Evaluation of knowledge, attitudes and practices regarding neosporosis and toxoplasmosis among farmers and animal health practitioners in Namibia

doi:10.21203/rs.3.rs-1752509/v1

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Evaluation of knowledge, attitudes and practices regarding neosporosis and toxoplasmosis among farmers and animal health practitioners in Namibia

https://doi.org/10.21203/rs.3.rs-1752509/v1

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published 26 Dec, 2022

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This study assessed the knowledge, attitudes and practices of livestock farmers in Namibia’s Khomas region and animal health practitioners (veterinarians & animal health technicians) in the whole country concerning neosporosis and toxoplasmosis. Structured questionnaires were used, and a total of 63 farmers and 51 animal health practitioners responded, out of an estimated 560 farmers in the Khomas region and 300 veterinarians and veterinary technicians in the country. Only 15.9% (n = 63) of the livestock farmers had heard about neosporosis or toxoplasmosis or knew how animals get infected (p < 0.0001). Only 5% of the farmers knew the risks associated with keeping dogs and cats concerning neosporosis and toxoplasmosis, respectively (p < 0.0001). None of the 51 animal health practitioners routinely requested Neospora caninum or Toxoplasma gondii laboratory tests in cases of cattle, sheep or goat abortions. Although all animal health practitioners indicated that they routinely interacted with livestock farmers, none regularly discussed neosporosis or toxoplasmosis with them. Only 3.9% (n = 51) of animal health practitioners indicated that they had ever discussed either neosporosis or toxoplasmosis at a farmers’ gathering (p < 0.0001), and only 21.6% had talked to at least one cat owner about toxoplasmosis in the previous 12 months (p < 0.0001). The authors concluded that farmers in the Khomas region were generally unaware of neosporosis and toxoplasmosis but could change their attitudes and practices if educated. The animal health practitioners lacked a deeper understanding and appreciation of the two diseases, which is required to cultivate enough confidence to educate farmers and cat owners.

knowledge

attitudes

practices

neosporosis

toxoplasmosis

Khomas

Namibia

Approximately 70% of Namibia's population depends directly or indirectly on agriculture, of which livestock production accounts for 80% (Humavindu & Stage 2013; Meat Board of Namibia 2015; Simasiku & Sheefeni 2017). Valued at approximately N$4.6 billion and equating to 4.3% of the gross domestic product (GDP) (Meat Board of Namibia 2019), the livestock sector employs roughly 30% of the nation's total labour force (Humavindu & Stage 2013; Simasiku & Sheefeni 2017). Furthermore, between 2004 and 2009, commercial farming contributed 5–6% of Namibia's GDP; animal products, livestock and crop exports constituted roughly 10.7% of the total Namibian exports (BDO Namibia 2019). Livestock production, therefore, constitutes a significant part of the country’s economy. Thus, any disease outbreak that causes reduced productivity in livestock has the potential to cause severe economic knock-on effects.

Outbreaks of diseases such as anthrax, contagious bovine pleuropneumonia, foot and mouth disease, besnoitiosis, sarcoptic mange, lumpy skin disease and rabies have been reported in different parts of Namibia (Bishi 2016; DVS 2013; Hikufe et al. 2019; Mbiri et al. 2020; Molini, Aikukutu, et al. 2018; Shoombe 2013; Tekleghiorghis et al. 2014). These diseases can potentially cause significant production losses if they are not controlled, especially if abortions are involved. Additionally, many infectious causes of abortions have been reported in the country. These include, among others, brucellosis (Madzingira et al. 2020), chlamydiosis (Samkange et al. 2010), coxiellosis (Bishi et al. 2018), Schamellenberg virus (Molini, Dondona, et al. 2018), Rift Valley Fever (Cosseddu et al. 2020) and bovine virus diarrhoea (Depner et al. 1991). Among the pathogens known to cause reproductive losses are Neospora caninum and Toxoplasma gondii, although they have not been reported in livestock in Namibia. However, N. caninum and T. gondii have recently been reported in Namibian wildlife (Seltmann et al. 2020).

Neosporosis caused by N. caninum and toxoplasmosis caused by T. gondii are important worldwide protozoal infections that negatively impact livestock productivity through abortions, stillbirths, infertility and birth of weak offspring (Al-Malki 2021; Dubey & Schares 2011; Khan & Noordin 2020; Monney et al. 2011). Globally, annual losses due to N. caninum-induced abortions have been estimated between US$633.4 million and US$2.380 billion (Reichel et al. 2013). Unfortunately, published studies on economic losses attributable to T. gondii are scarce and outdated (Stelzer et al. 2019); however, in parts of South America, Europe and Australia, these have been estimated between US$1.4 million and US$50 million (Bennett & IJpelaar 2005; Freyre et al. 1997; Stelzer et al. 2019). These figures clearly illustrate the significant economic impact of neosporosis and toxoplasmosis on the livestock industry worldwide.

To a great extent, livestock neosporosis and toxoplasmosis are generally overlooked in sub-Saharan Africa. Some authors have labelled toxoplasmosis as the most neglected disease in sub-Saharan Africa (Tegegne et al. 2016). Similar observations concerning neosporosis in Egypt have been made (Gaber et al. 2021), which is probably reflective of most of Africa. However, it is essential to carry out valid scientific studies to avoid making unproven assumptions.

An assessment of the knowledge, attitudes, and practices (KAP) regarding neosporosis and toxoplasmosis would provide a diagnosis of the education level of the surveyed population concerning the two diseases (Kaliyaperumal 2004; Sarria-Guzmán et al. 2021). KAP studies are used to gather information on what is “known, believed and done” regarding a given topic; this is done to evaluate to what degree that correlates with current scientific knowledge (Ul Haq et al. 2012).

Despite the evident negative impact of the two infections on livestock production, very little has been done to assess the KAP of key players in the livestock industry. To the authors’ knowledge, there is only one KAP study on N. caninum, which was done in Egypt (Gaber et al., 2021). Although several toxoplasmosis KAP studies have been done around the world, including in Morocco (Ait Hamou et al. 2021; Laboudi et al. 2020), Zimbabwe (Chikerema et al. 2013), Saudi Arabia (Mahfouz et al. 2019), Malaysia (Sadiq et al. 2021), the USA (Hill et al. 2012) and Senegal (Tebug et al. 2015), these studies were only from a zoonotic perspective with no reference to the livestock industry. In addition, no KAP of the two diseases has been done in southern Africa, including Namibia.

This study aimed to assess the knowledge, attitudes and practices of the livestock farmers in Namibia’s Khomas region and the animal health practitioners (veterinarians, animal health technicians & other para-veterinary professionals) in the country concerning neosporosis and toxoplasmosis.

Study area

The livestock producers enrolled on this study were drawn from the Khomas region of Namibia. The animal health practitioners (veterinarians, animal health technicians & private para-veterinary professionals) were drawn from the whole country. The Khomas region is one of fourteen regions of Namibia and covers approximately 36,964 km² (Namibia Statistics Agency 2011), and has approximately 560 commercial farms (Directorate of Veterinary Services 2010). The region is situated in the central part of the country. It is sandwiched between four other regions: Erongo to the west, Otjozondjupa to the north, Omaheke to the east, and Hardap to the south (Fig. 1).

Study subjects

The KAP study population included all the 560 livestock producers in the Khomas region and all animal health practitioners (approximately 85 veterinarians and over 200 animal health technicians) in Namibia who are involved in production animal practice.

Data collection

This study was carried out between 1 May and 31 May 2022. Two structured questionnaires, one each for the farmers and another for the animal health practitioners, were used to collect information on livestock farmers' knowledge, attitudes, and practices in the Khomas region and animal health practitioners in Namibia concerning neosporosis and toxoplasmosis. The farmer questionnaires were sent through emails, and the farmers would complete them and email them back. Others were completed during farmers’ meetings and through face-to-face and telephonic interviews. The animal health practitioner questionnaire was sent electronically, either directly or through the Veterinary Association of Namibia, which has direct access to most veterinarians practising in Namibia.

The farmers’ questionnaire solicited information on their educational level and experience in farming, their knowledge of causes of abortions, their specific knowledge of neosporosis and toxoplasmosis and the role of cats and dogs in their transmission. Questions on farmers’ attitudes centred on their perspectives on livestock abortions, what they would do if neosporosis and toxoplasmosis were diagnosed on their farms, and how important abortions were on their farms. Questions on the farmers’ practices gathered information on the vaccines in routine use at the farm, sources of replacement stock, what they do with aborted animals, and how much livestock production contributed to their livelihoods.

The animal health practitioner questionnaire assessed their knowledge of neosporosis and toxoplasmosis concerning transmission, clinical signs, availability of vaccines and zoonotic implications. In addition, questions on attitudes pertained to whether or not they thought the two diseases occurred in Namibia and whether they thought that the veterinary fraternity in Namibia was well informed concerning N. caninum and T. gondii. Finally, the questions on practices asked if the animal health practitioners routinely requested laboratory tests for the two diseases in abortion cases and whether they regularly educate their clients on these diseases.

Data analysis

The questionnaire data was captured in Microsoft Excel 2013, and statistical analysis calculations were done using the one-sample z-test for a population proportion calculator (https://epitools.ausvet.com.au/ztestone).

The majority of the interviewed farmers [93.7%; n = 63] had high literacy levels and more than ten years of experience [71.3%; n = 63] in livestock production (see Table 1). About 61.9% of the respondents had experienced abortions in their livestock and knew the causes (p = 0.0589). Only 1.6% (1/63) of the farmers listed neosporosis and toxoplasmosis among the causes of abortions they knew, and 4.8% (3/63) were aware that toxoplasmosis was a zoonotic cause of abortions (p < 0.0001). About 15.9% [n = 63] of the respondents had heard about neosporosis or toxoplasmosis or knew how animals get infected by these diseases (p < 0.0001). Only 5% (5/63) of the farmers were aware of the risks associated with keeping dogs and cats concerning neosporosis and toxoplasmosis (p < 0.0001).

Table 1

summary of the knowledge of farmers regarding neosporosis and toxoplasmosis
KNOWLEDGE	YES	NO	% YES	P value
Secondary school education level or higher	59	4	93.7	< 0.0001
At least ten years of farming experience?	45	18	71.4	0.0007
Known causes of abortions include neosporosis & toxoplasmosis	1	62	1.6	< 0.0001
Have you ever experienced abortions on the farm & do you know the causes?	39	24	61.9	0.0589
Knowledge of zoonotic causes of livestock abortions includes toxoplasmosis?	3	60	4.8	< 0.0001
Knowledge of how animals get infected by abortion-causing agents	23	40	36.5	0.0321
Knowledge of how to prevent livestock abortions	37	26	58.7	0.1673
Have you heard of neosporosis or toxoplasmosis?	10	53	15.9	< 0.0001
Know animals affected by neosporosis	9	54	14.3	< 0.0001
Know animals affected by toxoplasmosis	10	53	15.9	< 0.0001
Knowledge of the risk of keeping dogs	5	58	7.9	< 0.0001
Knowledge of the risk of keeping cats	5	58	7.9	< 0.0001

Most of the farmers (87.3%) indicated that they would be worried if abortions occurred in their livestock, and 79.4% would take corrective measures (p < 0.0001) (Table 2). About 69.8% correctly indicated that they would consult their veterinarian if their animals tested positive for neosporosis or toxoplasmosis, and 66.7% indicated that they would not purchase an animal with a history of abortion (p = 0.008). Less than half of the respondents (41.3%) listed abortion among the causes of livestock losses in their livestock (p = 0.167). Most respondents (69.8%) indicated that they preferred well-cooked meat (p = 0.0017), and only 17.5% of the respondents thought that other livestock farmers had ever heard of neosporosis or toxoplasmosis (p < 0.0001).

Table 2

summary table of the attitudes of farmers concerning neosporosis and toxoplasmosis
ATTITUDES	YES	NO	% YES	P value
They are worried that abortions are occurring.	55	8	87.3	< 0.0001
Are abortions taken seriously if they occur?	50	13	79.4	< 0.0001
Correct measures in response if animals test positive for neosporosis or toxoplasmosis	44	19	69.8	< 0.0001
Appropriate attitude towards purchase of an animal with a history of abortion	42	21	66.7	0.008
Ranking of important causes of livestock losses include abortions?	26	37	41.3	0.1673
Correct attitude about eating undercooked meat	44	19	69.8	0.0017
Whether they think other farmers have heard of neosporosis or toxoplasmosis	11	52	17.5	< 0.0001

About 76.2% of the respondents indicated that livestock production contributed at least 50% of their livelihoods (p < 0.0001) (Table 3). However, most of the farmers sold no more than 30 sheep (23.8%) or goats (14.3%) per year (p < 0.0001) and 57.1% of them sold more than 20 cattle per year (p > 0.05). In addition, none of the farmers included T. gondii in their vaccination programmes. 49.2% of the farmers indicated that they would cull their animals if they aborted more than once (p = 0.8989), and only 36.5% gathered animal health information concerning the farm from which they sourced replacement stock (p = 0.0321). 58.7% of the respondents preferred their grilled meat to be well-done (p = 0.1673).

Table 3

summary of farmer practices regarding neosporosis and toxoplasmosis
PRACTICES	YES	NO	% YES	P value
Does livestock production contribute at least 50% to livelihood?	48	15	76.2	< 0.0001
More than 20 cattle are sold per year	36	27	57.1	0.2597
More than 30 sheep are sold per year	15	48	23.8	< 0.0001
More than 30 goats sold per year	9	54	14.3	< 0.0001
Vaccines administered include T. gondii?	0	63	0.0	< 0.0001
Cull animals that abort more than once?	16	47	25.4	< 0.0001
Replacement stock sourced elsewhere	31	32	49.2	0.8989
Do you gather information on the farm from which replacement stock is sourced	23	40	36.5	0.0321
Grilled meat preferred well-done?	37	26	58.7	0.1673

The KAP of animal health practitioners (Table 4) showed that only 9.8% (n = 51) of the respondents listed neosporosis and toxoplasmosis among the common causes of livestock abortions they knew (p < 0.0001). However, on most key questions, the respondents showed good knowledge scores of the two parasites, ranging from 60.8–90.2% and averaging 68%. Low scores were on questions relating to the zoonotic implications of neosporosis (41.2%; p = 0.2088) and the risk of toxoplasmosis posed by veterinary inspected meat (23.5%; p = 0.0002).

Table 4

summary of the knowledge of animal health practitioners regarding neosporosis and toxoplasmosis
KNOWLEDGE	YES	NO	% YES	P value
Knowledge of common causes of abortions in cattle includes N caninum	5	46	9.8	< 0.0001
Knowledge of common causes of abortions in sheep & goats includes T gondii	5	46	9.8	< 0.0001
Average or higher level of knowledge of N. caninum	30	21	58.8	0.2088
Knowledge of N. caninum transmission	35	16	68.6	0.0079
Knowledge of final hosts of N caninum	34	17	66.7	0.0171
Knowledge of clinical signs of neosporosis in canids	21	30	41.2	0.2088
Ability to name at least one host of N. caninum	46	5	90.2	< 0.0001
Knowledge of the main problem caused by N. caninum in cattle	36	15	70.6	0.0033
Knowledge of zoonotic implications of N. caninum	21	30	41.2	0.2088
Knowledge about N. caninum vaccination	35	16	68.6	0.0079
Average or higher level of knowledge of T. gondii	30	21	58.8	0.2088
Knowledge of T. gondii transmission	35	16	68.6	0.0079
Knowledge of T. gondii definitive host	31	20	60.8	0.1229
Knowledge of T. gondii clinical signs in cats	14	37	27.5	0.0013
Knowledge of animals affected by T. gondii	34	17	66.7	0.0079
Knowledge of the main problem caused by T. gondii in goats & sheep	36	15	70.6	0.0033
Knowledge of zoonotic implications of T. gondii	38	13	74.5	0.0006
Knowledge of how humans get infected by T. gondii	34	17	66.7	0.0079
Knowledge about T. gondii vaccination	7	44	13.7	< 0.0001
Knowledge on whether inspected meat poses the risk of toxoplasmosis	12	39	23.5	0.0002

52.9% of the animal health practitioners thought that neosporosis was present in Namibia (Table 5), and 56.9% thought that this disease was important for the country and that farmers should be worried about it (p > 0.05). Furthermore, close to half of the respondents (47.1%) indicated that they would recommend routine vaccination against N. caninum and T. gondii if effective vaccines were available (p > 0.05). On the other hand, only 33.3% and 13.7% of the respondents thought other animal health practitioners were well informed about toxoplasmosis and neosporosis, respectively (p < 0.05). Ninety point two per cent (90.2%) felt that it was necessary to educate farmers on these two diseases (p < 0.0001), and 76.5% believed that N. caninum and T. gondii should be included in the abortion screening panel used at the central veterinary laboratory in Namibia (p = 0.0002).

Table 5

summary of the attitudes of the animal health practitioners regarding neosporosis and toxoplasmosis
ATTITUDES	YES	NO	% YES	P value
Do you think N. caninum is present in Namibia?	27	24	52.9	0.6787
Is N. caninum important for Namibia?	29	22	56.9	0.3244
Should farmers be worried about N. caninum?	29	22	56.9	0.3244
Whether they would recommend N. caninum vaccination by farmers if it were available	24	27	47.1	0.6787
If they thought the veterinary fraternity was well informed about toxoplasmosis	17	34	33.3	0.0171
If they thought the veterinary fraternity was well informed about neosporosis	7	44	13.7	< 0.0001
Whether they thought it necessary to educate farmers on toxoplasmosis & neosporosis	46	5	90.2	< 0.0001
I would recommend routine toxoplasmosis vaccination if it were available	24	27	47.1	0.6787
Would like T gondii & N caninum included in routine lab abortion screening	39	12	76.5	0.0002

The practices of the Namibian animal health practitioners are summarised in Table 6. None of the 51 respondents routinely requested N. caninum or T. gondii tests in cattle, sheep or goat abortion cases. Only one respondent (2% [n = 51]) ever requested laboratory testing for N. caninum or T. gondii (p < 0.0001). Although all respondents indicated that they routinely interact with livestock farmers, none of them normally discusses neosporosis or toxoplasmosis with them. However, only 3.9% (2/51) indicated that they had ever discussed either neosporosis or toxoplasmosis at a farmers' meeting (p < 0.0001), and only 21.6% (11/40) had talked to at least one cat owner about toxoplasmosis in the previous 12 months (p < 0.0001).

Table 6

summary of the practices of the animal health practitioners regarding neosporosis and toxoplasmosis
PRACTICES	YES	NO	% YES	P value
Lab tests routinely requested in cattle abortion cases include N. caninum	0	51	0.0	< 0.0001
Lab tests routinely requested for in sheep & goats abortions cases include T. gondii	0	51	0.0	< 0.0001
Have you ever requested lab tests for N. caninum or T. gondii?	1	50	2.0	< 0.0001
Do they usually interact with livestock farmers?	51	0	100.0	< 0.0001
Whether they usually have farmers' meetings	19	32	37.3	0.0697
Topics generally discussed at farmers' meetings include N caninum & T gondii	0	51	0.0	< 0.0001
Whether neosporosis or toxoplasmosis was ever discussed at any farmer gathering	2	49	3.9	< 0.0001
Whether they talked to any cat owner about toxoplasmosis in the previous 12mo	11	40	21.6	< 0.0001

To the authors' knowledge, this is the first KAP study in southern Africa regarding neosporosis and toxoplasmosis. Although the results showed high literacy levels and many years of experience in livestock farming among most farmers, 84.1% (53/63) of them had never heard of neosporosis or toxoplasmosis and how animals get infected. These findings are similar to one Egyptian study where none of the 41 farmers interviewed knew about neosporosis (Gaber et al. 2021). In addition, studies in Saudia Arabia, Malaysia and Ethiopia showed a very low level of toxoplasmosis awareness among farmers, pregnant women and female students, ranging from 5.9–20.9% (Desta 2015; Mahfouz et al. 2019; Sadiq et al. 2021). However, in another study, 84% of Italian women claimed to have heard about toxoplasmosis, although their level of knowledge was deemed superficial and incomplete (Martini et al. 2020).

Given that most farmers had never heard of neosporosis or toxoplasmosis, it is not surprising that an even higher proportion (92% [n = 63]) were unaware of the risks posed by dogs and cats as definitive hosts of N. caninum and T. gondii, respectively. The farmers’ attitudes concerning these two diseases further reflected this, as most of them (82.5%) thought other farmers were unaware of neosporosis and toxoplasmosis. Also unsurprising was that none of the respondents routinely vaccinated against T. gondii. However, it should be noted that there is only one registered vaccine against T. gondii in the world, Toxovax®, which is a live attenuated S48 strain licensed for sheep (Ducournau et al. 2020; Monney et al. 2011). There is currently no commercial vaccine against N. caninum (Marugan-Hernandez 2017). Bovilis Neoguard® was discontinued because it could only protect against horizontal transmission but not against vertical transmission of N. caninum (Monney & Hemphill 2014).

It was encouraging, however, that most farmers indicated that they would be worried if abortions occurred in their livestock and were prepared to take remedial measures if neosporosis or toxoplasmosis was diagnosed in their animals. This shows that most farmers might be inclined to change their attitudes and practices concerning the two diseases and adopt preventive measures like vaccination, keeping closed herds, and prior quarantining and testing all replacement stock. Worryingly though, only a tiny percentage (3.9% [n = 51]) of the animal health practitioners had ever discussed these two diseases with livestock producers. There is, therefore, a need for animal health practitioners to sensitise livestock producers about neosporosis and toxoplasmosis.

The fact that 76.2% (n = 63) of the farmers indicated that livestock production contributed at least 50% of their livelihoods shows a very high reliance on livestock production. This further collaborates with other studies, which estimated that about 70% of Namibia's population depends directly or indirectly on agriculture, of which livestock production accounts for 80% (Humavindu & Stage 2013; Meat Board of Namibia 2015; Simasiku & Sheefeni 2017). This high dependency on livestock production makes this industry sensitive to the effects of epizootics (Heath 2008), including neosporosis or toxoplasmosis, if they are not controlled, which could significantly impact the farmers’ livelihoods.

The animal health practitioners generally displayed a fair understanding of neosporosis and toxoplasmosis, as expected. However, only a small percentage (9.8%) listed N. caninum and T. gondii among the common causes of abortions they were aware of. In addition, many of them were unaware that veterinary inspected meat still poses a risk of toxoplasmosis (Franco-Hernandez et al. 2015) if it is not adequately cooked. Furthermore, none of them routinely requested the central veterinary laboratory to test for N. caninum or T. gondii in abortion cases. This shows a lack of a deeper understanding of these two diseases among the Namibian animal health practitioners. This probably explains why none of the respondents routinely discussed these diseases with farmers. Only a tiny percentage (3.9%) had ever discussed neosporosis or toxoplasmosis at any farmers’ gathering, even though all the respondents routinely interacted with livestock farmers.

This study has demonstrated that the farming community in the Khomas region of Namibia is generally unaware of neosporosis and toxoplasmosis. However, there are indications that they might be willing to change their attitudes and practices if they are educated. On the other hand, animal health practitioners have the basic knowledge of the two diseases. However, they lack a deeper understanding and appreciation required to cultivate enough confidence to educate the livestock farmers. Therefore, the failure of the animal health practitioners to educate livestock producers about neosporosis and toxoplasmosis during their routine interactions with them presents a missed opportunity which should be utilised.

Acknowledgement

The authors would like to thank Dr Israel Kaatura, who assisted in administering the questionnaires. Our sincere thanks to the farming community, animal health practitioners who took part in this research, and the University of Namibia for supporting this study.

Funding: No applicable.

Conflicts of interest: The authors declare no conflict of interest.

Ethics approval: This study was approved by the University of Namibia Ethics Committee (Reference number: NEC0007) and the University of Pretoria’s Research Ethics Committees (reference numbers REC087-21 and HUM00/0322).

Consent to participate: All participants signed a written consent to participate in this research.

Consent for publication: All participants signed a written consent permitting the publication of this research.

Availability of data and material

The data collected for this research is available upon request.

Code availability: Microsoft Office 2013

Authors' contributions: All authors contributed to the study's conception and design. Material preparation, data collection and analysis were performed by Alaster Samkange. Alaster Samkange wrote the first draft of the manuscript and all authors commented on previous versions. All authors read and approved the final manuscript.

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Evaluation of knowledge, attitudes and practices regarding neosporosis and toxoplasmosis among farmers and animal health practitioners in Namibia

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