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Caudell M, Mangesho PE, Mwakapeje ER, Dorado-García A, Kabali E, Price C, OleNeselle M, Kimani T, Fasina FO. Narratives of veterinary drug use in northern Tanzania and consequences for drug stewardship strategies in low-income and middle-income countries. BMJ Glob Health 2022; 7:bmjgh-2021-006958. [PMID: 35058305 PMCID: PMC8772431 DOI: 10.1136/bmjgh-2021-006958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/03/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Awareness-raising campaigns play a central role in efforts to combat drug resistance. These campaigns assume that knowledge deficits drive poor practices that increase resistance. Therefore, increasing awareness will promote prudent practices and reduce resistance. However, most awareness campaigns have been developed and evaluated in high-income and public health settings. Consequently, it is not clear whether these campaigns are effective in low-income and middle-income countries and/or within animal health settings. METHODS Focus group discussions and in-depth interviews were used to collect narratives of veterinary drug use among Maasai pastoralists (n=70), animal health professionals (n=10) and veterinary drug sellers (n=5). Thematic analysis was used to identify recurring themes across narratives and groups. RESULTS Narratives of Maasai and animal health professionals indicated that Maasai treated their livestock with limited input from the professional sector and that non-prudent treatment practices were observed (eg, using antimicrobials as 'energizers'). Professionals linked these practices to knowledge and attitudinal deficits among the Maasai, while Maasai narratives highlighted the importance of climatic uncertainties and cultural beliefs surrounding veterinary care. CONCLUSION Narratives of veterinary drug use from animal health professionals are consistent with the knowledge deficit assumption guiding awareness-raising efforts. In contrast, Maasai narratives highlight how animal health practices are patterned by cultural norms interacting with factors largely outside of Maasai control, including a constrained professional veterinary sector. If these cultural and structural contexts remain unconsidered in awareness-raising strategies, current campaigns are unlikely to motivate practices necessary to limit drug resistance, especially within low-income and middle-income settings.
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Affiliation(s)
- Mark Caudell
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Peter E Mangesho
- National Institute for Medical Research, Muheza, Tanzania, United Republic of
| | - Elibariki R Mwakapeje
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania, United Republic of
| | | | - Emmanuel Kabali
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Cortney Price
- Food and Agriculture Organization of the United Nations, Rome, Italy
| | - Moses OleNeselle
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania, United Republic of
| | - Tabitha Kimani
- Food and Agriculture Organization of the United Nations, Nairobi, Kenya
| | - Folorunso O Fasina
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania, United Republic of
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Mdegela RH, Mwakapeje ER, Rubegwa B, Gebeyehu DT, Niyigena S, Msambichaka V, Nonga HE, Antoine-Moussiaux N, Fasina FO. Antimicrobial Use, Residues, Resistance and Governance in the Food and Agriculture Sectors, Tanzania. Antibiotics (Basel) 2021; 10:antibiotics10040454. [PMID: 33923689 PMCID: PMC8073917 DOI: 10.3390/antibiotics10040454] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/23/2021] [Accepted: 03/18/2021] [Indexed: 02/05/2023] Open
Abstract
All infections are potentially curable as long as the etiological agents are susceptible to antimicrobials. The increased rate at which antimicrobials are becoming ineffective is a global health risk of increasing concern that threatens withdrawal of beneficial antimicrobials for disease control. The increased demand for food of animal origin, in particular eggs, meat and milk has led to intensification and commercial production systems where excessive use and misuse of antimicrobials may prevail. Antimicrobials, handled and used by farmers and animal attendants with no formal education, may be predisposed to incorrect dosages, misuse, incorrect applications and non-adherence to withdrawal periods. This study was conducted to assess the regulatory roles and governance of antimicrobials, establish the pattern and extent of their use, evaluate the antimicrobial residues and resistance in the food animals and crop agriculture value chains, and relate these findings to existing strategies in place for combating the emergence of antimicrobial resistance in Tanzania. A multimethod approach (desk review, field study and interviews) was used. Relevant establishments were also visited. High levels of resistance to penicillin G, chloramphenicol, streptomycin and oxytetracycline have been reported, especially for Actinobacter pyogenes, Staphylococcus hyicus, Staphylococcus intermedius and Staphylococcus aureus from dairy cattle with mastitis and in humans. Similar trends were found in poultry where eggs and meat are contaminated with Escherichia coli strains resistant to amoxicillin + clavulanate, sulphamethoxazole and neomycin. An increasing trend of emerging multidrug resistant E. coli, Klebsiella pneumoniae, Staphylococcus aureus and Salmonella was also found in food animals. An increase in methicillin resistant Staphlococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL) in the livestock sector in Tanzania have been reported. The pathogens isolated in animals were resistant to ampicillin, augmentin, gentamicin, co-trimoxazole, tetracycline, amoxicillin, streptomycin, nalidixic acid, azithromycin, chloramphenicol, tylosin, erythromycin, cefuroxime, norfloxacin and ciprofloxacin. An increased usage of antimicrobials for prophylaxis, and therapeutics against pathogens and for growth promotion in livestock, aquaculture and crop production were observed. A One Health strategic approach is advocated to combat antimicrobial resistance (AMR) in the food and agriculture sectors in Tanzania. Practical recommendations include (a) legislation review and implementation; (b) antimicrobial use (AMU), AMR and antimicrobial residue (AR) awareness and advocacy among stakeholders along the value chain; (c) strengthening of surveillance and monitoring programs for AMU, AMR and AR; (d) enhanced development and use of rapid and innovative diagnostic tests and the promotion of biosecurity principles; and (e) good husbandry practices. The utilization of this information to improve public health policies and reduce the burden of AMR will be beneficial.
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Affiliation(s)
- Robinson H. Mdegela
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro 3006, Tanzania;
| | - Elibariki R. Mwakapeje
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dar es Salaam 14111, Tanzania; (E.R.M.); (B.R.); (V.M.)
| | - Bachana Rubegwa
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dar es Salaam 14111, Tanzania; (E.R.M.); (B.R.); (V.M.)
| | - Daniel T. Gebeyehu
- Faculty of Veterinary Medicine, University of Liège, 4032 Liege, Belgium; (D.T.G.); (S.N.); (N.A.-M.)
- Department of Veterinary Medicine, School of Veterinary Medicine, Wollo University, Dessie 6000, Ethiopia
| | - Solange Niyigena
- Faculty of Veterinary Medicine, University of Liège, 4032 Liege, Belgium; (D.T.G.); (S.N.); (N.A.-M.)
| | - Victoria Msambichaka
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dar es Salaam 14111, Tanzania; (E.R.M.); (B.R.); (V.M.)
| | - Hezron E. Nonga
- Directorate of Veterinary Services, Ministry of Livestock and Fisheries, Dodoma 41000, Tanzania;
| | - Nicolas Antoine-Moussiaux
- Faculty of Veterinary Medicine, University of Liège, 4032 Liege, Belgium; (D.T.G.); (S.N.); (N.A.-M.)
| | - Folorunso O. Fasina
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dar es Salaam 14111, Tanzania; (E.R.M.); (B.R.); (V.M.)
- Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Onderstepoort 0110, South Africa
- Correspondence: ; Tel.: +255-68-613-2852
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Mangesho PE, Caudell MA, Mwakapeje ER, Ole-Neselle M, Kabali E, Obonyo M, Dorado-Garcia A, Valcarce A, Kimani T, Price C, Eckford S, Fasina FO. "We are doctors": Drivers of animal health practices among Maasai pastoralists and implications for antimicrobial use and antimicrobial resistance. Prev Vet Med 2021; 188:105266. [PMID: 33517159 DOI: 10.1016/j.prevetmed.2021.105266] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 02/08/2023]
Abstract
Animal health service providers can play an important role in limiting drug resistance by promoting responsible and prudent use of veterinary drugs. Recognizing this potential, international agencies and governments have called for these providers to receive drug stewardship training, particularly providers in low- and middle-income countries where top-down regulations (e.g., national regulation of veterinary prescriptions) are largely unfeasible. The success of these stewardship trainings to promote responsible and prudent use will depend on many factors, including understanding how livestock-keeping communities currently interact with animal health service providers. Here, we use a mixed methods approach to identify and understand animal health seeking practices among Maasai pastoralists in Tanzania. Combining qualitative interviews (N = 31) and structured surveys (N = 195), we show the majority of Maasai respondents (≈80 %) do not frequently consult animal health service providers with most relying on advice from family and friends. Logistic regression models of health seeking practices find that increasing age, education, observance of treatment failure, and herd disease burdens are associated with greater odds of seeking out health services. Quantitative results were supported by data from focus group discussions and in-depth interviews that showed Maasai view animal health service providers as measures of last resort, whose input is largely sought after self-treatment with veterinary drugs fail. We argue patterns of animal health seeking among the Maasai are partially the consequence of their high confidence in their own abilities in livestock disease and treatment and generally low confidence in the skills of animal health service providers. We link this high sense of self-efficacy to the culturally engrained process by which Maasai develop mastery in animal health and how the roles and norms in Maasai culture surrounding animal health influence Maasai perceptions of animal health professionals. Our results highlight the need for more research to understand Maasai perceptions of animal health service providers as well as the knowledge, attitudes, and practices of these providers. Finally, our study emphasizes that the success of drug stewardship trainings will require efforts to first understand the cultural and historical contexts driving health seeking practices that impact perceptions of animal health service providers and animal health practices more generally.
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Affiliation(s)
- Peter E Mangesho
- National Institute for Medical Research, Amani Medical Research Centre, P.O Box 81, Muheza, Tanzania.
| | - Mark A Caudell
- Food and Agriculture Organization of the United Nations, United Nations Complex, PO Box 30470, Nairobi, Kenya
| | - Elibariki R Mwakapeje
- Food and Agriculture Organization of the United Nations, Ali Hassan Mwinyi Rd, P.O Box 2 Dar es Salaam, Tanzania
| | - Moses Ole-Neselle
- Food and Agriculture Organization of the United Nations, Ali Hassan Mwinyi Rd, P.O Box 2 Dar es Salaam, Tanzania
| | - Emmanuel Kabali
- Food and Agriculture Organization of the United Nations, 00153, Rome, Italy
| | - Mark Obonyo
- Food and Agriculture Organization of the United Nations, Tendeseka Office Park, PO Box 3730, Harare, Zimbabwe
| | | | - Antonio Valcarce
- Food and Agriculture Organization of the United Nations, 00153, Rome, Italy
| | - Tabitha Kimani
- Food and Agriculture Organization of the United Nations, United Nations Complex, PO Box 30470, Nairobi, Kenya
| | - Cortney Price
- Food and Agriculture Organization of the United Nations, 00153, Rome, Italy
| | - Suzanne Eckford
- Veterinary Medicines Directorate, Woodham La, Addlestone, KT15 3LS, United Kingdom
| | - Folorunso O Fasina
- Food and Agriculture Organization of the United Nations, Ali Hassan Mwinyi Rd, P.O Box 2 Dar es Salaam, Tanzania
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Mangesho PE, Caudell MA, Mwakapeje ER, Ole-Neselle M, Kimani T, Dorado-García A, Kabali E, Fasina FO. Knowing Is Not Enough: A Mixed-Methods Study of Antimicrobial Resistance Knowledge, Attitudes, and Practises Among Maasai Pastoralists. Front Vet Sci 2021; 8:645851. [PMID: 33834048 PMCID: PMC8023390 DOI: 10.3389/fvets.2021.645851] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/03/2021] [Indexed: 02/05/2023] Open
Abstract
Global, national, and local efforts to limit antimicrobial resistance (AMR) often stress the importance of raising awareness among users, sellers, and prescribers of antimicrobial drugs. This emphasis is founded upon two assumptions. First, awareness is limited, particularly concerning the links between antimicrobial use (AMU) and AMR. Second, "filling the awareness gaps" will motivate practises that will limit AMR. The first assumption is supported by knowledge, attitudes, and practises (KAP) surveys but these same studies provide mixed support for the second, with several studies finding that knowledge and attitudes are not correlated with related practises. This disconnect may arise as these surveys typically do not collect data on the cultural or historical contexts that pattern AMU. To explore how these contexts impact KAP related to AMU and AMR, we use a mixed-methods approach to examine veterinary practises among Maasai pastoralists in Tanzania. We combine a quantitative KAP survey (N = 195 households) with extensive qualitative data from focus group discussions (N = 55 participants). Results document limited awareness of AMR but also find that knowledge and attitudes are not correlated with practise. Thematic analysis of qualitative data pointed to three reasons behind this disconnect, including (1) Maasai self-perceptions as veterinary experts, (2) the central role of livestock in Maasai culture, and (3) the use of ethnoveterinary knowledge in animal health treatment. We argue that mixed-method approaches will be critical to developing the targeted awareness campaigns needed to limit the emergence and transmission of AMR.
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Affiliation(s)
- Peter E. Mangesho
- Amani Medical Research Centre, National Institute for Medical Research, Muheza, Tanzania
- *Correspondence: Peter E. Mangesho
| | - Mark A. Caudell
- Food and Agriculture Organization of the United Nations, United Nations Complex, Nairobi, Kenya
| | | | - Moses Ole-Neselle
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania
| | - Tabitha Kimani
- Food and Agriculture Organization of the United Nations, United Nations Complex, Nairobi, Kenya
| | | | - Emmanuel Kabali
- Food and Agriculture Organization of the United Nations, Rome, Italy
- Woodham La, Addlestone, United Kingdom
| | - Folorunso O. Fasina
- Food and Agriculture Organization of the United Nations, Dar es Salaam, Tanzania
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Driciru M, Rwego IB, Ndimuligo SA, Travis DA, Mwakapeje ER, Craft M, Asiimwe B, Alvarez J, Ayebare S, Pelican K. Environmental determinants influencing anthrax distribution in Queen Elizabeth Protected Area, Western Uganda. PLoS One 2020; 15:e0237223. [PMID: 32810178 PMCID: PMC7446795 DOI: 10.1371/journal.pone.0237223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 06/08/2020] [Indexed: 11/23/2022] Open
Abstract
Bacillus anthracis, the bacteria that causes anthrax, a disease that primarily affects herbivorous animals, is a soil borne endospore-forming microbe. Environmental distribution of viable spores determines risky landscapes for herbivore exposure and subsequent anthrax outbreaks. Spore survival and longevity depends on suitable conditions in its environment. Anthrax is endemic in Queen Elizabeth Protected Area in western Uganda. Periodic historical outbreaks with significant wildlife losses date to 1950s, but B. anthracis ecological niche in the ecosystem is poorly understood. This study used the Maximum Entropy modeling algorithm method to predict suitable niche and environmental conditions that may support anthrax distribution and spore survival. Model inputs comprised 471 presence-only anthrax occurrence data from park management records of 1956–2010, and 11 predictor variables derived from the World Climatic and Africa Soil Grids online resources, selected considering the ecology of anthrax. The findings revealed predicted suitable niche favoring survival and distribution of anthrax spores as a narrow-restricted corridor within the study area, defined by hot-dry climatic conditions with alkaline soils rich in potassium and calcium. A mean test AUC of 0.94 and predicted probability of 0.93 for anthrax presence were registered. The five most important predictor variables that accounted for 93.8% of model variability were annual precipitation (70.1%), exchangeable potassium (12.6%), annual mean temperature (4.3%), soil pH (3.7%) and calcium (3.1%). The predicted suitable soil properties likely originate from existing sedimentary calcareous gypsum rocks. This has implications for long-term presence of B. anthracis spores and might explain the long history of anthrax experienced in the area. However, occurrence of suitable niche as a restricted hot zone offers opportunities for targeted anthrax surveillance, response and establishment of monitoring strategies in QEPA.
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Affiliation(s)
- Margaret Driciru
- Queen Elizabeth National Park, Uganda Wildlife Authority, Kampala, Uganda
- * E-mail: , (MD); (KP)
| | - Innocent B. Rwego
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minneapolis, United States of America
| | - Sood A. Ndimuligo
- Centre for Ecological and Evolutionary Synthesis, University of Oslo, Oslo, Norway
| | - Dominic A. Travis
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minneapolis, United States of America
| | - Elibariki R. Mwakapeje
- Epidemiology and Diseases Control Section, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Meggan Craft
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minneapolis, United States of America
| | - Benon Asiimwe
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Julio Alvarez
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minneapolis, United States of America
- VISAVET Health Surveillance Center, Universidad Complutense, Madrid, Spain
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense, Madrid, Spain
| | - Samuel Ayebare
- Wildlife Conservation Society, Bronx, New York City, NY, United States of America
| | - Katharine Pelican
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, Minneapolis, United States of America
- * E-mail: , (MD); (KP)
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Kitua AY, Scribner S, Rasmuson M, Kambarage D, Mghamba J, Mwakapeje ER, Chinyuka H, Bernard J, Zimmerman K, Duale S, Mutonga D. Building a functional national One Health platform: the case of Tanzania. One Health Outlook 2019; 1:3. [PMID: 33829124 PMCID: PMC7990094 DOI: 10.1186/s42522-019-0003-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/09/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND The USAID Preparedness and Response (P&R) project's publication on Multisectoral Coordination that Works identified five dimensions most critical to creating effective and sustainable One Health platforms: political commitment, institutional structure, management and coordination capacity, technical and financial resources, and joint planning and implementation. This case study describes Tanzania experience in using these dimensions to establish a functional One Health platform. The main objective of this case study was to document the process of institutionalizing the One Health approach in Tanzania. METHODS An analysis of the process used to establish and institutionalize the MCM in Tanzania through addressing the five dimensions mentioned above was conducted between August 2018 and January 2019. Progress activity reports, annual reports and minutes of meetings and consultations regarding the establishment of the Tanzania national One Health platform were examined. Relevant One Health publications were studied as reference material. RESULTS This case study illustrates the time and level of effort required of multiple partners to build a functional multi-sectoral coordinating mechanism (MCM). Key facilitating factors were identified and the importance of involving policy and decision makers at all stages of the process to facilitate policy decisions and the institutionalization process was underscored. The need for molding the implementation process using lessons learnt along the way -- "sailing the ship as it was being built" -- is demonstrated. CONCLUSIONS Tanzania now has a functioning and institutionalized MCM with a sound institutional structure and capacity to prevent, detect early and respond to health events. The path to its establishment required the patient commitment of a core group of One Health champions and stakeholders along the way to examine carefully and iteratively how best to structure productive multisectoral coordination in the country. The five dimensions identified by the Preparedness and Response project may provide useful guidance to other countries working to establish functional MCM.
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Affiliation(s)
- Andrew Y. Kitua
- DAI Global Health / USAID/EPT-2 Preparedness and Response Project, Kampala, Uganda
- Public Health and Environment Advancement Interventions NGO ‘NGALAKERI’, Kihonda, Plot 980/81, White House, P.O. Box 5465, Morogoro, United Republic of Tanzania
| | - Susan Scribner
- DAI Global Health / USAID/EPT-2 Preparedness and Response Project, Kampala, Uganda
| | - Mark Rasmuson
- DAI Global Health / USAID/EPT-2 Preparedness and Response Project, Kampala, Uganda
| | - Dominic Kambarage
- Mwalimu Julius Nyerere University, Musoma, United Republic of Tanzania
- Sokoine University of Agriculture (SUA), Morogoro, United Republic of Tanzania
| | - Janneth Mghamba
- Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Dar-es-Salaam, United Republic of Tanzania
| | - Elibariki R. Mwakapeje
- Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Dar-es-Salaam, United Republic of Tanzania
| | - Harrison Chinyuka
- Prime Minister’s Office, Disaster Management Department, Dar-es-Salaam, United Republic of Tanzania
| | - Jubilate Bernard
- Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC), Dar-es-Salaam, United Republic of Tanzania
| | - Kate Zimmerman
- DAI Global Health / USAID/EPT-2 Preparedness and Response Project, Kampala, Uganda
| | - Sambe Duale
- DAI Global Health / USAID/EPT-2 Preparedness and Response Project, Kampala, Uganda
| | - David Mutonga
- DAI Global Health / USAID/EPT-2 Preparedness and Response Project, Kampala, Uganda
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Mwakapeje ER, Ndimuligo SA, Mosomtai G, Ayebare S, Nyakarahuka L, Nonga HE, Mdegela RH, Skjerve E. Ecological niche modeling as a tool for prediction of the potential geographic distribution of Bacillus anthracis spores in Tanzania. Int J Infect Dis 2019; 79:142-151. [DOI: 10.1016/j.ijid.2018.11.367] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/24/2018] [Accepted: 11/27/2018] [Indexed: 01/06/2023] Open
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Mwakapeje ER, Høgset S, Softic A, Mghamba J, Nonga HE, Mdegela RH, Skjerve E. Risk factors for human cutaneous anthrax outbreaks in the hotspot districts of Northern Tanzania: an unmatched case-control study. R Soc Open Sci 2018; 5:180479. [PMID: 30839712 PMCID: PMC6170534 DOI: 10.1098/rsos.180479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/16/2018] [Indexed: 06/09/2023]
Abstract
Bacillus anthracis is an aerobic, Gram-positive and spore-forming bacterium, which causes anthrax in herbivores. Humans get infected after coming into contact with infected animals' products. An unmatched case-control study was conducted to identify the importance of demographic, biological and/or behavioural factors associated with human cutaneous anthrax outbreaks in the hotspot areas of Northern Tanzania. A semi-structured questionnaire was administered to both cases and controls. The age range of participants was 1-80 years with a median age of 32 years. In the younger group (1-20 years), the odds of being infected were 25 times higher in the exposed group compared to the unexposed group (OR= 25, 95% CI = 1.5-410). By contrast, the odds of exposure in the old group (≥20 years) were three times lower in the exposed group compared to the unexposed group (OR = 3.2, 95% CI = 1.28-8.00). Demographic characteristics, sleeping on animal's skins, contacting with infected carcasses through skinning and butchering, and not having formal education were linked to exposure for anthrax infection. Hence, a One Health approach is inevitable for the prevention and control of anthrax outbreaks in the hotspot areas of Northern Tanzania.
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Affiliation(s)
- Elibariki R. Mwakapeje
- Epidemiology and Diseases Control Section, Ministry of Health, Community Development, Gender, Elderly and Children, PO Box 9083, Dar es Salaam, Tanzania
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, PO Box 3021, Chuo Kikuu Morogoro, Tanzania
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, PO Box 8146 Dep., 0033 Oslo, Norway
| | - Sol Høgset
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, PO Box 8146 Dep., 0033 Oslo, Norway
| | - Adis Softic
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, PO Box 8146 Dep., 0033 Oslo, Norway
| | - Janneth Mghamba
- Epidemiology and Diseases Control Section, Ministry of Health, Community Development, Gender, Elderly and Children, PO Box 9083, Dar es Salaam, Tanzania
| | - Hezron E. Nonga
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, PO Box 3021, Chuo Kikuu Morogoro, Tanzania
| | - Robinson H. Mdegela
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, PO Box 3021, Chuo Kikuu Morogoro, Tanzania
| | - Eystein Skjerve
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, PO Box 8146 Dep., 0033 Oslo, Norway
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Nadri J, Sauvageot D, Njanpop-Lafourcade BM, Baltazar CS, Banla Kere A, Bwire G, Coulibaly D, Kacou N’Douba A, Kagirita A, Keita S, Koivogui L, Landoh DE, Langa JP, Miwanda BN, Mutombo Ndongala G, Mwakapeje ER, Mwambeta JL, Mengel MA, Gessner BD. Sensitivity, Specificity, and Public-Health Utility of Clinical Case Definitions Based on the Signs and Symptoms of Cholera in Africa. Am J Trop Med Hyg 2018; 98:1021-1030. [PMID: 29488455 PMCID: PMC5928804 DOI: 10.4269/ajtmh.16-0523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/20/2017] [Indexed: 11/07/2022] Open
Abstract
During 2014, Africa reported more than half of the global suspected cholera cases. Based on the data collected from seven countries in the African Cholera Surveillance Network (Africhol), we assessed the sensitivity, specificity, and positive and negative predictive values of clinical cholera case definitions, including that recommended by the World Health Organization (WHO) using culture confirmation as the gold standard. The study was designed to assess results in real-world field situations in settings with recent cholera outbreaks or endemicity. From June 2011 to July 2015, a total of 5,084 persons with suspected cholera were tested for Vibrio cholerae in seven different countries of which 35.7% had culture confirmation. For all countries combined, the WHO case definition had a sensitivity = 92.7%, specificity = 8.1%, positive predictive value = 36.1%, and negative predictive value = 66.6%. Adding dehydration, vomiting, or rice water stools to the case definition could increase the specificity without a substantial decrease in sensitivity. Future studies could further refine our findings primarily by using more sensitive methods for cholera confirmation.
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Affiliation(s)
| | | | | | | | - Abiba Banla Kere
- Institut National d’Hygiène, Lomé, Togo
- Ministry of Health, Lomé, Togo
| | - Godfrey Bwire
- Control of Diarrheal Diseases, Community Health Department, Ministry of Health, Kampala, Uganda
| | | | | | - Atek Kagirita
- Central Public Health Laboratory, Ministry of Health, Kampala, Uganda
| | - Sakoba Keita
- Division Prévention et Lutte contre la Maladie, Ministry of Health, Conakry, Guinea
| | | | | | - Jose P. Langa
- Instituto Nacional de Saúde, Ministry of Health, Maputo, Mozambique
| | - Berthe N. Miwanda
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo
| | - Guy Mutombo Ndongala
- Division Provinciale de la Santé du Nord Kivu, Goma, Democratic Republic of Congo
| | - Elibariki R. Mwakapeje
- Epidemiology and Diseases Control Section, Preventive Department, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Jacob L. Mwambeta
- Curative Department, National Health Laboratory Quality Assurance and Training Center, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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Mwakapeje ER, Assenga JA, Kunda JS, Mjingo EE, Makondo ZE, Nonga HE, Mdegela RH, Skjerve E. Prevention, detection, and response to anthrax outbreak in Northern Tanzania using one health approach: A case study of Selela ward in Monduli district. Int J One Health 2017. [DOI: 10.14202/ijoh.2017.66-76] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Narra R, Maeda JM, Temba H, Mghamba J, Nyanga A, Greiner AL, Bakari M, Beer KD, Chae SR, Curran KG, Eidex RB, Gibson JJ, Handzel T, Kiberiti SJ, Kishimba RS, Lukupulo H, Malibiche T, Massa K, Massay AE, McCrickard LS, Mchau GJ, Mmbaga V, Mohamed AA, Mwakapeje ER, Nestory E, Newton AE, Oyugi E, Rajasingham A, Roland ME, Rusibamayila N, Sembuche S, Urio LJ, Walker TA, Wang A, Quick RE. Notes from the Field: Ongoing Cholera Epidemic - Tanzania, 2015-2016. MMWR Morb Mortal Wkly Rep 2017; 66:177-178. [PMID: 28207686 PMCID: PMC5657858 DOI: 10.15585/mmwr.mm6606a5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Rupa Narra
- These authors contributed equally to this report
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Munier A, Njanpop-Lafourcade BM, Sauvageot D, Mhlanga RB, Heyerdahl L, Nadri J, Wood R, Ouedraogo I, Blake A, Akilimali Mukelenge L, Anné JCB, Banla Kere A, Dempouo L, Keita S, Langa JPM, Makumbi I, Mwakapeje ER, Njeru IJ, Ojo OE, Phiri I, Pezzoli L, Gessner BD, Mengel M. The African cholera surveillance network (Africhol) consortium meeting, 10-11 June 2015, Lomé, Togo. BMC Proc 2017; 11:2. [PMID: 28813542 PMCID: PMC5301166 DOI: 10.1186/s12919-016-0068-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The fifth annual meeting of the African cholera surveillance network (Africhol) took place on 10–11 June 2015 in Lomé, Togo. Together with international partners, representatives from the 11 member countries -Cameroon, Côte d’Ivoire, Democratic Republic of Congo, Guinea, Kenya, Mozambique, Nigeria, Tanzania, Togo, Uganda, Zimbabwe- and an invited country (Malawi) shared their experience. The meeting featured three sessions: i) cholera surveillance, prevention and control in participating countries, ii) cholera surveillance methodology, such as cholera mapping, cost-effectiveness studies and the issue of overlapping epidemics from different diseases, iii) cholera laboratory diagnostics tools and capacity building. The meeting has greatly benefitted from the input of technical expertise from participating institutions and the observations emerging from the meeting should enable national teams to make recommendations to their respective governments on the most appropriate and effective measures to be taken for the prevention and control of cholera. Recommendations for future activities included collecting precise burden estimates in surveillance sites; modeling cholera burden for Africa; setting up cross-border collaborations; strengthening laboratory capacity for the confirmation of suspected cholera cases and for vaccine impact assessment in settings where oral cholera vaccine would be used; adapting cholera surveillance to concurrent issues (e.g., Ebola); and developing national cholera control plans including rationale vaccination strategies together with other preventive and control measures such as improvements in water, sanitation and hygiene (WASH).
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Affiliation(s)
- Aline Munier
- Agence de Médecine Préventive, 21 bd Pasteur, 75015 Paris, France
| | | | | | | | | | - Johara Nadri
- Agence de Médecine Préventive, 21 bd Pasteur, 75015 Paris, France
| | - Richard Wood
- Agence de Médecine Préventive, Ferney-Voltaire, France
| | | | - Alexandre Blake
- Agence de Médecine Préventive, 21 bd Pasteur, 75015 Paris, France.,Current affiliation: Epicentre, Paris, France
| | - Laurent Akilimali Mukelenge
- Institut National de Recherche Biomédicale, Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Jean-Claude B Anné
- Institut Pasteur de Cote d'Ivoire, Centre National de Référence choléra et shigelloses, Abidjan, Côte d'Ivoire
| | | | | | | | | | - Issa Makumbi
- Ministry of Health, National Disease Control, Kampala, Uganda
| | | | | | | | - Isaac Phiri
- Ministry of Health and Child Welfare, Harare, Zimbabwe
| | - Lorenzo Pezzoli
- World Health Organization, Secretariat of the Global Task Force on Cholera Control (GTFCC), Geneva, Switzerland
| | | | - Martin Mengel
- Agence de Médecine Préventive, 21 bd Pasteur, 75015 Paris, France
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