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Rift Valley fever and invisible women

Published online by Cambridge University Press:  04 June 2025

A response to the following question: How can we improve and facilitate multi-sectoral collaboration in warning and response systems for infectious diseases and natural hazards to account for their drivers, interdependencies and cascading impacts?

Luke O’Neill Open the ORCID record for Luke O’Neill [Opens in a new window] ,
Simon Gubbins ,
Christian Reynolds ,
Kyriaki Giorgakoudi  and
Georgina Limon
Luke O’Neill*
Affiliation:
HSRM Department, School of Health and Psychological Sciences, City University of London, London, UK The Pirbright Institute, Pirbright, UK
Simon Gubbins
Affiliation:
The Pirbright Institute, Pirbright, UK
Christian Reynolds
Affiliation:
HSRM Department, School of Health and Psychological Sciences, City University of London, London, UK
Kyriaki Giorgakoudi
Affiliation:
HSRM Department, School of Health and Psychological Sciences, City University of London, London, UK
Georgina Limon
Affiliation:
The Pirbright Institute, Pirbright, UK
*
Corresponding author: Luke O’Neill; Email: Luke.oneill@citystgeorges.ac.uk
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Abstract

Public health interventions often neglect gender disparities. This perspective paper highlights the gendered risks using Rift Valley fever (RVF), a vector-borne zoonotic disease, as a case study, and discuss how gender inequality in RVF disease surveillance and control might impact women’s health. Most of the literature focuses on RVF exposure in males due to certain occupational roles being male dominated and neglects women’s varied responsibilities in livestock care. RVF-focused studies often lack sex-aggregated data, hindering our understanding of the gendered differences in RVF risk. Social and cultural norms limit women’s autonomy in livestock ownership, vaccination decisions and healthcare access. Therefore, there is a lack of gender-based policy for the prevention and control of RVF. To tackle the issues of gender inequality in disease surveillance and control, we need to integrate gendered considerations into RVF research design and analysis. This can lead to development of gender-responsive interventions for improved knowledge dissemination and access to veterinary care for women livestock keepers. Intervention programmes involving women (such as the We Rear Programme) have led to positive changes in social and cultural norms, resulting in greater access to markets and veterinary care for female farmers. Gender inequality in RVF disease surveillance compromises women’s health and the health of their livestock. Urgent action is required to bridge the knowledge gaps highlighted in this paper and develop equitable interventions for a One Health approach to the control of RVF.

Keywords

Rift Valley feverone healthgenderdisease surveillanceepidemiology

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Impact Paper
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Research Directions: One Health , Volume 3 , 2025 , e7
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Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited
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© The Author(s), 2025. Published by Cambridge University Press

Introduction

Livestock are of vital importance to communities globally and are the primary income for approximately 70% of the 1.4 billion extremely poor. Of these it is estimated 600 million subsistence livestock farmers globally and approximately two thirds of these are women (MacVicar, Reference MacVicar2020). It has been estimated that women contribute 40% of the agricultural labour force in Africa, though this is much higher in some countries, such as in Tanzania where women are thought to contribute 53% of the agricultural labour force (Palacios-Lopez et al., Reference Palacios-Lopez, Christiaensen and Kilic2017). Gender inequality within the wider food system is estimated to be responsible for a loss of 11% of Africa’s total wealth, and livestock plays a crucial role in rural women’s lives (Breisinger et al., Reference Breisinger, Keenan, Mbuthia and Njuki2023). For subsistence farmers livestock are critical for their survival because livestock generate income, a store of wealth and provide nutritional security. Women in particular face many challenges, including lack of access to agricultural extension services, aid, markets, and smallholder-focused policies (Gannaway et al., Reference Gannaway, Majyambere, Kabarungi, Mukamana, Niyitanga, Schurer, Miller and Amuguni2022; E. Mutua et al., Reference Mutua, De Haan, Tumusiime, Jost and Bett2019). These gendered disparities in access and support also mean that women are more vulnerable to shocks that affect livestock health and productivity.

Despite the economic importance of livestock, many rural subsistence farmers do not reach maximum productivity due to high mortality and morbidity rates due to infectious disease epidemics (Mukamana et al., Reference Mukamana, Rosenbaum, Schurer, Miller, Niyitanga, Majyambere, Kabarungi and Amuguni2022), such as Rift Valley Fever. Rift Valley fever (RVF) is a zoonotic vector-borne disease that has severe economic impacts, affects livestock productivity and survival and is a threat to human health (Nanyingi et al., Reference Nanyingi, Munyua, Kiama, Muchemi, Thumbi, Bitek, Bett, Muriithi and Njenga2015; Clark et al., Reference Clark, Warimwe, Di Nardo, Lyons and Gubbins2018). RVF can cause abortion storms and high mortality rates in livestock (Himeidan, Reference Himeidan2016; Clark et al., Reference Clark, Warimwe, Di Nardo, Lyons and Gubbins2018; Wright et al., Reference Wright, Kortekaas, Bowden and Warimwe2019; McMillen and Hartman, Reference McMillen and Hartman2021), leading to major economic impacts felt by farmers. Abortion storms refer to the sudden increase of abortions within a herd due to disease. Spillover to humans can occur via mosquito bites or close contact with infected materials, such as aerosol spray of blood or ingestion of unpasteurised milk (Clark et al., Reference Clark, Warimwe, Di Nardo, Lyons and Gubbins2018; Wright et al., Reference Wright, Kortekaas, Bowden and Warimwe2019). In human’s symptoms are often non-specific and can lead to misdiagnosis. A small proportion of cases progress onto the haemorrhagic phase of the disease, which has a significantly higher fatality rate (Javelle et al., Reference Javelle, Lesueur, Pommier De Santi, De Laval, Lefebvre, Holweck, Durand, Leparc-Goffart, Texier and Simon2020; Bron et al., Reference Bron, Strimbu, Cecilia, Lerch, Moore, Tran, Perkins and Ten Bosch2021; Chambaro et al., Reference Chambaro, Hirose, Sasaki, Libanda, Sinkala, Fandamu, Muleya, Banda, Chizimu, Squarre, Shawa, Qiu, Harima, Eshita, Simulundu, Sawa and Orba2022).

Given women’s vital but often under-recognised roles in livestock production, they are disproportionately affected by disease outbreaks (Mukamana et al., Reference Mukamana, Rosenbaum, Schurer, Miller, Niyitanga, Majyambere, Kabarungi and Amuguni2022; Byers et al., Reference Byers, Robinson, Hollmann, Ezeocha, Smith and Bukachi2025). Yet the gendered impacts of livestock diseases remain understudied. This is especially concerning for diseases like RVF, which, impacts livestock productivity but also threatens human health, livelihoods, and food security. Understanding how these impacts differ by gender is critical to designing equitable and effective public health and veterinary responses.

The aim of this perspective paper is to use Rift Valley fever as a case study to explore how gender inequality in relation to infectious diseases poses obstacles to the safety and wellbeing of women. It extends discussion of the results on gender identified as part of a rapid review of the literature on the socioeconomic impacts of RVF (O’Neill et al., Reference O’Neill, Gubbins, Reynolds, Limon and Giorgakoudi2024). To complement this previous academic literature review we searched the Overton policy database (https://overton.io/) and the Lens database to identify additional grey literature and policy reports. Neither search identified any relevant policy or civil society documents that explicitly mentioned these issues.

Gender disparity of exposure in occupational health

Epidemiological studies of RVF generally focus on animal infections and individuals in close contact with animals. Our previous work found no study which directly investigated the risks or impacts associated to RVF and women (O’Neill et al., Reference O’Neill, Gubbins, Reynolds, Limon and Giorgakoudi2024). Of the 17 epidemiological studies (out of 93 studies identified in our previous work) (Table 1), 11 studies had a bias towards male participants with an average of 67% male participants (range 57%–93% male). Women are grouped together under the occupation of housewife. As women have varied responsibilities, beyond household duties, including preparation of food/ animal products, tending to the young and sick livestock, and milking responsibilities (E. Mutua et al., Reference Mutua, De Haan, Tumusiime, Jost and Bett2019; Nyangau et al., Reference Nyangau, Nzuma, Irungu and Kassie2021), this classification makes it difficult to assess their risk of exposure to RVF.

Table 1.

Presents the participatory studies included in the socio-economic impact of Rift Valley fever: a rapid review and discussed in this perspective paper

1 KAP – knowledge, attitudes and practices.

Previous studies have suggested that men, especially in pastoralist communities, are at a greater risk of RVFV exposure due to the extended periods of time they spend moving their livestock (cattle) between pasture, compared to women and other occupations (Affognon et al., Reference Affognon, Mburu, Hassan, Kingori, Ahlm, Sang and Evander2017; A. Heinrich et al., Reference Heinrich, Saathoff, Weller, Clowes, Kroidl, Ntinginya, Machibya, Maboko, Löscher, Dobler and Hoelscher2012; Archer et al., Reference Archer, Thomas, Weyer, Cengimbo, Landoh, Jacobs, Ntuli, Modise, Mathonsi, Mashishi, Leman, le Roux, Jansen van Vuren, Kemp, Paweska and Blumberg2013; LaBeaud et al., Reference LaBeaud, Pfeil, Muiruri, Dahir, Sutherland, Traylor, Gildengorin, Muchiri, Morrill, Peters, Hise, Kazura and King2015; Ahmed et al., Reference Ahmed, Makame, Robert, Julius and Mecky2018; Bron et al., Reference Bron, Strimbu, Cecilia, Lerch, Moore, Tran, Perkins and Ten Bosch2021; E. N. Mutua et al., Reference Mutua, Bukachi, Bett, Estambale and Nyamongo2017). Other occupations, which are generally male dominated, such as butchers and abattoir workers, are at increased risk of RVFV exposure through close contact with animal blood and bodily fluids (Heinrich et al., Reference Heinrich, Saathoff, Weller, Clowes, Kroidl, Ntinginya, Machibya, Maboko, Löscher, Dobler and Hoelscher2012; Archer et al., Reference Archer, Thomas, Weyer, Cengimbo, Landoh, Jacobs, Ntuli, Modise, Mathonsi, Mashishi, Leman, le Roux, Jansen van Vuren, Kemp, Paweska and Blumberg2013; Nanyingi et al., Reference Nanyingi, Munyua, Kiama, Muchemi, Thumbi, Bitek, Bett, Muriithi and Njenga2015; Van Vuren et al., Reference Van Vuren, Kgaladi, Patharoo, Ohaebosim, Msimang, Nyokong and Paweska2018; Msimang et al., Reference Msimang, Thompson, van Vuren, Tempia, Cordel, Kgaladi, Khosa, Burt, Liang, Rostal, Karesh and Paweska2019; Bron et al., Reference Bron, Strimbu, Cecilia, Lerch, Moore, Tran, Perkins and Ten Bosch2021).

However, this assumed increased risk of exposure is not necessarily supported by seroprevalence studies, Of the six seroprevalence studies identified in our earlier research (Table 1), half (3/6) did not provide sex aggregated data for occupation. Two found no statistically significant difference in seropositivity rates between males and females and only one found males are more likely to be RVF seropositive. If studies are demonstrating no statistically significant difference in seropositivity levels between men and women, are we as researchers inadvertently reinforcing gender inequality within epidemiology studies by maintaining the narrative of men are at greater risk of RVF exposure? It is critical that gender is incorporated into epidemiological research to ensure both men and women are actively included in the planning and design of interventions. Only then can we achieve a truly One Health approach – one that develops balanced, gender-responsive strategies integrating human, animal and environmental health in RVF control and prevention.

Gender disparities in ownership, prevention, and treatment of livestock

In many societies women face limited control over their income, ownership of higher value livestock, access to and control of productive resources, and ownership and access to land (Fischer and Qaim, Reference Fischer and Qaim2012; Tavenner and Crane, Reference Tavenner and Crane2018; Acosta et al., Reference Acosta, Ludgate, McKune and Russo2022; Gannaway et al., Reference Gannaway, Majyambere, Kabarungi, Mukamana, Niyitanga, Schurer, Miller and Amuguni2022; Mukamana et al., Reference Mukamana, Rosenbaum, Schurer, Miller, Niyitanga, Majyambere, Kabarungi and Amuguni2022; Byers et al., Reference Byers, Robinson, Hollmann, Ezeocha, Smith and Bukachi2025). This is because of sociocultural, religious and institutional norms in RVF endemic countries. It must be noted that norms differ between communities and countries. A study in Rwanda reported the main barriers to women entering the livestock RVF vaccine value chain were laws and regulations, access to resources including credit, vaccines and infrastructure, cultural norms and gender stereotyping, and lastly weakness with vaccine distribution and training opportunities (Gannaway et al., Reference Gannaway, Majyambere, Kabarungi, Mukamana, Niyitanga, Schurer, Miller and Amuguni2022). These structural barriers restrict women’s autonomy of choice to protect themselves by vaccinating their livestock and highlights the clear disadvantage to women of sociocultural norms and the male-dominated design of the vaccine chain.

Women tend to own lower-value livestock, such as poultry and goats. In the context of RVF the main susceptible livestock species are cattle, sheep and goats, with sheep being the most susceptible. However, national vaccination programmes tend to focus on cattle, even though in the case of RVF sheep and goats are more susceptible compared to cattle (Acosta et al., Reference Acosta, Ludgate, McKune and Russo2022; Gannaway et al., Reference Gannaway, Majyambere, Kabarungi, Mukamana, Niyitanga, Schurer, Miller and Amuguni2022; Mukamana et al., Reference Mukamana, Rosenbaum, Schurer, Miller, Niyitanga, Majyambere, Kabarungi and Amuguni2022; Tukahirwa et al., Reference Tukahirwa, Mugisha, Kyewalabye, Nsibirano, Kabahango, Kusiimakwe, Mugabi, Bikaako, Miller, Bagnol, Yawe, Stanley and Amuguni2023; Byers et al., Reference Byers, Robinson, Hollmann, Ezeocha, Smith and Bukachi2025). Larger herd sizes are also prioritised for vaccination, excluding small herds often owned by women and other smallholders (Acosta et al., Reference Acosta, Ludgate, McKune and Russo2022; Tukahirwa et al., Reference Tukahirwa, Mugisha, Kyewalabye, Nsibirano, Kabahango, Kusiimakwe, Mugabi, Bikaako, Miller, Bagnol, Yawe, Stanley and Amuguni2023). Consequently, in an RVF outbreak, sheep and goats owned by women are at risk and so is their income and access to food especially animal source protein.

As part of the invisible work women and children do in livestock rearing, women are more likely to take care of sick livestock, increasing their risk of RVF exposure (Miller, Reference Miller2011; Breisinger et al., Reference Breisinger, Keenan, Mbuthia and Njuki2023). A study in Uganda reported women have excessive workloads completing more daily tasks in livestock production as compared to men, resulting in less time to tend to their own animals or attend educational programmes (Tukahirwa et al., Reference Tukahirwa, Mugisha, Kyewalabye, Nsibirano, Kabahango, Kusiimakwe, Mugabi, Bikaako, Miller, Bagnol, Yawe, Stanley and Amuguni2023). Although women spend more time compared to men with animals, women are restricted in their autonomy on treating sick animals and vaccination of livestock. For example, a study in Kenya and Uganda has reported that even when women are head of households, they are still required to consult male family members regarding treatment of sick livestock (E. Mutua et al., Reference Mutua, Namatovu, Campbell, Tumusiime, Ouma and Bett2024). These cultural and institutional norms not only limit women’s autonomy in livestock care but also influence their ability to engage in critical health interventions, such as vaccination.

In an attempt to address gendered barriers and increase vaccine uptake, a research team from ILRI, ran RVF vaccination campaigns in Kenya using a gender-based approach (Campbell, Reference Campbell2023). The modifications to the vaccination campaign included hiring women champions, working with community disease reporters and local leaders to ensure the correct messaging of the campaign was conveyed and providing facilities to make it easier for women to control their herds and prevent animal injury. Although preliminary data suggest that the intervention (with gender modifications) performed no better than the control group (without gender modifications), the impact indicators used were purely quantitative, limiting the ability to capture the full scope of the intervention’s effects. Logistical challenges were identified as potential reasons for the lack of positive differences in the intervention group, which included delays in vaccine delivery affecting only the intervention group, and the vaccination campaign occurred at the same time than most animals were pregnant, Nonetheless, lessons learned can inform future vaccination campaigns. Indeed, other studies have shown that reducing gendered barriers in the livestock sector increases women’s access to vaccines (McKune et al., Reference McKune, Serra and Touré2021; Serra et al., Reference Serra, Ludgate, Fiorillo Dowhaniuk, McKune and Russo2022; Njiru et al., Reference Njiru, Galiè, Omondi, Omia, Loriba and Awin2024).

Although this has not yet been translated into formal policy, the Kenyan Government has held workshops in how to consider gendered barriers to vaccine uptake for their RVF contingency plan (Bett, Reference Bett2022; Campbell, Reference Campbell2023; Tramsen, Reference Tramsen2023). At the time of writing (April 2025) the contingency plan is being finalised and has not been published. Other endemic countries, such as Tanzania, are also developing One Health preparedness plans for RVF. Now is the perfect time to acknowledge gender inequality and incorporate gender responsive interventions that will better target animal, environmental and the health of men, women and children in an equitable and sustainable fashion.

Gender disparity in knowledge of RVF

Knowledge of disease is of significant importance to reducing exposure and transmission, as a lack of knowledge can increase unsafe farming practices (Alemayehu et al., Reference Alemayehu, Mamo, Desta, Alemu and Wieland2021). However, it has been reported increased knowledge does not always lead to good farming practices (Alhaji et al., Reference Alhaji, Babalobi and Isola2018; Etter et al., Reference Etter, Gomez-Vazquez and Thompson2022; Ahmed et al., Reference Ahmed, Bhuiyan, Chalise, Mamun, Bhandari, Islam, Jami, Ali and Sabrin2025). Eight Knowledge, Attitudes and Practices (KAP) studies were identified in our previous research (Table 1). Six (out of eight) KAP studies were biased towards male participants (range 67%–83%). However, it is difficult to draw direct comparisons between the studies as they collected different information regarding knowledge of RVF. Moreover, KAP scores were not sex disaggregated in any of the studies, so it is not possible to distinguish if there was a knowledge-gap between men and women.

Female farmers are disadvantaged due to lack of relatable information (prevention and control) regarding RVF, and lack of access to this information (Gannaway et al., Reference Gannaway, Majyambere, Kabarungi, Mukamana, Niyitanga, Schurer, Miller and Amuguni2022). This is partly because women are not permitted to attend educational programmes if they are led by men for sociocultural and sometimes religious reasons. As a result, women have restricted access to vital information and education programmes regarding transmission, control and prevention of RVF (Njuki and Sanginga, Reference Njuki and Sanginga2013). Other examples of dissemination of information to the public, for example posters in public places (Mutua et al., Reference Mutua, De Haan, Tumusiime, Jost and Bett2019), are restrictive for women because of their domestic roles (Namatovu et al., Reference Namatovu, Campbell and Ouma2021). Many individuals in rural pastoral communities have limited or no education, with a high rate of illiteracy. For example, it has been reported the Maasai have the highest illiteracy rates (75%) (Pesambili, Reference Pesambili2020). This is a stark comparison to the estimated illiteracy rates of the continent of Africa which is estimated to be 33% (Statista, 2022; Mutua et al., Reference Mutua, De Haan, Tumusiime, Jost and Bett2019; Namatovu et al., Reference Namatovu, Campbell and Ouma2021). Access to this information is therefore limited to men who can read and are attending public spaces (UNESCO Institute for Statistics, 2019). Radios are also often used to disseminate information (Mutua et al., Reference Mutua, De Haan, Tumusiime, Jost and Bett2019), however these are more typically used by men, and so again leaves women to rely on their male counterparts to relay the information (Namatovu et al., Reference Namatovu, Campbell and Ouma2021).

Male dominated research teams are a further barrier for women to enter the livestock value chain, this further compounds the barriers discussed above. A greater inclusion of female researchers would enable more women to attend KAP studies and educational campaigns. Greater attendance of women at these events will enable them to have a greater influence on research agendas, put across their point of view and challenges faced, all of which may not be considered at a male dominated event. Empowering women through female led educational programmes will result in women gaining a greater understanding of RVF and reducing their risk of exposure (Namatovu et al., Reference Namatovu, Campbell and Ouma2021).

Maternal care

The risks posed by RVF to pregnant women are poorly understood, however, existing evidence suggests that urgent research is required to fill this knowledge gap and support the design of targeted policies to protect pregnant women during RVF outbreaks (Arishi et al., Reference Arishi, Aqeel and Al Hazmi2006; Adam and Karsany, Reference Adam and Karsany2008; Baudin et al., Reference Baudin, Jumaa, Jomma, Karsany, Bucht, Näslund, Ahlm, Evander and Mohamed2016; McMillen and Hartman, Reference McMillen and Hartman2021). To our knowledge, there is no specific national policies that address RVF and maternal health services. Our previous research (O’Neill et al., Reference O’Neill, Gubbins, Reynolds, Limon and Giorgakoudi2024) and the searches of grey literature and policy documents (Overton and Lens databases) did not find any national or global level policy documents of RVF and pregnant women.

In livestock, RVF is known to cause abortion storms during outbreaks. In fact, abortion storms in livestock are often considered the first indicators of RVF outbreaks in endemic countries (McMillen and Hartman, Reference McMillen and Hartman2021). Despite this well documented phenomenon, the potential for RVF to lead to miscarriages and other complications in pregnant women is not well understood.

Only a few studies have attempted to explore RVF related pregnancy outcomes in women. One study sampled the seroprevalence of three groups (45 women who aborted pre-outbreak; 51 women who aborted during the outbreak; and 115 randomly selected male and females from local villages) as a proxy for RVF abortions. No significant difference was seen between the three groups, with seroprevalences of 31%, 28% and 33%, respectively (Abdel-Aziz et al., Reference Abdel-Aziz, Meegan and Laughlin1980). Another study found a significantly higher rate of still births for RVF positive mothers (15%; 10/65) as compared to RVF negative mothers (6%; 209/3124) (Niklasson et al., Reference Niklasson, Liljestrand, Bergström and Peters1987). Both studies called for larger studies to be conducted to gain a greater understanding of RVF and pregnant women, but this call has largely been unanswered.

More recent evidence of vertical transmission (transmission of RVF from mother to foetus) of RVF in pregnant women has been reported in Saudi Arabia in 2000 (Arishi et al., Reference Arishi, Aqeel and Al Hazmi2006) and in Sudan in 2007 and 2011 (Adam and Karsany, Reference Adam and Karsany2008; Baudin et al., Reference Baudin, Jumaa, Jomma, Karsany, Bucht, Näslund, Ahlm, Evander and Mohamed2016). The first report was in Saudi Arabia during the outbreak in 2000, where a five-day old infant was admitted to hospital with respiratory issues and died two days later. It was later found that four days prior to the delivery, the mother developed RVF-like symptoms after being in contact with sick or aborting animals during the RVF outbreak (Arishi et al., Reference Arishi, Aqeel and Al Hazmi2006). The first report in Sudan included a pregnant woman who was hospitalised with RVF symptoms and was later diagnosed with RVF. The child was born with an enlarged spleen, liver and was clinically diagnosed with jaundice (Adam and Karsany, Reference Adam and Karsany2008). The second report in Sudan arose from a study conducted in 2011, where 28 out of 130 pregnant women (18%) were positive for RVF infection. Of these 28 women, 54% had a miscarriage compared to 12% of women who were RVF negative. Patients positive for RVF also had higher rates of bleeding, joint pain and malaise. The same Sundanese study reported vertical transmission in women (Baudin et al., Reference Baudin, Jumaa, Jomma, Karsany, Bucht, Näslund, Ahlm, Evander and Mohamed2016). Therefore, urgent research is required to gain a greater understanding of the risks related to RVF and pregnant women.

Despite these findings, the relationship between RVF and pregnancy complications in women remains severely underexplored. More robust data and research is urgently required to understand the full extent of the risks of RVF poses to pregnant women and to aide in the development of policies that ensure maternal health protected in future RVF outbreaks.

Conclusion

Gender inequality in RVF disease surveillance and control poses a significant threat to women’s wellbeing and livelihoods. This paper uses RVF as a case study but has also highlighted inequality using examples from other diseases. It is imperative that we acknowledge and tackle gender inequalities so that communities, public health, and veterinary systems are better prepared to respond to outbreaks in the future.

Despite an increasing frequency of RVF outbreaks, current surveillance efforts often overlook gender-specific interventions. It is evident that there is a clear knowledge gap in our understanding of transmission and impact on women. Women are also disadvantaged regarding access to knowledge and practices to prevent RVF because they do not have access to the relevant information.

Women’s participation in the agricultural sector has been widely documented, but it is critical for more gendered data on the roles of women in different contexts agricultural, livestock and vaccine value chains. This will ensure we build a greater understanding the transmission dynamics of both men and women. By incorporating gender-sensitive approaches in study design, data collection and analysis, we can target interventions and improve the effectiveness of RVF prevention and control measures for all populations.

Data availability statement

Data available within the article or its supplementary materials – “The authors confirm that the data supporting the findings of this study are available within the article.”

Author contributions

Luke O’Neill, Georgina Limon, Simon Gubbins, Christian Reynolds and Kyriaki Giorgakoudi

Conceptualisation CR, GL, KG, LO’N and SG

Data Curation LO’N

Formal Analysis LO’N

Funding Acquisition GL, KG and SG

Investigation LO’N

Methodology CR, GL, KG, LO’N and SG

Project Administration CR, GL, KG, LO’N and SG

Supervision CR, GL, KG and SG

Validation GL and KG

Visualisation CR, GL, KG, LO’N and SG

Writing – original draft LO’N

Writing – review and editing CR, GL, KG, LO’N and SG

Financial support

This work is part of a PhD project that is jointly funded by the School of Health and Psychological Sciences, City, University of London and The Pirbright institute. In addition, G.L. and S.G. acknowledge funding from the UKRI Biotechnology and Biological Sciences Research Council (grant codes BBS/E/I/00007036, BBS/E/I/00007037, BBS/E/PI/230002C and BBS/E/PI/23NB0004). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. None of the authors receive a salary from the funders.

Competing interests

The authors declare that they have no competing interests.

Ethics statement

The data used in this perspective paper is publicly available and public health data is based on anonymous data. Therefore, the study does not meet the criteria for “research involving human beings” and so does not require ethical approval.

References

Connections references

Fernandez de Cordoba Farini, C (2023). How can we improve and facilitate multi-sectoral collaboration in warning and response systems for infectious diseases and natural hazards to account for their drivers, interdependencies and cascading impacts? Research Directions: One Health 1, e11. https://doi.org/10.1017/one.2023.4.Google Scholar

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Figure 0

Table 1. Presents the participatory studies included in the socio-economic impact of Rift Valley fever: a rapid review and discussed in this perspective paper

Author comment: Rift Valley Fever and Invisible women — R0/PR1

Published online by Cambridge University Press:  04 June 2025
DOI: https://doi.org/10.1017/one.2025.10005.pr1 [Opens in a new window]
Luke O'Neill [Opens in a new window] City University of London, London, United Kingdom of Great Britain and Northern Ireland
Revision round: 0
Role: author

Comments

No accompanying comment.

Review: Rift Valley Fever and Invisible women — R0/PR2

Published online by Cambridge University Press:  04 June 2025
DOI: https://doi.org/10.1017/one.2025.10005.pr2 [Opens in a new window]
Date of review:  30 January 2025
Revision round: 0
Role: reviewer
Recommendation/decision: minor-revision

Comments

Reviewer Recommendations

The manuscript ‘Rift Valley Fever and Invisible Women’ tackles a severely underexplored topic considering gender disparities and Rift Valley Fever (RVF). Whilst this piece of research does provide a voice to integrate gender into this field of study, I believe the level of alteration required crosses into the realm of major revisions before this piece is ready for publication.

Weak and often unsupported introduction

The introduction contains numerous grammatical errors, the phrasing is often confusing, the paragraphs are often poorly structured, and this section often lacks adequate references to support its claims, particularly in reference to existing research about gender.

Unclear methodology

Despite including the appendix, the methodology lacks detail, and there are significant errors. The methodology section of the introduction states that 93 studies were found. The appendix states that all studies found were included, but then the results keep mentioning 17 studies are included. Aside from this, it would be extremely useful if there were some kind of table or visual aid to show how many papers were found and how many discussed each topic you have in your results, so it would be much clearer. If search terms are included for the Overton policy database, it doesn’t read well that this isn’t the case or even mentioned for the literature review section. Either way, I think a short justification should be included.

Mixing of results and outside literature without clear distinction

I found it quite confusing reading the results. It started off by clearly discussing the included studies, but in subsequent sections, it appears as though there are sections for which there are no included studies, but instead, you include a discussion of outside data? I think you need to edit the results to be very explicit about what the findings are and what is outside research. This would be helped by including a table with a breakdown of the key findings and explicitly acknowledging which data sources are used in each results section.

Structural and writing issues throughout the manuscript

Throughout the manuscript, there are grammatical issues. Sections are often poorly constructed, so arguments seem to jump around in a way that detracts from the findings and can be confusing. Occasionally, some parts of the discussion seem redundant.

Comments

I think this paper has the potential to be a valuable piece of work, beginning to fill this significant research gap. However, I think a significant amount of editing is required, particularly in clarity and structure, and stronger arguments are needed. I believe that once this initial step is completed, a deeper look at the results and arguments will be easier to consider. As it stands, the way the results are reported, coupled with the lack of clarity and inaccuracies in the reporting of the methodology, and the occasional unsubstantiated claims (which in some cases are stated as though they are generally true, when infact they may be true only in certain case studies, or are extreme cases, and are by no means just generally the case) make me unsure about the accuracy of the reported results. This really must be corrected in order to be published.

Below is the detailed feedback of the manuscript

Abstract:

Line 30 – ‘gendered-based policy’ is incorrect – change to ‘gender-based policy’ or ‘gendered policy’.

Line 33-34 – ‘This will lead to develop gender-responsive’ – The use of the word ‘develop’ is incorrect here, but also I think the ‘will’ should be changed to ‘can’ as I think ‘will’ may be too strong. I suggest changing to ‘this can lead to the development of gender-responsive interventions’ or something similar.

Line 35 – ‘Interventions’ – change to ‘Intervention’

Introduction:

Line 47-48 – ‘it has been estimated that women contribute 40% of the agricultural labour force in Africa, with some countries e.g. Tanzania, women contribute 53%’. The sentence structure is bad here. Consider changing to ‘It has been estimated that women contribute 40% of the agricultural labour force in Africa, though this is much higher in some countries, such as in Tanzania where women are thought to contribute 53% of the agricultural labour force’, or similar.

Line 52 – ‘provide the nutritional security’ – change to just ‘provide nutritional security’.

Line 57-59 – I think you need to expand on ‘Women have less disposable income to invest in their livestock and this can directly impact the health of their livestock and their children. This is because their livestock cannot be treated for illnesses and their children’s nutrition may not be prioritised.’ It's very generalised, lacks references, and needs expansion. I suggest including references that women have less disposable income, and that women’s income affects livestock health and child health.

Line 62-63 – ‘While the reasons as to why are not specified in these studies, one reason could be women earning less and thus spending a larger proportion of the income on basic needs.’

Perhaps not in these cited studies, but there is plenty of literature about and around this that I think would be better cited rather than making an assumption (at least not cited) in the introduction.

Line 63-66 – ‘In addition, it is considered a woman’s role to carry out household activities and therefore may spend more time on basic needs for the household (unpaid work), whereas it is considered the man’s role to invest and sell livestock.’ Again, this is lacking references and could be written better.

Line 68-71 – It seems like you mentioned nutrition above, left it behind, and now are coming back to it.

-Again, I think this could be better structured so that it flows better with the paragraph above.

Line 71 – ‘improving the access for women to markets’ – change to ‘women’s access to’

Line 71-72 – ‘Therefore, improving the access for women to markets, healthcare, veterinary care could lead to better health of animals and children.’

-You have only cited a study that suggests that children in female-headed households have better health outcomes, so I’m not sure you can suggest this off the back of that. Again, I think you either need to add some sources or change how this is written.

Line 73-76 – ‘This tackles multiple sustainable development goals at once. By greater consideration of gender inequalities in policy development for disease surveillance and control, will reduce the disparities that compromise on women’s health, reducing the risk of infection and death. This would also have positive knock-on effects by improving the health of their children.’

-Again, this is not well written. The grammar needs improvement, and you should specify more explicitly the SDGs you are talking about.

Line 88 – ‘the mosquito bites’ should be just ‘mosquito bites’.

Line 94-104 - Looking at the appendix with the search terms, I still believe there should be a clearer explanation of the terms you included and why. There should be a description for the PubMed search, and further description for the Overton policy database. My initial thought when I saw ‘pregnant women’ there was ‘Oh, I wonder why they specifically single out pregnant women’. I also think you need to add a table or visual description of how you got down to 17 included papers. There's some kind of error somewhere because you say in the body that you found 93 papers. In the appendix, you say all returned articles were included in the review, and then back in the body, you talk about 17 papers being included, so this isn’t adding up.

Gender disparity in occupational health

Line 111 – Which 17 participatory studies were previously identified? I think this is the first mention of it, and thus, this needs to be rewritten as such. This is the same for the mention of the seroprevalence studies.

Line 131-134 – This seems like a large number of studies cited. Are these studies assuming that women are housewives, or are they all discussing how that is something that is common in RVF studies?

Line 136 – I would change it from ‘these roles consist of…’ to ‘these roles include…’. The original phrasing makes it sound like that is a list of all the roles and responsibilities, and there is nothing else.

Lines 158-170—This paragraph doesn’t flow well. Something needs to be said between saying that 70% of the respondents were male in previous studies and questioning whether, if studies demonstrate no statistically significant difference in seropositivity between men and women, we are reinforcing gender inequality. The seropositive comment seems to come from nowhere.

Lines 167-168: This is a really important sentence, and I think the way it's written doesn’t do it justice. Also, I feel like saying ‘it’s time to acknowledge gender inequality’ could be improved on as well, perhaps mentioning that gender is a field of study in its own right, I think this last bit from 164-170 has potential to be a really impactful statement but it’s missing the mark.

Gender disparity in knowledge of RVF

Lines 174-182 - I think you need to say earlier how many KAP studies were included. Just generally, I think it makes more sense to put the context in this sense at the beginning of a section. For example, opening this section with something along the lines of

‘knowledge of disease is of significant importance to reducing exposure and transmission, as a lack of knowledge can increase unsafe farming practices (citation). Six KAP studies were included in the results, though none reported on sex-disaggregated KAP scores. Four of the six were heavily biased towards male participants, ranging from 67-83% of the participnts. These KAP studies showed that the participants generally had limited knowledge of RVF. ‘ That’s just an example but it currently reads a bit all over the place.

Line 184 – It would be good to expand on what is meant by ‘relatable information’. I don’t understand what this means.

Lines 184-187 – In what way are information and education programmes male-dominated, and why does this mean the information isn’t relatable or accessible to women? This needs a better explanation.

Line 189 – add a citation for this claim (literacy).

187-191 – These lines start well, up until the end of the sentence about literacy, but then the next two sentences don’t back up the claim you are implying they do. Its like the following 2 sentences are talking about something different, rather than continuing on about these other social and cultural factors at play, it suddenly changes to talking about how a lack of gender disaggregated data makes it impossible to distinguish gendered differences (and I assume you mean going back to knowledge of RVF again?). I would cut out those sentences and go straight from pastoral communities having low education and literacy rates, straight into the Maasai example.

Line 192 – highest illiteracy rates where?

Lines 192 -193 – ‘there is a stark comparison’ – change this to ‘this is a stark comparison’. I would rewrite the second sentence, too, for one to be talking about illiteracy and the other about literacy; it's easy to miss. Though the numbers are similar, they’re talking about opposite things.

Lines 198 – globally? If so, specify.

Lines 184-201 - Again, I think this paragraph is messy. It is actually only saying that literacy rates are low, and information is usually disseminated through posters in public places and over the radio, both of which are more visible to men, but I feel like we’ve got lost getting to that.

Line 203 – I don’t think you should start this paragraph this way, because again it feels like we’re suddenly off-track again. I think you are trying to make the point that women are more likely to attend KAP studies if there are more women in the research team. I would start there rather than suddenly talking about needing women in the design stages of research. You should frame it in terms of male dominated research teams being a barrier for entry for women (for whatever reason. Specify if it’s in the findings), then go on to say why women need to be included in KAP studies, and then about how including women in research terms from the start can help fix some of this.

Gender disparities in prevention and treatment in humans

This could be tightened up, but no specific comments.

Maternal care

You start this section by implying that there are no findings for this section and go on to discuss general observations about maternal health and epidemics/pandemics, but then further down, there are suddenly findings.

I don’t think it is good to say to your knowledge there is no research on RVF and maternal health service. This paper is only supposed to be talking about what you did find, not what there isn’t. Why jump to this so suddenly when that would be quite a specific example, and it hasn’t been mentioned previously? I think from line 235 you should state that no relevant studies were found by your search in PubMed or the Overton policy database. And in this case, I don’t understand why you’ve included a section for it. Surely, general discussion around research from outside your search should be mentioned in the introduction rather than having their own results section when they aren’t results? I’m really quite confused about what’s going on in this section. I’m also concerned if it is the case that there is this research and it wasn’t picked up in your search. If you know this data is there, but it didn’t come up in the search, it would have been better to adjust the search terms.

Line 258 – since what research was published?

Sorry if I’ve misunderstood anything here. It’s a confusing section, and I don’t understand what’s going on with these results here.

RVF Vaccines

Lines 277-279 – I think this should read more along the lines of ‘There are currently a handful (though if possible, it’s better to say how many) of licensed veterinary vaccines for RVF, but none are currently licensed for humans, though three are currently in RCT’.

Line 281 – Do you mean historically pregnant women have been excluded because you then talk about the reasons being pregnancy-related?

Line 295 – we’ve gone from talking about how it’s ok to test vaccines on pregnant women, to there being a cross-species vaccine presumably for RVF o RCTs (though earlier you mentioned there are 3)

I'm unsure again if this is data still from the results of your study or a more general literature review. There doesn’t seem to be a clear distinction.

Gender disparities in ownership, prevention and treatment of livestock

Line 306 – Women are usually able to own livestock, there just may be gendered ownership patterns (e.g. women owning lower-value livestock such as chickens in particular and goats). There is, however, often an issue around women owning land.

Line 310 – I have read this paper, and I think the way the claim is written here is a bit misleading. The paper states that among the study participants, rearing poultry and small ruminants is common for women, but there is a financial barrier to rearing larger livestock. It talks about data collected before their intervention that found that there had been a restrictive norm that women weren’t allowed to own animals, including to control the management of an animal or income derived from them, declare publicly they own animals, interact with male veterinarians, or sell or purchase animals. It was also considered inappropriate for women to eat animal-sourced food (as men feared they wouldn’t get enough to eat), and there could be a strong community backlash if a woman broke these rules. However, this certainly isn’t generally true around the world. It is a strong outlier and an interesting case study. I think the way it is included as an example here can be misleading because, more generally, women are able to own their own lower-value livestock, and it’s a vitally important part of their livelihoods. Also, strong gendered cultural norms like this differ then from the next example of women having to consult men as the decision makers regarding vaccination. The first is an extreme case, and the latter is a common occurrence. I think it needs to be acknowledged that this is an extreme case of cultural norm and community backlash, rather than a normal way things are. Also, if women don’t own or control livestock, I suppose they don’t need to be able to access vaccinations, so maybe this is not a good example of barriers to access.

Lines 317-325 – This paragraph is better, though grammatical errors need correcting.

Line 328 – ‘women are also disadvantaged by different types of barriers’. I don’t think the word also is necessary here.

Line 331-345 – having said that, you go straight into an example showing no differences between men and women, which I don’t think justifies the first sentence. Maybe this paragraph should read that women face a number of barriers to RVF vaccination, and then start with your second example in Rwanda that just lists different barriers women face. You can then go on to say that another one of your results papers found that although there may be varied barriers, they may not differ from those faced by men.

Conclusion

This is fine.

Review: Rift Valley Fever and Invisible women — R0/PR3

Published online by Cambridge University Press:  04 June 2025
DOI: https://doi.org/10.1017/one.2025.10005.pr3 [Opens in a new window]
Date of review:  15 February 2025
Revision round: 0
Role: reviewer
Recommendation/decision: minor-revision

Comments

Introduction:

Clearly written and motivates research

Did you consider searching the Lens database to make sure that you are identifying literature from the global south: https://www.lens.org/

It would be helpful to have a brief methods section on number of studies identified, inclusion/exclusion criteria, and how the results will be analysed.

Did you follow any guidelines in conducting your rapid review?

You mention that your discussion is based upon a rapid review of 93 studies, what new insights do you add, and what do you differently if anything in terms of themes identified? Is this review well suited to be a guide to look at gender differences?

Results:

Line 287-I would be cautious regarding stating that as the Covid-19 vaccine had no adverse effects on pregnant woman, that a RVF vaccine wouldn’t either, as unless they are produced in the exact same way with the exact same ingredients (if so that should be clarified), data is needed to confirm this statement.

Line 340-Laws should be lower case

Decision: Rift Valley Fever and Invisible women — R0/PR4

Published online by Cambridge University Press:  04 June 2025
DOI: https://doi.org/10.1017/one.2025.10005.pr4 [Opens in a new window]
Richard Kock [Opens in a new window] Independent Scholar, Kent, United Kingdom of Great Britain and Northern Ireland
Date of review:  04 March 2025
Revision round: 0
Role: Editor in Chief
Recommendation/decision: major-revision

Comments

Thank you for your patience in review. I am pleased that the reviewers feel this paper is of value and helping to fill a gap in the RVF social science field in One Health. Please address all the reviewer's comments and recommendations line by line, defending your position where you can of course. This is a major revision but I trust it will be much easier now that the weaknesses have been clearly stated.

Author comment: Rift Valley Fever and Invisible women — R1/PR5

Published online by Cambridge University Press:  04 June 2025
DOI: https://doi.org/10.1017/one.2025.10005.pr5 [Opens in a new window]
Luke O'Neill [Opens in a new window] City University of London, London, United Kingdom of Great Britain and Northern Ireland
Revision round: 1
Role: author

Comments

No accompanying comment.

Decision: Rift Valley Fever and Invisible women — R1/PR6

Published online by Cambridge University Press:  04 June 2025
DOI: https://doi.org/10.1017/one.2025.10005.pr6 [Opens in a new window]
Richard Kock [Opens in a new window] Independent Scholar, Kent, United Kingdom of Great Britain and Northern Ireland
Revision round: 1
Role: Editor in Chief
Recommendation/decision: accept

Comments

Thank you for submitting this interesting paper and novel subject promoting better understanding of impacts and future roles of women in its management prevention and control.