Rift Valley fever knowledge, mitigation strategies and communication preferences among male and female livestock farmers in Eastern Province, Rwanda

The Government of Rwanda reported an outbreak of Rift Valley fever (RVF) in the Eastern Province in 2018. To respond to the outbreak, vaccination and education campaigns about the disease were carried out. Because RVF cases continue to be detected in Rwanda and the disease impacts livelihoods and health, accurate knowledge and communication are imperative. The objectives of this study were to evaluate knowledge and risk perceptions of RVF transmission among livestock farmers in Nyagatare District, Eastern Province, Rwanda, and to compare RVF knowledge, risk perceptions, and farming practices between male and female livestock farmers. This cross-sectional, quantitative study was conducted in selected sectors of Nyagatare District in the Eastern Province of Rwanda in June 2019. A 34-question survey was used to ask about demographics, livestock ownership, risk perceptions about zoonotic diseases and livestock management, RVF knowledge, preferred communication sources and information sharing strategies, and protective strategies for RVF mitigation while working with livestock. Livestock farmers were interviewed at three milk collection centers, two village meeting points, a farm cooperative meeting, and during door-to-door visits in villages. In total, 123 livestock farmers were interviewed. The survey found that most livestock farmers lacked knowledge about epizootic and zoonotic transmission of RVF, more male livestock farmers were familiar with RVF and risk mitigation strategies, and female livestock farmers are not viewed as reliable sources of information. Additionally, most livestock farmers had not vaccinated their animals against RVF despite past vaccination campaigns. Radio was the most popular communication channel. These findings show that RVF knowledge and information sharing are inadequate among livestock farmers in Eastern Province. Therefore, vaccination and education campaigns may need to be reevaluated within the context of these trends in order to prepare for future RVF outbreaks.

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Knowledge and Risk Perceptions of Rift Valley Fever 253
Overall, more male participants (78.7%) had heard of RVF than female participants (59.7%, 254 p=0.031) and more men than women had received advice on minimizing the risk of infection 255 (37.7% versus 12.9%; p=0.002; Table 3). Less than half were aware that people could be 256 infected (43.0%) and few understood how livestock were infected (15.4%). Upon answering 257 follow-up questions, approximately half of participants (43.9%) could name specific zoonotic 258 diseases (Table 3). Most frequently named zoonotic diseases were foot and mouth disease, 259 tuberculosis, brucellosis, anthrax, and intestinal parasites, and of the participants who named 260 zoonotic diseases, only 5% named RVF. Educational level was statistically associated with 261 perception of risk associated with livestock rearing (p=0.020). 262

Communication Practices and Preferences 279
Most participants (88.6%) heard about disease outbreaks on the radio (Table 5). Respondents 280 most often preferred obtaining information on the radio (33%), followed by the telephone 281 (27.3%), face-to-face (23.4%), newspapers (1.9%) and other (14.4%), which included 282 community meetings, veterinarians, cooperatives, and community health workers. There were no 283 significant differences between men and women with respect to communication preferences. 284  production and raising livestock (p=0.014). Approximately half (52%) of respondents felt that 295 non-livestock farmers could provide credible crop production-and livestock-related information 296 (Table 6). There was no significant difference between the attitudes of male and female livestock 297 farmers toward the credibility of information from non-livestock farmers. 298

Rift Valley Fever Knowledge across Rwimiyaga and Rwempasha Sectors 301
Participants differed between sectors in zoonosis awareness (p=0.007), with 36.7% of 302 respondents from Rwimiyaga saying livestock can transmit disease, versus 14.7% of respondents 303 from Rwempasha. When faced with ill livestock, Rwimiyaga participants were more likely to 304 call a veterinarian than Rwempasha participants (43.1% and 23.9% respectively, p=0.030). There 305 was no significant difference between sectors regarding whether participants had heard of RVF, 306 knew if people can be infected with RVF, or knew how livestock become infected with the 307 disease. Sector was also not significantly related to wearing personal protective equipment when 308 slaughtering animals or having ever had animals vaccinated for RVF. 309

DISCUSSION 310
Our study of livestock farmers living adjacent to RVF outbreak areas highlighted generally poor 311 knowledge of RVF and its zoonotic nature among livestock farmers, poor vaccination 312 penetration, significant differences between men and women in RVF knowledge and risk 313 mitigation as well as preferred sources of livestock and disease prevention advice, and radio 314 being the most preferred communication channel. The differences found between male and 315 female livestock farmers highlight the gendered dimensions of education campaigns, access to 316 information, and knowledge uptake. Because RVF outbreaks continue to occur in Eastern 317 Province and throughout Rwanda, these trends present important considerations for behavior 318 change, zoonotic transmission prevention, and outbreak mitigation interventions. 319 Because many livestock farmers reported being familiar with RVF but did not have accurate 320 knowledge about epizootic or zoonotic transmission, livestock farmers may be unaware of their 321 lack of knowledge, and because of this they may not seek nor be receptive to more accurate, up-  Additionally, a previous study on disseminating nutritional information repeatedly over radio 389 found that this changed dietary behaviors in Rwanda [54]. Another found that men and women 390 were highly engaged in a radio drama aimed at improving family planning and that it encouraged 391 conversation [55]. Because radio has been used for past educational campaigns and communities 392 have heard disease outbreak information on the radio before, radio is effective and livestock 393 farmers prefer it as a reliable channel through which to receive information. 394 395 Finally, the previous RVF outbreak in Rwimiyaga