Parallel multi-criteria decision analysis for sub-national prioritization of zoonoses and animal diseases in Africa: The case of Cameroon.

The use of multi-criteria decision analysis (MCDA) for disease prioritization at the sub-national level in sub-Sahara Africa (SSA) is rare. In this research, we contextualized MCDA for parallel prioritization of endemic zoonoses and animal diseases in The Adamawa and North regions of Cameroon. MCDA was associated to categorical principal component analysis (CATPCA), and two-step cluster analysis. Six and seven domains made of 17 and 19 criteria (out of 70) respectively were selected by CATPCA for the prioritization of zoonoses and animal diseases, respectively. The most influencing domains were "public health" for zoonoses and "control and prevention" for animal diseases. Twenty-seven zoonoses and 40 animal diseases were ranked and grouped in three clusters. Sensitivity analysis resulted in high correlation between complete models and reduced models showing the robustness of the simplification processes. The tool used in this study can be applied to prioritize endemic zoonoses and transboundary animal diseases in SSA at the sub-national level and upscaled at the national and regional levels. The relevance of MCDA is high because of its contextualization process and participatory nature enabling better operationalization of disease prioritization outcomes in the context of African countries or other low and middle-income countries.

Antibiotic Residues in Foods of Animal Origin in Cameroon: Prevalence, Consumers' Risk Perceptions, and attitudes.

The use of antibiotics in food animals and the nonobservance of the withdrawal period might result in the accumulation and persistence of residues in foods. The contamination of foods by antibiotic residues might induce health risks including allergy, gastrointestinal dysbiosis, antimicrobial resistance, and cancer to consumers. Therefore, this study was initiated to investigate the presence of antibiotic residues in raw eggs, raw milk, and beef collected at the wholesale and retail points in the three major cities of Cameroon and consumers' perceptions of the risk of antibiotic residues in foods. Qualitative antibiotic residue kits (PremiTest® and Delvotest®) were used to screen 407 samples of foods collected in markets of three towns (Ngaoundéré, Yaoundé, and Douala) in Cameroon. A structured questionnaire was used to evaluate the knowledge and attitudes of 1462 consumers toward microbial drug residues in foods of animal origin. Prevalence of residues of 70.55%, 17.39%, and 69.63% for beef, eggs, and milk, respectively, was observed. More than 1/3 of the respondents believed that the consumption of contaminated foods with antibiotic residues is a risk to their health and thought that allergies and intoxication they often experience are related to the consumption of contaminated foods. Most of them showed their willingness to pay more to acquire quality foods, free from antibiotic residues.

Zoo-Sanitary Situation Assessment, an Initial Step in Country Disease Prioritization Process: Systematic Review and Meta-Analysis from 2000 to 2020 in Cameroon.

To prevent and/or control infectious diseases in animal and human health, an appropriate surveillance system based on suitable up-to-date epidemiological data is required. The systematic review protocol was designed according to the PRISMA statement to look at the available data on infectious diseases of livestock in Cameroon from 2000-2020. Data were searched through online databases. Grey literature was comprised of dissertations and theses from veterinary higher education institutions in Cameroon. A random-effects model was used to calculate pooled prevalence using Comprehensive Meta-Analysis Software. Based on disease prevalence, major infectious diseases of livestock in Cameroon were gastrointestinal parasitosis (57.4% in cattle, 67.2% in poultry, 88% in pigs), hemoparasites (21.6% in small ruminants, 19.7% in cattle), bovine pasteurellosis (55.5%), fowl salmonellosis (48.2%), small ruminant plague (39.7%), foot-and-mouth disease (34.5% in cattle), and African swine fever (18.9%). Furthermore, other important endemic zoonoses in the country included: Rift Valley fever (10.9% in cattle, 3.7% in small ruminants), brucellosis (7% in cattle, 8% in pigs), bovine tuberculosis (4.7% in cattle), hepatitis E virus (8.4% in pigs) and bovine leptospirosis (2.5%). Most of the retrieved research were carried out in the Adamawa, Northwest, and West regions of Cameroon. The evaluation of existing data as evidence, albeit publication-specific, is an important step towards the process of prioritizing animal diseases, including zoonoses.

First Expert Elicitation of Knowledge on Drivers of Emergence of Bovine Besnoitiosis in Europe.

Bovine besnoitiosis (BB) is a chronic and debilitating parasitic disease in cattle caused by the protozoan parasite Besnoitia besnoiti. South European countries are affected and have reported clinical cases of BB. However, BB is considered as emerging in other countries/regions of central, eastern and northern Europe. Yet, data on drivers of emergence of BB in Europe are scarce. In this study, fifty possible drivers of emergence of BB in cattle were identified. A scoring system was developed per driver. Then, the scoring was elicited from eleven recognized European experts to: (i) allocate a score to each driver, (ii) weight the score of drivers within each domain and (iii) weight the different domains among themselves. An overall weighted score was calculated per driver, and drivers were ranked in decreasing order of importance. Regression tree analysis was used to group drivers with comparable likelihoods to play a role in the emergence of BB in cattle in Europe. Finally, robustness testing of expert elicitation was performed for the seven drivers having the highest probability to play a key role in the emergence of BB: i.e., (i) legal/illegal movements of live animals from neighbouring/European Union member states or (ii) from third countries, (iii) risk of showing no clinical sign and silent spread during infection and post infection, (iv) as a consequence, difficulty to detect the emergence, (v) existence of vectors and their potential spread, (vi) European geographical proximity of the pathogen/disease to the country, and (vii) animal density of farms. Provided the limited scientific knowledge on the topic, expert elicitation of knowledge, multi-criteria decision analysis, cluster and sensitivity analyses are very important to prioritize future studies, e.g., the need for quantitative import risk assessment and estimation of the burden of BB to evidence and influence policymaking towards changing (or not) its status as a reportable disease, with prevention and control activities targeting, firstly, the top seven drivers. The present methodology could be applied to other emerging animal diseases.

Cross-Sectional Survey of Prophylactic and Metaphylactic Antimicrobial Use in Layer Poultry Farming in Cameroon: A Quantitative Pilot Study.

An evaluation of the patterns of antimicrobial use in livestock can help understand the increasing level of antimicrobial resistance worldwide. This study aimed at evaluating antimicrobial usage in modern layer poultry farms in the West Region of Cameroon. In this light, 70 layer poultry farms and 4 veterinary pharmacies were surveyed. Data on antimicrobial use were collected through interviews using a quantitative-frequency questionnaire and consultation of medical records. The four veterinary pharmacies sold a total of 2.8 tons of antimicrobials (active ingredients) during 2011. At the level of farms, 297 kg of antimicrobials (active ingredients) were used in the 50 layer poultry farms surveyed. Tetracycline, sulfonamides, quinolones, and ß-lactams (aminopenicillins) were the most sold and used drugs in layer farms. As for treatment indication, metaphylactic (58.1%) and prophylactic (41.9%) treatments were the most observed practices, and nearly all (99%) treatments were administered per os as remedies to respiratory (33.4%) and digestive (24.7%) tract symptoms. Overall, 78.2% of antimicrobials sold in pharmacies and 67.3% used in the farms belonged to the class of critically important antimicrobials of the WHO categorization of antimicrobials according to their importance to human medicine. Doxycycline, sulfonamide, ampicillin, and streptomycin, which have been banned for layer poultry in the production of eggs for human consumption, were still used in Cameroon. The treatment incidences based on the used daily dose (TIUDD) and animal daily dose (TIADD) were 11.59 and 10.45, respectively. In regard to dosage correctness based on the UDD/ADD ratio, aminoglycosides (100%), macrolides (90.6%), and tetracyclines (74.5%) were the most underdosed, while trimethoprim sulfonamides (45.8%) and ß-lactams (35.7%) were overdosed. This study highlights an irrational antimicrobial usage in layer poultry farms. Regulation of the use of antimicrobials and the education of farmers on adequate antimicrobial use are essential to preserve the effectiveness of drugs in both humans and animals.

Main determinants of the acceptance of COVID-19 control measures by the population: A first pilot survey at the University of Liege, Belgium.

BACKGROUND: In order to control the COVID-19 pandemic, barrier gestures were used to reduce the transmission of the virus within a community and avoid large peaks of infections with the risk of overwhelming the healthcare systems. The acceptability of these measures is the backbone of their successful implementation. However, population compliance with these measures within a community is uncertain, even when mandatory. At the beginning of the 2020-2021 academic year, the University of Liege complemented these measures, by organizing a weekly screening by saliva testing on a voluntary basis for all its workers and students. Their compliance with the different measures was necessary for effective control program and an intensive communication plan was implemented throughout the 2020-2021 academic year for that purpose METHOD AND PRINCIPAL FINDINGS: An online survey was launched upon the implementation of the saliva testing in order (i) to assess the level of acceptance of the different measures by the university workers and students and (ii) to identify the factors determining their acceptance (based on the Health Belief Model) and their reported level of implementation. A total of 921 responses was received and analysed by sub-group comparison, structural equation modelling and multivariable ordinal logistic regression. Health motivation, susceptibility, severity and perception of benefits were identified as the key determinants of protective measures acceptance CONCLUSION AND SIGNIFICANCE: In order to influence positively these mental constructs and to increase the level of implementation of control measures, it is therefore recommended to raise the awareness of the university workers and students about their self and collective responsibility to protect themselves and the population at risk that can be severely affected by the disease. The non-medical faculties (i.e. the Faculty of Medicine and the Faculty of Veterinary Medicine excluded) should be specifically targeted as their heath motivation was significantly lower. This survey demonstrates that the risk mitigation strategies against COVID-19 should integrate the importance of individual perception. The methodology developed in this survey can be generalised in space and time, in different contexts.

Emergence of Besnoitia besnoiti in Belgium.

Bovine besnoitiosis is a cattle disease caused by a protozoan parasite called Besnoitia besnoiti. It is of serious economic concern to the cattle industry and also compromises animal welfare. For several years, it has been considered an emerging disease in some countries and regions located in the north of Europe far away from the known endemic areas in the south. This study describes the situation in the southern part of Belgium, where the parasite was recently introduced through imports of animals coming from departments of France where the disease was present. It details the detection of clinical cases as well as disease transmission features related to contacts during grazing and sales of infected cattle. A tracking and monitoring system was quickly set up and detected twelve outbreaks. Several cattle were controlled, but the lack of appropriate regulations weakens disease-management efforts. Hopefully, this predictable and silent introduction triggers the awareness of decision-makers about the need for an appropriate prevention and control policy, law enforcement, and the implementation of necessary measures to avoid bovine besnoitiosis becoming endemic in Belgium or other non-endemic countries. In addition, more proactive surveillance is required from authorities through threat analysis in the context of the risk of emergence or re-emergence of infectious animal diseases.

Critical Systematic Review of Zoonoses and Transboundary Animal Diseases' Prioritization in Africa.

BACKGROUND: Disease prioritization aims to enhance resource use efficiency concerning human and animal health systems' preparedness and response to the most important problems for the optimization of beneficial outcomes. In sub-Sahara Africa (SSA), several prioritizations of zoonoses and transboundary animal diseases (TADs) have been implemented at different scales to characterize potential disease impacts. Method and principal findings: In this systematic review, we analyze the methodologies used, outcomes, and their relevance by discussing criteria required to align decision-makers' perceptions of impacts to those of other stakeholders for different prioritization in SSA. In general, the sectorial representativeness of stakeholders for processes implemented with the support of international partners showed slight differences with the absence of local stakeholders. Whatever the tool prioritized, zoonoses were similar in general because of the structured nature of those tools in assessing decision-makers' preferences through value trade-offs between criteria while ensuring transparency and reproducibility. However, by involving field practitioners and farmers, there were different outcomes with processes concerning only decision makers and experts who were more sensitive to infectious TADs, while the former raised parasitic disease constraints. In this context, multicriteria decision analysis-based zoonoses and TADs prioritizations involving a balanced participation of stakeholders might contribute to bridging these divergences, whatever the scale. CONCLUSION AND SIGNIFICANCE: Prioritization processes were important steps toward building and harmonizing technical laboratory and surveillance networks to coordinate projects to address priority zoonoses and TADs at the country and/or sub-regional level. Those processes should be enhanced.

Prescription Pattern of Antimicrobial Use in Small Animal Veterinary Practice in Cameroon.

Retrospective data on antimicrobial use (AMU) within the period ranging from January 2012-December 2015 was collected to assess the antimicrobial prescription patterns in pets (cats and dogs) treated by 16 veterinary private practitioners in the 2 main urban cities of Cameroon (Douala and Yaounde). The vet practitioners were interviewed in order to analyze prescribing behavior and factors influencing antimicrobial prescription. Out of a total of 3928 antimicrobial prescriptions, 3673(93.5%) were recorded in dogs and 255 (6.5%) in cats during the study period in 7 veterinary clinics. The most prescribed antimicrobials were sulfamethoxypyridazine-trimethoprim (dog: 31.2%; cat: 28.6%), benzylpenicillin-streptomycin (dogs:19.0%; cat:21.9%) and marbofloxacin (dogs:18.3%; cats:16.1%). Almost, 64.6% of antimicrobial prescription in dogs was categorized as highly important antimicrobials and 34.9% as critically important antimicrobial agents. In cats, 77.9% of antimicrobial prescription was categorized as highly important antimicrobials and 22.1% as critically important antimicrobial agents. Antimicrobials were mostly used for gastro-intestinal disorders (31.9%) and skin diseases (24. 1%) in dogs while they were mostly applied for surgical problems (29.8%), musculo-skeletal disease (20.4%) and gastro-intestinal tract diseases (19.6%) in cats. Fluoroquinolones were administered as first option instead of third option. Antimicrobials were associated with other veterinary drugs (anti-inflammatory, internal and external parasite therapy) in 75.3% of cases. The prescription of antimicrobials was based on clinical diagnosis (symptom-based), ease of drug administration, owner's purchasing power and antibiogram. This study highlights the necessity to promote antimicrobial stewardship in pet medicine in Cameroon. Confirmatory diagnosis and antibiotic susceptibility testing before antibiotic prescription should be encouraged. The uncontrolled use of critically important antimicrobials for human medicine and especially their indiscriminate use may favor the occurrence of AMR public health issues.

Challenges of antimicrobial consumption surveillance in food-producing animals in sub-Saharan African countries: Patterns of antimicrobials imported in Cameroon from 2014 to 2019.

OBJECTIVE: Antimicrobial consumption surveillance is a useful tool for planning antimicrobial resistance control strategies and risk analysis. The present study was carried out to evaluate the consumption trends of antimicrobials for veterinary use in food-producing animals in Cameroon from 2014 to 2019. METHODS: Data on quantities of classes of active substances were collected from the records of the technical authorization to import veterinary drugs of suppliers' invoices at the Ministry of Livestock (MINEPIA); animal population data were collected from the FAO-Stat database. RESULTS: The study revealed that 217.67tonnes of antimicrobials (by weight of active substance) were imported during the 6-year period, with an average of 36.28±10.11tonnes per year. Tetracyclines (31.71%), sulfonamides (23.84%), quinolones (11.11%) and ß-lactams (10.17%) were the most commonly imported classes of antimicrobials. With regard to the importance of veterinary antimicrobials to human medicine, critically important antimicrobial (34.3%), reserve (4.6%) and watch (25.5%) groups as classified by the WHO AWaRe categorization were recorded. Overall, a mean of 5.24±1.40mg/PCU (population correction unit) was used in all food-producing animals during the 6-year period. However, the mean quantity of antimicrobials adjusted by animal biomass was highest in poultry (213.32±50.26mg/kg), followed by pigs (63.04±18.87mg/kg), cattle (4.11±2.20mg/kg), sheep (0.83±0.43mg/kg) and goats (0.47±0.24mg/kg). CONCLUSION: Strict surveillance systems of antimicrobial consumption in the country are vital to optimize control strategies. Monitoring importation data of veterinary antimicrobial products could be useful for sub-Saharan African countries to quantify consumption and estimate trends for antimicrobial usage effectively.

Veterinary pharmacovigilance in sub-Sahara Africa context: a pilot study of adverse reactions to veterinary medicine in Cameroon.

BACKGROUND: Sub-Saharan African market is highly affected by counterfeit veterinary drugs. Though these counterfeit and non-compliance of drugs can induce adverse effects during their utilization, there is no monitoring system of veterinary medicines. The present pilot study was carried out in Cameroon to identify and describe suspected cases of adverse reactions to veterinary drugs in animals and / or humans as well as inefficacy of veterinary drugs. The methodology involved a descriptive cross-sectional survey of 67 actors in the veterinary medicine sector in Cameroon. RESULTS: A total of 74/120 (62%) cases of suspected adverse effects and or lack of efficacy of veterinary drugs in animals and 46 (38%) cases of adverse reactions in humans were identified. Antiparasitics were the most incriminated therapeutic class in animals (61%) and human (56%). Adverse reactions were reported in dogs (44%) and poultry (24%) while drug inefficacy was most observed in poultry (47%). According to animal health professionals, levamisole (24%) and ivermectin (16%) were identified to be responsible for the adverse effects and that the highest level of inefficacy was most frequently reported for oxytetracycline (29%). The main adverse reactions were systemic (22%), gastrointestinal (20%) and neurological (13%) disorders. CONCLUSION: The results of this study showed that misuse and circulation of poor quality as well as lack of efficacy of veterinary drugs is very common in Cameroon. Adverse reactions were observed in animals and humans. Therefore, the establishment of a national veterinary pharmacovigilance system based on solid legal bases is essential for a continuous assessment of the risks-benefits effects of veterinary drugs marketed in Cameroon.