Study setting

Data were collected in two villages in Nwoya district, Acholi sub-region, northern Uganda. The district is predominantly rural and has a population of approximately 130,000 people [37]. The climate is tropical, with a rainy season stretching from April to November and a dry season from December to March. The authors’ previous research and key contacts in the study villages and documented reports of ASF outbreaks were the factors that determined the choice of study area.

The vast majority of data were collected in what is referred to here as “village A”, where the first author stayed with a Ugandan family during fieldwork. Complementary data were collected in the home village of one of the field assistants, referred to here as “village B”. Smallholders in both villages commonly divide their time between crop and livestock production, and some of them also run small-scale business enterprises on the side [as described previously in 38]. The village centres are the locations of several of these businesses, including local bars, food joints and hair salons. In village A, two health clinics offer minor treatments to villagers, while access to pharmaceuticals for livestock and formal livestock markets requires travel to a nearby town or to the nearest city of Gulu. The main road connecting the city of Gulu and the capital Kampala can be reached by a 30 to 40-minute motorbike ride from the centre of village A. The distance between village A and B is about 30 kilometres. Village B is located alongside the tarred main road and served as an IDP camp during the most recent conflict. The size and population of village B are slightly larger than village A, and the range of services more comprehensive. The main livestock reared in villages A and B are poultry, goats and pigs. While cattle rearing is very rare in village A, it is more common in village B due to the availability of community grazing land. In the fields for crop production, often located close to smallholders’ homes, rice, groundnuts, cassava, sesame and other crops are commonly produced.

Data collection

Ethnographic fieldwork was carried out by the first author from September to December 2019, and smallholders in approximately 70 households were interviewed [see also 38]. In this paper, specific attention is paid to the responses related to livestock production, and more specifically to animal health issues in pigs. Alongside the semi-structured interviews, the first author observed and participated in smallholders’ daily lives and farming practices. In addition to interviews and participant observation, six focus group discussions with a total of 43 smallholders were organised. The overarching aim of these discussions was to contribute greater understanding of the participants’ views on the challenges related to livestock. Participants for the focus group discussions were chosen using the selection criteria of previous experience of livestock production and being over the age of 18. One of the field assistants guided each discussion by asking open-ended questions, and the other translated from Luo into English. The first author took detailed notes and intervened when clarification or follow-up questions were deemed appropriate. Since mixed groups with men and women risked being dominated by the perspectives of male participants, two groups were women only. All except one focus group discussion included a ranking exercise at the end of the discussion. Participants were asked to rank the challenges that had been mentioned during the discussion, with the purpose of capturing the perceived magnitude of each challenge. In two of the groups, the participants choose to discuss challenges with pig production, while the other groups decided to focus on challenges with goat and poultry production, with which they had more experience.

The names of animal diseases in this paper are taken from the field assistants’ English translations of smallholders’ responses in Luo. The first author discussed these translations with the assistants to ensure a translation that was close to the smallholders’ intended meanings, while avoiding forcing smallholders’ categorisation of diseases or problems in their livestock production into specific disease names in English if that was not the smallholders’ initial meaning.

In the final stage of fieldwork, a survey was designed with the aim of cross-checking and quantifying the qualitative findings [39]. The survey focused on smallholders’ perceptions of problems with livestock keeping and access to veterinary services. In the survey, smallholders were asked to rank the key challenges in livestock production that had previously been mentioned in interviews and focus group discussions. The survey was delivered by one of the field assistants, trained by the first author, who interviewed a total of 101 smallholders (16 from village A and 85 from village B) in Luo and wrote down responses in English. A mix of purposive and convenience sampling strategies were applied when selecting informants. The criteria that smallholders had to meet to be selected for the survey were that they were adults with previous knowledge of livestock production who were at home at the time of the field assistant’s visit. The predominant number of informants from village B was due to convenience because this was the field assistant’s home village.

Data analysis

Interviews and focus group discussions were not recorded, and thus not transcribed verbatim. Instead, the first author made detailed notes during and immediately after the interviews and focus group discussions. To avoid misunderstandings (thus ensuring the validity of the data) and identify potential gaps in the data, findings were frequently discussed with key informants and the field assistants throughout the fieldwork [39]. In addition, findings were discussed with the District Veterinary Officer (the person ultimately responsible for animal health in the district) as well as veterinary officers working in Nwoya district at the time of fieldwork in 2019. In this sense, the data analysis already started in the field. After the fieldwork, interview transcripts were imported into NVivo 12 (QSR International) and the first author continued the analysis by carefully rereading all notes as a way of becoming familiar with the material [40]. This close reading of the material was combined with coding, initially focusing on exploring potential connections and contradictions within the material. Broader themes around the studied smallholders’ livestock production evolved at this stage of the coding, such as “pig keeping”, “animal diseases” and “livestock advice”. These broader themes were discussed with the co-authors, identifying potentially interesting aspects on which this paper could focus and exploring varied interpretations of the data. In relation to this process, the research questions for the paper became clearer and the relatively broad themes of the codes developed into narrower topics, for example “local treatment methods”, “handling of dead pigs” and “syndromes that can be interpreted as ASF”. Application of theoretical concepts (presented in the conceptual framework) enabled identification of aspects in the empirical material that might otherwise have been overlooked and made it possible to generalize through theory [41]. In other words, the analysis was both inductive and deductive.

Survey data were collected on paper questionnaires by one of the field assistants and later entered into a Microsoft Excel spreadsheet for data analysis by the first author. This helped provide an overview of the data and determine the minimum, maximum and average in the quantitative results.

Ethical statement

This study was reviewed and approved by Makerere University, College of Health Sciences Research and Ethics Committee, under reference number 2019–062. Prior to participation, all the smallholders were provided information about the overarching aim and expected outcome of the study. They were also told that they could decline to take part of the study at any time and for any reason. Oral informed consent was given by all smallholders prior to participation. In accordance with the ethics approval (reference number 2019–062), the oral consent was documented in the written interview notes by the first author, who attended each interview, and witnessed by a field assistant. To protect the anonymity of the participants, the smallholders’ names have been changed and the names of the study villages have been excluded.

Perceptions and experiences of pig diseases

The uncertainty that informants felt regarding disease spread and causes of death in pigs were often expressed along similar lines to the comments made by smallholders Peter and Beatrice (man and woman, respectively, individual interviews):

“I think that the pig is the most challenging animal to keep; pigs are really difficult to keep healthy. I struggle to take care of my pigs, to take control over them in a good way, to ensure that they will not get sick and to find a way to treat them when they do get sick.” (Peter)

“There are lots of problems with pigs getting poisoned around here, it causes them to die. Some people kill pigs, someone might feed them raw food stuff or unprepared simsim ☯sesame] and they can die when they eat that. The problem is that it becomes difficult to know if the pigs were killed by disease or by poison, you can’t be sure what caused them to die.” (Beatrice)

Some explanations among the informants concerning the spread of disease and causes of death indicated the broader framing of problems in relation to animal health, with disease not clearly separated from issues related to witchcraft or poisoning. The risk of having your pig poisoned by a community member was considered a real threat in the study area, and many informants found it difficult to distinguish between a poisoned pig and a pig suffering from an infectious disease. Mention of witchcraft and curses among informants indicated the spiritual dimension of conceptualising disease, which has also been described in other contexts [see, for example, 24 p.55].

While informants commonly reported that they had observed some clinical signs before their pigs died, they reported high levels of uncertainty regarding the causes of disease, which affected opportunities to prevent the spread of infections. The following response from smallholder Christine (woman, individual interview) sheds light on this issue:

“When the pigs got sick, I recognised that they were not behaving normally, something was wrong in their heads. What I mean is that they started to run around, then they were just dead, all dead on the ground. I’m not sure why they were running around. But it was like they were not stable on their legs, I could see they weren’t walking properly anymore. When they died, we couldn’t eat the meat since we didn’t know what was wrong when the pigs died, so we threw the dead pigs into the bush.”

One reason for the perceived difficulty in interpreting disease in pigs was that practical know-how in livestock production, often passed down from parents and relatives, was mainly developed based on experiences with animal health issues in goats, poultry and cattle. This practical knowledge was sometimes found to be irrelevant or even harmful when applied to pigs, indicating the extent of how context-specific this local knowledge is and thus the difficulty of transferring it from one animal species to another [see also 20, 25, 26]. The section below examines some of the most common pig diseases and how they were dealt with by the informants.

Common pig diseases and treatments

In both focus group discussions and individual interviews, several informants said that pig diseases (including disease outbreaks) were more common between December and March. This correlated with the dry season, when many of them struggled to provide enough feed and water for their pigs, and therefore had to let them out to scavenge even if they had an enclosure. Other informants suggested that time of year did not have a major impact on the total occurrence of diseases, as the rainy season was perceived to increase the risk of ticks, lice and coughs, for example.

While all diseases were a potential threat to the success of pig production, some diseases were discussed as not necessarily resulting in rapid deaths, and were therefore perceived as less of a risk. Commonly mentioned pig health problems (many of them being clinical signs that were referred to by smallholders as separate diseases) that were possible to treat or did not result in rapid deaths included coughs, diarrhoea and jiggers (Table 1).

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Table 1. Description of common disease syndromes in pigs and smallholders’ suggestions of how to deal with these (based on data from focus group discussions and individual interviews).

https://doi.org/10.1371/journal.pone.0287041.t001

Informants had very limited access to pharmaceuticals and veterinary services. Several of those who had consulted an animal health service provider reported the poor quality of their services and advice. A variety of actors provided animal healthcare in the study area. There were veterinary officers who have a degree in veterinary medicine and look after large areas and who were therefore generally very inaccessible to the informants. The majority of informants reported that they did not know who their local veterinary officer was or how to contact them. Therefore, when facing animal health issues in livestock production, very few smallholders were able to receive assistance from a veterinary officer. Paraprofessionals with varying levels of training in animal health were generally the actors who more commonly provided advice to smallholders in the study area, and the informants generally perceived them to be veterinarians as well. Smallholders described paraprofessionals as more affordable and accessible. At the time of fieldwork in 2019, at least one paraprofessional lived in village A and several paraprofessionals lived in village B. Nevertheless, the majority of the informants relied mainly on locally available resources and the knowledge of more experienced peers for treating sick animals. This is illustrated in the response of Maria (woman, individual interview) here:

“When the sickness comes and you can’t identify what the problem is, and you find that the pigs start to die, that’s when you’re supposed to call the vet doctor ☯veterinarian]. The vet doctors that are supposed to move from home to home. But mostly, you get advice from people around instead, people that have been keeping pigs for a longer time than you.”

Homemade medicine mixes initially developed to treat diseases in poultry and goat production were commonly used (Table 1). An experience repeatedly expressed, however, was that such methods seemed less efficient in pigs than in other livestock. This resonates with previous studies on farmers’ local knowledge, in which evaluation, experimentation and constant adaptation are crucial for this practical knowledge to become precise enough to solve the problem at hand [20, 25, 26].

Perceptions and experiences of ASF

In contrast to the syndromes presented in the previous section, there were also pig diseases that were seemingly impossible to deal with. Situations that were particularly difficult to handle were when pigs died rapidly after the first signs of sickness, as Nancy (woman, individual interview) highlights here:

“A big problem with pigs is that they are very weak and get a lot of sickness. Think about goats, they are stronger and can be sick for longer before they die. So, when you have pigs and realise something is wrong, it becomes very difficult. They can die after just a few days, and then you do not even have time to see what was wrong, what made them sick in the first place.”

Like Nancy, several informants had experiences of rapid death in pigs. Some of them had given up on pig production as a result. Smallholder Morris (man, individual interview) describes such an experience here:

“Pigs get more diseases than other animals. Some very difficult ones. One challenge I have had with pigs has been visible during the months of January and February. The signs I could see was that the pigs stopped moving as before, they stopped eating, they were just lying down, like two days they were sick and then they just died. When they started to get sick, there was sweat from the nose, but I don’t know the name of this disease. I decided to not have more pigs after this experience because I would not know how to solve this disease if it happened again with some new pigs.”

Few informants explicitly talked about ASF. Instead, they often used a variety of names to describe similar syndromes, where the general theme was that several pigs were affected at the same time and that it was difficult to prevent the pigs from dying, despite different attempts to treat them. Based on knowledge of ASF epidemiology in East Africa [see, for example, 43] and documented outbreaks of ASF in the study area [44], this group of similar syndromes was interpreted by us as being descriptions of experiences with ASF. However, this should not be taken to mean that informants see these syndromes as being the same disease or as stemming from the same disease-causing agent (Table 2).

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Table 2. Local description of syndromes that the authors interpret as representing African swine fever (ASF), descriptions of clinical signs, and treatment and prevention method used (based on data from focus group discussions and individual interviews).

https://doi.org/10.1371/journal.pone.0287041.t002

Local responses to different syndromes interpreted as ASF

There was limited local understanding of the fact that there is currently no cure for ASF. Instead, when faced with syndromes that were interpreted by us to be ASF and that caused the rapid death of pigs, informants tended to interpret this as a result of not having access to the correct advice or treatment, as described by Charles (man, individual interview):

“Sometimes there is orere ☯disease outbreaks] in the pigs, they all get sick at once, and then a lot of pigs can die without us being able to do anything about it. That’s a big problem. Since the vets are almost never here, or perhaps only like two times per year to give some vaccines, we can’t get much help from them. We can’t rely on the vets to keep our animals healthy.”

Informants had experience of the effectiveness of purchased medication to treat some clinical signs, such as diarrhoea, and sometimes they pooled resources to fund one person’s travel costs to purchase pharmaceuticals in town. The informants’ use or aspiration to use pharmaceuticals is an example of the fluid relation between different technologies and knowledge systems in this study context [22]. Opinions varied as to whether pharmaceuticals would be efficient for treating the syndromes that were interpreted by the authors to be ASF (Table 2). For smallholder Blenda (woman, individual interview), the question was not whether pharmaceuticals would be useful in the case of ASF, but that the perceived difficulties were instead related to a lack of access and knowing what specific pharmaceuticals would be efficient in this context:

“With pigs, I don’t know much about sickness in pigs. But they just started dying. Their bodies became very thin. There was a lot of saliva from their mouths. How to know which drugs to give them? And how to get the drugs? They just die.”

The findings from the interviews and focus group discussions show that many informants had experience of “orere” in poultry, possibly caused by Newcastle disease (ND). Vaccination was commonly suggested as the preferable prevention and treatment method in this instance. Due to financial constraints and limited access to vaccines and veterinary services, few were able to vaccinate against ND. This might partly explain why some of the informants believed that “orere” in pigs could also be prevented with vaccinations.

Results also show that some of the informants who believed that all kinds of syndromes in pigs could be treated and cured with pharmaceuticals identified time as one of the most critical factors in successful treatment, as expressed by smallholder David (man, FGD):

“There is a disease that we call orere. If that disease comes, you will find that the pigs are running around the compound. They can also become weak and usually they die, all of them at once. But you can consult a vet, and then the disease can get cured if you just get some help from veterinarians. But this one, with the orere, if it stays for too long in the pigs, it can be hard to cure. So you have to get a vet to cure it very fast for the injection to help. In this sense, there is no disease that can’t get cured; everything can be solved with drugs.”

Some informants described how they had consulted an animal health service provider as a last resort when they were unable to deal with ASF (as well as other pig diseases) themselves. The person had then injected or dewormed the pigs, informing them that this would make the disease disappear. In this sense, responding to ASF also included elements of discerning between different, and sometimes conflicting, information, a situation that could lead to confusion about what knowledge to trust or not [see also 14]. In the following quote, smallholder Margret (woman, FGD) describes such a scenario:

“I experienced a difficult disease in my pigs, it was when the malaria came. The pigs began to sweat and their ears were filled with blood. One time when that happened to me, I called a vet. He gave some deworming to my pigs; he told me it was the worms that gave the weakness to my pigs, that disturbed them. My pigs first seemed to improve a bit, but then they died from this malaria, they all died very quickly.”

Overall, suggestions about how to prevent and treat what we here interpret as ASF differed between the informants. This was largely linked to their perceptions about how this disease spreads. A limited number of informants were well aware that it is not possible to treat ASF, and understood that biosecurity measures are needed to prevent it spreading before the animals get ill. This was evident, for example, in a response by smallholder Evelyn (woman, FGD):

“But to prevent ☯ASF], I think you should keep them in the same place and also not bring meat back home from the pork place in the centre. There was ASF here, about two months ago, it was here and my pigs died because of ASF. They ate the bones of dead pigs and died soon after.”

Several informants also emphasised that ASF can be transmitted to healthy pigs that are in contact with dead infected pigs or contaminated material, and therefore stressed that dead pigs should ideally be buried or burnt to avoid other pigs getting infected. Very few informants, if any however, implemented such measures. Instead, many butchered the dead pigs at home and sold the pork to community members. If the meat appeared unpleasant, dead pigs were reportedly thrown in the bush or used as dog feed. A common response when realising that something might be wrong with their pigs and fearing that money will be lost if the pigs die, was to sell the pigs, as described in smallholder Judith’s (woman, individual interview) response here:

“Last year I had four pigs, but I sold them to pay the school fees for my children. I haven’t bought new ones. It was difficult to keep pigs because the neighbour complained a lot about crops getting destroyed. But they got sick also. I could tell that something was wrong when looking at them. They started vomiting and got diarrhoea. One time, I called the doctor for animals, and someone came here and treated the pigs. They did not fully improve, but at least enough so that I could sell them.”

A few informants reported a reluctance to approach veterinary actors in relation to ASF. For example, one informant had heard on the radio that ASF outbreaks should be reported to the District Veterinary Officer, but was fearful that such reporting would lead to a request for all animals to be culled or to the implementation of other biosecurity measures requiring financial investment. This reflects the importance of acknowledging local conditions that affect smallholders’ ways of knowing and responding to pig diseases such as ASF when considering how veterinary knowledge and preventive measures to avoid ASF infection might have relevance in the local context [see also 36].

The limitations of practical knowledge in controlling pig diseases

The results show that compared with other livestock in the study area, pigs were generally perceived to be more sensitive and harder to keep healthy. In dealing with pig health issues, the informants mainly relied on the resources and knowledge accessible to them in their local communities. In relation to this, they often reported that they lacked the means to diagnose and treat sick pigs, something that has also been described in other studies on Ugandan smallholder pig production [see, for example, 14]. The smallholders’ strong dependence on local knowledge in pig production can partly be understood as a consequence of the limited access and sometimes poor quality of veterinary services available in the study area. Their request for other kinds of knowledge in dealing with pig health issues indicates the limitation of practical knowledge as a means of controlling ASF and other pig diseases [see also 16, 22]. The practical know-how and treatment methods used in pig production had mainly been developed in relation to poultry, goats and cattle, and were commonly perceived as less efficient in pigs. Thus, the relatively short history of pig production in the study setting can be assumed to play a key role in this perceived difficulty. This resonates well with how practical knowledge has been described and theorised in the literature, where it is assumed to develop over time through the constant adaptation, experimentation and fine-tuning of methods [20, 25, 26].

Local perceptions and responses to pig health issues

The informants reported that all pig health issues presented potential risks to their pig production. ASF and descriptions of syndromes and diseases that the authors interpreted as ASF were commonly described as being particularly difficult and stressful to handle, not least because it could cause the rapid death of all pigs. It is important to emphasise, both with regards to ASF as well as other pig health issues mentioned in this paper, that the disease terms used by the informants generally related to syndromes and not to specific diagnoses [see also 19, 22, 23].

Many informants expressed uncertainties about how ASF is transmitted, which may partly explain why they found it so difficult to prevent and control this disease. The complexity of local pig health should also be stressed here. This is related to previous reports about pigs and other livestock in Uganda often suffering from undernourishment as well as several subclinical infections at once [15, 46]. Assuming that this could also be the case in the context studied here, this may be a potential explanation for why several informants found it hard to distinguish ASF from other pig diseases. This study also identified uncertainties and different views among the informants regarding whether ASF was curable or not. Some of the informants, believing it possible to cure ASF, described the main hindrance to be a lack of access to pharmaceuticals and efficient treatment methods. This sheds light on the smallholders’ search for more accurate solutions in dealing with pig health issues, as well as their openness to combining their practical knowledge with aspects of scientific knowledge that have also been revealed in other studies on smallholder livestock production in sub-Saharan Africa [see, for example, 22, 23]. Some informants who had been in contact with an animal health service provider reported how this openness could entail risks, such as receiving incorrect advice or erroneous information in relation to ASF. This has also been reported in other studies on Ugandan smallholder pig production [14, 47, 48]. In this sense, the smallholders were not only at risk of losing money based on poor advice from animal health service providers, but incorrect information could potentially also exacerbate a general sense of uncertainty about how to act when pigs are infected by incurable diseases such as ASF.

The results from this study show that very few smallholders implemented preventive measures to hinder the spread of AFS. Preventive measures commonly recommended to farmers include constructing pigsties, buying an extra pair of boots to be used when entering the pigsty, and using commercially produced disinfectants to prevent the spread of ASF [see, for example, 49, 50]. With limited financial resources, however, the majority of informants considered preventive measures, such as the construction of pigsties, to be too costly. It was also a common practice among them to sell sick pigs as a strategy to reduce or avoid financial losses in the event of pig diseases. In such cases, the informants generally perceived it to more critical for their pigs to be healthy enough to sell rather than to resolve the actual sickness. In this sense, responses to pig health issues including ASF should not only be understood in the light of what knowledge the informants have, but can also be seen as a pragmatic response to having to meet numerous household needs and thus trying to make the best of a difficult situation. At the same time, the fact that some informants reached out to animal health service providers in an attempt to complement their practical know-how in pig production reveals how animal health was still very central to their pig production. The findings from this study further show that the informants generally made minimal investments in their pig production. Against this backdrop, the authors agree that there is a need to move beyond “universal” preventive approaches in relation to ASF [8], and encourage explorations of options and solutions better suited to poverty-constrained smallholder contexts [see also 51]. This is believed to have more relevance in the study setting, where the informants generally perceived commercial products and the construction of pigsties to be too expensive.

Barriers to combining knowledge systems

When attempting to combine knowledge systems in order to deal with animal health issues more efficiently, key factors for consideration have been discussed in several empirical studies on smallholder livestock production in the Global South [see, for example, 19, 22, 24]. One such aspect concerns different perspectives on health and disease between veterinary practitioners and smallholders. For example, a study from Kenya shows how the Western science used by veterinarians is based on a view of health as the normal state, in contrast to disease being something abnormal [19]. In that study, veterinarians assumed medical treatments to be required to return the livestock body to normality, whereas pastoralists did not differentiate conceptually or spatially between disease and health, but perceived diseases to be a natural part of the environment [19]. Thus, pastoralists considered treatment as potentially required to reduce the unnecessary loss of cattle, but did not perceive it as an imperative in order to eradicate or avoid diseases ☯19]. Similar observations were made in a study from western Uganda where cattle-keeping farmers perceived minor health issues and poor growth as something normal, rather than something worth controlling, despite the negative effects this had on their income and food security [15]. Another study on Ugandan pig farming showed that smallholders were more concerned with the growth of their pigs and their pigs appearing to be in good health so that they could sell them, rather than preventing the spread of ASF, despite this being a top priority for veterinarians [8]. Another interesting finding from that study was how smallholders generally preferred their pigs to be free roaming, partly due to their perception of pigs as part of the household and therefore not separable from humans through confinement [8]. These examples illustrate how priorities, methods and epistemologies may differ between animal health service providers and smallholders when it comes to animal health and disease [see also 52]. With this in mind, improved understanding of smallholders’ ways of knowing and conceptualising diseases will be critical for improving communication between smallholders and veterinarians, and ensuring appropriate animal health service delivery [22, 23].