Scientific Papers

Management of diseases in a ruminant livestock production system: a participatory appraisal of the performance of veterinary services delivery, and utilization in Ghana | BMC Veterinary Research

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Socio-demographic characteristics of study participants

Table 1 presents the socio-demographic characteristics of all study respondents stratified by study area. On average, the farmers completing the survey (N = 350) were 45 years old (SD = 14 years), with no significant differences in age between the study districts. Furthermore, the farmers reported an average of 9 years livestock rearing experience (IQR = 6 – 15 years), with farmers keeping an average of 2.9 TLUs of livestock (IQR = 1.4 – 7.8 TLUs); including cattle, goats, sheep, pigs, chicken, guinea fowls, ducks, and doves in their herds. Majority of the farmers (95%) own the animals reared. The livestock farming experience and herd sizes were not significantly different between the study districts. The farmers’ resilience similarly did not differ significantly between the study districts, with farmers having average resilience score of 80.5 out of 98 (IQR = 74 – 85). More than two-thirds (71%) of the farmers were male, with the proportion significantly different between districts. About half of the farmers had received no formal education (51%), with the level of educational attainment being significantly different between the study districts. The average number of individuals in farmer households was 8 (IQR = 6 – 11 individuals), and the average distance between the households and professional veterinary officers (VOs) was 8 km (IQR = 1.9 – 12.4 km). The household sizes and distance to VOs were significantly different between the districts. Households’ wealth index also differed significantly between study districts with Mion (59%) and Pru East (69%) Districts having the highest proportion of the poorest and least poor households respectively. Significant differences were observed in the availability of social support between the study districts, with more than half of farmers reportedly receiving low levels of social support. The primary sources of social support reported, in order of availability, were from family, friends, religious bodies, community leaders, credit associations, and law enforcement bodies.

Table 1 Socio-demographic characteristics of the study participants by study district

For farmers participating in the focus group discussions (FGDs) (N = 65), average age was 45.5 years (SD = 13.0 years). On average, the farmers keep 3.6 TLUs in their herds (IQR = 1.7 – 25.5 TLUs). The majority of the participants were male (85%). There were no significance differences observed in the age, herd size and sex distributions of farmers participating in the FGDs between the study districts. On average, majority of the farmers (60%) participating in the FGDs had at least some basic formal education, with educational attainment levels being significantly different between the study districts.

The VOs in the study districts were 36.1 years old (SD = 8.6 years) on average, with a majority (85%) being males. They have undergone an average of 3 years (IQR = 3 – 4 years) of veterinary training and worked on average for 2 years (IQR = 2 – 9 years) in the veterinary services. The age, sex, years of training and work experience did not differ significantly between the personnel by study district.

Severity of adverse events affecting livestock farming

Table 2 presents the top five ranked adverse events based on severity of impact on herds by farmers and their VOs stratified by study district. Overall, the adverse event ranked to have the most severe effect on livestock production by the majority of the participants (all livestock farmers and most of the VOs) across all the study districts was animal diseases. The severity ranking of the other adverse events were mainly district dependent. Pasture shortages was also ranked highly in all the districts although in the more arid Mion District than the other districts. Bush fires were ranked third by farmers in the Mion District, but is less of a challenge in the other two districts. While theft of animals was ranked second by farmers in the Pru East District, conflicts with other land users was ranked second by the farmers in the KAPS District.

Table 2 Most important adversities affecting livestock production based on reported severity of impact on herd by study district

The VOs perception of adverse events’ effect on livestock production was mainly district dependent. While the personnel in the KAPS and Mion Districts ranked animal diseases to have the most severe effect on livestock production, VOs in the Pru East ranked it fourth. The highly ranked challenge in the Pru East District by VOs was theft of animals. A majority of the personnel across the districts perceived livestock farmers’ conflicts with other land users, and ingestion of foreign objects like polythene rubbers by animals to have moderate to severe effects on livestock production. The perceptions of the severity of the adverse events generally was different from the farmers’ and the veterinary personnel’s perspective in the study district, except for the impact of animal diseases on herds.

In the FGDs, the farmers reported animal diseases as the main challenge facing the livestock farmers. The reported challenges were mainly animal-health related, with major concerns about the effects of the diseases on herd productivity and livelihoods, lack of animal health infrastructure, low access to, and inadequacy and high cost of animal health service provision.

“For us we have a big problem with diseases in our animals. When it comes to cattle, there is a disease called ‘suffer’ [Foot-and-Mouth Disease (FMD)], it worries us a lot. There are also other diseases but the ‘lung disease’ [Contagious Bovine Pleuropneumonia (CBPP)] is very serious. When they are infected, it brings out all other diseases that are hidden in the cattle. …, as for it when it enters the cattle kraal, hmm masa, unless you solve it, you cannot have peace of mind, …, you will weep before it goes. … When they contract the lung disease [CBPP], the pregnant cows do have premature births. Also, the milk production goes down drastically, [long pause], you can’t even get some of the milk. It will not be enough for the calves before you think of the farmer” (Male farmer, 46 years old, Mion District)

“Formerly, it would have been after 2 to 3 years before you inject your cattle once, but now within 1 month you could treat one cattle about 3 times for diseases” (Male farmer, 49 years old, KAPS District)

Other challenges reported were in relation to pasture and water shortages, housing challenges for the herds, and the cost of resolving conflicts occasioned by animals’ destruction of farms.

“The diseases are the single major problem for all of us. I think NH [referring to another FGD participant] also said something about feeding. When it gets to the dry season, there is bush burning everywhere. The pasture that cattle and goats will feed on, all of them, off [burnt]. When that happens, the animals begin to lose weight. So when something small [disease] infects them, then they begin to die. …. Hmm, also, the issue of housing, like our sister said; where the animals will sleep [is a problem]” (Female farmer, 46 years old, KAPS District)

“One major problem for us livestock farmers in this community especially the cattle and goat farmers is that, during the dry season, we [livestock farmers] do not get access to feed for the animals. As a result, it leads to a fight between livestock farmers and the crop farmers especially yam growers. Because the animals sometimes end up destroying the [crop] farms” (Male farmer, 53 years old, Pru East District)

To identify the most common or priority livestock diseases affecting ruminant livestock production, we inquired about the most recent disease cause of death in the past 12 months for farmers reporting a mortality of their ruminant livestock within the study period. About 82% (282/344) of the farmers who rear small ruminants reported animal mortalities compared to 78% (68/87) for the farmers rearing cattle. Specifically for the ruminant livestock species kept (cattle, sheep, and goats), the farmers reported an average of 10% mortality of their herds to diseases (IQR = 23%) in past 12 months. On the most likely disease to have caused the death, 40% of the small ruminant farmers reported Peste-Des-Petits-Ruminants (PPR), while 5% reported mange. Among farmers rearing cattle, 31% reported the recent mortality to be due to Contagious Bovine Pleuropneumonia (CBPP) with about 5% due to Foot-and-Mouth Disease (FMD) infection. In the local languages, farmers refer to PPR, Mange, CBPP and FMD as “ayamtuo yareɛ”, “krusakrusa”, “akoma yareɛ” and “suffer” respectively. The other non-specific factors reported to lead to mortalities were birth-related including abortions and birth complications during parturition, causing about 1% of reported deaths in small ruminants and 4% of reported deaths in cattle.

The VOs similarly provided the disease(s) likely to have caused the most recent reports of ruminant livestock mortality they received from the livestock farmers in their respective operational areas. In small ruminants, PPR was the most likely cause of death in small ruminants, reported by farmers to a majority of the VOs (69%). While in cattle, CBPP was most likely the cause of death reported to the VOs (31%).

In FGDs, farmers identified the most common diseases affecting their herds to include CBPP and FMD in cattle and, PPR and mange in goats and sheep. Based on this, the farmers reported the average distribution of each disease in their herds in a farming year, using proportional piling. Overall, the reported FMD prevalence was 50% on average (IQR = 50%), while CBPP prevalence was 40% (IQR = 20%) on average in cattle herds in a farming year. For the small ruminants, an average PPR prevalence of 50% (IQR = 40%) and average mange prevalence of 10% (IQR = 20%) among herds in a farming year were reported (Fig. 2).

Fig. 2
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Distribution of common infectious diseases in ruminant livestock (The figure shows the typical distribution of key infectious diseases in a farming year in farmers’ herds based on proportional piling by 65 experienced farmers purposively selected to participate in focus group discussions. The gradient of color shows the reported distribution of the diseases on a percentage scale (from 0 to 100%) with light coloration depicting low prevalence and deep coloration depicting high prevalence. The y-axis shows the proportion of the farmers reporting a specified prevalence level of each disease condition in their herds. Each column bar on the x-axis depicts the two most common diseases for large and small ruminant farmers respectively)

Management strategies for common livestock diseases

We found treatment for sick animals (82%), deworming (54%) and treatment of wounds (47%) as the most common disease management strategies the farmers utilized. Only 20% of farmers reported vaccinating their herds in the study year (Fig. 3). We assessed for each disease management strategy utilized by the farmers, the most recent veterinary service provider that rendered the service. Among farmers who used any of these services, the treatment services for sick animals were done almost evenly by informal providers 37% (106/286), professional veterinary officers 35% (96/286) and farmers themselves 29% (84/286). The VOs 39% (73/188) mostly did deworming of the animals, while the farmers and informal providers do about 30% each of the deworming of livestock. Similarly, the treatment of wounds was done mainly by the VOs 42% (69/166); 36% (60/166) of farmers reported treating wounds themselves, with informal providers delivering 22% of wound treatment services for farmers.

Fig. 3
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Veterinary services use preferences of ruminant livestock farmers in Ghana (Fig. 3 presents the distribution of most recent usage of key veterinary services requiring the application of medicines by farmers and the service providers used. The y-axis shows the proportion of farmers utilizing the services by provider type. The x-axis presents the services evaluated. The divisions and colors in the stacked bars depict the proportion of each service use accounted for by a service provider)

As shown in Fig. 4, among livestock farmers who used antimicrobials, the most frequently applied compounds are tetracyclines, penicillins and antiparasitic medicines to manage the diseases or conditions of their animals. The tetracyclines commonly used by the farmers were Oxytetracycline injections, and Tetracycline Hydrochloride capsules. Antiparasitic medicines used commonly were Ivermectin injections, and Albendazole suspensions. With respect to penicillins, farmers commonly used Procaine Penicillin or Procaine Penicillin with Dihydrostreptomycin (PenStrep) injections, and Amoxicillin Trihydrate capsules (See Additional File 3). However, after disaggregation of the application of the medicines, we found that although most farmers use tetracyclines and penicillins for most of the common conditions, the majority of the reported applications of these medicines were not useful (Fig. 5 Panel A). On the other hand, whereas the VOs also use tetracyclines and antiparasitic medicines quite frequently, the reported applications of the medicines were mostly useful for the conditions (Fig. 5 Panel B).

Fig. 4
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Medicines commonly used by livestock farmers for managing common diseases (The y-axis shows for each medicine used, the number of farmers (N = 282) who reported self-treating a disease or condition in their herds during the study year. The x-axis presents the medicines the farmers reported using or have medicine sachets, vials or bottles available during the survey to be captured. Farmers that used medicines but could not recall the medicine names nor provide the medicine sachets, vials or bottles are depicted as “Don’t know” on the column bar. The reported and captured medicines were grouped in medicine classes if possible, and usage frequencies presented in the column bars)

Fig. 5
figure 5

Frequency and utility of use of medicines by livestock farmers and veterinary officers for managing common diseases and conditions in ruminant livestock (Fig. 5 compares the medicines and the reported frequency of use in managing each disease or condition by livestock farmers and professional veterinary officers. Panel A and Panel B depicts farmers’ and veterinary officers’ application of the medicines respectively. Square shapes () in cells depict a useful medicine and disease or condition combination. The color gradient shows the frequency of use of each of the medicines by the study participants, ranging from no use (light color) to frequent use (deep color) respectively. The y-axis presents the disease or conditions treated while the x-axis presents the medicines applied)

In FGDs, we found that the diseases are treated also with traditional medicines including ethanol, herbal preparations and used automobile engine oils. The orthodox medicines for treatment are accessed from veterinary drug stores, human drug stores, livestock markets or from medicine vendors who roam the communities. Non-orthodox medicines are usually self-made or accessed from livestock markets or community herbalists.

“… there is not a specific drug, we use different drugs [in FMD treatment], …, everybody tries something. So if you are lucky and a particular treatment works, then you stick with it and it becomes a norm. I remember that a cattle disease [FMD] affected our cattle and someone advised me to buy some medicines to apply, …, The person told me to buy “battery water” [Sulphuric acid] and add a bit of salt to it, …” (Male farmer, 37 years old, KAPS District)

“…if it [FMD] is serious, we call the veterinary officers to come to assess the affected animal. But sometimes when it is less severe, we buy ‘DDT’ [Acaricide] and mix it with “tupaye” [Tetracycline] and we use the mixture on their affected hooves” (Female farmer, 30 years old, Pru East).

“…I use procaine penicillin for treating the diarrheal disease [PPR] in both sheep and goats. For the skin rashes [mange], I use ‘dirty oil’ [used automobile engine oil] for it” (Male farmer, 41 years old, Mion District)

For the factors influencing the disease management strategies adopted by the livestock farmers, we found that for the most part, either informal providers administer the treatments or the farmers treat the diseases on their own, due to lack of easy access to professional veterinary officers or reduced severity of the diseases. Few farmers seek professional veterinary officers in the first instance of a disease problem in their herds. The choice of medicines for treating diseases, were greatly influenced by farmers’ past experiences with the use of specific medicines, peer to peer referrals for specific treatment strategies or medicine vendors in communities or livestock markets. The medicines are administered by injections, orally, in drinking water or directly into the mouths with syringes, and topical application on lesions and wounds.

“Usually, I go to those who sell drugs in ‘gariki’ [livestock market in the district] and explain to them the symptoms the animal is showing. They are the ones that gave me a certain drug [to use for PPR infected small ruminants]. … Some of the drugs are pills, and some too are like milk in a gallon [anthelmintic] and you have to draw it with a syringe to administer it to the infected animals. Some of the drugs are also green in color [anthelmintic tablets], and we give these to them [orally] (Male farmer, 50 years old, Pru East District)

“For the diarrheal disease [PPR], we use our own mind [knowledge] to manage. Like my brother said, when the goats are having the diarrhea [PPR] and we don’t get the veterinary officer, we go and buy ‘Tupaye’ [Tetracycline],…, and then open a lot of them and put in water; and then open the mouth of the goat and give it to it to drink” (Male farmer, 43 years old, KAPS District)

“When there is the CBPP outbreak, I call the doctor [veterinary officer] to assess them, and he gave the animals some injections. Sometimes too, if the cattle are not feeding well, the herdsmen will let me know and then we get penicillin injections [procaine penicillin] to be given to the cattle [by the herdsmen]” (Female farmer, 46 years old, Mion District)

The treatment measures employed have varied effectiveness for the conditions they are applied; sometimes they are effective but in most cases, the treatment effects are short-lived.

“When we use the dirty oil for mange, we see immediate effect of the scaly skin peeling off and new hair regenerate in the affected area in a short while. But it doesn’t cure the disease in the animal’s system because it won’t be long enough and the animals [goat and sheep] would develop the mange again” (Male farmer, 41 years old, Mion District)

“For the animals that the disease is not advanced, when you administer them [drugs bought from livestock market], it seem to work… but it sometimes recurs. And for those that the disease is already advanced, it doesn’t cure them, and they end up dying (Male farmer, 60 years old, Pru East District)

Utilization of veterinary services

Overall, only 33% (116/350) of the surveyed farmers utilized professional veterinary services during past 12 months compared to 51% (177/350) utilizing the services of informal veterinary service providers. The proportion of farmers using professional veterinary services was significantly different between the study districts ranging from 54% (56/103) in the Pru East District to 21% (32/149) in the KAPS District (p < 0.001). We present the predictors of farmers’ utilization of professional veterinary services in Table 3. In our pre-specified model, we found the odds of farmers utilizing the services to be improved significantly by increasing years of experience with livestock rearing, increase in farmer resilience, increase in herd size, being male, educational attainment, increasing wealth status, increasing severity of perceived effect of diseases on herds and high levels of social support availability in the univariable analyses. While the odds significantly reduced with increase in distance between farmers and professional veterinary officers.

Table 3 Factors influencing livestock farmers’ utilization of professional veterinary services in Ghana

After adjusting for the farmers’ livestock rearing experience, resilience level, sex, and social support availability, the utilization of professional veterinary services was significantly influenced by distance between farmers and their veterinary personnel, farmers’ herd size, educational attainment, wealth status, and perceived severity of disease effect on herds (Pseudo R2 = 0.22, p < 0.001). We evaluated and found that our model was more effective than the null model, and fit the data well (Hosmer – Lemeshow goodness-of-fit 2(10) = 7.75, p = 0.46). We did not find evidence that the model assumptions were violated in our post estimation analysis; the residuals scatter randomly, the Pregibon leverage was below the recommended threshold and the predictors were not strongly correlated.

After adjusting for the other predictors, the odds of farmers utilizing professional veterinary services decreased by a factor of 0.91 with each 1-km increase in distance from a service provider (aOR = 0.91, 95% CI = 0.85 – 0.98, p = 0.01).

The odds of farmers using professional veterinary services were 2.1 times higher if they had large herd size (5.5 – 182.3 TLUs) (aOR = 2.11, 95% CI = 1.08 – 4.11, p = 0.03) compared to if they had small herds (0.3 – 1.8 TLUs). Farmers with basic education were also twice more likely to use services compared to if they had no formal education (aOR = 2.08, 95% CI = 1.07 – 4.06, p = 0.03). There was also a three-fold increase in the odds of utilizing the services if the farmer’s wealth status was above average (aOR = 2.62, 95% CI = 1.02 – 6.73, p = 0.04) and 3.6 times higher for the least poor households (aOR = 3.61, 95% CI = 1.27 – 10.2, p = 0.02), compared to the poorest households. The odds of a farmer utilizing professional veterinary services increases with increasing perception of disease risk to their herd. The odds increased by a factor of 3.6 if farmers perceived diseases effect to be moderate (aOR = 3.64, 95% CI = 1.24 – 10.7, p = 0.02), and by a factor of 4.0 if the perceived effect of diseases on the herds was severe (aOR = 4.00, 95% CI = 1.51 – 10.6, p = 0.005), compared to when farmers perceive no diseases effect on their herds.

The discussions with farmers similarly showed that, utilization of professional veterinary services was influenced mostly by the affordability of the service, farmer proximity and/or personal access to the veterinary personnel or in cases of complications from diseases or other conditions of the livestock. The professional veterinarians usually are sought after to address the situations that the farmers or informal providers could not successfully handle.

“When the veterinary officer comes to treat them, we are mostly unable to afford the cost. So, we usually buy the medicines ourselves. So, when we give the animals the injection [treatment] over time, and it gets to a point that it is difficult or beyond us, that is when we call him” (Male famer, 49 years old, KAPS District)

“My issue is, even when you have money to buy drugs, there is no veterinary post available where you can get the drugs needed. You see, rearing animals also requires a market, but we don’t have a slaughterhouse where you can send the animals to sell. And the veterinary officers here don’t even have any place to store the drugs, … So, unless, you go and request, and he will give you maybe two weeks, when he would have gone to Accra [Capital of Ghana] and bought the drugs to come and administer. So, by the time he returns with the drugs for you, the sickness would have worsened, …, you see. And the veterinary officers are also few (Male famer, 72 years old, KAPS District).

“…for my cattle, I don’t use any medicine [self-treatment]. I’m close to the veterinary officer in the community so whenever there’s any infection of my cattle, I quickly call him to come and treat them for me” (Male farmer, 41 years old, Mion District)

Appraisal of veterinary services performance

We assessed the farmers’ general perceptions of the performance of the veterinary service providers they had ever used. Figure 6 compares the relative importance indices (RII) for the performance attributes of VOs and their informal provider counterparts from farmers’ perspective. The VOs performed best on the efficacy of the medicines administered (RII = 0.86) and performed worse on the affordability of services rendered (RII = 0.66). The informal providers performed best on the availability of drugs (RII = 0.78) and worse on the provision of education or advisory services to the farmers (RII = 0.58). Except for the proximity to the farmers, popularity, and high usage of informal providers’ services among the farmers, the VOs were rated highly on all the other attributes. Thus, comparatively, VOs performed better with respect to the availability of medicines when attending to farmers, quality of medicines administered, positive outcome of the treatments administered, provision of health education, affordability of the services rendered, and trust of competence to address the animal health issues in the communities. The informal providers on the other hand were viewed to be closer to the farmers and their services were popular, and highly used by most of the farmers.

Fig. 6
figure 6

Farmers appraisal of the performance of their veterinary service providers (Fig. 6 presents the appraisal of farmers of the performance of the veterinary service providers that they ever used on 10-item 5-point Likert scale. The y-axis depicts the relative performance of the providers on each attribute. The Relative Importance Index (RII) of each attribute are depicted by the height of the bars, stratified by colors for each provider type)

The VOs evaluated themselves on the availability of key tools required to deliver their services effectively in a survey. Only 54% (7/13) of the VOs have personnel stationed at border posts to monitor animal movements in their operational areas. About 62% (8/13) reported having slaughter places in their operational areas and having official motorcycles for their work. None of the VOs reported having a designated laboratory to confirm suspected pathogens or any means to control the sale and use of medicines in the respective districts. Most of the VOs (54%) reported that they do not have any form of communication with public health personnel in the districts; 31% (4/13) had informal communications, while only 15% (2/13) had formal communications with public health personnel concerning diseases of zoonotic potential.

In the FGDs with the livestock farmers, we found farmers who had access to the professional veterinarians to be largely satisfied with the services provided to them. The veterinarians provide advice on ways to improve herd health, treat animals, and sometimes purchase medicines for farmers who provide them funds. However, there is generally a dissatisfaction regarding the timeliness of veterinarians’ response to the farmers call for help.

“What I have noticed is that when he [veterinary officer] comes and once the animal is sick, he does everything possible to help us out. Even if the money to pay is not available at the time he came, he will still consider you. … He considers us a lot” (Female farmer, 46 years old, KAPS District)

“…the veterinary doctors that attend to us here are very few [3 veterinary officers in KAPS]. So, if you call him [veterinary officer] to come, maybe it is not only you who needs the doctor; another person also calls him today and tomorrow. So, if he goes from one farm to another, by the time he or she would come to you, it would be too late. … But because it is the work you are doing; you need to try to do something to ensure that the animals are healthy by making provision to inject the animal. If you fail to do something, by the time the veterinary doctor comes, the animal will die” (Male farmer, 66 years old, KAPS District)

“When we call upon the veterinary and they are not able to come on time, we go to town to where they sell the cattle medicines [veterinary drug store]. And when we get there, we describe to them the type of sickness affecting them [livestock], and they give medicines to come and inject the animals” (Female farmer, 30 years old, Pru East District)

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