150 60.0 Sex Male 218 87.2 Female 32 12.8 Marital status Single 23 9.2 Married 224 89.6 Divorced 3 1.2 Education None 160 64 Primary 36 14.4 Secondary 34 13.6 Tertiary 20 8.0 Religion Christian 26 10.4 Muslim 208 83.2 Traditional 16 6.4 Profession Unemployed 3 1.2 Artisan 19 7.6 Trader 47 18.8 Farmer 107 42.8 White collar job 70 28.0 others 4 1.6 Table 2 Distribution o f Respondents by what they attribute sudden death in cattle to CHARACTERISTIC FREQUENCY PERCENTAGE Snake bite 57 22.8 Lightning 28 11.2 Poison 62 24.8 Anthrax 84 33.6 Others 19 7.6 University of Ghana http://ugspace.ug.edu.gh 25 4.2.3 VACCINATION AGAINST ANTHRAX On vaccination, 99.2% said they know about anthrax and all the respondents said it is necessary to vaccinate cattle (Table 4). On what vaccination does, 56.4% said it makes their cattle healthy, however 36.4% indicated it gives the cattle immunity for the disease they are vaccinated against (Table 3). More than half o f the respondents indicated they know o f anthrax, contagious bovine pleuro­ pneumonia (CBPP) and Rinderpest Vaccinations. On the purchase o f cattle, 62% o f the respondents said they do not consult the Veterinarian, before buying cattle. The rest, 38% said they do consult the Vet before buying cattle (Table 4). 4.2.4 CAUSATIVE AGENT Knowledge about the causative agent is non existent among the respondents. From the In-depth interviews, respondent gave various animals and insects such as birds, moths, spiders and wall gecko’s as agents that cause anthrax. Similar names were also given by majority o f participants in the Focus group discussions as causative agent for anthrax. University of Ghana http://ugspace.ug.edu.gh 26 Table 3 Distribution o f Respondents by their knowledge concerning Anthrax and Vaccination CHARACTERISTIC FREQUENCY PERCENTAGE Signs that suggest anthrax Blood from natural orifices 83 33.2 Blood will not clot 30 12.0 Flies do not settle on blood 119 47.6 All above 10 4.0 Others 8 3.2 Usefulness of vaccination of cattle Makes them strong 15 6 Makes them healthy 141 56.4 Given them immunity 91 36.4 Others 3 1.2 TvDes of cattle vaccinations Anthrax 90 36 CBPP 3 1.2 Rinderpest 10 4 Others (All above) 147 58.8 Knowledge about category of cattle to be vaccinated All cattle should be vaccinated 180 72 Pregnant cows should not be vaccinated 48 19.2 Calves should not be vaccinated 22 8.8 Table 4 Distribution of Respondents by what they know about anthrax and participation in vaccinations QUESTION YES NO FREQUENCY PERCENTAGE FREQUENCY PERCENTAGE Do you know the local name for anthrax? 240 96 10 4 Before buying cattle do you consult the Vet? 95 38 155 62 Do you know about vaccinations? 248 99.2 2 0.8 Is it necessary to vaccinate your cattle? 250 100 - - Do you vaccinate your cattle annually? 234 93.6 16 6.4 University of Ghana http://ugspace.ug.edu.gh 27 Table 5_______Distribution o f Respondents by their attitudes and beliefs on anthrax QUESTION VI s NO FREQUENCY PERCENTAGE FREQUENCY PERCENTAGE Do you think you can die when you consume a carcass? 226 9 0 4 24 9.6 Should meat for consumption be inspected? 247 98,8 3 1 2 Do you think cooking carcass with herbs can prevent anthrax? 42 16.8 208 83 2 Do you think anthrax can be spread by taking contaminated m eat from one place to another? 239 95.6 11 4.4 Table 6 Distribution of respondents by their attitudes and beliefs regarding anthrax CHARACTERISTIC FREQUENCY PERCENTAGE What to do in case of sudden death of animal Call in Vet 156 62.4 Bury or bum if Vet cannot be reached 99 36.4 Cut and distribute to family & friends 3 1.2 Where to send sick member of family after consumption of carcass Hospital 191 76.4 Herbalist 23 9.2 Vet Officer 36 14.4 Table 7 Distribution o f respondents by their perceptions and practices relating to Anthrax CHARACTERISTIC FREQUENCY PERCENTAGE Reasons whv carcass might be butchered Cattle is expensive 40 16 Source o f meat for a large community 160 64 Source of protein 28 11.2 Others 22 8.2 Disposal of carcass Bury 228 91.6 Bum 18 7.2 Butcher it and distribute 4 1.6 In which wav can human anthrax be prevented Annual vaccination o f cattle 191 76.4 Using herbs 20 8.0 Refraining from carcass consumption 31 12.4 Others 8 3.2 University of Ghana http://ugspace.ug.edu.gh 4.2.5 RISK FACTORS On the risk factors associated with the consumption o f carcass, 90.4% o f the respondents indicated that consumption o f carcass o f cattle that have died o f unnatural causes may lead to death. However 9.6% o f the respondents indicated there is not risk (Table 5). From the Study, 16.8% o f the respondents indicated cooking meat carcasses o f cattle that have died o f unnatural conditions with herbs can prevent anthrax (Table 5). From the study, 76.4% o f the respondents said they would send their sick member o f family who had consumed an anthrax carcass to the hospital. However 9.2% indicated they would send the patient to the herbalist (Table 6). On why cattle that had died o f unnatural conditions might be butchered, 64% o f respondents said, because the carcass would be a source o f meat for a large community, 16% indicated because cattle is expensive and 11.2% said because it is a source o f protein (Table 7). 4.2.6 DISPOSAL OF CARCASS From the study, 91.2% o f the respondents said they would dispose o f the carcass o f cattle by burial and 7.2% said they would bum it (Table 7). These figures are very laudable but may be critical because o f the stigma o f labeling someone a “carcass eater” However 1.6% boldly indicated they would butcher it and distribute for usage by family and friends. On their attitude on sudden death o f cattle, 62.4% said they would call a Vet, 36.4% said they would bury or bum the carcass if a Vet cannot be reached while 1.2% said they would family and friends ( Table 6). University of Ghana http://ugspace.ug.edu.gh 4.2.7 PREVENTION OF HUMAN ANTHRAX From the study 76.4% o f the respondents said human anthrax could be prevented by the annual vaccination o f cattle. Eight percent (8%) asserted that using herbs could prevent human anthrax while 12.4% indicated that refraining from carcass consumption could prevent human anthrax (Table 7). 4.3 DISTRIBUTION OF KAPB ON BUTCHERS AND CONSUMERS Apart from responses from the total sample population o f 250, responses were also categorized for 25 butchers and 125 consumers (Tables 8,9,10,1 land 12). All the butchers indicated that they have heard o f anthrax and that cutting anthrax carcass can cause sickness or even death. From the study 96% o f the butchers said they have heard o f animal anthrax outbreak in their community but only 12% said they have heard o f any human death due to anthrax in their community. On what anthrax is, 84% o f the butchers indicated it is an animal disease that can affect humans (Table 9). From the study 88% of the butchers said they would not butcher the carcass o f cattle that has died because o f their religion. (Table 10). O f the number o f consumers, 96.8% said diseases from animals can be transmitted to man and 89.6% indicated that one could die if he/she consumes carcass o f cattle that had died from unnatural causes. Also from the study, 90.4% o f the consumers said cooking meat with special herbs cannot prevent anthrax. However 9.6% said the opposite reflecting that special herbs can prevent anthrax. On what anthrax is, 81.6% o f the consumers said anthrax is an animal disease that affects humans. Ninety -tw o percent o f the consumers are in favour o f meat being inspected by Veterinary staff before being sold to the public. University of Ghana http://ugspace.ug.edu.gh 30 QUESTION YES NO FREQUENCY PERCENTAGE FREQUENCY PERCENTAGE Have you heard o f the disease anthrax? 25 100 - - Do you know anthrax carcass when cut can cause sickness or even death? 25 100 ■ ' Have you heard o f animal anthrax outbreak in your community? 24 96.0 1 4.0 Have you heard o f any human death in your community due to anthrax? 3 12.0 22 88.0 Table 9 Distribution o f respondents (butchers) on what anthrax is CHARACTERISTIC FREQUENCY PERCENTAGE Animal disease that can effect humans 21 84 Animal disease 4 16 Others Table io Distribution of respondents (butchers) on what they would do when called to butcher a carcass that has died CHARACTERISTIC FREQUENCY PERCENTAGE Call a Vet to ascertain cause o f death Would not butcher because o f my religion 3 22 12.0 88.0 Table 11 Distribution o f KABP o f consumers on anthrax QUESTION YES NO FREQUENCY PERCENTAGE FREQUENCY PERCENTAGE Do you know disease from animal can be transmitted to man? 121 96.8 4 3.2 Does it matter when meat has been inspected by Vet before being sold? 115 92.0 10 8 0 Do you know that you can die if you consume or handle carcass o f cattle that had died? 112 89.6 13 10.4 Would you by from your neighbour meat uninspected but cheap 7 5.6 118 94.4 If you know meat is from cattle that has died would you buy? 4 3.2 121 96.8 Have you heard o f the disease anthrax? 124 99.2 1 0.8 Do you think cooking carcass with special herbs can prevent anthrax? 12 9.6 113 90.4 Table 12 Distribution of respondents’ knowledge on what anthrax is CHARACTERISTIC FREQUENCY PERCENTAGE Animal disease that can effect humans 102 81.6 Disease that cause sudden death in cattle 17 13.6 Human disease occurring after eating cattle that had died 6 4.8 consumers) University of Ghana http://ugspace.ug.edu.gh 4.4 INTERRELATIONSHIPS BETWEEN SOCIO-DEMOGRAPHIC CHARACTERISTICS AND KABP An attempt was made to find the relationship (if any) between the respondent’s socio­ demographic characteristics and their knowledge, attitudes, beliefs and practices, with view that such information may be helpful in developing any education programme on anthrax control. Two variable classifications were run and the chi-square test used to explore any relationships. The results o f the chi-square tests suggest that most people would prefer to go to the hospital irrespective o f their religion. (Table 13). Table 13 Distribution of study population by religion and where to send sick member o f family Religion Where to send a sick member of family. Total Herbalist Hospital Vet. Officer Christian 0 23 2 25 Muslim 18 157 33 208 Traditional 5 11 1 17 Total 23 191 36 250 Table 14 Distribution o f study population by religion and knowledge o f local name for anthrax Religion Local name for anthrax Total Yes No Christian 21 4 25 Muslim 199 6 205 Traditional 20 0 20 Total 240 10 250 University of Ghana http://ugspace.ug.edu.gh Table 15 Distribution of study population by level o f education and usage o f herbs to prevent anthrax (P value significant at 0.05) Level o f education Cooking with herbs can Total prevent anthrax. Yes No None 36 123 159 Primary 4 32 36 Secondary/T ertiary 2 53 55 Total 42 208 250 P value = 0.003 Table 16 Distribution o f study population by age group and usage o f herbs to prevent anthrax Age group Cooking with herbs can prevent anthrax. Total Yes No Under 35 years 16 85 101 Above 35 years 26 123 149 Total 42 208 250 P value = 0.739 When the knowledge o f local name for anthrax was looked at from a respondent’s religious background, it was found that a greater percentage know the local name compared to those who did not know. (Table 14). Knowing the local name o f anthrax may therefore not depend on whether one is a Moslem or a Christian. Another test suggested there is a relationship between level o f education and the usage o f herbs in preventing anthrax. The higher the respondents level o f education, the less likely he/she would be to indicate usage o f herbs as a prevention for anthrax (Table 15). The chi-square test also indicated that there was no association between a respondent’s age and usage o f herbs to prevent anthrax (Table 16). University of Ghana http://ugspace.ug.edu.gh 4.5 FOCUS GROUP DISCUSSIONS (FGDs) AND IN DEPTH INTERVIEWS The orientation o f this study as indicated earlier called for the use o f qualitative and quantitative methods in data collection. In the qualitative approach, FGDs and in depth interviews were used. A structured questionnaire was used for the collection o f quantitative data. While structured questionnaire presents only a snapshot imagery o f a situation, if it is able to capture it, Focus Group Discussion and In Depth Interviews filled what was lacking in the questionnaire because the mix o f methodologies underscores the importance o f triangulation to enhance data (Senah 1997). To compliment the information gathered from the questionnaire, FGD’s and In depth interviews were held with a number o f cattle owners and herdsmen. Three FGD’s and two in depth interviews were conducted. The FGD’s were held at Nyerize, Kunyievilla and Nyehola involving a total o f 30 cattle owners/herdsmen. In depth interviews were made with the Acting Regent o f Nyerizee, a herbalist/soothsayer at Kunyeivilla. two cattle owners and two consumers at Nanbogu-Yakura and Nanbogu-Yapala respectively. The research questions included the following: What is anthrax?, What causes anthrax?, what are the signs o f anthrax? And what are the risk factors? University of Ghana http://ugspace.ug.edu.gh 4.5.1 FOCUS GROUP DISCUSSION FINDINGS The FGDs unveiled the perceptions o f the participants on anthrax. On what is anthrax, many said it is a disease o f both animals and humans. Some went on further to say that anthrax surfaces when someone casts a spell on a household or on to a kraal. On the causative agent, Nashanu Sulemana o f Kunyeivila said “Anthrax is caused by a moth-like organism hiding in the bush under grasses. It can be hiding in the crevices o f buldings or in roo f where it lays eggs ”. The belief is that the organism can be in a place and may not be harmful. It is when someone casts a spell using it that it becomes dangerous. From the village Nyerizee, it was realized that the services o f a herbalist/soothsayer must be sought before one can know the cause o f anthrax in his herd or home. According to a participant from the Nyerizee village, “ The causative agent o f anthrax is called Nantoo. It looks like a small vampire bat with a pointed mouth " It is believed that the Herbalist/soothsayer could arrest the causative agent from their hiding places and with their nests which look like cotton or spider web and bum them. Reacting to where to send an anthrax victim to the participant further said, “/ will not send my anthrax patient to the hospital but rather the herbalist because anthrax and injection do not match ” The belief that when one presents edema or boils to the hospital he/she is injected is ripe here. Also on the causes o f anthrax, Amidu Suleman o f Nanbogu-Yakura retorted “Nantoo or Birikogno which causes anthrax lives in the bush under grasses or within shrubs. It is brought home from the bush by wizards and witches. It is when they have cast a spell that the organism becomes harmful and poisonous. Otherwise it is not harmful in the bush. ” The signs that suggest anthrax could be mentioned by majority o f the respondents but the risk o f anthrax was downplayed. The belief was that for anthrax to strike and kill animals and humans is indicative o f the fact that a witch or wizard had cast a spell into that herd or house. Otherwise, concoctions o f “black medicine” or “Red Medicine” made from herbs by the medicine man University of Ghana http://ugspace.ug.edu.gh could cure it. The linkage o f anthrax to witchcraft is so strong that when anthrax is being discussed women dare not come near. Any woman who seems to be knowledgeable on it could be branded a witch. One respondent Abdul-Rashid Mumuni o f Kunyeivilla used a Dagbani proverb “ The meat that you will eat and put in medicine, i f you don't eat it, it is good fo r you ’ to illustrate that consumption o f carcasses is not the best even if one thinks he/she may not get sick. Some o f the perceptions revealed during the discussions include; ♦ Carcasses o f cattle when consumed would stop further deaths in the herd. ♦ When flies hover around the carcass it is an indication that the carcass is not harmful when consumed. When it is the opposite, the carcass is harmful. ♦ The old men do not partake in consumption o f the carcass. ♦ Concoctions o f “red medicine” sprinkled in rooms, on cattle, put in water for bathing and in food will ward o ff anthrax. ♦ The scent o f these concoctions in pots could scare o ff the anthrax organism as it flies over the community during the dry season. ♦ Anthrax is linked to witchcraft. 4.5.2 IN DEPTH INTERVIEW WITH HERBALIST/SOOTHSAYER An in depth interview was conducted with a herbalist/soothsayer Iddrisu Seidu at Kunyeivilla village on the Nyankpala road near Tamale. When asked about anthrax and its causative agents Iddrisu Seidu said, “Anthrax is a sudden killer disease known and called locally yogu. It affects both humans and animals but affects animals more. It is caused by an organism called ‘Nantoo or Birikogno' It is invisible and cannot be seen by the ordinary eye except with the spiritual eye ’ ” University of Ghana http://ugspace.ug.edu.gh On the structure and habitat o f the organism he said, “ Nantoo is like a small immatured vampire bat or a moth. Even though invisible it hibernates on tree tops, in crevices o f walls, under stones or logs " Can anthrax be treated? ''" Yes i f it is detected early. Treatment is effected by giving locally made medicine from herbs to the victim to drink in soup or put in water fo r bathing. I f it occurs in the form o f a boil, some o f the medicine can also be ground and smeared around the boil. ” Iddrisu emphasized. According to him preparations for the prevention o f anthrax include the bark, roots and leaves of trees and shrubs. He mentioned the following as part o f a preparation; Doo(Dawadawa tree), ‘Zankunga ’, ‘Kpiliga ’, ‘Gamampoo ’, Striga plant and a left over o f fire- torch after burning. He described one preparation as thus; “ Herbs collected are assembled. A fow l is slaughtered and its blood sprinkled over the herbs with some incantations. Herbs are then chopped and pounded in a mortar to make ‘red medicine' which is made into morsels. ” On his view on the link o f anthrax with witchcraft, Iddrisu Seidu said, “anthrax is associated with witchcraft. Witches cause the spread by casting a spell. The organism can f ly and can transfer the disease from one locality to another" To buttress this point he said; “it is goodfor one to take precaution before the disease strikes. He mentioned the warm season and the beginning o f the wet season as the periods to be wary of. An indepth interview with a consumer Afa Abdul-Razak Taufeeq also registered some invaluable perceptions. He said “anthrax is caused by 'Nantoo' which has features like a small vampire bat, a wasp or a very matured wall gecko. This type o f wall gecko is different from the normal one. It has hair all over the body with both the mouth and tail pointed like the tip o f a needle and is very fearful ” He also said anthrax is associated with witchcraft and it kills in a matter o f minutes or days. Taufeeq further said, ''the disease is in two forms the ‘hidden type’ which surfaces after it has killed its victim and the ‘superficial’ which can be treated” He describe symptoms similar to malaria and a very painful, hard, pointed and reddish boil on I any part o f the body as being some of the signs o f the disease in humans. At this point he University of Ghana http://ugspace.ug.edu.gh cautioned against sending the victim to the hospital, saying, “the disease does not like injections ’’ 4.5.3 IN-DEPTH INTERVIEW WITH ACTING REGENT An in-depth interview was made with the Acting Regent o f Kunyeivila. As an opinion leader, questions pertaining to the animal industry and the study were posed to him. The questions and responses are below cited: Question: What does vaccination do to your animals and what time do you want vaccination to be done? Acting Regent: “ Vaccination is good. It makes our animals healthy. I would like vaccinations to be done 2 times in a year. One in the dry season and one in the wet season " Question: Do you have any control over people who cut and consume their dead animals? Acting Regent: “Yes in this village dead animals are buried. We have made a law. There is a fine fo r any person who is caught butchering a dead animal. A fine o f 10,000 cedis has been instituted. In addition, the whole village will agree and seize the carcass and bury it” Question: Have you experienced an anthrax outbreak in your village before? Acting Regent: “Five years ago, there was an anthrax outbreak and many o f our animals were lost" Question: There is a National policy on privatization o f Vet Services. How do you see that affecting you? Acting Regent: “This may not be in our interest because veterinary charges will be high. The private man will charge a lot fo r his services in order to make profit. When our animals are sick we cannot pay for the services o f the vet, and they may die " Question: In your opinion what are the causes o f anthrax and how is it transmitted? University of Ghana http://ugspace.ug.edu.gh Acting Regent: “The anthrax disease is caused by an animal which looks like a small vampire bat, a spider or a butterfly. This animal resides in the crevices o f walls, in the thatch in our homes or under grasses in the bush. Only those who have “ double eyes " can see this animal. ’’ 4.6 DISCUSSION Anthrax is still a major health problem in the Tamale Municipality and the Northern Region as a whole. From the records studied, there were 4 anthrax outbreaks in the first quarter o f 1999 and 89 human anthrax cases the previous year. This is in line with what pertains in other countries in the sub-region eg. Burkina Faso and Togo where anthrax is considered to be one o f the most significant zoonoses (Wastling, Akanmori and Williams, 1999). Human anthrax is also endemic in those agricultural regions o f the world where anthrax in animals is common, including countries in south and central America, southern and eastern Europe, Asia and Africa (Beneson 1995). But why these anthrax outbreaks and its associated human cases in the Tamale Municipality? Human behaviour may obviously play a role in this because according to the study many o f the respondents do not know that anthrax is caused by a living organism, bacteria which is in the environment ie. the soil. This lack o f knowledge may lead to persons not following proper methods o f carcass disposal, thereby perpetuating anthrax in the environment. The social-demographic characteristics o f respondents revealed that 87.2% were males and 32 females. The livestock industry especially large ruminants is dominated by men and this supports the preponderance o f males.This is in line with observations in other countries in Africa (Koney 1992). Cattle is normally inherited in the Northern Region serving a form o f security, a source of income and prestige. Owners are therefore not young and may account for 60% o f the respondents being above 35 years. Nearly 40% o f the study population have some form o f education, this means that public education through leaflets in English and the local dialect will reach a considerable number o f people. According to Peterson, “M an’s conquest o f many preventable diseases is the consequence o f a highly organized campaign o f public information” . University of Ghana http://ugspace.ug.edu.gh 39 Community participation is also vital in the link to control anthrax. One reason health education programmes fail according to Hubley, is that they are directed at individuals and ignore the influences o f other people. Few people make decisions or perform actions without considering the opinions and views o f those around them. Thus before the community will participate, they should be enlightened on why they should participate and what they are expected to do (Hubley, 1993). Thus with the right information, cattle owners, herdsmen, butchers and consumers could make informed decisions that could help in the control o f anthrax. Ninety-six percent o f the study population having knowledge o f anthrax and at least a third knowing that anthrax causes sudden death can help in public health education for anthrax control. Knowledge about vaccination indicated by 99.2% o f the respondents and particularly on immunity as what vaccination does for their cattle by 36.4% could be harnessed for public health education. The Northern Region is the cradle o f the Veterinary profession in Ghana, and the livestock population is among the highest in the country. Vaccinations have been carried out here annually for a long time and one would expect a very high percentage knowledge on the types o f vaccinations carried out on cattle especially anthrax CBPP and Rinderpest. However 58.8% o f the respondents knowing more than one type o f animal vaccination is good for public health education. The results from the study also indicated that 62% o f the respondent do not consult the Vet before buying cattle. Though 38% o f respondents said they do consult the Vet, it would be important for the livestock industry to have cattle inspected before being purchased. This will ensure the breeding o f healthy animals and eliminate those which have not gone through vaccination programmes eg. Anthrax. It could also help find recalcitrant farmers and have their animals vaccinated. Knowledge about the causative agent, mainly ass< e supernatural ie. witchcraft, is very strong. University of Ghana http://ugspace.ug.edu.gh According to (Hubley, 1993), a belief can be shared by a group o f people, a whole community or even a country. These beliefs have been maintained for a long time and passed down from parents to children. Public health education should therefore include education on the causative agent. Confirmation o f causative agent by reliable laboratory tests is also important as found out during the study ( Fig 4). On the risk factors, 9.6% indicating that there is no risk in the consumption o f carcass o f cattle that has died o f unnatural causes is quite disturbing, because it could bring about incidence o f human anthrax and should therefore be a target for public health education. A percentage o f 16.8 asserting that cooking with herbs can prevent anthrax is also alarming and should be a target for public health education. This finding is similar to what pertains in Zambia. Turnbull, reports that it is a social custom for the people o f Zambia to skin, butcher and eat animals that die unexpectedly although villagers do understand that such animals may have had a serious transmissible illness such as anthrax (Tumbul, 1991). From the study, 9.2% indicated they would send their anthrax patient to the herbalist. This is also disturbing and should be a target for public health education. The responses for why cattle that had died o f unnatural conditions might be butchered such as, cattle being expensive (16%) and a source o f meat for large community (64%) are a cause for concern and may perpetuate human anthrax in the community. The focus group discussions and indepth interviews also revealed much o f traditional beliefs concerning anthrax as a disease in livestock and human, its causative agent and transmission. This is also vital in public health education. Human behaviour arising out o f the knowledge and attitudes o f people have played an important role in the control o f diseases such as guinea worm and schistosomiasis. It is envisaged that KABP o f cattle owners, herdsmen butchers and consumers from this study could help in the prevention o f human anthrax in the Tamale municipality. University of Ghana http://ugspace.ug.edu.gh 41 CHAPTER FIVE CONCLUSIONS AND RECOMMENDATIONS 5.1 CONCLUSIONS The study has revealed that more than two-thirds o f the respondents know that anthrax is an animal disease that can affect humans. The signs that suggest anthrax are known by more than 90% o f the respondents. However knowledge about the causative agent is nonexistent. Indigenous knowledge o f a causative agent linked to the supernatural is very much pronounced. This gives the indication that any public health education must be focused primarily on the causative agent. The period anthrax is likely to strike i.e. in the warm season is well known by two-thirds o f the respondents. All the respondents indicated it is pertinent to vaccinate cattle and more that 30% could tell about immunity. The importance o f vaccination is well recognized by the study population. This can be used effectively in anthrax control. Eight percent o f the respondents believe that using herbs can prevent human anthrax. Though this figure is not very large, it should not be overlooked because it suggests that human anthrax can persist in areas o f these respondents. A smaller percentage o f about 9% indicated that they would send their anthrax patients to the herbalist. This indicates that help may come very late for families o f such persons because the victims may be sent to the hospital after herbal treatment had failed. About two-thirds o f the respondents are o f the view that carcasses are butchered primarily because it serves as a source o f meat for a large community. This may suggest an underlying factor that is poverty. University of Ghana http://ugspace.ug.edu.gh The study has also revealed that more than 50% o f the study population do not seek veterinary assistance when they buy cattle. Cattle breeding would be very much improved, if cattle owners were educated to seek assistance in this area. On the risk factors o f anthrax about 10% indicating there is no risk in carcass consumption is alarming. This can perpetuate human anthrax. More than 16% o f the study population indicated that using herbs to cook meat from carcasses could prevent anthrax. This group is more likely to consume anthrax-contaminated carcasses, which may cause human anthrax outbreak. The findings have revealed that about two-thirds o f the study population would call a vet when there is sudden death in their herd. This is laudable meaning consumption o f carcass could be averted and the probable disease situation taken care of. The study also showed that butchers and consumers (a subset o f the study population) had adequate knowledge. However linking the causative agent to the supernatural, thus witches and wizards runs through. About 90% o f butchers would not butcher carcasses because o f their Religion and more that 90% o f consumers know disease from animals could be transmitted to humans. Finally, the study has revealed a gap between knowledge and practices, with regards to the risk anthrax poses to humans. The study population has a high level o f knowledge about anthrax apart from the causative agent, but some practices and beliefs are not consistent with the level of awareness found. University of Ghana http://ugspace.ug.edu.gh 5.2 RECOMMENDATIONS Based on the study findings and other information collected during the study, the following recommendations are made: 1. Livestock owners should be educated to consult the Veterinary Services when purchasing cattle and compelled by law to report all unexpected deaths. 2. The Veterinary Services in collaboration with MOH, the Municipal Assembly and other related agencies should organized regular durbars on anthrax. Such education should be on: ♦ The causative agent o f anthrax ♦ Disposal o f anthrax carcass. 3. A poster in English and the local dialects with pictures describing the disease, its causative agent, risk factors etc. should be pasted at vantage areas for the community to see and read. 4. Suspected anthrax cases should be confirmed by reliable laboratory tests. University of Ghana http://ugspace.ug.edu.gh A. REFERENCES 1. Andane, D. (1999). Ban on Slaughter, Movement o f Livestock. The Daily Graphic, 19th,June, pp 3. 2. Benenson, S. A (1995). Anthrax .Communicable Disease Manual. American Public Health Association, pp 18-22. 3. Dickson, K. B. and Benneh, G., (1970). A New Georgraphy o f Ghana. Longman, London, pp. 18. 4. Blood, D. C., Radostits, O. M, and Gay, C.C. (1994). Anthrax. Veterinary Medicine, 8th Edition. Bailiere Tindall, London, 671-676. 5. Hubley,J (1993). Communicating Health. Macmillan Education Ltd., London, pp. 24-25 6 . Koney, E. B.M. (1992). Livestock Production and Health in Ghana. Advent Press; Accra, Ghana, pp 31-33. 7. Ministry o f Health, Annual Report 1997/98, Tamale. 8 . Nester, E. W. (1983). Anthrax. Microbiology, 3rd Edition. Holt-Saunders, Japan, pp. 818-819. 9 .Obeng, L. E. (1997). Parasites, the sly and sneaky enemies inside you. Goldsear, U.K., pp. 159, 211. 10. Pfisterer, R. M. (1991). Anthrax cases in Switzerland. Veterinary Record, 128pp. 410. 11. Schwabe, C. N. (1998). Zoonoses. William and Wilkins, Baltimore, pp3-5. 12. Sekhar, P. C., and Singh, R. S. (1990). Anthrax Outbreak in Andhra Pradesh. Indian Journal o f Medical Research, 38 (4); 448-452. 13. Senah K.A. Money be Man. Het Spinhuis Publishers, Amsterdam 1997. University of Ghana http://ugspace.ug.edu.gh 14. The Merck Veterinary Manual, (1986), 6th Edition. Merck & Co Inc. USA pp.359-362 15. Titball R. W, Turnbull, P. C., and Huston, R. A. (1991). The Monitoring and Detection o f Bacillus anthracis in the Environment. Journal o f Applied Bacteriology. Symposium supplement, 70. Salisbury, Wilts U.K.,pp.95- 100. 16. Turnbull, P. C, Bell, P. H., and Saigawa, K. (1991). Anthrax in Wildlife in the Luangwa Valley. Veterinary Record, 128(4), pp. 339-403. 17. Wastling, J. M, Akanmori B. D., and Williams D.J.L. (1999). Zoonoses in West Africa: Impact and Control. Parasitology Today. Vol.l5(8) 301-349 18. WHO Bulletin (1994). Anthrax control and research with special reference to National Program Development in Africa. Memo from a WHO meeting. Switzerland, pp. 13-22. 19. Veterinary Services Department, Annual Report (1997/98). University of Ghana http://ugspace.ug.edu.gh Figure 2. Author administering questionnaire at Kunyemla. Tamale Municipality University of Ghana http://ugspace.ug.edu.gh Figure 3. Author with Herbalist/Soothsayer, Iddrisu Seidu(Left), at Kuuveivila, Tamale Municipality Figure 4. Sudden death o f 64 sheep at Zagyuri, initially suspected to be du-3 to anthrax but later confirmed by the Pong -Tamale Veterinary Diagnostic Laboratory as enteretoxaemia due to Clostridium perfnngens. This occurred during the study period University of Ghana http://ugspace.ug.edu.gh KNOWLEDGE. ATTITUDES. BELIEFS AND PRACTICES OF CATTLE OWNERS. HERDSMEN. BUTCHERS AND CONSUMERS ON ANTHRAX IN THE TAMALE MUNICIPALITY D ISTR IC T :.............................................. Serial No SUB-DISTRICT:................................................................. V ILLA G E :............................................................................ IN TERVIEW ER:................................................................. D A T E :.................................................................................... (A) 1. 2 . 3. 5. 6. Within which age group do you fall? (a) U n d e r l8 yrs (b) 18-35 yrs (c Sex (a) Male (b) Female Marital Status (a) Single (b) Married Religion (a) Muslim (b) Christian (c) Divorced (c) Traditional What level o f education have you attained? (a) Illiterate (b) Middle form 4/JSS © Secondary/vocational (d) Tertiary (polytechnic, university) What is your professional status? (a) Unemployed (b) artisan (c) trader (d) farmer (e) other specify above 35 yrs 7. If you are a cattle owner, herdsman or butcher how many cattle do you have? (a) below 25 (b) 25-50 (c) above 50 (d) above 100 University of Ghana http://ugspace.ug.edu.gh BKNOWLEDGE 1. To what would you attribute a sudden death in your herd? (a) Snakebite (b) lightening (c) poisoning (d) others specify 2. Do you know the local name for anthrax? (a) Yes (b) No 3. Which o f the following signs will suggest anthrax? (a) Blood from the natural orifices (b) Flies do not settle on the blood from the orifices (c) Blood will not clot (d) Others specify 4. Before buying cattle, do you consult the Vet? (a) Yes (b) No 5. I f No who do you consult? (a) Chief fiilani (b) Chief butcher (c ) any person who has some knowledge about cattle (e) others specify 6 . Do you know about vaccinations? (a) Yes (b) No 7. Is it necessary to vaccinate your cattle? (a) Yes (b) No 8 . I f yes what does vaccination do to your cattle? (a) Makes them strong (b) Makes them healthy (c ) Gives them immunity for the disease they are vaccinated against (d) Others specify 9. I f yes what types do you know? (a) Anthrax (b) CBPP (c) Rinderpest (d) Others specify 10. Who does anthrax vaccination? (a) Vet Personnel (b) MOH (c) Others specify 11. How much does the vaccination cost you? (a) Specify amount (b) no charge (c ) payment in kind (d) others specify University of Ghana http://ugspace.ug.edu.gh 12. Do you vaccinate your cattle annually? (a) Yes (b) No 13. If yes, what time o f the year? (a) before the raining season (b) after the raining season (c) beginning o f the dry season (d) others specify 14. If No, why don’t you? (a) Cattle die after vaccination (b) Cows abort after vaccination (c) Personnel collect money (d) Others specify 15. What category o f cattle do you think should not be vaccinated? (a) Pregnant cows (b) Young ones e.g. calves (c ) Breeding bulls (d) Others specify ATTITUDES AND BELIEFS 1. How would you recognize a sick cattle? (a) Cattle does not eat (b) Lags behind the group ( c ) Passes diarrhoea (d) Others specify 2. When your cattle die what would you do? (a) Cut it and distribution to family and friends (b) Call in the butcher to buy and sell to consumers (c) Call in the vet to ascertain cause o f death (d) Bury it or bum it if vet cannot be reached (e) Others specify 3. Do you think you can die when you consume the carcass o f cattle that has died? (a) Yes (b) No 4. Where would you go when members o f your family become sick after cutting, handling the carcass o f cattle that has died? (a) Vet officer (b) Hospital (c) Soothsayer (d) Herbalist (e) Others specify 5. Do you think meat meant for consumption should be inspected by veterinary personnel? (a) Yes (b) No - University of Ghana http://ugspace.ug.edu.gh 6 . Do you think cooking meat o f cattle which has died with certain herbs can prevent you from getting sick? (a) Yes (b) No 7. What herbs do you use? (a) (b) (c)(d) 8. Do you think you can spread anthrax by taking the contaminated meat from one place to another? (a) Yes (b) No PRACTICES 1. Why do you keep cattle? (a) For economic reasons (b) For food (c ) For prestige (d) Others specify 2. How would you dispose o f the carcass o f cattle which has died? (a) Bury (b) Bum it (c) Butcher it and distribute (d) Others specify 3. Would you exhume the carcass when the carcass has been buried by vet officials? (a) Yes (b) No 4. If you found someone exhuming carcass that has been buried by vet officials what would you do? (a) Report tot he chief (b) Report to the police ( c ) Report to vet officials (d) Report to MOH officials (e) Others specify 5. Who gives the order for the butchering o f the carcass? (a) Cattle owner (b) Herdsman (c) Family head ( e ) Others specify 6 . Why do you think cattle has died might be butchered? (a) Cattle is expensive (b) A source o f meat for a large community (c ) Source o f protein (d) Others specify 7. In which ways do you think animal anthrax can be prevented? (a) Annual vaccination o f cattle (b) Cooking anthrax contaminated meat with social herbs (c) Refraining from consuming carcass o f cattle that has died (d) Others specify University of Ghana http://ugspace.ug.edu.gh 8 . How often should vaccination be done? (a) Yearly (b) Once in the lifetime o f the animal (c ) Others specify QUESTIONNAIRE FOR CONSUMERS 1. Do you know diseases form animals can be transmitted to man (a) Yes (b) No 2. Do you eat beef? (a) Yes (b) No 3. How frequently? (a) Daily (b) Weekly (c) Monthly (d) Others specify 4. Where do you buy meat for cooking? (a) Butchers shop (b) Farmers (c) Others specify 5. Does it matter to you when meat has been inspected by a Vet before being sold to the public? (a) Yes (b) No 6 . How would you recognize meat which has been inspected by a vet? (a) When purchased from the butchers house (b) From the abattoir (c) Others specify 7. Would you buy from your neighbour meat that has not been inspected and it is cheap? (a) Yes (b) No 8 . I f you got to know the meat is from cattle that had died would you still buy? (a) Yes (b) No 9. Do you know that you can die when you cut, handle or consume meat from cattle that has died? (a) Yes (b) No 10. Do you think cooking the meat o f cattle that has died with some special herbs can prevent you from getting sick? (a) Yes (b) No 11. What do you look for when you buy meat? (a) Colour meat (b) Colour o f fat (c) Texture (d) Nothing (e) Others specify University of Ghana http://ugspace.ug.edu.gh 12. In your view what would you say is a wholesome meat? (a) Colour o f meat (b) firmness (c) Odour (d) Others specify 13. Have you heard o f the disease anthrax? (a) Yes (b) No 14. I f Yes, what is it? (a) Animal disease that affects humans (b) Human disease occurring after eating cattle that had died suddenly (c) Disease that cause sudden death in cattle (d) Others specify 15. How do you prepare meat? (a) Cook (b) Roast (c) Fry (d) Eat raw (e) Others specify QUESTIONNAIRE FOR BUTCHERS 1. How long have you been working as a butcher? (a) 1-5 yrs (b) 5-10 yrs (c) above 10 years 2. Where do you get meat from? (a) Cattle owners (b) Government farm (c) Others specify 3. Who inspects your meat before you sell? (a) Vet personnel (b) Environmental health personnel (c) Yourself (d) Others specify 4. If you were called to buy and butcher carcass o f cattle that has died what would you do? (a) Call a vet to ascertain cause o f death (b) Butcher it and sell because it is cheap (c) Would not butcher cattle which has already died because o f my religion (d) Others specify 5. If yes, what is it? (a) Animal disease (b) Human disease (c) Animal disease that can affect humans (d) Others specify University of Ghana http://ugspace.ug.edu.gh Do you know that anthrax contaminated meat, when cut, handled or consumed can cause sickness or even death? (a) Yes (b) No If you inadvertently open an anthrax carcass, what would you do? (a) call a Vet (b) call MOH personnel (c ) call Assembly man (d) others specify Have you ever heard o f animal anthrax outbreak in your community? (a ) Yes (b) No Have you heard of any human death in your community due to anthrax? (a) Yes (b) No University of Ghana http://ugspace.ug.edu.gh