Mixed methods survey of zoonotic disease awareness and practice among animal and human healthcare providers in Moshi, Tanzania

This work was supported by US National Institutes of Health-National (NIH) Science Foundation Ecology and Evolution of Infectious Disease program (R01 TW009237) and the UK Biotechnology and Biological Sciences Research Council (BBSRC) (BB/J010367). Additional support was provided by BBSRC grants BB/L018845 (RRK, JAC and JEBH) and BB/L018926 (SC, RRK, JPS and JAC). JAC is supported by NIH grant R01 TW009237 and Bill & Melinda Gates Foundation grant OPP1125993. JPS had additional support from an ESRC fellowship, RES-070-27-0039. HLZ received support from the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellows Program at Duke University.Background:  Zoonoses are common causes of human and livestock illness in Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever account for a large proportion of human febrile illness in northern Tanzania, yet they are infrequently diagnosed. We conducted this study to assess awareness and knowledge regarding selected zoonoses among healthcare providers in Moshi, Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain insights into contextual factors contributing to the apparent under-diagnosis of zoonoses. Methodology/Results:  We conducted a questionnaire about zoonoses knowledge, case reporting, and testing with 52 human health practitioners and 10 livestock health providers. Immediately following questionnaire administration, we conducted semi-structured interviews with 60 of these respondents, using the findings of a previous fever etiology study to prompt conversation. Sixty respondents (97%) had heard of brucellosis, 26 (42%) leptospirosis, and 20 (32%) Q fever. Animal sector respondents reported seeing cases of animal brucellosis (4), rabies (4), and anthrax (3) in the previous 12 months. Human sector respondents reported cases of human brucellosis (15, 29%), rabies (9, 18%) and anthrax (6, 12%). None reported leptospirosis or Q fever cases. Nineteen respondents were aware of a local diagnostic test for human brucellosis. Reports of tests for human leptospirosis or Q fever, or for any of the study pathogens in animals, were rare. Many respondents expressed awareness of malaria over-diagnosis and zoonoses under-diagnosis, and many identified low knowledge and testing capacity as reasons for zoonoses under-diagnosis. Conclusions: This study revealed differences in knowledge of different zoonoses and low case report frequencies of brucellosis, leptospirosis, and Q fever. There was a lack of known diagnostic services for leptospirosis and Q fever. These findings emphasize a need for improved diagnostic capacity alongside healthcare provider education and improved clinical guidelines for syndrome-based disease management to provoke diagnostic consideration of locally relevant zoonoses in the absence of laboratory confirmation.Publisher PDFPeer reviewe

One Health contributions towards more effective and equitable approaches to health in low- and middle-income countries

This research was supported by the UK Biotechnology and Biological Sciences Research Council (BB/J010367/1) and the UK Zoonoses and Emerging Livestock Systems Initiative (BB/L017679/1, BB/L018926/1 and BB/L018845/1) (S.C., J.E.B.H., J.S., J.B., A.D., J.A.C., W.A.d.G., R.R.K., T.K., D.T.H., B.T.M., E.S.S., L.W.). The Wellcome Trust provided supported for K.H. and A.L. (095787/Z/11/Z) and K.J.A. (096400/Z/11/Z). The US National Institutes of Health provided support for J.A.C. (R01AI121378) and M.P.R. (R01AI121378, K23AI116869).Emerging zoonoses with pandemic potential are a stated priority for the global health security agenda, but endemic zoonoses also have a major societal impact in low-resource settings. Although many endemic zoonoses can be treated, timely diagnosis and appropriate clinical management of human cases is often challenging. Preventive ‘One Health’ interventions, e.g. interventions in animal populations that generate human health benefits, may provide a useful approach to overcoming some of these challenges. Effective strategies, such as animal vaccination, already exist for the prevention, control and elimination of many endemic zoonoses, including rabies, and several livestock zoonoses (e.g. brucellosis, leptospirosis, Q fever) that are important causes of human febrile illness and livestock productivity losses in low- and middle-income countries. We make the case that, for these diseases, One Health interventions have the potential to be more effective and generate more equitable benefits for human health and livelihoods, particularly in rural areas, than approaches that rely exclusively on treatment of human cases. We hypothesize that applying One Health interventions to tackle these health challenges will help to build trust, community engagement and cross-sectoral collaboration, which will in turn strengthen the capacity of fragile health systems to respond to the threat of emerging zoonoses and other future health challenges. One Health interventions thus have the potential to align the ongoing needs of disadvantaged communities with the concerns of the broader global community, providing a pragmatic and equitable approach to meeting the global goals for sustainable development and supporting the global health security agenda.Publisher PDFPeer reviewe

Zoonotic diseases at the human-domestic animal - Wildlife interface in Southern and Eastern Africa

International Journal of Infectious Diseases, Volume 53-2016, Supplement, Page 5Southern and East African Countries are rich in ecosystems where human, livestock and wildlife populations are in close proximity and serviced by the ecosystems services such as water, land and fauna resources. In the course of mingling there are possibility of sharing pathogens which consequently may lead to outbreaks of zoonotic agents in the concern populations. In Tanzania various studies were conducted in the past decade which were determining the presence of zoonotic agents, the burden in individual populations, the dynamics and drivers of disease transmissions at the human-livestock-wildlife interfaces.. Using serological and molecular biological techniques, a cross sectional studies were conducted in human and animal populations at an various ecosystems neighbouring wildlife conservation areas of Tanzania. The selected agents studied included bacterial and viral zoonotic agents. Microscopic Agglutination Test (MAT) was carried out to test for leptospira antibodies in 1,351 livestock and 42 wildlife. The overall seroprevalence was 26.35% and 28.57% with serovars of Leptospira Interrogans; Hardjo, Hebdomadis, Grippotyphosa, Sokoine and Lora were common. Similarly, 30% of 267 human samples tested positive, for almost similar serovars. Sequencing alignment on 16S ribosomal DNA gene, suggested that serovars of Leptospira interrogans were common among human and animal populations. Using Rose bengal as a screen test, a total of 5.57% and 11.9% of sera from domestic animal and wild animals were found to be positive respectively. The IDEXX Q Fever ELISA for the detection of antibodies against Coxiella burnetii was employed and 40 of 587 (6.8%) cattle and 15 of 22 (68.2%) of wild animals were found to have antibodies against C. brunetti. RVF virus testing conducted IgG and IgM ELISA revealed, thirty two out of 800 (4%) and eight out of 42 (19%) from domestic animals and wildlife tested positive for IgG respectively. Of the 440 sera from domestic animal tested for IgM only 15 (3.4%) had IgM, while all wild animal samples were negative. Under the PREDICT Project protocol, a total of 268 wildlife animal species (Bats, Rodents and Non human primates) were subjected to molecular virology diagnostic tests and revealed the presence of 64 viruses including 48 novel viruses. The identification of the novel viruses is still underway to determine the peculiar genus and species. Using the geographical information system, the locations for infected animals and humans congregated at same coordinates putatively indicate cross infections between two populations. Findings from the present studies are providing important insight on presence of zoonotic agents which potentially may cause febrile illness among persons in frequent contact with animals and their products in the poor resources rural communities not only of Tanzania but across the developing world

Development of an item scale to assess attitudes towards domestic dogs in the United Republic of Tanzania

Domestic dogs are important sources of rabies exposure for humans in the developing world. Control of the disease in endemic areas relies on the vaccination of owned dogs, and thus owners' attitudes and behavior towards household dogs may be of relevance to rabies control programs. However, none of the instruments used to evaluate attitudes towards companion animals have been validated for use in developing countries. In this paper, we present the development of an item scale to measure attitudes towards owned dogs in Tanzania. We assess the scale's reliability and validity, and conduct a preliminary analysis of factors affecting respondents' attitudes. Twelve 5-point Likert scale items were selected from an item pool during the pilot phase. Following administration of these items to 824 dog owners across 12 study sites in Tanzania, two subscales were derived, representing the acceptance of dogs as equals and physical interactions with household dogs. Both subscales showed acceptable levels of reliability and concurrent validity, although the latter estimates were found to be influenced by interviewer identity. Male respondents had significantly higher scores on both subscales than females, and Muslim respondents showed more positive attitudes towards dogs as equals than did Christians. Among those respondents who were also the heads of their households, those whose dogs were vaccinated against rabies had a more positive attitude towards dogs as equals. It is hoped that the derived item scale will serve as a basis to further understanding of the motivational considerations of attitudes towards dogs in developing countries, and how these may influence aspects of dog ownership, welfare, and disease control

Female and male-controlled livestock holdings impact pastoralist food security and women’s dietary diversity

Background: Food insecurity is a global problem that requires a One Health approach. As many households in low- and middle-income nations rely on crops and livestock that they produce to meet their household’s needs, food security and nutrition are closely linked to the health of animals and the environment. Resources controlled by women are more often allocated to uses that benefit the entire household, such as food, health, and educating children, than men’s resources. However, studies of gender control of resources among pastoralist societies are scant. We examined the effect of female and male control of livestock resources on food security and women’s dietary diversity among households from one agro-pastoralist and two pastoralist tribes in Iringa Region in south- central Tanzania. Methods: We conducted surveys with 196 households, which included questions on food availability and food consumption among women, livestock holdings, gender control of livestock and livestock product income, and household demographics, as well as open-ended questions on the use of income. Food availability and food consumption responses were used to construct food security and women’s dietary diversity indexes, respectively. We conducted mixed effects logistic regression to analyze how household food security and dietary diversity were associated with livestock and other household variables. We also examined qualitative responses for use of income controlled by women and how the household obtained income when needed. Results: Female-controlled livestock generally supported better household nutrition outcomes. Greater chicken holdings increased the probability of being food secure in pastoralist households but decreased it in agro- pastoralist households, while increasing the probability of having medium-high dietary diversity among all tribes. Male-controlled livestock holdings were not related to food security status. Women used income to supplement food supplies and livestock they controlled as a primary response to unanticipated household needs. Conclusions: Our results show that female-control of livestock is significantly related to household food security and dietary diversity in pastoralists and agro-pastoralists in rural Tanzania. Importantly, the relationship between food security and dietary diversity differs among tribes for both male and female-controlled livestock, which suggests that blanket policies regarding management of livestock holdings may have unintended consequences