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    5. The Modified FAMACHA System: Making It Work For Compassionate Care
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    5. The Modified FAMACHA System: Making It Work For Compassionate Care
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    5. The Modified FAMACHA System: Making It Work For Compassionate Care

    The Modified FAMACHA System: Making It Work For Compassionate Care

    A sheep looking up at the camera.
    A sheep’s eyes can tell you a lot about their health!

    Updated October 30, 2020

    A Serious Risk

    If you’re caring for small ruminants such as goats and sheep (or camelids such as llamas and alpacas), you will need to become very familiar with the internal parasites they are prone to, including the very dangerous bloodsucking barber pole stomach worm (Haemonchus contortus). Due to its seriousness, part of your regular goat, sheep, llama, or alpaca health care protocols should involve evaluating them for signs barber pole worm infections. The FAMACHA test was created to help do just that, but was designed primarily for use in an animal agriculture setting. Due to the inherent differences between sanctuaries and farms, you may think that the FAMACHA system is not a useful tool for compassionate care. However, with a few modifications, it can be a valuable tool for compassionate caregivers to use as part of a larger barber pole worm screening strategy.

    What Is The FAMACHA Test?

    The FAMACHA test was originally developed in South Africa as a tool to determine which goats and sheep should be selectively dewormed based on their estimated degree of anemia. While not all anemia can be attributed to the presence of barber pole worms, it is the most common cause of anemia in small ruminants, especially during times when they are grazing on pasture. The test itself consists of comparing the color of the resident’s eye mucous membranes with one of five colors on a laminated color chart. Each of these colors correspond to a specific range of the percentage of red blood cells- also known as hematocrit or packed-cell volume (PCV). In theory, the higher the score, the lower the percentage of red blood cells, with a score of 5 indicating severe anemia. Performing the test is a relatively simple process (though you should be trained to perform it accurately), and it should not pose any risk (beyond annoyance) to any residents if performed correctly.

    When used as intended, caregivers score each individual and make decisions about selective deworming based on these scores. Typical FAMACHA training information recommends that individuals who score a 4 or 5 are always dewormed (or alternatively, killed) and individuals who score a 3 are dewormed on a case-by-case basis, factoring in how they are doing overall and whether or not they are considered a vulnerable population (training information often focuses on lactating mothers or very young individuals, rather than elderly individuals, simply due to the shorter lives individuals in these settings live and the fact that there is often a heavy focus on breeding).

    Why Deworm Selectively Rather Than Prophylactically?

    Many parts of the world are dealing with varying degrees of drug resistant barber pole worms, resulting from many years of using particular dewormers- in some cases to the point of overuse. Some drugs that used to be effective against barber pole worms, such as Ivermectin, are no longer recommended because of the high instances of resistance seen. Because there are currently only a limited number of dewormers that are typically effective against barber pole worm (in the US there are only 3 groups of dewormers used), and the evidence of growing resistance against those groups, prophylactic deworming is rarely recommended for small ruminants, nor is herdwide treatment after a confirmed case in the group (though these were common recommendations just a couple decades ago). For more information about drug resistance in barber pole worms, this video put out by Dr. Anne Zajac offers a good overview, but please note it is not a compassionate source (starting around the 27-minute mark and ending at the 45-minute mark).

    There are a few reasons why using the FAMACHA system as is, might not be the best practice in a sanctuary setting. First and foremost, managing parasite issues by killing residents is unacceptable in a sanctuary or other compassionate setting. There may be certain circumstances in which you must consider physically removing a particular individual from the herd due to parasite issues (and offering an alternative living arrangement), but this is very different than the typical FAMACHA recommendations. Studies show that, in most cases, approximately one third of the individuals in a group carry about 80% of the worms, and most recommendations suggest people consider “culling” or otherwise “removing” this entire third of the population.

    Fundamental philosophical differences in animal care aside, using the FAMACHA system as is could still result in deworming individuals who do not actually need to be dewormed. The whole point of the system is to have a relatively easy way to make an informed decision about who should be dewormed and who should not, in order to prevent (or slow the progression of) drug resistance in these worms. While each score is designed to correspond to a specific hematocrit range, multiple sanctuaries that have used FAMACHA in conjunction with fecal and blood testing have found that, especially in goats, these scores do not always match the intended hematocrit level. In fact, some individuals consistently scored 4 or even 5 despite having normal hematocrit levels. Additionally, certain factors, such as disease or irritation, can affect the color of an individual’s mucus membranes, thus affecting the efficacy of the test.   

    Using The Modified FAMACHA System

    You should work closely with your veterinarian or an experienced small ruminant parasitologist to determine the most effective way to implement the FAMACHA system at your sanctuary. Using FAMACHA scoring haphazardly or only when you are concerned about an individual is not going to be as useful as regular scoring. How often you should assess FAMACHA scores depends both on your region and also the time of year- in areas with significant barber pole worm issues, you may find that you need to perform FAMACHA testing every 2 weeks during the times of year when the worms are most prevalent. Regular scoring (along with proper recording keeping) will give you data to establish a baseline of what an individual’s normal FAMACHA score typically is (as some residents may have naturally paler mucous membranes than others), and will allow you to recognize any changes in mucous membrane color that could be a sign of anemia due to a barber pole worm infection.

    In addition to helping you determine how often you should perform FAMACHA testing, your veterinarian or other experienced professional can also help you establish additional screening protocols, as well as deworming protocols that are appropriate for your residents. Likely, rather than deworming individuals based on FAMACHA score alone, you will use the test to identify which individuals should be further assessed through diagnostic testing. For example, some sanctuaries perform additional screening on any individual who scores a 4 or 5 and does not have a history of scoring that high, as well as performing additional screening on anyone whose score increases by 2 points, even if they are not yet a 4 or 5 (such an an individual who is typically a 1 but is now a 3).

    Individuals who routinely score a 4 or 5 might not be further assessed each time, so long as they are not showing signs of clinical illness and recent diagnostics have confirmed that they are not actually anemic. We suggest working with your veterinarian to thoroughly assess the individual to make sure there is not something concerning going on. Keep in mind that an individual who is normally very pale will be difficult to monitor for signs of concern through FAMACHA scoring alone. Be sure to perform additional assessments if they are showing any signs of concern and consider regularly checking hematocrit levels to ensure they remain in a healthy range.

    Additional Screening Protocols

    Your veterinarian can help you determine the best protocols for your sanctuary, but be sure to discuss the value of fecal egg counting and hematocrit testing, as these can be very useful tools in deworming decisions. Regular use of these diagnostic tools is not always mentioned in traditional FAMACHA training materials, but as Dr. Anne Zajac states in the video link above, “The more information you have, the more refined and sophisticated your [selective deworming] decisions can be.”

    Fecal Egg Counts

    A fecal egg count (FEC), or quantitative fecal analysis (as opposed to a qualitative analysis), will tell you what types of parasites your residents are carrying as well as how many eggs of each parasite they have per gram of feces. However, in most cases, you will receive results for strongylid (or strongyle) eggs, in general (which includes barber pole worm as well as other types of worms), rather than for barber pole worms specifically. In areas where barber pole worm is a known issue, you can generally assume that most of the stronylid eggs are barber pole eggs. There are more specialized tests that can be performed to identify barber pole eggs specifically, but most experts feel this is often not necessary. Talk to your veterinarian or reach out to a small ruminant parasitologist to discuss whether or not this type of testing is recommended.

    Fecal testing alone will not necessarily tell you who should be dewormed because an individual’s parasite load does not necessarily correspond to their degree of clinical illness. Each individual will be impacted by parasitic infection differently. Therefore, some sanctuaries that once used an individual’s fecal egg count to determine whether or not to deworm an individual (for example, deworming anyone who had more than 1,000 egg per gram), now use fecal egg counts as one piece of information to consider along with an individual’s hematocrit level and clinical signs. However, fecal egg counts play a very important role in watching for resistance issues. By performing a fecal egg count before deworming an individual and again 10-14 days later, you will be able to calculate the percentage of reduction in the eggs. A successful treatment should show at least a 90% reduction (though reductions over 95% are preferred).

    Can I Perform These Diagnostic Tests Myself?

    While staff can be trained to perform fecal egg counts on-site, it is very important that this is only done by individuals who have demonstrated that they are able to perform fecal egg counts reliably. It’s a good idea to check your in-house results by also submitting the samples to a diagnostic lab to ensure that your results are accurate before solely relying on in-house results. Incorrect analysis could result in a misinterpretation of treatment efficacy and missed warning signs of drug resistance.

    Unfortunately, without tracking the efficacy of a deworming treatment, you may not see clear signs of developing parasite resistance until a drug’s efficacy has reduced significantly. By assessing if each treatment administered is effective, you will be able to re-evaluate your current protocols on an ongoing basis rather than waiting for serious resistance issues. Keep in mind that an ineffective treatment could also be the result of using expired medication, a lower than recommended dose, or incorrect administration resulting in the individual not getting the full dose. Be sure to discuss your practices with your veterinarian to ensure you are using these medications appropriately.

    Hematocrit Testing

    Hematocrit, or PCV, testing can be a very useful tool when making selective deworming decisions. As stated above, sanctuaries have found that an individual’s FAMACHA score does not always correspond to their percentage of red blood cells. Some sanctuaries check hematocrit levels of any individual whose FAMACHA score was concerning (either because it it was a 4 or 5, or because it increased by 2 points). With proper training and the proper equipment, you can check hematocrit levels on-site, which will save both time and money. Caregivers often use hematocrit results to determine which individuals should have fecal samples analysed (or in some cases, receive immediate interventions). So, instead of automatically deworming every individual with a concerning FAMACHA score, or even submitting fecal samples for every individual with a concerning score, caregivers are able to make more informed decisions by using FAMACHA to identify who should have their hematocrit level checked, and then using that information to determine who should have a fecal sample submitted. 

    Putting It All Together

    Any diagnostic results, as well as an individual’s history, clinical signs, and their current and recent FAMACHA scores should be thoroughly recorded, and these should be considered when making deworming decisions. Ideally, you should communicate all of this information to your veterinarian so that they can make a deworming recommendation based on as much information as possible (or so you can work together to determine the best course of action). Identifying which individuals should be dewormed is a very complex decision (and one that may change over time, based on the specific resistance challenges of your sanctuary). The more information you can gather, the better your deworming protocols will be.

    In some instances, you will not be able to wait for diagnostic results (if you are not able to perform them on-site) before treating the individual.  If an individual has a high FAMACHA score, or a significant increase in their score and also has diarrhea, bottle jaw, is lethargic, or is showing other concerning signs of illness, contact your veterinarian immediately. They may recommend immediate deworming and, if not already done, blood work to assess the individual’s degree of anemia. Similarly, if you are able to perform hematocrit testing and you find that an individual has dangerously low hematocrit levels and clinical signs of illness, you should contact your veterinarian immediately. Severe anemia is a life-threatening emergency- the individual may need hospitalization in order to receive a life-saving blood transfusion.

    Can I Use FAMACHA With Other Species?

    Although the FAMACHA scoring system was not originally intended for camelids, it has been determined to be effective in their health evaluations. FAMACHA is not an effective tool for any other species.

    How Do I Obtain The FAMACHA Test?

    The FAMACHA system requires non-veterinarian users to be trained and certified in its use before they are allowed to obtain a FAMACHA card. A certified instructor or veterinarian can perform this training. Here is a list of certified FAMACHA instructors in the United States. If you are not in the United States or there are no certified instructors near you, ask your veterinarian or local governmental department of agriculture about where you can obtain training.

    Alternatively, you can receive FAMACHA certification online here! Simply follow their online course and submit a practice video demonstrating your newly learned skills.

    Don't Just Print The Card

    You may be tempted to find a picture of the FAMACHA test online and print it out for use at your sanctuary. Don’t do this! Training is an important component of the FAMACHA system for accurate assessments, and there’s no guarantee that the very specific colors of the card, which are critical for accurate identification, will be rendered correctly by the picture your find or the printer you use.

    SOURCES:

    Goat Care | Farm Sanctuary

    Haemonchus Contortus And Camelids | American Consortium For Small Ruminant Parasite Control

    Certified FAMACHA Instructors | American Consortium For Small Ruminant Parasite Control

    Why And How To Do FAMACHA Scoring | University Of Rhode Island

    Why And How To Practice Integrated Parasite Control For Sheep and Goats | University Of Rhode Island (Non-Compassionate Source)

    Why And How To Do FAMACHA© Scoring (Video) | University Of Rhode Island (Non-Compassionate Source)

    Why and How To Do Sheep and Goat Fecal Egg Counts | University Of Rhode Island (Non-Compassionate Source)

    Updated on November 2, 2020

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