A mixed methods study of zootherapy practices and associated risks for zoonotic disease spillover in Rwanda

Abstract Background Zootherapy, the use of animals for human medicine and related cultural purposes, is an important component of traditional medicine, which is used by 80% of the global population. Human-animal interaction within zootherapy practices is a potential pathway for zoonotic disease spillover, and understanding these interactions is integral to the One Health approach. The objectives of this study were to assess and document zootherapy practices in Rwanda and identify sociocultural factors driving zootherapy use. Methods Using a mixed methods approach, 12 traditional healers were interviewed, 11 focus group discussions with community members were held, and 75 people were surveyed in 4 sectors of the Nyagatare District, Rwanda. Methods of preparation and administration of zootherapies were detailed and analyzed, highlighting methods that pose a risk for zoonotic transmission and calculating salience and fidelity levels. The demographic, educational, and cultural factors that shape human-animal interactions in Rwanda were evaluated via thematic analysis and chi-squared testing. Results This study identified 60 animal species used in zootherapy, including high-risk taxa for zoonoses, for a total of 336 zootherapeutic practices divided into 273 medical uses and 63 cultural uses. Of the survey participants, 57.1% reported the use of traditional medicine involving zootherapies, indicating that the general population partakes in self-treatment using animal parts/products. Cattle, the species identified as most salient by traditional healers, were used in the greatest number of zootherapies and were rated as the most important by focus group discussion participants. There is a significant relationship between sex and knowledge of zoonotic disease, with men more likely to declare knowledge of zoonotic disease (p = 0.0095). Preparation and administration methods are highly variable and generate diverse opportunities for zoonotic spillover. Across the survey and key informant populations, 85.1% indicated knowledge of zoonotic disease but nearly all participants had a desire to learn more about disease prevention. Conclusions Zootherapy use is a potential pathway for zoonotic spillover due to high-risk behaviors dictating usage. Interventions aimed at mitigating zoonoses should consider the risk of zootherapy practices and create policies that take into account sociocultural contexts.