The use of community-based animal health workers to strengthen disease surveillance systems in Tanzania.

An 18 month trial was conducted in three districts of Arusha region, northern Tanzania, to assess the use of community-based animal health workers (CAHWs) in an official disease surveillance system. Disease reports provided by CAHWs were assessed using six indicators for effective disease surveillance, i.e. sensitivity, specificity, timeliness, representativeness, simplicity and acceptability. To assess sustainability issues and determine the incentives required by CAHWs to report disease, three different incentive models were tested in the trial. None of the incentive models involved direct payments to CAHWs. Before involving CAHWs in disease surveillance in the three trial districts, disease case reports as a proportion of cattle population were 0.13%, 0.20% and 0.12%. During the trial, disease case reports as a proportion of cattle population increased to 5.0%, 5.6% and 6.3%. The CAHWs also improved the spatial and temporal coverage of the disease surveillance system and provided timely reports. During the trial, national-level disease reporting in Tanzania increased by 17% owing to the sensitisation and support activities of the Pan African Programme for the Control of Epizootics in Tanzania. In Arusha region, disease reporting increased by 118%, and 49% of this improvement was attributable to increased reporting in the three trial districts. Reporting from these districts far exceeded that from any other district in Tanzania. Veterinarians confirmed the CAHWs' clinical diagnosis in 88% of the 170 clinical cases examined. The increase in disease reporting resulting from CAHW activities was sufficient to enable the national epidemiology unit to achieve its target in relation to World Organisation for Animal Health (OIE) guidelines. The authors conclude that the use of CAHWs should be promoted in the national strategy for disease reporting. Additionally, CAHWs must be brought under the control of the Tanzanian veterinary authorities, a process that will include appropriate legislative reform.

Using participatory epidemiological techniques to estimate the relative incidence and impact on livelihoods of livestock diseases amongst nomadic pastoralists in Turkana South District, Kenya.

A participatory epidemiological (PE) study was carried out with Turkana pastoralists in Turkana South District, Kenya, to determine the relative incidence of livestock diseases and their impact on livelihoods. A sub-location was used as the sampling unit. A sub-location is the smallest administrative unit and is occupied by clusters of families (called adakars) that share common grazing patterns. A total of 32 sub-locations were randomly selected for the study. At least one focus group discussion involving more than 10 people was held with each adakar. In addition, key informant interviews involving local leaders and animal health service providers were conducted before or after the group sessions. PE techniques that were used with the stock owners include participatory mapping, relative incidence scoring, proportional piling, disease impact matrix scoring, seasonal calendars and probing. The methods used were pre-tested in four sub-locations that were excluded from further study. The study revealed that goats, with median score of 33 (10th and 90th percentiles of 25, 44, respectively) and sheep, median score of 20.5 (15, 26) were perceived to be the most abundant livestock species while goats (median score of 32 [21, 56]) and camels (median score of 22.5 [11, 33]) contributed the most to the livelihoods of the pastoralists. For goats, the overall relative incidence scores of peste des petits ruminants (PPR), contagious caprine pleuropneumonia (CCPP) and mange were 23.5% (15, 34), 25% (21, 45) and 20% (19, 28), respectively. The respective median scores for case fatality rates were 66% (45, 76.5), 62.5% (25, 100) and 73.2% (21.4, 85.7). Disease impact matrix scores indicated that mange was the most important disease of goats. Mange (range: 28-32%) and pox (range: 16-38%) were perceived to be the most prevalent diseases in camels. Livestock movements, limited access to veterinary services and stock theft were identified as key factors that contributed to the high prevalence and persistence of these diseases. This paper discusses strategies that could be used to control these diseases given the challenges associated with nomadic pastoralism and insecurity.

Health care needs and services for technology-dependent children in developmental centers.

In an attempt to document the trend toward a more seriously ill and medically needy population of children in California state developmental centers, we studied the medical status and health care needs of the pediatric and young adult population (birth to 22 years of age) residing in all acute care and skilled nursing care units in developmental centers in 1988. All children in California's state developmental centers are severely to profoundly mentally retarded and chronically disabled, and many have serious health problems. Of the 865 children in 5 developmental centers, 441 (51%) resided in acute and skilled nursing care units and were technology dependent (Office of Technology Assessment classification). We suspect that our findings (ethical and quality-of-care issues, staffing, licensing mandates, cost-of-care considerations) reflect the rapidly expanding population of children with special health care needs and may be important in planning for services in other states as well as in California.