Using One Health and Participatory Epidemiology to Assess Impacts of Anthrax on the Human-Animal Interface in Rural Uganda

Jeanne L Coffin, MS Fred Monje, DVM Grace Asiimwe-Karimu, DVM

PENAPH First Technical Workshop Dec. 11-13 2012, Chiang Mai, Thailand

Summary Slide Conservation Medicine and Participatory Methods Systematic Review Applying Participatory Epidemiology (PE) to Anthrax in Uganda Results and Discussion Management Proposal

Background Conservation Medicine & A Systematic Review of Participatory Literature

Conservation Medicine

Conservation medicine is an emerging, interdisciplinary field that studies the relationship between human and animal health and environmental conditions, or ecosystem health. It seeks to apply that knowledge to better the management of One Health or Ecohealth challenges. Case Study for a 1 year Masters in Conservation Medicine.

Systematic Review of Literature

Standard search and coding 13 papers met the exclusionary criteria Scoring of each accepted paper

counteracting bias level of participation reached as in Pretty 1994 quality of study design execution reporting

Results All but one study made adequate efforts to counteract bias

need more integration with quantitative methods

No paper reached the highest level5 Reporting and evaluation was highly variable

feed back to participants often not mentioned Study design was not clearly described

example outlines or questions needed

Learning from the Literature

Technical pitfalls to avoid Slippery definitions Avoid bias

use rigorous sampling and triangulation cross-check with conventional methodologies plan adequately

Evaluation and reporting Reporting as transparently as possible Pursuing follow up faithfully is important

In the Field

Anthrax in Uganda

Western Uganda is mixed livestock and banana farming Sporadic ongoing anthrax (B. anthracis) outbreaks

wildlife in 2005 in Queen Elisabeth National Park3 and again in 2010 cattle and people in 2011 in Sheema District6

Main Aims Understand the context surrounding the ongoing anthrax outbreaks Propose a management plan Gain on the ground experience and practice with participatory epidemiology methods

Specific Objectives Assess the impact of anthrax on humans and domestic animals around QENP

relative to other local diseases Assess knowledge of zoonoses Assess knowledge of wildlife role in anthrax life cycle Understand attitudes about anthrax, related veterinary services, and wildlife

Study Design Study Partners

AFENET fellows with Makerere University staff internship at Uganda Wildlife Authority

In the field in late July of 2012 pilot study

PE4 compared with conventional questionnaires

Techniques Used

Formal questionnaires Informal Interviews

semi-structured Focus groups

semi-structured interview participatory mapping simple and comparative ranking proportional piling matrix scoring

Sampling Two districts where anthrax outbreaks had occurred (purposive)

two subcounties – one adjacent to anthrax outbreaks, one further away (purposive) 1-2 villages in each subcounty (convenience) 2-3 focus groups in each village (convenience) 5+ questionnaires in each village (76 total)

Study Locations

Second Location

Collaborative Challenges short timeframe of program institutional communication

Participatory Epidemiology time constraints standardization gave way to flexibility data management bias introduced by previous studies participant frustration with

previous lack of feedback

The Bugs

Results Anthrax vs. other diseases

Not always top 3 Other diseases at top: brucellosis, tick diseases, trypanosomiasis

Impact of disease varied Non-disease issues also very important Disease impact varied by experience Economic and social impacts very important

Results

Color Key: Pink x > 50% Purple 49% > x > 35% Yellow 34% > x > 20% White x < 19%

Note frequency of economic impacts chosen in the top three listed here by disease. Anthrax in top 3 in 3/5 focus groups in Kasese, and in1/6 in Sheema.

Results

Knowledge and Attitudes Zoonoses

Knowledge of zoonosis varies Sometimes choose not to treat carcasses appropriately – cutting their losses

Wildlife role well known near park, unknown elsewhere Frequent dissatisfaction with availability of veterinary services

Lack of veterinarians, medications, vaccines Quarantines are unpopular

Management Proposal Widen survey – beyond reported case areas

follow PE trail, wide surveys of environmental factors

Include soil biology and chemistry amoebas1

Domestic canine seroprevalence2 Field or local tests these could be “immediate” feedback for participants

Use this data to tailor vaccination and education programs to high risk areas.

Further Study, or Surveillance? Research

Link to public service organizations Scientific or mixed funding

Surveillance, either sporadic or regular Some form of governmental support AFENET, work with the Ugandan PE network Non-profits

Appropriate technology

Recap/Conclusion PE and other participatory methods have room to grow PE could enhance and inform regular anthrax management in Uganda Frequency of outbreaks might be reduced if targeted vaccination and education were implemented.

References 1-Dey, R., Hoffman, P.S., and Glomski, I.J. (2012) Germination and Amplification of Anthrax Spores by Soil-Dwelling Amoebas. Appl. Environ. Microbiol. 78(22): 8075. 2-Lembo, T., Hampson, K., Auty, H., Beesley, . . . Cleaveland, S. (2011) Serologic surveillance of anthrax in the Serengeti ecosystem, Tanzania, 1996-2009. Emerging Infectious Diseases, 17(3), 387-394. 3-Mapesa, MW, Atimnedi, P, Tumwesigye C. (2008) Managing the 2004/05 anthrax outbreak in Queen Elizabeth and Lake Mburo National Parks, Uganda. African Journal of Ecology, 46(1): 24-31. 4-Mariner, J.C. and Roeder, P.L. (2003) Use of participatory epidemiology in studies of the persistence of lineage 2 rinderpest virus in East Africa. Veterinary Record 152: 641-647. 5-Pretty, J. (1994). Alternative systems of inquiry for a sustainable agriculture. IDS Bulletin, 25(2), 37-48. 6-Promed-mail, ISID. (2011) 2011-11-08 15:17:55. Anthrax, human, bovine - Uganda (02): (Wester). Archive Number: 20111108.3322. Note: For papers from the systematic review, feel free to ask for details.

Acknowledgements Dr. Hellen Amuguni for help and advice from start to finish. Tufts Institute of the Environment and Tufts Veterinarians for Global Solutions for funding the field research. PENAPH for support for this workshop Dr. Fred Monje and Dr. Grace Asiimwe Karimu, who worked in their “free time” Dr. Terence Odoch & Dr. David Owiny – on the ground assistance in Uganda. Dr. Jeffery Mariner for help with developing project ideas. Dr. Gretchen Kaufman Dr. Elena Naumova Dr. Patrick Atimnedi The Masters of Conservation Medicine class 2012 And you the audience Thank you!