S F % 1 ' M B & f I x S U f e - ^ S R _ O O Y 'A University of Ghana http://ugspace.ug.edu.gh PREVALENCE OF TUBERCULOSIS IN CATTLE IN THE DANGME- WEST DISTRICT: PUBLIC HEALTH IMPLICATIONS. BY DR. OSEI- AGYEMANG BONSU A DISSERTATION SUBMITTED TO THE SCHOOL OF PUBLIC HEALTH , UNIVERSITY OF GHANA, LEGON, IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF MASTER OF PUBLIC HEALTH DEGREE. SCHOOL OF PUBLIC HEALTH UNIVERSITY OF GHANA LEGON. SEPTEMBER 1998 University of Ghana http://ugspace.ug.edu.gh DECLARATION 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 in candidature for any other degree. CANDIDATE DR. OSEI- AGYEMANG BONSU II University of Ghana http://ugspace.ug.edu.gh DEDICATION THIS W ORK IS DEDICATED TO MY BELOVED CHILDREN ELVIS and EUNICE University of Ghana http://ugspace.ug.edu.gh ACKNOLEDGM ENT "It is the one who climbs a good tree that gets a good push”, I am therefore grateful to the good Lord for providing the opportunity, the strength and wisdom to see me through this Master’s course. I am also grateful to the Veterinary Services Department o f the M inistry o f Food and Agriculture for their sponsorship. I am indebted to all my lecturers for providing me with knowledge which helped me at the Dangme-West District during my data collection for the production o f this dissertation. I wish to place on record the enormous support from my field supervisor, Dr. Irene Agyepong , District director o f Medical Services , Dangme-W est D istrict and my academic supervisors: Prof. E. Laing, Botany Department, University o f Ghana, and Dr. B. D. A kanm ori, Head, Immunology Unit, Noguchi Memorial Research Institute for Medical Research, Legon, for their direction, supervision and constructive contributions during the preparation and implementation o f the research proposal as well as they writing of this work. I express my profound gratitude o f financial material moral emotional and prayerful support from my family and friends, especially Mr. Pobee.. I register my sincere gratitude to the Director and all the staff o f the school o f Public Health ,Legon, the staff of D odow a, Prampram and Ningo Health centres for assisting me in my data collection. University of Ghana http://ugspace.ug.edu.gh I thank all the respondent whom I came into contact with during this research period. Finally for all those who helped in diverse ways to get this work produced, I say may God be with you. v University of Ghana http://ugspace.ug.edu.gh TABLE OF CONTENTS PAGE Title ' i Declaration >i Dedication iii Acknowledgment iv Table of Content vi List o f Tables and Maps ix Abstract - x Chapter One Introduction ' 1 Chapter Two 4 Literature Review 2.1. Mycobacteria 4 2 .2 .1 . Mycobacterium Tuberculosis/ Bovis 5 2.2.2 Transmission/ Epidemiology 5 2.2.3 Clinical Diagnosis o f Bovine Tuberculosis 9 2.2.4 Clinical Pathology 10 2.3 The Tuberculin Test - 11 2.3.1 The Single Intradermal Test 11 2.3.2 The Short Thermal Test 11 2.3.3 Intravenous Tuberculin Test 11 University of Ghana http://ugspace.ug.edu.gh 2.3.4 I Stormont Test 12 2.3.5 The Comparative Test 12 2.4 Treatment O f Bovine Tuberculosis 12 2.5 Control O f Bovine Tuberculosis 13 2.5.1 Control O f Bovine Tuberculosis On Herd Basis 13 2.5.2 Control O f Bovine Tuberculosis On An Area Basis 14 2.5.3 Vaccination As a Control O f Bovine Tuberculosis 14 Chapter Three Methodology/ Materials 3.3.1 Study Area i 16 16 3.3.2 Location 16 3.3.3 Population 17 3.3.4 Land Area 17 3.3.5 Administrative Unit 17 3.3.6; Economic Activities 17 3.1.7;I Education 18 3.1.8 Transport 18 3.1.9 Communication 18 3.1.10 Common Diseases 19 3.2 Health Facilities 3.4 Veterinary Services 20 3.5 Study Population 20 3.6 Sample Size 21 3.7 Preparation For Field Work University of Ghana http://ugspace.ug.edu.gh 3.8 1 Type O f Study 22 3.9 Tuberculin Testing 23 3.10 ! Handling O f Milk 23 i 3.11 Limitations 23 3 .1 2 ; Ethical Considerations 24 Chapter Four Results 25 4.1 The Prevalence O f Tuberculosis 25 4.2 Conditions O f Cattle That Reacted Positive To TB Test 26 4.3 i Knowledge About Tuberculosis 27 4.4 Milk Handling 29 4.5 Discussions 29 4.6 Conclusions 33 4.7 Recommendations 35 References 37 Appendixes Appendixes 3 List o f Questions 41 Appendixes 4 Measurements o f skin thickness o f positive T B reactors 43 University of Ghana http://ugspace.ug.edu.gh LIST OF TABLES AND MAPS PAGE Table 1 Medically Important Mycobacteria 4 Table 2 District Distribution O f Bovine Tuberculin Reactors 25 Table 3 Bovine Tuberculin Reactors By Sex and Age 26 Table 4 Conditions O f Bovine Tuberculin Positive Cows 27 Table 5 Knowledge O f Cattle Herdsmen At Dangme-W est O f Ghana About Tuberculosis 28 Table 6 Knowledge o f Cattle Owners At Dangme-W est District O f Ghana About Tuberculosis 29 Table 7 Handling O f M ilk A t Dangme-W est District o f G hana. 30 Table 8 Results O f Tuberculin Test A t Dangme-W est District. 32 Table 9 Bovine Tuberculosis Detected At Slaughter Houses/ slabs in Southern Volta Region O f Ghana . Appendix 1 Map o f Ghana Showing The Dangme-W est District 39 Appendix 2 Map o f The Dangm-W est District. 40 University of Ghana http://ugspace.ug.edu.gh THE PREVALENCE OF TUBERCULOSIS IN CATTLE IN THE DANGME-WEST DISTRICT, PUBLIC HEALTH IMPLICATIONS ABSTRACT It has been documented that in developing countries, bovine infected with Mycobacterium bovis constitute a significant reservoir for human tuberculosis and unless bovine milk is pasteurized, consumption o f it can lead to the spread of gastrointestinal tuberculosis in humans.The Ghana Government through its peri-urban daiiy cattle development project, is encouraging the use o f milk and dairy products from local cows in selected districts o f the country, including the Dangme W est District o f Greater Accra Region. A survey was therefore undertaken to determine the risk of infection with tuberculosis through consumption o f milk from the Dangme-W est District and the level o f awareness with regard to this risk . The standard single intradermal comparative tuberculin test using purified protein derivative (PPD) o f M. bovis and M. avium was used. The study established a 13.8% prevalence o f tuberculosis in cattle in the district with prevalence as high as 50% in some kraals. Cattle o f all ages and both sexes were affected, but the prevalence in cows was twice as high as that o f heifers and bulls. This can be explained from the fact that cows being more productive are kept for much longer periods increasing their chances of getting infected . The result is significantly high compared the 5% prevalence regarded as low which makes test x University of Ghana http://ugspace.ug.edu.gh and s laugh te r e c o n o m ic a l B lood 1981), The study also established that, there is a considerable lack o f knowledge about bovine tuberculosis among cattle owners and herdsmen in the district and m ilk is often used untreated. The relatively high prevalence o f the disease and the accompanying lack o f knowledge about it calls for concerted effort by the Ministry o f Food and Agriculture, the Ministry o f Health, the District Assembly, and the local community leaders in order to put in place control measures to prevent human infection. There is also the need, first, for a nation wide survey to establish the general prevalence and distribution o f bovine tuberculosis in the country as a basis for selection o f animals for breeding. University of Ghana http://ugspace.ug.edu.gh CHAPTER ONE INTRODUCTION Human tuberculosis appears to be increasing globally as well as in Ghana . Even though tuberculosis seemed to be under control in the developed countries, the disease is re-emerging, and it is becoming even more o f a problem due to the emergence o f drug resistant strains in immmunocompromised individuals, especially those with AIDS . W H O estimates that, one third o f the w orld’s population is infected with tuberculosis, and many more are at risk. Mobility is also high and most o f it occur in developing countries.( W H O 1997). Bovine tuberculosis caused by Mycobacterium bovis at one time caused much infection in cattle in Europe and the Americas . Infection was passed on to man through milk . With control o f tuberculosis in cattle by killing infected animals and pasteurization of milk . these countries have largely prevented bovine tuberculosis in man. In UK, the proportion o f tuberculous cattle has shown a gradual reduction since 1950 when tuberculosis eradication scheme was introduced , and at the end o f 1960 all cattle were in officially tubercle-free herds. Tuberculosis in humans is caused by Mycobacterium bovis and Mycobacterium tuberculosis. Though, the majority o f cases o f human tuberculosis is caused by the human type o f bacillus, it is probable that all human beings are as susceptible to the bovine type as they are to the human, but the chances o f infection by the bovine type have been reduced in most countries as a result o f the eradication o f the disease from the cattle population. 1 University of Ghana http://ugspace.ug.edu.gh It can not be overemphasized, however, that the bovine bacillus is probably just as virulent for man as the human bacillus and is a deadly and killing organism, while it m ust also be stressed that it is erroneous to believe that small doses o f living bovine tubercle, taken accidentally with food, raise the specific resistance o f individual w ithout producing disease. It is thought that bovine tuberculosis is rare in developing countries , but there is as yet not enough information 011 this .It is thought th a t , perhaps , the disease seems to be rare because in some o f these countries , m ilk is boiled before use, whilst in others milk is not used at all. There is therefore the opinion that there is the need for more information about how much bovine tuberculosis exists and its distribution in Africa , both in animals and man ( Crofton , 1992 ). It has been documented that in developing countries bovine infected with M. bovis constitute a reservoir for human tuberculosis and also unless bovine m ilk is pasteurized, it can lead to the spread o f M- bovis causing gastrointestinal tuberculosis in humans. ( Warren 1994 ). It is currently estimated that there will be 10 million new cases o f tuberculosis per year during the next decade. If the hope o f Health For All by the year 2000 is to be approached, effective tuberculosis control must be a priority for all involved in health. The Government o f Ghana, through its peri-urban dairy cattle development project, is encouraging the use of milk from local cows in selected districts o f the country including the Dangme-West District o f the Greater Accra Region in southern Ghana . As very little is known about how much bovine tuberculosis exists'in Ghana, and in Africa as a whole, a study was conducted; 2 University of Ghana http://ugspace.ug.edu.gh • To determine the number of cattle infected with TB bacilli by means o f the intradermal tuberculin test. • To determine the safety o f milk from the district for human consumption. • To describe possible ways/ methods to help control tuberculosis in man and animals. 3 University of Ghana http://ugspace.ug.edu.gh CHAPTER TWO LITERATURE REVIEW 2.1 MYCOBACTERIA. Mycobacterium was first isolated by Robert Koch in 1882 ( Bakulov 1987). There are five types o f Mycobacteria: M. tuberculosis which is responsible for most human tuberculosis, M. bovis responsible for cattle tuberculosis , M. avium for birds, M. macroti for mouse and M- thamnopheose for reptiles. These organism can infect other animals rather than their natural hosts. There are also several types o f atypical mycobacteria. The other pathogen in this group is Mycobacteria leprae, the cause o f leprosy. Table 1. Medically important mycobacteria and their-modes of transmission. ORGANISM GROWTH ON BACTERIOLOGIC MEDIA PREFERRED TEMPERATURE IN V IV 0(D E G R E E S) SOURCE OR M ODE OF TRANSMISSION M. tuberculosis Slow ( w eeks) 37 Respiratory droplets M. bovis Slow (w eeks) 37 M ilk from infected animals M. leprae none 32 Prolonged closed contact M. kansali Slow ( w eeks) 37 Soil and water M. marianum Slow ( w eeks) 32 W ater M. avium Slow ( W eeks) 37 Soil and water M fortuitum Rapid ( days ) 37 Soil and water Source; W arren E . L. M edical M icrobiology and Im munology 1994 4 University of Ghana http://ugspace.ug.edu.gh 7 7 J MYCOBACTERIUM TUBERCULOSIS/ BOVIS Important properties Mycobacterium tuberculosis/ bovis grows slowly ( it' has a doubling time o f 18 hours, in contrast to most bacteria which can double in number in 1 hour or less ). Because growth is slow, cultures o f clinical specimens must be held for 6- 8 weeks before being recorded negative. M. tuberculosis/bovis can be cultured on bacteriologic media which contain complex nutrients ( e.g. egg y o lk ) and dyes (e.g. malachite green ). The dyes inhibit the unwanted normal flora present in the pathological sample. M. tuberculosis is an obligate aerobe ; this explains its predilection for causing disease in highly oxygenated tissue such as the upper lobe o f the lung and kidney. Its cell wall contains several complex lipids . Cord factor ( trehalose dimycolate) is correlated with virulence o f the organism . virulent strains grow in a characteristic “serpentine” cord like pattern , whereas avirulent strains do not .The organism also contains several protein , which, when combined with wax, elicit delayed hypersensitivity PPD ( purified protein derivative )skin test ( Warren, 1994 ). Although the organism does not form spores, it is relatively resistant to acids and alkalis. It is also resistant to dehydration and so survives in dried expectorated sputum ; this property may be important in its transmission by aerosol( Bakulov 1987 ). 2.2.2 Transm ission/Epidem iology Mycobacterium tuberculosis is transmitted from person to person by respiratory aerosol, and its initial sites o f infection is the lung. University of Ghana http://ugspace.ug.edu.gh In the body, it resides chiefly within cells o f reticuloendothelial system. In the USA , tuberculosis is almost exclusively a human disease. In developing countries, cows infected with M- bovis constitute a reservoir for the human disease. Unless pasteurized, cow’s milk can spread M. bovis. causing gastrointestinal tuberculosis in humans (W arren . 1994 ). Abdominal tuberculosis is common in developing countries , especially in females , but it is rare in industrialized countries. It may arise in the gastrointestinal tract with spread to the mesenteric nodes . There are three forms o f abdominal tuberculosis : primary, secondary and hyperplastic ileo-caecal tuberculosis. Clinically , the primary and secondary forms may be very similar. Tuberculosis can reach children through milk or food and infection can then begin in the mouth or intestine. Milk can carry bovine tuberculosis i f the cows in the area have tuberculosis and milk, not boiled before it is used. W hen that happens, the primary infection is in the intestine or sometimes in the tonsil. In Europe, primary tuberculosis was usually caused by M bovis with cow’s milk as source o f infection. In Africa, the disease is thought to have arisen from blood borne spread through the lymph nodes or the peritoneum, as bovine tuberculosis is thought to be rare , but there is still no sufficient information on this ( Crofton. 1992). In the secondary form, patients with pulmonary tuberculosis may swallow their sputum, the tuberculosis in the sputum infects the wall o f the intestines and cause ulceration. Fistula may occur . Infection may spread into the abdominal cavity and causes acites. Bovine tuberculosis is suspected in any patient who is losing weight, has fever, and has vague abdominal pain. University of Ghana http://ugspace.ug.edu.gh Be even more suspicious if there is an abdominal mass or fluid in the abdomen ( Crofton 1992). The disease tuberculosis occurs in only a small proportion o f infected individuals. In the USA , most tuberculosis is due to reactivation in elderly malnourished men. The risk o f infection and disease is highest among socio-economically disadvantaged people, who have poor housing and poor nutrition. These factors rather than genetic ones probably account for the high rate o f infection among native Americans , Blacks and Eskimos. Mycobacterium bovis is the common cause of tuberculosis in cattle. The source of infection is usually other infected cattle, although in some pulmonary or genitourinary tuberculosis o f man caused by bacilli o f bovine type, is the source o f infection in up to 60% o f re infected herds ( Veterinary Manual 1986). Tuberculous animals with open lung lesions throw infected droplets into the air by coughing . Such animals also swallow sputum and thus contaminate pasture and cow sheds via the feces. Adult animals are infected by inhalation o f air bone dust particles as well as contaminated feed and water facilities. Young calves may be infected by drinking unpasteurized infected milk. Early lesions are usually found in the chest and sometimes in the lymph nodes o f the head or intestines . In the advanced stages o f the disease, lesions may be found in many organs and tissues that are seldom affected primarily; thus, infection o f the udder, uterus, lymph nodes, kidneys and the meninges occurs with varying frequency. The skeletal muscles are very seldom affected , even in advanced cases. (Veterinary Manual 1986). Tuberculosis o f the udder is o f special significance because o f contamination o f milk 7 University of Ghana http://ugspace.ug.edu.gh with infective organisms. Apart from its Public Health importance, bovine tuberculosis is important for its detrimental effects on animal production. Housing predisposes to the disease as zero grazing , so the disease is more common and serious where these forms o f husbandry are practiced. In spite o f the low overall incidence o f the disease in countries where cattle are at pasture all the year round, individual herds with 60-70 % morbidity may be encountered (Blanco , 1974). An initial tuberculin test in some kraals at Ashie in the Tema district and Kasoa in the Ehutu Seya district showed a 2% tuberculin positive reactors. Another work done at Aveyime in the Dangme- East district showed a 4% positive reactors. As high as 50% positive tuberculin reactors was recorded in a kraal with a total stock o f 75 at Adedome in the Volta Region . A 60% morbidity was also encountered atN saw am in the Eastern Region. (Report on TB veterinary services Accra 1997). Among beef cattle, the degree o f infection is usually much lower because o f the open range condition under which they are kept. However, individual beef herds may suffer a high morbidity if infected animals are introduced and large number o f animals have to drink from stagnant water holes, especially during dry season( Blood . 1981). Spread o f tuberculosis from animals to man makes it an important zoonosis. Infection in man occurs largely through consumption o f infected milk, but spread can also occur by inhalation .All species and age groups o f animals are susceptible to M. bovis . with cattle, goats and pigs most susceptible, and sheep and horses showing natural resistance.(Blood. 1981). University of Ghana http://ugspace.ug.edu.gh Tuberculosis spreads in the body by two stages, primary complex and post- primary dissemination. The primary complex consist o f the lesion at the point o f entry and in the local lymph node. Post primary dissemination from the primary complex varies considerably in rate and route. It may take the form o f acute milliary tuberculosis, discrete nodular lesions in various organs, or chronic organ tuberculosis cause by endogenous or exogenous re- infection o f tissues rendered allergic to tubercul protein. In cattle, horses, sheep and goats, the disease is a progressive one and , although generalized tuberculosis is not common in pigs, localization as non progressive abscesses in the lymph nodes o f the head and neck is the most common finding. 2.2.3 Clinical Diagnosis of Bovine Tuberculosis. Some cows with extensive miliary tubercular lesions are clinically normal, but progressive emaciation unassociated with other signs should always arouse suspicion o f tuberculosis. A capricious appetite and fluctuating temperature are also commonly associated with the disease. Pulmonary involvement is characterized by a chronic cough due to bronchopneumonia. The cough is never loud or paroxysmal, occurring only once or twice at a time and is low, suppressed and moist. It is easily stimulated by squeezing the pharynx or by exercise and is most common in the morning or in cold weather. In the advanced stages when much lung has been destroyed; dyspnoea with increased rate and depth o f respiration becomes apparent. The most common sign o f alimentary involvement are caused by pressure o f enlarged lymph nodes on surrounding organs( Veterinary $&nual 1973). Retropharyngeal lymph nodes enlargement causes dysphagic and noisy breathing due to 9 University of Ghana http://ugspace.ug.edu.gh pharyngeal obstruction. Because o f the chronic nature o f the disease, and the multiplicity o f signs caused by the variable localization o f the infection, tuberculosis is difficult to diagnose on clinical examination. In cattle , other chronic pulmonary diseases which may be confused with tuberculosis pneumonia are; lung abscess due to aspiration pneumonia , pleurisy and pericarditis following traumatic reticulitis and chronic contagious bovine pleuropneumonia. Snoring respiration is relatively common in cattle and some differentiation o f the cause is necessary and practicable. But the final differentiation is by tuberculin test. In tuberculous mastitis, fibrosis begins at the base o f the gland instead o f the cistern as in most other forms o f mastitis, and abnormal milk commonly comes at the end o f milking instead o f the first few streams and is not marked until the late stages o f the disease. Peripheral lymph node enlargement should be suspected o f having tuberculosis origin, but abscesses caused by mixed infection or infection with Actinobacillus lignieresi o f the lymph nodes o f the head are much more common. 2.2 .3 Clinical Pathology. Because o f the universal dependence on the tuberculin test for diagnosis and the policy o f slaughtering all positive reactors whether they are open cases or not, few clinico pathological test are now carried out. Sputum or discharges may be examined by inoculation into guinea pigs, but improved cultural techniques make animal injection test unnecessary ( Hall. 1977). The basis o f all tuberculosis eradication schemes is therefore the tuberculin test. 10 University of Ghana http://ugspace.ug.edu.gh 2.3. THE TUBERCULIN TEST. 2.3.1 The single Intradermal Test. ( SID te s t). This test is applied by the intradermal injection o f tuberculin into an anal fold. The reaction is read between 72 and 96 hours after the injection and a positive reaction constitute diffused swelling at the injection site( Blood . 1981 ). The main disadvantage o f the SID test is it’s lack o f specificity and the number o f No Visible Lesion reactors ( N V L ) which occur. 2.3.2.The Short Thermal Test. Intradermal tuberculin is injected subcutaneosly into the neck o f cattle with rectal temperature o f not more than 39 degrees Celsius at the time o f the injection and for two hours later . If the temperature at 4, 6, and 8 hours after the injection rises above 40 degrees, the animal is classed as a positive reactor. The disadvantages are th a t , it requires a lot o f labour and also there are occasional deaths due to anaphylaxis. 2.3.3 Intravenous Tuberculin Test. This test has been used experimentally , but requires a special research tuberculin (Kopecky 1971). 11 University of Ghana http://ugspace.ug.edu.gh 2.3.4. Stormont Test. This test has been devised to select those animals which are poorly sensitized for any reason. The test is performed similarly to the SID test in the neck w ith further injection at the same site 7 days later (Larsen 1969 ). An increase in thickness o f 5mm or more , 24 hours after this second injection is a positive result. Cattle injected w ith M. avium do not give positive reaction but skin tuberculosis cases do. A practical difficulty is the necessity for three visits to the farm. Special purified protein derivative tuberculin o f a specified potency m ust be used to fulfill the requirements o f the 2.3.5. The Comparative Test. This test has been dealt with in chapter three. Serological Test For Diagnosis O f Bovine Tuberculosis Serological test including complement fixation, fluorescent antibody ,direct bacterial agglutination precipitation and haeagglutination tests are under review but seem to have little potential value (Blood . 1981). 2.4. TREATM ENT OF BOVINE TUBERCULOSIS Because o f the progress being made in the treatment o f human tuberculosis with such drugs as isoniazid, combination o f streptomycin and para- aminosalicylic and other acids, 12 University of Ghana http://ugspace.ug.edu.gh 2.5. CONTROL OF BOVINE TUBERCLOSIS. Eradication o f bovine tuberculosis has been virtually achieved in many countries. The test and slaughter policy has been the only one by which effective eradication has been achieved (Kleeberg 1968, Bakulov .1991). 2.5.1. Control O f Bovine Tuberculosis On Herd Bases This rests on: • removal o f infected animals. • prevention o f spread o f infection. • avoidance o f further introduction o f the disease. All the three points are o f equal importance and neglect o f one may result in breakdown o f the eradication Programme. Detection o f infected animals depend largely upon the use o f tuberculin test. Hygienic measures to prevent the spread o f infection should be instituted as soon as the first group o f reactors is removed. It is most important that calves being reared as herds replacements be fed on tuberculosis free milk either from known free animals or pasteurized. After reactors have been removed, steps should be taken to prevent reinfection. This can be done by preventing use o f communal watering facilities or pasture and maintaining adequate boundary fences. the treatment o f animals with tuberculosis has undergone the efficiency o f long term oral medication with isonizid both as treatment and prophylaxis ( Kleeberg. 1968 ). 13 University of Ghana http://ugspace.ug.edu.gh 2.5.2. Control O f Tuberculosis On An Area Basis. The method used to eradicate bovine tuberculosis from large areas depends on the incidence o f the disease, methods o f husbandry , attitude o f the farming community and the economic capacity o f the countiy to stand loses from a test and slaughter Programme. An essential first step in the inauguration o f an eradication Programme is the prior education o f the farming community (Blood. 1981). Livestock owners must be appraised o f the economic and public health significance o f the disease. Eradication must be compulsory since voluntary schemes have never achieved more than limited control and always leave foci o f infection. It is essential at the beginning o f a Programme to determine the incidence and distribution o f the disease by tuberculin testing o f samples o f cattle population and meat inspection services. The information collected in this way can indicate areas that are free o f tuberculosis or which have low incidence . The disease can be readily eradicated from the low incidence areas, thus providing a nucleus o f tuberculosis free cattle which can supply replacement for further areas as they are brought into the eradication scheme. Finally, the eradication Programme can be extended to the residual area. When the incidence o f tuberculosis is high a routine test and slaughter programme may be economically impossible. 2.5.3. Vaccination as a Measure of Control O f Bovine Tuberculosis. Vaccination may be considered when an eradication programme cannot be instituted for 14 University of Ghana http://ugspace.ug.edu.gh some time but it is desired to reduce the incidence o f the disease in preparation for eradication. BCG vaccination is the only method available for field use. When the overall incidence is low, ( 5% or less ) Compulsory testing and slaughter o f reactors is the only satisfactory method o f eradication ( Blood .1981) 15 University of Ghana http://ugspace.ug.edu.gh CHAPTER THREE METHODOLOGY/MATERIALS. 3.1.1. Study Area Data collection is important in any study because its analysis will lead to making good or reasonable conclusions and subsequently, valid recommendations. The Dangme W est District was chosen for the following reasons : 1. It is the district where the author was posted for field practice. 2. It is one o f the districts selected for the peri- urban dairy cattle development project. 3. The district has a large cattle/ human population ratio ( 1 : 2 ).(Dangme- W est Assembly 1996.) 4. The district was selected by the U N D P as the poorest district in the coastal savanna zone and has instituted a three year poverty reduction program , which among other things is to help the cattle farmers in the area to improve on the production o f milk to increase their income .Whilst trying to help the farmers to produce more milk , the milk they produce must be free from tuberculosis . 5. This is a percieved problem o f interest to the district Health and the veterinary / Animal production departments. 3.1.2 Location of the District The Dangme- W est District is in the Greater Accra Region . It is situated in the south eastern part o f Ghana. It lies between latitude 5.45 degrees and 6.05 degrees north, and longitude 0.05 east and 0.20 west.( fig. One ) It is one o f the 45 new districts created in 1988 as a result o f the govermnent redemarcation University of Ghana http://ugspace.ug.edu.gh exercise carried out in respond to decentralization reforms. 3.1.3 Population. The district has an estimated population o f about 100000 based on the 1984 census; 48.2% are males and 51.8% females. About 20% o f the population are below the age o f 15. 3.1.4. District Land Area. The district has a land area o f 1442 square kilometers. The district is the largest in the Greater Accra Region, claming about 41.5% o f the regional land area. 3.1.5. Administrative Units. The district, in spite o f its proximity to the national capital, is basically a rural district with a poor state o f socio- economic and infrastructural development. The district administration is the implementing arm o f the district assembly which is the highest political power in the district, the district administration is headed by the district Coordinating Director under the overall supervision o f the District C hief Executive. The name o f the District Chief Executive is Hon. Seth Ayertey Kpabitey. 3.1.6. Economic Activities. The main economic activities o f the people in the district are farming, fishing and forestry. 17 University of Ghana http://ugspace.ug.edu.gh 65% o f the labour force engage in agriculture. The district has a cattle population o f about 50 000 . The cattle human ratio is about 1:2 . There are over 5000 sheep and 6000 goats in the district. The people also keep poultry. The main crop farming season at the district starts from April and ends in September. There are no major industries. The small scale industries present are agro based, wood related, mining/ quarrying, construction and building. 3.1.7. Education. About 62.5 % of the inhabitants can read and write(District Assembly 1996). This compares favorably with the national level which stands at 49.4% . The district education directorate comprises four circuits: Osudoku, Ningo, Prampram and S h a i. Each o f the circuits has a chain o f basic schools and one senior secondary school. There are seven vocational/ technical schools in the district. The non formal education division of the Ministry o f education is also contributing in educating some o f the population. 3.1.8.Transport. The district has about 252 kilometers of road net work. Out of this total, about 40% is surfaced, while the rest are earth roads. Tracts and foot paths also links the villages. Public transport supply for goods and passenger movement is however inadequate. There is an average passenger waiting time o f about two hours on market days. 3.1.9. Communication System. The only telephone facility in the district is located at Dodowa within the district administration. The Ghana telecommunication company has stalled installing relay stations in 18 University of Ghana http://ugspace.ug.edu.gh two centers ( Prampram and Afienya), to boost telecommunication in the district. There is no radio station in the district. 3.1.10. Common Diseases in the district. The first five common disease in the district are : Malaria, Diarrhea, Anaemia, Upper Respiratory tract infection and skin diseases.( District Director’s report 1997) 3.2. HEALTH FACILITIES The health delivery system is poorly developed. The district health post at Dodowa, the capital o f the district, is in the process o f being upgraded to a district Hospital. There are also three health posts, 4 community clinics an 5 community based clinic/ MCH health posts in the d is tric t. There is only one medical officer and two nursing superintendents^ District Director’s report 1997) The District Health Management team consists of; * The District Director O f Medical Services. * The Principal Nursing Officer Public Health. * The Principal Nursing Officer General. * The District Environmental Officer. * The Principal Medical Assistant Dodowa * The Medical Assistant Ningo * The Medical Assistant Osudoku * Medical Assistant Prampram. * Principal Technical Officer Nutrition. 19 University of Ghana http://ugspace.ug.edu.gh * The Accountant. * The District Pharmacist * Technical Officer Nutrition. 3.4. VETERINARY SERVICES. Veterinary services is very poor in the district. There is only one veterinary officer in the district, instead o f a minimum o f four to take care o f the sub districts . There is a technical officer in each o f the four sub districts, but there are no offices from where they can be located. This makes it difficult for the officer in charge to coordinate veterinary activity in the district. There is no means o f transport for the officers in the district, this makes an out reach activities almost impossible. The officers are not provided with logistics . The most common disease problems facing livestock owners are worms, tick infestation, brucellosis leading to abortions, and foot and mouth disease. The four Sub- Districts controlled by technical officers are: * Ningo sub district, * Prampram sub d is tric t, * Dodowa sub d is tric t, * Osudoku sub district. 3..5. Study Population One thousand two hundred cattle o f both sexes and ages two years and above w ere screened These cattle w ere random ly selected from private individual farms .The breed w ere mainly zebus and their cross with the N ’dama, w est A frican shorthorn and w hite Fulani. 20 University of Ghana http://ugspace.ug.edu.gh N one o f the farmers practice zero grazing or supplem ent feeding, so the anim als w alk several kilometers during the dry season in search o f food and water. The herdsmen do not fully milk the cows. They take .an average o f about 1.5 liters from each cow and then allow the calf to drink directly from the mother. Milk is usually collected once in a day and sent in a special containers to the Amranhia dairy farms. Here, it is mixed with milk collected from other districts and then sent to Accra for distribution. Some customers go to the farm to buy directly from there. Almost all the cattle drink from stagnant w aters in dams or ponds w hich can serve as source o f tuberculosis infection. 3.6.SAMPLE SIZE: A total o f 1 200 out o f the 34000 cattle in the District ( cattle at Asutware area, even though are in Dangme west were not included because they form part o f Akuse district in the Eastern Region according to veterinary demarcation.) were tested. A total o f 1117 is suppose to be the sample size but was rounded up to 1200 . This sample size was arrived at using the formula: N=[ ( Z2 P q) / d2 ] Where ; N is the sample size, = ? Z is the confidence limit, = 95% (1.96 ) P is the assumed prevalence o f T B in cattle in the district, = 3% (0.03), based on previous works. ( Veterinary reports on tuberculosis ( 1997 ) Accra. T he an im als are k ep t in open kraals and a re sen t ou t fo r g razin g ev ery m o rn in g from 7 am to 6 21 University of Ghana http://ugspace.ug.edu.gh q = 1-p = 0 .97 d is the acceptable deviation from the true value. =1% (0 .0 1 ) . The power o f the test was set at 80%. Also 95% confidence limits was set. 3.7. PREPARATION FOR FIELD WORK. When the author went to the Dangme-W est District to start this study, two principal technical officers were assigned to help in data collection. Before the fieldwork, the team went round to inform the cattle owners whose animals were to be screened to seek their concern. The principal technical officers have had three weeks training in the screening methods. 3.8. TYPE OF STUDY. This study was exploratory and descriptive in content. 22 University of Ghana http://ugspace.ug.edu.gh 3.9. Tuberculin Testing. The standard single intradermal comparative tuberculin test using purified protein derivative ( PPD) Antigen( M bovis and M avium) as described by Blood , was used . A dose of 10 000 tuberculin units (0.1 ml tuberculin containing 2 mg of bovine PPD) was used. This test is selected so that false positive reaction due to Johnes disease or avian tuberculosis can be differentiated from bovine tuberculosis ( Blood 1981) Before the injection , the injection sites were shaved, so that the sites could be seen after the 72 hours. After shaving, a measurement o f the thickness o f the skin was taken with calipers and the results recorded. Each animal was given an identification number using permanent paint. Avian and Bovine tuberculin were injected simultaneously into two separate sites on the same side o f the n e c k , at least 12 cm apart and with the avian above the bovine , using the Mclintock tuberculin testing equipment. The test results was recorded 72 hours after the injection. Care was taken in placing the injection so that it goes intradermally as sensitivity varies from place to place in the skin. The thickness o f the skin was measured again after the 72 hours , and compared with the previous readings. The greater o f the two reactions indicates the organism responsible for the sensitization. 3.10. HANDLING OF MILK; There was an interview o f 30 herdsmen and 15 cattle owners to find out what they know about bovine tuberculosis and how to prevent themselves and others from getting infected . The process o f milking and how milk is handled before it is taken to the market for sale was also ascertained. 23 University of Ghana http://ugspace.ug.edu.gh LIMITATIONS; False negative reactions may result from : (a) Advanced cases o f tuberculosis due to desensitization . (b) Early cases until 6 weeks after infection due to low antibody levels. (c) Cows which have calved within the preceding 6 weeks due to desensitization. (d ) Animals desensitized by tuberculin administration during the preceding 8-60 days (e)) Old cattle. ETHICAL CONSIDERATION. After testing the animals, we had time to interview both the herdsmen and cattle owners who were around to know what they know about bovine tuberculosis. Based on what they know, we explained to them the possibility o f getting infected with tuberculosis from the cattle. We also told them how to prevent being infected and getting other people also infected. Consent was obtained from livestock owners and herdsmen and information was to be kept confidential. 24 University of Ghana http://ugspace.ug.edu.gh RESULTS: The prevalence o f tuberculosis A total o f 1200 cattle were tested; 747 cows, 400 heifers and 53 bulls. Out o f the 1200 cattle tested, 166 tested bovine tuberculin positive.. This represent 13.8% prevalence o f bovine tuberculosis in the district. The distribution o f the positive tuberculin reactors is shown on table 2. Table 2. Distribution of Bovine Tuberculin Reactors in the different subdistricts of the Dangine W est District o f Ghana. SUB- DISTRICT NO OF ANIMALS NO OF POSITIVE PREVALENCE TESTED REACTORS % Dodowa 450 66 14.7% Prampram 300 34 11.3% Osudoku 240 26 10.8% Ningo 210 40 19.0% TOTAL District 1200 166 13.8% Out o f the 210 cattle tested at the Ningo sub district, 40 tested positive. This represent 19. 0% prevalence in the Ningo sub district. The prevalence at Prampram was 11.3%. 34 out o f the 300 cattle tested, tested positive to bovine tuberculosis. At the Osudoku sub district, 240 cattle were tested with 26 testing positive to bovine tubercilosis. This represents 10. 8 % prevalence at the sub district. At the Dodowa sub district, 450 cattle were tested, with 66 testing positive. This represents 14.7% . The result shows a significantly high prevalence o f bovine tuberculosis in all the sub- districts, two or more times what is considered as low (5% ),( Blood 1981 ). The prevalence at Ningo was the highest, (19.0 %) followed by Dodowa sub- district, (14.7%) University of Ghana http://ugspace.ug.edu.gh Out o f 747 cows tested 125 were positive, representing 16.7 % (fig 2 ) The prevalence o f bovine tuberculosis was significantly higher in cows than in heifers and bulls. It was almost two times higher than in heifers,( 16.7% and 9.8 % ) and about four times higher than in bulls( 16.7% and 3.8%). See table 3 . The prevalence was also higher in female cattle than in bulls (14.3% in females and 3.8% in bulls). In all 400 heifers were tested. Out o f this , 39 tested positive. This represents 9.8 % . Fifty three bulls were also tested and 2 tested positive. This represents 3.8% . Tabic 3. Bovine tuberculin reactors by sex and age. CATEGORY AGE NO.TESTED NO OF REACTORS PREVALENCE % Cows >3 years 747 125 16.7% Heifers 2>4 years 400 39 9.8% Bulls >2 years 53 2 3.8% All females > 2 years 1147 164 14.3% Body Condition O f Cattle That Rcactcd Positive To Tuberculin Test In all, only 12 out o f the 125 cows tested positive showed some signs o f weight lost, dehydration, and ill health. All the remaining 113 were in good condition showing no sign o f ill health. Out o f the 166 cattle that reacted positive, 91 were producing milk for human consumption, 15 were either pregnant or dry, 19 were reported to have stopped calving, even though they were still within their reproductive ages. The conditions o f the bovine tuberculin reactors are shown on table 4. 26 University of Ghana http://ugspace.ug.edu.gh Tabic 4. Bodily Conditions O f Bovine Tuberculin Test Positive Cows In The Dandgme-W est District O f Ghana BODY CONDITION No o f reactors good Bad No coughing no producing milk No pregnant No not calving 125 113 12 11 91 15 19 Good bodily condition: Ribs not shown, Poverty triangle not prominent. Eyes not sunk into its obit. Bad bodily condition: When the above is present Knowledge About Tuberculosis. The knowledge o f cattle Herdsmen can be assessed from table 5. Out o f the 30 Herdsmen interviewed, 28 said they do not know what is tuberculosis ( the local name o f the disease was always used). Only two Herdsmen said they have heard about it. One Herdsman knew the symptom. However, after describing the disease, seven people said they know o f the disease and know that it is an ancestral disease. They said people who are cursed suffer from the disease. All the 30 herdsmen interviewed said they do not know that tuberculosis can be transmitted from cattle to man. None of them knew that cattle can suffer from the disease. None o f the 30 interviewed knew how the disease can be transmitted from cattle to man. Out o f the 30 herdsmen interviewed, 25 said they do not boil their milk before drinking, 5 of them said they boil the milk because they have been told to do so. One person said, if milk is not boiled and is given to children, they get stomach pains. Out o f the 30 herdsmen interviewed, 6 said they know that milk can give some disease to man if they allow the hair o f the cow to fall into the milk. They said if milk is filtered to get rid o f the hair, then the milk becomes safe for human consumption. Out o f the 30 herdsmen interviewed 19 said they have either drunk milk directly from the teat of the udder of a cow on the field when hungry or seen somebody do it. 27 University of Ghana http://ugspace.ug.edu.gh Table 5. Knowledge O f Cattle Herdsmen At Danginc- W est District O f Ghana A bout T uberculosis. NO STATEMENT NO OF HERDSMEN INTERVIEWED NO THAT KNOW NO THAT D ON’T KNOW 1 Know cause of TB 30 2 28 2 Know how TB is transmitted 30 1 29 J Know that cattle can suffer from TB. 30 nil 30 4 Know that cattle can transmit TB to man 30 nil 30 5 Know how man gets TB from cattle 30 nil 30 6 Know that boiling milk prevent TB. 30 nil 30 Table 6 indicates the level o f knowledge o f cattle owners about tuberculosis. Out o f the 15 cattle owners interviewed, 10 said they-know or have heard about tuberculosis, 6 knew the symptoms o f the disease, and 8 said they know that tuberculosis can be transmitted from cattle to man. 4 said human being get infected by drinking cow milk which has not been treated, however, none o f them boil milk before used. Also 2 of the owners said tuberculosis can be transmitted through milk and the consumption o f infected meat. 28 University of Ghana http://ugspace.ug.edu.gh Table 6. Knowledge of cattle owners in the Dangme- W est District O f Ghana About Tuberculosis. _____________________ __ NO STATEMENT NO OF CATTLE OWNERS INTERVIEWED NO THAT KNOW NO THAT D O N ’T KNOW. 1 Know cause o f T B 15 10 5 2 Know how T B is transmitted. 15 6 9 J Know that cattle can transmit TB. 15 8 7 4 Know that cattle can transmit TB to man 15 7 8 5 Know how man gets TB from cattle. 15 4 11 6 Know that boiling milk prevent TB. 15 2 13 MILK HANDLING. All the 30 herdsmen interviewed said they do not wash their hands or the teat o f the udder before milking. All o f them said they do not allow any day to pass after using acaricide on the animals before taking milk for human consumption. Out o f the 30 interviewed, 9 said they have ever applied acaricide on the animals whilst milking. But they said they are always careful to prevent the poison from getting into the milk ( table 7). During the interview, it was found that there were some abuse of the use o f antibiotics by the herdsmen. (Animals were under dosed and the drugs were used for wrong conditions). All the 30 herdsmen said they do not wait for any day to pass after injecting their animals with antibiotics before taking milk for human consumption. All the 30 herdsmen interviewed said they sell their milk either to the peri-urban milk collectors or to middlemen who go around to collect the milk and send it to the city for sale. Milking is done once a day. They all said yellow milk is given to dogs or thrown away. None o f them boils milk before drinking or selling. University of Ghana http://ugspace.ug.edu.gh Table 7. Handling o f milk at the Dangme -W est District o f Ghana. NO STATEMENT. NO OF HERDSMEN INTERVIEWED YES NO 1 Wash hands before milking cows. 30 nil 30 2 Wash teat o f udder before milking. 30 nil 30 oJ Ever applied acaricide while milking. 30 9 21 4 Obey withdrawal date on drugs. 30 nil 30 5 Boil milk before drinking. 30 5 25 6 Boil milk before selling. 30 nil 30 30 University of Ghana http://ugspace.ug.edu.gh Tab. 8. Results O f Tuberculin Test At Dangme - West District. LOCATION SUB. DIST. OW NER N O TESTED +REACTORS FALSE + REM ARK S M ataheko N ingo Mr. Kabute 60 4 - 55 55 Mr. Kwabi 30 nil nil 55 55 Mr. Botchway 30 nil 1 Dawa 55 M r Ntiam oah 30 15 nil " 55 Alfred Djagmah 30 16 nil ” ” Mr. N artey 30 5 nil Asebi Dodowa A. Tettey 30 3 nil ” 55 W. Teye 30 nil nil 55 55 Mr. O beng 30 1 nil ” 55 M. M amudu 30 2 nil 55 55 Col. Asase 30 1 nil Djopanya 55 D. Hadjo 30 nil 1 55 55 Mr. Donya 30 12 nil 55 55 G. Adegbenu 30 12 nil 55 55 S. Fulani 30 9 nil ” 55 M Abuli 30 6 nil ” 55 H. Tofa 30 nil nil 55 5? Mr. Akpali 30 6 nil 55 55 K. Teye 30 3 nil Djopanya 55 Mr. Koney 30 3 nil » 55 Osmanu Gali 30 6 nil Congo Osudoku Mr. Asubonteng 30 3 nil ” 55 Imoro Sambo 30 12 nil ” 55 Joseph Anumdjo 30 nil nil 55 N artey Amoni 30 1 nil 55 55 Atsu Sosi 30 nil nil 55 55 Tette Dadebo 30 1 nil 55 55 Osmanu Gali 30 6 nil ” 55 N ine Ayonu 30 3 nil University of Ghana http://ugspace.ug.edu.gh LOCATION SUB. DIST. O W NER N O TESTED +REACTORS FA LSE + REM A RK S Dawenya Prampram Mr. Botere 30 nil nil Abbey Kwo Paddy 30 10 nil " M alam Amadu 30 12 nil Prampram JJ Lartioko Farms 30 2 nil 55 M ensah Nyarko 30 nil 1 >’ >> Isaac Adoboli 30 7 nil >9 Seth T. 0 30 - nil nil Dawenya » K Asem 30 2 nil ” JJ Mr. Kwabi 30 1 nil ” 5? Mr. Botchway 30 nil nil TOTALS 1200 166 3 Total number of cattle tested = 1200 Total number of cattle that reacted = 166 Prevalence of Tuberculosis = 13.8% Table 9. Bovine Tuberculosis Detected At Slaughter House/ Slabs In Southern Volta Region .(Veterinary reports 1997). DISTRICT SLAUGHTERED CATTLE TUBRCULOSIS CASES % OF TOTA L Adidome 104 1 1.0 Juapong 537 10 0.2 Sogakope 47 0 0.0 Denu 587 10 0.2 Ho 1015 8 0.8 Totals 32 University of Ghana http://ugspace.ug.edu.gh DISCUSSION. The prevalence o f tuberculosis in cattle is said to be low when it is 5% or less and that is when the test and slaughter control method would be considered economical practice (Blood 1981 ). The 13.8% prevalence o f tuberculosis in cattle in the Dangme W est as shown by the results o f our study is therefore very significantly high. This calls for a nation wide survey to establish the general prevalence to help institute an appropriate control Programme. In Africa very little is known about how much bovine tuberculosis exist (Crofton 1992 ) making it difficult to institute appropriate control measures. hi Cuba an island wide testing programme has shown a prevalence o f 0.01%, while a 50% prevalence was reported in Aden in the gulf reg io n . Environmental conditions and stagnant water as source o f drinking water for the animals have been blamed for the high prevalence o f tuberculosis . The disease is reported as wide spread in all species o f animal in Nepal, Cameroon, and Guatemala. Bovine tuberculosis is said to be wide spread in cattle in Zaire, Angola , Malagasy republic, Agentine, Chile, Dominica, Hunduras, Mexico and W estern Samoa (Hall 1977). In Ghana this is the first o f the prevalence o f bovine tuberculosis. The high incidence, like in Aden, can be blamed on environmental factors, the most important o f which are the stagnant water sources. There are only few dams and,ponds in the district which serve as sources o f drinking water for most o f the animals in the d istric t, and most o f the animals graze at common grounds which are often over populated. The very high prevalence at Ningo with some kraals having up to 50% prevalence , may 33 University of Ghana http://ugspace.ug.edu.gh be due to the long period for which the people o f Ningo have been in cattle keeping relative to the other districts. The Author was informed during the data collection period that the people o f Prampram and Dodowa have all the time been crop farmers. The other point that may explain the high prevalence is that, Ningo is on a low and wet land, and cattle that feeds on low and wet land are at higher risk o f getting infected with bovine tuberculosis than those at higher lands ( Hall 1977 ) The prevalence, even though was highest at the Ningo sub district, it was significantly high in all the other sub districts. This general high prevalence may be due to the fact that most o f the livestock keepers at the other sub districts got their initial stock from Ningo, some o f which might have already been infected, and grazing on a common pasture and common source o f water increased the rate o f infection o f other animals. The body conditions o f most reactors confirms the report o f Clay, that the effect o f bovine tuberculosis on Zebu cattle is less, relative to other breeds ( Clay 1971). M ost o f the cattle screened were zebus or their cross breed. The poor knowledge o f cattle owners and herdsmen ,and the general public, about the disease and high prevalence indicated by the results show the risk involve in the consumption o f milk from the district. If the reactors are suffering from the pulmonary tuberculosis , then the general public is at risk because the reactors can throw contaminated droplets o f air into the atmosphere which can be a source o f infection to the public, especially in Ghana, where the animals are kept very close to the people and in some cases in the same houses . Also since the people who are nearer to the infected animals know very little about the disease , they will do very little to prevent themselves from getting infected. University of Ghana http://ugspace.ug.edu.gh The collection o f milk by the Ministry o f Food and Agriculture for distribution to the public may also help spread the disease as they mix all m ilk collected from all localities before distribution. This leads to high volume o f contaminated m ilk being distributed to the public. Unfortunately most o f the milk distributed are not pasteurized before distribution. This is because the distributors claim that it will add cost to the milk. Apart from the Public Health problems, bovine tuberculosis have economic consequences. Some o f the affected animals lose body weight, (in our study 12 out o f 166) and at times the whole carcass may be condemned at meat inspection. This cost the farmer money. In conclusion, it can be stated that tuberculosis in cattle in the Dangme -W est District is a serious problem as shown by our study and cattle owners , herdsmen as well as the general public are at risk from getting infected through consumption o f milk. The study results have also shown that the inhabitants o f the area know very little about bovine tuberculosis and the risk o f drinking unpasterized milk. Based on what has been determined, there is the need to plan an educational Programme which will help strengthen the control measures as well as institution o f new ones to control the disease. There is also the need to introduce practical training on dairy hygiene in order to make the peri-urban dairy programme a success. RECOM M ENDATIONS: => There is the need for an immediate tuberculosis control programme in the Ministry o f 4.6 CONCLUSION 35 University of Ghana http://ugspace.ug.edu.gh Food and Agriculture to control tuberculosis in cattle in the country. This will complement the efforts o f the Ministry o f Health in controlling tuberculosis in the country. => There is the need for an educational p ro g ram m ed educate cattle owners and herdsmen on the risk o f taking unpasteurized milk . This can be done by the front line staff o f the Ministry o f Food and Agriculture whilst they are on their normal duties. However, the front line staff need to be educated first so that they know what to tell the people. => There is a need for tuberculosis typing in the country, so that a possible link between human infection and cattle could be established. This will give seriousness to the control o f tuberculosis in cattle. => There is a need to train our meat inspectors so that they can recognize and report on tuberculosis in other organs in the body o f the animal apart from lungs and liver. 36 University of Ghana http://ugspace.ug.edu.gh REFERENCES: I. Abram S, et al.(1995) Tuberculosis. Control o f communicable diseases manual, sixteen edition Washington, 488-498 2. Bakulov I A, et al. (1987 ) Epidemiology and microbiology. Kalos 3, 142 3. Blood D C, et al. (1981) Veterinary medicine. E L B S, fifth edition. M acmillan New York. 19, 524- 530. 4. Crofton J, e ta l. .(1992) Clinical tuberculosis, M acmillan U. K. 10,131-134 . 5. Crofton J, et al. (1997). Guidelines for the management o f drug - resistant tuberculosis .W H O. Geneva. 6. Dangme -W est Assembly, (1996) 5 year development plan 1996. Dodowa . 7. Forest C, et al. (1975 ) Principles o f meat science. Freeman and Co USA 8. Hall H T B, et al. (197 8) Tuberculosis. Diseases and parasites o f livestock in the tropics, Longman, london. 83 - 86 9. Horace T, et al. ( 1978) Textbook o f meat hygiene, six edition. U. K252-272. U K dO 10. Konopatkin A A, et al .^Tropical diseases o f animals, Agropro, Moacow .(15>0) 4- 214 II . Oxfam Practical Guide number 4.(1985). Guidelines for tuberculosis control programs in developing countries U K. 12 Savaiskova A. G. ( 1985) Pathological Physiology o f farm animals ,Agropro, Moscow 13. Shull C R, (1997) Common medical problems in the tropics, M acmillan London.Urban 14.The Merck Veterinary M anual, . (1873 )4th Edition , Merck and Co, U .S. A. 364- 367. 37 University of Ghana http://ugspace.ug.edu.gh 15 Warren E L, et al. (1994) Medical microbiology and immunology, third edition. Appleton and Lang Connecticut.. 21 , 114-119. 16. W illiamson G, et al. (1978), Animal husbandry in the tropics, third edition longman London. 6, 429 17. Urban V P. (1987) Practical epidemiology and veterinary sanitation Agropro, Petrograd . 5. 155 18. Veterinary reports on tuberculosis, (1997) Accra, 38 University of Ghana http://ugspace.ug.edu.gh »-\: ri t;o r« u University of Ghana http://ugspace.ug.edu.gh University of Ghana http://ugspace.ug.edu.gh Koon<) Hnsohot (•) AkuseJft If^O -—C^^Aauliuore •̂vPAwolo n y f f ^ e u p wDor me II oniV,Y a ko « Yokuooyo \O 0 s «w « m N j - - * A Fu lanlkope L o r lo rv o r ’ Co Yo k ubtJ kop i ru s a le m Asut suor« !-Ju nc tio n „ f o "Kp ty lbor ' F°;k0! o /j * ] Agb«kots*kop« Y j Dedukcpe^^A Agoni''Vcc KPAH0OTE OKPEnYO A q o rto r ̂ gf Kponlsredor AmonaKpo ^ Somme .bechekope ■anfro J o r p o n yo [H ILLS M o o p o h o Dowg' I d u m i t M o o p nn g G ld lV o p tOcheblrki M o b o l e ^ 0 3 « rk o ,Ay«tfpoApoloni LokpleKi Teponyi A kp lobonya Le kpongunor K o p o d o r MokucH* o L o b o d i DANGME W E 3T DISTRICT H o w p o n j ITtMeh fyjoriMt W¥ ĥ /''llenyum v Memorialist Oodowa K p o r y t m ^ /T o k u V / ^ ^ \^ A ju m o )o n - A b o n y o ^ [o ^ ^ \ ^ S o r o ^ / V o k p Bo^oleihl ̂ _ A m o n l ro \ / ^ a t o r ^ (C a th o lic " M iss ion ) H u n g u p TEMA ------ H f g l o n n l B o u n d a r y 01 »Ir let Boundary , 1 Osnd^Vu Sub- d letrle t 2 Old Mingo S ub - fit | » rlc I 3 y Promprom Sub- dl jrrtcT A • Oodn o Sub - d l i lH e ! M p 1-1 Mfltarnol ond Child Health C'«nlc Old Nino© '"New Nlngo L E G E N D 9 S e t l l* m e « t* w ith p o p u la t io n o ver 3 ,0 0 0 ■K S e t t le m e n t * w ith p o p u lo t lo n 1 ,3 0 0 — 3 , 0 0 0 A S e t t le m e n t * w ith p o p u la tio n 5 0 0 — 1 ,5 0 0 O S e t t le m e n t * w ith p o p u la t io n b e lo w 3 0 0 M fp M a | f lo c a t e d o u ft ld e th e d l * t r l e t , b u l u »ed by th e p o p u la t io n H P M e o lih r 0»t C C C o m m u n i t y C l i n i c P C P r i v a t e - C lin ic P 'M P fW oi* -M o te rn fty Home l» t C l o u R o o d * O th e r H o a d * Railway M i l l * — R iv e r * 5 * 3 0 - L_ University of Ghana http://ugspace.ug.edu.gh APPENDIX 3 LIST OF QUESTIONS. 1. W h en d id y o u s ta r t c a ttle re a rin g ? 2. W h ere is th e so u rc e o f y o u r o rig in a l s to ck ? 3. D o yo u m ilk y o u r a n im a ls? I f no w hy? 4. I f yo u m ilk y o u r a n im a ls , do y o u and y o u r fam ily d r in k so m e o f th e m ilk? I f no w h y ? ) - ( > > ' ' c~ i r ! • • 5. I f yo u d rin k so m e, w h a t do y o u do w ith th e re m a in in g ? 6. I f yo u d rin k so m e , do y o u b o il it b e fo re y o u d r in k ? I f y e s w h y ? 7. I f yo u do n o t b o il, is it s a fe to d r in k ? I f n o t s a fe w h a t m ak es it n o t safe? 8. W h at can yo u d o to m ak e it sa fe? 9. H ave y o u d ra n k m ilk d ire c tly fro m th e te a t o f th e u d d e r o f th e c o w b e fo re o r seen so m eb o d y d rin k in g d irec tly fro m it ? 10. W hat do y o u k n o w a b o u t tu b e rcu lo s is? . 11. D o yo u k n o w th a t c a ttle g e t tu b e rc u lo s is ? 12. D o y ou k n o w th a t h u m an b e in g c an c o n tra c t tu b e rc u lo s is from c a ttle ? 13. I f yes, can yo u te ll m e h o w h u m an b e in g can c o n tra c t tu b e rc u lo s is fro m c a ttle ? 14. Is th e re an y b o d y in y o u r fam ily w h o h av e b een c o u g h in g fo r tw o w eek s o r m o re? 15. Is th e re an y b o d y in y o u r fa m ily w ith s to m a ch p ro b le m w h ich k e ep on w o rry in g h im /h e r? 16. I f y e s , can y o 1, • " m e h o w th e p e rso n fee ls w h en th e p ro b le m co m e? 17. W ho has b een tre a tin g y o u r an im a ls fo r yo u w h en th e y a re s ick ? 18. H ave y ou e v e r in jec ted y o u r an im a ls y o u rs e lf ? 19. I f yo u h av e in jec ted y o u r an im a ls b e fo re , te ll m e, h o w o ften do y o u do it? 20. I f you h a v e b een in je c tin g , c an y o u sh o w m e th e em p ty b o ttle s o f th e d ru g s y o u h a v e b een u sing , and h o w you u se th em ? 21. I f yo u tre a t y o u r an im a ls w ith d ru g s do y o u w a it fo r so m e d ay s to p a ss b e fo re y o u ta k e m ilk from the tre a te d an im al? University of Ghana http://ugspace.ug.edu.gh 22. H av e y o u u se d tic k m e d ic in e o n th e an im a ls w h ils t y o u a re a lso ta k in g m ilk from th e m ? 23 . D o y ou w a it fo r so m e d ay s to p ass a fte r yo u h a v e d o n e d ip p in g o f y o u r a n im a ls? 24 . W h a t do y o u th in k v e te r in a ry se rv ice s m ust d o w h ich th e y a re n o t d o in g ? 25 . T h a n k y o u v e ry m uch fo r a n sw e rin g m y q u e s tio n s , i f y o u h a v e s o m e q u e s tio n s o r so m e th in g you d o n o t u n d e rs tan d y o u c an say it. 42 University of Ghana http://ugspace.ug.edu.gh APPENDIX 4 TABLE 9. Measurement of Skin Thickness of positive Tuberculin Reactors mm(Cattle). ID N O SE X A G E S K IN T H IC K N E S S 1S 1 A N D 2 NU R E A D IN G S . D IF F . 1s 1 & 2 ND R E A D R E M A R K S B O V IN E S IT E A V IA N S IT E I st R ead . 2 nd R ead . 1st R ead . 2 nd R ead . B o v in e A v ian 1 f co w 6 ■14 6 6 8 0 + 2 f c o w 6 13 5.5 5.5 7 0 + 3 f co w 5 14 5 5 ' 9 0 + 4 f co w 7 15 7.5 7 .5 8 0 + 5 f co w 5 15 6 6 10 0 + 6 f heif. 4 .5 '• 15 6 6 10.5 0 + 7 f co w 6 15 6 .5 6.5 9 0 + 8 f co w 7 13 6.5 6.5 6 . 0 + 9 f c o v 7 16 7 7 9 0 + 10 f co w 5 12 5.5 5.5 7 0 + 11 f cow 6 13 6 6 7 0 + 12 f cow 6 12 5.5 5.5 6 0 + 13 f co w 6 18 7 7 12 0 + 14 f cow 16 25 18 18 9 0 + 15 f co w 8 2 0 8 8 12 0 + 16 f co w 6 16 6 6 10 0 + 17 f cow . 5 13 5.5 10 8 4.5 + 18 f co w 5 10 5.5 9 6 3 .5 + 19 f cow 6 12 6 6 6 0 + 20 f co w 6 16 7 1 10 0 + 21 f heif. 5 13 4 .5 4 .5 8 0 + 22 f heif. 6 14 6 6 8 0 + 23 f heif. 5 11 6 6 6 0 + 24 f co w 7 23 6.5 6 16 0 + 25 f co w 6 12 6 6 6 0 + 26 bull 15 23 17 17 8 0 + 27 f cow 5 , 11 5 5 6 0 + 28 f cow 6 12 6 6 6 0 + 29 f co w 5 12 5 5 7 0 ‘ “T4 30 f cow 9 17 10 10 8 0 + 31 f co w 5 12 5 5 - 7 0 + 32 f co w 6 15 7 9 9 2 + 33 f cow 6 15 6.5 6.5 9 2.5 + 34 f. H eif. 7 14 7 7 7 0 + 35 f co w 5 17 5 5 12 0 + 36 f cow 6 13 6 6 7 0 + 37 f cow 5 14 6 6 . 9 0 + 38 f cow 8 17 9 10 9 1 + 39 f h e if 5 13 5 5 7 0 + 43 A PPENDIX 4 com . University of Ghana http://ugspace.ug.edu.gh 4 0 f h e if 5 15 5 5 10 0 + 41 f co w 6 17 6 12 11 6 + 42 f cow 5.5 14 6 6 9.5 0 + 43 f cow 6 14 6 6 8 0 + 45 heif. 4 .5 15 4 .5 4 .5 8.5 0 + 46 f co w 9 17 9 9 8 0 + 47 f cow 6 18 6 6 12 0 + 4 8 f co w 5 19 6 6 14 0 + 49 f cow 6 15 6 6 9 0 + 50 f c o w 6 13 6 6 7 0 + 51 f co w 7 16 8 8 9 0 + 52 f heif. 5 12 5 6 7 1 + 53 f heif. 5 13 6 6 8 0 + 54 co w 6 14 6 6 8 0 + 55 f co w 6 18 6 6 12 0 + 56 c o w 7 17 7 7 10 0 + 57 f cow 7 18 7 7 11 0 + 58 f heif. 5 10 6 6 5 0 + 59 f he if. 5 12 6 6 7 0 + 60 f h e i f 6 16 6 6 10 0 + 61 f co w 6 11 6 6 5 0 + 62 f co w 9 16 9 9 7 0 + 63 f cow 8 15 8 8 7 0 + 64 f co w 7 19 7 7 12 0 + 65 f co w 6 12 6 6 6 0 + 66 f c o w 6 15 6 6 ' 9 0 + 67 f co w 7 15 7 7 8 0 + 68 f co w 7 16 7 7 9 0 + 69 f he if. 5 15 6 6 10 0 + 70 f co w 6 15 6 6 9 0 + 71 f co w 6 17 7 7 11 0 + 72 f ■heif. 4 18 6 6 14 0 + 73 f h e if 4 .5 19 6 6 14.5 0 +■ ■ 74 f h e if . 3.5 i e .U 6 6 11.5 0 + 75 f h e if 5 13 5 6 8 2 + 76 f co w 6 16 6 6 10 0 + 77 f co w 6 12 6 6 ' 6 0 + 78 f co w 7 13 7 7 6 0 + 79 f co w 6 17 6 6 11 0 + 80 f co w 6 19 7 7 13 0 + 81 f he if. 5 16 7 7 11 0 + 82 f heif. 5 11 6 6 6 0 + 83 f cow 6 12 6 6 - 6 0 + 84 f co w 6 15 6 6 9 0 + 85 f co w 6 15 7 7 9 0 + 86 f co w 6 13 6 6 7 0 + 87 f heif. 6 16 7 7 10 0 + [ 88 f co w 5 14 7 7 9 0 + University of Ghana http://ugspace.ug.edu.gh 90 F C ow 6 13 6 6 7 0 + 91 f co w 7 21 7 7 14 0 + 92 f co w 5 15 6 6 0 + 93 f c o w ° 6 14 6 6 10 0 + . 94 f co w 7 20 7 7 13 0 + 95 f cow 6 14 6 6 8 0 + 96 f ■eif. 6 13 6 6 7 0 + 97 f co w 8 18 8 8 10 0 + 98 f co w 5 12 6 6 7 0 + 99 f co w 6 11 6 6 5 0 + 100 f he if. 5 10 6 6 5 0 + 101 f co w 6 14 6 6 8 0 + 102 f co w 6 16 6 6 10 0 + 103 f cow 9 15 10 12 6 2 + 104 f co w 5. 15 6 6 10 0 + 105 f co w 6 15 6 6 9 0 + 106 f he if. 7 12 7 7 5 0 + 107 f heif. 5 11 6 6 6 0 + 108 f c o w 6 20 6 6 14 0 + • 109 f c o w 7 16 7 r 9 0 + 110 f co w 6 19 6 6 13 0 + 111 f co w 9 17 9 9 8 0 + 112 f co w 6 18 6 6 12 0 + 113 f heif. 5 13 5 6 8 1 + 114 f co w 6 12 6 6 6 0 + 115 f cow 7 16 7 7 9 0 + 116 f co w 7 13 7 7 6 0 + 117 f cow 6 15 6 6 9 0 + 118 f cow 5 19 6 6 14 0 + 119 f co w 6 18 6 6 12 0 + 120 f heif. 5 17 5 5 ' 12 0 + 121 co w 6 17 6 6 11 0 + 122 f co w 6 15 6 6 9 0 + 123 f heif. 5 16 5 5 11 0 + 124 f h e if. 3 .5 15 6 6 11.5 0 + 125 f h eif. 3 .5 12 5 6 8.5 1 + 126 f heif. 3 .5 19 5 6 15.5 1 + 127 f h eif. 4 .5 12 6 6 7.5 0 + 128 f heif. 5 11 6 6 6 0 + 129 f co w 5.5 11 6 6 5.5 0 + 130 f he if. 5 16 6 6 10 0 + 131 f co w 5.5 12 6 6 6.5 0 + 132 f co w 6 12 6 6 6 0 + 133 f co w 6.5 17 7 7 10.5 0 + 134 f co w 7 18 7 7 11 0 + 135 f co w 9 17 9 9 8 0 + 136 f co w "7 13 7 7 6 0 + 137 f cow 6 12 . 7 7 - 6 0 + 138 f co w 9 16 9 9 7 0 + 139 f I C O W 4 15 5 6 11 1 + University of Ghana http://ugspace.ug.edu.gh 45 A p p en d ix 4 c o r ' 140 f cow 5 13 5 5 8 0 + 141 f cow 6 14 6 6 8 0 + 142 heif. 4 .5 15 5 5 10.5 0 ■ + 143 f cow 9 15 9 9 6 0 + 144 f cow 6 17 6 6 11 0 + 145 f heif. 5 18 5 5 13 0 + 146 f cow 6 19 6 6 13 0 + 147 f cow 6 15 6 6 9 0 + 148 f cow 7 13 7 7 6 0 + 149 f cow 5 16 5 5 11 0 + 150 f cow 5 12 6 6 8 0 + 151 f cow 6 13 6 6 7 0 + 152 f cow 6 18 6 6 12 0 + 153 f cow 7 17 7 7 ' 10 0 + 154 f cow 7 2 0 7 7 13 0 + 155 f heif. 5 12 6 6 7 0 + 156 f cow 6 16 6 6 10 0 + 157 f cow ,6 12 6 6 6 0 + 158 m b u ll 9 15 9 9 6 0 + 159 f cow 6 19 -6 6 13 0 + 160 f cow 6 12 6 6 6 0 + 161 f cow 7 15 7 7 8 0 + 162 f heif. 5 15 6 6 10 0 + 163 f cow 6 16 6 6 10 0 + 164 f cow 6 15 6 6 ' 9 0 + 165 f heif. 7 15 7 7 8 0 + 166 f cow 6 17 6 6 11 0 + Key f. - F em ale m M a l e ♦ A ny d iffe ren ce m o re th an tw o u n its w as c o n s id e re d a p o s itiv e case 46 University of Ghana http://ugspace.ug.edu.gh