240 P. Livingstone and N. Hancox
the risks of M. bovis being transmitted from
livestock (cattle, buffalo, goats or camels) to
humans. If possible, TB management should
also lead to reduced livestock TB incidence, pro-
viding for animal health, production and eco-
nomic gains.
15.4.2 OptionsEmpowering people through knowledgeIn some low to medium–high GNI communities,
there is poor understanding of bovine TB and its
risks to human health. A study in Arusha, Tan-
zania, found that in areas where the prevalence
of TB herd infection was up to 50%, 75% of peo-
ple surveyed had little knowledge of TB; 50% did
not boil milk and 18% ate raw meat (Mfinanga
et al., 2003). In a similar study in Cameroon,
Ndukum et al. (2010) found ‘among cattle han-
dlers, 81.9% were aware of BTB, 67.9% knew
that BTB is zoonotic, and 53.8% knew one mode
of transmission, but over 27% consumed raw
meat and/or drank unpasteurised milk’. It has
been estimated that in East Africa, more than
80% of milk is sold untreated (Kurwijila, 2006).
This indicates a greater need for education of
milk producers and consumers, and promotion
of simple disease prevention measures such as
boiling milk or cooking meat. This would also
bring wider health benefits through killing other
potential pathogens such as Listeria monocyto-
genes, Staphylococcus aureus, Klebsiella pneu-
moniae and other enterobacteria, as well as
Brucella and Yersinia species (Rea et al., 1992;
Gran et al., 2003). There is a consensus that vil-
lagers in low to medium–high GNI communities
are better able to absorb and act on information
when it is provided by someone with standing in
the local community (O’Toole and McConkey,
1998). Mobile phones and other information
and communication technologies offer increas-
ingly cheap and available avenues for delivering
key disease control and health protection mes-
sages to rural populations (Masuki et al., 2010).
Uptake of these messages may be enhanced if
they are linked to other widely used information,
such weather forecasts.
In addition to providing grass-roots infor-
mation to rural villages, there is also a need to
ensure politicians, government officials, health
workers and community leaders understand
that drinking raw milk or eating poorly cooked
or raw meat can cause a range of diseases,
including TB. The risk of catching any of these
diseases can be greatly reduced by boiling milk
and ensuring that meat is well-cooked before
consumption.Pasteurization of milkThere may be opportunities for collectives of
small-scale cattle or goat farmers to limit
transmission of M. bovis to humans by treating
milk in small pasteurizers powered by wood or
gas stoves (Kurwijila, 2006) or solar power
(Wayua et al., 2013). Pasteurization of raw milk
before it is sold or made into products such as
soured milk or cheese would reduce health risks
to a broader cross-section of the community at
low cost, and may increase the value of milk or
milk produce sold by participating farmers or
collectives.
Calves can become infected from drinking
raw milk containing M. bovis (Doran et al.,
2009). Pasteurizing both colostrum and milk
prior to feeding to calves and kids mitigates the
risk of these animals becoming infected with
M. bovis early in life. Some Chilean cattle owners
used this sanitation process to assist them to
clear TB infection from their herds (C. Cabrera,
personal communication). Having young cattle
that are TB free is a pre-requisite to a successful
TB vaccination programme.Slaughterhouse TB surveillanceSlaughterhouse inspection of carcasses has
identified TB-infected livestock carcasses in a
number of low to medium–high GNI African
countries, including Nigeria (Cadmus et al.,
2009) and Cameroon (Ndukum et al., 2010).
However, routine slaughterhouse inspection
correctly detected only 32% of infected cattle
within a sample of 3322 cattle slaughtered at
five abattoirs in Ethiopia (Biffa et al., 2010).
While possibly unreliable as a disease detection
tool, finding TB at slaughterhouses may lead to
reduced payment to the supplier of the animal.
This in turn can provide a suitable opportunity
for targeted communication to affected cattle-
herders encouraging them to adopt improved
disease control practices.