Zoonotic diseases such as brucellosis, Rift Valley fever, anthrax, rabies and bovine tuberculosis are highly prevalent among pastoralist communities in low-and middle-income countries. This study adopts a One Health approach, employing a range of participatory methods including informal observations, “go-along interviews,” narrative-, and key informant- interviews, to explore the cultural, behavioral, and structural drivers of zoonotic disease transmission among pastoralist communities in East Africa. We unpack how the physical environment, socio-economic systems, health systems, community influence and cultural competence as well as individual pastoralists' unique characteristics, behaviors and lifestyles can be leveraged for effective public health interventions that reduce zoonotic risks and improve health outcomes for both humans and livestock. We present data from 214 purposively selected participants, including 19 key informants, 68 in-depth interviews, 20 focus group discussions, and 22 direct ethnographic observations. Traditional knowledge and beliefs, risky cultural dietary practices such as consumption of raw milk, meat and blood, unprotected parturition assistance, unsafe disposal of carcasses and aborted fetuses were common and carried increased risk of zoonotic transmission. Women and children handled and milked small ruminants while adult men and morans (young warriors) were mostly involved with cattle, camels and slaughtering; hence exposing them to zoonotic pathogens disproportionately. There were piles of manure made up of animal excreta and secretions that were potentially highly contaminated with saprophytes and soil-borne zoonotic pathogens. While livestock play a significant and indispensable role in the daily livelihoods of pastoralist communities, close association of pastoralists with livestock coupled with their unique cultural and behavioral practices increases their risk of exposure to deadly zoonotic diseases. Although, most of these practices are environmentally and culturally adaptive, their risk for transmission is often overlooked. The study also highlights inadequate sanitary practices, poor disposal of animal carcasses and placentae and the absence of veterinary oversight in the production, distribution and consumption of livestock products. Our study provides a holistic understanding of the subjective perspectives and nuanced insights underlying the emergence and persistence of zoonotic diseases within pastoralist communities. It also underscores the need for culturally sensitive One Health interventions that address these practices and enhance community awareness of zoonotic disease risks and prevention strategies which are often overlooked by conventional epidemiological studies. • Most pastoralists know and refer to common zoonotic diseases by their local names. • Therapeutic or ritual consumption of raw animal products increases zoonotic risk. • Women and children face higher zoonotic risk exposure from milking and animal care. • Behavior change communication with cultural relevance aids zoonotic control. • Local leaders pivot health interventions through culturally sensitive engagement

An important step towards COVID-19 pandemic control is adequate knowledge and adherence to mitigation measures, including vaccination. We assessed the level of COVID-19 knowledge, attitudes, and practices (KAP) among residents from an urban informal settlement in the City of Nairobi (Kibera), and a rural community in western Kenya (Asembo). A cross-sectional survey was implemented from April to May 2021 among randomly selected adult residents from a population-based infectious diseases surveillance (PBIDS) cohort in Nairobi and Siaya Counties. KAP questions were adopted from previous studies. Factors associated with the level of COVID-19 KAP, were assessed using multivariable regression methods. COVID-19 vaccine acceptance was 83.6% for the participants from Asembo and 59.8% in Kibera. The reasons cited for vaccine hesitancy in Kibera were safety concerns (34%), insufficient information available to decide (18%), and a lack of belief in the vaccine (21%), while the reasons in Asembo were safety concerns (55%), insufficient information to decide (26%) and lack of belief in the vaccine (11%). Our study findings suggest the need for continued public education to enhance COVID-19 knowledge, attitudes, and practices to ensure adherence to mitigation measures. Urban informal settlements require targeted messaging to improve vaccine awareness, acceptability, and uptake.

Background: Globally about 210 million women conceive annually and 38% of these pregnancies are unintended. Female sex workers (FSWs) are at increased risk of both unintended pregnancy and acquiring HIV, which could lead to adverse sexual and reproductive health (SRH) outcomes. We sought to assess contraceptive use or non-use, preferences and determinants among a cohort of FSWs screened for an HIV prevention clinical trial in Kisumu, Kenya. Methods: A cross sectional study of healthy FSWs referred for possible recruitment into the Antibody Mediated HIV Prevention (AMP) Study was conducted between December 2016 and September 2018. Potentially eligible participants were screened for HIV and data on social-demographic, contraceptive use and other SRH characteristics were collected. Those not on a method recorded their contraceptive preferences. Results: Data on 210 FSWs with a median age of 24.5 years (interquartile range, IQR 22-26) are presented. Of these, 187 (89.1%) had two children or fewer; only 56 (26.7%) had completed secondary or higher education. At the time of the interview, 18 (8.6%) were HIV-infected and 181 (86.2%) were using a modern contraceptive. Implants (48.6%) and depot injections (37.6%) were the most commonly used methods. Most (41.4%) of those not on family planning preferred oral pills. Respondents who had two or more children were three times more likely than their primiparous and nulliparous counterparts to report use of a contraceptive. Use of modern contraception methods did not differ by respondent’s ownership of a medical insurance cover or other occupation. Conclusion: There is high use of modern contraception among FSWs in Kisumu with the majority using subdermal implants. Reproductive health programs should implement targeted SRH interventions for specific populations and risk groups. Effective contraceptive counselling and interventions among FSWs should consider the client’s parity and level of education.

Brucellosis remains a major zoonotic disease worldwide, with disproportionate burden in low- and middle-income countries where limited veterinary and healthcare infrastructure constrain effective control measures. However, its pathways of transmission are poorly understood. In pastoralist settings, we hypothesize that camels have a high burden of Brucella spp. and play a key role in spreading it to humans and other livestock. This manuscript presents a study protocol to quantify the relative contribution of various livestock species to brucellosis transmission and identify cost-effective control strategies in Kenya. Using probability-proportional-to-size sampling, we aimed to recruit a longitudinal cohort of 170 households and their herds per site in the Marsabit and Kajiado counties. Households rearing at least one livestock species (cattle, camels, goats, sheep) were eligible. Serum, milk, and vaginal swabs (from livestock), and serum (from humans) were collected for testing using Rose Bengal Test, ELISA, qPCR, and culture methods. Concurrently, surveillance for suspected brucellosis was conducted in study health facilities. A qualitative ethnographic study and livestock movement monitoring using GPS-collared animals were nested within the cohort. These data will be used to parameterize a multi-host, multi-species infectious disease model through Approximate Bayesian Computation. Through this One Health approach, our study will identify and optimize potential interventions and help inform the development of a comprehensive cost-effective national control program for brucellosis.

An important step towards COVID-19 pandemic control is adequate knowledge and adherence to mitigation measures, including vaccination. We assessed the level of COVID-19 knowledge, attitudes, and practices among residents from an urban informal settlement in the City of Nairobi (Kibera), and a rural community in western Kenya (Asembo). A cross-sectional survey was implemented from April to May 2021 among randomly selected adult residents from a population-based infectious diseases surveillance (PBIDS) cohort in Nairobi and Siaya Counties. Factors associated with the level of COVID-19 KAP, were assessed using multivariable regression methods. COVID-19 vaccine acceptance was 83.6% for the participants from Asembo and 59.8% in Kibera. The reasons cited for vaccine hesitancy in Kibera were safety concerns (34.0%), insufficient information available to decide (18.0%), and a lack of belief in the vaccine (21.0%), while the reasons in Asembo were safety concerns (55.0%), insufficient information to decide (26.0%) and lack of belief in the vaccine (11%). Our study findings suggest the need for continued public education to enhance COVID-19 knowledge, attitudes, and practices to ensure adherence to mitigation measures. Urban informal settlements require targeted messaging to improve vaccine awareness, acceptability, and uptake.

Background: Brucellosis is a neglected zoonotic disease with significant health and socioeconomic impacts in pastoralist communities.Methods: We conducted a prospective case-control study in Laisamis, Marsabit County, Kenya, to assess the impact of human brucellosis on quality of life. Brucellosis cases were febrile patients with positive Rose Bengal Test (RBT); clinical controls (febrile, RBT-negative), and community controls (healthy, RBT-negative). We assessed functional impairment using WHO Disability Assessment Schedule (WHODAS) 2·0. Domain and total scores were calculated and compared across groups. Results: We enrolled 275 participants: 93 cases, 97 clinical controls, and 85 community controls. The median age was 15·0 (IQR: 9·0-30·0) years. Mean total WHODAS scores were significantly higher among brucellosis cases (mean 41·9, SD 14·0) compared to clinical controls (mean 33·8, SD 16·8) and community controls (mean 8·7, SD 12·2), p<0·0001(one-way ANOVA). The greatest impairments were observed in mobility, participation, and life activities. On average, brucellosis cases lost approximately three months of productive time per patient per year due to disability compared to only 11 days per year lost by apparently healthy individuals.Interpretation: Human brucellosis is associated with substantial functional impairment and disability by predominantly limiting mobility, productivity, and social participation domains, and ultimately impairing the quality of life of affected individuals. Integrating disability metrics into national surveillance systems could improve burden estimation, optimize resource allocation, and improve health outcomes in pastoralist settings.