Participatory Epidemiology Training

PENAPH

Participatory Epidemiology Training FOR VETERINARIANS

AND

DISTRICT VETERINARY OFFICERS FROM TURKANA, NAKURU, MOLO, KIPKELION, UASIN NGISHU AND TRANS NZOIA IN RIFT VALLEY

TRAINING WORKSHOP FINAL REPORTWorkshops conducted between 16th August and 29th August 2010

___________________________________________________________________________________

Training workshop were funded by FAO Kenya, RUFORUM and PENAPHOrganized and carried out by

VETWORKS East Africa

P.O. Box 10431 00200

Nairobi

[email protected] (contact person Simon Kihu)

Facilitated by: Simon Kihu and James WakhunguTABLE OF CONTENTS

2TABLE OF CONTENTS

2TABLE OF FIGURES

3ABBREVIATION

4ACKNOWLEDGEMENT

5BACKGROUND INFORMATION AND INTRODUCTION

5WORKSHOP OBJECTIVES

6FACILITATION METHODOLOGY

6ACTIVITIES UNDERTAKEN TO ACHIEVE A SUCCESSFUL PE TRAINING

12OUTPUTS

13COURSE EVALUATION

13APPENDICES

TABLE OF FIGURES8Figure 1 and 2: Participatory maps drawn by participant on ground and on flip chart

8Figure 3 and 4: Pairwise ranking

9Figure 5 and 6: Matrix scoring

10Figure 7: Seasonal calender

10Figure 8: Proportional piling

11Figure 9: disease impact matrix scoring

11Figure 10: Proportional piling mortality and morbidity

TABLE OF APPENDICESTraining program... 13

Summary session program .14

List of participant ..18Course evaluation .19

ABBREVIATION

CERF

Central Emergency Response Fund

DVOs

District Veterinary Officers

DVS

Department of Veterinary Services

FAO

Food and Agriculture Organization of the United Nations

FMD

Foot and Mouth Disease

GoK

Government of Kenya

ILRI

International Livestock Research Institute

NGOs

Non Governmental Organizations

PENAPH

Participatory Epidemiology network for animal and public healthPDS

Participatory Disease Search

PDVS

Provincial Director of Veterinary Services

PPR

Peste des Petits Ruminants

RVF

Rift Valley Fever

TAD

Trans-boundary Animal Disease

ACKNOWLEDGEMENT

Vetworks Eastern Africa is thankful to FAO KENYA , RUFORUM and PENAPH for funding the training of the Veterinarian, DVOs from Districts of Nakuru, Molo, Kipkelion, Trans Nzoia Uasin Ngishu and Turkana County. Acknowledgement goes to trainers Dr Simon Kihu and Dr James Wakhungu who facilitated the workshops successfully. The Veterinarian from VSFG, TUPADO, University of Nairobi, private practice and DVOs were willing to learn and share information which will help the Department of Veterinary Services in early detection surveillance and control of livestock diseases. They acknowledged that the training was vital in understand diseases and impacts of these diseases to community livelihoods in their districts Thanks are extended to Dr Songok PDVS Rift Valley for organising the DVOs and informing them in time to participate in the training.

I also thank Monicah Murigi for providing efficient logistical and other administrative services during the training.Lastly, to all those who contributed in one way or another in making the training a success, we say Ahsante Sana.

BACKGROUND INFORMATION AND INTRODUCTION

Between 2006 and 2008 two major events unfolded in Rift Valley; outbreak of Peste De Petit Ruminant (PPR) and the post-election violence and crisis affecting the livestock sector in the Northern Rift Valley.

In August 2006 Peste De Petit Ruminant (PPR); a fatal and highly contagious disease of goats was confirmed in Turkana district. The disease spread in the various parts of Turkana districts due to migration of the Turkana pastoral communities who are in constant search for water and pastures for their livestock. The disease has become endemic in Kenya. Despite intensive vaccination, quarantine and public awareness campaigns, the disease continues to spread southwards where the disease was reported in Tanzania in 2009. The disease has seriously affected the livelihoods of pastoral communities in north Rift Valley to date.In 2008 Northern Rift Valley was heavily affected by the post-election crisis. It is estimated that 20-30 per cent of high potential cropping land could be taken out of production as a result of two interrelated factors: firstly the displacement of approximately 40000 farm families from the area; and secondly the dramatic increase in the price of farm inputs. The post-election crises resulted in destruction of animal health infrastructure. The few remaining livestock have had to endure increase disease challenge. Diseases such as those spread by ticks has been rampant due to lack of cattle dips thus affecting dairy industry which is a major livelihood for central and north Rift Valley farmers. In this regard Vetworks Eastern Africa teamed up with partners in livestock sector (FAO, Ruforum and PENAPH) and developed participatory epidemiology training for capacity building of local veterinary officers of Turkana County and other districts of Rift Valley.WORKSHOP OBJECTIVES

The course introduced to the trainees the main theoretical and methodological aspect of PE. The agenda of the PE course was to

demonstrate to the trainees the key attitudinal and behavioural aspects of PE practise with trainees a range of PE methods correctly and analyse and present the findings

assist the trainees design research and/or surveillance work based on PE.

The trained private and public sector veterinarian will participate effectively in disease surveillance and control activities. The veterinarians will use participatory epidemiology skills in disease surveillance and strengthens their decision making process in event of disease outbreak thus effectively preventing the spread of animal diseases; protecting livestock assets and livestock production at local and national level as well as reinforcing epidemiological information system. Goal

Livestock diseases are quickly identified and stamped out thus improving the food security status of the target population through boosting of the livestock production sector.Objectives

To train 20 veterinarians from Turkana county and other Rift Valley districts in participatory epidemiology

Outcomes

Enhance capacity of veterinarians in Turkana county and other Rift Valley districts for implementing innovative PPR and other diseases control strategies based on the epidemiology and socio-economic information aspects of the diseasesActivities Design the training and formulates training team.

Inform key stakeholders on the proposed training and prepare trainees

Carry out the training

Feedback to stakeholders on the training & report writing.

Outputs 20 veterinarians trained. A report detailing the participatory epidemiology training FACILITATION METHODOLOGY

Participatory techniques and tools were utilized to ensure that all the participants were actively engaged. The methods used included:

An elaborate participatory and all-inclusive energisers and climate setting.

Brainstorming sessions.

Role plays.

Video Clips. Power Point presentation

Focussed Group discussions and plenary feedback sessions using newsprint/flipcharts.

Power Point presentations with graphic illustrations.

Practical session and demonstrations

Distribution of CDs and manuals on PE.

ACTIVITIES UNDERTAKEN TO ACHIEVE A SUCCESSFUL PE TRAINING Planning of the training

A training team of Dr Simon Kihu and Dr James Wakhungu was set up. Dr Kihu has wealth of experience in community based animal health training. Dr Wakhungu a DVO in Namanga is a PE trainer and was sponsored by PENAPH as the co-trainer. The training team prepared and designed the Participatory Epidemiology training that was carried out in Lodwar. Key materials prepared include Session plans, session hand outs, power point presentations, case studies, video presentation. The training material was been adapted from PENAPH training Guide and material provided by Dr Saskia Hendrickx as well as from AU IBAR PE training Guide. Copies of trainees PENAPH guides were provided by ILRI. Attached is the training programme and summary session plan.

The key stakeholders in livestock and animal health at National, Rift Valley Provincial and District levels were informed about the trainings. The local NGOs (VSFB, VSFG, Terra Nova, Practical Action, Oxfam) in Turkana were informed and invited to nominate participants to the training. So for only Vetworks Eastern Africa, University of Nairobi, TUPADO and VSFG nominated participants who attended the training. Samuel Ekal of TUPADO in Lodwar assisted the training team to secure training and accommodation venue at St Theresa Pastoral Centre for the 20 participants.

A formal invitation was circulated to the Dr Songok, Provincial Director of Veterinary services in Rift Valley. He nominated ten District Veterinary Officer from Nakuru, Molo, Uasin Ngishu, Kipkelion, Trans Nzoia and five other districts from Turkana County.

Climate setting

Official opening was done by Dr Njuguna, DVO Turkana who welcomed the participants to Turkana & wished them well during the training.

Introductions: All the participants did introduce them selves

Expectations.

GroupNoSome comments from participants

Interest in knowledge16-Have skills & technique in doing disease surveillance.

- To know what is PE and relevance in normal disease control strategies.

-know the different PE tools or method.

Recognition 3Given certificate of participation.

Usage of PE in projects2To know how to apply PE in place of work

To be able to introduce This approach in future VSF projects.

Fears.

Dissemination Not to utilise knowledge gained in work station.

Health concernsUnable to complete training due to illness.

Security Insecurity due to cattle rustling

Time Training would be long hence not able to attend to all session.

Facilitation How am I going to be paid?

Relaxation Training to be so intense & allow no socialization time

Understanding Not be able to understand the context as do not have experience in Turkana.

Ground Rules.

Keep time

Respect of opinion

Mobile phone on vibration

Punishment on breaking the rules

Sing in mother tongue

Dance to the class.

Give the culprit a warning.

Time keeper Dr Wambongo

Rule enforcer: Mr Elim Limlim

Team leader: Dr Mutai (acting DVO Turkana central)

Topics of PE training courseKey topics covered during the PE training course were General principles of Participatory epidemiologyDuring these sessions the participants were taken through a series of subtopics that generally introduced the general terms in Participatory Epidemiology. Community participation was dwelt at length through presentations, video and group work.Introduction to participatory epidemiology was carried out with brief presentations on PE approaches, qualitative and quantitative methods, PE methods, triangulation and veterinary surveillance systems.

Participatory Epidemiology approaches

The participants were taken through the key approaches of PE. The key sessions were on attitude and behaviour for PE practitioners, PE practitioner approach to traditional briefs, practices and ethno veterinary knowledge of livestock keepers; communication and group management. Participatory Epidemiology methods

Semi-Structured Interview

The participants were taken through semi-structured interviews (SSI) as the basic tool that is incorporated in all other tools in probing process. Mapping

The participants were given a presentation and a demonstration on participatory mapping. Practise session was also carried out.

Figure 1 and 2: Participatory maps drawn by participant on ground and on flip chart Simple ranking

A session on simple ranking (SR) was carried out. A demonstration to the participants was done thereafter they carried out practical work on SR tool. Pairwise rankingA session on pairwise ranking was carried and the tool demonstrated. Uses of pairwise ranking and comparison were highlighted. Pairwise ranking or comparison is a slightly more complex method of ranking where each item is compared individually with all the other items one-by-one. Pairwise ranking can be used to understand the relative importance of different species or diseases and through probing, to understand the benefi ts of different species or the impact of different diseases.Participants carried out practise on the tool. Figure 3 and 4: Pairwise ranking Clinical Case definationClinical Case definition was introduced and brief presentation and group work done. Clinical Case definition was defined as key signs used to identify a clinical case of the disease that you are interested in,

based on what the farmer is likely to know and see and can tell you or show you

it should be general enough to be able to pick up the majority of cases of the disease of interest

it assists in making decisions about what action to take next. Matrix scoring

This session on clinical case definition was followed by Matrix scoring session. The participants were taken through a presentation, demonstration and practical sessions on matrix scoring. The key point brought out during the matrix scoring presentation was that the tool establishes whether the PE practitioner is talking about the same diseases as the livestock keepers. Figure 5 and 6: Matrix scoring Time linesThe participants were taken through session on the timelines. Defined as a participatory data collection method for gathering time-related information. Such information includes the sequence of key events in the history of a community. The purpose of this method is to obtain a historical understanding of sequential changes that have occurred, relating to particular livestock disease of interest.

Seasonal calenderThe participants were given a presentation on seasonal calendar. It was explained that the tool is a scoring technique used to find traditional season names, their period and relation with onset of different events such as rainfall, livestock diseases, vector pattern and fodder shortage among other seasonal factors. It can also help in generating new hypothesis about association between diseases and environmental factors and interaction between wildlife and vectors Thereafter a demonstration was carried out. Participant practised making seasonal calendars based on the their communities defined seasons

Figure 7: Seasonal calender Proportional piling

Simple proportional piling technic was demonstrated to the participant following a brief presentation. It was explained that this technic is mainly used give relative scores to a number of different categories according to one parameter. The participant were given a chance t practice the technic.

Figure 8: Proportional piling Disease impact matrix scoring

The participants were taken through a session on disease impact matrix scoring. The technique is a two stage piling exercise. In the first stage, the respondents are asked to identify the benefits that they receive from livestock and then to score these benefits in terms of importance in what is essentially a simple proportional piling exercise. The scores they give the benefits serve as weights for the later matrix exercise. The participants were given a demonstration of the technic and were later allowed to practice the technic

Figure 9: disease impact matrix scoring Proportional piling mortality and morbidity

The participants were taken through a session on proportional piling for mortality and morbidity. It was highlighted that the tool is used to demonstrate the impact of diseases on the herd or flock, by demonstrating the relative morbidity, herd or flock mortality and case fatality of different diseases.The participants practiced the exercise in class and in the field.

Figure 10: Proportional piling mortality and morbidity

VENN diagramA session on Venn diagrams was provided to the participant. Defined as a set of elliptical diagrams that show all hypothetical possible logical relationship between finite collections of sets. The uses of venn was provided as being provision of background information on the relationships between different groups/communities or countries, identify stakeholders for effective disease control and management and contributes to design interventions Participants practised the tools in class. Transect walk

Transect walk session was presented to the participant. It was explained that transect walks can be used to:

identify and explain the cause-and-effect relationships among topography, natural vegetation, animal husbandry systems and other production activities and human settlement patterns;

identify major problems and possibilities perceived by different groups of participants in relation to features or areas along the transect;

learn about local technology and practices;

triangulate data collected through other tools such as mapping; and

probe the information that has already been mentioned by the community.

Participants were asked to practice transect in the area neighbouring the training venue.

Case studies

The participants were taken through two case studies which helped them consolidate the knowledge they had so far acquired from the training.

The first case study was participatory epidemiology disease investigation on PPR. The participants worked through the three steps of the case study and final were give the model answers.The second case study was participatory epidemiology disease investigation on FMD. The participants worked through the four steps of the case study. Model answers were provided at the end of case study. Field work

Three day field work was organised for the participants so that they could practise skills gained in the training. Three vehicles were used to ferry the 18 participants in different locations about 30 kms radius from Lodwar. PE data analysis and presentation

Participants were taken through session on how to analyse and present PE data. Key data tackled were simple ranking, matrix scoring, proportional piling and timelines.

Uses of PE The participant were taken through a consolidated list of uses of all PE methods showing their strengths

Design of PE field studies

During this session the participants were taken through a brainstorming session of designing a general study. There after the participants were asked to design a specific PE study they will undertake when they get back to their field stations. It was expected that a follow up of the training would be a Participatory Impact assessment of FAO funded animal health interventions in Rift Valley.OUTPUTS Sixteen participants were trained in the ten day Participatory Epidemiology training A training report has been prepared

COURSE EVALUATIONThe course monitoring was done through mood metres that were posted on the wall. Two session were monitor in a day, being the morning and the afternoon session. The general mood during the training was good and most people were lively. The end of course evaluation was done and showed that participant were satisfied though they needed more time in the field.

APPENDICES17th August 2010 Arrival at St Teresa pastoral centre,( For those who are booked)

18th August 2010Course opening, welcome and introduction, -SK

ground rules -JW

introduction to PE-SK

Community participation, PRA -SK

Triangulation in PE, -SK

Surveillance systems -JW

19th August 2010Adult learning, Altitudes and Behavior for PE

Communication skills, -SK

EVK -JW

20th August 2010Interviewing methods, Interviews (SSI, -JW)

Participatory mapping-SK

Simple ranking-JW

Pair-wise ranking-JW

21st August 2010Case definition, Matrix scoring (Disease characterization)-SK

Time line, Seasonal calendars-JW

22nd August 2010Review Matrix scoring

23rd August 2010Simple Proportional piling-JW

(DIMS), PPMM,-SK

Venn diagrams, transect walk- JW

24th August 2010Case studies 1 & 2 (JW & SK)

Uses of PE -JW

Design of field studies SK (Determination of AND consolidation of key tools to use checklist)

PE for outbreak investigation JW

25th August 2010Field work, Seasonal calendar, Disease impact matrix scoring, Risk factor scoring, PPMM

26th August 2010Field work, Seasonal calendar, Disease impact matrix scoring, Risk factor scoring, PPMM

27th August 2010Review of Field work

Data Management

Simple ranking-JW

Others-SK

28th Field work, SK/JW

29th August 2010Closure and Departure

Appendix 1 Training programme

Appendix 2 Summary session program

DAY 1 Wednesday

BlockTimeTopicMethodTiming

Session Plan 1: General principles of participatory epidemiology

Pre-session7.00 -8.30 amRegistrationCoffee and registration30

Block A8.30- 9:00 amIntroductions Introduction address

30

9.00- 9.15 amRest

9.15-9.30 am

9.30-10.30 am

Break

Block BRest

Lunch

Session Plan 2:

Block C3.00-3.30 pmIntroductionsGroup work30

Break

Session Plan 3: General principles of Participatory Epidemiology

Block D4.00-4.15Expectations and ConcernsPosted notes/charts15

4.15-4.30Ground rules and house-keeping

Overview of agenda and objectivesGroup work15

4.30-5.30Community participationGroup work60

5.30-5.5.55Community participation Video 25

5.55-6.00Wrap upKey messages 5

DAY 2 Thursday


Session Plan 1:

Pre-session8.00 -8.10 amRecappresentation10

Block A8.10- 8:50 amCommunity participation Group discussion 40

8.50- 9.00 amEmergence Community participation Presentation 10

8.00.9.10 amType of participationPresentation 10

9.10-9.20 amwrap upCards on key messages10

9.20-9.40 amParticipatory EpidemiologyBrainstorming 20

9:40-10.10 amPE approachesPresentation30

10.10- 10.40 amQualitative and quantitative methodsGroup work30

Break

Block B11.00-11.10 amPE Methodspresentation10

11.10-11.30 pmTriangulationBrainstorming20

11.30-12.10Surveillance systemsgroup40

12.10-12.55Surveillance systemsQ&A, brainstorming 45

12.55- 1.00Wrap upKey messages 5

Lunch

Session Plan 2:

Block C3.00-3.30 pmAttitude and Behaviour Brainstorm15

Attitude and BehaviourPresentation 15

Break

Session Plan 3:

Block D4.00-4.25Traditional briefs and practices Group work25

4.25-4.35Communication Role play10

4.35-4.55Communication Discussion20

4.55-5.15Communication presentation10

5.15-5.25Wrap UpKey Messages 10

5.25- 5.55Group ManagementGames30

5.55-5.55Wrap upCards 5

DAY Three Friday


Session Plan 1:

Pre-session8.00 -8.10 amrecappresentation10

Block A8.10- 9:10 amEVK 60

9.10-9.40 amSSI30

9.40-10.10 amSSI30

10.10-10.30SSI30

Break

Block B11.00-11.10 amMappingpresentation10

11.10-11.40 amMapping demonstration30

11.40-1.00 pmMapping Practical 80

Lunch

Session Plan 2:

Block C3.00-3.30 pmSRPresentation 10

SRGroup work20

Break

Session Plan 3:

Block D4.00-4.30SRGroup work30

4.30-5.00PWR30

5.00-5.50PWR 50

5.50-6.00Wrap up10

Day four Saturday


Session Plan 1:


Block A8.10- 8:40 amCase DefinitionPresentation 30

8.40- 8.50 amMSPresentation10

8.50-10.10 amMSDemonstration 80

10.10-10.40 amMSPractical30

Break

Block B11.00-11.50 amMSPractical50

11.50-12.00 amTimelines presentation10

12.00-1.00 pmTimelinesPractical 60

Lunch

Session Plan 2:

3.00-3.30 pmSeasonal calendarPresentation & demonstration30

Break

Session Plan 3:

4.00-5.00Seasonal calendarPractical 60

Block D5.00-5.15proportional pilingPresentation15

5.15-5.30-proportional pilingDemonstration 15

5.30-5.55proportional pilingGroup practice25

5.55-6.00Wrap upKey messages 5

Day five Monday


Session Plan 1:


Block A8.10- 8:20 amDIMS Presentation 10

8.20- 8.50 amDIMSDemonstration 30

8.50-9.30 amDIMSPractical40

9.30-9.40 amPPMM presentation10

9.40-1030PPMMDemonstration 50

Break

Block B11.00-11.45PPMMPractical 45

11.45-12.05VENNPresentation/Demonstration20

12.05-12.50VENNGroup work35

12.50-1.00Transect walkPresentation 10

Lunch

Session Plan 2:

Block C3.00-3.30 pmTransect walkpractical30

Break

Session Plan 3:

Block D4.00-4.30Transect walkpractical30

CASE STUDY 1 &2Group discussion 120

Six, Seven and eight (Tue, Wed & thur)


Session Plan 1:

Pre-sessionField day prep

Block A

Block BField work

Lunch

Session Plan 2:

Block CField work

Break

Session Plan 3:

Block DField work

Day ninth Friday


Session Plan 1:

Pre-session

Block A8.00-900Review Field workGroup discussion60

9.00-9.30Uses of PEPresentation/discussion30

9.30-10.30Design of Field Studydiscussion60

Break

Block B11.00-12.00Design of Field Studydiscussion60

12.00-12.30Data simple rankingpresentation30

12.30-1.00Data analysis Presentation 30

Lunch

Session Plan 2:

Block C3.00-3.30Data presentationpresentation30

Break

Session Plan 3:

Block D4.00-4.4.30Data presentationpresentation30

Evaluation

Close

Appendix 3 List of participantNumberNameSponsorOrganisation

1Nicoletta BuonoVSFGVSF Germany

2Erenius NakadioVSFGVSF Germany

3Benson KiboreVEAUniversity Of Nairobi

4Ezekiel EkuwamVEAPrivate Vet

5E.C. WanderaVEADDVO Nakuru North

6R. W. MuloosyVEADVO Molo

7F. N. C. Kahiro VEADVO Kipkelion

8J.K. Njuguna VEADVO Uasin Ngishu West

9C.M. WanyamaVEADVO Trans Nzoia West

10Siebei K. LangatVEADVO Turkana North

11J. W. Njuguna VEADVO Turkana East

12J. K. Sang VEADVO Kakuma

13S. K. MuttaiVEADVO Loima

14Boniface B. WambongoVEADVO Turkana south

15Elim LimlimVEATUPADO

16Simon KihuVEAVEA trainer

17James WakhunguVEAPENAPH trainer

18Monica Murigi VEAVEA admin

Appendix 4 Course evaluationParticipatory Epidemiology training

Evaluation form

Please circle the appropriate number to record your views

1. Were the training objectives relevant to your work?

Highly relevant 5 4 3 2 1 Not relevant

2. Were the training objectives achieved?

Achieved 5 4 3 2 1 Failed to achieve

3. Relevance and value of handouts

Highly relevant 5 4 3 2 1 Not relevant

4. Training approach/methods

Very good 5 4 3 2 1 Very poor

5. Time allocated to practical work

Too much 1 2 3 4 5 4 3 2 1 Too little

6. Time allocated for working groups and discussion


7. General organization and logistics for workshop


8. Value and relevance of field work


9. Time allocated to field work


10. What is the likelihood of you using PE methods in your future work, or helping others to do so?

Very high 5 4 3 2 1 Very low

11. Accommodation and food in training venue


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Participatory Epidemiology Training