{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T01:52:52Z","timestamp":1781056372416,"version":"3.54.1"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Vet. Sci."],"abstract":"<jats:p>From 2010 to 2017, as part of a wider animal welfare program, The Donkey Sanctuary piloted an integrated, community-based model for the control and prevention of epizootic lymphangitis (EZL) in cart mules in Bahir Dar, Ethiopia. Stakeholders included muleteers, service providers, and transport and animal health regulatory authorities. Interventions included muleteer education, wound prevention, harness improvement, animal health professional training, treatment of early EZL cases, euthanasia for advanced cases, and review of transport services and traffic guidelines. The project followed a participatory project management cycle and used participatory learning and action tools to facilitate stakeholder engagement and ownership. Participatory and classical epidemiology tools were employed to raise and align stakeholder understanding about EZL for effective control and prevention and to evaluate the progress impact of the model through annual prevalence surveys. During the intervention, the annual prevalence of EZL reduced from 23.9% (102\/430) (95%CI: 19.8%\u221227.0%) in 2010 to 5.9% (58\/981) (95% CI: 4.4%\u22127.4%) in 2017, and wound prevalence from 44.3% in 2011 to 22.2% in 2017; trends in the reduction of the prevalence maintained in the face of a mule population that increased from 430 in 2010 to ~1,500 in 2017. While non-governmental organization (NGO)-led interventions can facilitate change by trialing new approaches and accessing new skills and resources, sustainable change requires community ownership and strengthening of service provision systems. To this effect, the project raised muleteer competence in mule husbandry and EZL prevention strategies; strengthened veterinary competence; facilitated more mule-friendly traffic, transport, and waste disposal guidelines and practices; supported mule-community bylaws to control EZL; and established a supportive network between stakeholders including trusting relationships between muleteers and veterinary services. To advance the intervention model in other endemic areas, we recommend elucidation of local epidemiological factors with other stakeholders prior to the intervention, early engagement with veterinary and transport service regulatory authorities, early development of bylaws, exploration of compensation or insurance mechanisms to support euthanasia of advanced cases, and additional social, economic, and epidemiological investigations. In line with the OIE Working Equid Welfare Standards, we suggest that integrated community-based interventions are useful approaches to the control and prevention of infectious diseases.<\/jats:p>","DOI":"10.3389\/fvets.2021.648267","type":"journal-article","created":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T05:23:42Z","timestamp":1636694622000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Control and Prevention of Epizootic Lymphangitis in Mules: An Integrated Community-Based Intervention, Bahir Dar, Ethiopia"],"prefix":"10.3389","volume":"8","author":[{"given":"Bojia E.","family":"Duguma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tewodros","family":"Tesfaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmamaw","family":"Kassaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anteneh","family":"Kassa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Blakeway","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,11,12]]},"reference":[{"key":"B1","article-title":"Agricultural Sample Survey 2020\/21. Statistical Bulletin 589, Vol. 2 Report on Livestock and Livestock Characteristics (Private Peasant Holdings)","year":"2021"},{"key":"B2","unstructured":"The contribution of livestock to the Ethiopian economy - Part II, IGAD LPI Working Paper N\u00b0 2\u201311, Djibouti(2011)\n            BehnkeR\n            FitawekeM\n          p. 20-22"},{"key":"B3","unstructured":"9394\n            OchiengF\n            AlemayahuM\n            SmithD\n          Improving the productivity of donkeys in Ethiopia2004"},{"key":"B4","unstructured":"The welfare issues of working equine in Ethiopia: a review8290\n            TemesgenZ\n            SitotaT\n          Europ J Biol Sci.112019"},{"key":"B5","unstructured":"Population total \u2013 Ethiopia (1995-2019)"},{"key":"B6","unstructured":"BekeleH\n            TeshomeW\n            NahomW\n            LegesseG\n          Socioeconomic impact of epizootic lymphangitis in cart mules in Bahir Dar city, North West Ethiopia (Conference presentation)2014"},{"key":"B7","doi-asserted-by":"publisher","first-page":"98","DOI":"10.5829\/idosi.aejsr.2014.9.4.21802","article-title":"Injuries in donkeys and mules: causes, welfare problems and management practices in Amhara Region, Northern Ethiopia","volume":"9","author":"Fentie","year":"2014","journal-title":"Am-Euras J Sci Res"},{"key":"B8","unstructured":"Study On Welfare Assessment of Cart Pulling Mule in Bahir Dar Town, Northwest Ethiopia7386\n            DressieD\n            TemesgenW\n            YenewM\n          Rep Opinion.92017"},{"key":"B9","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1136\/vr.j5561","article-title":"We must tie equine welfare to international development","volume":"181","author":"Perry","year":"2017","journal-title":"Veterinary Record."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4172\/2157-7579.1000509","article-title":"Prevalence of epizootic lymphangitis and bodily distribution of lesions in cart-mules in Bahir Dar town, northwest Ethiopia","volume":"9","author":"Meselu","year":"2018","journal-title":"J Vet Sci Technol."},{"key":"B11","unstructured":"Assessment of carting equine welfare and management practice in Bahir Dar town100112\n            SolomonT\n            MussieHM\n            FanayeS\n          Int J Adv Res Biol Sci32016"},{"key":"B12","doi-asserted-by":"publisher","first-page":"4146","DOI":"10.5897\/AJMR11.1475","article-title":"Seroprevalence and risk factors of African Horse Sickness in mules and donkeys in selected sites of West Amhara Region, Ethiopia","volume":"6","author":"Mulualem","year":"2012","journal-title":"Afr J Microbiol Res."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1007\/s11250-016-1121-7","article-title":"The prevalence of lameness and associated risk factors in cart mules in Bahir Dar, Ethiopia","volume":"48","author":"Ali","year":"2016","journal-title":"Trop Anim Health Prod."},{"key":"B14","doi-asserted-by":"publisher","first-page":"13","DOI":"10.4314\/evj.v17i1.2","article-title":"Prevalence of gastrointestinal helminthes of donkeys and mules in and around Bahir Dar, Ethiopia","volume":"17","author":"Takele","year":"2013","journal-title":"Ethiop Vet J."},{"key":"B15","doi-asserted-by":"publisher","first-page":"673442","DOI":"10.3389\/fvets.2021.673442","article-title":"Estimating the economic impact and assessing owners' knowledge and practices of epizootic lymphangitis in equine cart animals in Central and South Gondar Zones, Amhara Region, Ethiopia","volume":"8","author":"Molla","year":"2021","journal-title":"Front Vet Sci."},{"key":"B16","doi-asserted-by":"publisher","first-page":"135","DOI":"10.4142\/jvs.2002.3.2.135","article-title":"Study on histoplasmosis (epizootic lymphangitis) in cart-horses in Ethiopia","volume":"3","author":"Amenil","year":"2002","journal-title":"J Vet Sci."},{"key":"B17","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.prevetmed.2004.09.008","article-title":"cross-sectional study of epizootic lymphangitis in cart-mules in Western Ethiopia","volume":"66","author":"Ameni","year":"2004","journal-title":"Prev Vet Med."},{"key":"B18","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.tvjl.2005.02.025","article-title":"Epidemiology of equine histoplasmosis (epizootic lymphangitis) in carthorses in Ethiopia","volume":"172","author":"Ameni","year":"2006","journal-title":"Vet J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1294\/jes.18.1","article-title":"Pathology and clinical manifestation of epizootic lymphangitis in cart mules in Ethiopia","volume":"18","author":"Ameni","year":"2007","journal-title":"J Equine Sci."},{"key":"B20","unstructured":"Comparative studies on the occurrence and distribution of Epizootic lymphangitis and Ulcerative lymphangitis in Ethiopia219222\n            EndebuB\n            RogerF\n          Int J Appl Res Vet Med.12003"},{"key":"B21","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.prevetmed.2015.03.012","article-title":"Participatory appraisal of the impact of Epizootic lymphangitis in Ethiopia","volume":"120","author":"Scantlebury","year":"2015","journal-title":"Prev Vet Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"59","DOI":"10.7358\/rela-2014-001-blak","article-title":"The multi-dimensional donkey in landscapes of donkey-human interaction","volume":"2","author":"Blakeway","year":"2014","journal-title":"Relat Beyond Anthropocentrism."},{"key":"B23","unstructured":"Promoting pack mule welfare on expedition146\n            CousquerG\n          Prof Mountaineer92015"},{"key":"B24","volume-title":"Knowing the mule: Faring well in Moroccan mountain tourism","author":"Cousquer","year":"2018"},{"key":"B25","first-page":"126","volume-title":"Donkeys and mules and tourism","author":"Blakeway","year":"2018"},{"key":"B26","first-page":"397","volume-title":"Epizootic lymphangitis.","author":"Scantlebury","year":"2009"},{"key":"B27","doi-asserted-by":"publisher","first-page":"691","DOI":"10.20506\/rst.18.3.1186","article-title":"Epizootic lymphangitis in horses: a review of literature","volume":"18","author":"Al-Ani","year":"1999","journal-title":"Rev Sci Tech Off Int Epiz"},{"key":"B28","unstructured":"Epizootic lymphangitis. In: Kahn CM, Line S, Aiello SE, editors\n            TaboadaJ\n          Whitehouse Station, NJMerck and CoThe Merck veterinary manual.2018"},{"key":"B29","first-page":"p. 284","volume-title":"Essentials of Veterinary Bacteriology and Mycology","author":"Carter","year":"1991"},{"key":"B30","article-title":"Clinical trial of iodides combined with ancillary treatment on Epizootic lymphangitis in cart horses at Debre Zeit and Akaki towns","author":"Getachew","year":"2004","journal-title":"Faculty Vet Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1016\/S2221-1691(12)60086-0","article-title":"Evaluation of berries of Phytolacca dodecandra for growth inhibition of Histoplasma capsulatum var. farciminosum and treatment of cases of epizootic lymphangitis in Ethiopia","volume":"2","author":"Mekonnen","year":"2012","journal-title":"Asian Pacific J Trop Biomed."},{"key":"B32","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1016\/j.tvjl.2006.06.003","article-title":"Epizootic lymphangitis: the impact on subsistence economies and animal welfare","volume":"172","author":"Jones","year":"2006","journal-title":"Vet J."},{"key":"B33","unstructured":"Review on equine Epizootic lymphangitis and its impact in Ethiopia18\n            TagesuA\n          J Vet Med Res.42017"},{"key":"B34","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1136\/vr.i2888","article-title":"Veterinary anthropology explored","volume":"178","author":"Gardiner","year":"2016","journal-title":"Vet Rec"},{"key":"B35","first-page":"p. 368","article-title":"Community-based animal healthcare: a practical guide to improving primary veterinary services","author":"Catley","year":"2002"},{"key":"B36","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/s0167-5877(01)00171-4","article-title":"Community participation and the delivery of veterinary services in Africa","volume":"49","author":"Catley","year":"2001","journal-title":"Prev Vet Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.tvjl.2011.03.010","article-title":"Participatory epidemiology: approaches, methods, experiences","volume":"191","author":"Catley","year":"2012","journal-title":"Vet J."},{"key":"B38","doi-asserted-by":"publisher","first-page":"532763","DOI":"10.3389\/fvets.2020.532763","article-title":"Participatory Epidemiology: principles, practice, utility, and lessons learnt","volume":"7","author":"Alders","year":"2020","journal-title":"Front Vet Sci."},{"key":"B39","unstructured":"Admassu, B. Community participation and the global eradication of rinderpest2933\n            MarinerJ\n            RoederP\n          PLA Notes.452002"},{"key":"B40","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1126\/science.1223805","article-title":"Rinderpest eradication: appropriate technology and social innovations","volume":"337","author":"Mariner","year":"2012","journal-title":"Science."},{"key":"B41","doi-asserted-by":"publisher","first-page":"20120139","DOI":"10.1098\/rstb.2012.0139","article-title":"Rinderpest: the veterinary perspective on eradication","volume":"368","author":"Roeder","year":"2013","journal-title":"Philos Trans R Soc Lond B Biol Sci."},{"key":"B42","doi-asserted-by":"publisher","first-page":"468","DOI":"10.3390\/w11030468","article-title":"Statistical assessment of rainfall characteristics in Upper Blue Nile Basin over the period from 1953 to 2014","volume":"11","author":"Samy","year":"2019","journal-title":"Water."},{"key":"B43","unstructured":"HartT, Burgess, R,.\n            Beukes OHart C..\n          2005"},{"key":"B44","unstructured":"2005"},{"key":"B45","unstructured":"Using stakeholder and power analysis and BCPs in multi-stakeholder processes18492\n            BrouwerJH\n            HiemstraW\n            MartinP\n          PLA Notes652012"},{"key":"B46","unstructured":"MichaelT\n            MatthewT\n            WilburL\n          InAAEP \u2013 Proceedings,A systematic approach to estimating the age of a horse.1999"},{"key":"B47","first-page":"p. 258","article-title":"Body Scoring","volume-title":"The Clinical Companion of the Donkey","year":"2018"},{"key":"B48","volume-title":"Survey research methods","author":"Fowler","year":"2009"},{"key":"B49","doi-asserted-by":"crossref","DOI":"10.1002\/9781118280249","volume-title":"Veterinary Epidemiology, 4th Ed","author":"Thrusfield","year":"2018"},{"key":"B50","unstructured":"RRA Notes 20: Livestock"},{"key":"B51","unstructured":"PLA Notes\n            IIED2013"},{"key":"B52","unstructured":"Planning tools: Problem Tree Analysis2009"},{"key":"B53","unstructured":"Lameness and associated risk factors in cart mules in Northwestern Ethiopia86977\n            MeseretB\n            MershaC\n            TewodrosT\n            AntenehK\n            BekeleM\n            NahomW\n          Global Veterinaria.122014"},{"key":"B54","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.prevetmed.2005.02.002","article-title":"Assessment of the welfare of working horses, mules and donkeys, using health and behaviour parameters","volume":"69","author":"Pritchard","year":"2005","journal-title":"Prev Vet Med."},{"key":"B55","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1186\/s12917-020-02582-2","article-title":"al. Epidemiology of epizootic lymphangitis of carthorses in northern Ethiopia using conventional diagnostic methods and nested polymerase chain reaction","volume":"16","author":"Hadush","year":"2020","journal-title":"BMC Vet Res"},{"key":"B56","first-page":"264","article-title":"Prevalence of work related wound and associated risk factors in cart mules of Adet town, North-Western Ethiopia","volume":"10","author":"Seyoum","year":"2015","journal-title":"Am-Euras J Sci Res"},{"key":"B57","unstructured":"Public-private partnerships (PPPs) for veterinary service delivery in Ethiopia\n            GizawS\n            BerhanuD\n          Nairobi, KenyaILRI2019"},{"key":"B58","first-page":"256","volume-title":"Epizootic lymphangitis in cart mules: a community-based clinical trial in Bahir Dar, north-west Ethiopia","author":"Worku","year":"2010"},{"key":"B59","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s11250-007-9099-9","article-title":"Equine histoplasmosis: treatment trial in cart horses in Central Ethiopia","volume":"40","author":"Hadush","year":"2008","journal-title":"Trop Anim Health Prod."},{"key":"B60","volume-title":"Veterinary Medicine: A Textbook of the Diseases of Cattle","author":"Radostits","year":"2007"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-22448\/v1","article-title":"The concept and methods of community participation in animal and human disease surveillance","author":"Waziri","year":"2020","journal-title":"Res Square."},{"key":"B62","doi-asserted-by":"publisher","first-page":"601878","DOI":"10.3389\/fvets.2021.601878","article-title":"Animal health service delivery in crop-livestock and pastoral systems in Ethiopia","volume":"8","author":"Gizaw","year":"2021","journal-title":"Front Vet Sci."},{"key":"B63","volume-title":"Africa's Changing Markets for Health and Veterinary Services: The New Institutional Issues","author":"Leonard","year":"2000"},{"key":"B64","author":"Leonard","year":""},{"key":"B65","unstructured":"Invisible Workers: The Economic Contributions of Working Donkeys, Horses and Mules to Livelihoods\n            ValetteD\n          2015"}],"container-title":["Frontiers in Veterinary Science"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fvets.2021.648267\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T05:23:55Z","timestamp":1636694635000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fvets.2021.648267\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,12]]},"references-count":65,"alternative-id":["10.3389\/fvets.2021.648267"],"URL":"https:\/\/doi.org\/10.3389\/fvets.2021.648267","relation":{},"ISSN":["2297-1769"],"issn-type":[{"value":"2297-1769","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,12]]},"article-number":"648267"}}