Navigating challenges: a socioecological analysis of sexual and reproductive health barriers among Eritrean refugee women in Ethiopia, using a key informant approach.

OBJECTIVES: The study aimed to explore the experiences and perceptions of healthcare providers (HCPs) regarding the sexual and reproductive health (SRH) challenges of Eritrean refugee women in Ethiopia. DESIGN: A qualitative exploratory design with the key informant approach. SETTING AND PARTICIPANTS: The study was conducted in the Afar regional state, North East, Ethiopia. The study participants were HCP responsible for providing SRH care for refugee women. RESULTS: Eritrean refugee women have worse health outcomes than the host population. The SRH needs were found to be hindered at multiple layers of socioecological model (SEM). High turnover and shortage of HCP, restrictive laws, language issues, cultural inconsistencies and gender inequalities were among the main barriers reported. Complex multistructural factors are needed to improve SRH needs of Eritrean refugee women. CONCLUSIONS: A complex set of issues spanning individual needs, social norms, community resources, healthcare limitations and structural mismatches create significant barriers to fulfilling the SRH needs of Eritrean refugee women in Ethiopia. Factors like limited awareness, cultural taboos, lack of safe spaces, inadequate healthcare facilities and restrictive policies all contribute to the severe limitations on SRH services available in refugee settings. The overlap in findings underscores the importance of developing multilevel interventions that are culturally sensitive to the needs of refugee women across all SEM levels. A bilateral collaboration between Refugees and Returnees Service (RRS) structures and the Asayta district healthcare system is critically important.

[Evolution and impact of the One Health approach in Switzerland and worldwide]. / Évolution et impact de l'approche une seule santé (One Health) en Suisse et dans le monde.

Integrated approaches to health such as One Health are needed to tackle complex problems that cannot be solved by a single discipline or country, such as climate change, biodiversity loss or antimicrobial resistance. The Swiss Tropical and Public Health Institute (Swiss TPH), one of the international pioneers in One Health with its African partners, the Institute of Global Health at the University of Geneva, which has also adopted One Health, and other activities in Berne and Zurich, make Switzerland a hub for One Health research and development worldwide. This article summarizes the development of the One Health approach in Switzerland, and uses examples to demonstrate its added value.

Les approches intégrées de la santé comme One Health « une seule santé ¼ sont nécessaires pour aborder les problèmes complexes ne pouvant être résolus par une seule discipline, un seul pays comme le changement climatique, la perte de biodiversité ou la résistance aux antimicrobiens. L'Institut tropical et de santé publique suisse (Swiss TPH), l'un des pionniers internationaux en One Health avec ses partenaires en Afrique, l'Institut de santé globale de l'Université de Genève, qui a aussi adopté One Health, et d'autres activités à Berne et Zurich, font de la Suisse une plaque tournante de recherche et développement sur l'approche One Health dans le monde. Cet article résume l'évolution de cette approche en Suisse et montre à travers d'exemples sa valeur ajoutée.

The Promotion and Development of One Health at Swiss TPH and Its Greater Potential.

One Health, an integrated health concept, is now an integral part of health research and development. One Health overlaps with other integrated approaches to health such as EcoHealth or Planetary Health, which not only consider the patient or population groups but include them in the social-ecological context. One Health has gained the widest foothold politically, institutionally, and in operational implementation. Increasingly, One Health is becoming part of reporting under the International Health Legislation (IHR 2005). The Swiss Tropical and Public Health Institute (Swiss TPH) has played a part in these developments with one of the first mentions of One Health in the biomedical literature. Here, we summarise the history of ideas and processes that led to the development of One Health research and development at the Swiss TPH, clarify its theoretical and methodological foundations, and explore its larger societal potential as an integrated approach to thinking. The history of ideas and processes leading to the development of One Health research at the Swiss TPH were inspired by far-sighted and open ideas of the directors and heads of departments, without exerting too much influence. They followed the progressing work and supported it with further ideas. These in turn were taken up and further developed by a growing number of individual scientists. These ideas were related to other strands of knowledge from economics, molecular biology, anthropology, sociology, theology, and linguistics. We endeavour to relate Western biomedical forms of knowledge generation with other forms, such as Mayan medicine. One Health, in its present form, has been influenced by African mobile pastoralists' integrated thinking that have been taken up into Western epistemologies. The intercultural nature of global and regional One Health approaches will inevitably undergo further scrutiny of successful ways fostering inter-epistemic interaction. Now theoretically well grounded, the One Health approach of seeking benefits for all through better and more equitable cooperation can clearly be applied to engagement in solving major societal problems such as social inequality, animal protection and welfare, environmental protection, climate change mitigation, biodiversity conservation, and conflict transformation.

Productivity loss and cost of bovine tuberculosis for the dairy livestock sector in Ethiopia.

Bovine tuberculosis (BTB) is endemic in Ethiopia. Although upgraded dairy cattle account for only 1% of the total cattle population, they are the backbone of the marketed milk production in the country. Supported by research data outputs from three years, we report in this paper an estimate of the productivity loss and cost of BTB to the Ethiopian dairy sector in two dairy settings, the urban production system in Central Ethiopia (model 1) and the national upgraded dairy production (model 2). Primary data sources were used (e.g. market survey; three-year longitudinal productivity survey; abattoir survey) as well as secondary data sources. A matrix population model, composed of a population vector representing the herd composition that is repeatedly multiplied with a projection matrix, was developed to simulate the livestock dairy population. The initial herd structure was simulated over 30 years to obtain an equilibrium herd-structure representing an Eigenvector of the projection matrix. We performed an incremental cost of disease analysis by comparing livestock production with and without BTB during a period of 10 years. We assumed a BTB prevalence of 40%. In year ten, the Net present value (NPV) of livestock production in terms of milk, meat and hides was estimated at 154.5 million USD for model 1 and 1.7 billion USD for model 2. Loss of NPV over 10 years was estimated at 12 million USD for model 1 and 131.7 million USD for model 2, representing roughly 7.3% loss in NPV or 219 USD per animal. This is a benchmark against which a national TB control program could be developed in the future to calculate its benefit/cost ratio.

Spoligotype analysis of Mycobacterium bovis isolates from cattle and assessment of zoonotic TB transmission among individuals working in bovine TB-infected dairy farms in Ethiopia.

Bovine tuberculosis (bTB) is a disease with impact on dairy productivity, as well as having the potential for zoonotic transmission. Understanding the genetic diversity of the disease agent Mycobacterium bovis is important for identifying its routes of transmission. Here we investigated the level of genetic diversity of M. bovis isolates and assessed the zoonotic potential in risk groups of people working in bTB-infected dairy farms in central Ethiopia. M. bovis was isolated and spoligotyped from tissue lesions collected from slaughtered cattle as well as from raw milk collected from bTB positive cows in dairy farms from six urban areas of central Ethiopia. From consented dairy farm workers, knowledge and practices related to zoonotic TB transmission, together with demographic and clinical information, was collected through interviews. Sputum or Fine Needle Aspirate (FNA) samples were collected from suspected TB cases. Spoligotyping of 55 M. bovis isolates that originated either from cattle tissues with tuberculous lesion or from raw milk revealed seven spoligotype patterns where SB1176 was the most prevalent type (47.3%). Most isolates (89.1%) were of the M. bovis African 2 clonal complex. All sputum and FNA samples from 41 dairy farm workers with symptoms of TB were culture negative for any mycobacteria. Among the 41 TB suspected farm workers, 61% did not know about bTB in cattle and its zoonotic potential, and over two-third of these workers practiced raw milk consumption. Our spoligotype analysis suggests a wider transmission of a single spoligotype in the study area. The results reported here may be useful in guiding future work to identify the source and direction of bTB transmission and hence design of a control strategy. Isolation of M. bovis from milk, knowledge gap on zoonotic TB and practice of consumption of raw milk in the study population showed potential risk for zoonotic transmission.

Health interventions among mobile pastoralists: a systematic review to guide health service design.

OBJECTIVE: Mobile pastoralists are one of the last populations to be reached by health services and are frequently missed by health campaigns. Since health interventions among pastoralists have been staged across a range of disciplines but have not yet been systematically characterised, we set out to fill this gap. METHODS: We conducted a systematic search in PubMed/MEDLINE, Scopus, Embase, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar and grey literature repositories to identify records that described health interventions, facilitators and barriers to intervention success, and factors influencing healthcare utilisation among mobile pastoralists. No date restrictions were applied. Due to the heterogeneity of reports captured in this review, data were primarily synthesised through narrative analysis. Descriptive statistical analysis was performed for data elements presented by a majority of records. RESULTS: Our search yielded 4884 non-duplicate records, of which 140 eligible reports were included in analysis. 89.3% of reports presented data from sub-Saharan Africa, predominantly in East Africa (e.g. Ethiopia, 30.0%; Kenya, 17.1%). Only 24.3% of reports described an interventional study, while the remaining 75.7% described secondary data of interest on healthcare utilisation. Only two randomised controlled trials were present in our analysis, and only five reports presented data on cost. The most common facilitators of intervention success were cultural sensitivity (n = 16), community engagement (n = 12) and service mobility (n = 11). CONCLUSION: Without adaptations to account for mobile pastoralists' unique subsistence patterns and cultural context, formal health services leave pastoralists behind. Research gaps, including neglect of certain geographic regions, lack of both interventional studies and diversity of study design, and limited data on economic feasibility of interventions must be addressed to inform the design of health services capable of reaching mobile pastoralists. Pastoralist-specific delivery strategies, such as combinations of mobile and 'temporary fixed' services informed by transhumance patterns, culturally acceptable waiting homes, community-directed interventions and combined joint human-animal One Health design as well as the bundling of other health services, have shown initial promise upon which future work should build.

OBJECTIF: Les éleveurs nomades sont l'une des dernières populations à être touchées par les services de santé et sont souvent ratés par les campagnes de santé. Etant donné que les interventions de santé parmi ces éleveurs ont été programmées dans une gamme de disciplines mais n'ont pas encore été systématiquement caractérisées, nous avons entrepris de combler cette lacune. MÉTHODES: Nous avons effectué une recherche systématique dans les répertoires PubMed/MEDLINE, Scopus, EMBASE, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar et de la littérature grise pour identifier les reports décrivant les interventions de santé, les facilitateurs et les obstacles au succès de l'intervention ainsi que les facteurs influençant l'utilisation des soins de santé chez les éleveurs nomades. Aucune restriction de date n'a été appliquée. En raison de l'hétérogénéité des rapports capturés dans cette revue, les données ont été principalement synthétisées au moyen d'une analyse narrative. Une analyse statistique descriptive a été effectuée pour les éléments de données présentés par une majorité des reports. RÉSULTATS: Notre recherche a révélé 4.884 rapports non dupliqués, dont 140 éligibles ont été inclus dans l'analyse. 89,3% des rapports présentaient des données d'Afrique subsaharienne, principalement en Afrique de l'Est (ex: Ethiopie, 30,0%; Kenya, 17,1%). Seuls 24,3% des rapports décrivaient une étude interventionnelle, tandis que les 75,7% restants décrivaient des données d'intérêt secondaires sur l'utilisation des soins de santé. Seuls deux essais contrôlés randomisés étaient présents dans notre analyse, et seuls cinq rapports présentaient des données sur le coût. Les facilitateurs les plus courants du succès des interventions étaient la sensibilité culturelle (n=16), l'engagement communautaire (n=12) et la mobilité des services (n=11). CONCLUSION: Sans adaptations pour tenir compte des modèles de subsistance et du contexte culturel uniques des éleveurs nomades, les services de santé formels les laissent de côté. Les lacunes de la recherche, y compris la négligence de certaines régions géographiques, le manque d'études interventionnelles et la diversité de la conception des études, et les données limitées sur la faisabilité économique des interventions doivent être comblées pour éclairer la conception de services de santé capables d'atteindre les éleveurs nomades. Des stratégies de prestation spécifiques aux éleveurs nomades, telles que des combinaisons de services mobiles et «fixes temporaires¼ éclairés par des schémas de transhumance, des maisons d'attente culturellement acceptables, des interventions dirigées par la communauté et une conception conjointe d'une seule santé homme-animal ainsi que le regroupement d'autres services de santé, ont montré une promesse initiale sur laquelle les travaux futurs devraient s'appuyer.

The impact of pastoralist mobility on tuberculosis control in Ethiopia: a systematic review and meta-synthesis.

BACKGROUND: Directly observed treatment, short-course (DOTS) is the current mainstay to control tuberculosis (TB) worldwide. Context-specific adaptations of DOTS have impending implications in the fight against TB. In Ethiopia, there is a national TB control programme with the goal to eliminate TB, but uneven distribution across lifestyle gradients remains a challenge. Notably, the mobile pastoralist communities in the country are disproportionately left uncovered. The aim of this study was to summarize the evidence base from published literature to guide TB control strategy for mobile pastoralist communities in Ethiopia. MAIN TEXT: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and systematically reviewed articles in seven electronic databases: Excerptra Medical Database, African Journal Online, PubMed, Google Scholar, Centre for Agriculture and Bioscience International Direct, Cochrane Library and Web of Science. The databases were searched from inception to December 31, 2018, with no language restriction. We screened 692 items of which 19 met our inclusion criteria. Using a meta-ethnographic method, we identified six themes: (i) pastoralism in Ethiopia; (ii) pastoralists' livelihood profile; (iii) pastoralists' service utilisation; (iv) pastoralists' knowledge and awareness on TB control services; (v) challenges of TB control in pastoral settings; and (vi) equity disparities affecting pastoralists. Our interpretation triangulates the results across all included studies and shows that TB control activities observed in pastoralist regions of Ethiopia are far fewer than elsewhere in the country. CONCLUSIONS: This systematic review and meta-synthesis shows that TB control in Ethiopia does not align well with the pastoralist lifestyle. Inaccessibility and lack of acceptability of TB care are the key bottlenecks to pastoralist TB service provision. Targeting these two parameters holds promise to enhance effectiveness of an intervention.

Cost estimate of bovine tuberculosis to Ethiopia.

While bovine tuberculosis (BTB) has been eliminated in some industrialized countries, it prevails worldwide, particularly in Africa. In Ethiopia, BTB is prevalent as numerous studies have shown its occurrence in livestock and in abattoirs but it has not been demonstrated in wildlife and only very few cases have been found in humans. The objective of this study is to estimate the cost of BTB to Ethiopia with the aim of informing Ethiopian policy on options for BTB control. BTB in livestock affects both animal productivity and herd demographic composition. The Livestock Development Planning System (LDPS2, FAO) was modified to allow for stochastic simulation of parameters. We performed an incremental cost of disease analysis, comparing livestock production with and without BTB. For the rural scenario we considered an endemically stable 4 % comparative intradermal test (CIDT) prevalence and for the urban scenario an endemically stable 32 % CIDT prevalence among cattle. The net present value of rural Ethiopian livestock products in 2005 is estimated at 65.7 billion (thousand million) Ethiopian Birr (95 % Confidence Interval (CI) 53.8-77.7 billion Birr), which is the equivalent of 7.5 billion US$ (95 %CI 6.1-8.9 billion US$) at a rate of 8.7 Birr per US$ in 2005. The cost of BTB ranges from 646 million Birr (75.2 million US$) in 2005 to 3.1 Billion Birr in 2011 (358 million US$) but is within the range of uncertainty of our estimate and can thus not be distinguished from zero. The cost of disease in the urban livestock production ranges from 5 to 42 million Birr (500,000-4.9 million US$) between 2005 and 2011 but is also within the range of uncertainty of our estimate. Our study shows no measurable loss in asset value or cost of disease due to BTB in rural and urban production systems in Ethiopia. This does not mean that there is not a real cost of disease, but the variability of the productivity parameters and prices are high and would require more precise estimates. This study does not preclude in any way the urgent need to control BTB in the urban dairy herd of Addis Ababa for other than financial reasons.