Aberrant use and poor quality of trypanocides: a risk for drug resistance in south western Ethiopia

Trypanocide usage in the cattle belt of southwestern Uganda

Background

Systematic infrastructure and regulatory weaknesses over many decades, in communities struggling with animal African trypanosomiasis (AAT) would be expected to create an environment that would promote drug misuse and risk development of drug resistance. Here, we explore rural community practices of livestock keepers, livestock extension officers and drug shop attendants to determine whether appropriate practice was being followed in administration of trypanocides and other drugs.

Methods

A questionnaire-based survey was undertaken in southwestern Uganda in 2022 involving 451 farmers who kept cattle, sheep or goats and 79 "professionals" who were either livestock extension officers or drug shop attendants.

Results

Respondents reported using one or more type of trypanocidal drug on 80.1% of the 451 farms in the last 30 days. Diminazene aceturate was used on around three-quarters of farms, while isometamidium chloride was used on around one-fifth. Homidium bromide was used on less than 1% of farms. Cattle were significantly more likely to be treated with trypanocides than sheep or goats. On around two-thirds of farms, trypanocides were prepared and injected by farmers, with extension officers administering these drugs on most of the other third, especially on cattle farms. Almost all drugs were obtained from privately-owned drug shops. For treatment of AAT with trypanocides, prescription-only medicines were routinely used by farmers without professional supervision and in the absence of a definitive diagnosis. While a far greater proportion of professionals had a better education and had received training on the use of trypanocides than farmers, there was relatively little difference in their ability to use these drugs correctly. Farmers were more likely than professionals to use only DA to treat trypanosomiasis and were more likely to use antibiotics as well as trypanocidal drugs to treat the animal. Furthermore, they estimated, on average, that twice the recommended dose of either diminazene aceturate or isometamidium chloride was needed to treat a hypothetical 400 kg bovine. A minority of both farmers and professionals reported that they observed the recommended withdrawal times following injection of trypanocidal drugs and very few of either group knew the recommended withdrawal times for milk or meat. Only one in six farmers reported using the sanative pair (alternating use of diminazene aceturate and isometamidium chloride), to reduce the risk of drug resistant trypanosome strains emerging, while this approach was more widely used by professionals. Farmers reported using antibiotics more commonly than the professionals, especially in sheep and goats, raising concerns as to overuse and misuse of this critical class of drugs. In addition to using trypanocides, most farmers also reported using a topical veterinary pesticide for the control of ticks and tsetse. On average, farmers spent 12.2% of their income from livestock sales on trypanocides.

Conclusion

This study highlights the complexity of issues involved in the fight against AAT using drug treatment. A multistakeholder campaign to increase awareness among farmers, drug shop attendants, and extension workers of the importance of adherence to recommended drug dosing, using the sanative pair and following recommended drug withdrawal guidance would promote best practice, reduce the risk of emergence of resistant strains of trypanosomes, and support enhanced food safety.

Comparative pathogenicity of single and mixed drug-resistant Trypanosoma brucei brucei and Trypanosoma congolense infections in rats

Drug-resistant trypanosomes are widespread in sub-Saharan Africa and in conjunction with the drug-sensitive phenotypes cause a serious endemic wasting disease in animals. We evaluated the pathogenicity of single and mixed drug-resistant Trypanosoma brucei brucei and T. congolense isolates in 35 female rats, randomly divided into seven groups (1-7) of five rats. Group 1 was the uninfected control. Groups 2 and 3 were infected with drug-sensitive T. brucei brucei and T. congolense, respectively, whereas groups 4 and 5 were infected with multidrug-resistant T. brucei brucei and T. congolense respectively. Group 6 were infected with drug-sensitive T. brucei brucei and T. congolense while group 7 were infected with multidrug-resistant T. brucei brucei and T. congolense. Parasitaemia kinetics, haematological parameters, body weight, clinical signs, survival time, gross and histopathological changes in the spleen were evaluated. Parasitaemia occurred between day 3-9 post-infection in all the infected groups. Rats in groups 4 and 7 had markedly prolonged (p < 0.05) pre-patent period, days to first peak parasitaemia, survival time, and lower (p < 0.05) parasitaemia level than groups 2 and 6 rats while these parameters were comparable for groups 3 and 5 rats. Anaemia was noted in the infected groups but the severity did not vary amongst the infected groups. Severe clinical signs and splenic lesions were noted in rats infected with drug-sensitive trypanosome species compared to the multidrug-resistant species. Therefore, we conclude that the trypanosome isolates were pathogenic. However, the drug-sensitive T. brucei brucei and mixed drug-sensitive trypanosome infections were more pathogenic than their multidrug-resistant counterparts.

Health, Economic, and Social Impacts of Substandard and Falsified Medicines in Low- and Middle-Income Countries: A Systematic Review of Methodological Approaches

Little is known about the adverse health, economic, and social impacts of substandard and falsified medicines (SFMs). This systematic review aimed to identify the methods used in studies to measure the impact of SFMs in low- and middle-income countries (LMICs), summarize their findings, and identify gaps in the reviewed literature. A search of eight databases for published papers, and a manual search of references in the relevant literature were conducted using synonyms of SFMs and LMICs. Studies in the English language that estimated the health, social, or economic impacts of SFMs in LMICs published before June 17, 2022 were considered eligible. Search results generated 1,078 articles, and 11 studies were included after screening and quality assessment. All included studies focused on countries in sub-Saharan Africa. Six studies used the Substandard and Falsified Antimalarials Research Impact model to estimate the impact of SFMs. This model is an important contribution. However, it is technically challenging and data demanding, which poses challenges to its adoption by national academics and policymakers alike. The included studies estimate that substandard and falsified antimalarial medicines can account from 10% to ∼40% of total annual malaria costs, and SFMs affect rural and poor populations disproportionately. Evidence on the impact of SFMs is limited in general and nonexistent regarding social outcomes. Further research needs to focus on practical methods that can serve local authorities without major investments in terms of technical capacity and data collection.

Molecular epidemiological survey of pathogenic trypanosomes in naturally infected cattle in northern Côte d'ivoire

Bovine trypanosomiasis is a significant health concern for livestock intensification in Côte d'Ivoire. This study aimed to determine the prevalence and distribution of pathogenic trypanosomes and identify the most infected cattle breed in northern Côte d&apos;Ivoire. We examined 700 cattle and found that polymerase chain reaction (PCR) was more sensitive (12.3%) than microscopic observation (5.6%). Among the trypanosome species detected in naturally infected cattle, Trypanosoma vivax was 7.3%, Trypanosoma simiae tsavo was 6.7%, and Trypanosoma congolense was 0.4%. The overall prevalence of trypanosome infection in all cattle breeds was 12.3%, while the prevalence in individual breeds was 14.8%, 7.3%, 10.6%, and 12.3% for N'Dama, Baoule, Zebu, and Mere breed, respectively. The infected animals had low packed cell volume, influencing the prevalence. Our findings indicate that bovine trypanosomes are prevalent in Côte d'Ivoire, and their prevalence varies by region and breed. These pathogens include T. vivax, T. simiae tsavo, and T. congolense.

Comparative pathogenicity of drug-resistant and drug-sensitive Trypanosoma brucei and Trypanosoma congolense infections in Nigerian local dogs

Animal trypanosomosis is an important endemic and wasting disease in sub-Saharan Africa. Its control relies on chemotherapy, and resistance to trypanocides has been widely reported. The pathogenicity of drug-resistant canine trypanosomes is not clear with scanty information available. Thus, this study assessed the comparative pathogenicity of drug-resistant and drug-sensitive Trypanosoma brucei and Trypanosoma congolense infections in dogs. Twenty Nigerian local dogs were used and were randomly assigned into five groups (A-E) of four dogs each. Group A served as the uninfected-control group, while groups B and C were infected with 10⁶ drug-sensitive T. congolense and T. brucei. Groups D and E were infected with 10⁶ multidrug-resistant T. congolense and T. brucei, respectively. The pre-patent period (PPP), clinical signs, level of parasitaemia (LOP), rectal temperature, body weight, packed cell volume (PCV), red blood cell count (RBC), haemoglobin concentration (HbC), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), total leucocyte count (TLC) and survivability were assessed. Groups D and E had longer (p < 0.05) mean PPP than groups B and C. Also, group E dogs had lower (p < 0.05) mean LOP, longer (p < 0.05) mean survivability, and higher (p < 0.05) mean body weight, PCV, HbC and RBC than group C dogs. The clinical signs were very severe in group C dogs, compared to group E dogs. However, these parameters did not differ statistically between groups B and D. Thus, multidrug-resistant T. brucei was of lower pathogenicity than drug-sensitive T. brucei, while multidrug-resistant and drug-sensitive T. congolense had comparable pathogenicity following infection in dogs.

The national atlas of tsetse flies and African animal trypanosomosis in Ethiopia

BACKGROUND

With the largest cattle population in Africa and vast swathes of fertile lands infested by tsetse flies, trypanosomosis is a major challenge for Ethiopian farmers. Managing the problem strategically and rationally requires comprehensive and detailed information on disease and vector distribution at the national level. To this end, the National Institute for Control and Eradication of Tsetse and Trypanosomosis (NICETT) developed a national atlas of tsetse and African animal trypanosomosis (AAT) for Ethiopia.

METHODS

This first edition of the atlas focused on the tsetse-infested areas in western Ethiopia. Data were collected between 2010 and 2019 in the framework of national surveillance and control activities. Over 88,000 animals, mostly cattle, were tested with the buffy-coat technique (BCT). Odour-enhanced traps were deployed in approximately 14,500 locations for the entomological surveys. Animal- and trap-level data were geo-referenced, harmonized and centralized in a single database.

RESULTS

AAT occurrence was confirmed in 86% of the districts surveyed (107/124). An overall prevalence of 4.8% was detected by BCT in cattle. The mean packed cell volume (PCV) of positive animals was 22.4, compared to 26.1 of the negative. Trypanosoma congolense was responsible for 61.9% of infections, T. vivax for 35.9% and T. brucei for 1.7%. Four tsetse species were found to have a wide geographic distribution. The highest apparent density (AD) was reported for Glossina pallidipes in the Southern Nations, Nationalities and People's Region (SNNPR) (3.57 flies/trap/day). Glossina tachinoides was the most abundant in Amhara (AD 2.39), Benishangul-Gumuz (2.38), Gambela (1.16) and Oromia (0.94) regions. Glossina fuscipes fuscipes and G. morsitans submorsitans were detected at lower densities (0.19 and 0.42 respectively). Only one specimen of G. longipennis was captured.

CONCLUSIONS

The atlas establishes a reference for the distribution of tsetse and AAT in Ethiopia. It also provides crucial evidence to plan surveillance and monitor control activities at the national level. Future work on the atlas will focus on the inclusion of data collected by other stakeholders, the broadening of the coverage to tsetse-free areas and continuous updates. The extension of the atlas to data on control activities is also envisaged.

Systematic Review and Meta-Analysis on Knowledge Attitude and Practices on African Animal Trypanocide Resistance

Background: African trypanocide resistance is an emerging public health emergency whose control requires a revisit on farmer’s knowledge, attitudes, and practices in developing countries. African animal trypanocide resistance (AATr) is rife in an environment where drug use and policy decisions are disjointed. The objective of the study was to identify community factors responsible for the development of AATr. This was important since diminazene aceturate (DA), isometamidium chloride (ISM), and homidium bromide (HB) have existed for over 30 years and no new drugs have been provided to farmers. Methods: An electronic keyword search across 12 databases was conducted using a search criterion from 1806 to June 2022. This generated a total of 24 publications, but after removing duplicates, review articles, and nonrelated articles, a total of eight papers were included in the analysis by following the PRISMA checklist. A meta-analysis was conducted on the data extracted and the risk ratio and inverse variance at 95% confidence interval were calculated using RevMan^®. Results: All the eight articles in the study showed that DA was the most preferred trypanocide in both West and Eastern Africa. Poor farmer knowledge of AATr and limited drug options were major drivers for trypanocide resistance. In addition, farmer treatments, use of untrained personnel, poor administration, poor dosing, and preparation of trypanocides were major drivers for the development of AATr and similarities were identified in DA and ISM practices (P = 0.13). Conclusions: AATr is spread in developing countries due to a lack of community knowledge, attitudes, and drug-use practices. This situation could be reversed through interdisciplinary collaborations in endemic communities by promoting effective treatments and responsible drug handling.

Post marketing surveillance of selected veterinary medicines in Tanzania mainland

BACKGROUND

Veterinary medicines have been widely used for the prevention and treatment of animal diseases. Globally, the veterinary medicine industry is growing. However, there is a significant increase of concern on the quality of veterinary medicines in various developing countries' legal markets. Poor-quality medicines are associated with treatment failure, development of drug resistance, increased healthcare cost, and death. These reasons warrant a need for monitoring the quality of the medicines circulating in the Tanzania Mainland.

METHODS

This was a survey study and veterinary medicines samples were collected from 9 out of 26 regions of Tanzania mainland between 2014 and 2017. Veterinary medicines were sampled from wholesale pharmacies, retail pharmacies, veterinary clinics and Veterinary Accredited Drug Dispensing Outlets (ADDO-vet). All sampled medicines were subjected to product information review and full quality control testing at the Tanzania Medicines and Medical Devices Authority-World Health Organization prequalified laboratory.

RESULTS

A total of 238 samples of veterinary medicines were collected. Out of these, 97.1% (231/238) were subjected to full quality control testing and product information review. All sampled veterinary medicines conformed to visual appearance, clarity, pH, solubility and sterility tests. Also, of the sampled veterinary medicines 97.8% (226/231) and 89.2% (206/231) passed identification and assay tests, respectively. As well as, the majority of the collected samples 92% (219/238) failed to comply with product information requirements. The most observed deficiencies on product information were inadequate information on the package insert 94.1% (224/238), inappropriate storage conditions 55.5% (132/238) and lack of Tanzania registration number 27% (64/238).

CONCLUSION

Veterinary medicines with poor quality were found circulating in the legal markets of Tanzania. This can potentiate treatment failure and the development of drug resistance in animals and humans. Post marketing surveillance program will continue to be implemented to ensure that only good quality, safe and efficacious medicines are circulating in the Tanzania Mainland market.

Phenotypic antimicrobial resistance (AMR) of avian pathogenic Escherichia coli (APEC) from broiler breeder flocks between 2009 and 2018

Colibacillosis is one of the most important diseases in poultry production. The use of antimicrobials remains a therapeutic cornerstone for avian pathogenic E. coli (APEC), thereby contributing to the development of antimicrobial resistance (AMR). The aim of this study was to characterize AMR in broiler breeder flocks reared under commercial conditions. Data covering ten years, from 2009 to 2018, were used to evaluate the phenotypic AMR of 264 APEC obtained from 158 broiler breeder flocks of a large company in Portugal. The APEC isolates were tested against eleven antimicrobials by the Kirby-Bauer disk diffusion test. The annual proportion of AMR was calculated by dividing the number of APEC with phenotypic resistance by the total number of APEC isolated that year. Similarly, the overall AMR of the whole period was calculated. The relationship of antimicrobial resistance with time (years) was investigated with a generalized linear model using logistic regression. The overall AMR of the 10-year period was: amoxicillin 78%, ampicillin 73.5%, tetracycline 63.3%, doxycycline 56.4%, apramycin 34.5%, neomycin 68.2%, enrofloxacine 32.6%, flumequine 39.4%, co-trimoxazole 47.7%, florfenicol 46.6% and lincospectin 66.3%. Over time, a significant decrease in AMR was observed for amoxicillin and ampicillin, neomycin, flumequine, co-trimoxazole, florfenicol and lincospectin. Multidrug resistance (MDR) decreased from 100% in 2009 to 48% in 2018. Only 7 (2.7%) APEC strains were fully susceptible to all tested antimicrobials. The decrease over time of AMR in APEC likely reflects the efficacy of manifold improvements in broiler breeder production systems. A further reduction in AMR is still desirable.

Access to Veterinary Drugs in Sub-Saharan Africa: Roadblocks and Current Solutions

Background

Access to veterinary drugs for livestock has become a major issue over the last decade. Analysis has tended to focus on the demand for these products, while studies looking at the drivers behind their use generally focus on farmer behavior and interactions between veterinarians and farmers. However, the use of drugs also depends on structural factors that determine the functioning of the drug supply chain and farmers' access to the drugs. This article presents an overview of the factors that limit access to veterinary drugs in sub-Saharan Africa (SSA) as well as the international policy tools and arrangements that claim to improve it.

Methods

We have conducted a scoping review of the scientific and grey literature as well as the publicly-available data from both the animal health industry and international organizations. We aimed to gather information on the veterinary drugs market in SSA as well as on the international norms, recommendations, guidelines, and initiatives that impact SSA farmers' access to these drugs.

Findings

We highlight numerous barriers to veterinary drug access in SSA. The SSA market is highly dependent on imports, yet the region attracts little attention from the international companies capable of exporting to it. It suffers from a high level of fragmentation and weak distribution infrastructures and services, and is driven by the multiplication of private non-professional actors playing a growing role in the veterinary drug supply chain. The distribution system is increasingly dualized, with on the one hand the public sector (supported by development organizations) supplying small scale farmers in rural areas, but with limited and irregular means; and on the other side a private sector largely unregulated which supplies commercial and industrial farming systems. Different innovations have been developed at the international and regional levels to try to reduce barriers, such as homogenizing national legislations, donations, and vaccine banks. Alongside decades-old inter-state cooperation, many new forms of public-private partnerships and other hybrid forums continue to emerge, signaling the private sector's increasing influence in global governance.

Conclusions

Policies on animal health would be bolstered by a better understanding of the drivers behind and the components of access to veterinary drugs in different regional and national contexts. Inequalities in drug access need to be addressed and a market-driven approach adopted in order to strengthen our understanding of what determines veterinary drug use at the farm level. Policies should balance the interests of the various stakeholders, being careful not to reinforce bias toward certain diseases deemed "interesting" and neglect others that could prove to be highly important for veterinary public health.

Study on identification, assay and organoleptic quality of veterinary medicines in Ethiopia

BACKGROUND

Medicines of poor quality are currently prevailing problems undermining the quality of health care services in veterinary and human medicine. In this study, physico-chemical quality of veterinary medicines was evaluated.

METHODS

A total of 959 veterinary medicines samples were collected during routine regulatory activities, i.e. pre-registration, re-registration, consignment checking and post-marketing surveillance, in Ethiopia. The samples were transported to Animal Products, Veterinary Drug and Feed Quality Assessment Centre (APVD-FQAC), which is the quality control laboratory of the Veterinary Drug and Feed Administration and Control Authority (VDFACA) and stored until analysis. The samples were subjected to visual inspection and chemical analysis following the United States, European or British Pharmacopoeias, or manufacturer's methods.

RESULTS

The findings revealed that 12 (1.3%) of tested products showed defects in physical characteristics, packaging, or labelling information, while a total of 66 (6.9%) samples of the investigated products failed to comply with the Pharmacopoeias and supplier's specification limit set for assay. Of these, 60 samples did not comply with the minimum assay specification limit.

CONCLUSION

Overall, 8.2% of the investigated veterinary medicine samples did not comply with the specification set for the investigated quality attributes and thus were categorized as of poor quality. This indicates the need for continued strengthening of regulatory functions.

Detection of Trypanosoma vivax in tissues of experimentally infected goats: what is the role of adipose tissue in the life cycle of this protozoon?

Trypanosomiasis, caused by Trypanosoma vivax, is responsible for great economic losses among livestock in Africa and South America. During the life cycle of these parasites, they may present different morphological, metabolic and physiological characteristics depending on the interactions that are encountered at each point of their life cycle. Although T. vivax is frequently reported in the circulation of its mammalian hosts, it has the ability to migrate to the tissues of these individuals. However, this characteristic is poorly understood. In this context, we aimed to investigate the presence of T. vivax and the changes caused in different tissues of experimentally infected goats. Despite the animals were not perfused before tissues collection, using different approaches, we demonstrated its presence in different samples, including in the adipose tissue and skin of infected animals. In addition, a mononuclear inflammatory reaction, mostly characterized by an infiltrate of lymphocytes, plasma cells and macrophages were observed. The results highlight the possibility that, like other trypanosomatids, T. vivax may use these tissues during its life cycle. Future studies aiming to elucidate the length of time for which T. vivax remains active in these sites, and whether it uses these sites as a refuge from trypanocidal drugs, and whether it is capable of recolonizing the blood circulation, are much needed.

Benchmarking national action plans on antimicrobial resistance in eight selected LMICs: Focus on the veterinary sector strategies

Background

The WHO Global Action Plan on antimicrobial resistance (GAP) provides a global strategy for combating antimicrobial resistance. Context-specific national action plans (NAP) translate GAP to reflect local priorities. However, the process by which countries translate GAP into NAPs, and the resultant concordance, is not well-known. The aim of the paper is to evaluate the NAPs of eight selected low- and lower-middle income countries (LMICs) against GAP and each other to identify best practices with a focus on the veterinary sector.

Methods

Using the WHO GAP, and the WHO Manual for designing NAPs, we performed a policy content evaluation for: Afghanistan, Bangladesh, Ethiopia, Ghana, Nepal, Nigeria, Pakistan and Uganda. NAPs were assessed as concordant with GAP if they contained ≥80% of the recommendations. Operational and monitoring and evaluation (M&E) plans were assessed as: Specific, Measurable, Assignable, and Time-bound (or SMAT). Financing, targets and legislation for antimicrobial use reduction, and medicine quality assurance mechanisms were assessed using a constructed framework. Countries were then ranked using a scoring system to identify best practices.

Results

All NAPs contained ≥80% of GAP’s recommendations. Whereas Nepal’s NAP was strategic, the rest were operational and uniformly SMAT; except Afghanistan’s. The M&E plans were not all SMAT. Detailed costing and funding sources were included for only Ghana and Uganda. Quantitative target for antimicrobial use reduction was found only in Nepal’s NAP and legislation only for Bangladesh. Ghana’s and Uganda’s medicine quality assurance mechanisms were the most robust.

Conclusions

All NAPs were concordant with GAP. However, gaps exist in relation to M&E, diminishing the countries’ capacity to be accountable and implement corrective action if necessary. Most lacked financing plans and targets for antimicrobial use reduction. The antimicrobial quality assurances strategies are limited in most of the NAPs assessed. A mechanism by which countries can benchmark their NAP would allow identification of specific limitations and areas of best practice.

The potential economic benefits of controlling trypanosomiasis using waterbuck repellent blend in sub-Saharan Africa

Trypanosomiasis is a significant productivity-limiting livestock disease in sub-Saharan Africa, contributing to poverty and food insecurity. In this paper, we estimate the potential economic gains from adopting Waterbuck Repellent Blend (WRB). The WRB is a new technology that pushes trypanosomiasis-transmitting tsetse fly away from animals, improving animals’ health and increasing meat and milk productivity. We estimate the benefits of WRB on the production of meat and milk using the economic surplus approach. We obtained data from an expert elicitation survey, secondary and experimental sources. Our findings show that the adoption of WRB in 5 to 50% of the animal population would generate an economic surplus of US$ 78–869 million per annum for African 18 countries. The estimated benefit-cost ratio (9:1) further justifies an investment in WRB. The technology’s potential benefits are likely to be underestimated since our estimates did not include the indirect benefits of the technology adoption, such as the increase in the quantity and quality of animals’ draught power services and human and environmental health effects. These benefits suggest that investing in WRB can contribute to nutrition security and sustainable development goals.

Knowledge, attitudes and practices on bovine trypanosomosis control in pastoral and agro pastoral communities surrounding Murchison Falls National Park, Uganda

A mixed method survey was conducted among pastoral and agro pastoral communities surrounding Murchison Falls National Park, Uganda to assess knowledge, attitudes and practices about control of bovine trypanosomosis. A total of 96.8% (n = 152) of the participants had seen tsetse flies, and close to 91.7% (n = 116) of the participants had heard about bovine trypanosomosis. Bovine trypanosomosis was reported as a major disease in their area by about 73.9% (n = 116). There was a significant difference (P < 0.05) in the level of awareness and perception about tsetse and bovine trypanosomosis across the study sub counties. The majority of the farmers (60.5%) stated that grazing near national parks was the main cause of bovine trypanosomosis. A small proportion of farmers associated sharing grazing land and watering points with wildlife (19.1%) and grazing cattle in tsetse fly-infested areas (8.3%) as the causes of trypanosomosis. The communities in the study sub counties were aware of at least one or two clinical signs of bovine trypanosomosis. Spraying cattle with insecticide and avoiding grazing animals in tsetse-infested areas were the control practices. Curative trypanocides were mainly used to treat their cattle against trypanosomosis. Bush clearing, targets and traps as tsetse fly control measures were less practiced by the farmers. Treatment of cattle was based on observation of clinical signs due to absence of blood diagnostic facilities. Implementing regular tsetse fly population monitoring surveys and promotion of disease rapid diagnostic tools at farm level as long-term strategies are key for effective control of the disease.

Pharma to farmer: field challenges of optimizing trypanocide use in African animal trypanosomiasis

Trypanocides are a key control component of African animal trypanosomiasis (AAT) in tsetse-infested areas of sub-Saharan Africa. While farmers are dependent upon trypanocides, recent research highlights their inappropriate and ineffective use, problems with drug quality, and treatment failure. There are currently gaps in knowledge and investment in inexpensive AAT diagnostics, understanding of drug resistance, and the effective use of trypanocides in the field. Without this important knowledge it is difficult to develop best practice and policy for existing drugs or to inform development and use of new drugs. There needs to be better understanding of the drivers and behavioural practices around trypanocide use so that they can be incorporated into sustainable solutions needed for the development of effective control of AAT.

Prioritizing smallholder animal health needs in East Africa, West Africa, and South Asia using three approaches: Literature review, expert workshops, and practitioner surveys

Managing the health needs of livestock contributes to reducing poverty and improving the livelihoods of smallholder and pastoralist livestock keepers globally. Animal health practitioners, producers, policymakers, and researchers all must prioritize how to mobilize limited resources. This study employed three approaches to prioritize animal health needs in East and West Africa and South Asia to identify diseases and syndromes that impact livestock keepers. The approaches were a) systematic literature review, b) a series of expert workshops, and c) a practitioner survey of veterinarians and para-veterinary professionals. The top constraints that emerged from all three approaches include endo/ ectoparasites, foot and mouth disease, brucellosis, peste des petits ruminants, Newcastle disease, and avian influenza. Expert workshops additionally identified contagious caprine pleuropneumonia, contagious bovine pleuropneumonia, mastitis, and reproductive disorders as constraints not emphasized in the literature review. Practitioner survey results additionally identified nutrition as a constraint for smallholder dairy and pastoralist small ruminant production. Experts attending the workshops agreed most constraints can be managed using existing veterinary technologies and best husbandry practices, which supports a shift away from focusing on individual diseases and new technologies towards addressing systemic challenges that limit access to veterinary services and inputs. Few research studies focused on incidence/ prevalence of disease and impact, suggesting better incorporation of socio-economic impact measures in future research would better represent the interests of livestock keepers.

Efficacy of diminazene diaceturate and isometamidium chloride hydrochloride for the treatment of Trypanosoma evansi in mice model

Diminazene diaceturate (DIM) and isometamidium chloride hydrochloride (ISMM) have been widely used for the treatment of animal trypanosomosis. We evaluated the efficacy of standard doses of DIM and ISMM followed by their double doses for the treatment of Trypanosoma evansi in experimentally infected mice. A T. evansi strain obtained from a naturally infected camel in Afar was used. 25 swiss white mice randomly divided in to five groups were inoculated with 0.2 mL of blood containing 10³ trypanosomes. At the peak of parasitemia (≈ 2 weeks post infection), groups A and B were treated with the standard dose (3.5 mg/kg body weight [BWT]) of DIM; groups C and D were treated with the standard dose (0.5 mg/kg BWT) of ISMM; and group E served as infected control. In the DIM standard dose groups, relapses and peak parasitemia were observed 20- and 25-days post treatment respectively. Similarly, relapses and peak parasitemia were observed 21- and 27-days post treatment in the ISMM standard dose groups. All mice in the control group died within two weeks post infection. Following relapses, mice were treated with the double doses of DIM (7 mg/kg BWT) or ISMM (1 mg/kg BWT). Parasitemia was not detected for 3 months following the double dose treatments. Following dexamethasone administration for 7 days, all but one mouse in the DIM group remained negative for another month. In general, although the T. evansi strain was resistant to the standard doses of DIM and ISMM their double doses completely cleared the infection.

Quality of fixed dose artemether/lumefantrine products in Jimma Zone, Ethiopia

Background

Malaria caused by Plasmodium vivax and Plasmodium falciparum is among the major public health problems in most endemic areas of the world. Artemisinin-based combination therapy (ACT) has been recommended as a first-line treatment for uncomplicated Plasmodium falciparum malaria almost in all endemic regions. Since ineffectively regulated medicines in resource limited settings could favour infiltration of poor quality anti-malarial medicines into pharmaceutical supply chain and jeopardize a positive treatment outcome, regular monitoring of the quality of anti-malarial medicines is critical. Thus, the aim of this study was to assess the quality of fixed dose combination (FDC) artemether (ART)/lumefantrine (LUM) tablets available in Jimma zone, Ethiopia.

Methods

This study was conducted in Jimma zone, Ethiopia. A total of 74 samples of FDC ART/LUM (20 mg ART/120 mg LUM) tablets were collected from 27 public facilities. All samples were subjected to visual inspection and the relevant information was recorded. The samples were transported to Jimma University Laboratory of Drug Quality (JuLaDQ) and stored at ambient temperature (20 °C to 25 °C) until analysis. The Pharmacopoeial conform/non-conform methods and the risk-based Derringer’s desirability function approach were employed to assess the pharmaceutical quality of the investigated products.

Results

The visual inspection results revealed that there were no signs of falsified in the investigated products. Identification test results of samples indicated that all samples contained the stated active pharmaceutical ingredients (APIs). The results of uniformity of mass indicated that all samples complied with International Pharmacopoeial specification limits. The assay results, expressed as percent label claim (%lc) of ART (89.8 to 108.8%, mean ± SD = 99.1 ± 3.9%) and LUM (90.0 to 111.9%, mean ± SD = 98.2 ± 3.8%) revealed that, all samples complied with International Pharmacopoeia acceptance specification limits (i.e. 90–110%lc), except one generic product (IPCA Laboratories Ltd., India) which contains excessive LUM (111.9 ± 1.7%lc). The risk priority number (RPN) results revealed that assay (RPN = 392) is relatively the most critical quality attribute followed by identity (RPN = 280) and mass uniformity (40). Quality evaluation based on psycho-physical Harrington’s scale revealed that more than 96% of samples were within the acceptable ranges (D ≥ 0.7–1.0).

Conclusions

Both Pharmacopoeial and risk-based desirability function approaches to quality evaluation applied to the investigated products revealed that above 96% FDC ART/LUM tablets circulating in public settings of Jimma zone are of good quality.

Electronic supplementary material

The online version of this article (10.1186/s12936-019-2872-1) contains supplementary material, which is available to authorized users.

Isometamidium chloride and homidium chloride fail to cure mice infected with Ethiopian Trypanosoma evansi type A and B

Background

Trypanosoma evansi is mechanically transmitted by biting flies and affects camels, equines, and other domestic and wild animals in which it causes a disease called surra. At least two types of Trypanosoma evansi circulate in Ethiopia: type A, which is present in Africa, Latin America and Asia, and type B, which is prevalent in Eastern Africa. Currently, no information is available about the drug sensitivity of any Ethiopian T. evansi type.

Methodology/principal findings

This study was conducted with the objective of determining the in vivo drug sensitivity of two T. evansi type A and two type B stocks that were isolated from camels from the Tigray and Afar regions of Northern Ethiopia. We investigated the efficacy of four trypanocidal drugs to cure T. evansi infected mice: melarsamine hydrochloride (Cymelarsan), diminazene diaceturate (Veriben and Sequzene), isometamidium chloride (Veridium) and homidium chloride (Bovidium). Per experimental group, 6 mice were inoculated intraperitoneally with trypanosomes, treated at first peak parasitemia by daily drug injections for 4 consecutive days and followed-up for 60 days. Cymelarsan at 2 mg/kg and Veriben at 20 mg/kg cured all mice infected with any T. evansi stock, while Sequzene at 20 mg/kg caused relapses in all T. evansi stocks. In contrast, Veridium and Bovidium at 1 mg/kg failed to cure any T. evansi infection in mice.

Conclusions/significance

We conclude that mice infected with Ethiopian T. evansi can be cured with Cymelarsan and Veriben regardless of T. evansi type. In contrast, Veridium and Bovidium are not efficacious to cure any T. evansi type. Although innate resistance to phenanthridines was previously described for T. evansi type A, this report is the first study to show that this phenomenom also occurs in T. evansi type B infections.

Surra is a vector borne disease in camels, horses, water buffaloes, cattle and other domestic animals caused by Trypanosoma (T.) evansi. This protozoan parasite is transmitted by biting flies such as tabanids and stable flies and is endemic in many countries in Northern and Eastern Africa, Latin America and Asia. Surra is responsible for high economic losses due to mortality and morbidity of draught animals and leads to animal trade restrictions in endemic regions. Control of surra is mainly based on the treatment of sick animals presenting clinical symptoms. In Ethiopia two different types of T. evansi (A and B) have been described, yet no data existed about the drug sensitivity of any T. evansi type. In this study, we show for the first time that T. evansi type B is naturally in vivo resistant to the phenanthridine class of trypanocidal drugs, a phenonomen that was previously described for T. evansi type A. All Ethiopian T. evansi types are sensitive to melarsamine hydrochloride and diminazene diaceturate. Unfortunately, the most efficacious drugs are either not registered in Ethiopia or escape quality control of the active substance in commercial drug formulations. Furthermore, the inefficacious drugs remain accessible on the market despite their toxicity for animals.