 My name is Caroline Michaki and I'm going to be talking to you about brucellosis control among agro-pastoralists in Tanzania. My focus will be on how to communicate risk effectively. To begin with brucellosis has been determined to be endemic in sub-Saharan Africa and it is a high priority disease in Tanzania so there are many efforts to control brucellosis in Tanzania. On the other hand brucellosis is the incidence of higher in pastoralist and agro-pastoralist context and this is related to their consumption of raw animal source foods as well as the way they handle their animals and they interact very closely with their livestock and therefore they have to be involved as key stakeholders in the control of brucellosis. On the other hand is the aspect of risk perception. What people make of a certain risk for disease for example in terms of its prevalence, in terms of its severity, in terms of how common that risk occurs will determine the kind of preventive and control efforts they are willing to take or not willing to take up and sometimes you might find that the risk perception of professionals will be different from the risk perception of communities and this will affect community sensitization and whether people are willing to take up those control strategies or not. The objective of this study therefore, what the objectives of this study therefore were to identify the risk perceptions of the agro-pastoralist communities in relation to animal handling and consumption of raw animal products as well as to determine the effective community engagement strategies. So first we wanted to understand what their perceptions about animal source foods, raw animal source foods as well as animal handling is concerned and in terms of disease in this case brucellosis and secondly to identify what would be the best ways to communicate to them in a way that is likely to lead to long-term behavior change. This study was conducted in three villages in Kilombero district in Tanzania. These three villages neighbor each other it was an ethnography so I lived in this community for six months and through these six months I was able to conduct a survey with almost all the agro-pastoralist households in the three villages and I was also able to do focus group discussions, in-depth interviews, care command interviews and also many informal interviews as well as a lot of observation. So I not only just heard from what they told me in the interviews but also observed their actual behavior and this study was conducted in 2019 between March and August. The results of this study show first of all that brucellosis is largely unknown many of the the pastoralist and agro-pastoralist had never heard of brucellosis and only a 7.2 percent of them had ever heard of brucellosis in livestock. On the other hand when we asked them whether they had observed symptoms of brucellosis in their animals including abortions, detained placenta, infertility, tailbars, many of some of them had actually observed those symptoms but they did not consider them to be a big problem. First of all this was related to the other livestock diseases in their context which they felt were a much bigger priority than these other symptoms that they had with Nest or brucellosis. On the other hand even when they observed the symptoms they did not know what caused them and sometimes they thought that some of them thought that they attributed them to supernatural factors and this is because many of these symptoms were reproductive health challenges which they compared to what happens in humans. So they said even for humans you will find tailbars, you will find infertility and so it was attributed to God that God decides who gives birth, God decides which animals live and which ones die. So it wasn't really considered to be a big issue. When it comes to the issue of retain placenta they had ways that they felt that they were able to extract the placenta and so it wasn't really a difficult challenge for them. On the other hand in this particular context having owning a large herd of animals was more important than the individual productivity of each animal. So they were willing to retain animals that were not necessarily productive just to have a large herd and for sentimental value. For example for infertile animals they would say that those animals became very big and they were beautiful to look at. So for that reason they were willing to retain them in the herd and maybe sell them at a much later date or slaughter them in the home when there was a function. So they still retained those kind of animals for other value. Not necessarily monetary value or productive value. On the other hand even for those who had had above brucellosis or new even brucellosis risk factors they did not change their behavior and they were willing to continue taking raw milk, consuming raw milk or assisting animals in deterioration with bare hands or handling aborted material with bare hands because it wasn't really a big it wasn't really a risk factor for disease. So they had had about it but they didn't believe that you can actually get sick from consuming raw milk or from assisting your animal or staying very close to your animal. On the other hand sensitization activities were usually conducted so they said for example when they went to a health facility for women child welfare clinic they would be told don't give raw milk to your child or when somebody had TB they would be told do not take raw milk because that is how you get TB. But they did not feel that this kind of sensitization activities were actually addressing their questions their doubts and their uncertainties. So for example they would say we know many people who do not take raw milk but they are getting many diseases or we know some people who have never consumed raw milk or communities that don't take raw milk but they're still getting TB. So they had those kind of questions which they felt that they never had they didn't often have an opportunity to ask like when women went to the clinic they were not able to ask these questions to nurses or when there was a community barraza they were not able to ask this question to the practitioners in a way that they felt that their questions were being responded to and that was a big challenge for them in terms of adopting new practices or beginning to change their behavior for example beginning to boil milk. In this regard therefore we found that there was a disparity in the risk perception of professionals and that of the community. So for the professionals they of course they already knew that consumption of our raw animal source foods residing with livestock and many of these other risk factors was a big challenge in terms of controlling brucellosis but for the community they did not believe that those practices could actually make you sick from brucellosis or any other disease for that matter and the reason is because these practices were rooted in in tradition this was their culture it was actually part of who they are and there were many other benefits that they attributed to these practices especially to raw milk consumption for example they said raw milk is more nutritious they said raw milk is more beneficial for children especially when they are young because of that nutritional value they also said that raw milk helps to counteract any poisonous substances so that if you ingest anything that is not good for you then and take raw milk then it will counteract that action and you will be okay they also said that there were also practical reasons why that prevented them from boiling milk for example women say that they were overworked and so boiling milk was an extra show that they were not willing to take up men said consuming raw milk when they in the forest had looking at the animals is much more effective and more time-saving so they do not want to go through that whole process of boiling milk and waiting for it to cool down before they can drink it and start their journey on the other hand there is a need for focus and long-term community engagement so the way this kind of engagement was done it was often done in a very haphazard manner so it wasn't focussed in the sense that it was not addressing the real issues in the community and on the other hand it was not targeting specific problems or specific questions that the communities had on the other hand this kind of engagement also was not long-term it was usually erratic so once in a while so like they would say when we had a relatively fever outbreak that we had on the radio that it should not be taking raw milk but it was not a long-term kind of thing that would make them think about it and begin to to process this information and to begin to question the kind of behavior that they were engaging in so it wasn't in that case therefore they didn't feel that it was so effective in their context in conclusion therefore these are the things that they propose first of all they felt that for community engagement to be very relevant and to be very accepted by them it needs to be culturally sensitive they felt that in many cases people who came to communicate to them used a very patronizing attitude or they did not understand their culture and they were not willing to listen to that this is part of who we are so the way the message came across to them was not respectful and therefore they were not willing to listen to it so like for women they would say when we go to a health facility and the nurses talk to us this way we just know denagrements but you're not planning to do to change our behavior or to even consider what they are telling us but if they were more culturally sensitive like listening to us trying to understand our rationale behind this behavior then there might be dialogue and we might be more willing to listen to them secondly they propose that this information needs to be targeted it needs to be very targeted to their specific questions or specific doubts so instead of this information being very general and broad it needs to be specific like I said they are questions that they have and these are the questions they want answered and so when professionals come to them not just talking down to them and telling them you need to do this and stop doing that but asking them what is it about raw milk that you value or why is it that you're having challenges with boiling milk then that way they will be more willing to consider taking up those new behavior and taking up those new practices on the other hand it needs to be dynamic the way it has been done in the past it's usually like called a community browser in which case in this context it is men who will attend but they are proposing it needs to be dynamic so that you are involving children in schools this education is being passed to children in schools it's being passed to women to others to men and that when it is so broadly done and when it is catering for many people then everybody will hear this message and maybe now the community can begin to examine it and to start thinking of long-term behavior change even if they don't change now it can lead to long-term behavior change and lastly it needs to be continuous so that it's not just a one-off kind of thing but it needs to be done repeatedly over and over and over again because that when they say that the more they keep hearing this message the more they are likely to consider it but if they hear it once in a while then to them it communicates that it's not really that important but if they hear it more and more like they give the example of HIV the way the the messaging has been done it's done so many times that people are now willing to consider it and start thinking about it and that is what they propose would eventually lead to long-term behavior change and that might start to help some of the brucellosis control strategies that are being employed in this particular context because even if we want to start doing vaccination or anything else like that the community still needs to own it and to still accept this kind of control Lastly these are the two publications so far from this work and you can look at them and they would give further insights and lastly I want to acknowledge the following individuals for supporting this study thank you and have a good afternoon yeah thank you very much Carol for keeping time and also for a very interesting and engaging presentation for me it was very interesting to see the footer of your slides that said involve communities information is not enough and I think you've highlighted the facts that we need to be looking at when we are engaging communities and how it needs to be done being cultural sensitive at certain levels ensuring that we are not condescending or looking down on them but addressing the real and felt issues