Cultural and behavioral drivers of zoonotic disease transmission and persistence among diverse pastoralist communities in East Africa.

Background: Zoonotic diseases such as brucellosis, Rift Valley fever, anthrax, rabies and bovine tuberculosis are highly prevalent among pastoralist communities in low-and middle-income countries. Methods: This study adopts a One Health approach, employing a range of participatory methods including informal observations, "go-along interviews," narrative-, and key informant- interviews, to explore the cultural, behavioral, and structural drivers of zoonotic disease transmission among pastoralist communities in East Africa. We unpack how the physical environment, socio-economic systems, health systems, community influence and cultural competence as well as individual pastoralist's unique characteristics, behaviors and lifestyles can be leveraged for effective public health interventions that reduce zoonotic risks and improve health outcomes for both humans and livestock. Results: We present data from 214 purposively selected participants, including 19 key informants, 68 in-depth interviews, 20 focus group discussions, and 22 direct ethnographic observations. Traditional knowledge and beliefs, risky cultural dietary practices such as consumption of raw milk, meat and blood, unprotected parturition assistance, unsafe disposal of carcasses and aborted fetuses were common and carried increased risk of zoonotic transmission. Women and children handled and milked small ruminants while adult men and Discussion: While livestock play a significant and indispensable role in the daily livelihoods of pastoralist communities, their close association of pastoralists with livestock coupled with their unique cultural and behavioral practices increases their risk of exposure to deadly zoonotic diseases. Although, most of these practices are environmentally and culturally adaptive, their risk for transmission is often overlooked. The study also highlights inadequate sanitary practices, poor disposal of animal carcasses and placentae and the absence of veterinary oversight in the production, distribution and consumption livestock products. Conclusions: Our study provides a holistic understanding of the subjective perspectives and nuanced insights underlying the emergence and persistence of zoonotic diseases within pastoralist communities. It also underscores the need for culturally sensitive One Health interventions that address these practices and enhance community awareness of zoonotic disease risks and prevention strategies which are often overlooked by conventional epidemiological studies.