“I will not accept to bury my pig”: Taenia solium, WASH, and gender roles in the smallholder pork value chain in Southern Province, Rwanda

Taenia solium is a zoonotic cestode and the causative agent of human taeniasis/cysticercosis and porcine cysticercosis. The burden in Rwanda is significant, including death and disability in people and income losses across the pork sector. Despite widespread recognition on the need for multi-sectoral and inclusive T. solium control programming, little is known about water, sanitation and hygiene (WASH) access and gendered disease exposure among rural smallholders involved in the formal and informal pork sectors. This study aimed to characterize gender roles and WASH access in the Nyamagabe District (Southern Province) pork value chain (PVC) to better inform future interventions for disrupting T. solium transmission. We conducted Focus Group Discussions with 23 men and 21 women across five nodes of the PVC (farmers, animal health workers, butchers, vendors, consumers) and interviewed six key informants. Audio-recordings were transcribed verbatim, translated into English and coded as part of inductive thematic analysis. PVC participants identified numerous biosecurity gaps in the Nyamagabe PVC, such as free-range pig production, re-use of human waste, lack of prevention services (deworming, vaccination), informal slaughter, and consumption of infected and/or undercooked pork. Traditional gender roles were prevalent, with women managing domestic roles related to pig husbandry and men managing roles related to building pens, buying/selling pigs and slaughtering/butchering. Water and sanitation facilities were frequently inadequate, causing serious lapses in human and pig hygiene. Participants identified poverty as a major barrier for implementing T. solium control but demonstrated enthusiasm for receiving information and resources to support this goal. Altogether, these findings support the need for One Health programming to reduce the burden of T. solium and other zoonotic diseases in people and pigs in Rwanda. Gendered norms among rural smallholders indicated a need for gender transformative information campaigns targeting specific recipients along the PVC nodes.Author summary: Taenia solium is a parasitic tapeworm that infects both people and pigs. This parasite is a serious concern due to human morbidity and mortality among infected people, and income losses to pig producers. Burden reduction requires a One Health approach, improving water and sanitation access, deworming people and pigs, educating stakeholders, and improving biosecurity measures. However, rural smallholder pig farmers often lack such services. Our study aimed to understand how men and women’s roles differed along five nodes of a rural pork value chain in Southern Rwanda and to characterize their access to water and sanitation. We hosted Focus Group Discussions with male and female farmers, animal health workers, butchers, vendors, consumers (n = 44) as well as various key informants (n = 6). We learned that women primarily cared for pigs while men built pens, slaughtered pigs and controlled finances. Key biosecurity gaps among rural smallholders included allowing pigs to eat human waste, evading veterinary inspection during slaughter, lack of pig deworming/vaccination services, and consuming undercooked pork from infected pigs. Poverty and poor access to water and sanitation impeded efforts to control T. solium. Altogether, this indicates the need for gendered community education and multidisciplinary veterinary public health solutions for pork value chain actors.