This study describes the results of a cross-sectional survey conducted in Mambwe
district in the Eastern Province in Zambia. It uses a One Health approach to assess
the impact of veterinary, medical, environmental and social determinants on animal
and human health and wellbeing. One Health is defined as a holistic and
interdisciplinary approach that describes the complexities between people, animals,
the environment and their health. Human wellbeing is defined in this thesis as ‘a
condition in which all members of society are able to determine and meet their needs
and have a large range of choices to meet their potential’ (Prescott-Allen, 2001). As
a first step, eight focus group discussions with the inhabitants followed by key
informant interviews with stakeholders in the area were conducted to give a primary
impression and narrow down the problems in relation to animal and human health of
the area in general.
Following this, a randomized selection of 210 households was visited and in each
household blood samples were taken from all humans and all animals belonging to
five animal species, namely cattle, goats, sheep, pigs and dogs. A third of the
households did not keep any of the animal species chosen for sampling, but their
inclusion was important for the social analysis. In all of these 210 households a
wellbeing questionnaire was administered and, for every human and animal sampled,
a health questionnaire.
The study area falls within the tsetse-infested region of Zambia. It has a high wildlife
density reflecting the proximity of several national parks and is historically endemic
for both human and animal African trypanosomiasis (HAT&AAT). Therefore
humans and animals were tested for trypanosomiasis using internal transcribed
spacer (ITS) polymerase chain reaction (PCR). Since it is important as a differential
diagnosis, malaria was tested for by a rapid diagnostic test in the field from human
blood. Sera from mature individuals from all animal species except pigs were tested
in a field laboratory for brucellosis using the Rose Bengal test. Additionally, cattle
and dogs were tested for five genera of tick-borne infections (TBI) including
Anaplasma, Ehrlichia, Theileria, Babesia and Rickettsia using reverse line blot
(RLB) in the laboratory at the University of Edinburgh (UoE). The blood samples for
PCR and RLB analysis at UoE were stored on WhatmanTM FTA cards.
A total of 1012 human samples were tested for HAT and none found positive. 1005
(seven people had been tested positive or treated against malaria shortly before the
sampling) people tested for malaria showed an overall prevalence of 15% (95% CI
13.2-17.7). None of the 734 Rose Bengal tests showed up positive for brucellosis.
The prevalence of AAT in 1275 samples tested was much lower compared to former
samplings; in cattle 22% (95% CI 18-27.2), in goats 7% (95% CI 4.5-9.2), in pigs
6% (95% CI 3.2-9.4), in dogs 9% (95% CI 5.2-13.6) and no samples were found
positive in sheep. The prevalence of TBIs is much more complex with many
multiple infections. A total of 340 cattle and 195 dogs were tested. In cattle the
number of samples positive for any microorganism was as follows; 92% (95% CI 88-
94.2). Overall there were fewer positive samples from dogs with 25% of animals
infected (95% CI 19.2-31.8).
The wellbeing and health questionnaires were designed to help to identify possible
risk factors for the above-mentioned diseases and signs, such as fever, diarrhoea and
seizures, indicative for several other diseases. The results of these surveys might also
help to identify potential reasons for a lower or higher prevalence of trypanosomiasis
and malaria found than expected from previous studies. Additionally, information on
personal happiness, attitudes towards veterinary and medical services, medical
treatments received, education, women’s reproductive history, drug abuse, people’s
perceptions of changes in environment and agriculture, demography, poverty and
migration were collected via the questionnaires alongside information on livestock
demographics and fertility.
One of the main conclusions is that both medical and veterinary health care systems
suffer from a number of shortcomings. The distance to appropriate treatment and
care facilities is far and the necessary drugs are often unavailable. Also, both the
knowledge and technology for diagnosing selected diseases is not in place. This
study suggests that neurocysticercosis (NCC) plays an important role in this area due
to the high number of seizures reported in people, in whom treatment for epilepsy
was unsuccessful. Samples taken from a few pigs indicated the presence of Taenia
solium, the causal agent of NCC. Furthermore, many of the TBIs are of zoonotic
nature and further investigations must be made to begin to assess the burden of these
diseases in humans and animals. Environmental changes such as degradation of the
vegetation are likely to have an influence on the prevalence of studied diseases and
this aspect is being investigated further in other studies. Due to the nature of a cross-sectional
study, only limited conclusions can be drawn on the causal relationships of
disease prevalence, but the social analysis conducted in this study confirmed the
interactions of selected factors related to health and wealth unique for this study area