One health zoonotic disease prioritization and systems mapping: An integration of two One Health tools.

One Health is a collaborative approach that requires synergies between human, animal and environmental health sectors, other key sectors, and partners supporting these capacity-building efforts. Multiple One Health capacity-building tools are available that can be used independently or together. Two tools that have been used in sequence to inform each other include the US Centers for Disease Control and Prevention's One Health Zoonotic Disease Prioritization (OHZDP) Process and University of Minnesota/US Department of Agriculture's One Health Systems Mapping and Analysis Resource Toolkit™ (OH-SMART). In August 2017, a workshop was held in Islamabad, Pakistan, that integrated these two tools for the first time. In this integrated workshop, we used the OHZDP to develop a list of priority zoonotic diseases for Pakistan and OH-SMART™ to conduct a partner assessment and disease-specific gap analysis. Both tools were used to identify areas for One Health collaboration for the priority zoonotic diseases. Additionally, we trained 11 in-country facilitators representing the human and animal health sectors on both tools. This manuscript describes the integration of these two tools-using the Pakistan workshop as a process case study-to inform future efforts to implement One Health tools synergistically. Implementation of the technical and logistical aspects of the integrated workshop was detailed: (1) workshop preparation, (2) facilitator training, (3) workshop implementation and (4) workshop outcomes. Sixteen months after the workshop, we conducted an in-country facilitator survey to follow-up on the utility of both tools and the training for facilitators. We evaluated facilitator survey results using a qualitative analysis software Atlas.ti. Using the OHZDP Process and OH-SMART™ together achieved continuity between the two processes and provided a professional development opportunity for in-country facilitators. Based on the success of this integrated workshop, partners developing and implementing One Health tools should recognize the importance of collaboration to maximize outcomes.

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.

Seromonitoring of brucellosis in goats and sheep slaughtered at an abattoir in Kampala, Uganda.

We conducted a cross-sectional serologic study at Kampala City abattoir in Uganda on 287 small ruminants (221 goats and 66 sheep) to determine the seroprevalence of brucellosis. The samples were tested using a modified rose bengal test (mRBT) and an indirect ELISA (iELISA). Small ruminant Brucella spp. seropositivity was 18 of 287 (6.3%) by mRBT and 19 of 287 (6.6%) by iELISA. The prevalence of brucellosis by mRBT was non-significantly higher in goats (17 of 221; 7.7%) than in sheep (1 of 66, 1.5%; p = 0.069), and also non-significantly higher by the iELISA in goats (18 of 221; 8.1%) than in sheep (1 of 66, 1.5%; p = 0.057). Brucellosis in slaughtered goats and sheep is a public health hazard to abattoir workers and consumers that calls for control and eradication measures at the farm level, given that testing is not carried out routinely at slaughter points.

"There are many fevers": Communities' perception and management of Febrile illness and its relationship with human animal interactions in South-Western Uganda.

Diagnosing the causative agent of febrile illness in resource-limited countries is a challenge in part due to lack of adequate diagnostic infrastructure to confirm cause of infection. Most febrile illnesses (>60%) are non-malarial, with a significant proportion being zoonotic and likely from animal origins. To better characterize the pathways for zoonotic disease transmission and control in vulnerable communities, adequate information on the communities' experiences and lexicon describing fever, and their understanding and perceptions of risk pathways is required. We undertook an ethnographic study to understand behaviors, exposures, and attitudes toward fever at the community level. Our hope is to better elucidate areas of priority surveillance and diagnostic investment. A focused ethnography consisting of participant observation, informal conversations, 4 barazas (community meetings), and formal ethnographic interviews (13 Focus group discussions and 17 Key informant interviews) was conducted between April and November 2015 in Kasese and Hoima Districts in Uganda. Perception of illness and associated risk factors was heavily influenced by the predominant livelihood activity of the community. The term "fever" referred to multiple temperature elevating disease processes, recognized as distinct pathological occurrences. However, malaria was the illness often cited, treated, or diagnosed both at the health facilities and through self-diagnosis and treatment. As expected, fever is as an important health challenge affecting all ages. Recognition of malarial fever was consistent with a biomedical model of disease while non-malarial fevers were interpreted mainly through ethno etiological models of explanation. These models are currently being used to inform education and prevention strategies and treatment regimens toward the goal of improving patients' outcomes and confidence in the health system. Development of treatment algorithms that consider social, cultural, and economic contexts, especially where human-animal interaction is prevalent, should factor animal exposure and zoonotic illnesses as important differentials.

Molecular epidemiology of anaplasmosis in small ruminants along a human-livestock-wildlife interface in Uganda.

BACKGROUND: Information as regards the epidemiology of the Anaplasmataceae in small ruminants in several low- and middle-income countries is scarce. METHODS: In this study a total of 712 DNA samples collected from small ruminants were analyzed for Anaplasmataceae and Anaplasma ovis using the 16S rRNA and MSP4 genes respectively. Infection risk was assessed by location, sex and age of the animals and qGIS® was used to construct spatial maps. RESULTS: The prevalence of Anaplasmataceae spp was 89.1% (95% CI: 77.5-95.9) and 79.1% (95% CI: 75.9-82.1) in ovines and caprines respectively (RR = 1.1, 95% CI: 1.0-1.3); higher than those previously reported in other eastern African countries. The prevalence of A. ovis was 26.1% and 25.4% for both ovines and caprines respectively with ovines showing significantly higher levels of infection than caprines (P < 0.05). The risk of Anaplasma ovis infections was not affected by age (OR = 1.2, 95% CI: 0.9-1.7) or sex (OR = 1.1, 95% CI: 0.6-2.0). Small ruminants located at the forest edge (<0.3 km) showed higher A. ovis prevalence than those found inland with infections present in the midland regions associated with increased agricultural activity. CONCLUSION: Anaplasma ovis remains a major challenge for small ruminant husbandry in Uganda and infections are under-reported. Policy efforts to prioritize management of Anaplasmataceae for small ruminant health would promote livestock productivity in vulnerable communities, improving livelihoods and ecosystem health.

A descriptive study of zoonotic disease risk at the human-wildlife interface in a biodiversity hot spot in South Western Uganda.

Zoonotic diseases pose a significant health challenge at the human-wildlife interface, especially in Sub-Saharan Africa where ecosystem services contribute significantly to local livelihoods and individual well-being. In Uganda, the fragmented forests of Hoima district, form part of a "biodiversity and emerging infectious disease hotspot" composed of communities with high dependency on these wildlife protected areas, unaware of the associated health risks. We conducted a cross-sectional mixed methods study from March to May 2017 and interviewed 370 respondents, using a semi-structured questionnaire from eight villages neighbouring forest fragments in Hoima District, Uganda. Additionally, a total of ten (10) focus group discussions (FGDs) consisting of 6-10 men or women were conducted to further explore the drivers of hunting and perception of zoonotic disease risks at community level. Qualitative and quantitative data were analysed using content analysis and STATA version 12 respectively. We found twenty-nine percent (29.0%, CI: 24.4-33.9) of respondents were engaged in hunting of wildlife such as chimpanzee (Pan troglodytes) and 45.8% (CI: 40.6-51.0), cane rats (Thryonomyidae spp). Acquisition of animal protein was among the main reasons why communities hunt (55.3%, CI: 50.1-60.4), followed by "cultural" and "medicinal" uses of wildlife and or its parts (22.7%, CI: 18.6-27.4). Results further revealed that hunting and bushmeat consumption is persistent for other perceived reasons like; bushmeat strengthens the body, helps mothers recover faster after delivery, boosts one's immunity and hunting is exercise for the body. However, respondents reported falling sick after consumption of bushmeat at least once (7.9%, CI: 5.3-11.1), with 5.3% (CI: 2.60-9.60) reporting similar symptoms among some family members. Generally, few respondents (37.0%, CI: 32.1-42.2) were aware of diseases transmissible from wildlife to humans, although 88.7% (CI: 85.0-92.0) had heard of Ebola or Marburg without context. Hunting non-human primate poses a health risk compared to edible rats (cane rats) and wild ruminants (cOR = 0.4, 95% CI = 0.1-0.9) and (cOR = 0.7, 95% CI = 0.2-2.1) respectively. Study suggests some of the pathways for zoonotic disease spillover to humans exist at interface areas driven by livelihoods, nutrition and cultural needs. This study offers opportunities for a comprehensive risk communication and health education strategy for communities living at the interface of wildlife and human interactions.

Misconceptions on COVID-19 Risk Among Ugandan Men: Results From a Rapid Exploratory Survey, April 2020.

Background: Transmission of COVID-19 in developing countries is expected to surpass that in developed countries; however, information on community perceptions of this new disease is scarce. The aim of the study was to identify possible misconceptions among males and females toward COVID-19 in Uganda using a rapid online survey distributed via social media. Methods: A cross-sectional survey carried out in early April 2020 was conducted with 161 Ugandans, who purposively participated in the online questionnaire that assessed understandings of COVID-19 risk and infection. Sixty-four percent of respondents were male and 36% were female. Results: We found significant divergences of opinion on gendered susceptibility to COVID-19. Most female respondents considered infection risk, symptoms, severe signs, and death to be equally distributed between genders. In contrast, male respondents believed they were more at risk of infection, severe symptoms, severe signs, and death (52.7 vs. 30.6%, RR = 1.79, 95% CI: 1.14-2.8). Most women did not share this perception and disagreed that males were at higher risk of infection (by a factor of three), symptoms (79% disagree), severe signs (71%, disagree), and death (70.2% disagree). Overall, most respondents considered children less vulnerable (OR = 1.12, 95% CI: 0.55-2.2) to COVID-19 than adults, that children present with less symptoms (OR = 1.57, 95% CI: 0.77-3.19), and that there would be less mortality in children (OR = 0.92, 95% CI: 0.41-1.88). Of female respondents, 76.4% considered mortality from COVID-19 to be different between the young and the elderly (RR = 1.7, 95% CI: 1.01-2.92) and 92.7% believed young adults would show fewer signs than the elderly, and 71.4% agreed that elderly COVID-19 patients would show more severe signs than the young (OR = 2.2, 95% CI: 1.4, 4.8). While respondents considered that all races were susceptible to the signs and symptoms of infection as well as death from COVID-19, they considered mortality would be highest among white people from Europe and the USA. Some respondents (mostly male 33/102, 32.4%) considered COVID-19 to be a "disease of whites" (30.2%). Conclusion: The WHO has identified women and children in rural communities as vulnerable persons who should be given more attention in the COVID-19 national response programs across Africa; however, our study has found that men in Uganda perceive themselves to be at greater risk and that these contradictory perceptions (including the association of COVID-19 with "the white" race) suggest an important discrepancy in the communication of who is most vulnerable and why. Further research is urgently needed to validate and expand the results of this small exploratory study.

Strengthening multi-sectoral collaboration on critical health issues: One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) for operationalizing One Health.

Addressing critical global health issues, such as antimicrobial resistance, infectious disease outbreaks, and natural disasters, requires strong coordination and management across sectors. The One Health approach is the integrative effort of multiple sectors working to attain optimal health for people, animals, and the environment, and is increasingly recognized by experts as a means to address complex challenges. However, practical application of the One Health approach has been challenging. The One Health Systems Mapping and Analysis Resource Toolkit (OH-SMART) introduced in this paper was designed using a multistage prototyping process to support systematic improvement in multi-sectoral coordination and collaboration to better address complex health concerns through an operational, stepwise, and practical One Health approach. To date, OH-SMART has been used to strengthen One Health systems in 17 countries and has been deployed to revise emergency response frameworks, improve antimicrobial resistance national action plans and create multi agency infectious disease collaboration protocols. OH-SMART has proven to be user friendly, robust, and capable of fostering multi-sectoral collaboration and complex system-wide problem solving.

Prevalence of hemoprotozoan parasites in small ruminants along a human-livestock-wildlife interface in western Uganda.

Small ruminants are important to community livelihood in developing countries; however information on the role of hemoprotozoan parasites is scanty. The objective of the study was to determine hemoprotozoan parasitic prevalence in western Uganda and identify major areas associated with these infections. This was a cross sectional study conducted at the edge of Budongo Conservation Forest in Masindi district of western Uganda in which 712 small ruminants were sampled. Blood from the jugular vein was collected from caprines and ovines and placed in an EDTA tube, and transported to the laboratory for examination. Thin and thick smears were prepared and examined by microscopy for hemoprotozoan parasites, and DNA was extracted and examined by PCR for Trypanosoma spp. A total of 13 villages in Budongo sub-county were surveyed and the study showed that caprines were the major small ruminants of importance to the community. Prevalence of hemoprotozoan parasites was as follows; anaplasmosis (3.65%) > theileriosis (0.45%) > trypanosomiasis (0.15%) and babesiosis (0%) by microscopy. Infections were found in the young with the exception of Anaplasma spp. while coinfections of anaplasmosis and theileriosis were high. Molecular analysis showed an overall trypanosome prevalence of 9.27% (PCR), mainly due to Trypanosoma brucei and T. congolense forest. Villages with trypanosomiasis were found in lowlands and swamps. The current trypanosomiasis prevalence in small ruminants of Uganda was 10 times greater than that previously reported showing that the disease burden has increased overtime within Uganda. A prevalence of 0.14% (95% CI: 0.00, 0.78) for the SRA gene showed that small ruminants would be important reservoirs of infection to humans. Hemoprotozoan parasites are a threat to community livelihood in developing countries and the role of molecular diagnostic techniques in disease monitoring was re-emphasized by this study. Information on primary hosts involved in the propagation of hemoprotozoan parasites in Uganda would help streamline prospective disease surveillance and control efforts.

Human-Wildlife Interactions Predict Febrile Illness in Park Landscapes of Western Uganda.

Fevers of unknown origin complicate treatment and prevention of infectious diseases and are a global health burden. We examined risk factors of self-reported fever-categorized as "malarial" and "nonmalarial"-in households adjacent to national parks across the Ugandan Albertine Rift, a biodiversity and emerging infectious disease hotspot. Statistical models fitted to these data suggest that perceived nonmalarial fevers of unknown origin were associated with more frequent direct contact with wildlife and with increased distance from parks where wildlife habitat is limited to small forest fragments. Perceived malarial fevers were associated with close proximity to parks but were not associated with direct wildlife contact. Self-reported fevers of any kind were not associated with livestock ownership. These results suggest a hypothesis that nonmalarial fevers in this area are associated with wildlife contact, and further investigation of zoonoses from wildlife is warranted. More generally, our findings of land use-disease relationships aid in hypothesis development for future research in this social-ecological system where emerging infectious diseases specifically, and rural public health provisioning generally, are important issues.

Leptospira Seroprevalence and Risk Factors in Health Centre Patients in Hoima District, Western Uganda.

BACKGROUND: The burden of human leptospirosis in Uganda is unknown. We estimated the seroprevalence of Leptospira antibodies, probable acute/recent leptospirosis, and risk factors for seropositivity in humans in rural Western Uganda. METHODOLOGY AND PRINCIPAL FINDINGS: 359 non-pregnant adults visiting the Kikuube and Kigorobya Health Centers were sequentially recruited during March and April 2014. A health history survey and serum were collected from consented participants. Overall, 69% reported having fever in the past year, with 49% reporting malaria, 14% malaria relapse, 6% typhoid fever, 3% brucellosis, and 0% leptospirosis. We tested sera by microscopic agglutination test (MAT) against eight Leptospira serovars representing seven serogroups. Leptospira seroprevalence was 35% (126/359; 95%CI 30.2-40.3%) defined as MAT titer ≥ 1:100 for any serovar. The highest prevalence was against L. borgpetersenii Nigeria (serogroup Pyrogenes) at 19.8% (71/359; 95%CI 15.9-24.4%). The prevalence of probable recent leptospirosis (MAT titer ≥1:800) was 1.9% (95%CI 0.9-4.2%) and uniquely related to serovar Nigeria (serogroup Pyrogenes). Probable recent leptospirosis was associated with having self-reported malaria within the past year (p = 0.048). Higher risk activities included skinning cattle (n = 6) with 12.3 higher odds (95%CI 1.4-108.6; p = 0.024) of Leptospira seropositivity compared with those who had not. Participants living in close proximity to monkeys (n = 229) had 1.92 higher odds (95%CI 1.2-3.1; p = 0.009) of seropositivity compared with participants without monkeys nearby. CONCLUSIONS/SIGNIFICANCE: The 35% prevalence of Leptospira antibodies suggests that exposure to leptospirosis is common in rural Uganda, in particular the Nigeria serovar (Pyrogenes serogroup). Leptospirosis should be a diagnostic consideration in febrile illness and "smear-negative malaria" in rural East Africa.

One Health: Lessons Learned from East Africa.

Africa is faced with many of the most daunting challenges of our time. It comprises roughly 15% of the world's human population, and most of its countries are perpetually ranked "Low" on the United Nations' Human Development Index. On the other hand, Africa has arguably the largest proportion of intact natural ecosystems, biodiversity, and sociocultural capital and the lowest impact on global warming of any continent. Thus, African leaders are faced with competing demands and values among a multitude of complex issues, such as high human population growth, extreme poverty, food insecurity, land use policy, climate change, and biodiversity conservation. In this context, building sustainable national systems for human and/or animal health is one of the grand challenges of this generation. Today's complex global health and development challenges require long-term commitment and a range of approaches that are too broad for any one discipline, institution, or country to implement on its own. The One Health concept recognizes the interconnectedness of global health issues and, as such, promotes the importance of and need for international, interdisciplinary, and cross-sectoral communication and collaboration at local, national, and international levels. By taking advantage of natural cultural tendencies for shared leadership, resource allocation, and community values, African leaders are currently proactively demonstrating the principles of One Health, and thus becoming a model for this global vision. And by focusing on partnerships rather than donor-recipient relationships, they are fostering the development of shared priorities and are increasingly driving their own health agenda to fulfill their own needs.