Disposable diaper waste accumulation at the human-livestock-wildlife interface

Improper management of disposable diaper waste is becoming a priority global health issue because it has resulted in environmental accumulation of fecal pathogens and non-biodegradable material. Concerns include drinking water safety, as well as chemical and physical contaminants that may harm human, animal (domestic and wildlife), and environmental health. In rural areas, especially those in low- and middle-income countries where municipal waste management infrastructure may be lacking, this issue is particularly challenging. Using a One Health approach, this study used spatial statistics to describe the location and proximity of disposable diaper waste sites to livestock grazing areas, human dwellings, rivers, and conservation areas in agro-pastoralist com- munities in South Africa. A total of 627 unique diaper waste sites were identified and plotted between May 2019 and March 2020. The mean distance of waste sites to rivers was 2,196 m (SD = 1,799) and 5,523 m (SD = 2,642) to protected areas. Most diaper waste sites were located along the perimeter of villages and dwellings, where livestock grazing areas are common. This description of waste sites is an important step in strategizing efficient and effective waste management programs and policies that prioritize those areas with greatest potential impact on human, animal, and environmental health for remediation.South Africa’s Department of Forestry, Fisheries and the Environment’s Environmental Monitors Program.http://www.elsevier.com/locate/envcam2023Veterinary Tropical Disease

One health profile of a community at the wildlife-domestic animal interface, Mpumalanga, South Africa

We used a community engagement approach to develop a One Health profile of an agropastoralist population at the interface of wildlife areas in eastern South Africa. Representatives from 262 randomly-selected households participated in an in-person, cross-sectional survey. Questions were designed to ascertain the participants’ knowledge, attitudes, and practices with regard to human health, domestic animal health, and natural resources including wildlife and water. Surveys were conducted within four selected villages by a team of trained surveyors and translators over four weeks in July-August 2013. Questions were a combination of multiple choice (single answer), multiple selection, open-ended, and Likert scale. The study found that nearly three-quarters of all households surveyed reported owning at least one animal (55% owned chickens, 31% dogs, 25% cattle, 16% goats, 9% cats, and 5% pigs). Among the animal-owning respondents, health concerns identified included dissatisfaction with government-run cattle dip facilities (97%) and frequent morbidity and mortality of chickens that had clinical signs consistent with Newcastle disease (49%). Sixty-one percent of participants believed that diseases of animals could be transmitted to humans. Ninety-six percent of respondents desired greater knowledge about animal diseases. With regard to human health issues, the primary barrier to health care access was related to transportation to/from the community health clinics. Environmental health issues revealed by the survey included disparities by village in drinking water reliability and frequent domiciliary rodent sightings positively associated with increased household size and chicken ownership. Attitudes towards conservation were generally favorable; however, the community demonstrated a strong preference for a dichotomous approach to wildlife management, one that separated wildlife from humans. Due to the location of the community, which neighbors the Great Limpopo Transfrontier Conservation Area, and the livestock-dependent lifestyle of the resource-poor inhabitants, a One Health approach that takes into consideration the interconnectedness of human, animal, and environmental health is necessary. The community profile described in this study provides a foundation for health research and planning initiatives that are driven by community engagement and consider the multitude of factors affecting health at the human-domestic animal-wildlife interface. Furthermore, it allows for the determination and quantification of the linkages between human, animal, and environmental health.The project was funded by the UC Davis Dean’s Innovation Fund and the UC Davis Global Affairs Seed Grant for International Activities.http://www.elsevier.com/locate/prevetmed2017-08-31hb2016Centre for Veterinary Wildlife StudiesVeterinary Tropical Disease

Risk factors for bacterial zoonotic pathogens in acutely febrile patients in Mpumalanga Province, South Africa

Endemic zoonoses, such as Q fever and spotted fever group (SFG) rickettsiosis, are prevalent in South Africa, yet often undiagnosed. In this study, we reviewed the demographics and animal exposure history of patients presenting with acute febrile illness to community health clinics in Mpumalanga Province to identify trends and risk factors associated with exposure to Coxiella burnetii , the causative agent of Q fever, and infection by SFG Rickettsia spp. Clinical and serological data and questionnaires elucidating exposure to animals and their products were obtained from 141 acutely febrile patients between 2012 and 2016. Exposure or infection status to C. burnetii and SFG Rickettsia spp. was determined by presence of IgG or IgM antibodies. Logistic regression models were built for risk factor analysis. Clinical presentation of patients infected by SFG rickettsiosis was described. There were 37/139 (27%) patients with a positive C. burnetii serology, indicative of Q fever exposure. Patients who had reported attending cattle inspection facilities (“dip tanks”) were 9.39 times more likely to be exposed to Q fever (95% CI: 2.9–30.4). Exposure risk also increased with age (OR: 1.03, 95% CI: 1.002–1.06). Twenty‐one per cent of febrile patients (24/118) had evidence of acute infection by SFG Rickettsia spp. Similarly, attending cattle inspection facilities was the most significant risk factor (OR: 8.48, 95% CI: 1.58–45.60). Seropositivity of females showed a significant OR of 8.0 when compared to males (95% CI: 1.49–43.0), and consumption of livestock was associated with a decreased risk (OR: 0.02, 95% CI: 0.001–0.54). A trend between domestic cat contact and SFG rickettsiosis was also noted, albeit borderline non‐significant. In this endemic region of South Africa, an understanding of risk factors for zoonotic pathogens, including exposure to domestic animals, can help clinic staff with diagnosis and appropriate therapeutic management of acutely febrile patients as well as identify target areas for education and prevention strategies.The National Institute for Communicable Disease, the University of Pretoria, and the University of California, Davis.http://wileyonlinelibrary.com/journal/zph2020-08-01hj2020Centre for Veterinary Wildlife StudiesVeterinary Tropical Disease

Gender and zoonotic pathogen exposure pathways in a resource-limited community, Mpumalanga, South Africa: A qualitative analysis.

The Mnisi community is a livestock-dependent community neighboring the Great Limpopo Transfrontier Conservation Area in South Africa. Here, zoonotic pathogens contribute to as many as 77% of cases of acute febrile illness. Previous gender-disaggregated analysis in the community has shown that men and women have different risks of zoonotic illness, suggesting that exposure routes for zoonotic infections should be further explored to inform gender-sensitive risk mitigation strategies. Using a One Health approach and ethnographic methodology, we examined interactions between community residents, domestic animals, and the built and natural environment to investigate potential exposure pathways for zoonotic infections from a gendered perspective. We combined data from direct household observations and focus group discussions on previously identified gendered tasks such as domestic animal care, water collection, and food preparation, and how and by whom these tasks were performed. We noted gender differences for household tasks, animal care duties, and environmental exposure. Both men and women access grazing land but for different tasks (water collection-females, cattle grazing-males), and both men and women experience more time in the bush in recent years due to decreased water availability. From observations, it was noted that men wore covered protective work clothes (such as long trousers and closed-toe shoes) more commonly than women did; women did not often wear these for household duties including water collection in the bush. We recommend that these gender-typed roles serve as critical control points for zoonotic pathogen exposure. For example, tick-bite exposure prevention should be directed at both men and women based on their daily activities, but prevention in men should target exposure from cattle and prevention in women should focus on personal protective measures during water and firewood collection. These findings can contribute to a more detailed understanding of the role of human behavior and critical control points for zoonotic disease-a significant contributor to acute febrile illness in this rural, resource-limited setting

A community-based One Health education program for disease risk mitigation at the human-animal interface.

The interface between humans, domestic animals, and wildlife has been implicated in the emergence of infectious diseases and the persistence of endemic human and animal diseases. For individuals who reside at this interface, particularly those in low-resource settings, the development of disease risk assessment and mitigation skills must be prioritized. Using a community engagement-One Health approach, we implemented a training program aimed at advancing these skills among agro-pastoralists living adjacent to conservation areas in South Africa. The program included professional development of local facilitators who then conducted workshops with community members. Workshops used a series of experiential, inquiry-based activities to teach participants the concepts of pathogen transmission and disease risk assessment and mitigation. The program was implemented over four weeks with 10 facilitators and 78 workshop participants. We conducted a within-subjects experimental study using a mixed methods design to evaluate the program in terms of facilitator and participant One Health knowledge and practices. Quantitative data included pre/post written assessments; qualitative data included focus group discussions, semi-structured interviews, and pre/post photographs. Mean post-test scores of facilitators increased by 17% (p = 0.0078). For workshop participants, improvements in knowledge were more likely for females than males (OR = 7.315, 95% CI = 2.258-23.705, p = 0.0009) and participants with a higher versus lower education level, albeit borderline non-significant (OR = 4.781, 95% CI = 0.942-24.264, p = 0.0590). Qualitative analysis revealed the implementation of risk mitigation strategies by 98% (60/61) of workshop participants during the three-month follow-up and included improved personal and domestic hygiene practices and enhanced animal housing. Although further evaluation is recommended, this program may be appropriate for consideration as a scalable approach by which to mitigate human and animal infectious disease risk in high-risk/low-resource communities

A community-based One Health education program for disease risk mitigation at the human-animal interface

The interface between humans, domestic animals, and wildlife has been implicated in the emergence of infectious diseases and the persistence of endemic human and animal diseases. For individuals who reside at this interface, particularly those in low-resource settings, the development of disease risk assessment and mitigation skills must be prioritized. Using a community engagement-One Health approach, we implemented a training program aimed at advancing these skills among agro-pastoralists living adjacent to conservation areas in South Africa. The program included professional development of local facilitators who then conducted workshops with community members. Workshops used a series of experiential, inquiry-based activities to teach participants the concepts of pathogen transmission and disease risk assessment and mitigation. The program was implemented over four weeks with 10 facilitators and 78 workshop participants. We conducted a within-subjects experimental study using a mixed methods design to evaluate the program in terms of facilitator and participant One Health knowledge and practices. Quantitative data included pre/post written assessments; qualitative data included focus group discussions, semi-structured interviews, and pre/post photographs. Mean post-test scores of facilitators increased by 17% (p=0.0078). For workshop participants, improvements in knowledge were more likely for females than males (OR=7.315, 95% CI=2.258–23.705, p=0.0009) and participants with a higher versus lower education level, albeit borderline non-significant (OR=4.781, 95% CI=0.942–24.264, p=0.0590). Qualitative analysis revealed the implementation of risk mitigation strategies by 98% (60/61) of workshop participants during the three-month follow-up and included improved personal and domestic hygiene practices and enhanced animal housing. Although further evaluation is recommended, this program may be appropriate for consideration as a scalable approach by which to mitigate human and animal infectious disease risk in high-risk/low-resource communities. Keywords: Community engagement, Health promotion, Experiential learning, Risk assessment, Infectious disease, Program evaluatio

Developing a Global One Health Workforce: The "Rx One Health Summer Institute" Approach.

The One Health approach has gained support across a range of disciplines; however, training opportunities for professionals seeking to operationalize the interdisciplinary approach are limited. Academic institutions, through the development of high-quality, experiential training programs that focus on the application of professional competencies, can increase accessibility to One Health education. The Rx One Health Summer Institute, jointly led by US and East African partners, provides a model for such a program. In 2017, 21 participants representing five countries completed the Rx One Health program in East Africa. Participants worked collaboratively with communities neighboring wildlife areas to better understand issues impacting human and animal health and welfare, livelihoods, and conservation. One Health topics were explored through community engagement and role-playing exercises, field-based health surveillance activities, laboratories, and discussions with local experts. Educational assessments reflected improvements in participants' ability to apply the One Health approach to health and disease problem solving, as well as anticipate cross-sectoral challenges to its implementation. The experiential learning method, specifically the opportunity to engage with local communities, proved to be impactful on participants' cultural awareness. The Rx One Health Summer Institute training model may provide an effective and implementable strategy by which to contribute to the development of a global One Health workforce

Risk factors for bacterial zoonotic pathogens in acutely febrile patients in Mpumalanga Province, South Africa

Endemic zoonoses, such as Q fever and spotted fever group (SFG) rickettsiosis, are prevalent in South Africa, yet often undiagnosed. In this study, we reviewed the demographics and animal exposure history of patients presenting with acute febrile illness to community health clinics in Mpumalanga Province to identify trends and risk factors associated with exposure to Coxiella burnetii , the causative agent of Q fever, and infection by SFG Rickettsia spp. Clinical and serological data and questionnaires elucidating exposure to animals and their products were obtained from 141 acutely febrile patients between 2012 and 2016. Exposure or infection status to C. burnetii and SFG Rickettsia spp. was determined by presence of IgG or IgM antibodies. Logistic regression models were built for risk factor analysis. Clinical presentation of patients infected by SFG rickettsiosis was described. There were 37/139 (27%) patients with a positive C. burnetii serology, indicative of Q fever exposure. Patients who had reported attending cattle inspection facilities (“dip tanks”) were 9.39 times more likely to be exposed to Q fever (95% CI: 2.9–30.4). Exposure risk also increased with age (OR: 1.03, 95% CI: 1.002–1.06). Twenty‐one per cent of febrile patients (24/118) had evidence of acute infection by SFG Rickettsia spp. Similarly, attending cattle inspection facilities was the most significant risk factor (OR: 8.48, 95% CI: 1.58–45.60). Seropositivity of females showed a significant OR of 8.0 when compared to males (95% CI: 1.49–43.0), and consumption of livestock was associated with a decreased risk (OR: 0.02, 95% CI: 0.001–0.54). A trend between domestic cat contact and SFG rickettsiosis was also noted, albeit borderline non‐significant. In this endemic region of South Africa, an understanding of risk factors for zoonotic pathogens, including exposure to domestic animals, can help clinic staff with diagnosis and appropriate therapeutic management of acutely febrile patients as well as identify target areas for education and prevention strategies.The National Institute for Communicable Disease, the University of Pretoria, and the University of California, Davis.http://wileyonlinelibrary.com/journal/zph2020-08-01hj2020Centre for Veterinary Wildlife StudiesVeterinary Tropical Disease