Reconciling surveillance systems with limited resources: an evaluation of passive surveillance for rabies in an endemic setting

Surveillance systems for rabies in endemic regions are often subject to severe constraints in terms of resources. The World Organisation for Animal Health (OIE) and the World Health Organisation (WHO) propose the use of an active surveillance system to substantiate claims of disease freedom, including rabies. However, many countries do not have the resources to establish active surveillance systems for rabies and the testing of dead dogs poses logistical challenges. This paper explores the potential of using a scenario tree model parameterised with data collected via questionnaires and interviews to estimate the sensitivity of passive surveillance, assessing its potential as a viable low-cost alternative to active surveillance systems. The results of this explorative study illustrated that given a large enough sample size, in this case the entire population of Colombo City, the sensitivity of passive surveillance can be 100% even at a low disease prevalence (0.1%), despite the low sensitivity of individual surveillance components (mean values in the range 4.077×10(-5)-1.834×10(-3) at 1% prevalence). In addition, logistic regression was used to identify factors associated with increased recognition of rabies in dogs and reporting of rabies suspect dogs. Increased recognition was observed amongst dog owners (OR 3.8 (CI, 1.3-10.8)), people previously bitten by dogs (OR 5.9 (CI, 2.2-15.9)) and people who believed they had seen suspect dogs in the past (OR 4.7 (CI, 1.8-12.9)). Increased likelihood of reporting suspect dogs was observed amongst dog owners (OR 5.3 (CI, 1.1-25)). Further work is required to validate the data collection tool and the assumptions made in the model with respect to sample size in order to develop a robust methodology for evaluating passive rabies surveillance

One Health continues to evolve for better health of people, animals and ecosystems

This article provides insights gained during a four-year project funded by the European Cooperation in Science and Technology (COST) named «Network for Evaluation of One Health», which brought together over 250 scientists, decision-makers and practitioners with expertise and/or interest in One Health to investigate the added value of One Health and elaborate and evaluation protocol for One Health. Here, we present our reflections on the significance of these findings for our common practice as health professionals. Two initial findings lie at the core of this analysis, namely the observation that 1) One Health integrates knowledge from various sources in a transdisciplinary way and that there are as many concepts of health as participants in a specific initiative; and 2) the nature of complex One Health problems necessitates systems thinking and consideration of emergences as a One Health initiative is implemented. An analysis of eight case studies, i.e., evaluations of different One Health initiatives, found that the capacity of an initiative to facilitate knowledge integration improves with the age of the initiative, political boundaries of any nature hinder knowledge integration, and the prevailing competitive mentality in academia may be a serious obstacle to trusted collaboration required for interdisciplinary progress. The COST project also revealed a number of important knowledge gaps, namely the need for: a scalable definition of health, balancing expert advice and citizen participation to tackle health challenges, bridging the scission between the benefits and risks arising from nature, discussing whether egoism will define the boundary to sustainable health, a biocentric social justice framework, and comparative values associated with health of people, animals, plants and ecosystems. Furthermore, methodological challenges were identified such as participatory methods that are scalable to large populations, a specific skill set to facilitate transdisciplinary research, and governing mechanisms alternative to legislation and markets. Finally, as a rather unexpected outcome, the project has revealed the tension between the academic and societal demands for infallibility and predictability versus the need for honesty, authenticity, humbleness and emotion to permit the full unfolding of human creativity

A Value Chain Approach to Characterize the Chicken Sub-sector in Pakistan

The chicken industry of Pakistan is a major livestock sub-sector, playing a pivotal role in economic growth and rural development. This study aimed to characterize and map the structure of broiler and layer production systems, associated value chains, and chicken disease management in Pakistan. Qualitative data were collected in 23 key informant interviews and one focus group discussion on the types of production systems, inputs, outputs, value addition, market dynamics, and disease management. Quantitative data on proportions of commodity flows were also obtained. Value chain maps were generated to illustrate stakeholder groups and their linkages, as well as flows of birds and products. Thematic analysis was conducted to explain the functionality of the processes, governance, and disease management. Major chicken production systems were: (1) Environmentally controlled production (97–98%) and (2) Open-sided house production (2–3%). Broiler management systems were classified as (I) Independent broiler production; (II) Partially integrated broiler production; and (III) Fully integrated broiler production, accounting for 65–75, 15–20, and 10–15% of commercial broiler meat supply, respectively. The management systems for layers were classified as (I) Partially integrated layer production and (II) Independent layer production, accounting for 10 and 80–85% in the egg production, respectively. The share of backyard birds for meat and eggs was 10–15%. Independent, and integrated systems for chicken production could be categorized in terms of value chain management, dominance of actors, type of finished product and target customers involved. Integrated systems predominantly targeted high-income customers and used formal infrastructure. Numerous informal chains were identified in independent and some partially integrated systems, with middlemen playing a key role in the distribution of finished birds and eggs. Structural deficiencies in terms of poor farm management, lack of regulations for ensuring good farming practices and price fixing of products were key themes identified. Both private and public stakeholders were found to have essential roles in passive disease surveillance, strategy development and provision of health consultancies. This study provides a foundation for policy-makers and stakeholders to investigate disease transmission, its impact and control and the structural deficiencies identified could inform interventions to improve performance of the poultry sector in Pakistan

3rd Annual Conference of the Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), Developing methods in agriculture and health research, London, 13–14 June 2013

Non-PRIFPRI3; ISI; CRP4; B Promoting healthy food systemsPHND; A4NHCGIAR Research Program on Agriculture for Nutrition and Health (A4NH

A Blueprint to Evaluate One Health

One Health (OH) positions health professionals as agents for change and provides a platform to manage determinants of health that are often not comprehensively captured in medicine or public health alone. However, due to the organization of societies and disciplines, and the sectoral allocation of resources, the development of transdisciplinary approaches requires effort and perseverance. Therefore, there is a need to provide evidence on the added value of OH for governments, researchers, funding bodies, and stakeholders. This paper outlines a conceptual framework of what OH approaches can encompass and the added values they can provide. The framework was developed during a workshop conducted by the “Network for Evaluation of One Health,” an Action funded by the European Cooperation in Science and Technology. By systematically describing the various aspects of OH, we provide the basis for measuring and monitoring the integration of disciplines, sectors, and stakeholders in health initiatives. The framework identifies the social, economic, and environmental drivers leading to integrated approaches to health and illustrates how these evoke characteristic OH operations, i.e., thinking, planning, and working, and require supporting infrastructures to allow learning, sharing, and systemic organization. It also describes the OH outcomes (i.e., sustainability, health and welfare, interspecies equity and stewardship, effectiveness, and efficiency), which are not possible to obtain through sectoral approaches alone, and their alignment with aspects of sustainable development based on society, environment, and economy

Characterisation and mapping of the surveillance system for antimicrobial resistance and antimicrobial use in the United Kingdom.

BACKGROUND: Surveillance of antimicrobial resistance (AMR) is an essential component of any strategy to mitigate AMR and needs regular evaluation to ensure its effectiveness. A first step for any evaluation is to describe the system and context. In this study, we aimed to characterise and map the surveillance system for AMR and antimicrobial use (AMU) in the United Kingdom (UK) using a One Health (OH) approach and to identify integration points in the system. METHODS: To describe the surveillance system for AMR/AMU, international guidelines for establishing surveillance systems for AMR and AMU were used. A review of the literature was conducted to collect information on the different parameters identified. RESULTS: Multiple data collection systems exist for AMU and AMR in humans, animals and food. Each sector is responsible for the planning, implementation, analysis and reporting of its own surveillance for AMR and AMU. Some cross-sectoral collaborative activities exist such as the UK AMR contingency plan and the publication of UK OH reports; there are opportunities for further integration such as the harmonisation of data analyses methods and interpretation across sectors and the publication of joint surveillance reports. CONCLUSION: This overview of key stakeholders, data collection streams, reporting, linkages within and across sectors and international monitoring forms an important basis for future evaluation of the UK AMR/AMU surveillance system from a OH perspective