The poultry sector contributes significantly to Kenya’s food and economic security. This contribution is expected to rise dramatically with a growing population, urbanization, and preferences for animal-source foods. Antimicrobial resistance is putting the poultry sector in Kenya—and worldwide—at risk of production losses due to the failure of medicines for animal (and human) health. The emergence and spread of antimicrobial resistance has been linked to overuse and misuse of antimicrobials in poultry and other sectors. Previous studies have documented poultry farmer antimicrobial use but without systematic consideration of the contexts (i.e., drivers) as important targets for behavior change, particularly in low- and middle-income countries. To improve understanding of antimicrobial use patterns in poultry systems, we conducted a mixed-methods knowledge, attitudes, and practices study of 76 layer farms in Kiambu County; Kenya. We found that commonly used antibiotics were often labeled for prophylactic, growth promotion, and egg production improvement purposes. Antimicrobial use was also motivated by the presence of diseases/disease symptoms, most of which could instead be managed through infection prevention measures. The results suggest that improving vaccination and biosecurity practices on farms and engaging with drug-makers to ensure proper labeling and marketing of antimicrobial drugs may represent important areas of opportunity for social behavior change communication and/or behavioral science interventions (i.e., nudges) to reduce disease burdens and promote prudent antimicrobial use. We conclude our findings with suggestions for further research into the behavioral insights at play in these scenarios to fuel future intervention development.

International organizations and governments have argued that animal health service providers can play a vital role in limiting antimicrobial resistance by promoting the prudent use of antimicrobials. However, there is little research on the impact of these service providers on prudent use at the farm level, especially in low- and middle-income countries where enforcement of prudent-use regulations is limited. Here, we use a mixed-methods approach to assess how animal health-seeking practices on layer farms in Ghana (n = 110) and Kenya (n = 76) impact self-reported antimicrobial usage, engagement in prudent administration and withdrawal practices and perceptions of antimicrobial resistance. In general, our results show that the frequency of health-seeking across a range of service providers (veterinarians, agrovets, and feed distributors) does not significantly correlate with prudent or non-prudent use practices or the levels of antimicrobials used. Instead, we find that patterns of antimicrobial use are linked to how much farmers invest in biosecurity (e.g., footbaths) and the following vaccination protocols. Our results emphasize that more research is required to understand the interactions between animal health service providers and farmers regarding antimicrobial use and antimicrobial resistance. Addressing these gaps will be crucial to inform antimicrobial stewardship training, curriculums and, guidelines whose ultimate purpose is to limit the selection and transmission of antimicrobial resistance.

Brucellosis is an important zoonotic disease globally, with particularly high burdens in pastoral settings. While the zoonotic transmission routes for Brucella spp. are well known, the relative importance of animal contact, food-handling and consumption practices can vary. Understanding the local epidemiology of human brucellosis is important for directing veterinary and public health interventions, as well as for informing clinical diagnostic decision making. We conducted a cross-sectional study in Ijara District Hospital, north-eastern Kenya. A total of 386 individuals seeking care and reporting symptoms of febrile illness were recruited in 2011. Samples were tested for the presence of Brucella spp. using a real-time PCR (RT-PCR) and results compared to those from the test for brucellosis used at Ijara District Hospital, the febrile Brucella plate agglutination test (FBAT). A questionnaire was administered to all participants and risk factors for brucellosis identified using logistic regression with an information theoretic (IT) approach and least absolute shrinkage and selection (LASSO). Sixty individuals were RT-PCR positive, resulting in a prevalence of probable brucellosis of 15.4% (95% CI 12.0–19.5). The IT and LASSO approaches both identified consuming purchased milk as strongly associated with elevated risk and boiling milk before consumption strongly associated with reduced risk. There was no evidence that livestock keepers were at different risk of brucellosis than non-livestock keepers. The FBAT had poor diagnostic performance when compared to RT-PCR, with an estimated sensitivity of 36.6% (95% CI 24.6–50.1) and specificity of 69.3% (95% CI 64.0–74.3). Brucellosis is an important cause of febrile illness in north-eastern Kenya. Promotion of pasteurisation of milk in the marketing chain and health messages encouraging the boiling of raw milk before consumption could be expected to lead to large reductions in the incidence of brucellosis in Ijara. This study supports the growing evidence that the FBAT performs very poorly in the diagnosis of brucellosis. Brucellosis is a neglected, debilitating disease transmitted from livestock to people through direct contact with animal birth products or through the consumption of raw animal products, particularly milk. The febrile Brucella agglutination test (FBAT), a low-cost laboratory test for brucellosis, is widely used in health facilities throughout East Africa. Previous studies have shown this test has poor diagnostic specificity, contributing to high levels of overdiagnosis in low brucellosis prevalence settings. In this study, we compared the performance of the FBAT with real-time PCR in a high brucellosis prevalence setting in Ijara, Kenya. Our findings suggest very low FBAT diagnostic sensitivity and specificity, which could contribute to brucellosis cases being both missed and over-diagnosed in settings where the disease is common. The use of this test should therefore be phased out. Local epidemiological information can assist diagnostic decision making for brucellosis while awaiting replacement with more accurate tests. In the town of Ijara, at the time of the study, livestock ownership did not predict brucellosis risk. Rather, consumption of milk purchased from local shops and the market and not boiling milk before consumption were the most important predictors of acute disease. These findings also suggest public health interventions in the milk marketing chain could substantially reduce the incidence of human brucellosis.

Background: Rabies causes an estimated 59,000 human deaths annually. In Kenya, rabies was first reported in a dog in 1912, with the first human case reported in 1928. Here we examine retrospective rabies data in Kenya for the period 1912 – 2017 and describe the spatial and temporal patterns of rabies occurrence in the country. Additionally, we detail Kenya’s strategy for the elimination of dog-mediated human rabies by 2030. Methods: Data on submitted samples and confirmed cases in humans, domestic animals and wildlife were obtained from Kenya’s Directorate of Veterinary Services. These data were associated with the geographical regions where the samples originated, and temporal and spatial trends examined. Results: Between 1912 and the mid 1970’s, rabies spread across Kenya gradually, with fewer than 50 cases reported per year and less than half of the 47 counties affected. Following an outbreak in the mid 1970’s, rabies spread rapidly to more than 85% of counties, with a 4 fold increase in the percent positivity of samples submitted and number of confirmed rabies cases. Since 1958, 7,584 samples from domestic animals (93%), wildlife (5%), and humans (2%) were tested. Over two-thirds of all rabies cases came from six counties, all in close proximity to veterinary diagnostic laboratories, highlighting a limitation of passive surveillance. Conclusions: Compulsory annual dog vaccinations between 1950’s and the early 1970’s slowed rabies spread. The rapid spread with peak rabies cases in the 1980’s coincided with implementation of structural adjustment programs privatizing the veterinary sector leading to breakdown of rabies control programs. To eliminate human deaths from rabies by 2030, Kenya is implementing a 15-year step-wise strategy based on three pillars: a) mass dog vaccination, b) provision of post-exposure prophylaxis and public awareness and c) improved surveillance for rabies in dogs and humans with prompt responses to rabies outbreaks.

The dairy value chain of Nairobi is comprised, in its majority, of small-scale independent enterprises that operate within a complex interlinked system. In this complexity, the coordination and power structures of the system may have major influences on the management of dairy food safety. Therefore, the aim of this study was to investigate the governance structure and challenges faced by stakeholders throughout the Nairobi dairy value chain and assess their potential implications on food safety. Qualitative data were collected through focus group discussions and key informant interviews based on a dairy value chain mapping framework previously developed. Thematic analysis enabled identification of governance themes, key challenges and analysis of their implications on food safety. Themes were organized depending on their association with farmers (informal settlement or peri-urban), dairy cooperatives, dairy traders, processing companies, retailers or government officers. The identified governance themes included: i) weak linkage between government and farmers, ii) inadequate compliance with government regulations by traders and retailers, iii) emphasis on business licenses and permits for revenue rather than for food safety, iv) multiple licensing resulting in high business cost and lack of compliance, v) fragmented regulation, vi) unfair competition and vii) sanctions that do not always result in compliance. The key challenges identified included, among others: i) inadequate farmer support, ii) harassment of traders and retailers and iii) high business costs for traders, retailers, dairy cooperatives and large processors. The implication of governance and challenges of food safety were, among others: i) inadequate extension services, ii) insufficient cold chain, iii) delivery of adulterated and low milk quality to bulking centers, iv) inadequate food safety training and v) lack of policies for management of waste milk. The range of issues highlighted are based on stakeholders' perceptions and reflects the complexity of the relationships between them. Many of the governance themes demonstrate the linkages that are both beneficial or confrontational between the formal and informal sectors, and between industry and regulatory authorities, with possible direct food safety consequences. Findings obtained provide indications to decision-makers of potential governance areas that could help improve efficiency and food safety along the dairy value chain.

Background: Antimicrobials are used on farms to manage livestock diseases. In many developing countries, antimicrobial use (AMU) is insufficiently controlled, and antimicrobials are prone to misuse and abuse, thereby fostering the emergence of antimicrobial resistance (AMR). AMR remains a challenge in Kenya, and the extent remains unknown. This study assessed the knowledge, attitudes, and practices (KAP) regarding AMU among multisectoral stakeholders in Kenya.Methods: The cross‐sectional survey was conducted in August 2021 among 381 livestock farmers in Busia, Nakuru, and Isiolo Counties, while 47 animal health service providers (AHSPs) and 32 One Health practitioners (OHPs) were enrolled across Kenya. The data collection tool uploaded on KoBoCollect software was used to collect information on demographics, farming systems, KAP on AMR and AMU, and sources of information. Descriptive statistics were performed. Knowledge was either correct or incorrect, while practices were assigned as desirable or undesirable. Bivariable analysis to assess factors associated with KAP using odds ratio (OR) at 95% confidence level (CL). The Pearson correlation test was conducted to test the correlation between demographic independent variables and farmers’ KAP, p < 0.05.Results: Most farmers, 234 (61.4%), were young adults between 30 and 49 years old. Additionally, 48.9% of the farmers had less than 5 years of experience in farming. Among the AHSPs, 76.6% were male, with 21 (44.7%) having 2–5 years of experience. All (32) OHPs had over 15 years of experience. Correct knowledge in AMR/AMU was observed in 52.6% of the farmers, 88.2% of AHSPs, and all OHPs. Desirable practices were observed in 133 (34.9%) of farmers, 22 (45.1%) of AHSPs, and 25 (76.4%) of OHPs. Among the farmers, having basic education was associated with correct knowledge (OR 4.07, p = 0.0007); however, being male (OR 1.584, p = 0.0456) and having a higher education level (OR 1.582, p = 0.0165) were associated with desirable practices. There was a significant positive correlation between having correct knowledge and level of education (p < 0.0001), years of farming, and correct knowledge (p < 0.0001). However, years of farming negatively correlated with the desirable practices (p < 0.0001). Farmers’ preferred sources of information regarding AMR/AMU were friends 130 (33.9%), farmer meetings/workshops 99 (25.9%), and radio 41 (10.7%). AHSPs obtain information from scientific conferences/trainings (17) (65.4%), workshops (13) (50.0%), and TV and radio (12) (46.2%), while OHSPs mostly get information through college training (14) (58.3%) and workshops (8) (33.3%).Conclusion: Correct knowledge of AMR/AMU did not result in adopting the desirable practices. A better understanding of the socioeconomic aspects of welfare, good livestock production measures, and AMU stewardship will be desired. This study provides a foundation for developing effective antimicrobial stewardship, best farm practices, and intervention programs to reduce inappropriate AMU.Public Implication: Farmers’ AHSP practices are likely to promote the emergence of AMR, a health challenge for animals and humans.