Knowledge and Practices on Consumption of Free-Range Chicken Viscera in Selected Rural Communities of Kwazulu-Natal, South Africa, with Focus on Zoonotic Transmission of Toxoplasma Gondii and Toxocara Spp.

doi:10.21203/rs.3.rs-1246622/v1

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Research Article

Knowledge and Practices on Consumption of Free-Range Chicken Viscera in Selected Rural Communities of Kwazulu-Natal, South Africa, with Focus on Zoonotic Transmission of Toxoplasma Gondii and Toxocara Spp.

https://doi.org/10.21203/rs.3.rs-1246622/v1

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published 17 Dec, 2022

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Free-range chickens (FRC) are a host to a variety of pathogens of zoonotic and economic importance which includes Toxoplasma gondii and Toxocara spp among others. Humans acquire infections via the ingestion of infective stages of T. gondii and Toxocara spp with raw or undercooked food. This study aimed to assess knowledge and practices on the household consumption of FRC meat and viscera by rural communities in KwaZulu-Natal (KZN), South Africa as risk factors in the transmission of zoonotic pathogens. A descriptive cross-sectional study was conducted among twenty (20) randomly selected households in each selected community on the northern coast (Gingindlovu and Ozwathini) and southern coast (uMzinto and Shongweni) of KZN province. An adult from each household was interviewed on FRC consumption practices using a semi-structured questionnaire. Data were analyzed using statistical package for social sciences (SPSS) version 25.0. Descriptive, and Chi-square statistics were used to assess knowledge and practices related to FRC consumption and zoonoses transmission. Knowledge of zoonosis transmission was estimated at (31.3%, 25/80) in the four localities and a significant association was found between the educational level of respondents and study locations (p<0.05). Knowledge was highest among respondents with a high school education (13.75%, 11/80) and lowest (1.3%, 1/80) among respondents with no formal education. Overall, over three-quarters (76.3%, 61/80) of respondents reported chicken viscera consumption although majority (96.7%, 59/80) preferred eating them ‘well-cooked’. This result underscores the need to intensify awareness on health risk associated with the consumption of raw/undercooked viscera from free-range chickens.

Toxoplasma gondii

Toxocara spp

Knowledge

Free-range chickens

Chicken viscera

KwaZulu-Natal

South Africa.

Free-range chickens are major agents in parasite transmission due to their exposure to infective stages of parasites existing in contaminated environment (De Vries et al. 2018). Commonly reported parasites from chickens include but not limited to; Toxoplasma gondii and Toxocara spp (Zibaei et al. 2017; dos Santos Silva et al. 2020). Toxoplasma gondii is an apicomplexan parasite that causes toxoplasmosis in animals and humans globally (Dubey 2020). The main definitive hosts are felids while birds and a wide range of animals serve as the intermediate hosts (Gaulin et al. 2020). Although Toxocara canis and T. cati are helminth parasites of canids and felids, they also are responsible for human toxocariasis worldwide (Yoshida et al. 2016).

Although free-range chickens (FRC) contribute significantly to animal protein, reports on their role in transmitting zoonotic pathogens is scanty (Rodrigues et al. 2019). Free-range chickens are infected during scavenging when they ingest the infective stage of parasites from the contaminated environment (Sasse et al. 2020). Humans acquire infection indirectly via the consumption of raw or undercooked infected chicken viscera or meat containing tissue cysts (T. gondii) or larvae (T. canis and T. cati) (Fan et al. 2015; Gaulin et al. 2020). Once ingested by humans, the parasites migrate through the viscera and are deposited in various organs where they cause varying degrees of diseases ranging from fever, headache, sore throat, arthralgia, myalgia, and blindness depending on the affected organs, infection intensity and duration, host age and immunity status of the infected host (Holland and Hamilton 2013; Fan et al. 2015; Gaulin et al. 2020).

Consumption of poultry meat viscera is a dietary habit that is common in different communities worldwide and dependent on socio-cultural practices and culinary habits where it can either be eaten raw or undercooked (Broglia and Kapel 2011). The practice of eating raw or undercooked meat or viscera is associated with zoonosis transmission (Trevisan et al. 2019), for instance, cases of toxocariasis transmission have been reported after ingesting raw chicken liver (Nagakura et al. 1989; Morimatsu et al. 2006; Campos-da-Silva et al. 2015). Similarly, human toxoplasmosis outbreak have been reported among individuals who consumed raw or undercooked meat (Dawson, 2005; Choi et al. 2006).

In South Africa, the greater population lives in rural areas and rear chickens following a free-range system (Mwale and Masika 2009; Mukaratirwa and Khumalo 2010a; Malatji et al. 2016). In KwaZulu-Natal (KZN) province of South Africa, the majority of the population are rural farmers and rear FRC for consumption, marketing and socio-cultural purposes (Naidoo 2005). The farming practice, allows the chickens to scavenge freely in the environment during daytime and use trees for shelter at night or confined to rustic chicken runs (Naidoo 2005).

The tendency of FRC to pick up T. gondii and Toxocara spp infective oocysts and eggs respectively in the environment increases with the abundance and availability of stray dogs and cats’ which are definitive hosts of the parasites, particularly in KwaZulu-Natal (KZN) province where stray dogs and feral cats have been reported to be abundant (Tannent et al. 2010; Mukaratirwa and Singh 2010b) thereby leading to persistent environmental contamination with these parasites.

Moreover, change in globalization has led to the adoption of a variety of culinary and consumption patterns regarding raw or undercooked food as delicacies (Broglia and Kapel 2011). Besides, due to the high poverty level in rural areas of KZN there is a high level of household food insecurity thereby leading to alternative foods and various ways of food preparation (Tarwireyi and Fanadzo 2013). Understanding the consumption pattern of the much available free-range chicken meat or viscera is imperative in these communities as a basis for guaranteeing food security as well as identifying risks related to food-borne diseases such as toxoplasmosis and toxocariasis.

Considering the poor socio-economic status and food insecurity of the rural communities in KZN province of South Africa, it is imperative to determine household consumption patterns of free-range chicken viscera and preparation practices that may be favouring zoonotic transmission in the study area. Hence, this study was designed to address this aim with the hope of using the information to create awareness on the health risks associated with the consumption of raw or undercooked FRC meat or viscera.

Study design and sample

A cross-sectional study was conducted in four rural communities in KwaZulu-Natal province to assess knowledge and practices of consumption of free-range chicken viscera with a focus on T. gondii and Toxocara spp transmission from March to July 2019. Localities where the study was conducted, and their population sizes are as follows; Gingindlovu (GI) (1,109) and Ozwathini (OZ) (1,979) in the northern coast and uMzinto (MZ) (16,205) and Shongweni (SH) (427,613) in the southern coast of KZN (Fig. 1) (http://www.durban.gov.za/). These localities have sugar cane farming as their main livelihood followed by livestock farming which include rearing of free-range chickens. The study population comprised 80 randomly selected participants and each participant represented a household. Twenty participants were randomly selected from each of the localities. The sample size was calculated using the following equation with 95% confidence level and 11% error margin.

n=1.96² pq/L²,

where:

n=sample size,

p=expected prevalence (0.5),

q=1-p, and

L=limits of error on the prevalence and the expected prevalence was set at 11%.

Study procedure

After briefing the community leaders regarding the objectives of the study, 20 household representatives were randomly selected from each locality and consent was obtained regarding their willingness to participate in the study. Questionnaires were translated into isiZulu, which is the local language of all the localities, and were administered to selected participants following an interview-guided approach. Prior to administration, a pilot study was done to validate the tool. The questionnaire administration process took approximately 20 minutes for each participant. Upon completion of questionnaires, participants were enlightened on the dangers associated with zoonosis transmission and prevention methods.

Data collected from the interview included socio-demographic information, knowledge, and practice of participants related to zoonosis transmission. Questions were asked specifically on habits on consumption of chicken viscera, type of the viscera eaten, and the preferred method of preparation and designated members of the family who eat each type of viscera. The demographic information collected included age, gender, household size, educational qualifications, and occupation of respondents. Information on ownership of free-range chickens (FRC) including the number of FRC owned per household were also collected. Information on ownership of pets, type of pets, and the number owned was also collected.

Study design and sample

n=1.96² pq/L²,

where:

n=sample size,

p=expected prevalence (0.5),

q=1-p, and

L=limits of error on the prevalence and the expected prevalence was set at 11%.

Study procedure

Statistical analysis

Data were processed and analyzed using statistical package for social sciences (SPSS) version 25.0. Descriptive and Chi-square statistics were used to assess knowledge and practices related to the consumption of FRC viscera and risks of transmission of T. gondii and Toxocara spp in KwaZulu-Natal. A p-value < 0.05 was considered as statistically significant.

Statistical analysis

Socio-demographic profile of participants

Table 1 shows the demographic characteristics of participants in all four study localities. Participants interviewed in the four localities ranged from the category of father, mother, and household member greater than 18 years (GI-5%, 55%, and 40%; OZ-5%, 80%, and 15%; MZ-10% 50%, and 40%; SH-25%, 60%, and 15%). Overall, the mean age of the respondents was 47.11±18.02) (Table 1). Ozwathini (OZ) had the highest mean age (53.3±16.82), followed by SH (50.25±17.12, GI (43±18.98) and MZ (41.9±17.80). A significant difference was observed between the educational level of study respondents among study locations (p<0.05). Most respondents (47.5%, 38/80) had a high school education while only (20%, 16/80) had completed tertiary education. The percentage of respondents who had tertiary education was highest in OZ (40%, 8/20), followed by GI (30%, 6/20), and SH (10%, 2/20) while none of the respondents in MZ had tertiary education.

The percentage of respondents that were unemployed was highest (90%, 18/20) in OZ, (85%, 17/20) in GI and SH, followed by (70%, 14/20) in MZ. Overall, household size ranged from 1-16 with a mean of (6.40±3.26). Household size ranged from 2-11 with a mean of 7.05±2.65, 2-14 (6.65±3.79), 2-13 (5.70±2.89) and 1-16 (6.20±3.67) in GI, MZ, OZ, and SH respectively (Table 1). Availability of playground for children was also observed to be significantly different among study locations (p<0.05), with only (5%, 1/20) in GI and MZ and (15%, 3/20) in SH having reported to have reserved playground for children in the household respectively while none was reported in OZ (Table 1). Overall, three-quarters (75%, 60/80) of the households utilized household vicinity as playgrounds while only (2.5%, 2/80) had reserved playgrounds for children (Table 1).

Table 1 Socio-demographic characteristics of study respondents from four localities of KwaZulu-Natal province of South Africa (GI = Gingindlovu; OZ = Ozwathini; MZ = uMzinto; SH = Shongweni).

			Localities
	GI (n = 20)			OZ (n = 20)		MZ (n = 20)			SH (n = 20)				Total (n = 80)
	Freq	%		Freq	%	Freq	%		Freq		%		Freq	%			p-Value
Age groups (years)
<21	1	5		1	5	-	-		1		5		3		3.75			0.733
21-30	7	35		6	30	3	15		2		10		18		22.50
31-40	1	5		4	20	1	5		2		10		8		10.00
41-50	5	25		4	20	5	25		5		25		19		23.75
51-60	2	10		2	10	4	20		4		20		12		15.00
61+	4	20		3	15	7	35		6		30		20		25.00
Educational level
None	2	10		2	10	1	5		1		5		6		7.50			0.020
Primary	1	5		3	15	8	40		8		40		20		25.00
High School	11	55		7	35	11	55		9		45		38		47.50
Tertiary	6	30		8	40	-	-		2		10		16		20.00
Occupational status
Employed	-	-		4	20	1	5		2		10		7		8.75			0.310
Unemployed	17	85		14	70	18	90		17		85		66		82.50
Self employed	3	15		2	10	1	5		1		5		7		8.75
Respondents’ categories
Father	1	5		2	10	1		5	5	25		9				11.25			0.088
Mother	11	55		10	50	16		80	12	60		49				61.25
Family members ≥ 18 years	8	40		8	40	3		15	3	15		22				27.50
Household size
1-5	6	30		10	50	8		40	11	55		35				43.75			0.340
6-10	13	65		8	40	8		40	7	35		36				45.00
11-15	1	5		2	10	4		20	1	5		8				10.00
16-20	-	-		-	-	-		-	1	5		1				1.25
Playground for children
Reserved	1	5		-	-	1		5	3	15		2				2.50			0.000
Vicinity of house	19	95		19	95	5		25	17	85		60				75.00
Both	-	-		-	-	11		55	-	-		11				13.75
Not applicable	-	-		1	14	3		43	3	43		7				8.75

Knowledge on health risks associated with the consumption of free-range chicken viscera

Overall, knowledge of zoonotic disease transmission associated with consumption of FRC viscera in the study localities was estimated at 31.3%. Knowledge was the same (35%, 7/20) in MZ and SH followed by GI (30%, 6/20) and OZ (25%, 5/20) (Table 2). The proportion of respondents having knowledge on zoonoses transmission through consumption of raw/undercooked chicken viscera was high in the age group 41-50 years and highest in GI (20%, 4/20) followed by SH (15%, 3/20) and OZ (10%, 2/20). However, in MZ, knowledge was highest in the age group ≥61 (20%, 4/20).

Based on education level, knowledge on zoonosis transmission was highest among respondents with high school education (13.8%, 11/80), followed by tertiary education (8.8%, 7/80), primary education (7.5%, 6/80) and (1.3%, 1/80) among respondents with no formal education (Table 2). The knowledge of zoonosis due to consuming undercooked/raw FRC was the same (35%, 7/20) in MZ and OZ, followed by (30%, 6/20), and (25%, 5/20) in GI and OZ respectively (Table 2). Regarding occupation, knowledge was highest among the unemployed, (26.3%, 21/80), followed by (3.8%, 3/80) and (2.5%, 2/80) among the employed and self-employed participants respectively. Furthermore, based on the household size, knowledge of zoonosis was highest (13.8%, 11/80) in household size 1-5 and 6-10, and decreased in household size 11-15 (2.5%, 2/80) and 16-20 (1.3%, 1/80) (Table 2).

Table 2

Responses on knowledge of zoonoses transmission from free range chickens in four localities in the KwaZulu-Natal province of South Africa (GI = Gingindlovu; OZ = Ozwathini; MZ = uMzinto; SH = Shongweni).
Variable	Localities
	GI (n=20)		OZ (n=20)		MZ (n=20)		SH (n=20)
	Yes (%)	No (%)	Yes (%)	No (%)	Yes (%)	No (%)	Yes (%)	No (%)
Age
<21	-	1 (100)	-	1 (100)	-	-	-	1 (100)
21-30	2 (29)	5 (71)	1 (17)	5 (83)	1 (33)	2 (67)	2 (100)	-
31-40	-	1 (100)	1 (25)	3 (75)	-	1 (100)	-	-
41-50	4 (80)	1 (20)	2 (50)	2 (50)	-	5 (100)	3 (60)	2 (40)
51-60	-	2 (100)	1 (50)	1 (50)	2 (50)	2 (50)	-	4 (100)
61+	-	4 (100)	-	3 (100)	4 (57)	3 (43)	2 (33)	4 (67)
Total	6 (30)	14 (70)	5 (25)	15 (75)	7 (35)	13 (65)	7 (35)	13 (65)
X², p-Value	(X² = 9.388, p = 0.095)		(X² = 3.556, p = 0.615)		(X² = 5.139, p = 0.273)		(X² = 8.864, p = 0.115)
Educational level
None	-	2 (100)	-	2 (100)	-	1 (100)	1 (100)	-
Primary	-	1 (100)	-	3 (100)	4 (50)	4 (50)	2 (25)	6 (75)
High school	2 (18)	9 (82)	3 (43)	4 (57)	`3 (27)	8 (73)	3 (33)	6 (67)
Tertiary	4 (67)	2 (33)	2 (25)	6 (75)	-	-	1 (50)	1 (50)
	6 (30)	14 (70)	5 (25)	15 (75)	7 (35)	13 (65)	7 (35)	13 (65)
X², p-Value	(X² = 5.859, p = 0.119)		(X² = 2.857, p = 0.414)		(X² = 1.618, p = 0.445)		(X² = 2.418, p = 0.490)
Occupation
Employed	-	-	1 (25)	3 (75)	-	1 (100)	1 (50)	1 (50)
Unemployed	4 (24)	13 (76)	4 (29)	10 (71)	7 (39)	11 (61)	6 (35)	11 (65)
Self employed	2 (67)	1 (33)	-	2 (100)	-	1 (100)	-	1 (100)
Total	6 (30)	14 (70)	5 (25)	15 (75)	7 (35)	13 (65)	7 (35)	13 (65)
X², p-Value	(X² = 2.260, p = 0.133)		(X² = 0.762, p = 0683)		(X² = 1.197, p = 0.550)		(X² = 0.737, p = 0.692)
Participant’s ID
Father	-	1 (100)	-	2 (100)	-	1 (100)	1 (20)	4 (80)
Mother	3 (27)	8 (73)	3 (30)	7 (70)	6 (38)	10 (62)	4 (33)	8 (67)
Children >18yrs	3 (38)	5 (62)	2 (25)	6 (75)	1 (33)	2 (67)	2 (67)	1 (33)
Total	6 (30)	14 (70)	5 (25)	15 (75)	7 (35)	13 (65)	7 (35)	13 (65)
X², p-Value	(X² = 0.682, p = 0.711)		(X² = 0.800, p = 0.670)		(X² = 0.586, p = 0.746)		(X² = 1.832, p = 0.400)
Household Size
1-5	1 (17)	5 (83)	3 (30)	7 (70)	2 (25)	6 (75)	5 (45)	6 (55)
6-10	4 (31)	9 (69)	2 (25)	6 (75)	4 (50)	4 (50)	1 (14)	6 (86)
11-15	1 (100)	-	-	2 (100)	1 (25)	3 (75)	-	1 (100)
16-20	-	-	-	-	-	-	1 (100)	-
Total	6 (30)	14 (70)	5 (25)	15 (75)	7 (35)	13 (65)	7 (35)	13 (65)
X², p-Value	(X² = 2.845, p = 0.241)		(X² = 0.800, p = 0.670)		(X² = 1.319, p = 0.517)		(X² = 4.244, p = 0.236)

Ownership of free-range chicken and pets in study localities

Overall, 65% (52/80) of the interviewed households in the study population owned free-range chickens ranging from 1-51 (17.2±1.4). Twenty percent (16/80) of the households had FRC greater than 20, while (10%, 8/80) of the study population have ≤5. FRC ownership was highest in MZ (80%, 16/20), followed by OZ (70%, 14/20), SH (60%, 12/20), and GI (50%, 10/20) (Table 3). With respect to pet ownership, 30% (24/80) of the households that were surveyed owned either of dogs, cats, or both in the proportion of 23.8%, 1.3%, and 5% respectively. Generally, the proportion of households owning cats was low, with only 10% (2/80) in GI and SH, and 1.25% (1/80) in MZ while there was nothing recorded in OZ. Also, 20% (16/80) of the household owning pets allow them to roam and (24%, 19/80) of the respondents reported pets deworming (Table 3).

Table 3

Ownership of free-range chicken and pets in four localities in the KwaZulu-Natal province of South Africa (GI = Gingindlovu; OZ = Ozwathini; MZ = uMzinto; SH = Shongweni)
Variable					Localities
	GI (n=20)		OZ (n=20)		MZ (n=20)		SH (n=20)		Total (n=80)
	Freq	(%)	Freq	(%)	Freq	(%)	Freq	(%)	Freq	(%)		p-Value
Ownership of free-range chickens
Yes	10	50	14	70	16	80	12	60	52	65.00			0.222
No	10	50	6	30	4	20	8	40	28	35.00
Number of free-range chickens in the household
1 – 5	1	5	4	20	1	5	11	55	8		10.00		0.416
6 – 10	1	5	5	25	2	10	7	35	10		12.50
11 – 15	2	10	2	10	7	35	1	5	14		17.50
16 – 20	1	5	-	-	1	5	1	5	4		5.00
20+	5	25	3	15	5	25	-	-	16		20.00
Presence of pet animal (dog or cats)
Yes	7	35	1	5	6	30	10	50	24		30.00		0.019
No	13	65	19	95	14	70	10	50	56		70.00
Number of dogs
1-5	5	25	1	5	5	25	9	45	20		25.00		0.946
6-10	1	33	-	-	1	33	1	33	3		3.75
Number of cats
1-5	2	40	-	-	1	20	2	40	5		6.25		-
Mode of rearing of pet
Allowed to roam	3	15	1	5	5	25	7	35	16		20.00		0.043
Not Allowed to roam	4	20	-	-	1	5	3	15	8		10.00
Not applicable	13	23	19	34	14	25	10	18	56		70.00

Chicken viscera consumption

Overall, 76.3% (61/80) of respondents reported consumption of chicken viscera (Table 4). The proportion of respondents consuming chicken viscera was highest in SH (90%, 18/20), followed by OZ (80%, 16/20), MZ (75%, 15/20), and GI (60%, 12/20). No significant association was found between household size and chicken viscera consumption (p>0.05).

A three-way Cross-Tabulation and Chi-square statistic for respondents’ categories (father, mother, or household members ≥ 18 years), the types of chicken viscera that were being consumed, and consumption preference showed a significant association in all the study locations (p<0.05) with the majority of the respondents (96.7%, 59/80) reporting their consumption preference as ‘well-cooked’ (Table 4). The proportion of respondents consuming the combination of all chicken viscera i.e., gizzard, heart, liver, lungs, kidney, and intestines was higher than the other chicken viscera combinations, however, the difference was not significant (p>0.05) (Table 5).

Table 4 Responses from participants on type and consumption preference of viscera from free range in four localities in KwaZulu-Natal province of South Africa.

Respondents Category	Viscera type consumed and preferred manner of consumption in Gingindlovu (n = 12)
	1, 3	1, 2, 3	1, 3, 4, 6	1, 2, 3, 6	1, 2, 3, 4, 5	1, 3, 4, 5, 6	1, 2, 3, 5, 6	1, 2, 3, 4, 5, 6	Consumption preference		p-Value
	1, 3	1, 2, 3	1, 3, 4, 6	1, 2, 3, 6	1, 2, 3, 4, 5	1, 3, 4, 5, 6	1, 2, 3, 5, 6	1, 2, 3, 4, 5, 6	Well cooked	Under cooked	p-Value
Father	-	-	-	-	-	-	-	1	1	-	0.001
Mother	-	-	-	-	-	1	2	4	7	-
Family members ≥ 18 years	-	-	-	-	-	-	2	2	3	1
Total	-	-	-	-	-	1	4	7	11	1
Respondents Category	Viscera type consumed and preferred manner of consumption in Ozwathini (n = 16)
Father	-	7-	-	-	-	-	-	1	1	-	0.006
Mother	-	1	-	1	-	-	3	2	7	-
Family members ≥ 18 years	1	-	1	-	-	1	2	3	8	-
Total	1	1	1	1	-	1	5	6	16	-
Respondents Category	Viscera type consumed and preferred manner of consumption in uMzinto (n = 15)
Father	-	-	-	-	-	-	-	1	1		0.000
Mother	-	-	-	-	7	-	-	5	11	1
Family members ≥ 18 years	-	-	-	-	2	-	-	-	2	-
Total	-	-	-	-	9	-	-	6	14	1
Respondents Category	Viscera type consumed and preferred manner of consumption in Shongweni (n = 18)
Father	-	1	-	-	1	-	-	2	4	-	0.000
Mother	-	-	-	3	3	-	-	5	11	-
Family members ≥ 18 years	-	-	-	-	1	-	-	2	3	-
Total	-	1	-	3	5	-	-	9	18	-
Overall Total	1	2	1	4	14	2	9	28	59	2
p-Value	0.000

Chicken viscera types are denoted as follows; 1 = Gizzard, 2 = Heart, 3 = Liver, Lungs = 4, Kidney = 5, Intestines = 6

Table 5

Categories of household members consuming each type of chicken viscera in four localities as per respondent responses.
Chicken viscera	Gingindlovu (N = 20)
Chicken viscera	1	2	3	1 and 2	1 and 3	2 and 3	1, 2, and 3	4
Gizzard	3 (15)	-	-	-	1 (5)	3 (15)	5 (25)	8 (40)
Heart	2 (10)	-	-	-	1 (5)	3 (15)	5 (25)	9 (45)
Liver	3 (15)	-	-	-	1 (5)	3 (15)	5 (25)	8 (40)
Lungs	1 (5)	-	1 (5)	-	-	3 (15)	4 (20)	11 (55)
Kidney	1 (5)	1 (5)	-	-	1 (5)	3 (15)	6 (30)	8 (40)
Intestines	2 (10)	-	-	-	1 (5)	3 (15)	6 (30)	8 (40)
Chicken viscera	Ozwathini (N = 20)
Gizzard	3 (15)	-	1 (5)	-	-	-	4 (20)	12 (60)
Heart	1 (5)	-	1 (5)	-	-	-	6 (30)	12 (60)
Liver	3 (15)	-	1 (5)	-	-	-	4 (20)	12 (60)
Lungs	1 (5)	-	-	-	-	-	11 (55)	8 (40)
Kidney	1 (5)	-	-	1 (5)	-	-	8 (40)	10 (50)
Intestines	2 (10)	-	-	-	-	-	6 (30)	12 (60)
Chicken viscera	uMzinto (N = 20)
Gizzard	1 (5)	-	-	-	-	7 (35)	5 (25)	7 (35)
Heart	1 (5)	-	-	-	-	7 (35)	5 (25)	7 (35)
Liver	1 (5)	-	-	-	-	7 (35)	5 (25)	7 (35)
Lungs	2 (10)	-	-	-	-	7 (35)	5 (25)	6 (30)
Kidney	2 (10)	-	-	-	-	7 (35)	5 (25)	6 (30)
Intestines	1 (5)	-	3 (15)	-	-	5 (25)	9 (45)	2 (10)
Chicken viscera	Shongweni (N = 20)
Gizzard	5 (25)	1 (5)	-	1 (5)	1 (5)	5 (25)	2 (10)	5 (25)
Heart	6 (30)	1 (5)	-	1 (5)	-	5 (25)	3 (15)	4 (20)
Liver	6 (30)	1 (5)	-	1 (5)	-	5 (25)	2 (10)	5 (25)
Lungs	3 (15)	-	1 (5)	1 (5)	1 (5)	6 (30)	4 (20)	4 (20)
Kidney	3 (15)	-	1 (5)	1 (5)	-	6 (30)	5 (25)	4 (20)
Intestines	2 (10)	-	2 (10)	1 (5)	1 (5)	4 (20)	6 (30)	4 (20)

Categories keys; 1 = Father, 2 = Mother, 3 = Family members ≥ 18 years, 4 = None of the categories

Toxoplasmosis and toxocariasis are global zoonotic diseases of public health importance that can be acquired either, directly via accidental ingestion of infective oocysts and egg with larvae respectively or indirectly through ingestion of raw or undercooked vegetables, meat or viscera infected with cysts/larvae from the intermediate host (Campos-da-Silva et al. 2015; Zibaei et al. 2017; Luna et al. 2018; Belluco et al. 2018; Omonijo et al. 2020; dos Santos Silva et al. 2020). The socio-demographic parameters obtained in this study revealed resource-limited settings and is in agreement with report from a study by Tarwireyi and Fanadzo (2013). Other studies have reported the vulnerability of resource-poor communities who keep FRC to zoonotic diseases such as toxoplasmosis and toxocariasis (Neghina 2010; Santarém et al. 2011; Mirza and Rathore 2019).

Our study showed that a quarter of the respondents in the study areas had only completed primary education. This is consistent with reports from other rural regions of South Africa where the low levels of education have been reported (Mwale and Masika, 2009; Spaull 2015). Similarly, the high unemployment rate observed in this study agrees with an earlier report from the Eastern Cape province of South Africa (Mwale and Masika 2009) and previous studies have shown that limited employment and socio-demographic factors influence the food and meat gathering practices of people in a way that predisposes them to parasitic infections (Simeone 2008; Drescher et al. 2012; Goyette et al. 2014).

This study showed that knowledge of zoonotic disease transmission was highest in the southern localities (MZ and SH) than in the northern (GI and OZ) of KZN respectively. Also, this study showed that the overall percentage of zoonosis transmission awareness was comparable to 30.1% recorded from cattle farmers in Senegal (Tebug et al. 2015), but higher than the awareness level of 19.1% of zoonotic risk associated with livestock in Ibadan Nigeria (Awosanya and Akande 2015). However, it was lower than 69% and 79.74% that was reported in Cambodia and Punjab respectively (Osbjer et al. 2015; Singh et al. 2019). Studies have shown that zoonosis transmission rates and associated risk factors may differ among localities within regions as observed in the USA (Congdon and Lloyd 2011; Ishaku et al. 2018).

Moreover, the significant association of playgrounds with study locations observed in this study may be of importance in zoonosis transmission especially among children, considering that most of them utilized household vicinity as playground. The exposure of these playgrounds to stray definitive hosts could result in environmental contamination with oocysts or eggs which are picked up by free-range chickens during foraging thereby making environmental contact an important route of infection for humans and animals (Campos-da-Silva et al. 2015; Yan et al. 2016; Gaulin et al. 2020).

Furthermore, this study revealed that ownership of free-range chickens in the study locations was 65% (52/80), this is higher than the 57.7% (41/71) reported in Ethiopia (Sambo et al. 2015), but lower than the 93.5% and 84% poultry (duck and chicken) ownership observed in Eastern Cape province of South Africa and Cambodia respectively (Mwale and Masika 2009; Osbjer et al. 2015). Also, the average flock size (17.2±1.4) observed in this study is higher than (16±2.1), reported in Eastern Cape province of South Africa (Mwale and Masika 2009), but lower than (22.03±2.85) in Limpopo province and (28.40±2.57) earlier reported in KwaZulu-Natal province respectively (Malatji et al. 2016).

Moreover, the co-existence of dogs, cats, and free-range chickens observed in this study may provide insight into the roles of these animals in transmitting toxoplasmosis and toxocariasis in KZN where the occurrence of T. gondii have been reported in cows (Thekisoe et al. 2020) and T. canis and Toxocara spp reported in dogs (Mukaratirwa and Singh 2010), and household dust (Mejia et al. 2020) respectively. Toxocara canis and T. cati are major parasites of canids and felids but can also infect a wide range of paratenic hosts and humans where they cause toxocariasis (Omonijo et al. 2020).

Furthermore, this study showed that 20%) (16/80) of the household owning pets allow them to roam. This may be attributed to low education level of owners thus, negatively influencing veterinary seeking practice for their pets. This is consistent with other studies who reported the positive influence of post-secondary education in seeking veterinary services (Pereira et al. 2016). This study underscores the need to intensify awareness on standard pet care practice and risk of disease transmission among animals and from animals to humans.

Regarding consumption patterns, the majority (76.3%, 61/80) of respondents reported the practice of consumption of FRC viscera in the households. The reason for the high demand for chicken viscera in the study area is however unknown. Studies have identified the role of poor socio-demographic parameters as well as globalization as important factors in meat consumption pattern (Tambi 2001; Simeone 2008; Goyette et al. 2014; Robertson et al. 2014). Additionally, viscera of chicken and other avian animals have been reported to be rich in essential nutrients that are highly valuable to humans (Schönfeldt and Gibson 2008).

Despite a high trend in the consumption of chicken viscera, this study does not find any significant association between the consumption of free-range chicken viscera and symptoms of zoonosis (p>0.05). This may be attributed to the respondents’ preference for ‘well-cooked’ viscera. Also, a study reported the important role of mothers in the provision and preparation of healthy meals for their households (Reid et al., 2015) which might be the case in our study. Although the association between household size and consumption pattern was not significant in this study, a previous study showed the inverse relationship between household size and certain food consumption patterns (Abdulai et al. 1999). Considering the high rate of chicken viscera consumption practiced by communities in this study, although most preferred “well-cooked”, it is important to intensify awareness on health associated with the consumption of raw/undercooked viscera from free-range chickens.

Acknowledgements The authors would like to thank the University of KwaZulu-Natal and the National Research Foundation who awarded A.O.O. a bursary for her PhD studies.

Authors’ contributions All authors contributed to the study conception and design Adejumoke O. Omonijo and Samson Mukaratirwa conceived and designed the study. Adejumoke O. Omonijo wrote the article and Samson Mukaratirwa reviewed the article. Both authors read and approved the final manuscript.

Data availability The data used to support the findings of this study are available from the corresponding author upon request.

Ethics approval The study was conducted under the Human and Social Sciences Research Ethics committee of the University of KwaZulu-Natal protocol reference number HSS/1655/018D.

Consent to participate • We confirm the confidentiality of each participant’s answer, and the data will be treated with complete confidentiality, and only for research and statistical purposes only.

• We confirm that their participation in the study was voluntary, with no financial compensation.

• We confirm the participants' right to not answer any question they do not want to, and their right to withdraw from the study at any time they wish without giving reasons without any negative consequences being applied to them.

• Written consent was obtained from each participant before their participation in the study.

Consent for publication The corresponding author confirms that the manuscript has been read and approved for submission by all the co-authors.

Conflict of interest The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Financial support This study is based on the research supported wholly by University of KwaZulu-Natal Research Productivity funds allocated to Samson Mukaratirwa.

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Knowledge and Practices on Consumption of Free-Range Chicken Viscera in Selected Rural Communities of Kwazulu-Natal, South Africa, with Focus on Zoonotic Transmission of Toxoplasma Gondii and Toxocara Spp.

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Introduction

Methodology

Study design and sample

Study procedure

Study design and sample

Study procedure

Statistical analysis

Statistical analysis

Results

Socio-demographic profile of participants

Ownership of free-range chicken and pets in study localities

Chicken viscera consumption

Discussion

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