Cat management in an unregulated shelter environment: relationship between care provision and cat health in Hong Kong

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2 95CI 2.24-12.5; p=0.001). The presence of oculo-nasal discharge -as a marker of upper 22 respiratory tract infection -was associated with a lack of regular veterinary input (OR 0.35, 23 95CI 0.16-0.77; p=0.014) and less frequent change of water within the shelter (OR 0.38, 95CI 24 0.17-0.81; p=0.013). A lack of regular feeding (OR 0.10, 95CI 0.04-0.29; p=0.008) was the 25 only factor associated with a dull coat. In summary, this study showed that some husbandry 26 practices had important associations with different aspects of cats' health for cats housed in 27 an unregulated shelter environment in Hong Kong. These findings provide evidence-base 28 support for husbandry guidelines or regulations for cat shelters which could have a positive 29 impact on cats' health and welfare for cats housed in a shelter. 30

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Keywords: cat shelters, cat health, feeding regime, husbandry, regulation, welfare. Shelters can be defined as those that provide a temporary home for dogs, cats, and other 43 animals that are offered for adoption and may receive charitable funding (Shelter 44 Terminology, Association of Shelter Veterinarians). With societal development, many novel 45 cat holding facilities have evolved. In Hong Kong, these include cat cafes, "shared office" 46 type facilities that double up as cat adoption centers, commercial offices and even a bookshop 47 that acts as a cat sanctuary. In this study we refer to all types of cat holding facilities/units as 48 "shelters" given the extreme heterogeneity of provision (Association of Shelter Veterinarians 49 Shelter Terminology 2017). 50 The management and practices of cat shelters vary substantially and there is no "shelter 51 registry" or strict regulation/licensing system to guide husbandry practices in Hong Kong. 52 Hence, the welfare of the animals held within these premises is completely contingent on the 53 organization's processes and can be a welfare concern (Rioja-Lang et al 2019).

Data collection 124
The shelter representative or contact person was interviewed via the use of a questionnaire 125 (see appendix) which included information on shelter managerial characteristics (e.g. funding 126 support of the shelter, record keeping, staff numbers) and husbandry practices (e.g. frequency 127 of feeding, litter change, disinfection, etc). Regular feeding was defined as food provided 128 daily at roughly similar time points and removed after a set interval. "Non-regular feeding" 129 was considered to be those shelters which provided ad lib feeding or free feeding where food 130 is accessible for 24h. 131 Any information that could not be obtained from the questionnaire was gathered during the 132 visit. Using our previous unpublished data (Kong et al 2018), a sample size of 15 cats per 133 shelter would allow us to have 90% to estimate the mean BCS of all the cats housed within 134 the same shelter, assuming that the mean and standard deviation of the BCS were 2.5 and 2.7, 135 respectively, and an alpha value of <0.05 was taken as significant. Thus, upon visiting, 15 136 cats were randomly chosen for observation of their body condition score, coat condition and 137 presence of oculo-nasal discharge. 138 Cats were included in the study if they had stayed in the shelter for more than four weeks. 139 Cats that were un-neutered, sick (in isolation or in quarantine or with chronic oculo-nasal 140 disease), kittens, pregnant cats and cats in hiding or where the face was not visible were not 141 included. Randomisation was performed with the rolling of a die. The first cat seen by the 142 assessor on entry to the premises was taken as subject number one. Then a die was rolled to 143 generate a number. Eg three. The third cat seen from the first subject was then chosen as the 144 second subject. For shelters with free roaming cats, a convenience sample of cats was 145 obtained. For shelters with group housing and free roaming cats, the same cat would not be 146 8 chosen twice. For shelters that held fewer than 15 cats, all cats that fulfilled the inclusion 147 criteria were assessed. 148 A single assessor (S-KK) visited all cat shelters and performed all the assessments. The 149 estimated age/breed/sex of the randomly selected cats were recorded. The body condition 150 score of each cat recruited into the study was assessed using the "Body and Muscle Condition 151 Score" (International Cat Care, n.d.), where the body condition was scored and grouped into 152 five categories: 1="very thin", 2="thin", 3='normal", 4="overweight" and 5= "obese". 153 Oculo-nasal discharge was graded as "none/low" (no clinical discharge or mild clinical signs 154 involving a single site), "mild" (clinical signs involving more than one site, mild , purulent 155 ocular or nasal discharge without any other signs, or severe clinical infection involving one 156 site), or "moderate to severe"(severe clinical signs involving one site in addition to purulent 157 ocular or nasal discharge, or mild clinical signs involving one or more site and presence of 158 In addition, cleanliness of the premises was graded as good, moderate or poor. Cleaning 161 involved "sweeping and dusting followed by washing with a detergent to leave a clean 162 surface" whereas disinfection involved "applying a disinfectant agent to an already clean 163 surface to kill micro-organisms such as viruses, ringworms spores and bacteria" (Haughi 164 1998

Statistical analysis 173
Data collected were analysed using SPSS for Windows (version 22, IBM, USA). In this study, 174 three outcomes -body condition score, upper respiratory tract signs (oculo-nasal discharge) 175 and coat condition -were considered as the main outcomes of interest. For ease of 176 interpretation, all three outcomes were dichotomised in the multivariable logistic regression 177 analysis and a body condition score more than or equal to three was considered as 178 satisfactory (although body condition scores of four or five are considered problematic, in 179 this case under nutrition/poor condition was considered a more pressing issue). One-way 180 analysis of variance (ANOVA) was first used to assess whether regular feeding and 181 veterinary check-ups were associated with a higher BCS. Predictors related to husbandry 182 practices that could have affected cats' health conditions were then further analysed by 183 multivariable logistic regression with Generalised Estimating Equation (GEE) (Wang 2014) 184 to account for potential clustering effect within each shelter. All analyses were two-tailed and 185 a p value <0.05 was considered significant. 186 187

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The characteristics and the other relevant parameters of each cat shelter are described in 189 Of the 45 shelters recruited, 18 did not respond and three responded but did not fulfil the 192 inclusion criteria. Of the 24 cat shelters (with 314 cats) included in our analysis, four were 193 foster homes, three were rescue group holding facilities, six were sanctuaries, and 11 were 194 shelters with charity status. Some of the latter 11 shelters also housed animals other than cats, 195 mostly dogs. Cat movement in/out of the premises-addition of new cats; "live exit"-whether 196 adopted or moved to another shelter; or died -naturally or euthanized over 12 months (on 197 date of visit) were reported in 17 shelters (71%). Management policies -including 198 documentations on admission/ isolation, adoption, cleaning guidelines, disaster protocols, and 199 staff training records -were complete in 12 (50%), incomplete in three (12%), and absent in 200 9 shelters (38%). 201 Health records were complete only in 13 shelters (54%); health records were either 202 incomplete (n=10, 42%) or absent (n=1, 4%) in other shelters. For those shelters with 203 complete health records, all the cats were vaccinated and dewormed. For shelters where the 204 records were incomplete or absent, the vaccination/deworming status of the cats were 205 unknown. 206 Of the eight shelters (33%) that provided regular veterinary checks for the residing cats, the 207 shelter representatives were unable to elaborate what type of veterinary care was provided. 208 Most of the time, in addition to one employed staff member, there were two volunteers 209 looking after the cats in each location. 210

Husbandry practices 211
Daily cleaning was conducted in two (17%) shelters, and in 20 shelters (83%) cleaning of the 212 cat holding area was performed more frequent than once daily. Disinfection was carried out 213 less than once daily in nine shelters (38%), daily in nine (38%) and more than once daily in 214 six shelters (24%). Cats were regularly fed (at fixed times with the food bowls removed 215 between meals) in 13 shelters (54%). The same brand of food was offered to cats in 14 216 shelters (58%). 217 Of the 181 cats in the 14 shelters offering same-brand food, 73% (144/181) had a body 218 condition score of more than three, compared to 53% (70/133) of cats that were not fed the 219 same brand of food (133 cats in 10 shelters). 220 Water was changed daily in 29% (7/24) of the shelters and more than once daily in 17% 221 (17/24). Litter was changed less frequent than once daily in 4% (1/24), daily in 33% (8/24) 222 and more than once daily in 63% (15/24) of the shelters; 83% (20/24) of the facilities used 223 the same brand of cat litter. The mean number of litter boxes per cat was 0.6 (standard 224 deviation 0.3), and the mean number of cats per litter box was 1.5 (standard deviation 2.0). 225

Cat health data 226
Almost all cats in the study were Domestic Short Hair (DSH) (96%). The premises were 227 deemed clean in 71% (17/24), moderately clean in 25% (6/24), and poor in 4% (1/24). Odour 228 of cat urine was strong in 4% (1/24), mild in 50% (12/24) and absent in 38% (9/24). 229 Most cats have a BCS of three (170/314 [54%]), and 110 cats (35%) had a BCS of less than 230 three. Only 34 cats (11%) had a BCS more than three. Oculo-nasal discharge and a dull coat 231 were noted in 28% (88/314) and 16% (51/314) of the cats, respectively. 232 In shelters where regular feeding (n=167, 53%) and regular veterinary checks (n=96, 30%) 233 were provided, cats were more likely to have a higher BCS (regular feeding: mean 2.9 with 234 standard deviation 0.7 vs ad hoc feeding: mean 2.7 with standard deviation 0.7, one-way 235 ANOVA p=0.017; and regular veterinary checks: mean 3.0 with standard deviation 0.6 vs 236 12 without regular veterinary checks: mean 2.7 with standard deviation 0.8, one-way ANOVA 237 p=0.001) (Figure 1 and 2). 238 The results of the multivariable model showed that cats with a satisfactory BCS were 239 associated with (a) regular veterinarian checks (odds ratio [OR 8.21 p=0.013). Regular feeding was the only predictor associated with a reduced risk of dull coat 246 (OR 0.10, 95%CI 0.04-0.29; p=0.008) ( Table 2). 247 The overall key findings of the predictors of cats' health housed in the unregulated cat 248 shelters are summarised in Table 3. Namely, regular veterinary input, regular disinfection, regular change of water and regular 254 feeding were associated with better health, as defined by a higher but not the highest body 255 condition score; less oculo-nasal discharge, and the coat being less dull. These results have 256 some health implications for shelter cats. 257 Feline URI is one of the commonest diseases in cat shelters (Steneroden et  In support of this, a recent study investigating the incidence of URI in shelter cats found that 295 those cats that were handled more frequently had less incidence of URI (Burns et al 2020). 296 Whether more volunteers/ carers were associated with better disinfection was not studied. Our study highlights the importance of regular disinfection, which was associated with a 303 better body condition score, less oculo-nasal discharge and less likely to have a dull coat. One factor affecting cat health is regular feeding; which is associated with better cat health. 345 Food preference may be one reason why cats have lower body condition score in some 346 shelters. Shelters are stressful for cats. Thorne (1982) found that when cats are stressed, they 347 chose familiar items to eat. An inconsistent supply/type of food creates another source of 348 stress. When faced with novelty food items, many cats also under-eat (Bradshaw et al 1996). 349 Other factors which may have contributed to this finding include inter-cat relationship during 350 mealtimes, food competition, food preference and the consistency of food supply which was 351 not thoroughly examined. 352 The present study found that regular feeding instead of ad libitum feeding was associated 353 with a higher body condition score. This is in contradiction to current literature which It is envisioned that our study could contribute to improving the welfare of shelter cats locally, 382 similar to the descriptive survey of animal shelters by Hirsch which was conducted in 383 Sweden where the husbandry practices and management were recorded with an aim to 384 improve the welfare of shelter cats (Hirsch et al 2014). 385 The mean body condition score of the cats in this study was three; 32% of cats had a body 386 condition score less than three, 11% had a body condition score of four and above (scattered 387 across all types of holdings). This agrees with Zito et al (2019) where managed and 388 unmanaged/stray cats in New Zealand were found to have satisfactory health. Hence the 389 feeding schedule and consistency of food supply may have an impact on cats' health in 390 shelters, but this warrants further studies. 391 Having regulations or guidelines may serve to improve the welfare of the shelter cats. As yet 392 there are no international guidelines on cat shelter management, but many countries have 393 "best practice" or "code of practice" for cats (USA, Canada, UK, Australia, Lithuania); and 394 and often succumbed to economic pressure and political red tape. In Zito's study looking at 401 managed and unmanaged stray cats in New Zealand; most cats observed were of satisfactory 402 health. Hence it seems with or without regulations; cats fare well, at least in Zito's study. 403 Across the globe, education of the general public seemed to be a common theme in 404 improving the welfare of all animals, not just cats (NCNMS 2020). 405 This study has some limitations, which are in and of themselves integral to its findings. 406 Operating an animal organisation in Hong Kong does not require a license and therefore there 407 is no registry of cat shelters making it infeasible to gain a representative sample. The inter-408 facility assessments variations also present a substantial hurdle meaning only the most 409 common factors could be reliably assessed at each site (e.g. BCS). Full parameters were 410 difficult to assess due to a lack of availability of formal records and assessment tools 411 specifically tailored to a heterogeneous shelter environment. 412 Confounding factors relating to stress in cats were not addressed in the present study, in part 413 because the over-arching impacts of major variations in practices had not been quantified.