Trop Anim Health Prod (2012) 44 (Suppl 1):S17–S23 DOI 10.1007/s11250-012-0203-4
SI (EMERGING ZOONOSES)
Social and gender determinants of risk of cryptosporidiosis, an emerging zoonosis, in Dagoretti, Nairobi, Kenya Violet N. Kimani & Grace Mitoko & Brigid McDermott & Delia Grace & Julie Ambia & Monica W. Kiragu & Alice N. Njehu & Judith Sinja & Joseph G. Monda & Erastus K. Kang’ethe
Accepted: 30 May 2012 / Published online: 5 August 2012 # Springer Science+Business Media B.V. 2012
Abstract The aim of the study was to investigate the social and gender determinants of the risk of exposure to Cryptosporidium from urban dairying in Dagoretti, Nairobi. Focus group discussions were held in six locations to obtain qualitative information on risk of exposure. A repeated cross-sectional descriptive study included participatory assessment and household questionnaires (300 randomly selected urban dairy farming households and 100 non-dairying neighbours). Onehundred dairy households randomly selected from the 300 dairy households participated in an additional economic survey along with 40 neighbouring non-dairy households. We found that exposure to Cryptosporidium was influenced by gender,
This paper is part of a special supplement on assessing and managing urban zoonoses and food-borne disease in two African cities (Nairobi, Kenya, and Ibadan, Nigeria). V. N. Kimani : J. Ambia Department of Community Health, University of Nairobi, Nairobi, Kenya B. McDermott Biometry Unit, Department of Crop Science, University of Nairobi, Nairobi, Kenya D. Grace (*) : A. N. Njehu : J. Sinja
age and role in the household. Farm workers and people aged 50 to 65 years had most contact with cattle, and women had greater contact with raw milk. However, children had relatively higher consumption of raw milk than other age groups. Adult women had more daily contact with cattle faeces than adult men, and older women had more contact than older men. Employees had greater contact with cattle than other groups and cattle faeces, and most (77 %) were male. Women took more care of sick people and were more at risk from exposure by this route. Poverty did not affect the level of exposure to cattle but did decrease consumption of milk. There was no significant difference between men and women as regards levels of knowledge on symptoms of cryptosporidiosis infections or other zoonotic diseases associated with dairy farming. Awareness of cryptosporidiosis and its transmission increased significantly with rising levels of education. Members of nondairy households and children under the age of 12 years had significantly higher odds of reporting diarrhoea: gender, season and contact with cattle or cattle dung were not significantly linked with diarrhoea. In conclusion, social and gender factors are important determinants of exposure to zoonotic disease in Nairobi. Keywords Social determinants of health . Gender . Cryptosporidiosis . Urban agriculture . Nairobi
International Livestock Research Institute, PO box 30709, Nairobi, Kenya e-mail:
[email protected] G. Mitoko : M. W. Kiragu Ministry of Agriculture, Nairobi, Kenya A. N. Njehu : J. G. Monda : E. K. Kang’ethe Department of Public Health, Faculty of Veterinary Medicine, University of Nairobi, Nairobi, Kenya
Introduction Food production in cities contributes between 15 and 20 % of the world's food (UNDP 1996) and often expands in times of economic hardship. Many people would not associate keeping dairy cattle with urban living; but while the inconvenience is considerable, so are the rewards, and
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dairying is now recognized as a widespread activity in Nairobi City and other urban areas of Kenya (Kang’ethe et al. 2007). This has led to concern about the potential negative public health impacts associated with keeping large animals in close confinement in densely populated areas. As described in Kang’ethe et al. in this supplement, the study presented here was part of the second phase of a project evaluating the risks and benefits of urban dairying which had suggested cryptosporidiosis was an important emerging dairy zoonosis. The epidemiology of individual risk factors has greatly advanced in the last few decades, but societal risk factors or social determinants of health are less well understood. Societal risk factors are the ‘causes of causes’, that is, the underlying social and economic factors that determine health. Known social determinants of health in developing countries include: gender, age, education, housing and sanitation, migration and poverty (AagaardHansen and Chaignat 2010). The aim of this second study, therefore, was to improve understanding of the risk to human health posed by exposure to zoonotic Cryptosporidium parvum originating from dairy cattle and to take social determinants of health into consideration in order to develop strategies to reduce health risks. This sub-component of the study looked at the social and gender factors that influenced exposure to C. parvum as well as mitigating practices.
Methodology Operationalisation of terms Gender is defined as the socio-cultural construction of roles and relationships between men and women. Gender analysis includes the examination of roles, responsibilities, duties, access and control of resources in relation to dairy farming activities and the implications for risk of exposure to Cryptosporidium. Gender biases are shown in cultural perceptions of femininity and masculinity that delineate access to opportunities and resources in a particular context. The household is defined as people who shared common residential facilities and ate from a common kitchen/pot on a continuous basis for a minimum period of 3 months prior to the study. In most cases, these are family members, but not exclusively, since employees such as house helps and farm workers are included. Study design The study design was a cross-sectional descriptive study that applied an interactive participatory approach. It was conducted in two phases. The first part collected qualitative
Trop Anim Health Prod (2012) 44 (Suppl 1):S17–S23
data through participatory methodology, including mapping, focus group discussions (FGD), key informant interviews and gender analysis. Data collection In each of the six locations, a separate FGD was held with men and women. Participants were selected from those who had attended initial workshops to introduce the project. A set of prepared checklist questions was used to guide collection of qualitative data. The FGDs and gender analysis consisted of three components namely, an activity profile, access and control profile and discussion of socio-economic, environmental and legal factors impacting on gender participation and benefits accrued. Data were analysed through the Harvard Analytical Framework for Gender Analysis (March et al. 1999). Household questionnaires were used to gather more information on practices and behaviour, measured by gender groups as described by Kang’ethe et al. in this supplement: the study randomly sampled 300 dairy households and 100 non-dairy neighbours. A followup survey on economic aspects was conducted on 100 dairy households randomly selected from the 300 dairy households. Housing type was used as a proxy for wealth: people living in stone houses with iron sheet or tile roofs were considered non-poor (54 % of the total), while those living in houses with mud, wood or iron sheeting walls and iron roofs were considered poor. Water samples (n038) were aseptically collected from household water sources, and standard laboratory tests were used to check for the presence of Escherichia coli (an indicator of faecal contamination) as described in Grace et al., in this supplement. Analysis All analyses apart from diarrhoea analysis were done in the statistical package R version 2.5.1 (2007), and p values result from comparison of proportions using a normal approximation or a chi square test with no correction for clustering. The diarrhoea analysis used univariate logistic with robust standard errors in STATA® (Statacorp, 2003) correcting for clustering at the household level.
Results We first considered exposure of dairy and non-dairy household members to C. parvum according to the main transmission pathways and its association with gender, age, poverty and status within the household. Transmission pathways considered were: ownership of cattle; contact with cattle; contact with cattle faeces; consumption of milk; consumption of, or contact with, potentially contaminated
Trop Anim Health Prod (2012) 44 (Suppl 1):S17–S23
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water; and care of sick people (because secondary personto-person transmission of zoonotic C. parvum is important (Quiroz et al. 2000)).
Table 1 Involvement of household members in dairy activities in Dagoretti
Cattle ownership
Shed cleaning Milking Spraying Watering Feeding
The cross-sectional survey found that dairy cattle-owning households had more members and the head of household was older than non-dairy neighbours; however, there was no significant difference in ownership of dairy cattle between men- and women-headed households. The economic study (n0100) also found no difference in the type of housing (a proxy for wealth) between men- and women-headed households. However, non-poor households owned significantly (p00.014) more cattle than poor households (3.7 and 2.6 cattle, respectively). Contact with cattle The economic study showed that 78 % of farms had one or more men involved in dairying, while 65 % of farms had one or more women involved in dairy activities (corresponding to an average of 0.99 men and 0.80 women per household). This difference was not significant (p0 0.11). While men were more likely to report their time involved in dairy activities was small than women were (18.7 % of men versus 27.8 % of women), this difference was also not significant (p00.27). The economic study also found no significant difference between numbers of family members involved in dairying activities in poor and nonpoor households (p00.72). However, qualitative assessment showed a more complex picture, in which gender emerged as an important determinant of risk. Women participants scored their involvement higher than men in all dairy activities except spraying animals for external parasites. Women considered they were predominantly involved in shed cleaning, manure disposal, fodder harvesting and feeding, treating sick animals, preparing milking utensils, milking, milk distribution and feeding calves. Men rated themselves more involved than women in the first four activities but less involved in the latter four activities which directly related to milking. There was consensus that children were not involved with dairying activities as this would interfere with schooling. The economic questionnaire (n0100) confirmed women were most involved in milking, watering and feeding while male employees were most involved in cleaning and spraying as shown in Table 1. Among the 1,539 individuals from the 296 dairy households in the cross-sectional study for which information was available, 171 people were listed as workers, and the majority of these were men (77 %), most of who (87 %) worked daily with cattle. However, when workers are excluded from the comparison, then men and women
Activity
Women (%) Men (%) Male employee (%) Son (%) 25 53 19 60 58
18 12 0 20 23
51 38 45 41 44
21 23 23 21 21
N0100 (subset of a larger survey of dairy households)
household members have similar proportions of individuals having daily contact (31 and 33 %, respectively). Daily contact was most frequent (60 % reporting this) for older adults (50 to 65 years of age) in dairy households. In contrast, only 8 % of children under 13 years had daily contact with cattle. Of the 364 individuals from 98 non-dairy neighbour households in the cross-sectional study for which we had results, only 6 % were reported to have daily contact with cattle with similar proportions having daily contact for male and female household members (8 and 5 %, respectively). Only five individuals were reported to be paid, household workers in non-dairy, neighbour households. Contact with cattle faeces Unsurprisingly, contact with cattle faeces shows a similar pattern to contact with cattle for those who were members of dairy households. The cross-sectional survey found that among adults less than 50 years of age, men were more likely to have daily contact with cattle faeces (51 versus 30 %; p
