Operationalizing One Health Interventions in Tanzania

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

Abstract

Endemic livestock zoonoses are important causes of human febrile illness and livestock productivity losses. Despite having major societal impacts in low- and middle-income countries, this group of diseases remains widely neglected. Although many of these infections can be treated, a lack of access to robust diagnostic tests means that many cases remain undiagnosed, which also limits access to effective treatment. Furthermore, prevention and control measures are often challenging as these diseases span both human and animal populations. This proposal aims to address several existing barriers and constraints to the design and development of interventions to mitigate zoonotic disease impact, focussing on areas of interventions that have the potential for both immediate and longer-term impact.

Our project will focus on key areas of One Health intervention research to prevent and control zoonotic diseases in poor livestock-keeping communities in Tanzania: (i) interventions delivered through the medical sector to improve clinical management of cases of human zoonotic diseases; (ii) community-led approaches to develop potential behavioural and livestock management interventions; and (iii) interventions to control infection in animal populations that could be implemented by veterinary service providers. The project builds directly from earlier ZELS research in Tanzania that have demonstrated clear potential for application and impact. Our research will focus in pastoral livestock-keeping communities, which have the greatest risk of zoonotic infections and where the greatest social and economic impact of zoonoses interventions is likely to be. Previous research has also demonstrated that rates of disease are higher for small ruminants (goats and sheep) than cattle. Therefore, for animal interventions, we will concentrate on establishing capacity for interventions targeted at small ruminants and associated transmission pathways.

The work will involve linked research activities to develop disease-specific interventions against brucellosis and Q fever (caused by infection with Coxiella burnetii), alongside community-led strategies that have potential to reduce impacts across multiple pathogens. Medical-sector interventions will address the common problem of mis-diagnosis of zoonotic causes of febrile illness. Research will involve verification of existing human brucellosis diagnostic tests as a first step towards roll out across Tanzania and a healthcare utilisation survey to generate robust estimates of healthcare availability in pastoral areas. These research activities are explicitly designed to support the development of the National Strategy for Brucellosis Control in Tanzania. Community-based activities will involve novel participatory action research that engages community co-researchers alongside academic researchers to develop and implement behavioural interventions to reduce infectious disease risks. Animal interventions will focus on a C. burnetii vaccine trial to investigate safety and effectiveness at reducing shedding in local-breed goats in endemic settings. This study will generate baseline longitudinal on shedding and infection patterns that will inform development of transmission models and will be integrated with economic models to evaluate a range of potential intervention strategies.

In addition to developing pathogen-specific interventions, our research activities will contribute to strengthening interdisciplinary capacity for One Health interventions that can be applied to a wider range of zoonoses. Our partnership with the Tanzanian One Health Coordination Desk (OHCD) in the Prime Minister's Office will ensure that the findings from this research will directly inform the Tanzanian One Health Strategic Plan through a series of stakeholder workshops to support knowledge exchange and effective communication with policymakers.

Technical Summary

This project will address key areas of One Health intervention research to prevent and control zoonotic diseases in poor livestock-keeping communities in Tanzania, focusing on: (i) interventions delivered through the medical sector to improve diagnostic testing and clinical management of human zoonotic diseases; (ii) community-led approaches to develop behavioural and livestock management interventions; and (iii) animal interventions implemented by veterinary service providers.

The project builds directly from earlier ZELS research that demonstrate clear potential for application and impact, focussing on pastoral systems where zoonotic disease impact is greatest. The work will involve linked activities to develop disease-specific interventions against brucellosis and Q fever, alongside community-led strategies that have potential to reduce impacts across multiple pathogens. The research will also strengthen interdisciplinary and cross-sectoral capacity for One Health interventions that can be applied to a wider range of zoonoses.

Medical-sector interventions will address the problem of mis-diagnosis of zoonotic febrile illness. Research will involve laboratory verification of an existing human brucellosis diagnostic test as a first step towards roll-out across Tanzania, and a healthcare utilisation survey to identify appropriate points for improving healthcare access and delivery. Community-based activities will involve novel participatory action research to develop and implement interventions that engage community co-researchers alongside academic researchers. Animal-based studies will involve a C. burnetii vaccine trial to investigate safety and effectiveness at reducing shedding in local-breed goats. This study will also generate baseline longitudinal on shedding and infection patterns that will inform parameterisation of transmission models, which will be incorporated with economic models to evaluate a range of potential intervention strategies.

Planned Impact

This project will build on platforms and strengthen capacities that span healthcare systems to develop interventions for the prevention and control of multiple zoonoses in Tanzania. The outputs of this project will inform the ongoing development and implementation of control policy in Tanzania for brucellosis and Q fever and the capacity established has potential to translate to other zoonoses. Further, the proposed co-development of interventions that target animal or environmental sources of infection (e.g. through participatory action research) has the potential to address risk factors that are common to multiple zoonoses and livestock disease problems.

The primary beneficiaries of this project will be pastoral livestock-keeping communities in Tanzania, who among the poorest communities and whose lives and livelihoods are most threatened by livestock zoonoses. However, the project will have potential for broader impact across livestock-keeping communities East Africa which have previously been identified as zoonoses hotspots (1).

Our research indicates that prevention and control of livestock zoonotic diseases in pastoral communities will have substantial benefits for human health and livelihoods. Our research has shown impacts of zoonotic diseases relating to: (i) human health, with high levels of human infection and disease caused by zoonotic pathogens; (ii) livestock productivity, with zoonoses being both a cause and a consequence of livestock production losses; and (iii) household livelihoods, with livestock abortion losses being associated with reduced spending on education and increased expenditure on food and livestock management.

These disease impacts present an obstacle to achieving Sustainable Development Goals, including ending poverty (SDG1), ending hunger (SDG2), achieving good health and well-being (SDG3), and education access and performance (SDG4). In relation to SDG3 specifically, the project will make a direct contribution to meeting targets on Universal Health Coverage through improved diagnostic capacity and management of human febrile illness across Tanzania and will support Tanzania in meeting targets on neglected diseases and specific zoonotic diseases identified as priorities through the Global Health Security Agenda prioritization exercise (2). By addressing cross-cutting SDGs and multiple targets within the SDGs, the project has further potential to contribute to expanded systems of health that have been advocated for sustainable development (3).

The project has been designed specifically to generate the evidence needed to address key gaps in knowledge and to build One Health intervention capacity across multiple sectors.

This will benefit national government policy makers, including Ministries of Health, Livestock, Local and Regional Governments, international agencies (e.g. WHO, OIE, FAO) and NGOs involved in rural development, human health and livestock health and production. Several project objectives are designed to map to the National Strategy for Brucellosis in Tanzania, with direct policy relevance. The project will also strengthen capacity for interdisciplinary research and intervention science, which will have broader impacts (see also Academic Beneficiaries).


1. Grace D. et al. 2012. Mapping of poverty and likely zoonoses hotspots. Report to DfID. ILRI.
2. CDC. 2018. One Health Zoonotic Disease Prioritization for Multisectoral Engagement in Tanzania. https://www.cdc.gov/onehealth/pdfs/tanzania-report-508.pdf
3. Dye C. 2018. Science 359(6382): 1337

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