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    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 February 15, 2021

    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?

    There was a time when it was standard practice to rely much more heavily on deworming medications and to use them prophylactically (preventatively). At the time, the thinking was to eliminate as many worms as possible, regardless of whether or not an individual was showing clinical signs of parasitism. Over the years, deworming recommendations, especially for small ruminants, have evolved in response to the growing issue of anthelmintic-resistant parasites (parasites that are resistant to deworming treatments). Anthelmintic-resistant barber pole worms are an issue in sheep, goats, llamas, and alpacas, though the degree of resistance and to which drugs worms are resistant will vary region by region and also property to property. More information on barber pole worm and anthelmintic resistance can be found here.

    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 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, and fecal egg counts alone are not a good indicator or who should or should not be dewormed because they do not necessarily correspond to clinical disease, but the more information you can gather about an individual, the better informed your deworming decisions will be. More information about targeted deworming and tools that can help make deworming decisions can be found here.

    Monitoring For Resistance Issues Is Important!

    Whenever you deworm one of your residents, be sure to use pre- and post-deworming fecal egg counts to assess whether or not the treatment was effective and to watch for signs of anthelmintic resistance. Unfortunately, without tracking the efficacy of a deworming treatment, you may not see clear signs of developing resistance until a drug’s efficacy has reduced significantly.

    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.


    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)

    Non-Compassionate Source?
    If a source includes the (Non-Compassionate Source) tag, it means that we do not endorse that particular source’s views about animals, even if some of their insights are valuable from a care perspective. See a more detailed explanation here.

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