Benefit-cost analysis of coordinated strategies for control of rabies in Africa.

Previous research suggests that dog mass vaccination campaigns can eliminate rabies locally, resulting in large human and animal life gains. Despite these demonstrated benefits, dog vaccination programs remain scarce on the African continent. We conducted a benefit-cost analysis to demonstrate that engaging into vaccination campaigns is the dominant strategy for most countries even in the absence of coordinated action between them. And quantify how coordinated policy measures across countries in Africa could impact rabies incidence and associated costs. We show that coordinated dog mass vaccination between countries and PEP would lead to the elimination of dog rabies in Africa with total welfare gains of USD 9.5 billion (95% CI: 8.1 - 11.4 billion) between 2024 and 2054 (30 years). Coordinated disease control between African countries can lead to more socially and ecologically equitable outcomes by reducing the number of lost human lives to almost zero and possibly eliminating rabies.

Antenatal care and skilled delivery service utilisation in Somali pastoral communities of Eastern Ethiopia.

OBJECTIVE: To assess maternal health care service utilisation and associated factors in Somali pastoral communities of eastern Ethiopia. METHODS: Community-based cross-sectional study complemented by qualitative assessments in Adadle district, Somali region, eastern Ethiopia, among 450 women in six kebeles from August to September 2016. Logistic regression was used to assess factors associated with antenatal care use and skilled delivery care use, controlling for confounders. RESULTS: About 27% [95%CI 22.8-31.2%] of women used antenatal care, and 22.6% [95%CI 18.7-26.5%] received skilled delivery service. None of the respondents reported post-natal care. About 43% reported that they had no knowledge of antenatal care, and 46% did not perceive delivery at a health facility as important. Pastoral lifestyle, husband's educational status, women's attitude towards health care service and financial support from the husband were significantly associated with antenatal care utilisation. Health professionals' attitudes, perceptions of institutional delivery, antenatal care utilisation and information about exemptions from maternal health care fees were associated with skilled delivery service utilisation. CONCLUSION: Improving community awareness of antenatal care, employing female health professionals and culturally adapted guidelines could improve skilled delivery utilisation. In a patriarchal society, involving male partners in all maternal health issues is essential to increase use of maternal health services and to decrease maternal mortality.

OBJECTIF: Evaluer l'utilisation des services de soins de santé maternelle et les facteurs associés dans les communautés pastorales somaliennes dans l'est de l'Ethiopie. MÉTHODES: Etude transversale basée sur la communauté complétée par des évaluations qualitatives dans le district d'Adadle, région somalienne, dans l'est de l'Ethiopie, portant sur 450 femmes dans six kebeles d'août à septembre 2016. Une régression logistique a été utilisée pour évaluer les facteurs associés à l'utilisation des soins prénatals et à l'accouchement sous soins qualifiés, en ajustant pour les facteurs confusionnels. RÉSULTATS: 27% [IC95%: 22.8-31.2%] des femmes ont utilisé des soins prénatals et 22,6% [IC95%: 18.7-26.5%] ont reçu des services d'accouchement qualifiés. Aucune des répondantes n'a signalé des soins postnatals. 43% ont déclaré qu'elles n'avaient aucune connaissance des soins prénatals et 46% ne percevaient pas l'accouchement dans un établissement de santé comme important. Le mode de vie pastoral, le niveau d'éducation du mari, l'attitude des femmes à l'égard des services de santé et le soutien financier du mari étaient significativement associés à l'utilisation des soins prénatals. Les attitudes des professionnels de la santé, les perceptions de l'accouchement en établissement, l'utilisation des soins prénatals et les informations sur les exemptions des frais de soins de santé maternelle ont été associées à l'utilisation des services d'accouchement qualifiés. CONCLUSION: Améliorer la sensibilisation de la communauté aux soins prénatals, employer des professionnels de la santé féminins et des directives culturellement adaptées pourrait améliorer l'utilisation de l'accouchement qualifié. Dans une société patriarcale, la participation des partenaires masculins à toutes les questions de santé maternelle est essentielle pour accroître l'utilisation des services de santé maternelle et réduire la mortalité maternelle.

Rabies in dogs, livestock and wildlife: a veterinary perspective.

While major progress has been made in the control of rabies in the Western Hemisphere, large parts of Europe and some parts of Asia, the disease continues to kill tens of thousands of people every year. Its highest burden is in resourcelimited countries in Asia and Africa, disproportionately affecting children and poor rural communities. Today, domesticated dogs are responsible for the vast majority of human rabies cases. In late 2015, rabies experts from around the world gathered at the Rabies Global Conference in Geneva, Switzerland, and launched the ambitious initiative to end deaths from dog-mediated human rabies by 2030. The most cost-effective and sustainable approach to achieve this goal is to eliminate the disease at source through mass dog vaccination. In this article, the role of and challenges faced by Veterinary Services in resourcelimited settings in implementing the dog vaccination strategy to reduce the human rabies burden are discussed, together with the role of wildlife in disease control and why the 'One Health' approach is indispensable on the path towards a dograbies- free future.

Malgré les progrès considérables accomplis en matière de lutte contre la rage dans l'hémisphère occidental, dans une grande partie de l'Europe et en certains endroits d'Asie, la maladie continue à faire plusieurs dizaines de milliers de victimes chaque année dans le monde. Ce sont les pays à faibles ressources d'Asie et d'Afrique qui sont les plus touchés, avec une majorité écrasante de victimes parmi les enfants et dans les communautés rurales pauvres. Aujourd'hui, les chiens domestiques sont de loin la principale cause des cas de rage humaine. En décembre 2015, des experts du monde entier réunis à Genève (Suisse) à l'occasion de la Conférence mondiale sur la rage intitulée « Élimination mondiale de la rage humaine transmise par les chiens : agissons maintenant ! ¼ ont lancé une initiative ambitieuse visant à mettre fin aux décès humains dus à la rage transmise par les chiens d'ici 2030. La méthode la plus efficace et durable pour atteindre cet objectif consiste à éliminer la maladie à sa source au moyen de la vaccination massive des chiens. Les auteurs examinent le rôle des Services vétérinaires et les difficultés auxquelles ceux-ci sont confrontés lorsqu'ils entreprennent d'appliquer une stratégie de vaccination des chiens destinée à réduire le fardeau de la rage humaine dans un contexte de ressources limitées. Ils évoquent également l'importance de prendre en compte la faune sauvage dans le cadre du contrôle de la rage et expliquent en quoi l'approche « Une seule santé ¼ est incontournable pour avancer vers l'objectif d'un monde indemne de rage canine.

Aunque la lucha antirrábica ha conocido avances muy sustanciales en el hemisferio occidental, grandes partes de Europa y ciertas zonas de Asia, la enfermedad sigue matando a decenas de miles de personas al año. La carga más elevada de rabia se da en países con escasos recursos de Asia y África, donde la enfermedad afecta desproporcionadamente a los niños y a las comunidades rurales pobres. A día de hoy, los perros domésticos son responsables de la inmensa mayoría de los casos de rabia humana. A finales de 2015, especialistas del mundo entero se dieron cita en Ginebra (Suiza) para celebrar la conferencia mundial titulada «Eliminación mundial de la rabia humana transmitida por perros. ¡Actuemos ahora!¼ y poner en marcha la ambiciosa iniciativa de acabar con las muertes por rabia transmitida por perros como muy tarde en 2030. Para cumplir este objetivo, el método más sostenible y más eficaz en relación con el costo consiste en eliminar la enfermedad en su foco de origen, procediendo para ello a vacunaciones masivas de perros. Los autores exponen la función de los Servicios Veterinarios y las dificultades que afrontan en situaciones de escasez de recursos a la hora de aplicar la estrategia de vacunación canina para reducir la carga de rabia humana, así como el papel de la fauna silvestre en el control de la enfermedad y la razón por la cual es indispensable aplicar los planteamientos de «Una sola salud¼ para avanzar hacia un futuro libre de rabia.

A vision for the future of pastoralism.

Pastoral regions are challenged by social and ecological changes. Yet, there is increasingly robust evidence that pastoralism is a viable and sustainable livelihood and that pastoralists play a role in attaining the United Nations Sustainable Development Goals (SDGs). In this issue of the Scientific and Technical Review of the World Organisation for Animal Health (OIE), the authors take a broad view of pastoralism and pastoral livestock production from a number of different perspectives, taking into account societal and ecological viewpoints as well as issues of animal and human health. Thematic reviews are complemented by regional perspectives from Central Asia, China, Europe, East, Central and West Africa, and Latin America. The broader issues of pastoral livestock production and its potential for improving and sustaining animal health are of great interest to the OIE. Summarising the diverse contributions, it appears that pastoral socialecological systems are hotspots of cultural and biological diversity. They are multifunctional in that they generate diversified sources of income and contribute to sustained natural resource management. Pastoral populations require favourable institutional and legal frameworks, so governance structures must be improved and reformed through effective participation and the empowerment of pastoralists. To sustain functional pastoral production systems, the key ingredients are decentralised governance of natural resources, better locally adapted social services, and high flexibility for maintaining mobility. Young people should be actively encouraged to engage in pastoral livelihoods, which should be supported by improved legal systems for land use by all interested parties. There is still untapped potential to optimise extensive livestock production through adapted genetic improvement and better transformation, stocking and marketing of animal-source food. Modern concepts of disease surveillance and response, combining human and animal health as 'One Health', are particularly suited to pastoral systems. The OIE's interest in pastoralism is highly justified given its economic and environmental importance and its significance for livelihoods. Sustainable improvements require understanding and discussion of diverse social and ecological interactions, and it is to this discussion which the authors and editors of this issue of the Review have endeavoured to contribute.

Les régions d'élevage pastoral sont confrontées à des mutations tant sociales qu'écologiques. En même temps, des éléments factuels chaque fois plus nombreux démontrent que le pastoralisme constitue un moyen de subsistance viable et durable et que les pasteurs participent à la réalisation des Objectifs de développement durable fixés par les Nations Unies. Ce numéro de la Revue scientifique et technique de l'Organisation mondiale de la santé animale (OIE) propose une large vue d'ensemble sur le pastoralisme et l'élevage pastoral, examinés sous différents angles et en prenant en considération divers points de vue, tant sociétaux qu'écologiques, sans oublier les problématiques de la santé animale et publique. Les examens thématiques sont complétés par des études régionales portant sur l'Asie centrale, la Chine, l'Europe, l'Afrique de l'Est, centrale et de l'Ouest et l'Amérique latine. Les questions plus générales liées à l'élevage pastoral et à sa capacité potentielle d'améliorer et de promouvoir la santé animale présentent un grand intérêt pour l'OIE. Les diverses contributions réunies dans ce numéro font apparaître que les systèmes socio-écologiques pastoraux constituent des zones sensibles en termes de diversité biologique et culturelle. Ils exercent de multiples fonctions, dans la mesure où ils génèrent des sources de revenus diversifiées et contribuent à une gestion durable des ressources naturelles. Les populations pastorales doivent être soutenues par des cadres juridiques et institutionnels favorables, ce qui suppose d'améliorer et de moderniser les structures de gouvernance au moyen d'une participation effective des pasteurs eux-mêmes et de la prise en main de leur destin. Les ingrédients majeurs pour soutenir le bon fonctionnement des systèmes de production pastoraux sont la gouvernance décentralisée des ressources naturelles, la fourniture de services sociaux spécifiquement adaptés aux besoins des pasteurs et une grande flexibilité afin de préserver le nomadisme. Les jeunes devraient être activement encouragés à participer à l'économie pastorale, et celle-ci devrait bénéficier d'un soutien juridique afin que l'utilisation des terres par toutes les parties intéressées soit mieux encadrée. La production animale extensive présente une grande marge d'amélioration encore inexploitée, grâce à l'amélioration génétique et à des méthodes plus efficaces de transformation, de stockage et de commercialisation des denrées alimentaires d'origine animale. Les concepts modernes de surveillance des maladies et de réaction aux évènements sanitaires en faisant appel à une approche intégrée de la santé animale et humaine selon le concept « Une seule santé ¼ sont particulièrement adaptés aux systèmes pastoraux. L'intérêt que suscite le pastoralisme pour l'OIE se justifie pleinement par l'importance économique et environnementale du pastoralisme et par sa valeur en tant que moyen de subsistance. La mise en place d'améliorations durables passe par une connaissance et un examen approfondis des nombreuses interactions sociales et écologiques à l'oeuvre dans le pastoralisme ; c'est à cet examen que les auteurs et coordinateurs de ce numéro de la Revue se sont attachés à contribuer.

Las regiones pastorales están viviendo difíciles transformaciones sociales y ecológicas. Aun así, hay pruebas cada vez más concluyentes de que el pastoreo constituye un medio de sustento viable y sostenible y de que las sociedades que viven de él contribuyen al cumplimiento de los Objetivos de Desarrollo Sostenible (ODS) fijados por las Naciones Unidas. En este número de la Revista científica y técnica de la Organización Mundial de Sanidad Animal (OIE) los autores ofrecen una vasta panorámica del pastoreo y de la producción ganadera que le es propia, abordando el tema desde múltiples ángulos y teniendo en cuenta tanto aspectos ligados a la sociedad y la ecología como las cuestiones zoosanitarias y sanitarias. El tratamiento temático se complementa con estudios de ámbito regional, dedicados a Asia Central, China, Europa, África Oriental, Central y Occidental y América Latina. Las cuestiones más generales ligadas a la producción ganadera por pastoreo y a las posibilidades que esta ofrece para mejorar y preservar la sanidad animal revisten gran interés para la OIE. Las diversas contribuciones aquí reunidas evidencian, en resumen, que los sistemas socioecológicos pastorales encierran una enorme diversidad cultural y biológica. Revisten además carácter polivalente, en el sentido de que generan fuentes diversificadas de ingresos y contribuyen a una gestión duradera de los recursos naturales. Las poblaciones dedicadas al pastoreo necesitan regímenes institucionales y jurídicos favorables, para lo cual es indispensable mejorar y reformar las estructuras de gobierno instrumentando una participación efectiva de esas poblaciones y fórmulas que las doten de poder de decisión y actuación. Los ingredientes básicos para mantener duraderamente y en buen funcionamiento los sistemas de producción propios del pastoreo son: una gestión descentralizada de los recursos naturales; servicios sociales más eficaces y adaptados a las condiciones locales; y un elevado grado de flexibilidad para mantener la movilidad. Es preciso alentar activamente a los jóvenes a que abracen los modos y medios de vida del pastoreo, lo que debe acompañarse de mejores ordenamientos jurídicos sobre el uso de las tierras por todas las partes interesadas. Todavía queda margen para optimizar la producción ganadera extensiva mediante mejoras genéticas adaptadas y técnicas más eficaces de transformación, almacenamiento y comercialización de los alimentos de origen animal. Los conceptos modernos de la vigilancia y la respuesta sanitarias, que combinan la salud humana y la sanidad animal con arreglo a los principios de «Una sola salud¼, casan especialmente con los sistemas de pastoreo. El interés de la OIE por el pastoreo está sobradamente justificado por la importancia económica y ambiental de esta actividad y por la repercusión que tiene en los medios de sustento. Toda mejora duradera en este ámbito pasa por entender un conjunto de interacciones sociales y ecológicas y por debatir al respecto, proceso este de reflexión al que se han propuesto contribuir los autores y compiladores del presente número de la Revista.

Institutional development and policy frameworks for pastoralism: from local to regional perspectives.

Pastoralists are among the most politically and economically marginalised communities in the world. They have less and less access to the natural resources on which their livelihoods depend and very limited access to basic socio-economic services and infrastructure. This paper builds on a number of studies carried out in the Sahel, the Horn of Africa, Central Asia and the Swiss Alps to address the institutional dynamics required for sustainable pastoralism. Specifically, the authors question the way in which institutions and policies are currently shaped and suggest that reforming these could contribute to new avenues for pastoralism. Among the main drivers of pastoralist marginalisation are poor public and private institutional arrangements. The consequences are violent conflict and increased mobility and relocation. Responses to the current weaknesses of pastoralism must encompass inclusive, comprehensive institutions which allow access to resources, economic viability and integration in the new socio-ecological space. The authors argue that those involved in pastoral development in national as well as international arenas, including pastoralist groups, states and agencies, are creatively engaged in a process of innovation for pastoralism, and this will contribute towards new forms of governance and improved institutional and policy frameworks.

Les communautés pastorales comptent parmi les plus marginalisées au plan politique et économique. Les pasteurs peuvent de moins en moins accéder aux ressources naturelles dont ils tirent leur subsistance ; leur accès aux services et aux infrastructures socio-économiques de base est également très limité. À partir d'une série d'études conduites au Sahel, dans la Corne de l'Afrique, en Asie centrale et dans les Alpes suisses, les auteurs cherchent à déterminer la dynamique institutionnelle nécessaire à la pérennisation du pastoralisme. En particulier, ils remettent en cause la manière dont les institutions et les politiques sont conçues à l'heure actuelle, estimant que leur réforme permettrait d'ouvrir de nouvelles perspectives pour le pastoralisme. La médiocrité des dispositifs institutionnels tant publics que privés compte parmi les principaux facteurs de la marginalisation des pasteurs. Celle-ci entraîne des conflits violents et une mobilité et relocalisation accrues. Les réponses aux faiblesses actuelles du pastoralisme passent nécessairement par des institutions à l'action inclusive et exhaustive, garantissant l'accés aux ressources, la viabilité économique et l'intégration dans le nouvel espace socio-écologique. Les auteurs estiment que les acteurs du développement du pastoralisme sur la scène nationale autant qu'internationale, y compris les groupes de pasteurs, les états et les agences de développement sont engagés de manière créative dans un processus d'innovation en faveur du pastoralisme, ce qui contribuera à créer de nouvelles formes de gouvernance et de meilleurs cadres institutionnels et d'élaboration des politiques.

Las comunidades que viven del pastoreo están entre las más marginadas tanto política como económicamente. Cada vez les resulta más difícil acceder a los recursos naturales de los que dependen para vivir y disponen de un acceso muy deficiente a la infraestructura y los servicios socioeconómicos básicos. Los autores, partiendo de una serie de estudios realizados en el Sahel, el Cuerno de África, Asia Central y los Alpes suizos, examinan la dinámica institucional necesaria para que el pastoreo llegue a ser sostenible. En concreto, tras cuestionar los procedimientos por los que actualmente se forjan instituciones y se formulan políticas, sugieren que la reforma de estos mecanismos podría ser útil para abrir nuevos horizontes al pastoreo. Entre los principales factores que determinan la marginación de las sociedades pastorales figuran las carencias de los dispositivos institucionales públicos y privados, lo que tiene por consecuencia conflictos violentos y un mayor grado de movilidad y relocalizaciones. Toda respuesta a la actual situación de fragilidad del pastoreo debe acompañarse de instituciones integradoras y completas, que hagan posible el acceso a los recursos, la viabilidad económica y la integración en el nuevo espacio socioecológico. Los autores postulan que todas aquellas instancias que intervienen en las cuestiones de desarrollo pastoral en foros tanto nacionales como internacionales, en particular los propios grupos de pastores, amén de los Estados y organismos, son componentes creativos de un proceso de innovación al servicio del pastoreo, proceso que ayudará a alumbrar nuevas formas de gobernanza, así como regímenes institucionales y parámetros normativos más eficaces.

The future of pastoralism: an introduction.

Two-thirds of the agricultural land on planet Earth is grassland on which no other crops can be grown, either because of limited rainfall, high altitude or mountainous conditions. Most of these semi-arid and high-altitude pastoral ecosystems are used by livestock husbandry systems with various forms of mobility and are not in competition with crop production for human nutrition. By devoting an issue of its Scientific and Technical Review to pastoralism, the World Organisation for Animal Health (OIE) is encouraging debate on this important topic and helping to shape the future of pastoralists and their livestock. Pastoralism is a complex system, driven by interacting ecological, social and economic factors that cannot be adequately addressed by one discipline or sector alone. For its future development, we must engage with local knowledge systems and with all stakeholders. This issue of the OIE Review endeavours to take a broad view and provide a synthetic vision for the sustainable use of pastoral ecosystems, with innovative ideas for livelihoods, economic development, sustained ecosystem services and social and institutional development as the context for animal and human health and wellbeing.

Les deux tiers des terres agricoles de notre planète sont des prairies d'herbage qui ne peuvent donner lieu à d'autres cultures, en raison des faibles précipitations, de l'altitude ou du contexte montagneux. La plupart des écosystèmes pastoraux semi-arides de haute altitude sont dédiés à des systèmes d'élevage diversement mobiles et ne sont pas concurrencés par les cultures agricoles vivrières. En consacrant un numéro de la Revue scientifique et technique au pastoralisme, l'Organisation mondiale de la santé animale entend jouer un rôle moteur pour que ce thème important soit davantage pris en compte et pour que des orientations soient proposées afin de protéger l'avenir des pasteurs et de leur bétail. Le pastoralisme est un système complexe, déterminé par des facteurs écologiques, sociaux et économiques en interaction qui ne peuvent être appréhendés par une seule discipline ou un seul secteur. Pour sauvegarder l'avenir du pastoralisme, nous devons nouer un dialogue avec des systèmes locaux de connaissance en y intégrant toutes les parties prenantes. Ce numéro de la Revue de l'OIE entend fournir un tableau aussi général que possible des écosystèmes pastoraux ainsi qu'une synthèse des stratégies envisageables pour leur développement durable, assortie de quelques propositions innovantes relatives aux moyens de subsistance, au développement économique, à la pérennisation des services écosystémiques et au développement du contexte social et institutionnel encadrant la santé et le bien-être des animaux et des personnes.

Dos tercios de las tierras agrícolas del planeta Tierra son pastizales en los que no es posible producir ningún otro cultivo, ya sea por la escasa pluviosidad o porque se trata de zonas montañosas o situadas a gran altitud. La mayoría de esos ecosistemas pastorales semiáridos o de altitud se destinan a sistemas de producción ganadera regidos por fórmulas diversas de movilidad que no entran en competencia con la producción de cultivos para la alimentación humana. Dedicando al pastoreo un número de su Revista científica y técnica, la Organización Mundial de Sanidad Animal (OIE) impulsa una reflexión para tener en cuenta este importante tema y orientar el futuro de las sociedades de pastores y sus animales. El pastoreo es un sistema complejo, gobernado por factores ecológicos, sociales y económicos interrelacionados, que no es posible abordar adecuadamente desde una sola disciplina o un solo sector. Su futuro desarrollo pasa por tener en cuenta los sistemas locales de conocimiento y por trabajar con todas las partes interesadas. El presente número de la Revista de la OIE aspira a ofrecer una visión a la vez general y sintética del tema, que haga posible un uso sostenible de los ecosistemas pastorales y permita potenciar la salud y el bienestar de animales y personas a partir de una serie de ideas innovadoras en relación con los medios de sustento, el desarrollo económico, la continuidad de los servicios ecosistémicos y el desarrollo social e institucional.

Cost-effective control strategies for animal and zoonotic diseases in pastoralist populations.

Animal diseases and zoonoses abound among pastoralist livestock, which is composed of cattle, sheep, goats, yak, camels, llamas, reindeer, horses and donkeys. There is endemic and, periodically, epidemic transmission of highly contagious viral and bacterial diseases in Africa, Asia and Latin America. Pastoralist livestock is often multiparasitised with endo- and ectoparasites, as well as being affected by vectorborne viral and protozoal diseases. Pastoral livestock can be a reservoir of such diseases and can also, conversely, be at risk from exposure to wildlife reservoirs. Public and private animal health services currently underperform in almost all pastoral areas due to structural reforms and lack of income, as indicated in assessments of national Veterinary Services by the World Organisation for Animal Health. Control of infectious disease in industrialised countries has been achieved through large-scale public funding of control measures and compensation for culled stock. Such means are not available in pastoralist areas of most low- and middle-income countries (LMICs). While the cost-effectiveness and profitability of the control of animal diseases and zoonoses is less of a consideration for industrialised countries, in the experience of the authors, understanding the economic implications of a control programme is a prerequisite for successful attempts to improve animal health in LMICs. The incremental costs of animal disease control can potentially be shared using crosssector assessments, integrated control, and regional coordination efforts to mitigate transboundary disease risks. In this paper, the authors discuss cost-effective animal disease and zoonoses control in LMICs. It illustrates frameworks and examples of integrated control and cross-sector economics, showing conditions under which these diseases could be controlled in a cost-effective way.

D'abondantes maladies animales et zoonoses affectent le cheptel pastoral, qui est composé de bovins, d'ovins, de caprins, de yaks, de chameaux, de lamas, de rennes, de chevaux et d'ânes. Il existe une transmission endémique (prenant périodiquement une dimension épidémique) des maladies virales et bactériennes hautement contagieuses en Afrique, en Asie et en Amérique latine. Le polyparasitisme à endoparasites et ectoparasites est fréquent dans les troupeaux pastoraux, ainsi que les maladies virales à transmission vectorielle et les maladies dues à des protozoaires. Les animaux élevés par les pasteurs font également office de réservoirs potentiels pour ces maladies et sont à leur tour exposés aux réservoirs sauvages. Les services de santé animale tant publics que privés sont actuellement sous-efficients dans pratiquement toutes les zones pastorales en raison des réformes structurelles et du manque de moyens, comme l'ont révélé les évaluations des Services vétérinaires nationaux réalisées par l'Organisation mondiale de la santé animale. Dans les pays industrialisés, les maladies infectieuses ont pu être maîtrisées grâce à un financement public massif des mesures de contrôle et à l'indemnisation des éleveurs dont le bétail avait été sacrifié. Ces moyens ne sont pas disponibles dans les zones pastorales de la plupart des pays à revenus faibles et moyens. Alors que les pays industrialisés n'ont pas tellement à prendre en compte les questions de rentabilité et d'efficience au regard des coûts lorsqu'ils ont à lutter contre des maladies animales ou des zoonoses, il n'en va pas de même dans les pays à revenus faibles et moyens, où, d'après l'expérience des auteurs, la prise en compte des conséquences économiques d'un programme de lutte est une étape préalable de toute tentative fructueuse d'amélioration de la santé animale. L'augmentation progressive des coûts de la lutte contre les maladies animales peut être prise en charge de manière partagée grâce aux évaluations intersectorielles, à une stratégie de lutte intégrée et aux efforts de concertation à l'échelle régionale pour atténuer les risques de maladies transfrontalières. Les auteurs de cet article examinent les méthodes efficientes au regard de leur coût déployées par les pays à revenus faibles et moyens pour lutter contre les maladies animales et les zoonoses. Ils présentent quelques cadres et exemples de lutte intégrée et d'approches économiques intersectorielles, en faisant ressortir les conditions qui permettent de contrôler ces maladies de manière efficace et à moindre coût.

Las enfermedades animales y las zoonosis son muy comunes en el ganado pastoral, formado por ganado vacuno, ovino y caprino, yaks, camellos, llamas, renos, caballos y asnos. En África, Asia y América Latina hay transmisión endémica (y periódicamente epidémica) de enfermedades víricas y bacterianas sumamente contagiosas. El ganado pastoral suele estar infestado por múltiples endo y ectoparásitos y padecer enfermedades víricas y protozoarias transmitidas por vectores. A veces ejerce de reservorio de esas enfermedades y también puede, a la inversa, verse expuesto al contacto con reservorios salvajes. Actualmente, en casi todas las zonas de pastoreo, los servicios zoosanitarios públicos y privados presentan un funcionamiento deficiente debido a las reformas estructurales y a la falta de ingresos, como se desprende de las evaluaciones de los Servicios Veterinarios nacionales realizadas por la Organización Mundial de Sanidad Animal. En los países industrializados, el control de las enfermedades infecciosas ha sido posible gracias a la financiación por el sector público de vastas y onerosas medidas de lucha y de indemnización por los animales sacrificados. Pero en las zonas de pastoreo de la mayoría de los países de ingresos bajos o medianos no existe la posibilidad de instrumentar tales medios. Mientras que los países industrializados prestan menos atención a la relación costoeficacia y la rentabilidad de las medidas de control de enfermedades animales y zoonosis, en los países de ingresos bajos o medianos, a tenor de la experiencia de los autores, el éxito de toda tentativa de mejorar la sanidad animal pasa necesariamente por tener en cuenta la dimensión económica de los programas de lucha. Existe la posibilidad de compartir los costos adicionales de la lucha zoosanitaria recurriendo a evaluaciones transectoriales, a medidas integradas de control y a actividades coordinadas a escala regional para reducir el riesgo de enfermedades transfronterizas. Los autores examinan aquí sistemas eficaces en relación con el costo para combatir las enfermedades animales y zoonosis en los países de ingresos bajos o medianos, exponiendo principios de referencia y ejemplos de lucha integrada y de economía transectorial que demuestran en qué condiciones sería posible controlar esas enfermedades de manera eficaz en relación con el costo.

Quantitative microbial risk assessment related to urban wastewater and lagoon water reuse in Abidjan, Côte d'Ivoire.

We assessed the infection risks related to the use of wastewater in Abidjan, Côte d'Ivoire, by using quantitative microbial risk assessment (QMRA). Giardia lamblia and Escherichia coli were isolated and identified in wastewater samples from the canal and lagoon. The exposure assessment was conducted using a cross-sectional survey by questionnaire with 150 individuals who were in contact with the wastewater during their daily activities of swimming, fishing, washing, and collecting materials for reuse. Risk was characterised using the Monte Carlo simulation with 10,000 iterations. Results showed high contamination of water by G. lamblia and E. coli (12.8 CFU/100 mL to 2.97 × 10(4)CFU/100 mL and from 0 cyst/L to 18.5 cysts/L, respectively). Estimates of yearly average infection risks for E. coli (90.07-99.90%, assuming that 8% of E. coli were E. coli O157:H7) and G. lamblia (9.4-34.78%) were much higher than the acceptable risk (10(-4)). These results suggest the need for wastewater treatment plants, raising awareness in the population in contact with urban wastewater and lagoon water. Our study also showed that QMRA is appropriate to study health risks in settings with limited data and budget resources.

Persistence of brucellosis in pastoral systems.

Regarded as a highly contagious, zoonotic disease with worldwide distribution, brucellosis is endemic in many countries and settings and is responsible for a considerable economic and health-related burden. Limited information is available on the persistence and prevalence of brucellosis in pastoral communities, due to the difficulty in gathering information and to their mobility. However, since these communities are economically and culturally dependent on livestock, it is important to further determine the cause of persistent disease and develop possible methods for its management. The two main objectives of this paper are to review the literature, identifying various epidemiological and social factors that affect the persistence of brucellosis in pastoral ecosystems, and determine prevalence estimates within these communities. The general trend of the summarised studies indicates low-level, relatively stable transmission of brucellosis in pastoral areas, when compared to transmission in intensive and semi-intensive peri-urban production systems. A formal mathematical analysis can be undertaken using matrix models or coupled differential equations. This allows an examination of the various conditions under which the number of diseased, infected or exposed animals remains stable. The authors examined an existing mathematical differential equation model for brucellosis in Mongolia for its equilibrium conditions and found it reasonably robust, though clearly more data are needed to estimate threshold densities for brucellosis transmission in other regions of the world. However, the results indicate the importance of livestock demographic determinants for brucellosis persistence. The paper concludes that brucellosis remains largely persistent in pastoral areas of the world, despite (varying) control efforts. Plans to control brucellosis in pastoral settings should include ecological considerations, such as sustaining ecosystem services in pastoral areas. This approach would include placing limitations on livestock stocking density, land reform, improved governance and integrated social and economic development.

Economics of brucellosis impact and control in low-income countries.

Most data and evidence on the economic burden of brucellosis and the benefits of its control are from high-income and middle-income countries. However, the burden of brucellosis is greatest in low-income countries. This paper focuses on estimating the economic burdens of brucellosis in low-income countries in tropical Asia and Africa. The prospects for national, technically feasible, and economically viable, national brucellosis control programmes in most low-income countries are limited. However, some targeted control programmes will be beneficial and can probably be feasibly managed and provide good economic returns. More ambitious control will require a more general strengthening of Veterinary Services and livestock-sector capacity, using risk-management-based approaches.

Health of mobile pastoralists in the Sahel - assessment of 15 years of research and development.

In the Sahel, between Mauritania and Somalia including Northern Kenya, about 20-30 million people live as mobile pastoralists. The rhythm of their migration follows the seasons and the availability of resources such as water, pasture and salt. Despite their high exposure to zoonoses and problems caused by extreme climatic conditions, mobile pastoralists are virtually excluded from health services because the provision of social services adapted to their way of life is challenging. In cooperation with various partners in the region, the Swiss Tropical and Public Health Institute has been active in research and development in the Sahel for 15 years. Based on the perceived needs of mobile pastoralists and the necessities of development, interdisciplinary research has considerably contributed to better understanding of their situation and their problems. Close contact between humans and livestock necessitates close cooperation between human and animal health specialists. Such useful approaches should be continued and extended.

Retinol assessment among women and children in sahelian mobile pastoralists.

Micronutrient deficiencies are widespread in developing countries, particularly in remote communities such as mobile pastoralists. The nutritional and vitamin A status of this population is not well-documented in Chad. This study assessed serum retinol levels among women and children under five-year-old in nomadic and semi-nomadic pastoralist and rural-settled communities, who are similarly exposed to risk factors such as gastrointestinal parasitic infection, anaemia and emaciation. The novel method of portable fluorometry was used for the first time to measure ß-carotene and retinol levels in a pastoral nomadic area. Moderate level blood retinol deficiency (<0.7 µmol/L) was observed in 5% (CI 1-11) of nomadic, 29% (CI 13-45) of semi-nomadic and 22% (CI 8-35) of sedentary women. In children, 1% (CI 0.1-4), 17% (CI 9-25) and 28% (CI 18-39), respectively, had moderate level blood retinol deficiency. In nomadic communities, women and children had blood retinol levels close to normal. Deficiency of retinol was strongly linked with lifestyle (nomadic, semi-nomadic and settled) among women and lifestyle and age among children. The results support an ecological linkage between human retinol levels and livestock milk retinol. This study shows the feasibility of portable retinol and ß-carotene measurement in human blood as well as human and animal milk under remote field conditions, but the approach requires further validation.

[Socio-economic impact at the household level of the health consequences of toxic waste discharge in Abidjan in 2006]. / Impact socio-économique du déversement de déchets toxiques à Abidjan en 2006 à l'échelle des ménages.

In August 2006, toxic wastes were discharged in the district of Abidjan, causing important health consequences in many households in the area. In order to appreciate the socio-economic impact of the consequences of toxic waste discharge on the households and of the measures taken by the authorities to deal with this catastrophe, and to appreciate the spatial extent of the pollution, we undertook a multidisciplinary transversal investigation at the sites of discharge of oxic waste, from October the 19th to December the 8th, 2006, using a transect sampling methodology. This paper presents the results related to the socio-economic aspects of the survey while the environmental and epidemiological results are presented in two other published papers. The socioeconomics investigation, conducted using a questionnaire, concerned 809 households across the various sites of discharge of toxic waste. More than 62% of households had at least one person who had been affected by toxic waste (affected households). 62.47% of these households were in Cocody district (with 2 sites and 4 points of discharge), 30.14% in Abobo district (with 2 sites and 3 points) and 7.39% in Koumassi district (with 1 site and 1 point). To escape the bad smell and the nuisance, 22.75% of the 501 "affected" households had left their houses. To face the health consequences generated by the toxic waste, 30.54% of the "affected" households engaged expenses. Those were on average of 92 450 FCFA (€141), with a minimum of 1 000 FCFA (€1.5) and a maximum of 1500000 FCFA (€2.287), in spite of the advertisement of the exemption from payment treatment fees made by the government. The decision of destroying cultures and farms near the points of discharge of the toxic products in a radius of 200 meters, taken by the authorities, touched 2.22% of the households. For these households, it did nothing but worsen their state of poverty, since the zone of influence of the toxic waste went well beyond the 200 meters prescribed by the authorities as the limit of the operations of destruction.

[Transmission dynamics and cost-effectiveness of rabies control in dogs and humans in an African city]. / Dynamique de transmission et coût de la lutte contre la rage chez les chiens et les hommes dans une ville Africaine.

Control of human rabies in developing countries depends on prevention in dogs. The purpose of this study was to evaluate the cost-saving potential for the public health sector of intervention to control rabies in animal-host reservoirs. An existing deterministic model was adapted to allow study of dog-to-human rabies transmission. Model parameters were fitted to data from routine weekly reports on the number of rabid dogs and human rabies exposures in N'Djamena, Chad. At the onset of study, the estimated effective reproductive ratio (Re) was 1.01 indicating stable low-level endemic rabies transmission. Simulations were performed to determine what effects mass vaccination and culling of dogs would have on the incidence of human rabies. Findings showed that a mass campaign allowing single parenteral vaccination of at least 70% of the canine population would be sufficient to interrupt transmission of rabies to humans for at least 6 years. The cost-effectiveness of mass dog vaccination was compared to that of "postexposure prophylaxis" (PEP) which would not reduce future human exposure. Results showed that a sustained 5-year PEP program together with a dog-vaccination campaign would be as cost-effective as PEP alone. Beyond a time-frame of 7 years, combining parenteral dog vaccination campaigns with human PEP appeared to be more cost-effective than human PEP alone.

Transmission dynamics and economics of rabies control in dogs and humans in an African city.

Human rabies in developing countries can be prevented through interventions directed at dogs. Potential cost-savings for the public health sector of interventions aimed at animal-host reservoirs should be assessed. Available deterministic models of rabies transmission between dogs were extended to include dog-to-human rabies transmission. Model parameters were fitted to routine weekly rabid-dog and exposed-human cases reported in N'Djaména, the capital of Chad. The estimated transmission rates between dogs (beta(d)) were 0.0807 km2/(dogs x week) and between dogs and humans (beta(dh)) 0.0002 km2/(dogs x week). The effective reproductive ratio (R(e)) at the onset of our observations was estimated at 1.01, indicating low-level endemic stability of rabies transmission. Human rabies incidence depended critically on dog-related transmission parameters. We simulated the effects of mass dog vaccination and the culling of a percentage of the dog population on human rabies incidence. A single parenteral dog rabies-mass vaccination campaign achieving a coverage of least 70% appears to be sufficient to interrupt transmission of rabies to humans for at least 6 years. The cost-effectiveness of mass dog vaccination was compared to postexposure prophylaxis (PEP), which is the current practice in Chad. PEP does not reduce future human exposure. Its cost-effectiveness is estimated at US $46 per disability adjusted life-years averted. Cost-effectiveness for PEP, together with a dog-vaccination campaign, breaks even with cost-effectiveness of PEP alone after almost 5 years. Beyond a time-frame of 7 years, it appears to be more cost-effective to combine parenteral dog-vaccination campaigns with human PEP compared to human PEP alone.

Effectiveness of dog rabies vaccination programmes: comparison of owner-charged and free vaccination campaigns.

We investigated the percentage of dogs that could be vaccinated against rabies by conducting a pilot campaign in N'Djaména, Chad. Owners were charged US$4.13 per dog vaccinated, and 24% of all dogs in the three city districts covered by the campaign were vaccinated. Total campaign costs were US$7623, resulting in an average of US$19.40 per vaccinated dog. This is five times more expensive than the cost per animal vaccinated during a previous free vaccination campaign for dog-owners, conducted in the same districts. The free campaign, which vaccinated 2605 more dogs than this campaign, cost an additional US$1.45 per extra dog vaccinated. Campaigns in which owners are charged for vaccinations result in lower vaccination rates than in free campaigns. Public health officials can use these results when evaluating the costs and benefits of subsidizing dog rabies vaccination programmes.

Invited review: Role of livestock in human nutrition and health for poverty reduction in developing countries.

Livestock keeping is critical for many of the poor in the developing world, often contributing to multiple livelihood objectives and offering pathways out of poverty. Livestock keeping also affects an indispensable asset of the poor, their human capital, through its impact on their own nutrition and health. This paper outlines the linkages between livestock keeping and the physical well-being of the poor, and examines a number of commonly held beliefs that misrepresent livestock development issues related to these linkages. These beliefs limit the scope of intervention programs to promote livestock and limit their potential contribution to poverty reduction. Recognition of the complexity of the role livestock play in household decision-making and of the opportunities foregone due to these misconceptions can enhance the ability of livestock to contribute to human well-being in the developing world.

Cost-description of a pilot parenteral vaccination campaign against rabies in dogs in N'Djaména, Chad.

In the discussion about policies and strategies for rabies prevention in developing countries, intervention costs arise as a major issue. In a pilot mass vaccination campaign against rabies in N'Djaména, Chad, 3000 dogs were vaccinated. We assessed vaccination coverage and cost, showing the cost per dog vaccinated for the public sector and for society. An extrapolation to city level calculated the approximate cost of vaccinating all 23 600 dogs in N'Djaména. In the pilot mass campaign with 3000 dogs the average cost per dog was 1.69 euro. to the public and the full societal cost was 2.45 euro. If all 23 600 dogs in N'Djaména were vaccinated, the average cost would fall to 1.16 euro to the public and 1.93 euro to society. Private sector costs account for 31% of the cost to vaccinate 3000 dogs, and 40% of the cost to vaccinate 23 600 dogs. Mass dog vaccination could be a comparatively cheap and ethical way to both control the disease in animals and prevent human cases and exposure, especially in developing countries. The cost-effectiveness of dog vaccination compared with treating victims of dog bites for prevention of human rabies should be further assessed and documented.

[Health care services for nomadic people. Lessons learned from research and implementation activities in Chad]. / Quels types de services de santé pour les populations nomades? Apprentissages des activités de recherche et d'action au Tchad.

To overcome barriers of access to health care of nomadic people and to alleviate inequities in health, a transdisciplinary team has initiated research and intervention activities among three nomadic groups of Chad: Foulbé, Arabes and Gouranes. A regular and consistent communication among all actors involved (nomadic groups, researchers, planners and administrators of health and veterinary services, etc.) through repetitive meetings and workshops showed to be a crucial element for success. Differences between ethnic nomadic groups made it necessary to develop specific communication strategies adapted to each group. As to interventions to improve the vaccination coverage, mixed teams combining health and veterinary specialists were able to vaccinate an important number of children and women and showed to have a high potential in terms of organisational and logistic feasibility, acceptability as well as good cost-effectiveness. With regard to improving access to health care, Information--Education and Communication approaches adapted to the intervention context and linked to the provision of essential services and generic drugs showed to be crucial.