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Wenham C, Brand TL, Carlin EP, Donachie D, Fèvre S, Greve LC, Hardy E, Okello AL, Standley CJ, Stärk KDC, Lawrence Welle CC. How can gender considerations be better integrated into animal health emergency preparedness and response? J Am Vet Med Assoc 2024; 262:572-575. [PMID: 38295516 DOI: 10.2460/javma.23.10.0589] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 10/27/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024]
Abstract
Global and national authorities have not historically approached animal health emergencies through a gendered lens. Yet these events almost certainly have gendered dimensions, such as differential engagement of women or men depending on their culturally accepted or assigned roles for animal care; risk of exposure to zoonoses; and access to emergency resources during response and recovery. Despite the role that gender seems to play with respect to animal health emergencies, little research has been conducted to better understand such dynamics, and little policy has been promulgated to address it in a way that optimizes response while ensuring equitable outcomes. This piece summarizes 3 key themes that emerged from a panel discussion on gender and animal health emergencies at the World Organisation for Animal Health Global Conference on Emergency Management in April 2023. These themes were differential gendered exposure to pathogens; a lack of equitable gender representation in animal health decision-making; and enhancement of pathways for recognizing gender in national and international actions in preparing for, detecting, and responding to animal health emergencies. Beyond increasing opportunities for women to engage in leadership, the animal health and veterinary communities will benefit from connecting practitioners with gender experts to develop more integrative approaches to emergency preparedness and management. Animal health professionals should also advocate for further research to elucidate gender-specific dynamics in human populations in the context of animal emergencies and the promulgation of evidence-based policies. Such transformative efforts will lead to better outcomes for all people who depend on and provide care for animals.
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Affiliation(s)
- Clare Wenham
- 1London School of Economics and Political Science, London, England
| | | | | | | | - Sonia Fèvre
- 2World Organisation for Animal Health, Paris, France
| | - Lydia C Greve
- 2World Organisation for Animal Health, Paris, France
| | - Emily Hardy
- 4School of Foreign Service, Georgetown University, Washington, DC
| | - Anna L Okello
- 5Australian Centre for International Agricultural Research, Canberra, ACT, Australia
| | - Claire J Standley
- 6Center for Global Health Science and Security, Georgetown University, Washington, DC
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Okello WO, Okello AL, Inthavong P, Tiemann T, Phengsivalouk A, Devleesschauwer B, Shaw A, Allen J. Improved methods to capture the total societal benefits of zoonotic disease control: Demonstrating the cost-effectiveness of an integrated control programme for Taenia solium, soil transmitted helminths and classical swine fever in northern Lao PDR. PLoS Negl Trop Dis 2018; 12:e0006782. [PMID: 30231029 PMCID: PMC6185856 DOI: 10.1371/journal.pntd.0006782] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 06/20/2018] [Revised: 10/12/2018] [Accepted: 08/23/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Control and elimination of zoonotic diseases requires robust information about their effect on both human and livestock health in order to enable policy formulation and the allocation of resources. This study aimed to evaluate the cost-effectiveness of controlling Taenia solium taeniasis/cysticercosis in both humans and pigs, and soil-transmitted helminths (STH) in humans by integrating their control to on-going human and animal health control programmes in northern Lao People's Democratic Republic. METHOD A cross-sectional study was carried out in 49 households, focusing on the prevalence of T. solium taenias/cysticercosis and soil transmitted helminths before and after a twelve month intervention. The village data was collected using a semi-structured questionnaire through a door-to-door survey. The village data was then projected to the wider northern Lao PDR population using stochastic modelling and cost-effectiveness ratio (after aggregating the net cost to capture both human and animal health parameters) and GDP per capita as a threshold, to determine the cost-effectiveness of the integrated control of T. solium taeniasis/ cysticercosis and STH, assuming linear scaling out of the intervention. The zoonotic DALY (zDALY) approach was also used as an alternative method of estimating the cost-effectiveness ratio of controlling T. solium taeniasis/cysticercosis in humans and pigs. FINDINGS Using cost-effectiveness analysis after aggregating the net cost and control of T. solium taeniasis/cysticercosis alone as the base case, the study found that simultaneous control of T. solium taeniasis/cysticercosis in humans and pigs, STH in humans and Classical Swine Fever (CSF) in pigs was USD 14 per DALY averted and USD 234 per zDALY averted using zDALY method hence considered highly cost-effective whereas controlling T. solium taeniasis/cysticercosis without incorporating STH and CSF was the least cost-effective (USD 3,672 per DALY averted). Additionally, the cost-effectiveness of controlling T. solium taeniasis/cysticercosis in people and pigs using zDALY as an alternative method was USD 3,662 per zDALY averted which was quite close to our findings using the aggregate net cost method. CONCLUSION The study showed that control of T. solium taeniasis/cysticercosis alone in humans and pigs is not cost-effective in northern Lao PDR whereas control of STH is. Consequently, integrating T. solium taeniasis/cysticercosis control with other cost-effective programmes such as STH and CSF markedly improved the cost-effectiveness of the intervention. This is especially important in low resource countries where control of zoonotic neglected tropical diseases could be integrated with the human and animal health sectors to optimize use of the limited resources. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614001067662.
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Affiliation(s)
- Walter O. Okello
- Division of Infection and Pathway Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Anna L. Okello
- Australian Animal Health Laboratory (AAHL) Regional Program, CSIRO, Geelong, VIC, Australia
| | - Phouth Inthavong
- Department of Livestock and Fisheries, National Animal Health Laboratory (NAHL), Vientiane, Lao PDR
| | - Tassilo Tiemann
- Tropical Forages Program, Centro Internacional de Agricultura Tropical (CIAT in Asia), Vientiane, Lao PDR
| | - Ammaly Phengsivalouk
- Department of Livestock and Fisheries, National Animal Health Laboratory (NAHL), Vientiane, Lao PDR
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Alexandra Shaw
- Division of Infection and Pathway Medicine, University of Edinburgh, Edinburgh, United Kingdom
- A P Consultants, Andover, United Kingdom
| | - John Allen
- Australian Animal Health Laboratory (AAHL) Regional Program, CSIRO, Geelong, VIC, Australia
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Abstract
Human taeniasis is a zoonotic condition resulting from infection with the adult stages of Taenia saginata ("beef tapeworm"), Taenia solium ("pork tapeworm") or Taenia asiatica ("Asian tapeworm"). Although these parasites have a worldwide distribution, the overwhelming burden is felt by communities in low- and middle-income countries. This is particularly true for T. solium, whereby infection of the central nervous system with the larval stage of the parasite (neurocysticercosis) is a major cause of acquired epilepsy in low-resource settings. With a focus on endemic countries, this review provides an insight into the prevention and management of human taeniasis, concluding with some recent case studies describing their implementation. Discussion of the opportunities and challenges regarding current fecal and serological diagnostic assays for detecting Taenia spp. highlights the importance of accurate and accessible diagnostic options for the field situation. The lack of long-term impact on the parasites' lifecycle from human anthelmintic treatment, coupled with the propensity for adverse reactions, highlights the importance of a "two-pronged" approach that considers the relevant animal hosts, particularly in the case of T. solium. Aside from the therapeutic options, this review reiterates the importance of adequate assessment and consideration of the associated behavioral and policy aspects around sanitation, hygiene and meat inspection that have been shown to support parasite control, and potential elimination, in endemic regions.
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Affiliation(s)
- Anna L Okello
- Division of Infection and Pathway Medicine, Edinburgh Medical School, Biomedical Sciences College of Medicine and Veterinary Medicine, University of Edinburgh, Scotland
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Okello AL, Tiemann TT, Inthavong P, Khamlome B, Phengvilaysouk A, Keonouchanh S, Keokhamphet C, Somoulay V, Blaszak K, Blacksell SD, Okello WO, Allen J. Integrating market chain assessments with zoonoses risk analysis in two cross-border pig value chains in Lao PDR. Asian-Australas J Anim Sci 2017; 30:1651-1659. [PMID: 28423884 PMCID: PMC5666201 DOI: 10.5713/ajas.16.0887] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/13/2017] [Accepted: 03/21/2017] [Indexed: 01/27/2023]
Abstract
Objective Lao PDR’s recent accession to the World Trade Organization necessitates a greater understanding of the patterns and risk of livestock production in order to better align national policy with the Agreement on the Application of Sanitary and Phytosanitary Measures. This eco-health study was conducted to improve understanding of the interrelations between market chains and zoonotic infection risks at two strategic cross border points between Lao PDR, Thailand and Viet Nam. Methods Information gained from smallholder farmer/trader interviews was integrated with serological surveys for pig-associated zoonoses—including hepatitis E virus (HEV), Taenia solium (T. solium) and trichinella—to identify potential linkages between disease risk and pig production and slaughter in low input systems common across the country. Results Trichinella and HEV exposure was high in both humans and pigs in both study areas, significantly associated with pig slaughter and the subsequent consumption and handling of raw pork products. T. solium demonstrated a strong geographical and ethnic association with the northern study area bordering Vietnam. With the right knowledge and accessible, affordable inputs, the majority of smallholder farmers indicated a willingness to invest more in pig production, which could simultaneously improve livelihoods and decrease exposure to HEV, Trichinella, and T. solium through increased access to formal markets and an improved slaughter processes. Conclusion The linkages identified when assessing disease risk in the context of potential economic and cultural drivers of transmission highlight the importance of a systems-based approach for the detection and control of zoonotic disease, and contributes to an improved understanding of the Lao PDR livestock sector.
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Affiliation(s)
- Anna L Okello
- CSIRO, Australian Animal Health Laboratory (AAHL) Regional Program, Geelong, VIC 3220, Australia.,School of Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Tassilo T Tiemann
- Centro Internacional de Agricultura Tropical (CIAT in Asia), Tropical Forages Program, Vientiane, Lao PDR, Australia
| | - Phouth Inthavong
- National Animal Health Laboratory (NAHL), Department of Livestock and Fisheries, Vientiane, Lao PDR, Australia
| | - Boualam Khamlome
- Department of Hygiene and Prevention, Ministry of Health, Vientiane, Lao PDR, Australia
| | - Ammaly Phengvilaysouk
- National Agricultural and Forestry Research Centre, Livestock Research Center, Vientiane, Lao PDR, Australia
| | - Soukanh Keonouchanh
- National Agricultural and Forestry Research Centre, Livestock Research Center, Vientiane, Lao PDR, Australia
| | - Chattouphone Keokhamphet
- National Animal Health Laboratory (NAHL), Department of Livestock and Fisheries, Vientiane, Lao PDR, Australia
| | - Virasack Somoulay
- National Centre for Laboratory and Epidemiology (NCLE), Ministry of Health, Vientiane, Lao PDR, Australia
| | - Kate Blaszak
- Independent consultant, Newport VIC 3015, Australia
| | - Stuart D Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford OX3 7BN, UK
| | - Walter O Okello
- School of Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - John Allen
- CSIRO, Australian Animal Health Laboratory (AAHL) Regional Program, Geelong, VIC 3220, Australia
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Okello AL, Thomas L, Inthavong P, Ash A, Khamlome B, Keokamphet C, Newberry K, Gauci CG, Gabriël S, Dorny P, Thompson RCA, Lightowlers MW, Allen J. Assessing the impact of a joint human-porcine intervention package for Taenia solium control: Results of a pilot study from northern Lao PDR. Acta Trop 2016; 159:185-91. [PMID: 26992295 DOI: 10.1016/j.actatropica.2016.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/09/2016] [Accepted: 03/13/2016] [Indexed: 11/24/2022]
Abstract
Following confirmation that a remote village of approximately 300 inhabitants in northern Lao PDR was hyperendemic for the Neglected Tropical Disease Taenia solium, a pilot human-porcine therapeutic control intervention was implemented between October 2013 and November 2014. Mass drug administration with a three day albendazole 400mg protocol was offered to all eligible humans in October 2013 and March 2014. At these times, and again in October 2014, eligible village pigs received the anti-cysticercosis TSOL18 vaccination and an oral dose of oxfendazole anthelmintic at 30mg/kg, both repeated one month later. Community and individual human taeniasis prevalences were estimated via copro-antigen ELISA of volunteered human faecal samples prior to October 2013, and again in January 2015, in order to examine the short term impact of the intervention.
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Okello AL, Burniston S, Conlan JV, Inthavong P, Khamlome B, Welburn SC, Gilbert J, Allen J, Blacksell SD. Prevalence of Endemic Pig-Associated Zoonoses in Southeast Asia: A Review of Findings from the Lao People's Democratic Republic. Am J Trop Med Hyg 2015; 92:1059-1066. [PMID: 25802431 PMCID: PMC4426289 DOI: 10.4269/ajtmh.14-0551] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/19/2015] [Indexed: 12/02/2022] Open
Abstract
The increasing intensification of pork production in southeast Asia necessitates an urgent requirement to better understand the dual impact of pig-associated zoonotic disease on both pig production and human health in the region. Sharing porous borders with five countries and representing many regional ethnicities and agricultural practices, the Lao People's Democratic Republic (Lao PDR) appears well placed to gauge the levels of pig-associated zoonoses circulating in the wider region. Despite this, little is known about the true impact of zoonotic pathogens such as leptospirosis, Trichinella, hepatitis E virus (HEV), Japanese encephalitis (JE), and Taenia solium on human health and livestock production in the country. A comprehensive review of the published prevalences of these five pig-associated zoonoses in Lao PDR has demonstrated that although suspicion remains high of their existence in pig reservoirs across the country, epidemiological data are scarce; only 31 epidemiological studies have been undertaken on these diseases in the past 25 years. A greater understanding of the zoonoses prevalence and subsequent risks associated with pork production in the southeast Asian region could help focus public health and food safety interventions at key points along the value chain, benefiting both livestock producers and the broader animal and human health systems in the region.
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Affiliation(s)
- Anna L. Okello
- School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom; School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia; National Animal Health Laboratory, Department of Livestock and Fisheries, Ministry of Agriculture, Vientiane, Lao People's Democratic Republic; Department of Hygiene and Prevention, Ministry of Health, Vientiane, Lao People's Democratic Republic; International Livestock Research Institute, Nairobi, Kenya; Australian Animal Health Laboratory (AAHL), CSIRO Animal, Food and Health Sciences, Geelong, Victoria, Australia; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Oxford, United Kingdom
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Okello AL, Beange I, Shaw A, Moriyón I, Gabriël S, Bardosh K, Johansen MV, Saarnak C, Mukaratirwa S, Berkvens D, Welburn SC. Raising the political profile of the neglected zoonotic diseases: three complementary European commission-funded projects to streamline research, build capacity and advocate for control. PLoS Negl Trop Dis 2015; 9:e0003505. [PMID: 25741705 PMCID: PMC4351249 DOI: 10.1371/journal.pntd.0003505] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Anna L. Okello
- Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Iona Beange
- Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
| | - Alexandra Shaw
- Agriculture and Veterinary Information and Analysis (Avia-GIS), Zoersel, Belgium
| | - Ignacio Moriyón
- Instituto de Salud Tropical y Depto Microbiología y Parasitología, Universidad de Navarra, Pamplona, Spain
| | | | - Kevin Bardosh
- Centre of African Studies, School of Social and Political Science, The University of Edinburgh, Edinburgh, United Kingdom
| | | | - Maria Vang Johansen
- Section for Parasitology and Aquatic Diseases, Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christopher Saarnak
- Section for Parasitology and Aquatic Diseases, Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Samson Mukaratirwa
- School of Life Sciences, University of KwaZulu‐Natal, Durban, South Africa
| | | | | | | | - Susan C. Welburn
- Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
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Burniston S, Okello AL, Khamlome B, Inthavong P, Gilbert J, Blacksell SD, Allen J, Welburn SC. Cultural drivers and health-seeking behaviours that impact on the transmission of pig-associated zoonoses in Lao People's Democratic Republic. Infect Dis Poverty 2015; 4:11. [PMID: 25973203 PMCID: PMC4430026 DOI: 10.1186/2049-9957-4-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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] [Received: 10/30/2014] [Accepted: 01/19/2015] [Indexed: 11/10/2022] Open
Abstract
Pig rearing is an important income source in the Lao People's Democratic Republic (PDR), with many smallholder farmers using traditional free-range pig production systems. Despite the potentially significant health risks posed by pig production regarding pig-associated zoonoses, information on the sociocultural drivers of these zoonoses is significantly lacking. This review summarises the existing sociocultural knowledge on eight pig-associated zoonoses suspected to be endemic in Southeast Asia: brucellosis, Q fever (Coxiella burnetii), trichinellosis, hepatitis E virus, leptospirosis, Japanese encephalitis, Streptococcus suis and Taenia solium taeniasis-cysticercosis. It summarises current knowledge on these diseases grouped according to their clinical manifestations in humans to highlight the propensity for underreporting. A literature search was conducted across multiple databases for publications from 1990 to the present day related to the eight pig-associated zoonoses and the risk and impact connected with them, with Lao PDR as a case study. Many of these pig-associated zoonoses have similar presentations and are often diagnosed as clinical syndromes. Misdiagnosis and underreporting are, therefore, substantial and emphasise the need for more robust diagnostics and appropriate surveillance systems. While some reports exist in other countries in the region, information is significantly lacking in Lao PDR with existing information coming mainly from the capital, Vientiane. The disease burden imposed by these zoonoses is not only characterised by morbidity and mortality, but directly impacts on livelihoods through income reduction and production losses, and indirectly through treatment costs and lost work opportunities. Other factors crucial to understanding and controlling these diseases are the influence of ethnicity and culture on food-consumption practices, pig rearing and slaughter practices, hygiene and sanitation, health-seeking behaviours and, therefore, risk factors for disease transmission. Published information on the knowledge, attitudes and beliefs of people regarding pig zoonoses and their risk factors is also extremely limited in Lao PDR and the broader Southeast Asian region. The need for more transdisciplinary research, using a One Health approach, in order to understand the underlining social determinants of health and their impacts on health-seeking behaviours, disease transmission and, ultimately, disease reporting, cannot be more emphasized.
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Affiliation(s)
- Stephanie Burniston
- Division of Infection and Pathway Medicine, College of Medicine and Veterinary, Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB UK
| | - Anna L Okello
- Division of Infection and Pathway Medicine, College of Medicine and Veterinary, Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB UK ; CSIRO Animal Food and Health Sciences, Australian Animal Health Laboratory (AAHL), Regional Programme, 5 Portarlington Road, East Geelong, Victoria 3219 Australia
| | - Boualam Khamlome
- Department for Communicable Disease Control (DCDC), Ministry of Health, Thadeua Road, Vientiane, Lao PDR
| | - Phouth Inthavong
- Department of Livestock and Fisheries, Ministry of Agriculture and Forestry, Ban Sithan Nua, Luang Prabang Road, Sikhottabong District, Vientiane, 7042 Lao PDR
| | - Jeffrey Gilbert
- International Livestock Research Institute (ILRI), Asia Programme, Kabete, Naivasha Road, Nairobi, 30709-00100 Kenya
| | - Stuart D Blacksell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithee Road, 10400 Bangkok, Thailand ; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LJ UK
| | - John Allen
- CSIRO Animal Food and Health Sciences, Australian Animal Health Laboratory (AAHL), Regional Programme, 5 Portarlington Road, East Geelong, Victoria 3219 Australia
| | - Susan C Welburn
- Division of Infection and Pathway Medicine, College of Medicine and Veterinary, Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB UK
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Okello AL, Welburn SC. The importance of veterinary policy in preventing the emergence and re-emergence of zoonotic disease: examining the case of human african trypanosomiasis in Uganda. Front Public Health 2014; 2:218. [PMID: 25405148 PMCID: PMC4217318 DOI: 10.3389/fpubh.2014.00218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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] [Received: 07/13/2014] [Accepted: 10/16/2014] [Indexed: 11/21/2022] Open
Abstract
Rapid changes in human behavior, resource utilization, and other extrinsic environmental factors continue to threaten the current distribution of several endemic and historically neglected zoonoses in many developing regions worldwide. There are numerous examples of zoonotic diseases which have circulated within relatively localized geographical areas for some time, before emerging into new regions as a result of changing human, environmental, or behavioral dynamics. While the world’s focus is currently on the Ebola virus gaining momentum in western Africa, another pertinent example of this phenomenon is zoonotic human African trypanosomiasis (HAT), endemic to south and eastern Africa, and spread via infected cattle. In recent years, the ongoing northwards spread of this disease in the country has posed a serious public health threat to the human population of Uganda, increasing the pressure on both individual families and government services to control the disease. Moreover, the emergence of HAT into new areas of Uganda in recent years exemplifies the important role of veterinary policy in mitigating the severe human health and economic impacts of zoonotic disease. The systemic challenges surrounding the development and enforcement of veterinary policy described here are similar across sub-Saharan Africa, highlighting the necessity to consider and support zoonotic disease control in broader human and animal health systems strengthening and associated development programs on the continent.
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Affiliation(s)
- Anna L Okello
- Division of Pathway Medicine, Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh , Edinburgh , UK
| | - Susan C Welburn
- Division of Pathway Medicine, Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh , Edinburgh , UK
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Bardosh K, Inthavong P, Xayaheuang S, Okello AL. Controlling parasites, understanding practices: the biosocial complexity of a One Health intervention for neglected zoonotic helminths in northern Lao PDR. Soc Sci Med 2014; 120:215-23. [PMID: 25261615 DOI: 10.1016/j.socscimed.2014.09.030] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022]
Abstract
A parasitological survey in northern Lao PDR showed a remote ethnic minority village to be hyper-endemic for Taenia solium, a Neglected Tropical Disease (NTD) that impacts human and pig health. An intervention combining human Mass Drug Administration (MDA) with porcine vaccination and antihelmintic treatment was then implemented, targeting both T. solium and other soil-transmitted helminths. To understand the biosocial complexity of this integrated One Health intervention, we conducted a rapid ethnographic study exploring the transmission dynamics of T. solium and locally acceptable long-term control options. Informed by two years of project work in the village, this included six focus group discussions, 35 semi-structured interviews, a latrine survey, a school-based education meeting, participant observation and many unstructured interviews conducted over two weeks in October 2013. We found that risk behaviours were mediated by various social determinants including limited market access, interrelationships between alcohol, ancestral sacrifices and the consumption of raw pork, seasonal variations and poor latrine coverage. Only sixteen percent of households had latrines, attributed to the unacceptability of dry latrines, lack of water access, poor building techniques and poverty. Whilst women could explain T. solium transmission, most men and children could not, revealing that distributed posters/leaflets relied too heavily on text and ambiguous images. Compliance with MDA was high due to trust between project staff and village leaders. However understandings of pharmacology, minor side effects, human migration and children's fear of worms may lead to resistance in future programmes. Our research highlights the complexities of controlling T. solium and other soil-transmitted helminths in a remote ethnic minority village and the need to integrate biomedical and participatory approaches. Although we showcase the heuristic value of using rapid ethnography to inform intervention strategies as part of a One Health/NTD agenda, we also identify several possible paradoxes and conundrums in embedding locally-grounded biosocial analysis into NTD programmes. These need to be acknowledged and negotiated by multidisciplinary teams.
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Affiliation(s)
- Kevin Bardosh
- School of Social and Political Science, The University of Edinburgh, 58 George Square, Edinburgh, United Kingdom; Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom.
| | - Phouth Inthavong
- National Animal Health Laboratory, Ministry of Agriculture and Forestry, Department of Livestock and Fisheries, Luang Prabang Road, Ban Huanmouang, Vientiane Capital, Lao Democratic People's Republic
| | - Sivilai Xayaheuang
- CSIRO Animal, Food and Health Sciences, Australian Animal Health Laboratory (AAHL) Regional Programme, 5 Portarlington Road, East Geelong, Victoria, Australia
| | - Anna L Okello
- National Animal Health Laboratory, Ministry of Agriculture and Forestry, Department of Livestock and Fisheries, Luang Prabang Road, Ban Huanmouang, Vientiane Capital, Lao Democratic People's Republic; CSIRO Animal, Food and Health Sciences, Australian Animal Health Laboratory (AAHL) Regional Programme, 5 Portarlington Road, East Geelong, Victoria, Australia
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Okello AL, Bardosh K, Smith J, Welburn SC. One Health: past successes and future challenges in three African contexts. PLoS Negl Trop Dis 2014; 8:e2884. [PMID: 24851901 PMCID: PMC4031173 DOI: 10.1371/journal.pntd.0002884] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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: 09/24/2013] [Accepted: 04/08/2014] [Indexed: 12/25/2022] Open
Abstract
Background The recent emergence of zoonotic diseases such as Highly Pathogenic Avian Influenza (HPAI) and Severe Acute Respiratory Syndrome (SARS) have contributed to dominant Global Health narratives around health securitisation and pandemic preparedness, calling for greater co-operation between the health, veterinary and environmental sectors in the ever-evolving One Health movement. A decade later, One Health advocates face increasing pressure to translate the approach from theory into action. Methodology/Principal Findings A qualitative case study methodology was used to examine the emerging relationships between international One Health dialogue and its practical implementation in the African health policy context. A series of Key Informant Interviews (n = 32) with policy makers, government officials and academics in Nigeria, Tanzania and Uganda are presented as three separate case studies. Each case examines a significant aspect of One Health operationalisation, framed around the control of both emerging and Neglected Zoonotic Diseases including HPAI, Human African Trypanosomiasis and rabies. The research found that while there is general enthusiasm and a strong affirmative argument for adoption of One Health approaches in Africa, identifying alternative contexts away from a narrow focus on pandemics will help broaden its appeal, particularly for national or regionally significant endemic and neglected diseases not usually addressed under a “global” remit. Conclusions/Significance There is no ‘one size fits all’ approach to achieving the intersectoral collaboration, significant resource mobilisation and political co-operation required to realise a One Health approach. Individual country requirements cannot be underestimated, dismissed or prescribed in a top down manner. This article contributes to the growing discussion regarding not whether One Health should be operationalised, but how this may be achieved. The One Health movement requires more robust evidence around its practical implementation if it is to truly become a way forwards for addressing health issues at the human, animal and ecosystem interface. The research in this paper discusses some of the recent successes and challenges with both Emerging and Neglected zoonoses in the sub-Saharan Africa context. Through speaking to various human and animal health practitioners and policy makers in Uganda, Nigeria and Tanzania, the authors have created three case studies highlighting the various successes of the approach to date, but also clarifying areas where the approach will take longer to implement, often as a result of the wide institutional and policy changes required in many countries. The authors conclude that whilst the “goodwill” is certainly there, the reality of planning, executing and budgeting for joint interventions – particularly at the national or regional level – proves in many cases more difficult than first thought. It is hoped however that through gaining better insight from those charged with the decision-making in these countries, One Health practitioners will be encouraged to build on the momentum through addressing some of the issues that arise with its implementation.
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Affiliation(s)
- Anna L. Okello
- Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Kevin Bardosh
- Centre of African Studies, School of Social and Political Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - James Smith
- Centre of African Studies, School of Social and Political Science, The University of Edinburgh, Edinburgh, United Kingdom
- Department of Geography, Environmental Management and Energy Studies, University of Johannesburg, Johannesburg, South Africa
| | - Susan C. Welburn
- Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
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Affiliation(s)
- Anna L. Okello
- College of Medicine and Veterinary Medicine; University of Edinburgh; Chancellor's Building, 49 Little France Crescent Edinburgh EH16 4SB UK
| | - E. Paul J. Gibbs
- College of Veterinary Medicine; University of Florida; Gainesville FL 32610 USA
| | - Alain Vandersmissen
- European Union, European External Action Service, CHAR 13/106; 1046 Brussels Belgium
| | - Susan C. Welburn
- College of Medicine and Veterinary Medicine; University of Edinburgh; Chancellor's Building, 49 Little France Crescent Edinburgh EH16 4SB UK
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