Accelerating Progress beyond the MDG-era through addressing endemic zoonoses in the East African Community Member States
1.1 Introductory statement
This blog post will initially provide an overview of the achievements and “pending issues” of the Millennium Development Goals (MDGs) and the opportunities that the Sustainable Development Goals (SDGs) present to the East African Community (EAC) Member States so as to accelerate progress beyond the MDGs. Secondly, it will propose priority zoonotic diseases to be targeted (that will act as a model of controlling the other zoonotic diseases) and lastly, provide recommendations on adequate measures to improve their surveillance, prevention and control.
1.2.1 Transition from Millennium Development Goals to Sustainable Development Goals
The eight MDGs adopted on 18th September 2000 have guided development efforts for fifteen years (2000 to 2015), with a clear focus on poverty and on developing nations. The EAC Member States comprise of Kenya, Uganda, Tanzania, Burundi and Rwanda (Figure 1), all of which are classified as developing countries and lower income economies, except Kenya which was recently re-classified as a lower-middle income economy. Three of the 8 MDGs focused directly on health (MDG-4, MDG-5 and MDG-6), with the goal of reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other diseases, respectively. The MDG Report 2015: “Assessing Progress in Africa toward the Millennium Development Goals” highlights important success stories from the MDGs in Africa.
Contrary to the success stories, there are “pending issues” that cannot be overlooked especially with respect to the EAC Member States. The MDGs were compartmentalized to specific health goals which drove resources to specific types of programmes. This is very evident from the MDG country progress reports from the EAC Member States i.e. Kenya, Uganda, Tanzania, Burundi, and Rwanda, all of which provide elaborate documentation on the progress made and statistics on TB, Malaria and HIV/AIDS forgetting the “other neglected and endemic diseases”. Therefore a key lesson from the MDGs for the EAC Member States is that endemic zoonotic diseases are a great burden to human and animal health characterized by lack of reliable data which undermines the ability to set goals, optimize investments, decisions, and measure progress.
The 17 Sustainable Development Goals (SDGs), originally conceptualized as “The Future We Want” on September 2012 were adopted on September 2015 after a series of inclusive and consultative meetings (Figure 2).
In contrast to the 3 MDGs focused on health, only 1 out of the 17 proposed SDGs focus on health framed broadly as: to ensure healthy lives and promote well-being for all at all ages. Based on the ‘Alma Ata Declaration’ defining health as, “A state of complete physical, mental and social well-being”, it therefore means that health priorities may also be sustained through several of the other SDGs, namely: Goal 8, Goal 11, Goal 16 and Goal 10. The SDGs therefore spur transformative change towards sustainable development, addressing systemic barriers to social, economic and environmental progress at the global, regional and national level and between different sectors. They thus form the basis of a more comprehensive and integrated development agenda and requiring far-reaching change in domestic policy and action [2, 18].
1.1 Zoonoses as a platform of addressing the SDG goal 3, target 3.3 & 3.d
1.1.1 Burden of zoonotic diseases in the EAC Member States
Outbreaks of endemic zoonotic diseases in the EAC Member States, such as anthrax and rabies have considerable impact on the health care systems at the local level and adversely affect livelihoods. The burden of zoonotic diseases in this region remains poorly defined, in part, because of weak surveillance and health information systems and also because endemic zoonoses are not considered of high priority within both the human and animal health sectors.
The increasing burden of zoonotic diseases in the EAC Member States can be attributed to several factors[3, 12]. The intensification of farming, for example, leads to closer relationships between individual animals, generating opportunities for more rapid mutations as organisms move from host to host, while also providing a structured way for those pathogens to enter highly ordered food chains that branch out and reach very large numbers of people. At the same time development of antimicrobial resistance poses an increasing burden in the treatment of some of the zoonotic diseases in the region.
1.1.2 Suggested priority diseases to target
In the EAC Member States, several zoonotic diseases of neglected populations conspire to hinder the health of people and the animals they depend on for their livelihoods which are transmitted in many ways. For the scope of this report let us focus on four:
- Brucellosis is an important source of morbidity in all EAC Member States. It causes a chronic debilitating disease in humans and often misdiagnosed thus wrongly treated. Misdiagnosis is expensive; individuals incur significant expenses in failing to acquire diagnosis and treatment, and fail to conduct their daily activities by being unwell. Across the EAC Member States, brucellosis is still a very common but often neglected disease, and constitutes a major under-reported problem. Geographical distribution depends upon local food habits, milk processing methods, animal husbandry types and standards of personal and environmental hygiene. Cattle, sheep and goats harbour this bacterium, which they transmit to each other and humans through milk or through contaminated aborted materials.
- Rabies is a well-known, but nonetheless, neglected zoonotic infection, caused by the rabies virus and a public health problem in the region. For example in Kenya it is estimated that 2000 human deaths occur annually due to rabies. It is transmitted and maintained mostly in domestic dog populations (though in areas with a wildlife interface, the epidemiology may get more complex), which transmit the infection to humans through bites. It is best controlled by vaccinating the dog reservoir to prevent disease from developing if infection occurs, but a human vaccine is available both as a pre- and post-exposure course, and effective and timely delivery of the vaccine will minimize mortality (but the human vaccine is very costly). Lack of cooperation between the health and veterinary sectors often impedes progress in the control of rabies. Limited accessibility to modern rabies vaccine, lack of public awareness and insufficient political commitment are the major problems in EAC Members States.
- Cysticercosis is a disease caused by the tapeworm Taenia solium. It has a relatively complex lifecycle, involving pigs eating Taenia egg-carrying human faeces that contaminates the environment, humans eating undercooked pork meat, and environmental contamination with eggs that can encyst in humans. The greatest problem with solium is that it may cause a neurological disease called neurocysticercosis in people who are infected with tapeworm eggs; in the EAC Member States, it is the single largest cause of acquired epilepsy in humans[24, 25].
- Anthrax is a disease caused by the spore-forming bacteria Bacillus anthracis, that is classified as a category ‘A’ agent by the CDC . Anthrax is a very serious zoonotic disease of livestock and wild animals because it can potentially cause the rapid loss of a large number of animals in a very short time. It is estimated that 1 livestock case equals 10 human cutaneous and enteric cases . A recent (July 2015) outbreak of the disease in Nakuru County in Kenya killed over one hundred buffaloes and 2 rhinos.
1.2 Conclusion and recommendations
Many factors involved in prevention and control of zoonotic infections in the EAC Member States cannot be addressed by the livestock or health sector alone. To effectively address the proposed priority zoonoses (to act as a model to control other zoonoses and infections) it will entail focusing transmission control, prevention and burden reduction in animals so as to accrue the benefits of control and prevention in humans as documented by other studies in Chad and Mongolia. This, in turn, requires a One Health approach, involving joint surveillance, control and policy management by veterinary, medical and other sectors. The outstanding opportunity that is at hand is there is already a working model of a One Health office in Kenya, this model offers a “success story” that can be adopted to suit the needs of the other EAC Member States in addressing the priority zoonotic diseases and others as well. The good thing is that, the model will utilize the existing medical and veterinary workforce within the respective countries (Figure 3).
For these suggested priority diseases many aspects of their basic biology are well understood, and the transmission of the pathogens has been controlled in many countries. The outstanding issues that the EAC Member States need to address to effectively deploy intervention efforts, are:
- High-level commitment and the ability of national programmes to mobilize the necessary resources and to strengthen collaboration with the pre-existing funding agencies and organisations from the MDG era e.g. the World Health Organization among others to scale up intervention strategies in order to cope with the common challenges in the control of zoonoses.
- Create multisectoral committees responsible for surveillance and control of zoonoses. These committees should be empowered to coordinate zoonosis control activities at national level and be provided with adequate budget. The committees should comprise members from all sectors and the community involved in zoonoses surveillance and control, particularly public health and veterinary services.
- Develop national integrated surveillance systems with an open policy of cross sharing information among the EAC Member States on occurrence, distribution and disease burden. These integrated surveillance systems to be linked to the National statistics system to complement monitoring the SDGs.
- Update veterinary and health professions educational curricula according to current knowledge and practical needs for control of zoonotic diseases, with emphasis on multisectoral and community led approaches
- Diagnostic facility strengthening by deploying, and in some cases developing, new and better tools to diagnose the infections in humans and animals esp. for brucellosis, and cysticercosis (because accurate and efficient detection is key to both delivering cure and also to gathering good surveillance data)
- Finally and most importantly, develop key indicators (reflecting each country socio-economic context and political priorities) so as to measure progress in the work of controlling the four priority zoonotic diseases.
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