Population Structure and Antimicrobial Resistance in Campylobacter jejuni and C. coli Isolated from Humans with Diarrhea and from Poultry, East Africa.

Campylobacteriosis and antimicrobial resistance (AMR) are global public health concerns. Africa is estimated to have the world's highest incidence of campylobacteriosis and a relatively high prevalence of AMR in Campylobacter spp. from humans and animals. Few studies have compared Campylobacter spp. isolated from humans and poultry in Africa using whole-genome sequencing and antimicrobial susceptibility testing. We explored the population structure and AMR of 178 Campylobacter isolates from East Africa, 81 from patients with diarrhea in Kenya and 97 from 56 poultry samples in Tanzania, collected during 2006-2017. Sequence type diversity was high in both poultry and human isolates, with some sequence types in common. The estimated prevalence of multidrug resistance, defined as resistance to >3 antimicrobial classes, was higher in poultry isolates (40.9%, 95% credible interval 23.6%-59.4%) than in human isolates (2.5%, 95% credible interval 0.3%-6.8%), underlining the importance of antimicrobial stewardship in livestock systems.

Taenia solium Cysticercosis and Taeniosis Reporting in the Current Medical and Veterinary Diseases Reporting Systems in Tanzania: A Cross-Sectional Study.

Taenia solium cysticercosis and taeniosis (TSCT) are two forms of a zoonotic disease caused by T. solium tapeworm. Towards promotion of a One Health approach to the control of TSCT, we assessed TSCT reporting in the medical and veterinay sectors in Tanzania. We conducted a cross-sectional study between January and April 2020 in Babati and Mbulu districts (northern Tanzania), Kongwa district (central Tanzania), Mbinga and Nyasa districts (southern Tanzania), and the Zonal Veterinary Centres in Iringa (southern Tanzania) and Arusha (northern Tanzania) regions. A questionnaire was administered to 154 officers in charge (OsIC) of primary healthcare facilities (PHFs) and 110 meat inspectors (MIs) to collect quantitative data. Key informant interviews (KIIs) were conducted to 16 medical and 17 veterinary officers from level one healthcare facilities and district livestock offices, respectively, to their respective ministries. OsIC admitted absence of specific reporting (100%, n = 154) of T. solium taeniosis and neurocysticercosis (NCC) in the medical diseases reporting system (MDRS) despite the presence of optimum facilitation in terms of report preparation and submission (92.2%, n = 154) with 83.8% (n = 154) timely report submission rate. The veterinary diseases reporting system (VDRS) accommodated porcine cysticercosis (PCC) reporting. Nevertheless, approximately 77.3% (n = 110) of the MIs admitted inadequate facilitation in VDRS that hindered efficient reporting of PCC among other diseases. In addition, all MIs admitted that disease reports submitted were incomplete, submitted late (73.3%, n = 110), or not submitted at all (88.8%, n = 110). Similarly, KIIs results revealed suboptimal facilitation and reporting efficiency in VDRS than it was with the MDRS. It is concluded that the MDRS did not provide for specific reporting of taeniosis and NCC. Inadequate facilitation of the general VDRS hindered efficient PCC reporting despite its provision for PCC reporting. A One Health approach in strengthening the medical and veterinary diseases reporting systems for efficient TSCT reporting is recommended.

Effect of awareness training to frontline health workers and the use of e-based technology on reporting of brucellosis cases in selected pastoral communities, Tanzania: a quasi-experimental study.

INTRODUCTION: Brucellosis is a serious community health problem and endemic disease in Tanzania in both humans and animals. Frontline health workers (FHWs) play a vital role in reporting and hence prevent and control brucellosis in rural settings. This study aims to evaluate the effect of awareness training to frontline health workers and use of electronic technology (e- technology) on reporting of brucellosis cases. METHODS: A quasi-experimental design was implemented in two pastoral communities in eastern part of Tanzania with one as control and another as treatment involving 64 FHWs who were purposively selected from May 2020 to December 2020. A total of 32 FHWs from treatment pastoral community were purposively selected for awareness training, rapid diagnosis using Rose Bengal test (RBT) and use of electronic technology (AfyaData app) for brucellosis reporting while nothing was done in control community. Before and after training information about their knowledge, attitude and practices were collected from all participants using a structured questionnaires uploaded in the mobile phone powered by AfyaData application. Blood samples were collected from 141 febrile patients attending the selected facilities in treatment community. Serum obtained from collected blood were analyzed using RBT and Competitive Enzyme Linked Immunosorbent Assay (c-ELISA) for brucellosis screening and confirmatory, respectively. Results from this analysis were reported back to the health facility using AfyaData app. Chi-square was used to analyze categorical variables and t-test and/Anova test was used to assess the effectiveness of the intervention. RESULTS: Results revealed that before the training majority of the participants were ignorant about brucellosis, although they had good attitude towards brucellosis prevention. Participant's awareness, practice and attitude increased significantly (p = 0.003, p = 0.001, p = 0.032) respectively, after the intervention. Total of 17(12.1%) patients were positive on RBT and four (2.8%) were confirmed by c-ELISA. AfyaData app was proven to provide quick reports regarding brucellosis in the study area. CONCLUSION: The training program was effective in increasing the level of knowledge and practice about brucellosis. Electronic based technology (AfyaData app) improved the reporting of brucellosis cases. There is a need for the use of electronic based technology to improve timely management of brucellosis in pastoral communities. Also, continuous training on FHWs regarding the disease is needed to improved their awareness and practices.

Occurrence and Risk Factors of Brucellosis in Commercial Cattle Farms from Selected Districts of the Eastern Coast Zone, Tanzania.

Brucellosis is a disease of major socio-economic importance worldwide, particularly in low-income countries. This retrospective study aimed to estimate seroprevalence and risk factors associated with brucellosis in commercial cattle farms in the eastern coast zone of Tanzania (ECZT). A total of 1,052 serum samples collected from 20 commercial farms were subjected to rose bengal plate test (RBPT) and indirect enzyme-linked immunosorbent assay (i-ELISA). Descriptive analysis was employed to determine frequencies and proportions. To establish risk factors, a multivariate logistic regression analysis was carried out using a backward elimination procedure, following a univariate analysis, with 0.1 set as a cut-off point for the selection of putative risk factors. Agreement between RBPT and i-ELISA was determined using a Kappa coefficient (κ). The overall animal-level seroprevalence was 25.9% based on i-ELISA. Logistic regression analysis revealed that odds of infection were significantly higher in females (OR = 1.8, 95% CI: 1.2-2.5, p = 0.002) and in young animals than in adults (OR = 3.6, CI: 2.1-6.2, p < 0.001). In addition, odds of infection were higher during the wet season (OR = 3.4, CI: 3.2-5.2, p < 0.001), in cattle reared in rural farms (OR = 4.8, CI: 2.0-11.5, p < 0.001), in cattle reared in areas, not in contact with wildlife (OR = 2.9, CI: 1.4-2.3, p = 0.004), and in medium-sized farms (OR = 12.5, CI: 6.9-22.9, p < 0.001). These findings confirm that bovine brucellosis was prevalent among commercial cattle farms in the ECZT, posing a serious public health concern to the community living in these settings. The one health approach should be adopted for effective control of brucellosis.

Exclusive Breastfeeding and Its Determinants in Yaoundé, Cameroon: A Retrospective Survival Analysis.

Exclusive breastfeeding (EBF) of infants for the first six months of life is a global public health goal that is linked to the reduction of morbidity and mortality in infants, especially in low middle-income countries. In low middle-income countries like Cameroon, it is realistic that compliance with EBF can significantly reduce the burden of under five mortality rate. The purpose of this study was to assess adherence and determinants influencing the duration of exclusive breastfeeding in Yaoundé, Cameroon. Data was collected through a mixed method and systematically through a retrospective survival analysis approach where a total number of 503 randomly selected individuals in Yaoundé, Cameroon, participated in the study. Data was collected between November 2019 and May 2020. A Cox proportional hazard modelling and Kaplan-Meier analysis were employed to identify prognostic factors affecting survival time defined as the duration, in months, from birth until the time of stopping EBF. The average time for nursing mothers to practice EBF was 3.61 ± 0.010 months. This study found that more than 90% of mothers were aware of the importance of compliance with EBF but only 38% practiced EBF and 62% of mothers could not adhere to EBF recommendations. Factors that influence compliance with EBF included a mother being married (HR: 0.70; 95% CI = [0.55-0.89], P =0.003) which was a protective factor while mother's tertiary education (HR: 1.43; 95% CI = [1.11-1.84], P =0.005) was a risk factor with non-compliance with EBF when compared to those with basic or no formal education. The Kaplan-Meier curve indicated that as time goes on, babies are less likely to be exclusively breastfed after a specific time period within two and three months. This implies that the chance for a baby to remain exclusively breastfed after five months is 74.3% (0.74). Continuous sensitization and enforcement measures are recommended to promote EBF.

Challenges in the Diagnosis of Taenia solium Cysticercosis and Taeniosis in Medical and Veterinary Settings in Selected Regions of Tanzania: A Cross-Sectional Study.

Background: Taenia solium (neuro) cysticercosis/taeniosis (TSCT) is a zoonotic disease complex. There is a perceived inefficient diagnosis of infections by either form, the adult pork tapeworm (taeniosis) and the larval stage of it (cysticercosis), in low-income settings, including Tanzania. This study aimed at identifying potential gaps around TSCT diagnosis and knowledge of primary healthcare providers (officers in charge (OICs) of primary healthcare facilities (PHFs)) and veterinarians (meat inspectors (MIs)) on various aspects of TSCT disease complex and addressing effective disease control in Tanzania. Methodology. A cross-sectional study was conducted between January and April 2020 in Manyara, Dodoma, Ruvuma, Iringa, and Arusha regions in Babati, Mbulu, Kongwa, Mbinga, and Nyasa districts. We interviewed 152 OICs of PHFs and 108 MIs using a structured questionnaire and 33 medical and veterinary officers from level I healthcare facilities and district livestock offices, respectively, from selected study districts to the respective ministerial level using key informant interviews. Results: Quantitative data revealed inadequate microscopic diagnostic facilities (54.6%) and personnel (100%) for taeniosis diagnosis in PHFs (n = 152). Approximately 81.2% of MIs compared with only 42.1% of OICs of PHFs scored above average regarding T. solium cysticerci knowledge. Nevertheless, 61.2% of OICs of PHFs compared with only 42.6% of MIs scored above average regarding the adult T. solium tapeworm knowledge. Qualitative data revealed inadequate availability of advanced diagnostic facilities (neuroimaging) and trained personnel for specific diagnosis of TSCT with a focus on neurocysticercosis (NCC) in secondary and tertiary healthcare facilities. Inadequately number of qualified MIs, slaughter slabs, and resource facilitation challenged porcine cysticercosis diagnosis. Conclusion: It is concluded that diagnostic capacity and knowledge of OICs of PHFs and MIs regarding TSCT are insufficient in both medical and veterinary sectors. A One Health approach should be adopted to improve TSCT diagnostic capacity and practitioners' knowledge in both medical and veterinary sectors.

Rift Valley fever seropositivity in humans and domestic ruminants and associated risk factors in Sengerema, Ilala, and Rufiji districts, Tanzania.

OBJECTIVES: Data on Rift Valley fever virus (RVFV) prevalence in urban settings and pastoral areas of Tanzania are scarce. We performed a cross-sectional study of RVFV seroprevalence and determinants in humans and animals from Ilala, Rufiji, and Sengerema districts of Tanzania. METHODS: Blood samples from the study participants were tested for anti-RVFV immunoglobulin G (IgG) antibodies using an enzyme-linked immunosorbent assay. Logistic regression was used to determine association between exposure risk practices and RVFV seropositivity. RESULTS: The study involved 664 humans, 361 cattle, 394 goats, and 242 sheep. The overall anti-RVFV IgG seroprevalence in humans and animals was 2.1% (95% confidence interval [CI] 0.01-0.04) and 9.5% (n = 95, 95% CI 0.08-0.12), respectively. Seroprevalence in humans in Rufiji, Ilala, and Sengerema was 3.0% (n = 225, 95% CI 0.01-0.06), 1.8% (n = 230, 95% CI-0.005- 0.04), and 1.4% (n = 209, 95% CI 0.01-0.04), respectively (P >0.05). Seroprevalence in animals in Sengerema, Rufiji, and Ilala was 12.1% (n = 40, 95% CI 0.09-0.16), 11.1% (n = 37, 95% CI 0.08-0.15), and 5.4% (n = 18, 95% CI 0.03-0.08), respectively (P = 0.006). Handling of carcasses increased the odds of RVFV seropositivity 12-fold (odds ratio 11.84, 95% CI 1.97-71.16). CONCLUSION: The study confirms previous occurrence of RVFV in multiple species in the study districts. Animal handling practices appear to be essential determinants of seropositivity.

Knowledge, attitude and practices of frontline health workers in relation to detection of brucellosis in rural settings of Tanzania: a cross-sectional study.

BACKGROUND: Brucellosis an important zoonotic disease worldwide, which frequently presents as an undifferentiated febrile illness with otherwise varied and non-specific clinical manifestations. Despite its importance, there are few reports on its awareness among frontline health workers. This study aimed at assessing the baseline knowledge, attitude and practice (KAP) related to detection and management of brucellosis among frontline health workers (FHWs) namely; healthcare workers (HWs) and community health workers (CHWs). METHODS: A cross-sectional study was conducted from December 2019 to January 2020 in Kilosa and Chalinze districts of Tanzania. Data on demographic characteristics, knowledge, attitude and practices regarding brucellosis were collected from the study participants using a structured questionnaire. Interviews were conducted with 32 HWs and 32 CHWs who were systematically selected in study districts. Chi square/fisher Exact was used to assess the association between sociodemographic variables and those related to knowledge, attitude and practices. RESULTS: Overall, a total of 30 (93.8%) HWs and nine (28.1%) CHWs from the study districts heard about brucellosis, with (34.4%) of HWs having knowledge about the causative organism. Overall, knowledge showed almost half (46.9%) HWs and (28.1%) CHWs were aware of the symptoms, clinical signs, diagnosis and control regarding brucellosis. Knowledge difference was statistically significant with HWs' age (p = 0.016). Almost half (46.9%) HWs and less than quarter (12.5%) CHWs had good practices regarding brucellosis control. Almost three quarters (71.9%) of HWs and (21.9%) CHWs had positive attitude regarding brucellosis control; overall attitude was statistically significant with CHWs age (p = 0.028) and education level (p = 0.024). Lack of awareness and unavailability of diagnostic tools were the main challenges faced by FHWs in the two districts. CONCLUSION: The majority of participants were not aware of human brucellosis. Moreover, their overall knowledge was inadequate and the common practices were diagnostic tools, and adequate knowledge to manage brucellosis cases. These findings highlight the need to strengthen frontline health workers knowledge, practices and diagnostic capacities related to brucellosis.

Brucellosis and its associated risk factors to humans and domestic ruminants in Kagera Ecosystem, Tanzania.

BACKGROUND: Brucellosis is an important disease for both veterinary and public health. A study was conducted to understand the seroprevalence of brucellosis and its associated risk factors in pastoral areas of Kagera, Tanzania. METHODS: Sera from 156 patients with malaria-like symptoms were analyzed using the commercial rapid agglutination test (specific for B.abortus and B.melitensis detection) and Fluorescence Polarization Assay (FPA). Sera from 426 cattle, 206 goats and 197 sheep were analyzed using Rose Bengal Plate (RBPT) and Competitive ELISA (c-ELISA) tests. RESULTS: In humans, overall brucellosis, B. abortus, and B. melitensis sero-prevalences were 7.7% (95%CI: 3.8-12.2%), 1.9% (95% CI: 0.4-4.5%), and 5.8 % (95%CI: 2.6-10.6%), respectively. At animal level, seropositivity was 5.9% (95%CI: 4.0-8.6%), 2.5% (95%CI: 0.8-5.7%) and 0.5% (95%CI: 0.01-2.8%) in cattle, goats and sheep, respectively. At herd level, seropositivity was 18.2% (95%CI: 12.0-25.8%) in cattle and 6.9% (95%CI: 2.2-15.3%) in small ruminants. Brucellosis was associated with assisting in parturition without wearing protective gears (OR= 5.6; p= 0.02) in humans, herds of 50-200 animals (OR= 4.2, p= 0.01) and cattle (OR=3.5; p=0.01). The knowledge of brucellosis among pastoralists (OR=0.1; p<0.01) was a protective factor. CONCLUSION: Brucella infections could be occurring in pastoralists and domestic ruminants in Kagera. Community health education is necessary for the control of brucellosis in Tanzania.

Seroprevalence and associated risk factors of chikungunya, dengue, and Zika in eight districts in Tanzania.

BACKGROUND: This study was conducted to determine the seroprevalence and risk factors of chikungunya (CHIKV), dengue (DENV), and Zika (ZIKV) viruses in Tanzania. METHODS: The study covered the districts of Buhigwe, Kalambo, Kilindi, Kinondoni, Kondoa, Kyela, Mvomero, and Ukerewe in Tanzania. Blood samples were collected from individuals recruited from households and healthcare facilities. An ELISA was used to screen for immunoglobulin G antibodies against CHIKV, DENV, and ZIKV. RESULTS: A total of 1818 participants (median age 34 years) were recruited. The overall CHIKV, DENV, and ZIKV seroprevalence rates were 28.0%, 16.1%, and 6.8%, respectively. CHIKV prevalence was highest in Buhigwe (46.8%), DENV in Kinondoni (43.8%), and ZIKV in Ukerewe (10.6%) and Mvomero (10.6%). Increasing age and frequent mosquito bites were significantly associated with CHIKV and DENV seropositivity (P < 0.05). Having piped water or the presence of stagnant water around the home (P < 0.01) were associated with higher odds of DENV seropositivity. Fever was significantly associated with increased odds of CHIKV seropositivity (P < 0.001). Visiting mines had higher odds of ZIKV seropositivity (P < 0.05). CONCLUSIONS: These findings indicate that DENV, CHIKV, and ZIKV are circulating in diverse ecological zones of Tanzania. There is a need to strengthen the control of mosquito-borne viral diseases in Tanzania.

Occurrence of Extended Spectrum Beta Lactamase (ESBL) Producers, Quinolone and Carbapenem Resistant Enterobacteriaceae Isolated from Environmental Samples along Msimbazi River Basin Ecosystem in Tanzania.

We conducted environmental surveillance of antimicrobial resistance (AMR) bacteria in the Msimbazi river basin in Tanzania to determine the occurrence of extended-spectrum ß-lactamase (ESBL)-producing, carbapenem resistant Enterobacteriaceae (CRE) and quinolone resistant Escherichia coli and Klebsiella spp. A total of 213 Enterobacteriaceae isolates were recovered from 219 samples. Out of the recovered isolates, 45.5% (n = 97) were Klebsiella pneumoniae and 29.6% (n = 63) were Escherichia coli. K. pneumoniae isolates were more resistant in effluent (27.9%) compared to the E. coli (26.6%). The E. coli had a higher resistance in river water, sediment and crop soil than the K. pneumoniae (35 versus 25%), respectively. Higher resistance in K. pneumoniae was found in nalidixic acid (54.6%) and ciprofloxacin (33.3%) while the E. coli isolates were highly resistant to ciprofloxacin (39.7%) and trimethoprim/sulfamethoxazole (38%). Resistance increased from 28.3% in Kisarawe, where the river originates, to 59.9% in Jangwani (the middle section) and 66.7% in Upanga West, where the river enters the Indian Ocean. Out of 160 E. coli and K. pneumoniae isolates, 53.2% (n = 85) were resistant to more than three classes of the antibiotic tested, occurrence being higher among ESBL producers, quinolone resistant and carbapenem resistant strains. There is an urgent need to curb environmental contamination with antimicrobial agents in the Msimbazi Basin.

Safety, Immunogenicity and Antibody Persistence of Rift Valley Fever Virus Clone 13 Vaccine in Sheep, Goats and Cattle in Tanzania.

Background: Vaccination is considered to be the best approach to control Rift Valley fever (RVF) in animals and consequently in humans. This study assessed the efficacy and safety of the RVF virus (RVFV) Clone 13 vaccine under field conditions. Methodology: A vaccine trial was conducted in sheep (230), goats (230), and cattle (140) in Ngorongoro district, Tanzania. Half of each of the animal species were vaccinated and the other half received the placebo. Animals were clinically monitored and bled before vaccination and at days 15, 30, 60, 180 and 360 (+/- 10) post-vaccination to measure Immunoglobulin M (IgM) and IgG antibody responses to RVFV. Survival analysis was conducted using cox-proportional hazard regression model to measure the time until an event of interest had occurred and to compare the cumulative proportion of events over time. Results: Of 600 animals included in the study, 120 animals were lost during the study, leaving a total of 480 (243 in the vaccinated group and 237 in the control group) for complete follow-up sampling. There was no adverse reaction reported at the injection site of the vaccine/placebo in all animals. Abortions, deaths, or body temperature variations were not associated with vaccination (p > 0.05). By day 15 post-inoculation, the IgG seroconversion in vaccinated goats, cattle and sheep was 27.0% (n = 115), 20.0% (n = 70) and 10.4% (n = 115), respectively. By day 30 post-inoculation, it was 75.0% (n = 113), 74.1% (n = 112) and 57.1% (n = 70) in vaccinated sheep, goats and cattle, respectively. By day 60 post-inoculation, IgG seroconversion in sheep, goats and cattle was 88.1% (n = 109), 84.3% (n = 108) and 64.60% (n = 65), respectively. By day 180, the IgG seroconversion in sheep, goats and cattle was 88.0% (n = 108), 83.8% (n = 105) and 66.1% (n = 62), respectively. By day 360, the IgG seroconversion in sheep, goats and cattle was 87.2% (n = 94), 85.6% (n = 90) and 66.1% (n = 59), respectively. Only five animals from the vaccinated group were RVFV IgM positive, which included four sheep and a goat. Conclusion: RVFV Clone 13 vaccine was well tolerated by sheep, goats, and cattle. The vaccine induced detectable, but variable levels of IgG responses, and of different duration. The vaccine is considered safe, with high immunogenicity in sheep and goats and moderate in cattle.

Investigating the Meat Pathway as a Source of Human Nontyphoidal Salmonella Bloodstream Infections and Diarrhea in East Africa.

BACKGROUND: Salmonella Enteritidis and Salmonella Typhimurium are major causes of bloodstream infection and diarrheal disease in East Africa. Sources of human infection, including the role of the meat pathway, are poorly understood. METHODS: We collected cattle, goat, and poultry meat pathway samples from December 2015 through August 2017 in Tanzania and isolated Salmonella using standard methods. Meat pathway isolates were compared with nontyphoidal serovars of Salmonella enterica (NTS) isolated from persons with bloodstream infections and diarrheal disease from 2007 through 2017 from Kenya by core genome multi-locus sequence typing (cgMLST). Isolates were characterized for antimicrobial resistance, virulence genes, and diversity. RESULTS: We isolated NTS from 164 meat pathway samples. Of 172 human NTS isolates, 90 (52.3%) from stool and 82 (47.7%) from blood, 53 (30.8%) were Salmonella Enteritidis sequence type (ST) 11 and 62 (36.0%) were Salmonella Typhimurium ST313. We identified cgMLST clusters within Salmonella Enteritidis ST11, Salmonella Heidelberg ST15, Salmonella Typhimurium ST19, and Salmonella II 42:r:- ST1208 that included both human and meat pathway isolates. Salmonella Typhimurium ST313 was isolated exclusively from human samples. Human and poultry isolates bore more antimicrobial resistance and virulence genes and were less diverse than isolates from other sources. CONCLUSIONS: Our findings suggest that the meat pathway may be an important source of human infection with some clades of Salmonella Enteritidis ST11 in East Africa, but not of human infection by Salmonella Typhimurium ST313. Research is needed to systematically examine the contributions of other types of meat, animal products, produce, water, and the environment to nontyphoidal Salmonella disease in East Africa.

Community Health Workers and Disease Surveillance in Tanzania: Promoting the Use of Mobile Technologies in Detecting and Reporting Health Events.

This cross-sectional study was conducted in the Kilosa, Morogoro Urban, Ngorongoro, and Ulanga districts of Tanzania to investigate the practices of community health workers (CHWs) related to disease surveillance functions and to establish their needs and technology capacities. We also established the strength of mobile phone networks and internet connections in the study areas to inform the feasibility of using mobile-based applications in community-based disease surveillance. A total of 135 CHWs from 85 villages participated in the study. Health events captured at the community level were entirely paper-based. CHWs submitted reports to higher-level health authorities mainly on foot (100%), but they also used public transport (65%) and telephone calls (56%). The median number of days between the onset of a suspected disease outbreak at the community level and reporting to a primary healthcare facility was 10 days (interquartile range [IQR] 2-30). The median number of days between submitting a report and receiving a response was 7 days (IQR 2-30). Of the 53 CHWs who reported the most recent health events to a higher-level health authority, 39 (74%) never received feedback. All 85 villages had a reliable mobile phone network and 74 (87%) had a mobile phone internet connection that was strong enough to support data transmission using digital technology. Almost all (n = 132, 98%) of the CHWs owned mobile phones. The practices related to detection and reporting of health events could be improved to enhance early warning disease surveillance. Reliable mobile networks and internet connections and the ownership of mobile phones among CHWs in the study areas present opportunities to strengthen community event-based surveillance using mobile-based solutions.

Molecular characterization of Brucella species detected in humans and domestic ruminants of pastoral areas in Kagera ecosystem, Tanzania.

Brucellosis is a zoonotic disease of importance to both public health and the livestock industry. The disease is likely to be endemic in Tanzania and little is reported on molecular characterization of Brucella species in pastoral settings. This study aimed at characterizing Brucella species (targeting genus Brucella) infecting humans, cattle and goat in Kagera region (Ngara and Karagwe districts) using real-time PCR, PCR amplification of 16S rRNA genes and Sanger sequencing. Brucella spp. were detected in 47 samples (19 sera and 28 milk) out of 125 samples (77 sera, 35 milk and 13 aborted materials) using real-time PCR. All aborted materials (13 samples) were negative to real-time PCR. Out of the 47 real-time PCR positive samples (28 milk and 19 sera), 20 samples (10 milk and 10 sera) showed an expected 16S rRNA gene PCR product. Sequence analysis and blasting confirmed the presence of Brucella spp. in pastoral areas of Kagera region. The Brucella spp. from Kagera were phylogenetically grouped in two clades and three branches all closer to B. melitensis, B. abortus and B. suis from USA, Sudan and Iran. However, they were distinct from other species isolated also in USA, New Zealand, Germany and Egypt. This was expected based on the distance between the geographical regions from which the data (nucleotides sequences from 16S gene sequencing) for the phylogeny reconstruction were obtained. This is the first study to report Brucella species identified using 16S rRNA gene sequencing in East and Central Africa. A livestock vaccination program re-inforced with a high index of Brucella diagnosis is needed to eradicate brucellosis in animals and minimize suffering from Brucella infections in humans in Tanzania.

Association of brucellosis to abortions in humans and domestic ruminants in Kagera ecosystem, Tanzania.

Brucellosis is a worldwide zoonotic disease of socio-economic importance. Understanding the association of this disease with pregnancy outcome has the potential of contributing to the reduction of its reproductive burden in humans and animals among pastoral communities in Tanzania. A prospective cohort study was conducted in Kagera Region on pregnant women (n = 76) and gravid ruminants (121 cattle, 125 goats and 111 sheep). Exposed and non-exposed groups to brucellosis were followed for 6 months (from 15 November 2017 to 15 April 2018). Sera were collected and analysed using Rose Bengal Test (RBT) and Fluorescence polarization assay (FPA) test. Measures of effect, univariable and multivariable logistic regression analyses were computed. Positivity to both RBT and FPA tests was 21% (95% CI: 12.5-32) in pregnant women and 5% (95% CI: 3.1-8) in gravid ruminants. Among aborted cases, four women (out of nine), two cows (out of seven), two goats (out of 26) and zero sheep (out of 11) were positive to brucellosis. The abortion rate in humans and ruminants was 11.8% and 12.3%, respectively. Seropositivity to brucellosis was similar in aborted and non-aborted cases in humans (p = .08) and in ruminants (p = .2). At the population level, brucellosis was associated with abortions (population attributable risk: PAR) at 3.5% in pregnant women and at 0.5% in gravid ruminants in the study area. Infections to brucellosis were increased in exposed pregnant women (OR = 19; 95% CI: 1.8-203, p = .01) and in cattle (OR = 11; 95% CI: 1.3-88, p = .02). There is an indication that brucellosis could be contributing to abortions in pregnant women and domestic ruminants Kagera Region. Molecular tools could support more the results from serological tests to avoid cross-reaction with other pathogen agents. Control of brucellosis in animals is likely to reduce the threat of abortions in humans.

Association of Brucellosis with Abortion Prevalence in Humans and Animals in Africa: A Review.

Brucellosis is a worldwide zoonotic disease suspected to be the cause of abortions which remain largely undiagnosed in both humans and animals. A review of literature was performed to elucidate the contribution of brucellosis to abortions in humans, livestock and wildlife in Africa. A total number of 18 published articles associated brucellosis to abortions observed in humans and livestock in some parts of Africa. The contribution of brucellosis to abortions in humans was less reported in the literature compared to livestock; and no report was done in wildlife in Africa. The association of brucellosis to abortions in Africa was mostly based on bacteriologic, serologic or molecular techniques and Brucella abortus biovar 3 seemed more associated to abortions in cattle. The isolation and molecular characterization of Brucella species could advance the assessment of the contribution of brucellosis to abortions in Africa, focusing much in humans. The epidemiologic approach based on case-control comparisons could elucidate more about the contribution of brucellosis to abortions in Africa. The economic impact evaluation of abortions due to brucellosis could justify implementation of eradication programs of this disease in Africa, such as occupational and food hygiene in humans; with a vaccination and culling in animals.

A One Health Evaluation of the Southern African Centre for Infectious Disease Surveillance.

Rooted in the recognition that emerging infectious diseases occur at the interface of human, animal, and ecosystem health, the Southern African Centre for Infectious Disease Surveillance (SACIDS) initiative aims to promote a trans-sectoral approach to address better infectious disease risk management in five countries of the Southern African Development Community. Nine years after SACIDS' inception, this study aimed to evaluate the program by applying a One Health (OH) evaluation framework developed by the Network for Evaluation of One Health (NEOH). The evaluation included a description of the context and the initiative, illustration of the theory of change, identification of outputs and outcomes, and assessment of the One Healthness. The latter is the sum of characteristics that defines an integrated approach and includes OH thinking, OH planning, OH working, sharing infrastructure, learning infrastructure, and systemic organization. The protocols made available by NEOH were used to develop data collection protocols and identify the study design. The framework relies on a mixed methods approach by combining a descriptive and qualitative assessment with a semi-quantitative evaluation (scoring). Data for the analysis were gathered during a document review, in group and individual interviews and in an online survey. Operational aspects (i.e., OH thinking, planning, and working) were found to be balanced overall with the highest score in the planning dimension, whereas the infrastructure (learning infrastructure, systemic organization, and sharing infrastructure) was high for the first two dimensions, but low for sharing. The OH index calculated was 0.359, and the OH ratio calculated was 1.495. The program was praised for its great innovative energy in a difficult landscape dominated by poor infrastructure and its ability to create awareness for OH and enthuse people for the concept; training of people and networking. Shortcomings were identified regarding the balance of contributions, funds and activities across member countries in the South, lack of data sharing, unequal allocation of resources, top-down management structures, and limited horizontal collaboration. Despite these challenges, SACIDS is perceived to be an effective agent in tackling infectious diseases in an integrated manner.

A Smartphone App (AfyaData) for Innovative One Health Disease Surveillance from Community to National Levels in Africa: Intervention in Disease Surveillance.

BACKGROUND: We describe the development and initial achievements of a participatory disease surveillance system that relies on mobile technology to promote Community Level One Health Security (CLOHS) in Africa. OBJECTIVE: The objective of this system, Enhancing Community-Based Disease Outbreak Detection and Response in East and Southern Africa (DODRES), is to empower community-based human and animal health reporters with training and information and communication technology (ICT)-based solutions to contribute to disease detection and response, thereby complementing strategies to improve the efficiency of infectious disease surveillance at national, regional, and global levels. In this study, we refer to techno-health as the application of ICT-based solutions to enhance early detection, timely reporting, and prompt response to health events in human and animal populations. METHODS: An EpiHack, involving human and animal health experts as well as ICT programmers, was held in Tanzania in 2014 to identify major challenges facing early detection, timely reporting, and prompt response to disease events. This was followed by a project inception workshop in 2015, which brought together key stakeholders, including policy makers and community representatives, to refine the objectives and implementation plan of the DODRES project. The digital ICT tools were developed and packaged together as the AfyaData app to support One Health disease surveillance. Community health reporters (CHRs) and officials from animal and human health sectors in Morogoro and Ngorongoro districts in Tanzania were trained to use the AfyaData app. The AfyaData supports near- to real-time data collection and submission at both community and health facility levels as well as the provision of feedback to reporters. The functionality of the One Health Knowledge Repository (OHKR) app has been integrated into the AfyaData app to provide health information on case definitions of diseases of humans and animals and to synthesize advice that can be transmitted to CHRs with next step response activities or interventions. Additionally, a WhatsApp social group was made to serve as a platform to sustain interactions between community members, local government officials, and DODRES team members. RESULTS: Within the first 5 months (August-December 2016) of AfyaData tool deployment, a total of 1915 clinical cases in livestock (1816) and humans (99) were reported in Morogoro (83) and Ngorongoro (1832) districts. CONCLUSIONS: These initial results suggest that the DODRES community-level model creates an opportunity for One Health engagement of people in their own communities in the detection of infectious human and animal disease threats. Participatory approaches supported by digital and mobile technologies should be promoted for early disease detection, timely reporting, and prompt response at the community, national, regional, and global levels.

Using local language syndromic terminology in participatory epidemiology: Lessons for One Health practitioners among the Maasai of Ngorongoro, Tanzania.

Pastoralists and agro-pastoralists often occupy remote and hostile environments, which lack infrastructure and capacity in human and veterinary healthcare and disease surveillance systems. Participatory epidemiology (PE) and Participatory Disease Surveillance (PDS) are particularly useful in situations of resource scarcity, where conventional diagnostics and surveillance data of disease prevalence may be intermittent or limited. Livestock keepers, when participating in PE studies about health issues, commonly use their local language terms, which are often syndromic and descriptive in nature. Practitioners of PE recommend confirmation of their findings with triangulation including biomedical diagnostic techniques. However, the latter is not practiced in all studies, usually due to time, financial or logistical constraints. A cross sectional study was undertaken with the Maasai of Ngorongoro District, Tanzania. It aimed to identify the terms used to describe the infectious diseases of livestock and humans with the greatest perceived impact on livelihoods. Furthermore, it aimed to characterise the usefulness and limitations of relying on local terminology when conducting PE studies in which diagnoses were not confirmed. Semi-structured interviews were held with 23 small groups, totalling 117 community members within five villages across the district. In addition, informal discussions and field observations were conducted with village elders, district veterinary and medical officers, meat inspectors and livestock field officers. For human conditions including zoonoses, several biomedical terms are now part of the common language. Conversely, livestock conditions are described using local Maasai terms, usually associated with the signs observed by the livestock keeper. Several of these descriptive, syndromic terms are used inconsistently and showed temporal and spatial variations. This study highlights the complexity and ambiguity which may exist in local terminology when used in PE studies. It emphases the need for further analysis of such findings, including laboratory diagnosis where possible to improve specificity before incorporating them into PDS or disease control interventions.