After-action review of rabies and anthrax outbreaks multisectoral response in Tanzania, challenges and lessons.

After-action review uses experiences gained from past events to adopt best practices, thereby improving future interventions. In December 2016 and late 2018, the government of Tanzania with support from partners responded to anthrax and rabies outbreaks in Arusha and Morogoro regions respectively. The One Health Coordination Desk (OHCD) of the Prime Minister's Office (PMO) later coordinated after-action reviews to review the multi-sectoral preparedness and response to the outbreaks. To establish and describe actions undertaken by the multi-sectoral investigation and response teams during planning and deployment, execution of field activities, and outbreak investigation and response, system best practices and deficiencies. These were cross-sectional surveys. Semi-structured, open and closed-ended questionnaire and focus group discussions were administered to collect information from responders at the national and subnational levels. It was found that the surveillance and response systems were weak at community level, lack of enforcement of public health laws including vaccination of livestock and domestic animals and joint preparedness efforts were generally undermined by differential disease surveillance capacities among sectors. Lack of resources in particular funds for supplies, transport and deployment of response teams contributed to many shortfalls. The findings underpin the importance of after-action reviews in identifying critical areas for improvement in multi-sectoral prevention and control of disease outbreaks. Main sectors under the coordination of the OHCD should include after action reviews in their plans and budget it as a tool to continuously assess and improve multi-sectoral preparedness and response to public health emergencies.

Occurrence and Determination of Antimicrobial Resistant Escherichia coli Isolates in Fish and Vegetables as Indicator Organism of Faecal Contamination in Dar es Salaam, Tanzania.

Escherichia coli such as E. coli O157:H7, a non-sorbitol-fermenting (NSF) E. coli, is an essential human pathogen among other common zoonotic pathogens carried by animals especially cattle. They are discharged through cattle faeces into the environment. With the increasing practice of urban farming, livestock manure is used as organic fertiliser in either fish ponds or vegetable gardens. This practice increases the risk of transmission of such pathogens to humans. This study aimed at determining the occurrence, antimicrobial resistance profiles, and genetic relatedness of E. coli isolates from manure, vegetables, and fish. Microbiological standard methods were used to isolate and identify E. coli isolates from manure, vegetable, and fish samples. Confirmed isolates on biochemical tests were tested for resistance against six antibiotics using the disc diffusion method. Enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) typing method was used to generate fingerprints and determine the genetic relatedness of the E. coli isolates. Of 156 samples including 89 manure, 53 vegetables, and 16 fish, 36 (23.1%) samples were positive for E. coli from where a total of 48 E. coli different isolates were recovered that were subjected to antimicrobial susceptibility testing and genetic relatedness. Of these isolates, 25 (52.1%) were resistant to at least one antimicrobial agent and 12 (48.0%) showed multidrug resistance. ERIC-PCR profiles of E. coli isolates from manure, vegetables, and fish showed genetic diversity with genetic relatedness ranging from 74.5% to 100%. Nine phylogenetic clusters (I-IX) determined at 90% threshold level of genetic relatedness were identified among the isolates. This study determined the occurrence, antimicrobial resistant patterns, and genetic diversity of antimicrobial-resistant E. coli isolates from different sources. This study showed the potential of microbial health risk to humans through contamination, and hence, it is necessary to monitor and improve husbandry practices in urban farming.

Building a functional national One Health platform: the case of Tanzania.

BACKGROUND: The USAID Preparedness and Response (P&R) project's publication on Multisectoral Coordination that Works identified five dimensions most critical to creating effective and sustainable One Health platforms: political commitment, institutional structure, management and coordination capacity, technical and financial resources, and joint planning and implementation. This case study describes Tanzania experience in using these dimensions to establish a functional One Health platform. The main objective of this case study was to document the process of institutionalizing the One Health approach in Tanzania. METHODS: An analysis of the process used to establish and institutionalize the MCM in Tanzania through addressing the five dimensions mentioned above was conducted between August 2018 and January 2019. Progress activity reports, annual reports and minutes of meetings and consultations regarding the establishment of the Tanzania national One Health platform were examined. Relevant One Health publications were studied as reference material. RESULTS: This case study illustrates the time and level of effort required of multiple partners to build a functional multi-sectoral coordinating mechanism (MCM). Key facilitating factors were identified and the importance of involving policy and decision makers at all stages of the process to facilitate policy decisions and the institutionalization process was underscored. The need for molding the implementation process using lessons learnt along the way -- "sailing the ship as it was being built" -- is demonstrated. CONCLUSIONS: Tanzania now has a functioning and institutionalized MCM with a sound institutional structure and capacity to prevent, detect early and respond to health events. The path to its establishment required the patient commitment of a core group of One Health champions and stakeholders along the way to examine carefully and iteratively how best to structure productive multisectoral coordination in the country. The five dimensions identified by the Preparedness and Response project may provide useful guidance to other countries working to establish functional MCM.

Post-Ebola Awakening: Urgent Call for Investing in Maintaining Effective Preparedness Capacities at the National and Regional Levels in Sub-Saharan Africa.

BACKGROUND: The 2014 Ebola outbreak reminded us of the importance of preparedness for addressing health security threats. Learning from this experience, we aim to (1) enhance the understanding of preparedness by policy and decision makers, (2) discuss opportunities for Africa to invest in the prevention of health security threats, (3) highlight the value of investing in preventing health security threats, and (4) propose innovations to enhance investments for the prevention or containment of health security threats at the source. METHODS: We used observations of governments' attitudes towards investing in preparedness for health security prevention or containment at the source. We conducted a literature review through PubMed, the World Wide Web, and Mendeley using the keywords: "health emergency financing", "investing in health threats prevention", and "stopping outbreaks at the source". RESULTS: Countries in sub-Saharan Africa invest inadequately towards building and maintaining critical capacities for preventing, detecting, and containing outbreaks at the source. Global health security emergency funding schemes target responses to outbreaks but neglect their prevention. Governments are not absorbing and maintaining adequately capacity built through GHS, World Bank, and development aid projects - a lost opportunity for building and retaining outbreak prevention capacity. RECOMMENDATIONS: Governments should (1) allocate adequate national budgets for health honouring the Abuja and related commitments; (2) own and maintain capacities developed through International Development Aids, OH networks, research consortia and projects; (3) establish a regional health security threats prevention fund. The global community and scientists should (1) consider broadening existing health emergency funds to finance the prevention and containment outbreaks at the source and (2) Strengthen economic analyses and case studies as incentives for governments' budget allocations to prevent health security threats.

Sero-prevalence and associated risk factors of peste des petits ruminants and contagious caprine pleuro-pneumonia in goats and sheep in the Southern Zone of Tanzania.

A retrospective Sero-prevalence analysis was conducted in 2012 in order to find out whether contagious caprine pleuro-pneumonia (CCPP) and peste des petits ruminants (PPR) had already been introduced in Mtwara and Lindi regions of Southern Tanzania by 2007 and 2009. A total of 477 randomly selected sera from a bank of 3500 small ruminant samples that were collected as part of Rift Valley Fever surveillance of 2007 in Mtwara and Lindi regions were used in this study. Seroconversion was also evaluated in the 504 sera that were collected in 2009 as part of disease outbreak investigations in Tandahimba and Newala districts of Mtwara region. Seroconversions to CCPP and PPR were tested using competitive ELISA. In addition, information on different variables available in the existing surveillance forms gathered during sampling was used in the analysis of risk factors associated with seropositivity to the two diseases. The overall seroprevalence of CCPP for the sera of 2007 and 2009 in goats was 52.1% (n=447) and 35.5% (n=434) respectively; while in sheep the seroprevalence was 36.7% (n=30) and 22.9% (n=70) respectively. Seroconversion to PPR in goats and sheep was 28.7% (n=434) and 35.7% (n=70) respectively based on the sera of 2009. However, no antibodies were detected in the 2007 sera. Mixed infections were detected in 7.4% (n=434) of the goat and 12.9% (n=70) of sheep samples. Significant risk factors associated with seropositivity to CCPP in 2007 included introduction of new animals in flocks (OR=3.94; 95% CI 1.86-8.36; p<0.001) and raising animals in government farms (OR=4.92; 95% CI 1.57-15.76; p=0.02); whereas, seropositivity to CCPP in 2009 increased with introduction of new animals in flocks (OR=18.82; 95% CI 8.06-43.96; p<0.001), raising animals in government farms (OR=4.04; 95% CI 2.69-6.42; p<0.001) and raising animals in Newala district (OR=2.35; 95% CI 1.53-3.62; p<0.001). On the other hand, predictors for seropositivity to PPR in 2009 were introduction of new animals in flocks (OR=2.83; 95% CI 1.73-4.62; p<0.001) and communal grazing of animals (OR=7.60; 95% CI 1.77-32.58; p=0.01). Therefore, these results show that CCPP was already circulating in goats in the southern zone by 2007 and that PPR was probably introduced thereafter. Their presence in this emerging animal keeping area in Tanzania calls for improved surveillance and control systems.

Practice of One Health approaches: bridges and barriers in Tanzania.

The practice of one health approaches in human and animal health programmes is influenced by type and scope of bridges and barriers for partnerships. It was thus essential to evaluate the nature and scope of collaborative arrangements among human, animal, and wildlife health experts in dealing with health challenges which demand inter-sectoral partnership. The nature of collaborative arrangement was assessed, and the respective bridges and barriers over a period of 12 months (July 20011 to June 2012) were identified. The specific objectives were to: (1) determine the proportion of health experts who had collaborated with other experts of disciplines different from theirs, (2) rank the general bridges for and barriers against collaboration according to the views of the health experts, and (3) find the actual bridges for and barriers against collaboration among the health experts interviewed. It was found that 27.0% of animal health officers interviewed had collaborated with medical officers while 12.4% of the medical officers interviewed had collaborated with animal health experts. Only 6.7% of the wildlife officers had collaborated with animal health experts. The main bridges for collaboration were instruction by upper level leaders, zoonotic diseases of serious impacts, and availability of funding. The main barriers for collaboration were lack of knowledge about animal/human health issues, lack of networks for collaboration, and lack of plans to collaborate. This thus calls for the need to curb barriers in order to enhance inter-sectoral collaboration for more effective management of risks attributable to infectious diseases of humans and animals.

The Southern African Centre for infectious disease surveillance: a one health consortium.

Formed in 2008, the Southern African Centre for Infectious Disease Surveillance (SACIDS) is a One Health consortium of academic and research institutions involved with infectious diseases of humans and animals. Operating in partnership with world-renowned centres of research in industrialised countries, its mission is to harness innovations in science and technology for improving southern Africa's capacity to detect, identify, monitor (DIM) and manage the risk posed by infectious diseases of humans, animals, and ecosystems. The consortium's major capacity development activities include a series of One Health-based Master of Science (MSc) courses and a five-year DIM-driven research program. Additionally, SACIDS organized Africa's first One Health conference, in July 2011. This paper describes these and other major activities that SACIDS has undertaken to improve infectious disease surveillance across southern Africa. The paper also describes the role and collaboration of SACIDS with other national, regional and international consortia/networks that share a vision and interest in promoting novel approaches to infectious disease surveillance and outbreak response.

Development of a One Health National Capacity in Africa : the Southern African Centre for Infectious Disease Surveillance (SACIDS) One Health Virtual Centre Model.

Among the many challenges to health, infectious diseases stand out for their ability to have a profound impact on humans and animals. The recent years have witnessed an increasing number of novel infectious diseases. The numerous examples of infections which originated from animals suggest that the zoonotic pool is an important and potentially rich source of emerging diseases. Since emergence and re-emergence of pathogens, and particularly zoonotic agents, occur at unpredictable rates in animal and human populations, infectious diseases will constitute a significant challenge for the public health and animal health communities in the twenty-first century. The African continent suffers from one of the highest burdens of infectious diseases of humans and animals in the world but has the least capacity for their detection, identification and monitoring. Lessons learnt from recent zoonotic epidemics in Africa and elsewhere clearly indicate the need for coordinated research, interdisciplinary centres, response systems and infrastructures, integrated surveillance systems and workforce development strategies. More and stronger partnerships across national and international sectors (human health, animal health, environment) and disciplines (natural and social sciences) involving public, academic and private organisations and institutions will be required to meet the present and future challenges of infectious diseases. In order to strengthen the efficiency of early warning systems, monitoring trends and disease prediction and timely outbreak interventions for the benefit of the national and international community, it is essential that each nation improves its own capacity in disease recognition and laboratory competence. The SACIDS, a One Health African initiative linking southern African academic and research institutions in smart partnership with centres of science excellence in industrialised countries as well as international research centres, strives to strengthen Africa's capacity to detect, identify and monitor infectious diseases of humans and animals, to better manage health and socio-economic risks posed by them, and to improve research capacity in investigating the biologic, socio-economic, ecologic and anthropogenic factors responsible for emergence and re-emergence of infectious diseases.

A socio-economic approach to One Health policy research in southern Africa.

One-health approaches have started being applied to health systems in some countries in controlling infectious diseases in order to reduce the burden of disease in humans, livestock and wild animals collaboratively. However, one wonders whether the problem of lingering and emerging zoonoses is more affected by health policies, low application of one-health approaches, or other factors. As part of efforts to answer this question, the Southern African Centre for Infectious Disease Surveillance (SACIDS) smart partnership of human health, animal health and socio-economic experts published, in April 2011, a conceptual framework to support One Health research for policy on emerging zoonoses. The main objective of this paper was to identify which factors really affect the burden of disease and how the burden could affect socio-economic well-being. Amongst other issues, the review of literature shows that the occurrence of infectious diseases in humans and animals is driven by many factors, the most important ones being the causative agents (viruses, bacteria, parasites, etc.) and the mediator conditions (social, cultural, economic or climatic) which facilitate the infection to occur and hold. Literature also shows that in many countries there is little collaboration between medical and veterinary services despite the shared underlying science and the increasing infectious disease threat. In view of these findings, a research to inform health policy must walk on two legs: a natural sciences leg and a social sciences one.

Analysis of host genetic factors influencing African trypanosome species infection in a cohort of Tanzanian Bos indicus cattle.

Trypanosomosis caused by infection with protozoan parasites of the genus Trypanosoma is a major health constraint to cattle production in many African countries. One hundred and seventy one Bos indicus cattle from traditional pastoral Maasai (87) and more intensively managed Boran (84) animals in Tanzania were screened by PCR for the presence of African animal trypanosomes (Trypanosoma congolense, Trypanosoma vivax and Trypanosoma brucei), using blood samples archived on FTA cards. All cattle screened for trypanosomes were also genotyped at the highly polymorphic major histocompatibility complex (MHC) class II DRB3 locus to investigate possible associations between host MHC and trypanosome infection. Overall, 23.4% of the 171 cattle tested positive for at least one of the three trypanosome species. The prevalence of individual trypanosome species was 8.8% (T. congolense), 4.7% (T. vivax) and 15.8% (T. brucei). The high prevalence of T. brucei compared with T. congolense and T. vivax was unexpected as this species has previously been considered to be of lesser importance in terms of African bovine trypanosomosis. Significantly higher numbers of Maasai cattle were infected with T. brucei (23.0%, p=0.009) and T. congolense (13.8%, p=0.019) compared with Boran cattle (8.3% and 3.6%, respectively). Analysis of BoLA-DRB3 diversity in this cohort identified extensive allelic diversity. Thirty-three BoLA-DRB3 PCR-RFLP defined alleles were identified. One allele (DRB3*15) was significantly associated with an increased risk (odds ratio, OR=2.71, p=0.034) of T. brucei infection and three alleles (DRB3*35, *16 and *23) were associated with increased risk of T. congolense infection. While further work is required to dissect the role of these alleles in susceptibility to T. brucei and T. congolense infections, this study demonstrates the utility of FTA archived blood samples in combined molecular analyses of both host and pathogen.

Towards a conceptual framework to support one-health research for policy on emerging zoonoses.

In the past two decades there has been a growing realisation that the livestock sector was in a process of change, resulting from an expansion of intensive animal production systems and trade to meet a globalised world's increasing demand for livestock products. One unintended consequence has been the emergence and spread of transboundary animal diseases and, more specifically, the resurgence and emergence of zoonotic diseases. Concurrent with changes in the livestock sector, contact with wildlife has increased. This development has increased the risk of transmission of infections from wildlife to human beings and livestock. Two overarching questions arise with respect to the real and perceived threat from emerging infectious diseases: why are these problems arising with increasing frequency, and how should we manage and control them? A clear conceptual research framework can provide a guide to ensure a research strategy that coherently links to the overarching goals of policy makers. We propose such a new framework in support of a research and policy-generation strategy to help to address the challenges posed by emerging zoonoses.

Quantifying risk factors for human brucellosis in rural northern Tanzania.

BACKGROUND: Brucellosis is a zoonosis of veterinary, public health and economic significance in most developing countries. Human brucellosis is a severely debilitating disease that requires prolonged treatment with a combination of antibiotics. The disease can result in permanent and disabling sequel, and results in considerable medical expenses in addition to loss of income due to loss of working hours. A study was conducted in Northern Tanzania to determine the risk factors for transmission of brucellosis to humans in Tanzania. METHODS: This was a matched case-control study. Any patient with a positive result by a competitive ELISA (c-ELISA) test for brucellosis, and presenting to selected hospitals with at least two clinical features suggestive of brucellosis such as headache, recurrent or continuous fever, sweating, joint pain, joint swelling, general body malaise or backache, was defined as a case. For every case in a district, a corresponding control was traced and matched by sex using multistage cluster sampling. Other criteria for inclusion as a control included a negative c-ELISA test result and that the matched individual would present to hospital if falls sick. RESULTS: Multivariable analysis showed that brucellosis was associated with assisted parturition during abortion in cattle, sheep or goat. It was shown that individuals living in close proximity to other households had a higher risk of brucellosis. People who were of Christian religion were found to have a higher risk of brucellosis compared to other religions. The study concludes that assisting an aborting animal, proximity to neighborhoods, and Christianity were associated with brucellosis infection. There was no association between human brucellosis and Human Immunodeficiency Virus (HIV) serostatus. Protecting humans against contact with fluids and tissues during assisted parturition of livestock may be an important means of reducing the risk of transferring brucellosis from livestock to humans. These can be achieved through health education to the communities where brucellosis is common.

A longitudinal study on morbidity and mortality in youngstock smallholder dairy cattle with special reference to tick borne infections in Tanga region, Tanzania.

The incidence and potential determinants of tick borne diseases (TBDs) were estimated in a longitudinal study that was conducted in cohorts of youngstock animals of less than 3 years kept in smallholder dairy farms in Tanga region, Tanzania. A combination of serological tests, blood and lymph node smears were used as diagnostic tests for TBDs during the study. A total number of 549 youngstock were followed for a total of 532.2 animal years from August 1999 to July 2001. Overall morbidity and mortality rates (due to all causes) were 8.26 and 12.0 per 100 animals year at risk, respectively. Of the total deaths, 56% were attributed to TBDs (37.5%-East Coast fever (ECF) and 18%-anaplasmosis). Specific morbidity and mortality rates for ECF were estimated to be 3.57 and 4.51 per 100 animals year risk, respectively, and for anaplasmosis 2.21 and 2.25 per 100 animals year risk, respectively. Analysis of survival times to death indicated that calves < 6 months of age and those out on pasture had higher death rates than older calves and those kept under zero-grazing systems (relative risk [RR] 3.80, P = 0.001 for pasture-grazed calves). There was no mortality or morbidity arising specifically from cowdriosis (heartwater) or babesiosis during the whole period of monitoring. The study revealed that most farms were applying under strength acaricide and using acaricides at irregular intervals. It is concluded that TBDs namely ECF and anaplasmosis are important diseases in this farming system and reducing morbidity and mortality in smallholder dairy farms in Tanga region is an achievable goal. Both farmers and extension services should target at risk calves with the provision of both strict tick control and optimal husbandry management practices.

Health-seeking behaviour of human brucellosis cases in rural Tanzania.

BACKGROUND: Brucellosis is known to cause debilitating conditions if not promptly treated. In some rural areas of Tanzania however, practitioners give evidence of seeing brucellosis cases with symptoms of long duration. The purpose of this study was to establish health-seeking behaviour of human brucellosis cases in rural Tanzania and explore the most feasible ways to improve it. METHODS: This was designed as a longitudinal study. Socio-demographic, clinical and laboratory data were collected from patients who reported to selected hospitals in rural northern Tanzania between June 2002 and April 2003. All patients with conditions suspicious of brucellosis on the basis of preliminary clinical examination and history were enrolled into the study as brucellosis suspects. Blood samples were taken and tested for brucellosis using the Rose-Bengal Plate Test (RBPT) and other agglutination tests available at the health facilities and the competitive ELISA (c-ELISA) test at the Veterinary Laboratory Agencies (VLA) in the UK. All suspects who tested positive with the c-ELISA test were regarded as brucellosis cases. A follow-up of 49 cases was made to collect data on health-seeking behaviour of human brucellosis cases. RESULTS: The majority of cases 87.7% gave a history of going to hospital as the first point of care, 10.2% purchased drugs from a nearby drug shop before going to hospital and 2% went to a local traditional healer first. Brucellosis cases delayed going to hospital with a median delay time of 90 days, and with 20% of the cases presenting to hospitals more than a year after the onset of symptoms. Distance to the hospital, keeping animals and knowledge of brucellosis were significantly associated with patient delay to present to hospital. CONCLUSION: More efforts need to be put on improving the accessibility of health facilities to the rural poor people who succumb to most of the diseases including zoonoses. Health education on brucellosis in Tanzania should also stress the importance of early presentation to hospitals for prompt treatment.

A comparison of seroprevalence and risk factors for Theileria parva and T. mutans in smallholder dairy cattle in the Tanga and Iringa regions of Tanzania.

A cross sectional serological survey was carried out in two geographical small-scale dairying areas of Tanzania to determine the distribution and prevalence and to quantify risk factors for Theileria parva and T. mutans during the period January to April 1999. The prevalence of serum antibodies to these two Theileria parasites was determined using an indirect enzyme-linked immunosorbent assay (ELISA) technique. The results suggest that the parasites are widely distributed through out the two study sites and seroprevalence of 23% and 48% for T. parva were obtained for Tanga and Iringa regions, respectively. Seroprevalence of T. mutans ranged from 17% in the Tanga region to 40% in the Iringa region. Farm and animal data were collected and analysed by multiple logistic regression models to explore the risk factors associated with seroprevalence to T. parva and T. mutans pathogens. In both regions, seroprevalence for the two Theileria spp. pathogens increased significantly with age. Pasture grazed animals were more likely to be seropositive than those that were zero-grazed. Among individual animal characteristics, seropositivity was higher in cash-bought and charity gifted animals compared to cattle obtained using a formal credit agreement. Further studies on the relative role of risk factors for theileriosis found in this study may assist in the development of an effective control package.

Studies on mastitis, milk quality and health risks associated with consumption of milk from pastoral herds in Dodoma and Morogoro regions, Tanzania.

The prevalence of mastitis, milk quality and health risks associated with milk consumption were investigated on 96 randomly selected traditional herds in Dodoma rural and Mvomero districts of Tanzania. Mastitis was investigated based on clinical signs, microbiology and California mastitis test (CMT), while milk quality was evaluated using total viable count (TVC)and total coliform count (TCC). Animals were tested for tuberculosis using a single comparative intradermal tuberculin test. The prevalence of subclinical mastitis based on CMT was low (8.3%). The major isolates were Staphylococcus aureus (35.3%), other staphylococci (20.8%), coliforms (27.7%), microcci (5.8%) and streptococci (9.8%). The average TVC of milk in Dodoma rural district (1.0 x 10(7) +/- 3.4 x 10(7)) was significantly higher than that in Mvomero district (8.9 x 10 (5) 3.5 x 10(6)) (p < 0.001) and the proportion of TCC-positive samples in Dodoma (70.7%) were significantly higher (p < 0.001) than that of Mvomero sample(20.8%). Whereas no tuberculin reactor animal was detected in the study animals, atypical mycobacteria were isolated from milk and one sample from Dodoma had Mycobacterium tuberculosis. Knowledge on health risks associated with milk consumption was low (20.8%). It is concluded that lack of awareness on health risks associated with milk consumption amongst rural communities needs to be addressed in order to safeguard their health.