"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.