ETHICOBOTS (Ethiopia Control of Bovine Tuberculosis Strategies)

Lead Research Organisation: University of Cambridge
Department Name: Veterinary Medicine

Abstract

Ethiopia is the second most populous sub-Saharan African country with a rapidly growing population. It is a least-developed, predominantly agrarian country struggling to emerge from extreme poverty, through an ambitious national growth and transformation plan, to achieve middle income status by 2025. Livestock contributes to a high proportion of national income and is one of the pillars to economic development. Traditional extensive farming systems with the less productive local Zebu cattle are being supplemented and replaced with intensive farming of imported Holstein-Friesian and their cross breeds at a rapid rate driven by high demand for dairy and meat products of a rapidly growing urban population. Although bovine tuberculosis (bTB) is endemic in Ethiopia, the prevalence is low among the local Zebu cattle because of their relative resistance. Expansion of dairy farms around major urban centres has however created hotspots of TB infected exotic cattle. With no legal requirement to test and cull infected cattle in Ethiopia, unlike in developed countries, the potential for rapid spread of bTB across the cattle trade routes through amplification by the dairy farms in peri-urban areas is a real emerging danger.
We propose to develop control strategies for bTB in Ethiopia based on investigation and analysis of the epidemiology of the disease and its determinants through a series of interlinked social and biological science studies, encompassing the emerging livestock system, livelihood of affected farmers and available tools for bTB control. We will determine disease prevalence among dairy cattle in different areas, capture cattle trading and exchange mechanisms, study risk management and mitigation practices for households and document how prevailing social, cultural and economic factors impact them. We will quantify the burden of bTB among exposed intensive farm and abattoir workers and determine how illness and health is managed in poor families. Local perceptions of infection and disease transmission, coping mechanisms and gender roles in order will help explain consumption practices. In turn, these may enhance disease risk and impact poverty and wellbeing amongst an expanding high risk group. We will compare disease susceptibility among the local and Holstein cattle and evaluate the degree of protection given by BCG vaccination to cross-breed cattle. Based on the multidisciplinary information gathered by these investigations, we will assess the feasibility of various bTB control strategies such as vaccination, control of animal movements and health education within the Ethiopian context. We will determine factors that affect implementation such as cost-efficiency, social and cultural acceptability and practicality. This will be coordinated with targeted capacity building of Ethiopian researchers and institutions to enhance multidisciplinary scientific capabilities for sustainable local research for the longer term.
The results will provide practical and effective bTB control strategies, which when applied, will significantly reduce the high rate of bTB and its zoonotic transfer in the expanding dairy sector; minimize trading of bTB infected dairy cattle to protect the national zebu herd and the livelihood of poor farmers; and reduce the risk of zoonosis in high risk populations. The current proposal builds on previous experience of a successful collaboration with the Ethiopian Government on bTB to focus on an emerging rapid change in the nature of livestock systems in this developing country, dairy farms, that impact on the livelihoods and health of poor people. The project will be carried out with the active participation of the relevant government units and local communities in the field to maximize the likelihood of implementation of results into policy and practice. The main expected outcome is reduced impact of a zoonotic disease on poor people and their livestock in a least developed country.

Technical Summary

Ethiopia has the largest livestock population in Africa including 53 million cattle. A rapidly growing human population (85 million people) and high rate of urbanization give increased challenges on farmers and government to meet the demand for food. Meat is supplied to urban centres through trading of zebu cattle. In contrast, milk production of zebus is poor compared to exotic breeds such as Holstein or their crosses with zebus; zebus alone cannot meet the increased demand for milk and dairy products. An emerging dairy sector in Ethiopia aiming to increase milk supply is however more vulnerable to diseases thriving in intensive husbandry systems. Epidemiological surveys on bovine TB (bTB) in Ethiopian livestock have mapped out relatively low prevalence (0-9%) in the domestic zebu cattle in rural Ethiopia, reared under extensive conditions, while studies of exotic or cross bred cattle in the peri-urban intensive dairy farms in central Ethiopia recorded over 30% tuberculin prevalence. Thus, the impact of such high bTB prevalence could be significant on both animal productivity and public health, especially on high-risk populations exposed to cattle. Expansion of the dairy farm sector and the current centrifugal trade of high value cattle from an area of high bTB prevalence can result in new hotspots of bTB in emerging dairy farm regions around peripheral urban centres. Such trading may also highly affect agro-pastoralists of the Ethiopian highlands, increasing the risk of zoonosis and transmission to their zebu herds. The main objective of this proposal is to develop control strategies for bTB in Ethiopia that could significantly reduce the high rate of bTB and its zoonotic transfer in the expanding dairy sector. Experimental, social and economic information gathered in a multi-disciplinary research programme built on six work-packages will be used to assess feasibility, acceptance and cost-efficiency of various bTB control strategies, including cattle vaccination.

Planned Impact

This programme will deliver a greater scientific and socio-political base for the control of zoonotic mycobacterial infections spreading from the emerging dairy industry in Ethiopia. The dairy industry is a major emerging livestock system in Ethiopia, concentrated around growing urban centres. This industry depends on 'exotic', imported Holstein-Friesian (HF) cattle and their crosses with local Zebu cattle. The importation and breeding of these HF cattle is now associated with a high prevalence of Mycobacterium bovis, the cause of bovine tuberculosis (bTB), which can reach 40% or more in infected herds. It was this prevalence of infection in the national herd in Britain that was associated with milk-borne transmission of M. bovis to humans with an annual zoonotic death toll of ~2,500, prior to the introduction of pasteurisation. We hypothesise that the poor workers in this industry and their families are at particular risk of zoonotic exposure and transmission.

Although the traditional Zebu industry is not heavily infected with M. bovis, the increasing cross breeding of Zebu animals with HF cattle runs the risk of the infection spreading into more extensive, lower value traditional farms, typically managed in smallholdings. In common with most countries in sub-Saharan Africa, there are no control programmes for bTB. Furthermore, given that 90% or more of dairy products are sold direct to consumers, unpasteurised, there is a risk, as the dairy industry emerges further in peri-urban areas, of widespread zoonotic transmission of M. bovis in here - and also if any significant spread to the traditional husbandry systems occurs.

This project aims to deliver an innovative programme of development of applied and socially and economically acceptable controls of bTB. With our focus on integrated, cross-disciplinary approaches, we will identify innovative interventions to protect and benefit the poor. This proposal has been put together with a clear focus on the long-term impact of the research results. The programme, which involves senior scientists from both Ethiopian and UK government research institutes, will feed directly into policy making in both countries, as well as to the international agencies that we are connected to. This work is of direct future relevance for other emerging dairy industries in the developing world, especially in sub-Saharan Africa, as well as indirectly for the UK industry, where cattle vaccination is actively being pursued.

Stakeholder workshops are planned early in the programme to engage with government, veterinary, medical, industry and farming stakeholders, to ensure that key issues are considered. In addition to a comprehensive capacity building programme for the Ethiopian partners, our training workshops and educational programmes will also be focused on the farming and high risk cohorts identified in the work. With research sites in the key dairy farm regions in Ethiopia known to be affected by bTB, we will have a strong and representative regional coverage. We will also build out from these regions to ensure actual coverage across the whole country in all relevant groups. We will also engage with relevant international agencies (eg OIE).

Through our interaction with individual farmers, farm-workers, community health workers and vets, we will develop targeted information about bTB with the aim of changing attitudes and practices relating to animal husbandry, consumption practices, and health seeking behaviour, in order to reduce the zoonotic impact on the health and economic burden of low-income farm workers and their families.

Taken together, the overall impact of the outcomes of the research will be to improve bTB control in Ethiopia and thus lead to significantly better human and animal health that will eventually translate itself into a significant input to accelerated economic development in Ethiopia and in other regions where the work may be of future relevance.

Publications

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Teklewold (2019) Ethiopian Dairy and Animal Health Policy Sector: A Stakeholders' Network Analysis in Ethiopian Journal of Agricultural Sciences

 
Title The Theory and Practice of Integrated Health - Prof Henrietta Moore 
Description Professor Henrietta Moore gave an overview of the One Health initiative at our Stakeholder Meeting in December 2017 in Addis Ababa. 
Type Of Art Film/Video/Animation 
Year Produced 2017 
Impact Raising awareness of One Health initiative which is particularly pertinent to the problem of zoonotic disease. 
URL https://www.youtube.com/watch?v=NhPnYrcYix4
 
Description Ethiopian government state minister established a working group to develop national strategy for the control of bovine tuberculosis. Work on this is on-going and out next visit is in April 2019.
First Year Of Impact 2019
Sector Agriculture, Food and Drink
Impact Types Societal,Policy & public services

 
Description Membership of national stakeholder group on bovine tuberculosis in Ethiopia
Geographic Reach Africa 
Policy Influence Type Membership of a guideline committee
 
Description Prof James Wood membership to The Science Advisory Council (SAC)
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
Impact The Science Advisory Council (SAC) provides independent advice on science policy and strategy to the Department for Environment Food and Rural Affairs. Sub groups are set-up to react to sudden global threats and other challenges (one of which is exotic diseases).
URL https://www.gov.uk/government/organisations/science-advisory-council/about/our-governance
 
Description Round table TB event hosted by Michael Gove
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact Professor James Wood inputted into a round table event chaired by The Secretary of State for Environment, Food and Rural Affairs (Micheal Gove) with invited experts in the field of TB, in order to discuss plans for eradicating TB from England by 2038. Since then a small working group has been set-up to develop and drive the necessary strategies.
URL https://www.gov.uk/government/news/bovine-tb-strategy-review
 
Description Scientific Capacity Building in Ethiopia
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Building a Network to identify the Brucella species in cattle diseased with brucellosis
Amount £21,000 (GBP)
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 10/2016 
End 03/2017
 
Description ETHICOBOTS 2 - One Health Research for Impact
Amount £449,990 (GBP)
Funding ID BB/S013806/1 
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 02/2019 
End 01/2021
 
Description The Impact of atypical TB in Children in Ethiopia
Amount £18,000 (GBP)
Organisation Biotechnology and Biological Sciences Research Council (BBSRC) 
Sector Public
Country United Kingdom
Start 10/2016 
End 03/2017
 
Title Course on Qualitative data collection 
Description Course on Qualitative data collection and analysis, led by Catherine Hodge (MSc), University College London 
Type Of Material Improvements to research infrastructure 
Year Produced 2019 
Provided To Others? No  
Impact Improvement of data collection methods from field data. 
 
Description Enabling control of Mycobacterial disease, enhancing food productivity and animal health 
Organisation University of Nottingham
Country United Kingdom 
Sector Academic/University 
PI Contribution The University of Cambridge has co-written an application with the University of Nottingham and PDP BIO.
Collaborator Contribution Co-writers of grant application.
Impact The application was unsuccessful
Start Year 2016
 
Description Ethicobots Consortium 
Organisation Addis Ababa University
Department Aklilu Lemma Institute of Pathobiology
Country Ethiopia 
Sector Academic/University 
PI Contribution This is the overall consortium that makes up the Ethicobots consortium, tasked with delivering this whole project
Collaborator Contribution this is described in the overall activities of the Ethicobots grant programme
Impact see the report against the grant as a whole
Start Year 2014
 
Description Ethicobots Consortium 
Organisation Animal and Plant Health Agency
Country United Kingdom 
Sector Public 
PI Contribution This is the overall consortium that makes up the Ethicobots consortium, tasked with delivering this whole project
Collaborator Contribution this is described in the overall activities of the Ethicobots grant programme
Impact see the report against the grant as a whole
Start Year 2014
 
Description Ethicobots Consortium 
Organisation Armauer Hansen Research Institute
Country Ethiopia 
Sector Charity/Non Profit 
PI Contribution This is the overall consortium that makes up the Ethicobots consortium, tasked with delivering this whole project
Collaborator Contribution this is described in the overall activities of the Ethicobots grant programme
Impact see the report against the grant as a whole
Start Year 2014
 
Description Ethicobots Consortium 
Organisation Ethiopian Ministry of Agriculture
PI Contribution This is the overall consortium that makes up the Ethicobots consortium, tasked with delivering this whole project
Collaborator Contribution this is described in the overall activities of the Ethicobots grant programme
Impact see the report against the grant as a whole
Start Year 2014
 
Description Ethicobots Consortium 
Organisation National Animal Health Diagnostic and Investigation Center
PI Contribution This is the overall consortium that makes up the Ethicobots consortium, tasked with delivering this whole project
Collaborator Contribution this is described in the overall activities of the Ethicobots grant programme
Impact see the report against the grant as a whole
Start Year 2014
 
Description Ethicobots Consortium 
Organisation Swiss Tropical & Public Health Institute
Country Switzerland 
Sector Public 
PI Contribution This is the overall consortium that makes up the Ethicobots consortium, tasked with delivering this whole project
Collaborator Contribution this is described in the overall activities of the Ethicobots grant programme
Impact see the report against the grant as a whole
Start Year 2014
 
Description Ethicobots Consortium 
Organisation University College London
Department Ear Institute
Country United Kingdom 
Sector Academic/University 
PI Contribution This is the overall consortium that makes up the Ethicobots consortium, tasked with delivering this whole project
Collaborator Contribution this is described in the overall activities of the Ethicobots grant programme
Impact see the report against the grant as a whole
Start Year 2014
 
Description Ethicobots Consortium 
Organisation University of Cambridge
Country United Kingdom 
Sector Academic/University 
PI Contribution This is the overall consortium that makes up the Ethicobots consortium, tasked with delivering this whole project
Collaborator Contribution this is described in the overall activities of the Ethicobots grant programme
Impact see the report against the grant as a whole
Start Year 2014
 
Description - Stakeholder workshop at EIAR, Addis Ababa 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact - Stakeholder workshop at EIAR, Addis Ababa - July 18th 2016:
A one day workshop was held at the Ethiopian Institute for Agricultural Research (EIAR) with a selected group of stakeholders. The aim was to get a better understanding of the Stakeholder Network in the Ethiopian dairy sector and to collect animal health, zoonosis control and dairy sector related information for stakeholders salience analysis.
All node and edge data collection has been finalized for social network analysis.
The following stakeholders took part in this workshop:

1. Ministry of Livestock and Fisheries - Dairy Development Directorate
2. Ministry of Livestock and Fisheries - Urban Agriculture Directorate
3. Ministry of Livestock and Fisheries - Veterinary Public Health Directorate
4. National Veterinary Institute (NVI) (2 individuals)
5. National Artificial Insemination Center (NAIC)
6. Ethiopian Meat and Dairy Industry Development Institute - Dairy Directorate
7. Ethiopian Meat and Dairy Industry Development Institute - Meat Directorate
8. Agricultural transformation Agency (ATA)
9. Ethiopian Institute of Agricultural Research - Livestock Research Directorate
10. Amhara Agricultural Research Institute - Livestock Research Directorate
11. Amhara Region - Bahir Dar Animal Health Laboratory
12. SNNP - Bureau of Livestock and Fisheries
13. SNNP - Agricultural Research Institute
14. Addis Ababa University - College of Veterinary Medicine (2 lecturers)
15. Addis Ababa Bureau of Agriculture
16. Addis Ababa Abattoirs Enterprise
17. Armaur Hansen Research institute (AHRI) (2 individuals)
Year(s) Of Engagement Activity 2017
 
Description Brucellosis workshop, NAHDIC, 23 February 2017 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Industry/Business
Results and Impact Our PhD student (ZELS-AS), Bedaso Edao Mamo held a 'Brucella awareness creation workshop' at National Animal Health Diagnostic and Investigation center (NAHDIC), Sebeta, with 50 dairy farmers and dairy sector representatives from nine districts of central Ethiopia.
Year(s) Of Engagement Activity 2017
 
Description Interview for The Bartlett - article about collaboration in Bovine TB research 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Industry/Business
Results and Impact Social Scientist Catherine Hodge gave an interview which formed part of an article on The Bartlett which highlights the collaboration of different stakeholders in our project. The article is mainly about the collaboration of our project, ETHICOBOTS and can be found through the link provided, below.
Year(s) Of Engagement Activity 2019
URL http://wbartlett100.com/article/pathogens-vs-prosperity
 
Description Paediatric TB workshop, AHRI, 6 March 2017 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact ETHICOBOTS (AHRI) organized a workshop for Clinicians, Researchers and Program Personnel on atypical childhood tuberculosis. In the workshop there was a total of 20 participants (5 clinicians, 7 nurses, 7 researchers working on tuberculosis and nutrition, and 2 participants from the National TB control program. The clinicians and nurses were from Bishoftu Hospital, St Paul, St Peter, Tirunesh Beijing, Yekatit 12, and Zewditu Hospitals.
Year(s) Of Engagement Activity 2017
 
Description Stakeholder Meeting: The Importance of Animal health and Disease control 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact We held two workshops held a day apart in both English and the local language, Amharic, primarily for delegates that are actually working in the dairy sector. The second delegation represented government agencies, academia and other officials. Many have signed up to stay closely linked with the project. The Vet Record will publish an article about the workshop in the coming weeks.
Year(s) Of Engagement Activity 2017
 
Description Training of farmers 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Industry/Business
Results and Impact WP6 gave a series of one-to-one training sessions to about 20 farmers on their farms.
Topics: results from a fodder study that we conducted in their farms; discussions of the importance of fodder and how to calculate adequate rations; impact of fodder on productivity including fertility, milk and calf mortality; how to properly detect heat and what factors that affects heat detection; the importance of record keeping and going through the official farm record with them and show how to fill them (these are record sheets distributed by the Government).
Year(s) Of Engagement Activity 2016,2017
 
Description Vet Record Article 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact We wrote an article for the Vet Record to share information on the project and in particular, focusing on our two day stakeholder meeting in December 2017, involving over 100 vets, health professionals, farmers, scientists and ministers. Lots of interest generated through interaction with farmers and policy makers and awareness of zoonic diseases and their threat to animal and human health.
Year(s) Of Engagement Activity 2018
URL http://veterinaryrecord.bmj.com/content/182/5/126