Using local language syndromic terminology in participatory epidemiology: Lessons for One Health practitioners among the Maasai of Ngorongoro, Tanzania

Participatory survey of risk factors and pathways for Rift Valley fever in pastoral and agropastoral communities of Uganda

To assess pastoralists' and agropastoralists' knowledge on Rift Valley fever (RVF), participatory epidemiological studies were conducted with 215 livestock keepers and 27 key informants in Napak, Butebo, Isingiro and Lyantonde districts, Uganda, between January and February 2022. Livestock keepers in all four districts had knowledge of RVF and even had local names or descriptions for it. Pastoralists and agropastoralists possessed valuable knowledge of RVF clinical descriptions and epidemiological risk factors such as the presence of infected mosquitoes, living in flood-prone areas, and excessive rainfall. RVF was ranked among the top ten most important cattle diseases. Pastoralists called RVF Lonyang, symbolizing a disease associated with jaundice, high fever, abortions in pregnant cows, and sudden death in calves. Key informants identified infected domestic animals, the presence of infected mosquitoes, livestock movement and trade, and infected wild animals as risk pathways for the introduction of RVF into an area. Drinking raw blood and milk was perceived as the most likely pathway for human exposure to RVF virus; while the highest consequence was high treatment costs. The results indicate that pastoralists provided key epidemiological information that could be essential for designing an effective national RVF surveillance and early warning system.

A Participatory Approach in Assessing the Knowledge, Attitude, and Practices (KAP) of Stakeholders and Livestock Owners about Ticks and Tick-Borne Diseases from Sindh, Pakistan

Ticks and tick-borne diseases (TTBDs) are responsible for significant losses in terms of treatment costs, decreased productivity (such as milk and meat), reduced reproductive ability, and financial crisis to livestock owners. In Pakistan, it is crucial to periodically assess the risk of TTBDs and ecological factors, potential causes of acaricidal resistance in tick fauna, and the intensive increase in the spread of TTBDs. Participatory epidemiological approaches are key to assessing the livestock owners' and stakeholders' knowledge, attitude, and practices (KAP) about TTBDs. The current study determined the KAP about ticks and tick-borne diseases of respondents from Sindh, Pakistan. A total of 240 respondents were interviewed from different ecological zones: among them, 42.5% (n = 102) of the respondents practiced the manual removal of ticks from animals, while acaricide usage was indicated by 137 respondents (57.0%) as occurring sometimes, 50 (20.8%) monthly, 41 (17.0%) fortnightly, and 12 (5%) weekly, during the peak infestation season. Ticks were 2.6 times [OR = 2.5 (95% Cl = 1.47-4.06)] and viruses were 1.89 times [OR = 188 (95% Cl = 1.09-2.9)] more likely to cause the development of disease in animals than any other pathogen. Despite the appropriate usage of acaricides, the knowledge of participants was inadequate. The findings of this study emphasize the need to take into account identified knowledge gaps and to take the initiative in carrying out appropriate education activities and extension programs to enhance the adoption of effective tick prevention and control strategies.

"He Who Relies on His Brother's Property Dies Poor": The Complex Narratives of Livestock Care in Northern Tanzania

Background: Endemic zoonoses have important impacts for livestock-dependent households in East Africa. In these communities, people's health and livelihoods are severely affected by livestock disease losses. Understanding how livestock keepers undertake remedial actions for livestock illness has the potential for widespread benefits such as improving health interventions. Yet, studies about livestock and human health behaviours in the global south tend to focus on individual health choices. In reality, health behaviours are complex, and not solely about individualised health experiences. Rather, they are mediated by a range of “upstream” factors (such as unequal provision of services), which are beyond the control of the individual.

Methods: This paper presents qualitative research conducted from 2014 to 2019 for a study focused on the Social, Economic, and Environmental Drivers of Zoonoses in Tanzania (SEEDZ). Qualitative data were collected via focus group discussions, community meetings, informal interviews, formal in-depth interviews, observations and surveys that addressed issues of health, disease, zoonotic disease risks, and routes for treatment across 21 villages. Thematic analysis was carried out on in-depth interviews and focus group discussions. Conceptual analyses and observations were made through application of social science theories of health.

Findings: Livestock keepers undertake a range of health seeking strategies loosely categorised around self and formal treatment. Two key themes emerged that are central to why people make the decisions they do: access to resources and trust in health care providers. These two issues affect individual sense of agency which impacts their ability to act to improve livestock health outcomes. We suggest that individual choice and agency in veterinary health seeking decisions are only beneficial if health systems can offer adequate care and health equity is addressed.

Significance: This study demonstrates the value of in-depth qualitative research which reveals the nuance and complexity of people's decisions around livestock health. Most importantly, it explains why “better” knowledge does not always translate into “better” practise. The paper suggests that acknowledging and addressing these aspects of veterinary health seeking will lead to more effective provision.

Cost-benefit and feasibility analysis for establishing a foot-and-mouth disease free zone in Rukwa region in Tanzania

Tanzania has the second largest livestock population in Africa and livestock keeping is an integral part of most people's livelihoods. Foot-and-mouth disease (FMD) is a transboundary disease, affecting cloven-hoofed animals, that is currently endemic in Tanzania. The Tanzania Development Vision 2025 aspires to make the livestock sector more competitive. Part of this plan foresees establishing a FMD-free zone in the Rukwa region to be able to increase the export of animals and animal products. The aim of this study was to assess the economic efficiency and feasibility of establishing such an FMD-free zone and to advise policy makers on the profitability of the investment. A stochastic benefit-cost model, set-up in Palisade @Risk for Excel for a time frame of ten years, was developed to assess whether the benefits of establishing a FMD-free zone would outweigh the costs. Data were collated from reviewing literature, government statistics, and key informant interviews with farmers, traders and veterinarians in Tanzania, and complemented by informed assumptions and expert opinion. Moreover, feasibility aspects including underlying infrastructure, market structures and resource availability were discussed based on key informant interviews, literature review and historical analyses. The net present value for the establishment of a FMD-free zone was negative and the benefit-cost ratio was below one (mean 0.09, min 0.05 - max 0.15 in the scenario considering vaccination of all susceptible domestic animals, and mean 0.11, min 0.06 - max 0.20 when considering vaccinating cattle only), excluding potential benefits from trade. The sensitivity analysis showed that variables related to the cost of vaccination had the largest negative impact on the net present value. The proposed FMD-free zone in Rukwa region is unlikely to be cost-effective with the current FMD status and export trade prospects in Tanzania. Interviews with stakeholders revealed that vaccine availability, funding, farmers' willingness to participate, and lack of staff continuity in key roles were the main barriers to establish a reliable FMD control programme in the country. Recommendations towards FMD control and potential short and middle term strategies are discussed.

One Health in Indigenous Communities: A Critical Review of the Evidence

Indigenous populations around the world face disproportionately high rates of disease related to the environment and animals. One Health is a concept that has been used effectively to understand and address these health risks. One Health refers to the relationships and interdependencies between animal, human, and environmental health and is an emerging research field that aligns with indigenous views of health. To understand the applicability of One Health in indigenous communities, a critical review was undertaken to investigate evidence of One Health research in indigenous communities internationally, assess the strength of evidence, and understand what gaps are present. This review included the appraisal of twenty-four studies based in five regions: Canada, Africa, Australia, South America, and Central America. The review found that there is a need for studies of high strength, with rigorous methods, local leadership, and active involvement of indigenous viewpoints, to be undertaken in indigenous communities internationally that focus on One Health. It highlights the need to further consider indigenous viewpoints in research to reduce limitations, increase effectiveness of findings, consider appropriateness of recommendations, and benefit communities.

Using local knowledge in emerging infectious disease research

Emerging infectious diseases (EIDs) are a growing global health threat. The Stockholm Paradigm suggests that their toll will grow tragically in the face of climate change, in particular. The best research protocol for predicting and preventing infectious disease emergence states that an urgent search must commence to identify unknown human and animal pathogens. This short communication proposes that the ethnobiological knowledge of indigenous and impoverished communities can be a source of information about some of those unknown pathogens. I present the ecological and anthropological theory behind this proposal, followed by a few case studies that serve as a limited proof of concept. This paper also serves as a call to action for the medical anthropology community. It gives a brief primer on the EID crisis and how anthropology research may be vital to limiting its havoc on global health. Local knowledge is not likely to play a major role in EID research initiatives, but the incorporation of an awareness of EIDs into standard medical anthropological practice would have myriad other benefits.

"Can we agree on that"? Plurality, power and language in participatory research

Participatory epidemiology (PE) is a method that gathers data from groups through focus group interviews and participatory visual and scoring exercises. The method is often used in poor communities in low-income countries where it is hard to obtain conventional epidemiological data. This paper draws on research on the public sphere and democratic deliberation, along with research on language and interpretation, to suggest how PE research could be better equipped to account for diversity in local knowledge, include minority views and acknowledge power dynamics. These aspects are discussed under the three themes of 'plurality', 'power' and 'language'. A review of highly-cited PE literature suggests that PE research engages with plurality and power to a very limited extent, and only marginally more so with language and translation. Examples are taken from the authors' own PE research on African swine fever in -Uganda, classical swine fever in Germany, peste des petits ruminants (PPR) in Eastern Europe, and Ugandan pastoralists' understanding of cattle disease to provide more detail as to why conventional PE studies might fail to record issues of plurality, power and language, and also to suggest how this can be addressed. With reference to the literature on the public sphere and democratic deliberation, and on language and interpretation, this paper concludes with some suggestions as to how to take plurality, power and language into greater consideration in PE studies in future, thus improving the validity and reliability of PE data.

Estimating acute human leptospirosis incidence in northern Tanzania using sentinel site and community behavioural surveillance

Many infectious diseases lack robust estimates of incidence from endemic areas, and extrapolating incidence when there are few locations with data remains a major challenge in burden of disease estimation. We sought to combine sentinel surveillance with community behavioural surveillance to estimate leptospirosis incidence. We administered a questionnaire gathering responses on established locally relevant leptospirosis risk factors and recent fever to livestock-owning community members across six districts in northern Tanzania and applied a logistic regression model predicting leptospirosis risk on the basis of behavioural factors that had been previously developed among patients with fever in Moshi Municipal and Moshi Rural Districts. We aggregated probability of leptospirosis by district and estimated incidence in each district by standardizing probabilities to those previously estimated for Moshi Districts. We recruited 286 community participants: Hai District (n = 11), Longido District (59), Monduli District (56), Moshi Municipal District (103), Moshi Rural District (44) and Rombo District (13). The mean predicted probability of leptospirosis by district was Hai 0.029 (0.005, 0.095), Longido 0.071 (0.009, 0.235), Monduli 0.055 (0.009, 0.206), Moshi Rural 0.014 (0.002, 0.049), Moshi Municipal 0.015 (0.004, 0.048) and Rombo 0.031 (0.006, 0.121). We estimated the annual incidence (upper and lower bounds of estimate) per 100,000 people of human leptospirosis among livestock owners by district as Hai 35 (6, 114), Longido 85 (11, 282), Monduli 66 (11, 247), Moshi Rural 17 (2, 59), Moshi Municipal 18 (5, 58) and Rombo 47 (7, 145). Use of community behavioural surveillance may be a useful tool for extrapolating disease incidence beyond sentinel surveillance sites.

A Participatory Investigation of Bovine Health and Production Issues in Pakistan

Systems to record the frequency of animal health events in Pakistan are limited. A participatory approach was used to address gaps in farmers' knowledge and understanding of bovine health and production issues in five agroecological zones (AEZs) of Pakistan. Participatory tools, including simple ranking, pairwise ranking, constraint impact scoring, and constraint profiling were used in group discussions with farmers and animal health professionals (AHPs) in six districts of two provinces, Punjab and Sindh. The results of the ranking activities showed that foot-and-mouth disease (FMD), clinical mastitis, ticks, hemorrhagic septicemia, reproductive disorders, blackleg, and endoparasites were the most important bovine health and production constraints for small-scale dairy farmers. Constraint impact scoring showed that the participants perceived that: (1) milk production was severely affected by FMD and mastitis; (2) blackleg and parasitism led to poor growth rates and reduced meat production; (3) reproductive disorders and mastitis caused major economic losses (due to the high cost of treatment); and (4) blackleg and hemorrhagic septicemia were the leading causes of mortality in cattle and buffaloes. Although there was strong agreement in responses and constraint impact scores between farmers and AHPs, farmers were more concerned about health issues that cause high mortalities, whereas AHPs emphasized the importance of disorders with a high economic impact. Despite socioeconomic differences among AEZs, farmers' knowledge about bovine health and production constraints was similar. The findings from this study revealed that farmers had limited understanding of the risk factors and routes of transmission of various infectious diseases of bovines, which emphasizes the need to develop and implement tailored extension programs in Pakistan to control contagious diseases of animals and to improve the profitability of small-scale dairy farmers.

Participatory Surveillance Based on Crowdsourcing During the Rio 2016 Olympic Games Using the Guardians of Health Platform: Descriptive Study

Background

With the evolution of digital media, areas such as public health are adding new platforms to complement traditional systems of epidemiological surveillance. Participatory surveillance and digital epidemiology have become innovative tools for the construction of epidemiological landscapes with citizens’ participation, improving traditional sources of information. Strategies such as these promote the timely detection of warning signs for outbreaks and epidemics in the region.

Objective

This study aims to describe the participatory surveillance platform Guardians of Health, which was used in a project conducted during the 2016 Olympic and Paralympic Games in Rio de Janeiro, Brazil, and officially used by the Brazilian Ministry of Health for the monitoring of outbreaks and epidemics.

Methods

This is a descriptive study carried out using secondary data from Guardians of Health available in a public digital repository. Based on syndromic signals, the information subsidy for decision making by policy makers and health managers becomes more dynamic and assertive. This type of information source can be used as an early route to understand the epidemiological scenario.

Results

The main result of this research was demonstrating the use of the participatory surveillance platform as an additional source of information for the epidemiological surveillance performed in Brazil during a mass gathering. The platform Guardians of Health had 7848 users who generated 12,746 reports about their health status. Among these reports, the following were identified: 161 users with diarrheal syndrome, 68 users with respiratory syndrome, and 145 users with rash syndrome.

Conclusions

It is hoped that epidemiological surveillance professionals, researchers, managers, and workers become aware of, and allow themselves to use, new tools that improve information management for decision making and knowledge production. This way, we may follow the path for a more intelligent, efficient, and pragmatic disease control system.

Characterisation of Peste Des Petits Ruminants Disease in Pastoralist Flocks in Ngorongoro District of Northern Tanzania and Bluetongue Virus Co-Infection

Peste des petits ruminants (PPR) disease was first confirmed in Tanzania in 2008 in sheep and goats in Ngorongoro District, northern Tanzania, and is now endemic in this area. This study aimed to characterise PPR disease in pastoralist small ruminant flocks in Ngorongoro District. During June 2015, 33 PPR-like disease reports were investigated in different parts of the district, using semi-structured interviews, clinical examinations, PPR virus rapid detection test (PPRV-RDT), and laboratory analysis. Ten flocks were confirmed as PPRV infected by PPRV-RDT and/or real-time reverse transcription-polymerase chain reaction (RT-qPCR), and two flocks were co-infected with bluetongue virus (BTV), confirmed by RT-qPCR. Phylogenetic analysis of six partial N gene sequences showed that the PPR viruses clustered with recent lineage III Tanzanian viruses, and grouped with Ugandan, Kenyan and Democratic Republic of Congo isolates. No PPR-like disease was reported in wildlife. There was considerable variation in clinical syndromes between flocks: some showed a full range of PPR signs, while others were predominantly respiratory, diarrhoea, or oro-nasal syndromes, which were associated with different local disease names (olodua-a term for rinderpest, olkipiei-lung disease, oloirobi-fever, enkorotik-diarrhoea). BTV co-infection was associated with severe oro-nasal lesions. This clinical variability makes the field diagnosis of PPR challenging, highlighting the importance of access to pen-side antigen tests and multiplex assays to support improved surveillance and targeting of control activities for PPR eradication.

Using longitudinal syndromic surveillance to describe small ruminant health in village production systems in Myanmar

A novel syndromic surveillance approach was used to describe small ruminant health in Myanmar, to help overcome limitations in disease diagnosis common in many parts of the world, especially in low and middle income countries (LMICs). Observations were made from July 2015 to June 2016 of ten clinical syndromes in 12 goat herds and sheep flocks owned by smallholders in the Central Dry Zone. Strengths and weaknesses to using syndromic surveillance in a village setting were identified using a formal surveillance evaluation framework, 'SERVAL'. Larger reporting teams made disproportionately more reports than smaller ones (86% compared to 14% of all reports, with a reporting rate ratio of 4.3 95% CI 3.5-5.4), which may have affected surveillance sensitivity. The benefits of the syndromic surveillance included its relatively low cost and ability to produce quantitative disease estimates that could be used to prioritise further disease investigation and extension activities. In particular, significant mortality was observed, with monthly mortality of 3.0% (95% CI 2.5-3.7%) and 0.28% (0.15-0.53%) in young and adult animals, respectively, and a population attributable fraction of mortality for young animals of 82% (68-91%). Mortality was associated with ill-thrift in young animals but had not previously been considered an important production-limiting condition in Myanmar. This information contributes to an understanding of the prevalence of excessive mortality in smallholder goat and sheep production systems. It is a practical example of the use of syndromic surveillance in a LMIC livestock production system, the results of which can direct future disease research, treatment and prevention to improve the health and productivity of small ruminants in Myanmar.

Participatory epidemiology of endemic diseases in West African cattle - Ethnoveterinary and bioveterinary knowledge in Fulani disease control

Fulani pastoralists in Nigeria lack adequate access to good quality veterinary services and often resort to treating their animals themselves. There are several negative aspects to this, including poor treatment outcomes, misuse of veterinary drugs and subsequent resistance, and further barriers to good relations between pastoralists and veterinary services. A participatory epidemiology survey was undertaken in Fulani communities, to examine their ability to diagnose and treat bovine diseases. Qualitative participatory epidemiology techniques including semi-structured interviews, ranking and participant and non-participant observations were used for data collection. Quantitative analysis to match Fulani disease descriptions to veterinary diseases was done by hierarchical clustering and multi-dimensional scaling. A concurrent parasitological survey for soil-transmitted parasites, trypanosomiasis and tick-borne diseases was undertaken to validate results. Fulani pastoralists displayed high levels of ethnoveterinary knowledge and good clinical diagnostic abilities. Diseases considered important by pastoralists included: hanta (CBPP); sammore (trypanosomiasis); boro (foot and mouth disease), gortowel (liver fluke), dauda (parasitic gastro-enteritis with bloody diarrhoea) and susa (parasitic gastro-enteritis). The parasitology survey supported the participatory epidemiology results but also showed a high prevalence of tick-borne diseases that were not mentioned by pastoralists in this study. The use of "hanta" to describe CBPP is important as the accepted translation is liver-fluke (hanta is the Hausa word for liver). Gortowel and dauda, two previously undescribed Fulfulde disease names have now been matched to liver fluke and PGE with bloody diarrhoea. Fulani showed low levels of bovine veterinary knowledge with mostly incorrect veterinary drugs chosen for treatment. Levels of ethno- and bio-veterinary knowledge and their application within pastoralist livestock healthcare practices are discussed.

Is syndromic data from rural poultry farmers a viable poultry disease reporting tool and means of identifying likely farmer responses to poultry disease incursion?

Syndromic surveillance is a well described tool used in developed countries for alerting authorities to livestock disease incursions. However, little work has been done to evaluate whether this could be a viable tool in countries where disease reporting infrastructure and resources is poor. Consequently, a syndrome-based questionnaire study in Eastern Zambia was designed to gather data on previous encounters farmers had with poultry diseases, as well as control measures they use to mitigate them. Descriptive statistics and logistic regression were used to analyse the data. Farmers reported an overall annual disease incidence in rural poultry for eastern Zambia of 31% (90% CI 29-32%). Occurrence of poultry disease in the last 12 months was associated with use of middlemen to purchase poultry products (p = 0.05, OR = 7.87), poultry products sold or given away from the farm (p = 0.01, OR = 1.92), farmers experiencing a period with more trade of poultry and its products (p = 0.04, OR = 1.70), presence of wild birds near the farm or village (p = 0.00, OR = 2.47) and poultry diseases being reported from neighbouring farms or villages (p = 0.00, OR = 3.12). The study also tentatively identified three poultry diseases (Newcastle Disease, Gumboro Disease and Fowl Pox) from the thirty-four disease syndromes provided by farmers. Farmers reported an incidence of 27% for Newcastle Disease in 2014. When compared with the state veterinary services data which reported Newcastle Disease incidence at 9% in 2014, it seems syndromic data obtained from farmers may be more sensitive in identifying disease incursion. Thirty-six remedies and strategies farmers use to treat and control these diseases were revealed. The main control strategy for identified diseases was vaccination and the main treatment was unspecified herbs, which warrants further investigation and presents an opportunity for further research in ethno-veterinary medicine. More still, this study identified chilli, Aloe Vera, garlic onion, moringa, and ash as traditional remedies that are commonly being used in Eastern Zambia, and which are also used to treat poultry diseases in Zimbabwe and Botswana. Only fourteen remedies described are conventionally accepted by veterinarians as remedies and disease control measures for poultry diseases. This study shows that syndromic data obtained from farmers is a useful disease reporting tool and could be used as an effective means of alerting authorities to disease incursion. In addition, it shows that these data may give a more accurate estimate of incidence for certain diseases than current surveillance methods and could be useful in assessing significant risk factors associated with disease occurrence.