Availability of over-the-counter antibiotics in Guatemalan corner stores.

Widespread availability of antibiotics without prescription potentially facilitates overuse and contributes to selection pressure for antimicrobial resistant bacteria. Prior to this study, anecdotal observations in Guatemala identified corner stores as primary antibiotic dispensaries, where people purchase antibiotics without prescriptions. We carried out a cross sectional study to document the number and types of antibiotics available in corner stores, in four study areas in Guatemala. A total of 443 corner stores were surveyed, of which 295 (67%) sold antibiotics. The most commonly available antibiotics were amoxicillin, found in 246/295 (83%) stores, and tetracycline, found in 195/295 (66%) stores. Over the counter sales result from laissez-faire enforcement of antibiotic dispensing regulations in Guatemala combined with patient demand. This study serves as a baseline to document changes in the availability of antibiotics in informal establishments in light of new pharmacy regulations for antibiotic dispensing, which were adopted after this study was completed.

Mortality as the primary constraint to enhancing nutritional and financial gains from poultry: A multi-year longitudinal study of smallholder farmers in western Kenya.

BACKGROUND: Chickens are a widely held economic and nutritional asset in rural Africa and are frequently managed by women. Despite potential benefits of larger flock sizes, the average number of chickens kept at the household level is reported to be low. Whether this reflects decision-making to maximize benefits per unit labor by voluntary reduction of chicken numbers by consumption or sale versus involuntary losses due to mortality is a significant gap in knowledge relevant to improving smallholder household welfare. METHODS: In a 4-year longitudinal study of 1,908 smallholder households in rural western Kenya, the number of chickens owned by quarterly census at each household was determined. Households reported gains and losses of chicken over the immediate previous quarter. Gains were classified as on-farm or off-farm; losses were classified as voluntary (sales, gifts, consumption) or involuntary (mortality, unclassified loss). RESULTS: The mean number of chickens owned over the 16 quarters was 10, consistent with prior cross-sectional data. Involuntary losses represented 70% of total off-take, while voluntary off-take represented the remaining 30%. Mortality composed 60% of total reported off-take and accounted for most of the involuntary losses. Household consumption, sales, and gifts represented 18%, 9%, and 3% of off-take, respectively. CONCLUSION: The overwhelming majority of off-take can be classified as involuntary off-take, principally due to mortality, that does not reflect the owner's decision to maximize value through nutritional gain, income, or social capital. This strongly suggests that there is substantial opportunity to enhance the value of chickens as an asset, both nutritional and income generating, for smallholder households living at poverty level. Our findings suggest that programs emphasizing community level poultry vaccination and feed supplementation are much more likely to be effective than those solely focused on providing chickens.

An integrated health delivery platform, targeting soil-transmitted helminths (STH) and canine mediated human rabies, results in cost savings and increased breadth of treatment for STH in remote communities in Tanzania.

BACKGROUND: Achieving the Sustainable Development Goal of a 90% reduction in neglected tropical diseases (NTDs) by 2030 requires innovative control strategies. This proof-of-concept study examined the effectiveness of integrating control programs for two NTDs: mass drug administration (MDA) for soil-transmitted helminths in humans and mass dog rabies vaccination (MDRV). METHODS: The study was carried out in 24 Tanzanian villages. The primary goal was to demonstrate the feasibility of integrating community-wide MDA for STH and MDRV for rabies. The objectives were to investigate the popularity, participation and cost and time savings of integrated delivery, and to investigate the reach of the MDA with respect to primary school-aged children and other community members. To implement, we randomly allocated villages for delivery of MDA and MDRV (Arm A), MDA only (Arm B) or MDRV only (Arm C). RESULTS: Community support for the integrated delivery was strong (e.g. 85% of focus group discussions concluded that it would result in people getting "two for one" health treatments). A high proportion of households participated in the integrated Arm A events (81.7% MDA, 80.4% MDRV), and these proportions were similar to those in Arms B and C. These findings suggest that coverage might not be reduced when interventions are integrated. Moreover, in addition to time savings, integrated delivery resulted in a 33% lower cost per deworming dose and a 16% lower cost per rabies vaccination. The median percentage of enrolled primary school children treated by this study was 76%. However, because 37% of the primary school aged children that received deworming treatment were not enrolled in school, we hypothesize that the employed strategy could reach more school-aged children than would be reached through a solely school-based delivery strategy. CONCLUSIONS: Integrated delivery platforms for health interventions can be feasible, popular, cost and time saving. The insights gained could be applicable in areas of sub-Saharan Africa that are remote or underserved by health services. These results indicate the utility of integrated One Health delivery platforms and suggest an important role in the global campaign to reduce the burden of NTDs, especially in hard-to-reach communities. TRIAL REGISTRATION: clinicaltrials.gov NCT03667079 , retrospectively registered 11th September 2018.

Drivers of vaccination preferences to protect a low-value livestock resource: Willingness to pay for Newcastle disease vaccines by smallholder households.

Vaccination can be an effective risk management approach to minimize the burden of disease and increase livestock productivity for smallholder households in low income countries. In contrast to vaccination of cattle, a high-value smallholder asset, there is a significant knowledge gap for the drivers of vaccine adoption of smallholder poultry. Newcastle disease virus (NDV) causes high mortality in chickens and is one of the greatest constraints to East African poultry production. To determine preferences and willingness to pay for NDV vaccines by chicken-owning households in Tanzania, we administered a survey with a contingent valuation activity to 535 households across six villages in Arusha, Singida, and Mbeya regions. Given the low current vaccination rate, we tested the null hypothesis that smallholder households do not value NDV vaccines and found overwhelming evidence that smallholders do value NDV vaccines. The willingness to pay (WTP) estimate was 5853 Tanzanian shillings ($2.64) to vaccinate ten chickens given the vaccine was protective for a period of three months. This estimate is about twice the market price reported by households in the study areas suggesting chicken-owning households value and benefit from NDV vaccines, but face other barriers to vaccination. Previous vaccination had the largest positive effect size on WTP suggesting smallholders observe benefits from vaccinating. In contrast to studies of vaccination of higher-cost cattle where off-farm income sources often drive willingness to pay, on-farm income was a driver of WTP for NDV vaccines suggesting different drivers affect protection of low-value livestock assets as compared to high-value assets.

Livestock vaccinations translate into increased human capital and school attendance by girls.

To fulfill the United Nation's Sustainable Development Goals (SDGs), it is useful to understand whether and how specific agricultural interventions improve human health, educational opportunity, and food security. In sub-Saharan Africa, 75% of the population is engaged in small-scale farming, and 80% of these households keep livestock, which represent a critical asset and provide protection against economic shock. For the 50 million pastoralists, livestock play an even greater role. Livestock productivity for pastoralist households is constrained by multiple factors, including infectious disease. East Coast fever, a tick-borne protozoal disease, is the leading cause of calf mortality in large regions of eastern and Southern Africa. We examined pastoralist decisions to adopt vaccination against East Coast fever and the economic outcomes of adoption. Our estimation strategy provides an integrated model of adoption and impact that includes direct effects of vaccination on livestock health and productivity outcomes, as well as indirect effects on household expenditures, such as child education, food, and health care. On the basis of a cross-sectional study of Kenyan pastoralist households, we found that vaccination provides significant net income benefits from reduction in livestock mortality, increased milk production, and savings by reducing antibiotic and acaricide treatments. Households directed the increased income resulting from East Coast fever vaccination into childhood education and food purchase. These indirect effects of livestock vaccination provide a positive impact on rural, livestock-dependent families, contributing to poverty alleviation at the household level and more broadly to achieving SDGs.

Linking human health and livestock health: a "one-health" platform for integrated analysis of human health, livestock health, and economic welfare in livestock dependent communities.

BACKGROUND: For most rural households in sub-Saharan Africa, healthy livestock play a key role in averting the burden associated with zoonotic diseases, and in meeting household nutritional and socio-economic needs. However, there is limited understanding of the complex nutritional, socio-economic, and zoonotic pathways that link livestock health to human health and welfare. Here we describe a platform for integrated human health, animal health and economic welfare analysis designed to address this challenge. We provide baseline epidemiological data on disease syndromes in humans and the animals they keep, and provide examples of relationships between human health, animal health and household socio-economic status. METHOD: We designed a study to obtain syndromic disease data in animals along with economic and behavioral information for 1500 rural households in Western Kenya already participating in a human syndromic disease surveillance study. Data collection started in February 2013, and each household is visited bi-weekly and data on four human syndromes (fever, jaundice, diarrhea and respiratory illness) and nine animal syndromes (death, respiratory, reproductive, musculoskeletal, nervous, urogenital, digestive, udder disorders, and skin disorders in cattle, sheep, goats and chickens) are collected. Additionally, data from a comprehensive socio-economic survey is collected every 3 months in each of the study households. FINDINGS: Data from the first year of study showed 93% of the households owned at least one form of livestock (55%, 19%, 41% and 88% own cattle, sheep, goats and chickens respectively). Digestive disorders, mainly diarrhea episodes, were the most common syndromes observed in cattle, goats and sheep, accounting for 56% of all livestock syndromes, followed by respiratory illnesses (18%). In humans, respiratory illnesses accounted for 54% of all illnesses reported, followed by acute febrile illnesses (40%) and diarrhea illnesses (5%). While controlling for household size, the incidence of human illness increased 1.31-fold for every 10 cases of animal illness or death observed (95% CI 1.16-1.49). Access and utilization of animal source foods such as milk and eggs were positively associated with the number of cattle and chickens owned by the household. Additionally, health care seeking was correlated with household incomes and wealth, which were in turn correlated with livestock herd size. CONCLUSION: This study platform provides a unique longitudinal dataset that allows for the determination and quantification of linkages between human and animal health, including the impact of healthy animals on human disease averted, malnutrition, household educational attainment, and income levels.