Brucellosis in dairy herds: Farm characteristics and practices in relation to likely adoption of three potential private-public partnership (PPP) vaccination control strategies in West and Central Africa.

Brucellosis is regarded as one of the highest burden zoonotic diseases to persist in many regions globally. While sustained vaccination against B. abortus in an endemic setting can markedly reduce the prevalence of large ruminant and human brucellosis and benefit local livelihoods, the implementation of effective and sustainable control programmes has often failed in the worst affected areas. In a cross-sectional study of 728 peri-urban dairy farmers in nine areas of six West and Central African countries, levels of commercialization and farm characteristics were examined alongside B. abortus seroprevalence estimates to hypothesize the most appropriate model for brucellosis vaccination delivery in each country. Demographic and economic data were collated and used to describe the farming systems currently in place. Furthermore, these data were utilized in a likelihood assessment to generate a quantitative score to hypothesize which of three private-public partnership (PPP) vaccine delivery models, that is 1) transformative, 2) transactional or 3) collaborative, would be most appropriate in each setting. The study sites had substantial differences in their levels of dairy commercialization and the farming practices employed; the heterogeneity across the study sites was evident in the conclusions of which models would be appropriate for vaccination delivery. While Lomé (Togo) had a strong indication for a transformative PPP model, Burkina Faso had strong indication for the collaborative PPP model. Of the remaining study sites, the scores were less dominant for any one model with Cameroon and Ivory Coast sites only just scoring highest on the transformative model and Senegal and Mali sites only just scoring highest on the collaborative model. Interestingly, none of the countries included in the study scored highest on the transactional model which currently is the most commonplace delivery model in the majority of sub-Saharan African countries.

"Everything in this world has been given to us from cows", a qualitative study on farmers' perceptions of keeping dairy cattle in Senegal and implications for disease control and healthcare delivery.

The dairy industry in Senegal is growing and evolving against a backdrop of rapid urbanisation and increasing consumer demand for dairy products. Consideration of appropriate cattle healthcare delivery and disease control in these evolving farming systems is of paramount importance given the risks posed by zoonotic pathogens and the economic consequences of disease for livestock keepers. Planning and implementation of disease control and healthcare delivery generally follows a top down approach. Often this does not take into account the views and perceptions of the farmers it impacts and who must behave in the expected way for successful outcomes to materialise. In this study, we asked 76 farmers to discuss their experience and opinions of farming milk producing cattle in 11 focus group discussions conducted in two peri-urban areas of Senegal. The objectives were to investigate farmers' perceptions of the current conditions in farming, to understand how these might impact the future direction of this particular system and how this might affect the feasibility and appropriate methods of cattle healthcare delivery and disease control. The data collected were subjected to thematic analysis and four themes were identified; 1. Revered cattle, 2. The changing face of livestock keeping, 3. Powerlessness, 4. Optimism for the future. Farmers in our study had a deep affinity with their cattle, they respected the traditions surrounding cattle keeping at the same time as striving for advances within the system and their animal's productivity. Within strong social groupings and hierarchical structures they recognised the inherent challenges they face but were hopeful and optimistic about growth and opportunity in the future of milk production. A holistic approach to embedding healthcare delivery and disease control within the broader context in which farmers operate may prove successful. This could involve consideration of funding channels for farmers, access to appropriate inputs and utilising the strong community spirit and social norms of farmers to initiate and facilitate change.

"We never boil our milk, it will cause sore udders and mastitis in our cows"- consumption practices, knowledge and milk safety awareness in Senegal.

BACKGROUND: Milk is a nutrient-rich food that makes an important contribution to diets in several Low and Middle Income Countries such as Senegal. Milk can also harbour several pathogenic microorganisms. As in other low and middle income countries, the dairy industry in Senegal is growing, with an expansion of farms to meet rapidly growing demand in the cities. However, most of the production still happens in the informal sector, and little is known about consumption of milk and milk products, or knowledge, awareness and practices of actors in informal dairy supply chains. METHODS: We conducted structured focus group discussions with dairy farmers and milk processors in three selected regions (Dakar, Thies and Fatick) in Senegal to investigate the consumption practices, awareness of milk borne hazards, and practices relevant to the risk of milk contamination to gain a deeper understanding of drivers of milk-borne diseases. Data on the consumption of milk and milk products were also collected using a closed questionnaire. RESULTS: Results indicate that milk is an important part of the diet in the study regionsand raw milk consumption is very common. The most common milk product consumed was fermented milk. Awareness of milk borne hazards was limited. Several farmers and processors reported risky practices, despite being aware of better practices, due to cultural beliefs. In households, children, pregnant women and older people were prioritised when milk and milk products were distributed. Dairy farmers and milk processors were more concerned with the lack of food for animals, low production and seasonality of production than the safety of the milk and milk products. CONCLUSIONS: Lack of awareness of milk borne infections and some traditional practices put milk and milk product consumers in the study area at high risk of milk borne diseases.. Prioritising certain sub population at households (Pregnant women and children) makes then vulnerable to milk-borne hazards. It will be challenging to change the risky practices as they are motivated by cultural beliefs hence the best strategy to promote milk safety will be to encourage the boiling of milk by consumers.

Brucellosis in dairy herds: A public health concern in the milk supply chains of West and Central Africa.

Ten herd-level cross-sectional studies were conducted in peri-urban dairy production areas of seven West and Central African countries (Burkina Faso, Burundi, Cameroon, Mali, Niger, Senegal and Togo). The objectives were to estimate herd level Brucella spp. seroprevalence and identify risk factors for seropositivity. In each of the ten study areas, herds (between 52 and 142 per area, total = 965) were selected probabilistically and a structured questionnaire was administered to gather information on their structure and management. A bulk milk sample from each herd was tested by indirect ELISA for Brucella spp. For each area, herd seroprevalence estimates were obtained after adjusting for the assumed performance of the diagnostic test. Herd level risk factors for Brucella spp. seropositivity were identified by means of stratified logistic regression, with each peri-urban zone as a stratum. Area-specific models were also explored. Estimated herd seroprevalences were: Lomé (Togo) 62.0% (95% CI:55.0-69.0), Bamako (Mali) 32.5% (95% CI:28.0-37.0), Bujumbura (Burundi) 14.7% (95%CI:9.4-20.8), Bamenda (Cameroon) 12.6% (95% CI:7.6-21.9), Ouagadougou (Burkina Faso) 3.0% (95% CI:1.0-9.1), Ngaoundere (Cameroon) 2.3% (95% CI:1.0-7.0), Thies (Senegal) 1.3% (95% CI:0.1, 5.3), Niamey (Niger) 1.2% (95% CI:0.08-5.3), Dakar (Senegal) 0.2% (95% CI:0.01-1.7) and Niakhar (Senegal) <0.04%. Logistic regression modelling revealed transhumant herds to be at lower risk of infection (adjusted OR: 0.25, 95% CI: 0.13 - 0.5) and in one of the areas (Bamenda), regular purchase of new animals was found to be strongly associated with Brucella spp. seropositivity (adjusted OR = 5.3, 95% CI: 1.4-25.9). Our findings confirm that Brucella spp. circulates among dairy cattle supplying milk to urban consumers in West and Central Africa, posing a serious public health concern. Control programs are urgently needed in areas such as Lomé or Bamako, where more than 30% of the herds show evidence of infection.

Reconciling surveillance systems with limited resources: an evaluation of passive surveillance for rabies in an endemic setting.

Surveillance systems for rabies in endemic regions are often subject to severe constraints in terms of resources. The World Organisation for Animal Health (OIE) and the World Health Organisation (WHO) propose the use of an active surveillance system to substantiate claims of disease freedom, including rabies. However, many countries do not have the resources to establish active surveillance systems for rabies and the testing of dead dogs poses logistical challenges. This paper explores the potential of using a scenario tree model parameterised with data collected via questionnaires and interviews to estimate the sensitivity of passive surveillance, assessing its potential as a viable low-cost alternative to active surveillance systems. The results of this explorative study illustrated that given a large enough sample size, in this case the entire population of Colombo City, the sensitivity of passive surveillance can be 100% even at a low disease prevalence (0.1%), despite the low sensitivity of individual surveillance components (mean values in the range 4.077×10(-5)-1.834×10(-3) at 1% prevalence). In addition, logistic regression was used to identify factors associated with increased recognition of rabies in dogs and reporting of rabies suspect dogs. Increased recognition was observed amongst dog owners (OR 3.8 (CI, 1.3-10.8)), people previously bitten by dogs (OR 5.9 (CI, 2.2-15.9)) and people who believed they had seen suspect dogs in the past (OR 4.7 (CI, 1.8-12.9)). Increased likelihood of reporting suspect dogs was observed amongst dog owners (OR 5.3 (CI, 1.1-25)). Further work is required to validate the data collection tool and the assumptions made in the model with respect to sample size in order to develop a robust methodology for evaluating passive rabies surveillance.