Rapid appraisal or time-consuming qualitative study?

Now that you have learned about qualitative methods – read extracts of an article from a study that uses a rapid appraisal method called knowledge, attitude and practice (KAP) study.

KAP studies are frequently used. We invite you to read the abstracts and extracts that are shown below and to reflect on the following questions:

  • What do you like about the study?
  • What are shortcomings of the study and why?

Abstract

Slaughterhouse surveys are important in the detection and management of zoonotic diseases. Routine reports from the Kumasi slaughterhouse, in the Ashanti region of Ghana, include cases of zoonotic diseases. Due to its location and size, Kumasi is the major cattle market and an important transit point for cattle trade from places within and outside Ghana.
This present study was designed to examine slaughterhouse reports and to explore the nature of the knowledge, attitude and practices of butchers who operate at this slaughterhouse in relation to zoonoses. The study was largely descriptive, employing qualitative methods and tools. Butchers were interviewed and their practices along the production line observed.

The study indicates that zoonotic diseases are frequently detected at the Kumasi slaughterhouse. However the knowledge, attitudes, practices and beliefs of the butchers are largely inadequate for their profession in view of the important public health role that butchers play. The butchers have never received any form of training. It is recommended that the butchers receive training on a regular basis and that laws be formulated and implemented to protect the health of the butchers and the general public.

A photograph of abattoir workers Image one: Abattoir workers in a slaughterhouse. © Swiss TPH (Laura Falzon)

Extracts from Methods and Materials

The Kumasi slaughterhouse was built in 1955 and was meant for the slaughter and processing of a maximum of 12 cattle at any given time. The slaughterhouse serves the metropolis and other big towns, some over 150 km away from the city. The butcher population is about 750 men and boys ranging in age from 11 to 78 years old.

A descriptive study was designed that used specific questions to determine the butchers’ knowledge, attitudes, practices and beliefs in relation to meat-borne zoonoses. Primary data were collected using interviews. All 38 members of the committee of elders of the butcher community were interviewed individually as well as in groups consisting of 5–8 members each. All interviews were recorded on tape. Focus group discussions were held with different age groups of butchers, and a discussion guide was used. Non-participant observation was undertaken of slaughterhouse procedure as effected by the butchers. A checklist was used and photographs were taken.

Extracts from Results

3.1. Common attitudes
1. Self-medication was common — a common response was, ‘I take some para and am fine’ (I take some antipyretic drugs and I get well). Asked the reason for self-medication, most butchers responded as follows, ‘If I go to hospital, I no go fit pay’ (If I go to the hospital or a health facility, I will not be able to pay my bill). ‘Those who sell medicine for here too be doctors’ (the drug peddlers who sell to the butchers are doctors too).
2. Butchers felt they were at risk only when cutting beef. They did not consider any other activity as posing a risk.

3.2. Common practices
1. Butchers were without adequate protection, such as overcoats and had prolonged and close contact with the floor and walls which were, very often, dirty.
2. Butchers ate, smoked, spat and drank (water and non-alcoholic beverages) in the lairage and on the killing floor.
3. Carcass to carcass contact was frequent, while carcass to surface contact was very frequent. Faecal spillage onto carcasses was also common.
4. During peak slaughter hours, 50–60 carcasses (instead of the maximum of 12) and up to 500 people, including women and children were present on the slaughterhouse killing floor.
5. Surfaces were not sanitised during the processing day.

3.3. Common belief
The butchers believed that their religious beliefs protected them from all risks, including the risk of contracting zoonotic disease.

3.4. Knowledge
The butchers had not received any formal training and had learnt their trade exclusively from older colleagues. A summary of their knowledge of zoonoses is shown in Tables 4 and 5.

Knowledge of butchers in relation to zoonoses a

Table showing knowledge of butchers in relation to zoonoses This table shows the knowledge of butchers in relation to zoonoses. © Otupiri et al, 2000 Acta Tropica

Local names for major zoonotic diseases prevalent at the Kumasi slaughterhouse a

Table showing local names for major zoonitic diseases prevalent at the Kumasi slaughterhouse This table shows the local names of zoonoses in the Kumasi slaughterhouse.
© Otupiri et al, 2000 Acta Tropica

Extracts from Discussion

Although some of the butchers had some knowledge about zoonoses and could provide names for some of the important diseases, the majority of them lacked basic knowledge about how these diseases are transmitted to humans, making it difficult to apply basic preventive methods to minimise the risk of infection. Most butchers were unaware of common and frequent food-borne diseases such as salmonellosis or anthrax. The beliefs of the local people serve as an additional contributor to the risk of exposure to zoonoses. Most of them believe that they are protected from disease because of their Islamic faith and, therefore, do not take any precautionary measures. Added to this is the very common habit of self-medication, which means chronic diseases such as brucellosis and tuberculosis often go undiagnosed. To some extent, there is a degree of authority vested in the butchers which makes it difficult to enforce any regulations at most slaughterhouses in the country. More widespread training and public education are urgently required to improve the situation.

You might agree that it was good that the authors combined different approaches such as observation and focus group discussions to assess the knowledge, attitude and practices.

We do not know how many days the data was collected at the slaughterhouse, but we can assume that the 38 elders were interviewed within a few days since interviewers were present and received the permission of the slaughterhouse director to conduct these interviews. The findings are interesting in view of the astonishingly low knowledge on zoonoses. This is in spite of the fact that the authors have gathered local names of the zoonoses. However, we do not really know if these were assessed prior to the interviews and then used in the questioning.

Alternatively the researchers might have assessed these local names in parallel with knowledge of eg anthrax and only then were the participants asked how they call the disease causing this and that symptom. The study led to a rather straightforward recommendation to increase information among abattoir workers. However, we do not learn much more about which particular aspects of knowledge should be addressed and what the best entry points for effective information on risk and prevention are because the understanding of issues at hand remains very superficial.

In surveys, people tend to give answers that they believe to be correct from the perspective of the interviewer or of other listeners if interviews are not done privately. In the case of interviews with the slaughterhouse workers, it would be inappropriate if, for example, the director were present. When knowledge of interviewees is not in good agreement with the biomedical model, it is often labelled as ‘beliefs’ since more information on the socio-cultural constructions is not available and alternative interpretations can be found. Local knowledge could represent good entry points for information campaigns or to strengthen resilience of communities.

Now think about what you have just read. What do you like and where do you identify shortcomings?

In the next step you will learn more about the strengths and pitfalls of KAP studies.


References

Otupiri, E. et al. (2000). Detection and Management of Zoonotic Diseases at the Kumasi Slaughterhouse in Ghana, in: Acta Tropica 76, 15. © 2000 Elsevier Science B.V. All rights reserved.

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One Health: Connecting Humans, Animals and the Environment

University of Basel