Identifying Gaps in the Control of Porcine Cysticercosis in Kenya: A One Health Qualitative Study of Multi-Stakeholder Perspectives from Busia County

Simple Summary

Porcine cysticercosis is an infection of pigs caused by the larval stage of a zoonotic parasite, Taenia solium (Pork tapeworm). This study examines stakeholder perspectives on porcine cysticercosis control, identifies factors that contribute to disease transmission, and documents proposed measures to guide the development of interventions in similar endemic settings. Data were collected through key informant interviews and focus group discussions and were summarized qualitatively. Free-range pig farming is a common practice, mainly driven by economic constraints, and a predominant risk factor of pork tapeworm transmission. Poor sanitation and hand washing practices are also identified as major risk factors. In addition, informal and home-based slaughter practices compromise pork safety. Low public awareness limits the adoption of preventive practices. The study highlights the urgent need for integrated interventions, including education campaigns, strengthened veterinary and public health services, improved sanitation infrastructure, and enforcement of meat inspection regulations, through a One Health approach to reduce the burden of pork tapeworm infection in pigs and humans in the study area and beyond.

Abstract

Porcine cysticercosis, caused by the larval stage of the zoonotic parasite Taenia solium, poses a public health and economic burden in endemic regions. This study explored stakeholder perspectives on porcine cysticercosis control and risk factors in Busia County and documented proposed control measures with relevance to endemic regions. A qualitative design was used, involving eight key informant interviews (KIIs) and twelve focus group discussions (FGDs). Data were analyzed qualitatively by identifying emerging themes. The study found that smallholder semi-confined pig farming is the dominant system in the area, driven mainly by economic constraints, which elevates the risk of porcine cysticercosis. Poor hygiene, inadequate sanitation, and lack of safe water also contribute, alongside informal pig slaughter and weak meat inspection, compromising pork safety. Low public awareness limits preventive practices and hinders effective public health interventions. These findings highlight the need for integrated control measures, including community education on preventive behaviors and practices; strengthened veterinary services; improved sanitation; and enforced meat inspection. Coordinated One Health actions across public health, veterinary services, and communities are crucial to mitigate these interconnected health risks. The findings may guide interventions in comparable endemic settings and offer insights for managing other zoonotic diseases with similar transmission dynamics.

1. Introduction

Porcine cysticercosis, caused by Cysticercus cellulosae, the larval stage of the zoonotic parasite Taenia solium, remains a significant public health and economic challenge, particularly in low-income regions [1,2,3]. Human taeniasis occurs from consuming raw or undercooked pork containing viable cysticerci. Infected individuals shed tapeworm eggs in their feces, leading to environmental contamination, particularly in areas with open defecation or poor sewer systems. Pigs become infected by ingesting these eggs while roaming in contaminated environments. In humans, accidental ingestion of tapeworm eggs via the fecal–oral route can result in neurocysticercosis (NCC), a leading cause of preventable epilepsy in endemic areas, contributing to substantial health and economic burdens [4,5,6,7]. Schematic illustration of the complete lifecycle is provided in the Supplementary File (File S8).

Taenia solium taeniasis and cysticercosis (TSTC) are declared eradicable diseases [8] but remain endemic in pig-producing and pork-consuming parts of low-income countries [1]. The ecological and socio-economic factors sustaining transmission, such as free-range pig management, limited sanitation infrastructure, inadequate meat inspection, and low community awareness, are common across endemic regions across Africa, Latin America, and Asia [1,2]. TSTC is an emerging public health and economic problem in many parts of the Sub-Saharan Africa (SSA) region [6,9].

Endemic transmission of T. solium taeniasis and porcine cysticercosis has been reported across multiple settings of SSA [9,10,11], including Kenya [12,13,14,15,16,17], where smallholder pig production systems and related environmental and social factors [18,19,20] provide a valuable case study for understanding porcine cysticercosis transmission dynamics in similar endemic contexts at regional and global levels.

Despite efforts to prevent the disease through routine preventive practices, gaps in disease surveillance and intersectoral collaboration hinder the effectiveness of control strategies in many endemic settings [6,18,21,22]. Moreover, global frameworks, such as World Health Organization (WHO) recommendations [1,2,23,24,25], exist for the control of cysticercosis, but the lack of consistent and locally tailored interventions continues to impede progress [22].

Understanding the perceptions, knowledge, and practices of stakeholders involved in pig production and health systems is essential for controlling T. solium taeniasis and porcine cysticercosis worldwide. Identifying socio-cultural and institutional barriers to effective disease management is critical for tailoring interventions in endemic regions such as Kenya and for informing strategies in similar low- and middle-income contexts.

Such insights help identify key risk factors, address gaps in existing prevention and control efforts, and guide the development of context-specific, culturally appropriate, and operationally feasible interventions across human and animal health systems. Participatory approaches of this kind are increasingly recognized as important for managing zoonotic diseases at the human–animal-environment interface [26,27,28].

Qualitative approaches are particularly valuable, as they enable an in-depth exploration of stakeholder perceptions, behaviors, and institutional constraints that are not readily captured through quantitative methods [26].

By integrating perspectives from multiple stakeholders, including pig farmers, community members, veterinary personnel, and community health workers, this study moves beyond the identification of known risk factors to examine how these factors are embedded within local socio-cultural practices and institutional structures in a specific high-transmission setting. Rather than treating them as isolated determinants, it reframes commonly reported risk factors as manifestations of underlying system-level constraints. In doing so, it provides empirically grounded insights into barriers to control that are less frequently captured in prior quantitative or single-stakeholder studies in Busia County, and identifies practical entry points for operationalizing One Health through locally tailored, cross-sectoral interventions.

This study aimed to explore stakeholder perspectives on the control and prevention of porcine cysticercosis in Busia County, identify key contextual factors influencing its transmission, and document proposed control measures to generate insights relevant to endemic regions worldwide.

2. Materials and Methods

2.1. Study Area

The study was conducted in Busia County, located in western Kenya along the Kenya–Uganda border and within the Lake Victoria Crescent ecosystem. Busia County is predominantly rural, with agriculture, fishing, and trade forming the main economic activities, and over 65% of households depend on small-scale, mixed crop–livestock farming systems. Livestock production is largely traditional, with pigs, cattle, small ruminants, and poultry mainly reared under small-scale systems [19,27,28,29]. The county is reported to have the second-highest population of pigs in Kenya [30].

The county experiences a bimodal rainfall pattern, moderate temperatures, and environmental conditions conducive to agriculture [18,19,20,31]. However, it is characterized by high poverty levels and a relatively limited infrastructure, particularly in rural areas [18,19,32]. Administratively, Busia County comprises seven sub-counties, namely, Samia, Bunyala, Butula, Matayos, Nambale, Teso North, and Teso South.

Busia County was purposively selected due to its large pig population and predominance of backyard/free-range pig production systems, which are recognized risk factors for Taenia solium transmission [31]. The county has also been reported as having the second-highest pig population in Kenya [30] and is characterized by documented endemic transmission of T. solium taeniasis and cysticercosis [17,18,19,20,31]. These characteristics make Busia County a suitable setting for examining porcine cysticercosis risk factors and associated public health risks through a qualitative lens.

The key informant interviews (KIIs) were conducted with representative veterinary officers drawn from all sub-counties to obtain comprehensive insights at both county and sub-county levels.

Bunyala and Teso South sub-counties were purposively selected for the focus group discussions (FGDs) based on previous research identifying them as high-risk areas for porcine cysticercosis transmission [33]. The selection of two sub-counties is consistent with qualitative research designs that prioritize depth of contextual understanding over statistical representativeness, particularly in exploratory studies conducted in endemic settings. The map showing the study location and data collection methods is illustrated in Figure 1.

2.2. Study Design

This study employed a qualitative study design to explore stakeholder perspectives on risk factors and control strategies for porcine cysticercosis in Busia County, Kenya. Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs) were used as the primary data collection methods. These methods were selected to provide in-depth insights into local perceptions, beliefs, and practices regarding the persistence of risk factors and disease transmission, which are central to the study’s objectives [35,36].

2.3. Sample Size, Study Population, and Sampling Procedures

County- and sub-county-level veterinary officers across all seven sub-counties of Busia County were purposively selected [37] for key informant interviews (KIIs) based on their expertise and direct involvement in veterinary service delivery and disease control, including porcine cysticercosis. In total, eight veterinary officers participated in semi-structured interviews.

FGD participants included community health workers (CHWs), animal health extension workers (AHEWs), community leaders, and male and female pig farmers residing in the study area. Eligible participants were aged ≥18 years and had relevant experience in pig production, animal health services, community health activities, or local leadership roles related to disease prevention and control. Purposive sampling was used to ensure that participants represented the required stakeholder categories, with snowball sampling [38] employed to facilitate recruitment through referrals from initial participants and local gatekeepers.

Pig farmers and community leaders were recruited with the support of the research team, sub-county veterinary assistants, and ward chiefs from the ten wards in Bunyala and Teso South sub-counties. Community health workers were recruited in collaboration with the sub-county public health officer and the community health strategy focal person. Animal health extension workers were invited to participate through the sub-county veterinary offices, as they were small in number.

In total, twelve homogeneous FGDs were conducted across stakeholder groups. These included four FGDs with male pig farmers (n = 40), three FGDs with female pig farmers (n = 30), two FGDs with community leaders (n = 24), two FGDs with community health workers (n = 19), and one FGD with animal health extension workers (n = 7). Each FGD comprised 6–13 participants, and the final total number of participants across all FGDs was 120. No participants were excluded after recruitment.

Data collection continued until thematic saturation was reached. Saturation was assessed iteratively through regular debriefing sessions with the research team, during which emerging codes and themes were reviewed. Data collection was stopped when additional discussions yielded no new substantive insights or meaningful variation in the data. Informational redundancy was identified when the same emerged across multiple participants and settings, signaling that further sampling was unnecessary. For instance, the practice of free-range pig farming was repeatedly mentioned by both KII participants and focus group discussants as a coping strategy for economic constraints, with no new perspectives emerging.

While the study acknowledges potential selection bias associated with purposive and snowball sampling, efforts were made to reduce its impact. This included using multiple recruitment pathways through involving local administrative and technical officers, thereby enhancing the inclusion of information-rich participants. Additionally, maximum variation sampling was applied to ensure diversity across gender, age, and pig production practices.

2.4. Data Collection Methods

2.4.1. Data Collection Using KIIs

Data were collected through semi-structured KIIs with County and sub-county veterinary officers (n = 8) between November 2019 and December 2021. Each interview lasted between 30 and 45 min and was audiotaped with the informed consent of the participants. The interviews were conducted by an investigator and a research assistant, both of whom were trained and experienced in qualitative data collection. The topics covered during KIIs include: pig rearing and health management, epidemiology of porcine cysticercosis, meat inspection and pork safety, water, hygiene, and sanitation issues in the Busia County context, and existing control strategies of porcine cysticercosis.

2.4.2. Data Collection Using FGDs

A total of 120 participants were involved in 12 FGDs conducted between 11 and 28 June 2022. Participants were recruited from various stakeholder groups, including pig farmers, community leaders, CHWs, and AHEWs. Three experienced facilitators were identified and trained to moderate, observe, and record the FGDs. The average duration of the discussions was about an hour to an hour and a half. The discussion was audio-recorded with participants’ informed consent to capture all raised opinions and ideas. The topics covered during FGDs included pig rearing practices, sanitation, the occurrence of porcine cysticercosis and its risk factors, and opinions on control measures.

The FGD guide was pre-tested in one FGD conducted in a village outside the study area and fine-tuned before use in the study. Visual aids, including photographs of cyst-infected pork and pig housing, were used to facilitate discussion and to ensure clarity of concepts. Field observations of pig housing and sanitation conditions were also conducted to corroborate and contextualize the information provided by participants. A structured checklist was employed for these observations, focusing on pig confinement practices, sanitation infrastructure, water source points, and environmental exposure risks such as open defecation and sewer contamination. These observations helped to enhance the consistency and reliability of the data collected.

2.5. Data Management and Analysis

The audio recordings of KIIs and FGDs were transcribed verbatim, and interviews conducted in local languages were translated into English, with careful attention to preserving original meanings and contextual nuances. Transcripts were cross-checked against the audio recordings to ensure accuracy and completeness before analysis. Data were managed and analyzed using NVivo software (Release 1.7.1, QSR International, Denver, CO, USA), which facilitated systematic organization, coding, and retrieval of data. An inductive thematic analysis approach was applied, following the six-phase framework described by Nowell et al. [39]. Line-by-line coding was conducted to identify recurrent patterns and salient issues across KIIs and FGDs. Codes were iteratively refined and grouped into higher-level categories and themes reflecting key dimensions of the study.

Two researchers were involved in the coding process. YG developed the initial coding framework, which was refined in consultation with HA. Initial coding was conducted independently, followed by comparison and discussion to resolve discrepancies and reach consensus.

Data triangulation was used to examine convergence and divergence across KIIs, FGDs, and field observations [40]. This strengthened the credibility of the findings by enabling comparison across multiple data sources. The researchers engaged in reflexive practice throughout the study by continuously and critically reflecting on their perspectives and on how these may have shaped data collection, analysis, and interpretation of findings.

Direct participant quotations were used to illustrate themes and ground interpretations in participants’ perceptions. Emerging themes were organized into conceptual frameworks and summary tables to clarify relationships between pig husbandry practices, environmental and behavioral risk factors, institutional constraints, and opportunities for disease control. The analysis adhered to established standards for qualitative research reporting, including transparency in analytic procedures, reflexive interpretation, and clear linkage between data, themes, and conclusions, consistent with the Standards for Reporting Qualitative Research [41].

3. Results and Discussion

3.1. Demographic Characteristics of Participants

A total of 128 participants were included in the study. The table below presents the demographic characteristics of the study participants, categorized by the data collection method Focus Group Discussions (FGDs) and key informant interviews (KIIs), participant group, sex, and age groups (

Table 1. Demographic Characteristics of Participants in FGDs and KIIs.

Participant Group	Data Collection Tool	Sub-County	Female				Male				Total Participants
			18–35	36–45	46–65	>65	18–35	36–45	46–65	>65
Animal Health Extension Workers	FGD	Teso South & Bunyala	0	1	0	0	3	3	0	0	7
Community Health Workers	FGD	Teso South	1	1	1	0	0	4	2	0	9
Community Health Workers	FGD	Bunyala	0	2	1	0	2	2	3	0	10
Community leaders	FGD	Teso South	0	1	1	1	0	3	5	2	13
Community leaders	FGD	Bunyala	0	1	0	1	2	2	3	2	11
Male pig farmers	FGD	Teso South	0	0	0	0	5	8	7	1	21
Male pig farmers	FGD	Bunyala	0	0	0	0	5	6	7	1	19
Female pig farmers	FGD	Teso South	5	8	6	0	0	0	0	0	19
Female pig farmers	FGD	Bunyala	3	4	3	1	0	0	0	0	11
Sub-county VO & County DVS	KII	All Busia sub-counties *	0	0	0	0	1	4	3	0	8

VO, veterinary officer; DVS, director of veterinary service; All Busia sub-counties *, Bunyala, Teso South, Teso North, Nambale, Butula, Samia, and Matayos.

). This demographic breakdown provides a clear view of the composition of the sample and highlights the diversity in terms of gender, age, and participant type.

3.2. From Feed to Fear: Uncovering the Public Health Implications of Porcine Cysticercosis in Busia County

This study draws on findings from eight KIIs with veterinary officers and twelve FGDs with diverse stakeholders, including community leaders, smallholder pig farmers (men and women), Animal Health Extension Workers (AHEWs), and Community Health Workers (CHWs). Integrating expert perspectives from the KIIs with community-level insights from the FGDs provides a comprehensive understanding of the multifaceted issues associated with porcine cysticercosis and its public health impact. The findings are organized into six key themes addressing challenges in pig production systems; animal health management; sanitation and hygiene practices; meat inspection; pork safety; community awareness; and recommended interventions.

The persistence of porcine cysticercosis in endemic areas such as Busia County is driven and sustained by a complex combination of interconnected factors, including poverty, free-range pig systems, open defecation or the lack of sewage systems, inadequate meat inspection, and limited community awareness [15,16,18,19,20]. These risk behaviors and practices create an environment conducive to maintaining the T. solium lifecycle and its transmission to humans and pigs [18,42]. The study identified key risk factors driving the transmission of porcine cysticercosis in Busia County, explored gaps in existing control strategies, and captured participants’ perspectives on potential solutions, offering valuable insights that could inform targeted interventions and public health strategies in the region, with potential for transferability to other similar endemic areas.

3.2.1. What Drives Pig Production in Busia County?

Economic, Cultural, and Social Drivers of Smallholder Extensive Pig Farming

The pig sector in Kenya has experienced steady growth [33], aligning with broader trends across Sub-Sahara Africa (SSA) [19,27], where pigs are predominantly raised under traditional smallholder systems [9]. Similarly, Busia County is among the regions with high pig populations [30,31,33], where production is largely characterized by small-scale extensive systems [15,16,17,18,27,31,33]. This broader context corresponds with the present findings, where most households reported keeping two to three pigs under a tethering or semi-free-range system, particularly during the daytime and crop-growing season.

KIIs and FGDs indicated that economic constraints shaped pig management practices. Participants explained that constructing pig housing and purchasing commercial feed for intensive production were often unaffordable, particularly in the context of limited household resources and land availability. A veterinary officer explained, “most farmers keep only 2–3 pigs, and the system is mostly extensive because it is affordable and there is limited space” (KII1, veterinary officer). Similarly, another respondent emphasized that “they cannot afford to feed them” (KII4, veterinary officer), while an additional key informant stated that “the main reason for free-range pigs is economic. People believe it is cheaper than building pens and buying commercial feed” (KII7, veterinary officer). FGD participants further confirmed that the lack of capital limits the ability to construct pig housing and purchase feed (FGD 11, AHEW). These constraints are further reinforced by limited access to affordable commercial feeds, making full confinement systems difficult to sustain in the study context.

One key informant explained, “when people have limited resources, some of them may not even have better houses, so it will be difficult for them to construct a good house for pigs. And they believe that the indigenous pig is very hardy, so they feel that they do not need the house” (KII1, veterinary officer). This illustrates how limited resources, together with perceptions of pig resilience, reduce the perceived need for confinement and thereby sustain low-input management systems.

This finding aligns with smallholder pig systems across sub-Saharan Africa, where limited capital and high feed costs constrain investment in intensive production [43,44,45], suggesting that the management patterns observed in this study reflect broader characteristics of low-input pig production systems.

Beyond economic limitations, the persistence of free-range and tethering practices reflects livelihood-maximization strategies, in which scavenging behavior is exploited to reduce feeding costs. Pig management decisions are also influenced by socio-behavioural considerations, including perceptions that indigenous pigs are naturally resilient and well adapted to scavenging environments. These perceptions reinforce the continuation of low-input production systems.

FGD participants corroborated these findings, describing tethering as a common and practical approach. One female farmer stated, “most of us opt for tethering” (FGD 2, female farmer), while a community leader explained, “We let our pigs roam freely because it saves on feed costs, and they can graze in the nearby fields” (FGD3, community leader). Others described a restricted roaming system, where pigs are tied but allowed limited movement for grazing, such as “tying a rope on the animal and leaving it to graze … with restrictions” (FGD 5, male pig farmer). Seasonal variation was also reported, with some farmers releasing pigs at night, which occasionally led to crop damage and disputes. Field observations also confirmed the presence of tethered pigs within homesteads as well as freely roaming pigs within village environments.

At the same time, participants demonstrated awareness of the risks associated with these systems, particularly increased exposure to diseases such as porcine cysticercosis and African swine fever (ASF), as well as contributing to crop damage and social conflict. Poor biosecurity practices were also described as exposing pigs to multiple health risks and creating challenges, including crop-damage disputes and potential legal consequences. These views were consistently expressed across FGDs and KIIs and were further supported by field observations of pigs moving freely within village environments. Free-range pig production is a recognized risk factor for porcine cysticercosis in endemic settings [2,5,9,42,46], including Kenya [12,14,15,18], and may contribute to sustained transmission in the study area [31].

Despite this awareness, the continued use of tethering and free-range systems reflects the interaction of livelihood needs, cultural practices, and resource limitations. Pigs are often treated as flexible household assets that can be sold or used to meet immediate financial needs, which reinforces the persistence of low-cost management practices despite known risks.

Participants proposed several strategies to address the challenges associated with pig confinement, reflecting their practical experiences. Improving access to affordable feed was frequently emphasized, with one key informant suggesting the need “to make access to feed market” (KII7, veterinary officer). Financial constraints were also highlighted as a barrier to change, as one participant explained, “lack of capital… to construct the structure or even buy the feeds or the management… becomes a serious problem” (FGD 11, AHEW). In addition, improving market access was suggested by key informants as a way to incentivize better production practices, particularly where quality-based pork markets could encourage investment in improved systems. Strengthening extension services, including guidance on pig breeds and improved production methods, was also highlighted. However, across discussions, participants indicated that awareness alone would be insufficient without addressing the underlying economic barriers. These findings suggest that interventions focusing on feed accessibility, financial support, and market incentives may represent more feasible entry points than enforcement-based approaches alone. Such context-specific approaches may be transferable to similar smallholder pig systems in endemic settings, although their effectiveness is likely to depend on broader structural support.

3.2.2. Keeping Pigs Healthy: Navigating the Minefield of Production Challenges

Health concerns were prominent in participant narratives. Several endemic pig diseases were identified in Busia County, with porcine cysticercosis frequently mentioned as a suspected but underreported condition due to limited diagnostic capacity. One interviewee noted, “We also suspect cases of porcine cysticercosis, but we do not have proper diagnostic facilities to confirm this” (KII 2, veterinary officer). Other diseases commonly reported by farmers included African Swine Fever (ASF), pneumonia, and parasitic infestations, which were especially common during the rainy season.

These findings highlight the complex array of challenges that pig farmers face, extending beyond production constraints. Free-roaming was identified as a major contributor to health challenges, exposing pigs to porcine cysticercosis and other pathogens, including ASF, consistent with previous studies [18,31].

One of the major challenges contributing to health problems in pigs was inconsistent deworming practices. Many farmers reported treating pigs only when visible illness or poor growth was observed. One veterinary officer explained that “the only time … medical treatment is offered is when the pig is sick … they do not deworm regularly” (KII 2, veterinary officer). Other participants also noted that routine deworming was uncommon, highlighting that “it is a practice that is not commonly followed” (KII 6, veterinary officer) and that “we sometimes deworm … but it is not a regular practice” (FGD 12, CHW).

This reactive approach leaves pigs vulnerable to preventable parasitic diseases. This approach, consistent with findings by Kagira et al. [31], increases susceptibility to preventable parasitic diseases.

Despite inconsistent deworming practices, effective control of porcine cysticercosis remains constrained by limited operational uptake and variable regulatory availability of specific anthelmintics in endemic settings. Oxfendazole, although shown to be highly effective against porcine cysticercosis in experimental and field trials, is not yet widely registered for routine use or implemented as part of standard control programmes across many endemic regions [2,9]. These interconnected challenges are further compounded by limited access to veterinary and extension services, especially in rural areas. Participants reported a shortage of veterinary personnel and difficulties accessing professional support when pigs became ill. One participant noted, “there are not enough veterinary officers … it is hard to get help when you need it” (FGD 5, male pig farmer), while another explained that “many people just try to treat them at home due to lack of information and access” (FGD 7, female pig farmer).

In line with this, the inadequate health extension service was identified as one of the challenges faced by pig farmers in the study area [31] and in other low- and middle-income countries [43,44,47,48], highlighting the need for improved veterinary outreach and community education to promote improved health management practices, especially routine deworming.

Focus group participants attributed these service delivery constraints in part to broader changes in governance and administrative restructuring under devolution. They perceived that decentralization of veterinary and extension services to county governments has been accompanied by reduced consistency in funding and logistical support for field-based outreach and farmer sensitization activities. As a result, the reach and regularity of extension services in Busia County appear to have declined. This was reflected in statements such as: “Previously when we used to be part of the government, we used to be funded, we used to have several programs educating these farmers… but ever since devolution… we have not been facilitated to do most of that work” (FGD 11, AHEW).

Key informants further emphasized operational constraints affecting service delivery, particularly mobility, logistics, and resource availability. One veterinary officer noted, “some areas may not be accessible… sometimes you need to go somewhere with your own means. So that makes it harder to organize workshops for farmers” (KII 6, veterinary officer). Another explained that “since devolution, things are not the same as it used to be… the biggest area of influence has been education through extension, but to some extent that is failing” (KII 7, veterinary officer).

Taken together, findings from FGDs and KIIs indicate that extension service delivery has been constrained by structural and operational limitations within the devolved governance system. This has contributed to the reduced effectiveness of veterinary outreach and weakened preventive animal health management at the community level. Overall, these findings demonstrate that pig health challenges in Busia County are driven not only by farmer-level practices, such as free-ranging and inconsistent deworming, but also by systemic constraints in animal health service delivery, creating an interconnected vulnerability within the local pig production system.

3.2.3. The Unsolved Risks of Sanitation, Hygiene, and Water Quality

Breaking the Cycle of Poor Latrine Access

Limited sanitation facilities and poor personal hygiene were consistently reported as major challenges in Busia County. Despite reports of improved latrine coverage following the National Total Sanitation Program [17], open defecation, inadequate latrine access, and poor sewer systems were identified as major challenges in some areas, increasing environmental contamination. One participant noted, “Sanitation is a huge problem here. Many households lack proper latrines, and open defecation is still practiced in some areas” (KII 8, veterinary officer). This finding aligns with the 2019 Kenya household census, which reported 6% open defecation in Bunyala sub-county [49], and relatively low latrine coverage, with most open-pit latrines often unusable during the rainy season [33]. Although many KII and FGD participants shared the persistence of challenges in improved sanitation, some key informants insist the sanitation problem in the county has already been addressed as a result of previous national sanitation efforts. One KII participant noted “in terms of pit latrines…no. Last year, Busia was the only county with 100% no free or open defecation” (KII 6, veterinary officer). In FGDs, participants similarly indicated partial improvement in household sanitation access, noting that “Most homesteads today have at least a pit latrine; very few isolated homes don’t” (FGD 11, AHEW). Furthermore, structural and environmental barriers such as flooding and unstable soils were significant hindrances to latrine construction. One discussant explained, “You may dig a latrine today, but when floods occur, the waste mixes with water or the latrine collapses, which discourages people from having them” (FGD 9, male pig farmer). Similarly, residents in low-lying areas face unstable soil conditions, making pit latrine construction, particularly during the rainy season. As a result, some households opt not to construct or maintain latrines due to these environmental constraints.

Participants also noted that inadequate sanitation affects both human and animal health: “Without proper toilets, we are risking contamination, not just for pigs but for people too” (FGD 1, male pig farmer). Supporting this, a study in Busia County found that about thirty percent of pigs had access to human excreta [33].

During field observations, signs of open defecation were noted in some lakeside areas. In addition, leakage from pit latrines was observed in several locations across the study area, indicating potential pathways for environmental contamination. These observations were consistent with participant accounts from KIIs and FGDs, which highlighted sanitation challenges as a persistent issue in the study area. Overall, triangulation across FGDs, KIIs, and field observations indicates a shared recognition of generally improved latrine coverage in some areas; however, persistent gaps in sanitation quality and use were consistently evidenced through observational findings and divergent KII responses, highlighting that reported improvements do not fully translate into satisfactory sanitation conditions on the ground.

These findings highlight sanitation-related environmental contamination as a key risk factor in the study area, driven by a combination of behavioural practices and structural constraints. Evidence from the field indicates that sanitation challenges persist despite ongoing public health and sanitation improvement efforts. Community health workers also reported that government and public health programmes continue to promote sanitation uptake and hygiene practices; however, environmental conditions such as flooding and poor soil stability limit the effectiveness and sustainability of these interventions in some areas.

These findings align with broader evidence from endemic regions of SSA, where inadequate sanitation has been identified as a key factor in the transmission of porcine cysticercosis and other zoonotic and communicable diseases [9]. The persistence of environmental contamination highlights the need for context-specific sanitation interventions that address both behavioural practices and structural environmental constraints in endemic rural settings.

Handwashing Practices: From Practice to Persistence

Study participants acknowledged limited knowledge of proper handwashing, often relying on shared basins rather than running water and soap, which reduces hygiene effectiveness. Discussants noted that handwashing practices were improved during the COVID-19 pandemic but declined once the perceived risk of infection decreased. As one discussant explained, “When COVID was prevalent, people washed their hands regularly … but when cases dropped, people stopped, and some even removed the handwashing stations” (FGD 6, CHW). This aligns with findings from a study in Tanzania that reported a decline in handwashing after the COVID-19 pandemic [50]. This suggests that the adoption of hygiene behaviours can be temporary when driven solely by crises rather than sustained, long-term public health efforts.

Access to water and soap emerged as a key barrier to consistent handwashing. Some participants reported that the long distances to water sources made it difficult to do basic hygiene routines. Economic constraints further limited soap use, with some households unable to afford it despite widespread recognition of its importance. These findings align with evidence from other studies in Kenya [51], which reported that inadequate access to water and soap is associated with inconsistent hygiene practices.

These structural and economic constraints contribute to inconsistent hygiene behaviours in the study area, particularly in resource-constrained households. Sustaining effective handwashing practices, therefore, requires not only behavioural change but also improved access to essential water and hygiene resources.

Water Source and Treatment Practices

Participants reported that communities in their area rely on multiple water sources, including boreholes, wells, rivers, and lakes, which are often untreated. Water sources varied by location, with rivers or lakes commonly used depending on proximity. Participants emphasized that untreated water was frequently used for both household consumption and feeding pigs, as illustrated by one participant who noted, “Many people just rely on untreated water for drinking and for feeding the pigs” (FGD 5, male pig farmer). This finding is supported by other reports indicating that a substantial portion of the population in Busia County relies on untreated water sources for domestic use [52,53].

Many participants also reported limited access to safe drinking water in the study area. It was noted by community health workers that water treatment chemicals were available at several water collection points, supported through county government initiatives and non-governmental organisations working to improve access to clean water (FGD 12, CHW). During field observations, newly established water points were observed in some villages. These observations support participant accounts regarding ongoing efforts to improve water access, although challenges in consistent household-level access remain.

The reliance on untreated water and inconsistent access to safe water sources may increase exposure to waterborne and fecal-oral pathogens in both humans and animals. These findings are consistent with other reports highlighting challenges in access to safe drinking water in similar settings [54]. Together, these findings highlight the importance of improving water quality and access as part of efforts to reduce health risks in smallholder settings.

3.2.4. Pork Source and Inspection Practices: Health Risks from Home Slaughter and Inspection Gaps

This study identified significant gaps in meat inspection practices and consumer awareness regarding pork safety in Busia County. Participants reported that many consumers purchase pork from informal, unregulated sources without the meat inspection status. As one key informant noted, “Many consumers do not understand the importance of meat inspection … they buy pork from informal sources, even though it may not be safe” (KII 1, veterinary officer). These findings are consistent with previous studies in Kenya that reported limited awareness of the risks associated with the consumption of uninspected meat [55,56].

Home slaughtering was also widely reported by both key informants and community participants, despite legal requirements for inspection at designated slaughter facilities. One participant explained, “People slaughter pigs at home without any supervision, and that’s a major health risk” (FGD 3, community leader), while another noted, “When pigs are slaughtered at home, there is no inspection, and it is hard to know if the meat is safe” (KII 8, veterinary officer). These practices reflect continued reliance on informal slaughter systems within the study area and are consistent with earlier reports documenting similar practices in Busia County and comparable settings [14,16,18,19].

Participants further highlighted constraints within the formal meat inspection system. Key informants reported that limited staffing and logistical capacity restrict effective inspection coverage. One veterinary officer stated, “For the whole sub-county … we only have one inspector … most of the pork is not inspected” (KII 2, veterinary officer), while another noted that pigs may be slaughtered and transported to butcheries before inspection takes place (KII 1, veterinary officer). These findings indicate that, even within formal market channels, gaps in enforcement and inspection capacity may compromise meat safety. Similar challenges related to limited inspection capacity have been reported in other settings [43,57,58].

Together, these findings highlight interconnected gaps in consumer awareness, slaughter practices, and inspection system capacity within the study area. These factors may contribute to continued exposure to uninspected pork and associated health risks, including zoonotic infections such as T. solium, as also noted in previous studies [43,59].

3.2.5. Awareness Gaps Triggering Critical Risks: Public Health and Economic Consequences

Participants demonstrated a limited and fragmented understanding of porcine cysticercosis and its transmission. Some participants doubted the risk of infection from pigs, drawing on traditional consumption practices. As one participant explained, “I do not think I will be infected … even our grandfather consumed it like this” (KII 7, veterinary officer). Others associated infection with poor hygiene, contaminated food or water, and undercooked pork.

Other participants associated infection with general hygiene and food safety factors rather than a specific parasite transmission cycle. These included perceptions that contaminated food, dirty water, and undercooked pork were the main causes of infection. As one FGD participant explained, “Dirty water and not well-cooked food can cause infection” (FGD 4, female pig farmer), while another added, “A pig can defecate in water and someone can walk in it, and the bacteria can enter the body” (FGD 9, male pig farmer).

Many participants did not clearly understand the zoonotic nature of porcine cysticercosis or its link to human disease, including neurocysticercosis. A discussant noted, “People just think it is a problem with the pigs. They do not know it can affect humans” (FGD 7, female pig farmer). This gap was also acknowledged by key informants, who emphasized the severity of disease outcomes associated with the consumption of unsafe pork, including neurological complications such as epilepsy (KII 6, veterinary officer). Similar awareness gaps have been reported in other endemic settings [12,13,14,17,18,20,60,61].

These perceptions reflect limited exposure to structured veterinary and public health education on zoonotic diseases and reliance on informal knowledge systems in livestock management. Key informants further highlighted environmental and behavioural risk factors, particularly open defecation and poor sanitation practices that facilitate transmission between humans and pigs (KII 7, veterinary officer). However, community-level understanding of this transmission cycle remained limited, indicating weak integration of human, animal, and environmental health knowledge necessary for effective One Health disease prevention.

This limited understanding may influence behaviour, including continued reliance on informal pork markets and low prioritization of meat inspection in purchasing decisions. Beyond health implications, participants also highlighted the economic consequences of the disease. Key informants reported that infected pigs are often condemned at slaughter, resulting in financial losses for farmers. One participant explained, “Economically, there are heavy losses due to condemnation of pork … this results in a loss of income for farmers” (KII 5, veterinary officer).

Overall, fragmented knowledge of transmission and limited recognition of the zoonotic nature of infection may hinder the adoption of effective preventive practices. Participants’ narratives suggest a need for strengthened community-level awareness of disease transmission pathways and safer pork handling practices within the study context.

3.2.6. Pathways to Change: Proposed Interventions and Strategic Recommendations

Strengthening Education and Awareness

Participants from both KIIs and FGDs emphasized the urgent need for sustained and context-specific education campaigns to improve pig management practices and reduce the risk of porcine cysticercosis in Busia County. Education was viewed as critical for both pig farmers and consumers, particularly regarding safe pig husbandry, regular deworming, sanitation, and proper pork preparation.

Participants highlighted the importance of using locally appropriate communication channels and existing social structures to improve uptake of preventive practices. As one participant noted, “By using the local radio station, youth groups, and gatherings like church services or barazas, people can learn about handwashing and safe pork handling” (FGD 9, male pig farmer). Similarly, key informants emphasized the importance of sustained outreach, noting that “ongoing education campaigns, especially those targeting rural communities, are essential to raise awareness about safe pig management and the risks associated with unsafe pork consumption” (KII 7, veterinary officer).

These findings indicate that improving access to consistent and contextually relevant information remains a key priority for addressing persistent risk behaviours within the community. Different community-based health education intervention studies reported reducing the risk of porcine cysticercosis [45,62] and improving awareness and preventive behaviours [50,63,64,65].

Integrated One Health Governance: Enhancing Intersectoral Collaboration and Community–Government Engagement

Across KIIs and FGDs, participants consistently highlighted that although formal One Health structures exist at the national level, their operationalization at the County and sub-county levels remains weak, limiting coordinated control of porcine cysticercosis. A veterinary officer explained, “At national level there is an initiative between the Department of Veterinary Services and the Zoonotic Diseases Unit … but … at the county level, it is still not very strong” (KII 7, veterinary officer). This indicates a disconnect between policy-level One Health coordination and its implementation in local settings. Key informant participants reported that existing control measures were largely limited to meat inspection and regulations discouraging free-range pig rearing. However, these measures were described as inconsistently implemented, particularly regarding free-ranging pigs. These observations point to a structural gap in coordinated control strategies, where available measures lack sufficient support and enforcement to be effective in practice (

Table 2. Summary of key findings, identified gaps, and prioritized intervention strategies across themes in Busia County.

Theme	Key Finding	Gap Identified	Proposed Intervention
Theme 1: Drivers of pig production	Extensive pig production predominated, influenced by feed and housing costs, limited land, livelihood strategies, and perceptions of indigenous pigs as hardy.	Limited affordability of feed and housing, weak access to financial credit, limited market incentives for improved production, weak enforcement of confinement-related regulations	Improve access to affordable feed markets, strengthen financial and credit support for farmers, promote market incentives for improved production systems, support context-appropriate enforcement of pig confinement regulations, and strengthen extension services
Theme 2: Pig health challenges and system constraints	High burden of pig diseases (ASF, suspected cysticercosis, and parasitic infections), potentially linked to free-roaming practices, irregular deworming, and inadequate preventive health management.	Limited routine veterinary care (including irregular deworming), shortage of veterinary/extension personnel, weak diagnostic capacity for diseases such as porcine cysticercosis, and limited access to animal health services	Strengthen veterinary outreach and workforce capacity improve routine deworming campaigns, enhance diagnostic capacity at local level, and strengthen integrated One Health surveillance between veterinary and public health sectors
Theme 3: Sanitation, hygiene, and water contamination risks	Poor sanitation (open defecation, inadequate latrines) and poor hygiene practices contribute to environmental contamination affecting humans and pigs	Structural barriers to sanitation (including flooding, poor soil conditions), limited access to clean water and soap, and inconsistent hygiene behavior	Implement context-specific sanitation infrastructure (flood-resilient latrines), improve water access systems, expand hygiene education linked to infrastructure support, and integrate WASH interventions with livestock management practices
Theme 4: Pork source and meat inspection gaps	Gaps in meat inspection capacity, informal slaughter practices, and limited consumer awareness regarding pork safety	Insufficient meat inspection capacity (including staffing and logistical constraints); weak enforcement of slaughter regulations; low public awareness of food safety risks	Strengthen meat inspection workforce and logistics, enforce slaughter regulations, enhance consumer awareness of safe pork sourcing, and support formalization of pork value chains
Theme 5: Awareness gaps on zoonotic risks	Limited understanding of porcine cysticercosis transmission and zoonotic risks; partial awareness of hygiene-related risks but weak understanding of full transmission cycle	Limited awareness of porcine cysticercosis and zoonotic transmission, fragmented understanding of transmission pathways, reliance on informal knowledge systems, and weak One Health education.	Strengthen community-level One Health education campaigns, integrate zoonotic disease education into extension services, and use locally appropriate communication channels
Theme 6: Pathways to change and system-level interventions	Strengthening community education, improving feed access, and One Health coordination, including veterinary–public health collaboration.	Weak operational One Health implementation, fragmented coordination between veterinary and public health sectors; limited enforcement of existing regulations	Strengthen One Health governance at county level; improve intersectoral coordination; enhance extension systems; combine education with structural support (credit, markets, feed access); support community-based engagement

).

From a One Health perspective, the findings demonstrate that disease control efforts remain sectorally fragmented. Veterinary services were primarily associated with animal-level interventions, while public health actors were linked to food safety and human disease prevention, with limited evidence of structured joint action. A key informant emphasized the need for stronger regulatory and service support, stating, “There is a need for more stringent regulations on pig farming, especially regarding free-range systems and meat inspection” (KII 4, veterinary officer). Similarly, another respondent noted, “The government needs to support farmers with better education, veterinary services, and stricter regulations to manage pig diseases” (KII 5, veterinary officer). This fragmentation illustrates that One Health in practice remains largely conceptual, with limited translation into coordinated field-level implementation linking animal health, human health, and regulatory enforcement systems.

Importantly, both KIIs and FGDs emphasized the need for stronger intersectoral collaboration between the veterinary and public health sectors to improve disease surveillance and control. A KII participant stated, “There should be more collaboration between public health and veterinary sectors to tackle zoonotic diseases and improve sanitation” (KII 5, veterinary officer), while an FGD participant similarly noted, “It would help if the public health department worked more closely with veterinarians to address the health risks associated with pig farming” (FGD 9, male pig farmer). This suggests that while collaboration is recognized across stakeholder groups, it remains insufficiently institutionalized in practice.

FGDs further emphasized that effective implementation also depends on community-level engagement. As one participant noted, “We need to work together as a community, with help from the government, to educate people on how to handle pigs and cook pork safely” (FGD 9, male pig farmer). This highlights that One Health implementation requires integration not only at the institutional level but also through community-linked preventive practices.

Both KII and FGD participants further emphasized the need for structured joint planning, improved resource sharing, and clearer coordination mechanisms across veterinary and public health departments at county and sub-county levels. Strengthening these institutional linkages was seen as essential for improving communication, surveillance, and translating One Health from policy into coordinated implementation. Local NGOs and grassroots initiatives were also identified as potential complementary actors for extending awareness and outreach in rural communities.

Overall, findings indicate that while One Health is conceptually recognized within existing policy structures, its practical implementation in Busia County remains limited. The main gap is not the absence of policies, but weak intersectoral operational integration and insufficient local enforcement capacity, which together reduce the effectiveness of existing control measures. Integrated One Health approaches have similarly been recommended for porcine cysticercosis control in endemic areas [18,19,20,42,45,66].

Although this study is specific to Busia County, the findings may be transferable to other endemic settings with similar contexts. However, differences in socio-cultural practices, health system capacity, and regulatory enforcement may influence how these findings translate to other contexts. As such, the results should be interpreted within their local context while recognizing their relevance to comparable settings.

4. Conclusions

This study highlights that porcine cysticercosis transmission in Busia County is driven by an interplay of behavioural, environmental, and systemic factors. These include inadequate meat inspection capacity, limited knowledge on disease transmission, poor hygiene and sanitation practices, inconsistent de-worming, and the persistence of free-range and tethering pig production systems. Together, these conditions reflect broader livelihood constraints, weak veterinary service delivery, and gaps in regulatory enforcement, which collectively sustain infection risk at the human–animal–environment inter-face.

A key gap identified was the lack of an integrated control strategy in the study area, where current interventions primarily target isolated aspects of the problem, such as meat inspection, without addressing the broader range of behavioural and structural drivers. Additionally, although regulating frameworks governing free-range pig farming exist, weak enforcement mechanisms contribute to the persistence of transmission risk. Addressing these challenges requires coordinated, context-specific, and multidisciplinary interventions. Priority areas include strengthening veterinary and meat inspection services, improving access to affordable pig feed and housing options, and implementing sustained community education on safe pig management, hygiene, and pork handling. Improving sanitation infrastructure and supporting feasible and culturally appropriate behaviour change initiatives are also critical, particularly in resource-limited rural settings. Effective control further depends on strengthened intersectional collaboration between public health and veterinary sectors through the operationalization of the One Health approach at county and sub-county levels.

Overall, the findings underscore that controlling porcine cysticercosis requires moving beyond isolated sectoral actions toward integrated, system-level strategies that address both structural constraints and everyday farming practices. While this study is grounded in Busia County, these insights are likely applicable to other similar endemic settings where smallholder pig production systems and limited-service delivery structures prevail.

5. Limitation

This study has several limitations that should be considered when interpreting the findings. Data collection was conducted over an extended period (2019–2022), with key informant interviews (KIIs) carried out between November 2019 and December 2021 and focus group discussions (FGDs) conducted in June 2022. The non-simultaneous nature of these data sources may have introduced temporal bias, as participant perspectives captured at different time points may reflect changing contextual conditions. This is particularly relevant given potential COVID-19-related behavioural changes, which may have influenced reported hygiene behaviours and levels of community awareness over the study period.

Although some participants re-contacted after the pandemic reported broadly consistent perspectives, the possibility of unobserved temporal variation cannot be excluded. As a result, comparisons and convergence across KIIs, FGDs, and observations should be interpreted with caution, particularly in relation to evolving contextual conditions over the study period.

The use of purposive sampling in the selection of study sites and participants in FGDs may have introduced selection bias, as participants who were more accessible or engaged may have been more likely to participate, potentially limiting the representation of less visible or marginalized groups. While this approach ensured inclusion of information-rich cases, findings should be interpreted in relation to the specific porcine cysticercosis risk context of the selected sub-counties, and may not be directly transferable to settings with different epidemiological profiles.

Social desirability bias may also have influenced responses, particularly in discussions related to sanitation, hygiene practices, and pig management behaviours, where respondents may have overreported socially acceptable practices.

FGDs were conducted in local languages and translated into English, which may have resulted in partial loss of nuance despite efforts to ensure accuracy during transcription and translation. Hence, the interpretation of the study findings should be considered in light of these limitations.