Introduction à l’épidémiologie participative et son application à la surveillance participative de l’influenza aviaire hautement pathogène: Manuel pour les praticiens de la surveillance participative des maladies

Dans le cadre du projet de détection précoce, de rapportage et de surveillance de l’influenza aviaire en Afrique, financé par l’Agence américaine pour le développement international (USAID), un certain nombre de formations en surveillance participative de la maladie (SPM) concernant l’influenza aviaire hautement pathogène (IAHP) ont été réalisés en Afrique de l’Ouest et de l’Est en 2008 et 2009. L’objet de ce manuel est d’offrir une référence aux vétérinaires et aux agents de santé animale pendant et après une formation en SPM. Le manuel est principalement axé sur la SPM de l’IAHP, mais les méthodes peuvent être facilement adaptées et appliquées à d’autres maladies du bétail

Introduction to participatory epidemiology and its application to highly pathogenic avian influenza participatory disease surveillance: A manual for participatory disease surveillance practitioners

The purpose of this manual is to provide a reference for veterinarians and animal health workers during and after PDS training. The main focus of the manual is on HPAI PDS but the methods can be easily adaptedand applied to address other livestock diseases

Evaluation of participatory disease surveillance for highly pathogenic avian influenza in Africa and rinderpest in Pakistan

Participatory disease surveillance (PDS) has been promoted in developing countries to complement conventional surveillance, particularly for rinderpest eradication and Highly Pathogenic Avian Influenza (HPAI) control. We conducted an evaluation participatory epidemiology (PE) and PDS capacity building outcomes by examining PDS as a surveillance tool for national animal disease surveillance. The evaluation framework pillars (relevance, effectiveness, efficiency, sustainability and impact) were developed from over 30 indicators adapted from established animal and public health surveillance criteria together with additional measures of sustainability and participation. Data were collected from 120 individuals by workshops, questionnaires and semi-structured interviews in Benin, Nigeria, Pakistan, Tanzania, Togo and Uganda. PDS results were consistent with other data for absence of disease but the absence of detected cases and a dearth of epidemiological and surveillance data prevented quantification of some indicators. In contexts of limited epidemiological capacity, PDS was considered a useful epidemiological tool, most appropriate for small-scale farmers and applied in complement to conventional surveillance. PDS generated large amounts of unanalyzed data which were incompatible with conventional databases. The approach did not alter the one-way information flow characteristic of surveillance systems. PE skills continued to be used by some individual practitioners but PDS sustainability was compromised by dependence on external funding, the lack of legal frameworks and failure to integrate into national surveillance systems. In extracting surveillance information from communities, PDS was inconsistent with empowerment and ownership espoused by participatory learning and action approaches. Stakeholders had a positive attitude towards PDS despite the limited evidence for impact or cost effectiveness

Experiences with the use of participatory approaches in highly pathogenic avian influenza (HPAI) surveillance

Animal health surveillance needs to provide information for action. Veterinary Services (VS), particularly in developing countries, are often under-resourced in personnel and budget and thus lack frequent contact with livestock farmers. By emphasizing the importance of farmers’ knowledge and experience, participatory disease surveillance (PDS) is an approach that helps VS to address this gap. It is a process of learning and discovery that fosters better cooperation and understanding between veterinary professionals and farmers. It evolved in response to past failures with classical approaches. Practitioners of PDS rely on semi-structured interviews during which techniques that allow for visualization, scoring and direct observation are used to increase communication and understanding. Secondary sources of information and diagnostic testing provide critical additional information. Indonesia was one of the first countries to adopt PDS for HPAI surveillance. The program which started in 2006, expanded to include 31 of 33 provinces with an estimated coverage of 76% of villages using over 2,000 PDS practitioners. The program adopted a broad HPAI case definition for unvaccinated poultry that can be summarized as rapid death in one or more birds. The program evolved to consider the village rather than the household as the epidemiological unit of concern, and to link disease response (R) directly to surveillance (PDSR). The PDSR program in Indonesia quickly revealed that HPAI was widespread and circulating unimpeded, exhibited seasonal fluctuations, and showed geographic variability. In March 2009, the program considered 86.3% of villages visited by PDSR practitioners to be ‘apparently’ free from HPAI. However, there was variation in the implementation of control measures. Other countries benefited from Indonesia’s pioneering experience. Egypt adopted PDS in 2007, creating a small team of highly skilled PDS practitioners. Eleven other countries in Africa adopted a standardized training program and performance assessment tool, and integrated PDS data into the national surveillance system. No further outbreaks were documented in these countries after the implementation of PDS. The successful use of PDS for HPAI surveillance has provided valuable lessons for the use of PDS as a surveillance tool. Case definitions should be consistently applied with a clear understanding of diagnostic accuracy. Well-planned surveillance systems need to be properly budgeted and resourced, with PDS integrated as one component of a holistic system. Emphasis should be placed on the quality of the PDS program, not size. Permanent capacity should be created at public, private and academic levels, so as to meet emerging epidemiological problems. Data generated using PDS need to be integrated into normal reporting channels and structures, with policies that recognize the complementarity of PDS results. Surveillance should be tied to a functional national disease control plan. In some cases, it has been found that VS that adopt PDS undergo policy and institutional change, and therefore identifying the need for change should be recognized as an opportunity to improve VS. The Participatory Epidemiology Network for Animal and Public Health (PENAPH) works to support adoption of these best practices

Integration of participatory approaches into surveillance systems

Animal health surveillance is essential for protecting public health, enhancing access to international markets for animals and their products, and improving animal health, production and welfare. It is of vital importance for protecting and improving the livelihoods of diverse groups of livestock keepers and stakeholders in livestock value chains. Surveillance systems consist of sets of complementary components which generate information to inform risk assessment, decision-making and policy formulation for both national programmes and international trade. Participatory approaches have the potential to add value to surveillance systems by enhancing their performance, especially their sensitivity and timeliness, and encouraging the inclusion of marginalised groups. This paper summarises key considerations in the assessment and design of animal health surveillance and discusses how participatory approaches can be integrated into comprehensive surveillance systems, leading to a more effective overall outcome for both domestic and international purposes