Impact of livestock interventions on maternal and child nutrition outcomes in Africa: A systematic review and meta-analysis protocol.

The challenge of undernutrition (stunting and wasting) still remains a major health concern in children below 5 years of age in Africa, with the continent accounting for more than one third of all stunted children and more than one quarter of all wasted children globally. Despite the growing evidence on the role of agriculture interventions in improving nutrition, empirical evidence on the impact of livestock intervention on nutrition in Africa is scant. This review is aimed at determining whether livestock interventions are effective in reducing undernutrition in children below five years of age and in pregnant and lactating women in Africa. The review will be conducted according to PRISMA guidelines. Major electronic databases will be searched and complemented with grey and non-indexed literature from google and google scholar, and expert consultation for additional articles and reports. PICO criteria will be used while employing search strategies including MeSH, Boolean search operators and truncation/wildcard symbol to narrow or broaden the search. Articles on effect of livestock interventions on maternal and child nutrition conducted in Africa that meet the set inclusion criteria will be included in the review after critical appraisal by two independent reviewers. A standardized form will be used to extract data from included studies. The extracted data will be summarized and synthesized both qualitatively and quantitatively and key outcomes presented. Evidence generated from the systematic review and meta-analysis will be important for guiding nutrition sensitive livestock interventions and policies on nutrition programming, specifically on how to leverage on livestock interventions to reduce the burden of undernutrition.

The nexus between improved water supply and water-borne diseases in urban areas in Africa: a scoping review.

Background: The sub-Saharan Africa has the fastest rate of urbanisation in the world. However, infrastructure growth in the region is slower than urbanisation rates, leading to inadequate provision and access to basic services such as piped safe drinking water. Lack of sufficient access to safe water has the potential to increase the burden of waterborne diseases among these urbanising populations. This scoping review assesses how the relationship between waterborne diseases and water sufficiency in Africa has been studied. Methods: In April 2020, we searched the Web of Science, PubMed, Embase and Google Scholar databases for studies of African cities that examined the effect of insufficient piped water supply on selected waterborne disease and syndromes (cholera, typhoid, diarrhea, amoebiasis, dysentery, gastroneteritis, cryptosporidium, cyclosporiasis, giardiasis, rotavirus). Only studies conducted in cities that had more than half a million residents in 2014 were included. Results: A total of 32 studies in 24 cities from 17 countries were included in the study. Most studies used case-control, cross-sectional individual or ecological level study designs. Proportion of the study population with access to piped water was the common water availability metrics measured while amounts consumed per capita or water interruptions were seldom used in assessing sufficient water supply. Diarrhea, cholera and typhoid were the major diseases or syndromes used to understand the association between health and water sufficiency in urban areas. There was weak correlation between the study designs used and the association with health outcomes and water sufficiency metrics. Very few studies looked at change in health outcomes and water sufficiency over time. Conclusion: Surveillance of health outcomes and the trends in piped water quantity and mode of access should be prioritised in urban areas in Africa in order to implement interventions towards reducing the burden associated with waterborne diseases and syndromes.

One Health education in Kakuma refugee camp (Kenya): From a MOOC to projects on real world challenges.

Today, the world counts millions of refugees but only a fraction of them have access to higher education. Despite the multiple public health problems in refugee camps and the need to build local capacities to prevent and combat them, University level courses in public health are largely unavailable for refugees. This paper describes the development, implementation and evaluation of an innovative two-module blended-learning programme on One Health in Kakuma refugee camp (Kenya). This programme combines: (I) Interdisciplinary and multi-expert MOOC on "Global Health at the Human-Animal-Ecosystem interface"; (II) peer-to-peer learning involving students from University of Geneva Master of science in Global Health and research collaborations around specific and locally-relevant problems; (III) online mentoring and lecturing by experts from the Institute of Global Health of the University of Geneva in Kakuma. A total of 67 refugees applied to Module 1; 15 started the Module 1 in October 2017, of these 14 completed it and 6 passed the exams, finally five students started the Module 2 in October 2018 which they all passed in February 2019. Five student-led collaborative projects were developed focusing on the conception of a community-based monitoring system for prevalent diseases in the camp. With such a pedagogic approach, the programme provides an overview on Global Health challenges at the human-animal-ecosystem interface and the importance of the One Health approach, and introduces students to scientific research through interdisciplinary and international collaborations and innovation. The high number of applicants and positive feedback from students in Kakuma show the interest in One Health education in the camp. This learning experience ultimately aims at building local knowledge and capacity fostering "One Health" champions to reinforce local and national health system. This framework for One Health education could be potentially scaled up to other camps in Africa and the world.

Comparison of knowledge, attitude, and practices of animal and human brucellosis between nomadic pastoralists and non-pastoralists in Kenya.

BACKGROUND: The seroprevalence of brucellosis among nomadic pastoralists and their livestock in arid lands is reported to be over10-fold higher than non-pastoralists farmers and their livestock in Kenya. Here, we compared the seroprevalence of nomadic pastoralists and mixed farming with their knowledge of the disease and high-risk practices associated with brucellosis infection. METHODS: Across-sectional study was conducted in two counties - Kiambu County where farmers primarily practice smallholder livestock production and crop farming, and Marsabit County where farmers practice nomadic pastoral livestock production. Stratified random sampling was applied, in which sublocations were initially selected based on predominant livestock production system, before selecting households using randomly generated geographical coordinates. In each household, up to three persons aged 5 years and above were randomly selected, consented, and tested for Brucella spp IgG antibodies. A structured questionnaire was administered to the household head and selected individuals on disease knowledge and risky practices among the pastoralists and mixed farmers compared. Multivariable mixed effects logistic regression model was used to assess independent practices associated with human Brucella spp. IgG seropositivity. RESULTS: While the majority (74%) of pastoralist households had little to no formal education when compared to mixed (8%), over 70% of all households (pastoralists and mixed farmers) had heard of brucellosis and mentioned its clinical presentation in humans. However, fewer than 30% of all participants (pastoralists and mixed farmers) knew how brucellosis is transmitted between animals and humans or how its transmission can be prevented. Despite their comparable knowledge, significantly more seropositive pastoralists compared to mixed farmers engaged in risky practices including consuming unboiled milk (79.5% vs 1.7%, p < 0.001) and raw blood (28.3% vs 0.4%, p < 0.001), assisting in animal birth (43.0% vs 9.3%, p < 0.001), and handling raw hides (30.6% vs 5.5%, p < 0.001). , CONCLUSION: Nomadic pastoralists are more likely to engage in risky practices that promote Brucella Infection, probably because of their occupation and culture, despite having significant knowledge of the disease.

The nexus between improved water supply and water-borne diseases in urban areas in Africa: a scoping review protocol.

Introduction: Currently, an estimated two thirds of the world population is water insufficient. As of 2015, one out of every five people in developing countries do not have access to clean sufficient drinking water. In an attempt to share the limited resource, water has been distributed at irregular intervals in cities in developing countries. Residents in these cities seek alternative water sources to supplement the inadequate water supplied. Some of these alternative sources of water are unsafe for human consumption, leading to an increased risk in water-borne diseases. Africa contributes to 53% of the diarrheal cases reported globally, with contaminated drinking water being the main source of transmission. Water-borne diseases like diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus are a major public health concern. The main objective of this scoping review is to map the available evidence to understand the sources of water among residents in cities in Africa and the relationship between clean water sufficiency and water-borne diseases in urban Africa. Methods and analysis: The search strategy will identify studies published in scientific journals and reports that are directly relevant to African cities that have a population of more than half a million residents as of 2014 AND studies on the ten emerging water-borne diseases, which are diarrhea, cholera, typhoid, amoebiasis, dysentery, gastroenteritis, cryptosporidium, cyclosporiasis, giardiasis, guinea worm and rotavirus. Ethics and dissemination: This scoping review did not require any formal ethical approval. The findings will be published in a peer-reviewed journal.

Catalysts for implementation of One Health in Kenya.

The recent Zika outbreak in the Americas, Ebola epidemic in West Africa and the increased frequency and impact of emerging and re-emerging infections of animal origin have increased the calls for greater preparedness in early detection and responses to public health events. One-Health approaches that emphasize collaborations between human health, animal health and environmental health sectors for the prevention, early detection and response to disease outbreaks have been hailed as a key strategy. Here we highlight three main efforts that have progressed the implementation of One Health in Kenya.

Cryptosporidium infection in calves and the environment in Asembo, Western Kenya: 2015.

INTRODUCTION: Cryptosporidium species, a zoonotic enteric coccidian parasite, is among the leading causes of diarrhea in children. We evaluated the prevalence of Cryptosporidium infections in calves, factors associated with calf infection, environmental contamination of manure by Cryptosporidium and factors that expose humans to zoonotic transmission in Asembo. METHODS: in a cross-sectional study conducted from January to July 2015, we collected fecal specimens from 350 randomly selected calves aged ≤ 6 months old and 187 manure samples from the same farms. We assessed farmers' knowledge about Cryptosporidium and collected data on characteristics using structured questionnaires. Modified Ziehl Nielsen staining was used to detect Cryptosporidium oocysts from calves' stool and manure. The prevalence of infected calves and 95% confidence interval (CI) were calculated. Odds ratios (OR) and 95% (CI) were calculated to identify possible factors associated with Cryptosporidium infection; multivariable logistic regression performed to identify factors independently associated with the presence of Cryptosporidium. RESULTS: calves' fecal Cryptosporidium prevalence was 8.3% (95% CI: 5.7-11.8) and 7.5% (95% CI: 4.2-12.2) in manure. Odds of infection was higher in calves with loose stool compared to those with normal stool (AOR = 6.1, 95% C.I: 2.2-16.9), calves ≤ 2 months old compared to older calves (AOR=12.7, 95% C.I: 4.5-35.8) and calves in poor sanitation compared to calves in good hygienic conditions (AOR = 9.9, 95% C.I: 3.1-30.7). CONCLUSION: presence of Cryptosporidium species in calves and environment and reported human contact with animals increases zoonotic risk. We recommend further studies that determine specific Cryptosporidium species infecting animals and humans which would better estimate risk of disease transmission to humans.

Design and descriptive epidemiology of the Infectious Diseases of East African Livestock (IDEAL) project, a longitudinal calf cohort study in western Kenya.

BACKGROUND: There is a widely recognised lack of baseline epidemiological data on the dynamics and impacts of infectious cattle diseases in east Africa. The Infectious Diseases of East African Livestock (IDEAL) project is an epidemiological study of cattle health in western Kenya with the aim of providing baseline epidemiological data, investigating the impact of different infections on key responses such as growth, mortality and morbidity, the additive and/or multiplicative effects of co-infections, and the influence of management and genetic factors.A longitudinal cohort study of newborn calves was conducted in western Kenya between 2007-2009. Calves were randomly selected from all those reported in a 2 stage clustered sampling strategy. Calves were recruited between 3 and 7 days old. A team of veterinarians and animal health assistants carried out 5-weekly, clinical and postmortem visits. Blood and tissue samples were collected in association with all visits and screened using a range of laboratory based diagnostic methods for over 100 different pathogens or infectious exposures. RESULTS: The study followed the 548 calves over the first 51 weeks of life or until death and when they were reported clinically ill. The cohort experienced a high all cause mortality rate of 16% with at least 13% of these due to infectious diseases. Only 307 (6%) of routine visits were classified as clinical episodes, with a further 216 reported by farmers. 54% of calves reached one year without a reported clinical episode. Mortality was mainly to east coast fever, haemonchosis, and heartwater. Over 50 pathogens were detected in this population with exposure to a further 6 viruses and bacteria. CONCLUSION: The IDEAL study has demonstrated that it is possible to mount population based longitudinal animal studies. The results quantify for the first time in an animal population the high diversity of pathogens a population may have to deal with and the levels of co-infections with key pathogens such as Theileria parva. This study highlights the need to develop new systems based approaches to study pathogens in their natural settings to understand the impacts of co-infections on clinical outcomes and to develop new evidence based interventions that are relevant.