Healthcare provider-focused antimicrobial stewardship in sub-Saharan Africa: opportunities and challenges.

To address the antimicrobial resistance (AMR) crisis, governments around the world have created action plans to optimize antimicrobial use (AMU). These plans include antimicrobial stewardship (AMS) that encompasses educational programs for healthcare workers. We discuss these programs in sub-Saharan Africa, including the opportunities and challenges arising from a highly constrained healthcare environment.

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.

A One Health approach to rabies management in Manitoba, Canada.

A One Health approach was developed in the province of Manitoba in 2014 to manage human and domestic animal exposures to rabies. Manitoba Rabies Central is a collaboration of 3 provincial departments responsible for animal, human, and environmental health. Since the inception of the program 537 samples from animals suspected of rabies and causing an exposure to a human or domestic animal have been evaluated with 11.3% testing positive, 85.7% testing negative, and 3.0% being unfit for testing. Most of the positive rabies test results came from skunks (52.0%), which accounted for 12.5% of submissions. Dogs and cats accounted for 52.5% of submissions; however, only 18.9% of these animals tested positive for rabies. Domestic animals were more likely to be exposed to a rabid animal (most commonly skunks) than were humans. Humans were more likely to be exposed to dogs and cats (regardless of rabies test result).

Approche Une seule santé pour la gestion de la rage au Manitoba, au Canada. Dans la province du Manitoba, une approche Une seule santé a été mise au point en 2014 pour gérer l'exposition des humains et des animaux domestiques à la rage. Manitoba Rabies Central est une collaboration de trois ministères provinciaux responsables pour la santé animale, humaine et environnementale. Depuis la création du programme, 537 échantillons d'animaux suspectés d'être infectés par la rage et de causer une exposition pour un humain ou un animal domestique ont été évalués et 11,3 % ont obtenu des résultats positifs, 85,7 % des résultats négatifs et 3,0 % étaient inaptes pour le test. La majorité des résultats positifs pour la rage provenait des moufettes (52,0 %), ce qui représentait 12,5 % des soumissions. Les chiens et les chats représentaient 52,5 % des soumissions, cependant, seulement 18,9 % de ces animaux ont eu des résultats positifs pour la rage. Il était plus probable que les animaux domestiques soient exposés à un animal enragé (pour la plupart des moufettes) que les humains. Il était plus probable que les humains soient exposés aux chiens et aux chats (sans égard au résultat du test pour la rage).(Traduit par Isabelle Vallières).

Randomized controlled trial on impacts of dairy meal feeding interventions on early lactation milk production in smallholder dairy farms of Central Kenya.

There is limited field-based research and recommendations on the effect of cattle feeding management practices on smallholder dairy farms (SDF) for the growing dairy industry in Kenya. This controlled trial aimed to determine the effect of feeding locally produced dairy meal (DM) on early lactation daily milk production (DMP) on Kenyan SDF, controlling for other factors associated with DMP. Privately owned, recently calved cows (n=111) were randomly assigned to one of three groups of feeding recommendations for DM (meeting predicted DM requirements by: (1) 100%; (2) 50%; or (3) feeding by the farmer's discretion). DM was provided for free to groups 1 and 2 to ensure they had sufficient DM to feed to the recommendations. Data collection on cow and farm characteristics occurred biweekly for a 60-day period post-calving starting in June 2013. A repeated measures multivariable linear regression model was used on the DMP outcome variable. With variability in DM consumption within feeding groups due to variability in DMP, actual DM fed was assessed as an independent variable rather than assigned feeding groups. DMP was positively associated with each kg/day of DM fed (0.53kg/day), cow weight (0.13kg/day), feeding DM in the month prior to calving (1.42kg/day), and feeding high protein forage (0.41kg/day), and was negatively associated with having mastitis (-0.30kg/day). In interaction terms, taller cows had higher DMP than shorter cows, whereas heifers (first parity cows) had similar DMP regardless of height. Also, thin cows (2+ parity with body condition score<2.5 out of 5) produced less milk (1.0kg/day less) than cows with a better body condition score at calving,whereas thin heifers produced more milk (2.0kg/day more) than heifers in better body condition-this association is possibly due to a small unrepresentative sample size of heifers. In conclusion, feeding DM in the month prior to calving, improving body condition in cows prior to calving, and enhancing dietary DM and high protein forage were positively associated with DMP in early lactation on Kenyan SDF. In addition there was an association between, taller cows and increased DMP, evidence supporting the importance of educating farmers on good genetic selection and heifer management. These findings will help with future management recommendations for higher DMP on SDF.

Associations of farm management practices with annual milk sales on smallholder dairy farms in Kenya.

AIM: Cows on smallholder dairy farms (SDF) in developing countries such as Kenya typically produce volumes of milk that are well below their genetic potential. An epidemiological study was conducted to determine reasons for this low milk production, including limited use of best management practices, such as suboptimal nutritional management. METHODS: An observational cross-sectional study of 111 SDF was performed in Nyeri County, Kenya in June of 2013 determining the effect of cow factors, farmer demographics and farm management practices on the volume of milk sold per cow per year (kg milk sold/cow). In particular, the effect of feeding high protein fodder trees and other nutritional management practices were examined. RESULTS: Approximatly 38% of farmers fed fodder trees, but such feeding was not associated with volume of milk sold per cow, likely due to the low number of fodder trees per farm. Volume of milk sold per cow was positively associated with feeding dairy meal during the month prior to calving, feeding purchased hay during the past year, deworming cows every 4 or more months (as opposed to more regularly), and having dairy farming as the main source of family income. Volume of milk sold per cow was negatively associated with a household size of >5 people and feeding Napier grass at >2 meters in height during the dry season. An interaction between gender of the principal farmer and feed shortages was noted; volume of milk sold per cow was lower when female farmers experienced feed shortages whereas milk sold per cow was unaffected when male farmers experienced feed shortages. CONCLUSIONS: These demographic and management risk factors should be considered by smallholder dairy farmers and their advisors when developing strategies to improve income from milk sales and animal-source food availability for the farming families.

Prevalence of Cryptosporidia, Eimeria, Giardia, and Strongyloides in pre-weaned calves on smallholder dairy farms in Mukurwe-ini district, Kenya.

AIM: Gastrointestinal diseases are among the leading causes of calf morbidity and mortality in Kenya and elsewhere. This study was undertaken to determine the prevalence of Cryptosporidia, Eimeria, Giardia, and Strongyloides in calves on smallholder dairy farms (SDF) in Mukurwe-ini District, Nyeri County, Kenya. These infections have been associated with economic losses by decreased growth rates, decreased productivity, and increased susceptibility to other diseases. MATERIALS AND METHODS: An observational study was conducted on 109 farms in Mukurwe-ini District, Nyeri County, Kenya, where 220 calf fecal samples (each calf at 4 and 6 weeks of age) from 110 calves (1 set of twins) were collected and analyzed for Cryptosporidia, Eimeria, Giardia, and helminth parasites. RESULTS: Eimeria oocysts, Cryptosporidia oocysts, and Strongyloides eggs were detected in the fecal samples examined, but no Giardia cysts were found. The overall period prevalence of Eimeria, Cryptosporidia, and Strongyloides was 42.7% (47/110), 13.6% (15/110), and 5.4% (6/110), respectively. The prevalence at 4 weeks of age for Eimeria, Cryptosporidia, and Strongyloides was 30.0% (33/110), 8.2% (9/110), and 3.7% (4/109), respectively, while the prevalence at 6 weeks of age was 20.2% (22/109), 6.5% (7/107), and 2.7% (3/110), respectively. There was, however, no significant difference in the prevalence at 4 and 6 weeks (p>0.05). CONCLUSION: Findings from this study show that Eimeria, Cryptosporidia, and Strongyloides, are prevalent in the study area and indicate the need to adopt optimal management practices to control infections in calves.