The Role of Animal Source Foods in Improving Nutritional Health in Urban Informal Settlements: Identification of Knowledge Gaps and Implementation Barriers

Childhood undernutrition is a health crisis in the rapidly expanding informal settlements of low-income countries worldwide. Nearly half of Kenyan children in the Kibera settlement, in Nairobi, were reported to be stunted, indicating low height-for-age. Stunted children are at greater risk for poor cognitive and physical health outcomes in the long-term, problems that tend to be perpetuated in subsequent generations. Animal-source foods (ASF) supply a calorically dense source of micro- and macronutrients, and supplementation with ASF has been shown to improve linear growth and cognition. Correspondingly, increasing consumption of ASF by pregnant women and children has been proposed as a means to disrupt the intergenerational cycle of undernutrition caused by food insecurity. Household surveys indicate that consumption of ASF is low in urban slums, despite the availability of these foods in local markets. Here we review the studies addressing the role of ASF in the diets of the urban poor and identify knowledge gaps relevant to improving nutrition by increasing consumption of ASF. Based predominantly on studies in Kibera and greater Nairobi, these gaps include determining the minimal amount and frequency of dietary ASF to prevent stunting, defining how consumer preferences, markets, and income interact to impede or promote ASF consumption, and understanding the interaction between diet and both clinical and sub-clinical enteric disease on growth outcomes

Thermotolerance of an inactivated rabies vaccine for dogs

This study provides the first robust data that the antibody response of dogs vaccinated with Nobivac® Rabies vaccine stored for several months at high temperatures (up to 30 °C) is not inferior to that of dogs vaccinated with vaccine stored under recommended cold-chain conditions (2–8 °C). A controlled and randomized non-inferiority study was carried out comparing the four-week post vaccination serological responses of Tanzanian village dogs inoculated with vaccine which had been stored at elevated temperatures for different periods of time with those of dogs vaccinated with the same product stored according to label recommendations. Specifically, the neutralizing antibody response following the use of vaccine which had been stored for up to six months at 25 °C or for three months at 30 °C was not inferior to that following the use of cold-chain stored vaccine. These findings provide reassurance that the vaccine is likely to remain efficacious even if exposed to elevated temperatures for limited periods of time and, under these circumstances, it can safely be used and not necessarily destroyed or discarded. The availability of thermotolerant vaccines has been an important factor in the success of several disease control and elimination programs and could greatly increase the capacity of rabies vaccination campaigns to access hard to reach communities in Africa and Asia. We have not confirmed a 3-year duration of immunity for the high temperature stored vaccine, however because annual re-vaccination is usually practiced for dogs presented for vaccination during campaigns in Africa and Asia this should not be a cause for concern. These findings will provide confidence that, for rabies control and elimination programs using this vaccine in low-income settings, more flexible delivery models could be explored, including those that involve limited periods of transportation and storage at temperatures higher than that currently recommended

Local Disease Concepts Relevant to the Design of a Community-Based Surveillance Program for Influenza in Rural Guatemala

Background Early detection of emergent influenza strains is a global health priority. However, maintaining active surveillance is economically and logistically challenging. While community-based surveillance is an attractive alternative, design and operation of an effective epidemiological surveillance program requires community engagement that can be linked to public health reporting and response. We report the results of a study in rural Guatemalan communities aimed at identifying opportunities for and barriers to community engagement in disease surveillance. Methods Using an ethnographic approach followed by a descriptive cross-sectional survey, we documented local terms and ideas about animal illnesses, including the possibility of animal-human transmission. Results The community perceived disease causation principally in terms of changes in the physical environment and weather and categorized illnesses using local terminology based on observable clinical signs. Knowledge about prevention and treatment was derived predominantly from local networks of family and friends without evidence of professionally-based knowledge being regularly introduced into the community. Conclusions Bridging the divide between professional and community-based descriptive disease terminology, incorporating animal and human health responsiveness to common illnesses, and providing professional knowledge into the community-based networks were identified as addressable challenges to effective implementation of community-based surveillance

Child height gain is associated with consumption of animal-source foods in livestock-owning households in Western Kenya

OBJECTIVE: To clarify the pathways between household livestock and child growth by assessing the relationships between consumption of animal-source foods (ASF) and child growth and evaluating the household livestock correlates of child consumption of ASF. DESIGN: We conducted a longitudinal cohort study of anthropometry and 3 d feeding recalls among children <5 years old between June 2014 and May 2015. In addition, we collected data on wealth, livestock ownership and livestock diseases in the same households. We used linear and negative binomial mixed models to evaluate the relationships between household livestock characteristics, reported consumption of ASF and child growth. SETTING: An 1800-household surveillance catchment area in Western Kenya within the structure of human and animal health surveillance systems. SUBJECTS: Children (n 874) <5 years old. RESULTS: Among children >6 months old, reported frequency of egg and milk consumption was associated with increased monthly height gain (for each additional report of consumption over 3 d: adjusted β (95% CI) = 0·010 (0·002, 0·019) cm/month and 0·008 (0·004, 0·013) cm/month, respectively). Poultry ownership was associated with higher reported frequency of egg, milk and chicken consumption (adjusted incidence rate ratio (95% CI) = 1·3 (1·2, 1·4), 1·4 (1·1, 1·6) and 1·3 (1·1, 1·4), respectively). Some livestock diseases were associated with lower reported frequency of ASF intake (livestock digestive Child growth diseases-adjusted incidence rate ratio (95% CI) = 0·89 (0·78, 1·00)). CONCLUSIONS: Child height gain was associated with milk and egg consumption in this cohort. ASF consumption was related to both household livestock ownership and animal health

Spatial and temporal risk as drivers for adoption of foot and mouth disease vaccination

Identifying the drivers of vaccine adoption decisions under varying levels of perceived disease risk and benefit provides insight into what can limit or enhance vaccination uptake. To address the relationship of perceived benefit relative to temporal and spatial risk, we surveyed 432 pastoralist households in northern Tanzania on vaccination for foot-and-mouth disease (FMD). Unlike human health vaccination decisions where beliefs regarding adverse, personal health effects factor heavily into perceived risk, decisions for animal vaccination focus disproportionately on dynamic risks to animal productivity. We extended a commonly used stated preference survey methodology, willingness to pay, to elicit responses for a routine vaccination strategy applied biannually and an emergency strategy applied in reaction to spatially variable, hypothetical outbreaks. Our results show that households place a higher value on vaccination as perceived risk and household capacity to cope with resource constraints increase, but that the episodic and unpredictable spatial and temporal spread of FMD contributes to increased levels of uncertainty regarding the benefit of vaccination. In addition, concerns regarding the performance of the vaccine underlie decisions for both routine and emergency vaccination, indicating a need for within community messaging and documentation of the household and population level benefits of FMD vaccination.Sociolog

Why isn’t everyone using the thermotolerant vaccine? Preferences for Newcastle disease vaccines by chicken-owning households in Tanzania

This research article published by PLOS ONE, 2019Understanding preferences for veterinary vaccines in low and middle-income countries is important for increasing vaccination coverage against infectious diseases, especially when the consumer is responsible for choosing between similar vaccines. Over-the-counter sales of vaccines without a prescription gives decision-making power to consumers who may value vaccine traits differently from national or international experts and vaccine producers and distributers. We examine consumer preferences for La Sota and I-2 Newcastle disease vaccines in Tanzania to understand why two vaccines co-exist in the market when I-2 is considered technically superior because of its thermotolerance. Household survey and focus group results indicate consumers perceive both vaccines to be effective, use the two vaccines interchangeably when the preferred vaccine is unavailable, and base preferences more on administration style than thermotolerance. Considering the consumers’ perspectives provides a way to increase vaccination coverage by targeting users with a vaccine that fits their preferences

The first Forecasters Handbook for West Africa

Bridging the gap between rapidly moving scientific research and specific forecasting tools, Meteorology of Tropical West Africa: The Forecasters' Handbook’, gives unprecedented access to the latest science and combines this with pragmatic approaches to forecasting. It is set to change the way forecasters, researchers and students learn about tropical meteorology and will serve to drive demand for new forecasting tools. The Handbook builds upon the legacy of the AMMA project, making the latest science applicable to forecasting in the region. By bringing together, at the outset, researchers and forecasters from across the region, and linking to applications, user communities and decision-makers, the Forecasters’ Handbook provides a template for finding much needed solutions to critical issues such as building resilience to climate change in West Africa