Perceived Causes, Diagnosis and Treatment of Babesiosis and Anaplasmosis in Cattle by Livestock Farmers in Communal Areas of the Central Eastern Cape Province, South Africa

INTRODUCTION Extension officers serving in the rural areas of central Eastern Cape Province identify tick-borne diseases, including gallsickness (anaplasmosis), redwater (babesiosus) and heartwater (cowdriosis), as the secondmost important cause of morbidity and mortality amongst cattle in communal areas, malnutrition being the main cause. Several authors have reported that small-scale livestock farmers in the central Eastern Cape perceive redwater and gallsickness to be problem diseases in cattle

Kwabhonke (Zwelitsha district), and Tshabo and Dongwe (Mdantsane district).None of the respondents to the questionnaire had previously participated in the RRA meetings or semi-structured interviews.The questionnaire survey constituted the 3rd phase of the investigation.It enabled the authors to obtain quantitative data, free of bias introduced by group dynamics, which may affect similar data obtained using RRA techniques 6 .Responses to the questionnaire were analysed using the computer programme NWA Statpak, version 3.2 (North West 2 Analytical, Portland, Oregon).Potential respondents to the questionnaire were identified as being owners of high and densely-woven holding pens.Experience had shown that such holding pens were used almost exclusively for cattle.The owners of these holding pens were visited individually, and asked if they were willing to respond to the questionnaire.In each of the 5 target areas this procedure was repeated until 12 responses had been obtained.The survey was conducted during October and November 1995.The data presented below refer to the questionnaire survey only.

Main causes of cattle mortality as perceived by livestock owners
The most important causes of cattle mortality identified by farmers are shown in Fig. 2. Farmers regard diseases as the main cause of mortalities, followed by hunger, because most livestock are lost during drought periods, when food supply is limited.Farmers report diseases, especially tick-borne diseases, to have the greatest impact during spring and summer and much less impact during autumn and winter.The converse applies for droughtrelated hunger, which is most prominent during the dry winter season, when availability of herbage reaches a low, often exacerbated by the practice of winter veld burning.

Most common cattle diseases as perceived by livestock owners
Livestock owners perceive tick-borne diseases in cattle to be of major importance, especially gallsickness and redwater, but not heartwater (Fig. 3).This may be due to the prevalence of the clinically inapparent form of heartwater, which is difficult to diagnose under field conditions 1 , or because farmers do not know the presenting signs of this disease in cattle.It is also possible that cattle in the communal areas have well-developed immunity against heartwater, and a state of endemic stability may prevail, which would result in few clinical cases being observed.
Most farmers believe redwater and gallsickness to occur simultaneously in the same animal.Concurrent infections of anaplasmosis and babesiosis may occur 17 , but are not the norm.
Farmers use the term 'gallsickness' for a range of ailments associated with one or more of the following conditions: jaundice, distension of the gallbladder with bile, and lesions of the liver.At times diseases such as redwater, heartwater and mixed infections of these diseases are all referred to as 'gallsickness' 11 .As a result incorrect diagnoses are thought to be common.

Perceived causes of gallsickness and redwater
Most farmers in the communal areas associate the occurrence of gallsickness (anaplasmosis), an arthropod-borne rickettsial disease 17 , and redwater (babesiosis), a tick-borne protozoan disease 8 , with a range of other causes, as shown in Fig. 4. The majority of respondents stated gallsickness to be caused by excessive consumption of lush green grass, which typically occurs a few weeks after good spring rains have fallen.Only 2 % of the respondents identified ticks as the cause of gallsickness in cattle.Relating gallsickness to eating of grass is not as far-fetched as it may at first glance appear.Many years ago a similar case occurred in England, where farmers thought that abortion in their ewe flocks was connected with the presence of carrion crows 10 .Farmers then perceived abortions to be caused by the birds frightening the sheep.It is now known that sheep may abort because of infection with the bacterium Vibrio fetus, and that this organism is often found in the intestines of crows.As a result, these birds may be the source of infection in isolated flocks of sheep 10 , and thus indirectly involved in causing abortion.A similar indirect relationship exists between lush growth of grass and the occurrence of anaplasmosis.In central Eastern Cape Province, most active growth of grass occurs during the period October to March, when the availability of soil water reaches a maximum 13 , and temperatures are sufficiently high to permit rapid leaf and stem elongation 7 .The period of active growth of grass coincides with the period during which tick numbers reach a maximum, causing cattle to be exposed to a high tick challenge.Grass provides a suitable microhabitat for ticks to survive and multiply 18 .Low winter temperatures result in synchronisation of egg development and hatching, and warming of the weather during spring results in the presence of high numbers of larvae on the pastures 16 .As a result, the exposure of cattle to a high tick challenge and active growth of grass occur more or less simultaneously.This has led to the perception amongst farmers that eating of lush green grass by cattle results in anaplasmosis.Some of the other perceived causes of gallsickness and redwater are animals eating insects and spiders attached to the grass, especially early in the morning.This is one of the reasons why many livestock farmers do not let their stock out to graze before 9:00-10:00, although fear of predators such as jackals is another reason why animals are released late in the morning.
In the case of redwater, a larger number of farmers (12 %) identified ticks to be associated with the disease than was the case for gallsickness (2 %).The perception of lush green grass consumption as the cause of disease was not as strong for redwater, with only 8 % of respondents associating it with the occurrence of the disease.Failure to vaccinate animals with herbs is thought by 2 % of the respondents to lead to the disease.A large number of farmers (42 %) claim not to know its cause.

Symptoms and diagnosis used by farmers
The majority of livestock owners diagnosed gallsickness and redwater on the basis of presenting signs and on post mortem findings.As has been shown elsewhere in Africa, the knowledge of ethno-veterinarians closely parallels conventional veterinary approaches with respect to the diagnosis of livestock diseases using clinical symptoms and post mortem signs 21 .
Generally, symptoms used by farmers to diagnose redwater are constipation, red urine and loss of appetite.Staggering, moving in circles and head-shaking are taken to be signs of gallsickness.These symptoms form part of a range of signs, namely anaemia, icterus, emaciation and nervous signs for gallsickness, and anorexia, depression, anaemia, icterus and dark urine for redwater, by which the respective infections can be identified 2,12 .In addition to using visual signs, farmers rely on post mortem findings to confirm their diagnosis of redwater and gallsickness.A post mortem examination is not performed for the sake of making a diagnosis, but forms part of dressing the carcass for consumption.Post mortem changes that the farmers associate with redwater are an enlarged gall bladder, bloody urine, yellowish tinge of the carcass and a yellowish and soft liver.In the case of gallsickness, an enlarged gall bladder and yellowish intestines are reported.These post mortem findings are not pathognomonic for gallsickness, but they agree with some of those reported by several authors 2,12,17 .The yellowish tinge of the carcass, which is due to icterus, leads farmers to conclude that excessive bile in the animal's body is the pathogenesis of these diseases.
Despite farmers using red urine to diagnose redwater infection, red urine may be absent in some redwater infections 11 .Nervous signs, for example  hyperexcitability, are used by farmers to diagnose gallsickness, as also reported by Blood et al. 2 , but redwater patients and patients with acute heartwater also exhibit nervous signs 12 .There is a high probability that such animals suffer from mixed infection, since outbreaks of gallsickness and redwater may occur concurrently 17 .Confirmation of a diagnosis is possible only when clinical signs and post mortem findings are complemented by examination of blood smears and by serological and transmission tests 2 .

Treatment
The majority of respondents (89 %) make use of herbal remedies to treat redwater and gallsickness (60 % of all respondents use a combination of herbal and conventional remedies and 29 % rely on herbal remedies only).Six percent of respondents apply conventional remedies only and 3 % claim never to have treated their cattle for these diseases.A small proportion (2 %) of respondents do not know how to treat these diseases.
Many respondents consider it dangerous to administer both herbal remedies and conventional remedies at the same time, and recommend administering herbal remedies after the conventional remedies.At KwaTyutyu and Koloni, respondents reported cases of deaths that they attributed to simultaneous application of herbal and conventional remedies.
The majority of respondents (60 %) believe that the pathogenesis of redwater and especially gallsickness is due to the accumulation of bile in the body.This perception concurs with the observations by Bryant 4 and Ngubane 14 that perception of the aetiology of many human ailments also determines treatment, and that most common ailments are believed to be caused by an excess of bile, which needs to be removed.As in humans, the treatment given to animals perceived to be suffering from gallsickness and redwater is aimed at removing excess bile from the animal's body and relieving fever and pain (Holani, Stutterheim, pers.comm., 1995 a .An enlarged gall bladder and icterus support the belief that bile accumulates in the bodies of animals suffering from these diseases. The plants most often used to treat redwater and gallsickness vary in their recorded effects.These range from purgative in the case of Teucrium capense, Kedrostis africana, Hypoxis spp. 22and Eucomis undulata 3 , analgesic in the case of Heteromorpha trifoliata (T G Fourie, Noristan, pers.comm., 1995), to antimicrobial e.g.Plectranthus spp.(T G Fourie, Noristan, pers.comm., 1995).Salix capense is recorded to possess anti-pyretic activity 22 .Some of the plant combinations used by farmers appear to be carefully selected.
For example, the use of a combination of Salix spp.and Hypoxis spp.possibly assists in reducing the animal's high body temperature, caused by fever, which is symptomatic of both diseases 8,17 , and in correcting the gastrointestinal disturbances, such as ruminal stasis and constipation, which are typical symptoms of gallsickness 17 .A combination of H.trifoliata, which possesses both anti-inflammatory and analgesic activity (T G Fourie, Noristan, pers.comm., 1995), and Cussonia spicata, which possesses anti-inflammatory activity (T G Fourie, Noristan, pers.comm., 1995), may both relieve pain and stress in the animal.Despite these plants having different activities that could benefit the animals symptomatically, their efficacy against the causative organisms of redwater and gallsickness has not been proven.Several of the plants possessing antimicrobial activity, for example Melia azedarach, Olea spp., Tulbaghia alliaceae 22 and Plectranthus spp.(T G Fourie, Noristan, pers.comm., 1995) may be effective remedies in the treatment of these tick-borne diseases.

CONCLUSION
Tick-borne diseases, especially redwater and gallsickness, are present in the study area, and are considered by local farmers to be the main infectious causes of cattle mortalities.Although heartwater, another tick-borne disease, is said to be prevalent in the area, farmers consider it less impor-a Holani from Kubusi, Stutterheim, is one of the herbalists that participated in the study.tant, especially in cattle.Redwater and gallsickness are perceived to be caused by eating of green grass, especially at the beginning of the rainy season in spring, but very few farmers associate ticks with the 2 diseases.A lack of understanding of the causes and transmission of gallsickness and redwater, leading to ill-directed treatment and widespread deviation from the directions of use when administering conventional medicines, are problems that could be addressed by farmer training and supplying appropriate information.
The majority of farmers use herbal remedies to treat their cattle, most often in combination with conventional drugs.Some of the plants used in the preparation of herbal remedies are known to produce certain beneficial effects, and the combination of plants used in the remedies indicates that farmers possess intimate knowledge of the activities of plants.It follows that verification of the effectiveness of the different herbal remedies used by farmers to treat gallsickness and redwater may yield useful results.Little has been published on the efficacy of ethnoveterinary remedies and practices.There is a need for further analysis in order to identify, select and test practices that may be suitable for development as effective remedies.
Training of farmers and ensuring the availability of appropriate information enabling farmers to obtain good understanding of the causes and treatment of diseases prevalent in their areas, is an important task that could be undertaken by governmental extension services and other agents active in communal areas.
This in turn will enable farmers to realise better economic returns from their livestock enterprises.

Fig. 1 :
Fig. 1: Map of South Africa (top) showing the location of the Eastern Cape Province and the former homelands of Transkei and Ciskei, and the districts and locations where the study was conducted (bottom).

Fig. 3 :
Fig. 3: Most common diseases of cattle as perceived by farmers.