The impact and social ecology of bacterial zoonoses in northern Tanzania

Lead Research Organisation: University of Glasgow
Department Name: College of Medical, Veterinary &Life Sci

Abstract

It is well recognized that zoonotic pathogens - agents which can lead to diseases that are transmitted from animal to human populations - predominate as the cause of emerging human diseases, but in the shadow of the high-profile emerging zoonoses, such as Influenza A H5N1 and SARS corona virus, zoonoses that are prevalent in localised areas have often been overlooked. However, awareness is growing that many of these localised zoonoses are responsible for a substantial burden of disease both in terms of public health and livestock health, and that these dual impacts contribute to perpetuating cycles of poverty in the marginalized communities that are most affected. In northern Tanzania, the location of this research, human diseases caused by three zoonotic diseases (leptospirosis, Q-fever and brucellosis) result in 11 times as many hospital admissions as malaria. However, almost nothing is known about transmission patterns among animal hosts, which host species are responsible for human disease, or the key behavioural determinants of human disease risk in different settings.

The aim of this research is to quantify the impacts of these three zoonoses in different communities (located at the edge of town, in agricultural landscapes and in pastoral areas) and to develop a predictive understanding of the impact of environmental and social relationships on disease risk. Specifically, they address infection and transmission patterns between animals and from animals to humans, ecological and social determinants of transmission, and the cultural, social, behavioural and economic and environmental dimensions of disease communication. The results of this work are directly applicable to policy and practice that is relevant to both public health and economic development related to livestock production.

Technical Summary

With growing recognition of the widespread over-diagnosis of malaria in many parts of Africa, increasing attention is being given to other causes of human febrile illness. Preliminary studies in northern Tanzania indicate that febrile disease caused by the zoonotic diseases, leptospirosis, Q-fever and brucellosis, result in 11 times as many cases of febrile admissions as malaria. These pathogens can infect and be transmitted among a wide range of host species. However, almost nothing is known about transmission patterns among animal hosts, which host species are responsible for human disease, or the key social, economic and behavioural determinants of human disease risk in different agro-ecological settings. This study aims to address the overarching question: what are the origins and determinants of human disease risk for bacterial zoonoses? In addition, the research will determine how risk factors vary among different livestock-owning communities and explore the effectiveness of different control and prevention strategies in these communities. The project will integrate several different disciplinary approaches, including social behavioral studies, human febrile illness surveillance, and linked human-animal epidemiological studies (cross-sectional and case-control studies), to generate data for incorporation into models of human disease risk. These models, together with an understanding of community risk perception and knowledges, will allow us to identify appropriate strategies for disease control and prevention. The project brings together medical, social science, veterinary and ecology research groups working together to conduct the first integrated research into this group of bacterial zoonoses in Africa.

Planned Impact

Leptospirosis, brucellosis and Q-fever comprise a group of bacterial zoonoses that occur throughout Africa, but have been neglected as a cause of human disease and livestock production losses. This interdisciplinary research will draw on medical, veterinary, social science and ecological expertise to generate valuable data on the impact and social ecology of these diseases in northern Tanzania, and will provide outputs that will inform the design of effective and appropriate disease control strategies for different communities. As such, the research will have wide-ranging impacts:

(a) The study will generate the first quantitative data on disease incidence and burden (DALYs) for human leptospirosis and Q-fever, and the most detailed data on the burden of human brucellosis in Africa, proving a valuable evidence-base for engaging with public health policy makers at national and international level about the importance of these diseases in Africa, which hitherto have been virtually ignored;
(b) Quantitative data on livestock infection prevalence in different communities will generate awareness about the relative importance of these diseases in different livestock-owning communities and thus allow livestock control measures (e.g. vaccination) to be targeted most appropriately;
(c) Data on the relative importance of different animal origins of human infection and different ecological and behavioral risk factors (through case-control studies and cross-sectional studies) will provide critical information for the design of control and prevention strategies in human populations, which will be evaluated through modeling;
(d) Qualitative data from social science approaches will provide critical insight for understanding how knowledges and perceptions in different communities affect disease risk, and how these may also affect the uptake of potential control strategies;
(e) These quantitative and qualitative outputs will directly assist in developing control measures that can be designed to suit the specific social and ecological context of different rural and peri-urban communities in Tanzania, increasing the likelihood that control strategies will be adopted by communities and that they will significantly improve public health and livestock production (where interventions in the animal population are implemented).
(f) Enhanced capacity for effective diagnosis of these diseases in human and livestock populations in Tanzania, and improved diagnostic awareness among clinicians will result in more rapid and effective treatment and management of these conditions and hence mitigation of disease burden.

Given the findings of preliminary studies, which suggest that the incidence of these bacterial zoonoses in northern Tanzania is likely to be high (exceeding malaria), the potential public health impacts of this research are likely to be substantial. Febrile illness is the most common reason for presentation to health facilities in much of Africa, therefore small improvements in diagnosis and management of febrile illness have the potential to lead to major health gains.

Conceptual knowledge and understanding will be enhanced by developing a genuinely inter-disciplinary approach, whereby social scientists and veterinary/medical scientists engage together on the same research objectives, rather than simply conducting a series of discipline-specific studies in parallel. An on-going, iterative process of knowledge exchange will further support this approach.

In addition to enhancing diagnostic capacity for zoonoses, the project will also support research capacity-building within Tanzania by providing scientific and technical training and mentorship for Tanzanian post-doctoral fellows, graduate students and laboratory technicians. Furthermore, the study will provide opportunities for developing new partnerships between regional research consortia to build an effective network for bacterial zoonoses research in East Africa.

Publications

10 25 50

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Allan KJ (2018) Assessment of animal hosts of pathogenic Leptospira in northern Tanzania. in PLoS neglected tropical diseases

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Ao TT (2015) Global burden of invasive nontyphoidal Salmonella disease, 2010(1). in Emerging infectious diseases

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Biggs HM (2011) Leptospirosis among hospitalized febrile patients in northern Tanzania. in The American journal of tropical medicine and hygiene

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Biggs HM (2013) Leptospirosis and human immunodeficiency virus co-infection among febrile inpatients in northern Tanzania. in Vector borne and zoonotic diseases (Larchmont, N.Y.)

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Bouley AJ (2012) Brucellosis among hospitalized febrile patients in northern Tanzania. in The American journal of tropical medicine and hygiene

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Carugati M (2018) Incidence of human brucellosis in the Kilimanjaro Region of Tanzania in the periods 2007-2008 and 2012-2014. in Transactions of the Royal Society of Tropical Medicine and Hygiene

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Carugati M (2018) Predicting Mortality for Adolescent and Adult Patients with Fever in Resource-Limited Settings. in The American journal of tropical medicine and hygiene

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Cash-Goldwasser S (2018) Risk Factors for Human Brucellosis in Northern Tanzania. in The American journal of tropical medicine and hygiene

 
Description This project concluded in April 2015. For the cross-sectional study element serological diagnostic testing of human, cattle, sheep and goat samples for Brucella, Coxiella and Leptospira has been concluded. The prevalence of each infection in each species and setting has been estimated and in most cases there is clear evidence of higher prevalence in pastoral (as compared to peri-urban and agropastoral) settings. Hospital based research has revealed significant clinical impacts of the study pathogens and identified risk factors for these clinical presentations. Findings from study focus groups indicate limited community level awareness of the presence or impacts of study pathogens, with greater evidence of concern about other livestock diseases and non-infectious threats to human health. The survey of healthcare provider awareness (in human and animal healthcare sector providers) reveal limited awareness of zoonoses, specifically leptospirosis and Q fever. Analyses of these data alongside data from the hospital studies reveals mismatches between clinical awareness of different pathogens and their clinical impact in this setting. These findings reveal and characterize barriers to the control of these study pathogens that will need to be addressed to reduce the impact of the study pathogens.
Several systematic reviews have been published as outputs from this study. A systematic review of Q fever in Africa revealed that C. burnetii infection is detected in humans and in a wide range of animal species across Africa. Seroprevalence varies widely by species and location but understanding of the different risk factors underlying this variability is poor, as is the role of C. burnetii in livestock abortion. Q fever consistently accounts for a notable proportion of undifferentiated human febrile illness and infective endocarditis in cohort studies, but incidence estimates are lacking. C. burnetii presents a real yet underappreciated threat to human and animal health throughout Africa. A systematic review of leptospirosis in Africa demonstrates that Leptospira spp. infection is an important cause of non-malarial febrile illness in people, and is geographically widespread in people and animals across Africa. There is considerable local variation in infection incidence, prevalence and Leptospira spp. diversity. To date, human and animal research efforts have been poorly integrated many outstanding questions remain regarding the epidemiology of this pathogen in Africa. A systematic review conducted to describe the occurrence and distribution of zoonotic causes of human febrile illness reported in malaria endemic countries reveals profound data gaps and the widespread distribution of a diverse range of zoonotic causes of febrile illness.
Exploitation Route Our findings will be taken forward by the Ministry of Health and Welfare, Tanzania with workshops and clinician guidelines developed for management of febrile illness. Findings on healthcare provider awareness of zoonoses were used as the foundation of a follow on workshop with clinicians to develop update guidance for clinicians in their evaluation of febrile patients. Since the conclusion of the grant, ongoing work from this project and others has also contributed to the development of new policy on brucellosis control in Tanzania. Study findings have also been taken forward by GALVmed in exercises to identify and support potential livestock disease interventions that could be targeted for investments to reduce economic and public health burden in Africa (e.g. leptospirosis, brucellosis and Q-fever vaccination of livestock). Our results highlighting the potential importance of soured milk as source of zoonotic pathogens are also likely to be taken forward in partnership with collaborators in west Africa who are developing improved techniques for soured milk preparation for uptake by the dairy sector and consumers.
Sectors Agriculture, Food and Drink,Healthcare

 
Description Findings from the project in relation to the importance of zoonoses as a cause of non-malaria febrile illness have been disseminated to policy-makers in the Tanzania National Institute of Medical Research (NIMR) and Ministry of Health and Social Welfare and have contributed to on-going discussion and policy decisions around diagnosis, clinical management and prevention of human febrile illness in Tanzania. Insights from analyses of brucellosis risk factors, including recognition of the importance of transmission from small ruminants, have been incorporated in the Tanzanian National Strategy for Prevention and Control of Brucellosis in Humans and Animals (2018-2023). The research findings from this project have also contributed to the prioritisation of brucellosis in the national zoonoses prioritisation exercise in Tanzania (2018). Project partners were closely involved in the establishment of the One Health coordination desk and the launch of the One Health Strategic Plan for Tanzania (2018). At international levels, information from the Tanzanian study has been disseminated within the WHO strategic and technical advisory group for neglected tropical diseases, with zoonotic causes of non-malaria febrile illness highlighted as a priority area of the neglected zoonoses working group.
First Year Of Impact 2014
Sector Healthcare
Impact Types Policy & public services

 
Description Knowledge Exchange Workshop - NCA Aug 2016
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact Attended by 25 people (Community Animal Health Workers, Livestock Field Officers, nurses, medical attendants, hospital administrators, pastoral council representatives, medical doctors, medical attendants and clinical officers) representing nine wards of the eleven wards in the Ngorongoro Conservation Area (Ngoile, Ngorongoro, Olbalbal, Eyasi, Kakesio, Endulen, Laitole, Misigiyo, Alailelai). Content of the 3-day workshop focussed on anthrax and brucellosis, particularly identifying the nature of the challenges associated with these diseases and developing ideas for surveillance, prevention and treatment.
 
Description Management of non-malaria febrile illness
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Interactions with the National Institute of Medical Research, Tanzania, to raise awareness and provide information for clinician training on the aetiology of non-malaria fever and treatment guidelines.
 
Description One Health Strategic Plan for Tanzania
Geographic Reach Africa 
Policy Influence Type Membership of a guideline committee
URL http://livestocklivelihoodsandhealth.org/blog/one-health-plan/
 
Description WHO informal consultation on fever management in peripheral healthcare settings: a global review of evidence and practice
Geographic Reach Multiple continents/international 
Policy Influence Type Participation in a advisory committee
URL http://www.who.int/malaria/publications/atoz/9789241506489/en/
 
Description BACTOCAP: Sequence capture for multiple bacterial zoonoses of international health importance
Amount £59,127 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 01/2018 
End 12/2018
 
Description BBSRC Innovator of the Year Award 2017
Amount £10,000 (GBP)
Funding ID International impact Category winner of BBSRC Innovator of the Year 2017 competition 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 06/2017 
End 05/2020
 
Description Collaborative fever research in Southeast Asia - John Crump
Amount $449,627 (NZD)
Organisation Health Research Council of New Zealand (HRC) 
Sector Public
Country New Zealand
Start 07/2016 
End 06/2019
 
Description Febrile illness evaluation in a broad range of endemicites (FIEBRE) - John Crump
Amount £10,000,000 (GBP)
Organisation Government of the UK 
Department Department for International Development (DfID)
Sector Public
Country United Kingdom
Start 04/2017 
End 03/2021
 
Description Investigating Febrile Deaths in Tanzania (INDITe) - John Crump
Amount $2,679,841 (USD)
Funding ID R01AI121378 
Organisation National Institutes of Health (NIH) 
Sector Public
Country United States
Start 01/2016 
End 12/2020
 
Description Lord Kelvin Adam Smith scholarship
Amount £90,000 (GBP)
Organisation University of Glasgow 
Sector Academic/University
Country United Kingdom
Start 10/2014 
End 09/2017
 
Description MRC-AHRC Global Public Health: Partnership Awards
Amount £176,425 (GBP)
Funding ID MR/R024448/1 
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 03/2018 
End 08/2019
 
Description Severe typhoid in Tanzania (STT) - John Crump
Amount $302,591 (USD)
Funding ID OPP1158210 
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 10/2016 
End 10/2021
 
Description Supporting evidence-based interventions to achieve agricultural development goals in Tanzania (SEBI TZ) - John Crump
Amount $7,997,372 (USD)
Funding ID OPP1134229 
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 05/2017 
End 04/2019
 
Description Typhoid vaccine acceleration consortium (TyVAC) - John Crump
Amount $36,900,000 (USD)
Funding ID OPP1151153 
Organisation Bill and Melinda Gates Foundation 
Sector Charity/Non Profit
Country United States
Start 10/2016 
End 10/2021
 
Description Viral zoonoses and severe febrile illness in northern Tanzania - Matt Rubach
Amount $150,448 (USD)
Funding ID K23AI116869 
Organisation National Institutes of Health (NIH) 
Sector Public
Country United States
Start 07/2016 
End 06/2021
 
Description ZELS-AS doctoral training centre
Amount £1,500,000 (GBP)
Organisation Natural Environment Research Council 
Sector Public
Country United Kingdom
Start 09/2015 
End 03/2019
 
Description Zoonoses and Emerging Livestock Systems - Brucella
Amount £666,579 (GBP)
Funding ID BB/L018845/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 11/2014 
End 10/2017
 
Description Zoonoses and Emerging Livestock Systems - HAZEL
Amount £754,309 (GBP)
Funding ID BB/L017679/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 11/2014 
End 10/2017
 
Description Zoonoses and Emerging Livestock Systems - SEEDZ
Amount £2,738,706 (GBP)
Funding ID BB/L018926/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 10/2014 
End 09/2018
 
Title Mixed methods survey of zoonotic disease awareness and practice among animal and human healthcare providers in Moshi, Tanzania 
Description  
Type Of Material Database/Collection of data 
Year Produced 2016 
Provided To Others? Yes  
 
Description Collaboration - Aix Marseille Universite 
Organisation Aix-Marseille University
Country France 
Sector Academic/University 
PI Contribution Intellectual input and input into study and research opportunities
Collaborator Contribution Input into study and research opportunities and laboratory analysis of field samples
Impact Preliminary diagnostic data
Start Year 2016
 
Description Collaboration on leptospirosis 
Organisation Royal Tropical Institute, Netherlands KIT
Department WHO/FAO/OIE Leptospirosis Reference Centre
Country Netherlands 
Sector Academic/University 
PI Contribution Collaboration with the Royal Tropical Institute, Netherlands, WHO/FAO/OIE Leptospirosis Reference Centre. Support for establishment of leptospirosis diagnostics, training of laboratory staff, research scientists and PhD students, quality assurance, input into study design
Start Year 2012
 
Description Collaboration with Kilimanjaro Clinical Research Institute 
Organisation Kilimanjaro Clinical Research Institute
Country Tanzania, United Republic of 
Sector Academic/University 
PI Contribution We have provided partial access costs, all staff training, and various pieces of equipment (incubators, spiral plater, pipettes, etc) to a new lab dedicated to Zoonotic Disease. This lab is a new facility resulting from the requirements of our research collaboration with KCRI and is staffed by project employees.
Collaborator Contribution The in-kind contribution noted is the additional bench fees associated with the cost of this lab's operation over the two years the lab has been in operation. Prof. Kibiki participated in the BBSRC-DfiD ZELS launch meeting in London, 10 November 2014, and in a project specific meeting in London, 11 November 2014. Prof Mmbaga participated in the ZELS Grantholders meeting in Cambridge in December 2015, project meetings in Moshi in 2016 and the ZELS Grantholders' meeting in Arusha in January 2017.
Impact Allan KJ, Biggs HM, Halliday JEB, Kazwala RR, Maro VP, Cleaveland SC, Crump JA. 2015. Epidemiology of Leptospirosis in Africa: A Systematic Review of a Neglected Zoonosis and a Paradigm for 'One Health' in Africa. PLoS Negl Trop Dis 9(9): e0003899. doi:10.1371/journal.pntd.0003899 Allan KJ, Halliday JEB, Cleaveland S. 2015. Renewing the momentum for leptospirosis research in Africa. Transaction of the Royal Society of Tropical Medicine and Hygiene. 109 (10). Pp 605-606. DOI: 10.1093/trstmh/trv072 Crump JA, Heyderman RS. A Perspective on Invasive Salmonella Disease in Africa. Clinical Infectious Diseases. 2015;61(S4):S235-40. DOI: 10.1093/cid/civ709 Crump JA, Kirk MD. 2015. Estimating the Burden of Febrile Illnesses. PLoS Negl Trop Dis. 9(12): e0004040. doi:10.1371/journal.pntd.0004040 Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. 15 July 2015. Epidemiology, clinical presentation, laboratory diagnosis, antimicrobial resistance, and antimicrobial management of invasive Salmonella infections. Clin Microbiol Rev doi:10.1128/CMR.00002-15. Penno EC, Baird SJ, Crump JA. 2015. Cost effectiveness of surveillance for bloodstream infections for sepsis management in low resource settings. Am J Trop Med Hyg 93(4), 2015, pp. 850-860. doi:10.4269/ajtmh.15-0083. Viana M, Shirima GM, John KS, Fitzpatrick J, Kazwala RR, Buza JB, Cleaveland S; Haydon DT, Halliday JEB. 2016. Integrating serological and genetic data to quantify cross-species transmission: brucellosis as a case study. Parasitology, available on CJO2016. doi:10.1017/S0031182016000044. Zhang HL, Mnzava KW, Mitchell ST, Melubo ML, Kibona TJ, Cleaveland S, Kazwala RR, Crump JA, Sharp JP, Halliday JEB. 2016. Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania. PLoS Negl Trop Dis 10(3): e0004476. doi:10.1371/journal.pntd.0004476 Zhang HL, Kunda W, Mnzava KW, Mitchell ST, Melubo ML, Kibona TJ, Sharp JP, Kazwala RR, Cleaveland S, Crump JA, Halliday JEB. Mixed methods survey of zoonotic disease awareness and practice among animal and human healthcare providers in Moshi, Tanzania. Abstract 1105. 64th American Society of Tropical Medicine and Hygiene annual meeting, Philadelphia, PA, 25-29 October 2015.
Start Year 2014
 
Description Collaboration with Nelson Mandela African Institution for Science and Technology 
Organisation Nelson Mandela African Institute for Science and Technology
Department School of Life Sciences and Bioengineering
Country South Africa 
Sector Academic/University 
PI Contribution Established partnership for livestock disease and zoonoses research with active engagement on development of funding proposals and co-supervision of MSc and PhD students.
Collaborator Contribution Provision of laboratory facilities, including minus 80 freezer storage. Contributions to design, implementation and analysis of field research studies in Tanzania, including student supervision. Contributions to development of collaborative research proposals. Contributions to writing of research manuscripts.
Impact Collaboration which was initially established in relation to research on malignant catarrhal fever and has now been extended to foot-and-mouth disease research, rift valley fever, brucellosis and Q-fever, with the institution now a key partner in three BBSRC ZELS projects led by the University of Glasgow. Joint publication in Science on rabies control and elimination. Training of four Tanzanian MSc students, with successful completion of research projects. Successful collaboration for ZELS grant funding of zoonoses and emerging livestock systems (ZELS) projects Successful collaboration on Bill and Melinda Gates Grants funding for a doctoral training program on livestock health and production (16 PhD studentships) Successful collaboration on ZELS associated doctoral training centre Successful collaboration on AfriqueOne ASPIRE programme Joint publication submitted on Rift Valley Fever in the Serengeti Publications: Viana M, Shirima GM, John KS, Fitzpatrick J, Kazwala RR, Buza JB, Cleaveland S; Haydon DT, Halliday JEB. 2016. Integrating serological and genetic data to quantify cross-species transmission: brucellosis as a case study. Parasitology, available on CJO2016. doi:10.1017/S0031182016000044. Zhang HL, Mnzava KW, Mitchell ST, Melubo ML, Kibona TJ, Cleaveland S, Kazwala RR, Crump JA, Sharp JP, Halliday JEB. 2016. Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania. PLoS Negl Trop Dis 10(3): e0004476. doi:10.1371/journal.pntd.0004476 Conference Presentations: Zhang HL, Kunda W, Mnzava KW, Mitchell ST, Melubo ML, Kibona TJ, Sharp JP, Kazwala RR, Cleaveland S, Crump JA, Halliday JEB. Mixed methods survey of zoonotic disease awareness and practice among animal and human healthcare providers in Moshi, Tanzania. Abstract 1105. 64th American Society of Tropical Medicine and Hygiene annual meeting, Philadelphia, PA, 25-29 October 2015.
Start Year 2012
 
Description Collaboration with Sokoine University of Agriculture 
Organisation Sokoine University of Agriculture
Country Tanzania, United Republic of 
Sector Academic/University 
PI Contribution Research team members are in regular contact with collaborators at Sokoine University, including monthly skype calls.
Collaborator Contribution Collaborators at Sokoine University are in regular contact with team members, both at annual in-person meetings and via monthly skype calls. Professor Rudovick Kazwala provides results from the collaborative research conducted to policy-makers via meetings such as the Meeting for Tanzania's National One Health Strategic Plan in 2016.
Impact Contribution to Tanzania's One Health Strategic Plan. Contribution to the Tanzania Livestock Modernization Initiative - http://agriprofocus.com/upload/post/Tanzania_Livestock_Modernization_Initiative1437567817.pdf Publications: Allan KJ, Biggs HM, Halliday JEB, Kazwala RR, Maro VP, Cleaveland SC, Crump JA. 2015. Epidemiology of Leptospirosis in Africa: A Systematic Review of a Neglected Zoonosis and a Paradigm for 'One Health' in Africa. PLoS Negl Trop Dis 9(9): e0003899. doi:10.1371/journal.pntd.0003899 Viana M, Shirima GM, John KS, Fitzpatrick J, Kazwala RR, Buza JB, Cleaveland S; Haydon DT, Halliday JEB. 2016. Integrating serological and genetic data to quantify cross-species transmission: brucellosis as a case study. Parasitology, available on CJO2016. doi:10.1017/S0031182016000044. Zhang HL, Mnzava KW, Mitchell ST, Melubo ML, Kibona TJ, Cleaveland S, Kazwala RR, Crump JA, Sharp JP, Halliday JEB. 2016. Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania. PLoS Negl Trop Dis 10(3): e0004476. doi:10.1371/journal.pntd.0004476 Conference Presentations: Zhang HL, Kunda W, Mnzava KW, Mitchell ST, Melubo ML, Kibona TJ, Sharp JP, Kazwala RR, Cleaveland S, Crump JA, Halliday JEB. Mixed methods survey of zoonotic disease awareness and practice among animal and human healthcare providers in Moshi, Tanzania. Abstract 1105. 64th American Society of Tropical Medicine and Hygiene annual meeting, Philadelphia, PA, 25-29 October 2015.
Start Year 2014
 
Description Collaboration with University of Otago 
Organisation University of Otago
Country New Zealand 
Sector Academic/University 
PI Contribution University of Otago is a partner institution on the Social, Economic and Environmental Drivers of Zoonoses (BB/L018926/1) project. Team members from the University of Glasgow participate in regular meetings (in person and via skype) with research associates at the University of Otago.
Collaborator Contribution Professor John Crump contributes intellectual input into study design for the SEEDZ project. Professor Crump participates in regular skype meetings and annual in-person meetings. In 2016, Professor John Crump and SEEDZ Pi Sarah Cleaveland successfully applied for a William Evans Visiting Fellowship for Prof Cleaveland to travel to New Zealand for six weeks.
Impact William Evans Visiting Fellowship for Professor Sarah Cleaveland, 2016 - $7500 Publications: Allan KJ, Biggs HM, Halliday JEB, Kazwala RR, Maro VP, Cleaveland SC, Crump JA. 2015. Epidemiology of Leptospirosis in Africa: A Systematic Review of a Neglected Zoonosis and a Paradigm for 'One Health' in Africa. PLoS Negl Trop Dis 9(9): e0003899. doi:10.1371/journal.pntd.0003899 Crump JA, Heyderman RS. A Perspective on Invasive Salmonella Disease in Africa. Clinical Infectious Diseases. 2015;61(S4):S235-40. DOI: 10.1093/cid/civ709 Crump JA, Kirk MD. 2015. Estimating the Burden of Febrile Illnesses. PLoS Negl Trop Dis. 9(12): e0004040. doi:10.1371/journal.pntd.0004040 Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. 15 July 2015. Epidemiology, clinical presentation, laboratory diagnosis, antimicrobial resistance, and antimicrobial management of invasive Salmonella infections. Clin Microbiol Rev doi:10.1128/CMR.00002-15. Penno EC, Baird SJ, Crump JA. 2015. Cost effectiveness of surveillance for bloodstream infections for sepsis management in low resource settings. Am J Trop Med Hyg 93(4), 2015, pp. 850-860. doi:10.4269/ajtmh.15-0083. Zhang HL, Mnzava KW, Mitchell ST, Melubo ML, Kibona TJ, Cleaveland S, Kazwala RR, Crump JA, Sharp JP, Halliday JEB. 2016. Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania. PLoS Negl Trop Dis 10(3): e0004476. doi:10.1371/journal.pntd.0004476 Conference Presentations: Crump JA. The highs and lows of typhoid disease burden: a story of inequities and moving targets. In symposium 510. Bridging the gap towards defining the burden of typhoid in sub-Saharan Africa and Southeast Asia. 65th American Society of Tropical Medicine and Hygiene annual meeting, Atlanta, GA, 13-17 November 2016. Crump JA. Insights on global epidemiology of severe febrile illness. In symposium 501: Febrile illness: epidemiology, diagnostics, management. 65th American Society of Tropical Medicine and Hygiene annual meeting, Atlanta, GA, 13-17 November 2016. Hopkins H, Thomas NV, Crump JA, González IJ, Guérin PJ, Newton PN, Schellenberg D, Bell D, Reyburn H. Mapping fever aetiologies in malaria-endemic areas: an interactive, open-access, on-line map. Abstract. 9th European Congress on Tropical Medicine and International Health, Basel Switzerland. 6-10 September 2015. Zhang HL, Omondi OM, Musyoka AM, Afwamba IA, Swai RP, Karia FP, Muiruri C, Reddy EA, Crump JA, Rubach MP. The challenges of maintaining Good Clinical Laboratory Practices in low-resource settings: a health program evaluation framework case study from East Africa. Abstract 1326. 64th American Society of Tropical Medicine and Hygiene annual meeting, Philadelphia, PA, 25-29 October 2015. Zhang HL, Kunda W, Mnzava KW, Mitchell ST, Melubo ML, Kibona TJ, Sharp JP, Kazwala RR, Cleaveland S, Crump JA, Halliday JEB. Mixed methods survey of zoonotic disease awareness and practice among animal and human healthcare providers in Moshi, Tanzania. Abstract 1105. 64th American Society of Tropical Medicine and Hygiene annual meeting, Philadelphia, PA, 25-29 October 2015.
Start Year 2014
 
Description Establishing diagnostic tests in Tanzania, development tools for economic analysis of impact of bacterial zoonoses and of new diagnostic tests 
Organisation Washington State University
Country United States 
Sector Academic/University 
PI Contribution Collaboration with Washington State University established with Paul G. Allen School for Global Animal Health, Washington State University and Washington Animal Diagnostic Disease Laboratory
Start Year 2012
 
Description ASTMH 2014 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation poster presentation
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Poster presentation sparked follow up conversations with peers

Identification of other ongoing activities in this area of research
Year(s) Of Engagement Activity 2014
 
Description Assessing the non-biologic contributors to mortality among patients with febrile illness in Tanzania: a prospective cohort social biopsy study. - John Crump 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Research meeting at 66th American Society of Tropical Medicine and Hygiene annual meeting, Baltimore, MD, 5-9 November 2017. Abstract 92: Assessing the non-biologic contributors to mortality among patients with febrile illness in Tanzania.
Year(s) Of Engagement Activity 2017
 
Description CONACYT Brucellosis Workshop - Mexico 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Identification of techniques developed by other researchers that could be applied for ongoing research

After the workshop follow up communications have led to further collaborations
Year(s) Of Engagement Activity 2014
 
Description Continuing Medical Education NCA Aug2016 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Patients, carers and/or patient groups
Results and Impact Attended by 19 people representing Faraja Health Care Centre, Jaffery Charitable Medical Services, Kilimanjaro Christian Medical Centre, Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical College, Majengo Healthcare Centre, Mawenzi District Hospital, Moshi Upendo Healthcare Centre, Ministry of Health, Community Development, Gender, Senior and Children, Nelson Mandela African Institution of Science and Technology, Pasua Healthcare Centre, St Joseph's Hospital, and TPC Hospital. This workshop provided information about the Livestock, Livelihoods and Health pathogens to doctors from across northern Tanzania, and gathered feedback on what sorts of zoonoses doctors encountered, what kinds of information would be helpful for them to receive and what information would be useful for patients to receive regarding zoonotic disease.
Year(s) Of Engagement Activity 2016
 
Description Contribution of food animals to human nontyphoidal Salmonella disease in East Africa. - Kate Thomas 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Research meeting at 10th International Conference on Typhoid Fever and Other Invasive Salmonelloses, Kampala, Uganda. 4-6 April 2017. Abstract: Contribution of food animals to human nontyphoidal Salmonella disease in East Africa.
Year(s) Of Engagement Activity 2017
 
Description DNA and RNA sequencing-based metagenomics for unbiased pathogen detection among Tanzanian adults with undifferentiated febrile illness - John Crump 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Research meeting at 66th American Society of Tropical Medicine and Hygiene annual meeting, Baltimore, MD, 5-9 November 2017. Abstract 1984: DNA and RNA sequencing-based metagenomics for unbiased pathogen detection among Tanzanian adults with undifferentiated febrile illness.
Year(s) Of Engagement Activity 2017
 
Description David Livingstone Anniversary Symposium 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Talk stimulated interactions with representatives from the Bill and Melinda Gates Foundation and the WHO Neglected Tropical Disease groups.

Following discussions after the presentation, submissions made to the Gates Grand Challenges grants, and invitation for engagement with the WHO Strategic and Technical Advisory Group for Neglected Tropical Diseases.
Year(s) Of Engagement Activity 2013
 
Description EPIZONE meeting - keynote presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Talk discussed debate about definition of reservoirs and understanding of reservoir systems, and stimulated development of a paper that has subsequently been published in Trends in Ecology and Evolution.

Publication of a manuscript in Trends in Ecology and Evolution on disease reservoirs
Year(s) Of Engagement Activity 2012
 
Description Evaluation of performance of three commercially available leptospirosis IgM point-of-care tests to diagnose acute leptospirosis among patients with fever in northern Tanzania - John Crump 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Research meeting at 10th International Leptospirosis Society Meeting, Palmerston North, New Zealand, 27 November - 1 December 2017. Paper titled: Evaluation of performance of three commercially available leptospirosis IgM point-of-care tests to diagnose acute leptospirosis among patients with fever in northern Tanzania.
Year(s) Of Engagement Activity 2017
 
Description Integrative & Innovative Approaches: Why social sciences are central to zoonoses research workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This one-day workshop, to run ahead of the annual DFiD-RCUK-funder meeting annual meeting of the Zoonoses and Emerging Livestock Systems research groups (ZELS) in Hanoi, Vietnam, in January 2018, will draw out some of the lesson's learned and best practices from integrating social sciences into zoonoses research. Drawing on experience from the ZELS research projects and elsewhere, the workshop will present state of the art research and explore challenges still facing both social sciences research in zoonoses, and the integration of these approaches to interdisciplinary projects. The workshop is intended to reach all ZELS scientists, both social and non-social scientists alike who will highlight their experiences in interdisciplinary research. The workshop will also present a range of useful approaches and practices to improve integrative research in the future. The one-day event should be of interest to all researchers interested in zoonoses and will not assume a social science background.

Expected workshop outcomes:
" Detailed presentation and discussion about the importance of social science and social science themes in interdisciplinary zoonoses research.
" Best practices based on ZELS project processes and outcomes to help further/inform interdisciplinary research in the future
Year(s) Of Engagement Activity 2018
 
Description Invited seminar participant - The One Health and Zoonosis lens: how can interdisciplinary development science meet global challenges? Institute of Development Studies, Brighton, 15 October. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The One Health and Zoonosis lens: how can interdisciplinary development science meet global challenges? Institute of Development Studies, Brighton, 15 October. I was an invited participant in this workshop alongside funders and partners from the Global South.
Year(s) Of Engagement Activity 2018
 
Description Invited to present a session on "The role of social science in zoonosis research" to an international workshop: Addressing the challenge of zoonotic disease with inter-disciplinary research, School of Biological Sciences, University of Aberdeen, 27-29th March. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I was invited to a meeting of predominantly biomedical researchers to explain the importance of including social science researchers, questions and methods in zoonoses research. The workshop was attended by an international audience, and aimed to establish a new research project. Discussion on the day indicated a positive response in terms of audience members realising the value of social science contributions to health research.
Year(s) Of Engagement Activity 2017
 
Description Kilimanjaro Christian Medical Centre clinical conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Dr Shama Cash-Goldwasser and Dr Michael Maze presented to a group of medical doctors, nurses, clinical laboratory scientists and students, to inform them of the results of the Bacterial Zoonoses study, particularly how they impact on clinical practice.
Year(s) Of Engagement Activity 2016
 
Description Leptospirosis presentation - ILS 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Identification of additional research questions and opportunities for further collaboration

Follow up communication with members of the audience regarding additional collaborative work opportunities.
Year(s) Of Engagement Activity 2013
 
Description Leptospirosis presentation - TAWIRI 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Talk sparked exploration of additional opportunities for collaboration with other scientists

Considerable discussion of findings from this study and comparison with findings of other researchers in this area.
Year(s) Of Engagement Activity 2013
 
Description Leptosporosis among febrile outpatients attending hospital in a pastoral area in northern Tanzania - John Crump 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Research meeting at 10th International Leptospirosis Society Meeting, Palmerston North, New Zealand, 27 November - 1 December 2017. Paper titled: Leptosporosis among febrile outpatients attending hospital in a pastoral area in northern Tanzania.
Year(s) Of Engagement Activity 2017
 
Description Mawenzi Regional Referral Hospital clinical education meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Dr Matthew Rubach and Dr Michael Maze presented to a group of medical doctors, nurses, clinical laboratory scientists and students, to inform them of the results of the study, particularly how they impact on clinical practice.
Year(s) Of Engagement Activity 2016
 
Description Multi-Host Epidemiology of Bacterial Zoonoses in northern Tanzania - Aberdeen - March 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presentation at workshop to inform development of research approaches for future funding applications
Year(s) Of Engagement Activity 2017
 
Description NIMBioS Leptospirosis Meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Discussions helped identify gaps in current research and opportunities for further targeted research

Links with new collaborators and identification of new techniques and approaches that can be applied to analyse project data.
Year(s) Of Engagement Activity 2014
 
Description Newspaper articles 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach international
Primary Audience Media (as a channel to the public)
Results and Impact Press articles in two Tanzanian newspapers describing the project and the importance of zoonotic diseases in Tanzania. Press articles in two Tanzanian newspapers describing the project and the importance of zoonotic diseases in Tanzania.

no actual impacts realised to date
Year(s) Of Engagement Activity 2012
 
Description One Health and Geography 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact Overview of One Health research in Tanzania as introduction to geography school teachers to the One Health approach.
Year(s) Of Engagement Activity 2018
 
Description One Health in Tanzania, keynote presentation One Health EcoHealth Congress, Melbourne 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Overview of One Health research in Tanzania given as a keynote presentation at the One Health EcoHealth conference in Melbourne, with > 500 participants in attendance, and sparking a wide range of questions and discussions.
Year(s) Of Engagement Activity 2016
 
Description One Health research and impact: Insights from northern Tanzania - BBSRC Presentation - Sept 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Supporters
Results and Impact Presentation at BBSRC to share insights from past projects with funders and developers of future funding schemes
Year(s) Of Engagement Activity 2017
 
Description One Health: understanding interactions, informing interventions, keynote presentation, St. George's University, October 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Attended by veterinary and medical researchers and practitioners, sparked discussion on further research relating to zoonotic pathogens in Africa.
Year(s) Of Engagement Activity 2017
URL http://www.sgu.edu/news-and-events/sgu-host-international-ohom-symposium/
 
Description Policy brief on bacterial zoonoses 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Policy brief on bacterial zoonoses to National Institute of Medical Research and Ministry of Health and Social Welfare, Tanzania Policy brief

no actual impacts realised to date
Year(s) Of Engagement Activity 2012
 
Description Predicting mortality for adolescent and adult patients with fever in resource-limited settings - John Crump 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Research meeting at 66th American Society of Tropical Medicine and Hygiene annual meeting, Baltimore, MD, 5-9 November 2017. Abstract 497: Predicting mortality for adolescent and adult patients with fever in resource.
Year(s) Of Engagement Activity 2017
 
Description Public Lecture on One Health at Oxford May Music Festival 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Talk generated many questions and interest, with a follow up collaboration developed for fund-raising activities linked to dog rabies control and elimination.
Year(s) Of Engagement Activity 2017
 
Description Queen Margaret School lecture 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Schools
Results and Impact Generated interest of sixth form students in disease research.

No known impacts.
Year(s) Of Engagement Activity 2012
 
Description RCVS Open Day presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Talk stimulated interest and awareness about rabies and zoonoses as a major cause of non-malaria febrile illness, including approaches for dog management in rabies control.

Discussions with parliamentarians regarding potential opportunities for highlighting the problems of zoonotic diseases and engagement of UK government within global initiatives on zoonoses control.
Year(s) Of Engagement Activity 2014
URL http://www.rcvs.org.uk/news-and-events/news/rcvs-day-an-updated-charter-and-a-royal-accolade/
 
Description Scoping review on identifying global knowledge gaps in acute febrile illness surveillance. - John Crump 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Research meeting at 66th American Society of Tropical Medicine and Hygiene annual meeting, Baltimore, MD, 5-9 November 2017. Abstract 90: Scoping review on identifying global knowledge gaps in acute febrile illness surveillance.
Year(s) Of Engagement Activity 2017
 
Description Sensitivity of C-reactive protein for the identification of patients with laboratory confirmed bacterial infections in northern Tanzania - John Crump 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Paper presentation at 66th American Society of Tropical Medicine and Hygiene annual meeting, Baltimore, MD, 5-9 November 2017. Abstract LB-5089: Sensitivity of C-reactive protein for the identification of pateints with laboratory confirmed becterial infections in nothern Tanzania.
Year(s) Of Engagement Activity 2017
 
Description Society of Biology Teachers' Conference presentation 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Schools
Results and Impact Talk trigger requests for information from school teachers for teaching material.
Year(s) Of Engagement Activity 2013
 
Description Special Issue of the Geographer 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Editing of the special issue of this magazine by members of the study team led to engagement with members of the public regarding the research project.

After the production of this special issue Prof Jo Sharp was asked to conduct several public lectures on the material covered in the special issue.
Year(s) Of Engagement Activity 2013
URL http://www.rsgs.org/publications/geographer.shtml
 
Description The One Health and Zoonosis Lens: how can interdisciplinary development science meet global challenges 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Meeting at the Institute of Development Studies, Brighton to discuss the role of social sciences in One Health work - Sharp and Waldman as invited participants.
Year(s) Of Engagement Activity 2015,2018
 
Description The global distribution and host range of Leptospira species and serovars - John Crump 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Research meeting at 10th International Leptospirosis Society Meeting, Palmerston North, New Zealand, 27 November - 1 December 2017. Paper titled: The global distribution and host range of Leptospira species and serovars
Year(s) Of Engagement Activity 2017
 
Description Three species of Leptospira detected in blood of patients with fever in northern Tanzania - John Crump 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Research meeting at 10th International Leptospirosis Society Meeting, Palmerston North, New Zealand, 27 November - 1 December 2017. Paper titled: Three species of Leptospira detected in blood of patients with fever in northern Tanzania
Year(s) Of Engagement Activity 2017