Foot-and-mouth disease in Tanzania from 2001 to 2006.

Foot-and-mouth disease (FMD) is endemic in Tanzania, with outbreaks occurring almost each year in different parts of the country. There is now a strong political desire to control animal diseases as part of national poverty alleviation strategies. However, FMD control requires improving the current knowledge on the disease dynamics and factors related to FMD occurrence so control measures can be implemented more efficiently. The objectives of this study were to describe the FMD dynamics in Tanzania from 2001 to 2006 and investigate the spatiotemporal patterns of transmission. Extraction maps, the space-time K-function and space-time permutation models based on scan statistics were calculated for each year to evaluate the spatial distribution, the spatiotemporal interaction and the spatiotemporal clustering of FMD-affected villages. From 2001 to 2006, 878 FMD outbreaks were reported in 605 different villages of 5815 populated places included in the database. The spatial distribution of FMD outbreaks was concentrated along the Tanzania-Kenya, Tanzania-Zambia borders, and the Kagera basin bordering Uganda, Rwanda and Tanzania. The spatiotemporal interaction among FMD-affected villages was statistically significant (P≤0.01) and 12 local spatiotemporal clusters were detected; however, the extent and intensity varied across the study period. Dividing the country in zones according to their epidemiological status will allow improving the control of FMD and delimiting potential FMD-free areas

Risk Factors for Foot-and-Mouth Disease in Tanzania, 2001-2006

We developed a model to quantify the effect of factors influencing the spatio-temporal distribution of foot-and-mouth disease (FMD) in Tanzania. The land area of Tanzania was divided into a regular grid of 20 km x 20 km cells and separate grids constructed for each of the 12-month periods between 2001 and 2006. For each year, a cell was classified as either FMD positive or negative dependent on an outbreak being recorded in any settlement within the cell boundaries. A Bayesian mixed-effects spatial model was developed to assess the association between the risk of FMD occurrence and distance to main roads, railway lines, wildlife parks, international borders and cattle density. Increases in the distance to main roads decreased the risk of FMD every year from 2001 to 2006 (ORs ranged from 0.43 to 0.97). Increases in the distance to railway lines and international borders were, in general, associated with a decreased risk of FMD (ORs ranged from 0.85 to 0.99). Increases in the distance from a national park decreased the risk of FMD in 2001 (OR 0.80; 95% CI 0.68-0.93) but had the opposite effect in 2004 (OR 1.06; 95% CI 1.01-1.12). Cattle population density was, in general, positively associated with the risk of FMD (ORs ranged from 1.01 to 1.30). The spatial distribution of high-risk areas was variable and corresponded to endemic (2001, 2002 and 2005) and epidemic (2003, 2004 and 2006) phases. Roads played a dominant role in both epidemiological situations; we hypothesize that roads are the main driver of FMD expansion in Tanzania. Our results suggest that FMD occurrence in Tanzania is more related to animal movement and human activity via communication networks than transboundary movements or contact with wildlife

The Active Recovery Triad (ART) model:A new approach in Dutch long-term mental health care

Unlike developments in short-term clinical and community care, the recovery movement has not yet gained foothold in long-term mental health services. In the Netherlands, approximately 21,000 people are dependent on long-term mental health care and support. To date, these people have benefited little from recovery-oriented care, rather traditional problem-oriented care has remained the dominant approach. Based on the view that recovery is within reach, also for people with complex needs, a new care model for long-term mental health care was developed, the active recovery triad (ART) model. In a period of 2.5 years, several meetings with a large group of stakeholders in the field of Dutch long-term mental health care took place in order to develop the ART model. Stakeholders involved in the development process were mental health workers, policy advisors, managers, directors, researchers, peer workers, and family representatives. The ART model combines an active role for professionals, service users, and significant others, with focus on recovery and cooperation between service users, family, and professionals in the triad. The principles of ART are translated into seven crucial steps in care and a model fidelity scale in order to provide practical guidelines for teams implementing the ART model in practice. The ART model provides guidance for tailored recovery-oriented care and support to this “low-volume high-need” group of service users in long-term mental health care, aiming to alter their perspective and take steps in the recovery process. Further research should investigate the effects of the ART model on quality of care, recovery, and autonomy of service users and cooperation in the triad