One Health regional network for the Horn of Africa (HORN)

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Maintaining essential healthcare services in Addis Ababa during COVID-19: A qualitative study
(Journal Article, 2024-12-27) Fenta, E.H.; Tassew, B.; Abera, A.; Wolde, F.B.; Legesse, M.; Pulford, J.; Mor, Siobhan M.; Kaba, M.
Background: Worldwide, health systems have been challenged by the overwhelming demands of the COVID-19 pandemic. In Ethiopia, maintaining essential health services during the COVID-19 pandemic is critical to preventing severe outcomes and protecting the gains made over the past years in the health sector. This project aims to explore the health system’s response to maintaining essential healthcare services in Addis Ababa, Ethiopia. Methods: A total of 60 key informant interviews were conducted by purposively selecting key stakeholders from Federal Ministry of Health, Addis Ababa Regional Health Bureau, Sub-city Health Offices, and frontline healthcare providers. Interviews were transcribed verbatim and coded using Open Code. Thematic analysis was employed to analyze the data. Result: COVID-19 affected the delivery of essential health services in several ways, namely: decline in health service utilization, fear of infection among healthcare providers, stigma towards healthcare providers, and perceived decrease in quality-of-service provision. However, the health system actors made efforts to sustain services while responding to the pandemic by enacting changes in the service delivery modality. The most significant service delivery changes included repurposing health centers and prolonged prescriptions (multi-month medication dispensing). The primary challenges encountered were burnout of the health workforce and a shortage of personal protective equipment. Conclusion: COVID-19 has affected the delivery of essential health services in multifaceted ways. System actors have accordingly made efforts to sustain services while responding to the pandemic.
Impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia: Implications for future pandemics
(Journal Article, 2024-10-30) Abera, A.; Fenta, E.H.; Woldehanna, B.T.; Wolde, F.B.; Legesse, M.; Regassa, L.D.; Mor, Siobhan M.; Kaba, M.
Background: Responding to the COVID-19 pandemic has presented an unprecedented challenge to health systems, with countries needing to balance the demands of responding directly to the pandemic, while simultaneously continuing provision of essential health services. This study aimed to explore the impact of COVID-19 on essential healthcare services in Addis Ababa, Ethiopia. Methods: A facility-based retrospective study was undertaken in 30 health centers in Addis Ababa which were selected using simple random sampling. Secondary data were extracted for 22 indicators on maternal and child health, communicable and non-communicable diseases, and outpatient services for the period spanning between July 2019 and October 2020. These indicators were selected based on the WHO operational guidance on maintaining essential health services during an outbreak guide, essential packages of health services in Ethiopia and expert consultation. The difference in the trends of services before and during COVID-19 was compared using linear-by-linear tests and the difference of magnitude across the indicators was compared using Autoregressive Integrated Moving Average (ARIMA) interrupted time series analysis at a 5% significance level. Results: Overall, more than 1.7 million people visited the studied facilities for outpatient services, and 18,325 mothers attended skilled delivery in the study period. The present study found that the mean number of patients treated for TB declined by 35 patients (β: -34.62; 95%CI: -50.29, -18.95) compared to the pre-COVID-19 era while the number of new patients enrolled for ART decreased by 71 patients (β: -70.62; 95%CI: -107.19, -34.05). Regarding maternal health services, the number of women who received post-natal care decreased by about 215 mothers (β: -214.87; 95%CI: -331.57, -98.17). Similarly, the mean number of clients served at inpatient services declined by 34 (β: -33.72; 95%CI: -68.55, 1.05). On the other hand, the mean number of patients screened for diabetes and hypertension during the pandemic increased by more than 1014 (β: 1014.5; 95%CI: 103.07, 1925.92) and 610 patients (β: 611.21; 95%CI: 302.42, 919.99), respectively. However, changes with regard to antenatal care, skilled birth delivery, and children immunization services did not show a statistically significant change after COVID-19 was reported in Ethiopia. Conclusion: Despite the notable efforts to sustain essential health services amidst the COVID-19 pandemic, our study revealed that there were disruptions in these services. This reinforces the need to adapt strategies to ensure sustainable provision of essential health services when pandemics of COVID19 magnitude cause disruptions of the health services.
Goat seropositivity as an indicator of Rift Valley fever (RVF) infection in human populations: A case-control study of the 2018 Rift Valley fever outbreak in Wajir County, Kenya
(Journal Article, 2024-12) Omani, Ruth; Cavalerie, Lisa; Daud, A.; Cook, Elizabeth A.J.; Nakadio, Erenius; Fèvre, Eric M.; Gitao, G.; Robinson, J.; Nanyingi, M.; Baylis, M.; Kimeli, P.; Onono, J.
Rift Valley fever (RVF) is a viral zoonosis, which is considered as a threat to food security in the Horn of Africa. In Kenya, RVF is the 5th ranked priority zoonotic disease due to its high morbidity and mortality, frequent outbreak events, and associated socioeconomic impacts during outbreak events. In 2018, an RVF outbreak was confirmed in Kenya's Siaya, Wajir, and Marsabit counties. During this outbreak, 30 people were confirmed infected with RVF through laboratory tests; 21 in Wajir, 8 in Marsabit, and 1 in Siaya Counties. Seventy-five (75) households (15 cases and 60 controls) were selected and interviewed using a case-control study design in 2021 (?). A case was a household with a member who was diagnosed with RVF in 2018. In addition, a total of 1029 animals were purposively selected within these households and serologically tested for RVF. The study aimed to estimate the contribution of various risk factors to RVF human occurrence in Kenya with a special focus on Wajir County. Wajir County was chosen due to high number of confirmed human cases reported in the 2018 outbreak. A univariable regression model revealed that owner-reported RVF virus exposure in livestock significantly increased the odds of an RVF human case in the household by 32.7 times (95 % CI 4.0–267.4). The respondent being linked to a goat flock that was IgG-positive increased the odds of an RVF human case by 3.8 times (95 % CI 1.17–12.3). In the final multivariable analysis, the respondent being linked to their own animals affected by RVF increased odds of having an RVF human case in the household by 56.9 times (95 % CI 4.6–700.4), while the respondent being linked to a neighbor household member affected decreased odds of having a RVF human case by 0.1 times (95 % CI 0.08–0.75). In summary, these results have revealed a potential link for the spread of RVF infection from animals to humans in pastoralist households, hence it is critical to carry out targeted, community education, One Health surveillance, prevention, and control measures against the disease. This will be critical to protecting humans against potential spillovers of infections during outbreak events in livestock.
Seroprevalence of brucellosis, knowledge, and risky practices in dairy cattle owners and workers in Maekel and Debub regions, Eritrea
(Journal Article, 2024-08-07) Efrem, G.H.; Mihreteab, B.; Ghebremariam, M.K.; Tesfai, B.; Mor, Siobhan M.; Mamo, G.
Brucellosis is a zoonotic disease with worldwide distribution. In Eritrea, the status of the disease in occupa tionally exposed dairy farmers is unknown. The objective of this study was to determine the seroprevalence of brucellosis, level of knowledge, and risky practices of dairy cattle owners/workers in Maekel and Debub regions, Eritrea. A cross sectional study was conducted between August 2021 and February 2022. A total of 416 dairy cattle owners and workers underwent blood collection and interview using a standardized questionnaire. Blood samples were tested using Rose Ben gal Plate Test, and positive samples were confirmed using competitive ELISA. Variation in knowledge scores by sociode mographic factors and practices were explored statistically. The apparent and true seroprevalence was 1.2% (95% CI: 0.05–2.8%) and 1.4% (95% CI: 0.6–3.4%), respectively. Apparent seroprevalence was similar in Maekel (1.1%) and Debub (1.2%) regions. Nearly half of the participants (49.5%) had never heard of brucellosis before. Overall, brucellosis knowledge score was low (mean score: 6.53/20). Knowledge score was higher in participants from Maekel region (P < 0.001), older participants (P = 0.035), those with higher educational attainment (P = 0.001), and those with more years of experience working in dairy farming (P = 0.001). Knowledge score was lower in farm workers compared with family members (P = 0.016). No significant differences in knowledge score existed between participants who engaged in or did not engage in potential risky practices. In summary, the prevalence of brucellosis in dairy cattle owners/workers in Maekel and Debub regions, Eritrea, was low. Participants demonstrated limited knowledge of brucellosis and engaged in risky practices.
IHR-PVS national bridging workshop for Somalia: An interactive and participatory approach for operationalizing the One Health roadmap
(Journal Article, 2024) Osman, A.Y.; Saidouni, A.; Wambua, L.W.; Mahrous, H.; Malik, S.M.M.R.; Lubogo, M.; Weerdt, R.V. de; Adam, A.H.; Mohamed, H.H.; Makhzoumi, K.A.; Ali, G.A.; Nur, M.O.; Fevre, S.; Mucheru, G.; Njue, S.; Mosindo, A.O.; Sandhaus, K.; Wigand, R.C.; Standley, C.; Sorrell, E.; Kock, R.; Guitian, J.; Zumla, A.; Dar, O.; Mor, Siobhan M.
Background: National Bridging Workshops (NBW) are a tool for reviewing collaboration gaps between line ministries relevant to the One Health framework. Methods: The NBW for Somalia was held on November 11–13, 2023 in Nairobi, Kenya with support from WHO and WOAH. Participants included representatives from the Somali government both national and sub-national (including Ministry of Health; Ministry of Livestock, Forestry and Range; Ministry of Agriculture and Irrigation; and Ministry of Environment and Climate Change). Other participants included representatives from non-governmental organizations, academia and the quadripartite. Structured sessions guided participants through a step-by-step process, starting from identifying gaps to collectively developing solutions. The design of these sessions aimed to foster active engagement and collaboration with the outcomes of each session contributing to the subsequent one. Results: A total of 60 participants partook in the exercise, representing human health (35%), animal health (27%), agriculture (13%), environmental health (7%) and other relevant sectors (18%). Eighty-three percent of participants represented the national level and 17% the sub-national level. The collaborative effort yielded a joint roadmap comprising 36 activities and 11 objectives. Priority objectives included: development of national joint surveillance systems for selected One Health threats (41/47 votes, or 87% of the total votes); establishment of a high-level ministerial system to govern and coordinate One Health activities (30/47; 64%); and establishment of emergency funding structures for priority zoonotic diseases along with development of a 5-year national investment plan for One Health (27/47; 57%). A total of 94% of activities required low or moderate cost to be implemented, and 90% of activities were identified to have a likely high impact on multisectoral collaboration. The timeline for implementing the activities is projected to span one to two years. Conclusion: The workshop promoted high-level engagement, national ownership, and leadership in addressing health threats at the human-animal-environment interface. The resulting co-created roadmap will be integrated into the National Action Plan for Health Security, supporting ongoing One Health efforts in Somalia.
“It will be a desert”: Extreme weather and the effects of climate catastrophe on vulnerable riparian spaces in Nairobi, Kenya
(Journal Article, 2024-07-01) Howland, Olivia
Urban riparian spaces are notoriously vulnerable, and pressure on water resources is growing. In the context of a fast-growing urban population and a lack of state-level structures and services to deal with water and sanitation, these spaces—including both land and water—are rapidly being degraded. Ongata Rongai, a satellite town in the Nairobi Metropolitan Area, is one of these spaces. Traditional livelihoods exist cheek-by-jowl with modern life; livestock are watered at the rivers, lions frequent the riverbanks, large commercial farms extract water for crops, industrial factories release heavy metal contaminants into the rivers, and rapidly constructed poor-quality apartment blocks with no provision for human waste release untreated sewage and dump trash into the rivers. Compounding these anthropogenic impacts is that of climate change. Riparian spaces have become sites where humans and animals fight for access to water and riparian space, and rain becomes less reliable or frequent, yet at other times, these spaces experience flash flooding and catastrophic water levels leading to the destruction of land. This study explores the dynamics of a rapidly changing riparian environment which finds itself dominated by urbanity, under the increasing pressure of anthropogenic climate change using a One Health perspective. This study contributes much needed human voices to a growing body of literature led by indigenous Kenyan scholars, calling for urgent structural level action to conserve urban riparian zones for the benefit of human and non-human actors.
Prioritization of zoonoses for multisectoral, One Health collaboration in Somalia, 2023
(Journal Article, 2023-09) Osman, A.Y.; Mohamed, H.; Mumin, F.I.; Mahrous, H.; Saidouni, A.; Elm, S.A.; Adawe, A.K.; Mo'allim, A.A.; Lubogo, M.; Malik, S.M.M.R.; Mwatondo, A.; Raji, T.; Ahmed, A.D.; Zumla, A.; Dar, O.; Kock, R.; Mor, Siobhan M.
Background The population of Somalia is vulnerable to zoonoses due to a high reliance on animal husbandry. This disease risk is exacerbated by relatively low income (poverty) and weak state capacity for health service delivery in the country as well as climate extremes and geopolitical instability in the region. To address this threat to public health efficiently and effectively, it is essential that all sectors have a common understanding of the priority zoonotic diseases of greatest concern to the country. Methods Representatives from human, animal (domestic and wildlife), agriculture, and environmental health sectors undertook a multi-sectoral prioritization exercise using the One Health Zoonotic Disease Prioritization tool developed by the US CDC. The process involved: reviewing available literature and creating a longlist of zoonotic diseases for potential inclusion; developing and weighting criteria for establishing the importance of each zoonoses; formulating categorical questions (indicators) for each criteria; scoring each disease according to the criteria; and finally ranking the diseases based on the final score. Participants then brainstormed and suggested strategic action plans to prevent, and control prioritized zoonotic diseases. Results Thirty-three zoonoses were initially considered for prioritization. Final criteria for ranking included: 1) socioeconomic impact (including sensitivity) in Somalia; 2) burden of disease in humans in Somalia); 3) availability of intervention in Somalia; 4) environmental factors/determinants; and 5) burden of disease in animals in Somalia. Following scoring of each zoonotic disease against these criteria, and further discussion of the OHZDP tool outputs, seven priority zoonoses were identified for Somalia: Rift Valley fever, Middle East respiratory syndrome, anthrax, trypanosomiasis, brucellosis, zoonotic enteric parasites (including Giardia and Cryptosporidium), and zoonotic influenza viruses. Conclusions The final list of seven priority zoonotic diseases will serve as a foundation for strengthening One Health approaches for disease prevention and control in Somalia. It will be used to: shape improved multisectoral linkages for integrated surveillance systems and laboratory networks for improved human, animal, and environmental health; establish a multisectoral public health emergency preparedness and response plans using One Health approaches; and enhance workforce capacity to prevent, control and respond to priority zoonotic diseases.
A tale of two rivers: development, destruction, and despair in Ongata Rongai, Kenya
(Journal Article, 2023-08-25) Howland, Olivia
Introduction: Ongata Rongai is a rapidly growing peri-urban space in Nairobi Metropolitan, Kenya. The last 10 years have seen exponential population growth and building development leading to overcrowding and pressure on water and environmental resources. This original research sheds light on interactions among humans, animals, and this rapidly changing urban environment. It is therefore a quintessentially One Health study. Methods: Qualitative and ethnographically informed methods are employed to better understand the impact of rapid growth on the riparian environment and the effect of this on those who depend on it. The reflexive use of archival material and a historical ethnographic approach enabled in-depth narratives to address these issues within a longitudinal context, and the use of deliberate walking alongside visual methodologies and more traditional anthropological methods make this study novel both in terms of methodological approach and findings. Results: This study finds that people cite high levels of pollution from solid waste and sewage have made the rivers almost unusable and a hazardous place for both humans and animals. Yet, in the past, these rivers played key roles in daily life. There is frustration with structural-level actors' moribund attitude to the environment. The poor health of the rivers and riparian environment leads to human and animal health challenges, increased pressure on water resources, and economic pressure due to a loss of livelihoods. Discussion: The study contributes to what is currently a fairly small literature on urban riparian spaces globally, but one which is of growing and vital importance given the rapidly increasing percentage of humans who now reside in urban spaces. It contributes to WASH and urban clean water knowledge as well as One Health, public health, and urban growth narratives, and directly addresses challenges faced by SDG 6.
Prioritization of livestock diseases by pastoralists in Oloitoktok Sub County, Kajiado County, Kenya
(Journal Article, 2023-07-12) Mburu, C.M.; Bukachi, S.; Majiwa, H.; Ongore, D.; Baylis, M.; Mochabo, K.; Fèvre, Eric M.; Howland, Olivia
Introduction Livestock diseases are a big challenge for the livelihood of pastoralists in sub-Saharan Africa because they reduce livestock productivity and increase mortality. Based on the literature available there is limited understanding on how pastoralists prioritize these diseases in the context of their culture, ecosystems and livelihoods. A study was conducted to provide insights on lay prioritization of animal diseases by pastoralists in Kenya. Methodology A qualitative study was undertaken between March and July 2021. Thirty in-depth interviews and six focus group discussions (FGDs) were conducted with community members to explore community attitudes on livestock diseases prioritization. Male and female livestock keepers were purposively selected and interviewed and they were all long-term residents of the area. Fourteen key informant interviews (KIIs) were conducted with professionals from different key sectors to provide detailed stakeholder perspectives on livestock diseases. The interviews were analyzed thematically using the QSR Nvivo software to identify the emerging themes related to the study objectives. Results The pastoralists prioritized livestock diseases based on effect on their economic wellbeing, cultural values and utilization of ecosystem services. There were gender variabilities in how diseases were prioritized among the pastoralists. Men cited high priority diseases as foot and mouth disease and contagious bovine pleuropneumonia due to their regular occurrence and effect on livelihood. Notably, women regarded coenuruses as very important because it affected sheep and goats with a high mortality rate and lumpy skin disease because it rendered the meat from the carcasses inedible. Malignant catarrhal fever and trypanosomiasis were noted as some of the common diseases in the livestock-wildlife interface but not cited as priority diseases. Challenges related to disease control in pastoralist contexts exist including limited access to livestock treatment services, inadequate information on disease impact and complex environmental factors. Conclusion This study sheds light on the body of knowledge in Kenya regarding livestock diseases and their prioritization by livestock keepers. This could aid in the development of a common disease control framework and prioritization at the local level which would take into consideration the dynamic socio-cultural, ecological, livelihood and economic contexts of the communities.
One health insights into pastoralists’ perceptions on zoonotic diseases in Ethiopia: perspectives from South Omo Zone of SNNP Region
(Journal Article, 2023-05-11) Alemu, S.T.; Ero, D.; Mor, Siobhan M.
Zoonotic diseases negatively impact pastoral communities in Ethiopia. In addition to impacts on human health, the interaction between people, livestock and environment which is so fundamental to the pastoralist way of life, means zoonoses pose additional challenges to social bonds and protection networks. These challenges are compounded by adverse impacts from climate change, poor health care services, market problems and cultural practices that increase pastoralists’ vulnerability to zoonotic diseases. This research adopted a grounded theory approach and attempted to capture the perception of Hamer and Dassenetch pastoralists on zoonotic diseases and rangeland health through focus group discussions and key informant interviews. Involved in the research were human and animal health experts, and woreda (Woreda is a third level of administrative unit in Ethiopia following region and zone) level government officials. Thematic framework analysis was used to analyse the data. Zoonotic diseases are a significant public health concern and have a substantial economic burden on local livelihoods. Poor access to human and livestock health services contributed towards the widespread transmission of zoonotic pathogens. In most cases, pastoralists were aware of the possibility of zoonotic disease transmission from livestock to humans and were cognizant of infections contracted from animals. However, the level of risk perception from zoonotic diseases and the subsequent measures of protection was poor. In almost all cases, despite pastoralists’ awareness of zoonotic diseases, they did not consider zoonoses as harmful to human health as they are to animals. It was evident that the burden of zoonotic diseases was high in livestock camps away from settlements in Hamer while for Dassenetch the resettlement clusters created a conducive environment for transmission. This research underscored the importance of engaging with local communities on the risk implications of zoonotic diseases including those related to their food habits and practices.
Improved latrine coverage may reduce porcine cysticercosis: a comparative cross-sectional study, Busia County, Kenya 2021
(Journal Article, 2023-07-05) Chege, Bernard; Ndambuki, Gideon; Owiny, M.; Kiyong'a, Alice; Fèvre, Eric M.; Cook, Elizabeth A.J.
Introduction: Smallholder pig farming is an important economic activity for many poor, rural communities in developing countries. Porcine cysticercosis is a growing public health risk in countries where pig rearing is popular. A sanitation-based intervention to reduce the prevalence of open defecation was completed in Busia County, Kenya in 2016. We capitalized on this third party intervention to evaluate its impact on porcine cysticercosis prevalence. Methods: We conducted a comparative cross-sectional survey from August through to September 2021. Household selection was done using multistage sampling. Household questionnaire data on pig production, transmission, risk factors and awareness of porcine cysticercosis were collected from 251 households. Lingual palpation was used to test for cysticerci in 370 pigs while serum was tested for circulating antigen using Ag-ELISA. We compared results of our survey to an effective baseline, which was a near equivalent cross sectional survey conducted in 2012 before the third party sanitary intervention was established. The difference in prevalence was measured using Chi-square tests. Multivariable logistic regression analysis was used to identify risk factors for lingual cysts in pigs. Results: The prevalence of palpable lingual cysts was estimated to be 3.8% (95% CI 2.3–6.3%) (14/370). This was 6% (95% CI 0.8–13.9%; p-value 0.0178) lower than the prevalence reported in the pre-implementation period of 9.7% (95% CI: 4.5–17.6%). Circulating antigen was detected in 2 samples (0.54%, 95% CI: 0.2–1.9). Latrine coverage was 86% (95% CI: 81–90%), which was 11% (95% CI: 4.8–16.8%; p < 0.001) higher than the pre-implementation period coverage of 75% (95% CI: 71–79%). There was reduced prevalence of lingual cysts in pigs from households that had a latrine (OR = 0.14; 95% CI: 0.05–0.43; p < 0.001) and where pigs were confined or tethered (OR = 0.27; 95% CI: 0.07–1.02; p = 0.053). Conclusion: There was a reduction in the prevalence of porcine cysticercosis in Busia County over the study period from 2012 to 2021. This was not a trial design so we are unable to directly link the decline to a specific cause, but the data are consistent with previous research indicating that improved sanitation reduces porcine cysticercosis. Programs for controlling porcine cysticercosis should include a focus on sanitation in addition to other integrated One Health approaches.
Prevalence of human and animal fasciolosis in Butajira and Gilgel Gibe health demographic surveillance system sites in Ethiopia
(Journal Article, 2023-03-30) Abaya, S.W.; Mereta, S.T.; Tulu, F.D.; Mekonnen, Z.; Ayana, M.; Girma, M.; Vineer, H.R.; Mor, Siobhan M.; Caminade, C.; Graham-Brown, J.
Fasciolosis is regarded as a major challenge to livestock productivity worldwide, but the burden of disease in humans has only started to receive some attention in the past three decades. The aim of this study was to determine the prevalence of human and animal fasciolosis and its determinant factors in the Gilgel Gibe and Butajira Health and Demographic Surveillance System (HDSS) sites in Ethiopia. A study was undertaken among 389 households across the two sites. Face-to-face interviews were conducted to investigate the knowledge, attitudes and practices of households with regard to fasciolosis. Stools from 377 children aged 7–15 years, and 775 animals (cattle, goats and sheep) were analyzed using a proprietary Fasciola hepatica (F. hepatica) coproantigen ELISA kit. The prevalence of fasciolosis in children was 0.5% and 1% in Butajira and Gilgel Gibe HDSS sites, respectively. The overall prevalence of animal fasciolosis was 29%, 29.2%, and 6% among cattle, sheep, and goats, respectively. More than half of the respondents from Gilgel Gibe (59%, n = 115) did not know that humans can be infected with F. hepatica. The majority of respondents in Gilgel Gibe (n = 124, 64%) and Butajira (n = 95, 50%) did not know the transmission route for fasciolosis. Grazing animals were 7 times more likely to be infected with fasciolosis than animals in cut-and-carry production systems (adjusted odds ratio [AOR] = 7.2; 95% confidence interval [CI]: 3.91–13.17). The findings indicated a lack of knowledge amongst local populations about fasciolosis. Thus, there is a need for public health awareness campaigns about fasciolosis in the study areas.
Effects of land-use and environmental factors on snail distribution and trematode infection in Ethiopia
(Journal Article, 2023-03-01) Mereta, S.T.; Abaya, S.W.; Tulu, F.D.; Takele, K.; Ahmednur, M.; Melka, G.A.; Nanyingi, M.; Vineer, H.R.; Graham-Brown, J.; Caminade, C.; Mor, Siobhan M.
Freshwater snails are intermediate hosts for several snail-borne diseases affecting humans and animals. Understanding the distribution of snail intermediate hosts and their infection status is very important to plan and implement effective disease prevention and control interventions. In this study, we determined the abundance, distribution, and trematode infection status of freshwater snails in two agro-ecological zones of Ethiopia. We sampled snails from 13 observation sites and examined them for trematode infections using a natural cercarial shedding method. A redundancy analysis (RDA) was used to examine the relationship between snail abundance and environmental variables. Overall, a total of 615 snails belonging to three species were identified. Lymnea natalensis and Bulinus globosus were the dominant snail species, representing 41% and 40% of the total collection, respectively. About one-third of the total snail population (33%) shed cercariae. The cercariae species recorded were Xiphidiocercaria, Brevifurcate apharyngeate distome (BAD), Echinostome, and Fasciola. Snail species were found in high abundance in aquatic habitats located in the agricultural landscape. Therefore, land-use planning and protection of aquatic habitats from uncontrolled human activities and pollution can be considered as important strategies to prevent and control the spread of snail-borne diseases in the region.
COVID-19 and its prevention in internally displaced person (IDP) camps in Somalia: impact on livelihood, food security and mental health
(Journal Article, 2022-12-22) Mumin, F.I.; Wesonga, F.D.; Handuleh, J.I.M.; White, R.G.; Mor, Siobhan M.
Background Somalia has over 2.6 million internally displaced people (IDP) that depend on daily wages and humanitarian assistance for their livelihoods. This study investigated the impact of COVID-19 on livelihoods, food security and mental health of Somalia’s IDPs. Methods A questionnaire was conducted with “breadwinners” (n = 585) residing in 15 randomly selected IDP camps. Mental health was assessed using the 5-item World Health Organization Wellbeing Index (WHO-5) and the Patient Health Questionnaire-9 (PHQ-9). Multivariable regression was used to explore the effect of depressive symptoms on soap use and ability to pay for food/medicine/rent. Results Knowledge of COVID-19 symptoms, transmission and prevention was relatively high, however only 55% reported using soap for hand washing. Around one third perceived that prohibition of public gatherings had negatively impacted weekly earnings. Participants reported difficulty buying food (85%), medicine (82%) and paying rent (51%) because of COVID-19. The majority were assessed as having low wellbeing and high depressive symptoms (mean WHO-5 = 44.2/100; mean PHQ-9 = 18.6/27), with most (74%) indicating that they felt worse than before the pandemic. Compared to people with low depressive symptoms, people with high depressive symptoms were less likely to use soap (aOR = 0.3, 95% CI = 0.2, 0.7; P < 0.001) and more likely to report difficulty buying food (aOR = 2.2; 95% CI = 1.1, 4.3; P = 0.02). Conclusion COVID-19 and associated restrictions have negatively impacted Somalia’s internally displaced population. Livelihood and mental health support is urgently needed in the recovery phase of the pandemic and should be factored into future pandemic planning.
Rabies research in Ethiopia: A systematic review
(Journal Article, 2022-12) Gelgie, A.E.; Cavalerie, Lisa; Kaba, M.; Asrat, D.; Mor, Siobhan M.
Rabies is an important zoonosis in Ethiopia, where lack of research is cited as a constraint to implementation of the national rabies control strategy. We conducted a systematic review of publications and theses on rabies in Ethiopia, to document research gaps and areas of knowledge saturation in relation to geographic and species focus, methods and findings. We also examined funding sources and extent of local researcher participation. After screening titles and abstracts, the full text of 119 publications was included in data extraction. More than 40% of publications involved data collection in one region (Oromia); no publications reported findings from Benishangul-Gumuz, Dire Dawa or Gambella. Dogs and wildlife (especially Canis simensis) were the focus of research in 45% and 24% publications, respectively. Descriptive epidemiology (N = 39 publications), ethno-medicine/−pharmacology (N = 17) and knowledge, attitude, and practice surveys (KAP, N = 15) were amongst the most common study designs, while studies involving economic methods (N = 3) and experimental epidemiology to test interventions (N = 3) were under-represented. Incidence surveys (N = 9) commonly used post-exposure prophylaxis administration in humans as a proxy for exposure without laboratory confirmation of the rabies status of the animal. KAP surveys tended to highlight reasonable levels of knowledge of rabies and poor practices, including overreliance on medicinal plants. International researchers were the first or last (senior) author on 42% and 58% of publications, respectively, most of which were funded by international organizations (45/72 publications reporting funding source). Based on this systematic review, we suggest more applied research is needed to address gaps in laboratory surveillance (including in humans, domestic and wild animals); identify effective ways to overcome socio-cultural and other barriers to accessing effective rabies treatments; inform best approaches to incentivizing mass dog vaccination programs; and generate local estimates of the cost-benefit and cost-effectiveness of different control strategies to improve financing and political buy-in for rabies control in Ethiopia.
Assessment of food safety knowledge, attitudes, and practices among meat handlers in Bishoftu City, Ethiopia
(Journal Article, 2023-01-11) Abunna, F.; Kaba, M.; Mor, Siobhan M.; Megersa, B.
Meat handlers play a critical role in food safety by preventing contamination of food for human consumption. A cross-sectional survey was undertaken with 391 meat handlers working in abattoirs and retail meat stores in Bishoftu, Ethiopia, to investigate their food safety knowledge, attitudes, and practices (KAP). Data were collected in interviews using a semistructured questionnaire adapted from previous research. An overall score for each topic area was calculated based on the responses to individual questions. Logistic regression was used to assess the independent associations between sociodemographic characteristics and good knowledge, attitudes, and practices. Almost all meat handlers were males (97.2%), and more than half (51.9%) had primary-level education. Most (72.4%) meat handlers had a good knowledge level with a median score of 16 out of 21 (interquartile range [IQR] = 6). Similarly, most (94.6%) meat handlers had a positive attitude toward food safety with a median score 18 out of 20 (IQR = 1). However, most (83.7%) meat handlers had poor food safety practices with median score of 11 out of 20 (IQR = 3). In multivariable models, good knowledge was significantly (P < 0.05) associated with male gender and older age; positive attitudes were associated with lower educational attainment and good knowledge; and good practices were associated with working in an abattoir and having received training on food safety. Regular hands-on training and enforcement of general and personal hygiene is recommended.
Detection of antibodies to Ehrlichia spp. in dromedary camels and co-grazing sheep in northern Kenya using an Ehrlichia ruminantium polyclonal competitive ELISA
(Journal Article, 2022-04-27) Collins, M.; Ngetich, Collins; Owido, Milton; Getange, D.; Harris, R.; Bargul, J.L.; Bodha, B.; Njoroge, D.; Muloi, Dishon M.; Martins, D.J.; Villinger, J.; Githaka, Naftaly W.; Baylis, M.; Fèvre, Eric M.; Kanduma, E.; Younan, M.; Bell-Sakyi, L.
A disease with clinical and post-mortem presentation similar to those seen in heartwater, a tick-borne disease of domestic and wild ruminants caused by the intracellular bacterium Ehrlichia ruminantium, was first reported in dromedary camels in Kenya in 2016; investigations carried out at the time to determine the cause were inconclusive. In the present study, we screened sera from Kenyan camels collected before (2015) and after (2020) the 2016 disease outbreak for antibodies to Ehrlichia spp. using an E. ruminantium polyclonal competitive ELISA (PC-ELISA). Median antibody levels were significantly higher (p < 0.0001) amongst camels originating from areas where the heartwater-like disease was reported than from disease-free areas, for animals sampled in both 2015 and 2020. Overall median seropositivity was higher in camels sampled in 2015 than in 2020, which could have been due to higher mean age in the former group. Camels that were PCR-positive for Candidatus Ehrlichia regneryi had significantly lower (p = 0.03) median antibody levels than PCR-negative camels. Our results indicate that Kenyan camels are frequently exposed to E. ruminantium from an early age, E. ruminantium was unlikely to have been the sole cause of the outbreak of heartwater-like disease; and Ca. E. regneryi does not appreciably cross-react with E. ruminantium in the PC-ELISA.
Strengthening global health security by improving disease surveillance in remote rural areas of low-income and middle-income countries
(Journal Article, 2022-04) Worsley-Tonks, K.E.L.; Bender, J.B.; Deem, S.L.; Ferguson, A.W.; Fèvre, Eric M.; Martins, D.J.; Muloi, Dishon M.; Murray, S.; Mutinda, M.; Ogada, D.; Omondi, G.P.; Prasad, S.; Wild, H.; Zimmerman, D.M.; Hassell, James M.
The COVID-19 pandemic has underscored the need to strengthen national surveillance systems to protect a globally connected world. In low-income and middle-income countries, zoonotic disease surveillance has advanced considerably in the past two decades. However, surveillance efforts often prioritise urban and adjacent rural communities. Communities in remote rural areas have had far less support despite having routine exposure to zoonotic diseases due to frequent contact with domestic and wild animals, and restricted access to health care. Limited disease surveillance in remote rural areas is a crucial gap in global health security. Although this point has been made in the past, practical solutions on how to implement surveillance efficiently in these resource-limited and logistically challenging settings have yet to be discussed. We highlight why investing in disease surveillance in remote rural areas of low-income and middle-income countries will benefit the global community and review current approaches. Using semi-arid regions in Kenya as a case study, we provide a practical approach by which surveillance in remote rural areas can be strengthened and integrated into existing systems. This Viewpoint represents a transition from simply highlighting the need for a more holistic approach to disease surveillance to a solid plan for how this outcome might be achieved.
Epidemiology of porcine cysticercosis in Eastern and Southern Africa: Systematic review and meta-analysis
(Journal Article, 2022-03-16) Gulelat, Y.; Eguale, T.; Kebede, N.; Aleme, H.; Fèvre, Eric M.; Cook, Elizabeth A.J.
Taenia solium cysticercosis is the most common cause of acquired epilepsy in pig-raising and pork-consuming parts of Africa, Latin America, and Asia. This review aimed to systematically compile and synthesize data on the epidemiology of porcine cysticercosis in the Eastern and Southern Africa (ESA) region. Comprehensive searching strategies were employed to retrieve the studies published or reported between January 1,1997 and March 1, 2021, from Pub Med, Hinari, and Google Scholar databases and search platforms. The identified studies that met the inclusion criteria were then appraised for methodological quality. Finally, 44 studies obtained from nine countries were selected and included in this review. Relevant data were extracted using standardized templates for qualitative synthesis and meta-analysis. The overall pooled prevalence estimate of porcine cysticercosis in the ESA region was 17% (95% CI: 14–20%). The prevalence level between and within countries showed high variability. The pooled estimate showed high heterogeneity among the reports (the inverse variance index value (I2) of 98.99%, p < 0.05). The meta-analysis sub-grouped by the type of diagnostic test showed the pooled prevalence estimate of 27% (95% CI: 9–50) by carcass dissection; 23% (95% CI: 14–33) by Antibody-based immunodiagnostic techniques; 23% (95% CI: 18-29) by antigen detecting (Ag)-ELISA, 12% (95% CI: 7–18) by meat inspection, and 9% (95% CI: 7-11) by lingual examination. The meta-analysis sub-grouped by region showed a relatively higher pooled prevalence estimate for the Southern region 22% (95% CI: 15–30) compared to 13% (95% CI: 11–15) in the Eastern region. The highest country-based pooled prevalence was obtained from South Africa (33%, 95% CI: 20–48) and Zambia (22%, 95% CI: 16–29), whereas the lowest pooled prevalence was identified in Madagascar (5%, 95% CI: 4-5) and Rwanda (7%, 95% CI: 6–8). The lack of latrine, traditional pig husbandry practices, unprotected water sources, and increase in age were identified as significant risk factors for the occurrence of porcine cysticercosis in the pooled studies. The findings of this review will provide context-specific input to prioritize the possible intervention programs for T. solium control in the ESA region. More sensitive and specific test-based prevalence estimates, detailed risk factor investigations, and financial losses analysis are needed to establish feasible control strategies.
First PCR confirmed anthrax outbreaks in Ethiopia–Amhara region, Ethiopia 2018–2019
(Journal Article, 2022-02-10) Wassie, B.A.; Fantaw, S.; Mekonene, Y.; Teshale, A.M.; Yitagesu, Y.; Tsige, E.; Getahun, D.; Tasew, G.; Abichu, G.; Moges, B.; Abate, E.; Abayneh, T.; Zeru, T.; Belay, Z.; Mor, Siobhan M.
Background Anthrax is a disease that affects humans and animals. In Ethiopia, anthrax is a reportable disease and assumed to be endemic, although laboratory confirmation has not been routinely performed until recently. We describe the findings from the investigation of two outbreaks in Amhara region. Methods Following reports of suspected outbreaks in Wag Hamra zone (Outbreak 1) and South Gondar zone (Outbreak 2), multi-sectoral teams involving both animal and public health officials were deployed to investigate and establish control programs. A suspect case was defined as: sudden death with rapid bloating or bleeding from orifice(s) with unclotted blood (animals); and signs compatible with cutaneous, ingestion, or inhalation anthrax ≤7 days after exposure to a suspect animal (humans). Suspect human cases were interviewed using a standard questionnaire. Samples were collected from humans with suspected anthrax (Outbreak 1 and Outbreak 2) as well as dried meat of suspect animal cases (Outbreak 2). A case was confirmed if a positive test was returned using real-time polymerase chain reaction (qPCR). Results In Outbreak 1, a total of 49 cows died due to suspected anthrax and 22 humans developed symptoms consistent with cutaneous anthrax (40% attack rate), two of whom died due to suspected ingestion anthrax. Three people were confirmed to have anthrax by qPCR. In Outbreak 2, anthrax was suspected to have caused the deaths of two livestock animals and one human. Subsequent investigation revealed 18 suspected cases of cutaneous anthrax in humans (27% attack rate). None of the 12 human samples collected tested positive, however, a swab taken from the dried meat of one animal case (goat) was positive by qPCR. Conclusion We report the first qPCR-confirmed outbreaks of anthrax in Ethiopia. Both outbreaks were controlled through active case finding, carcass management, ring vaccination of livestock, training of health professionals and outreach with livestock owners. Human and animal health authorities should work together using a One Health approach to improve case reporting and vaccine coverage.

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