Antibiotic prescription, dispensing and use in humans and livestock in East Africa: does morality have a role to play?

Background: Antimicrobial resistance (AMR) is a global threat to human and livestock health. Although AMR is driven by use of antimicrobials, it is often attributed to "misuse" and "overuse", particularly for antibiotics. To curb resistance, there has been a global call to embrace new forms of moral personhood that practice "proper" use, including prescription, dispensing and consumption of antimicrobials, especially antibiotics.

Exploring drivers of self-treatment with antibiotics in three agricultural communities of northern Tanzania.

Background: Antimicrobial resistance (AMR) poses a significant global health threat, particularly in low- and middle-income countries (LMICs). Self-treatment with antibiotics, the practice of using antibiotics without professional guidance, is often considered an important contributor to the emergence and spread of AMR.

Method: This study investigated the drivers of self-treatment in three common types of agricultural communities in northern Tanzania.

Continent-wide genomic analysis of the African buffalo (Syncerus caffer).

The African buffalo (Syncerus caffer) is a wild bovid with a historical distribution across much of sub-Saharan Africa. Genomic analysis can provide insights into the evolutionary history of the species, and the key selective pressures shaping populations, including assessment of population level differentiation, population fragmentation, and population genetic structure. In this study we generated the highest quality de novo genome assembly (2.

Developing a logic model for communication-based interventions on antimicrobial resistance (AMR).

The importance of communication in enhancing people's awareness and understanding of antimicrobial resistance (AMR) is consistently recognised in global and national action plans (NAPs). Despite this, there have been relatively few national AMR communication campaigns which use a structured approach to take account of the local context, encompass co-design with the target audience and use a logic model to help inform its design, implementation and evaluation. Designing a logic model for communication-based interventions can help map out the planning, resources, messaging, assumptions and intended outcomes of the campaign to maximise its impact, ensure it is fit for context and minimise any unintended consequences on individuals and society.

Local and wide-scale livestock movement networks inform disease control strategies in East Africa.

Livestock mobility exacerbates infectious disease risks across sub-Saharan Africa, but enables critical access to grazing and water resources, and trade. Identifying locations of high livestock traffic offers opportunities for targeted control. We focus on Tanzanian agropastoral and pastoral communities that account respectively for over 75% and 15% of livestock husbandry in eastern Africa.

Integrating contact tracing and whole-genome sequencing to track the elimination of dog-mediated rabies: An observational and genomic study.

Background: Dog-mediated rabies is endemic across Africa causing thousands of human deaths annually. A One Health approach to rabies is advocated, comprising emergency post-exposure vaccination of bite victims and mass dog vaccination to break the transmission cycle. However, the impacts and cost-effectiveness of these components are difficult to disentangle.

"If You Do Not Take the Medicine and Complete the Dose…It Could Cause You More Trouble": Bringing Awareness, Local Knowledge and Experience into Antimicrobial Stewardship in Tanzania.

Antimicrobial resistance (AMR) is a global health issue disproportionately affecting low- and middle-income countries. In Tanzania, multi-drug-resistant bacteria (MDR) are highly prevalent in clinical and community settings, inhibiting effective treatment and recovery from infection. The burden of AMR can be alleviated if antimicrobial stewardship (AMS) programs are coordinated and incorporate local knowledge and systemic factors.

Healthcare provider-focused antimicrobial stewardship in sub-Saharan Africa: opportunities and challenges.

To address the antimicrobial resistance (AMR) crisis, governments around the world have created action plans to optimize antimicrobial use (AMU). These plans include antimicrobial stewardship (AMS) that encompasses educational programs for healthcare workers. We discuss these programs in sub-Saharan Africa, including the opportunities and challenges arising from a highly constrained healthcare environment.

Crossover-Use of Human Antibiotics in Livestock in Agricultural Communities: A Qualitative Cross-Country Comparison between Uganda, Tanzania and India.

Antibiotic use in animal agriculture contributes significantly to antibiotic use globally and is a key driver of the rising threat of antibiotic resistance. It is becoming increasingly important to better understand antibiotic use in livestock in low-and-middle income countries where antibiotic use is predicted to increase considerably as a consequence of the growing demand for animal-derived products. Antibiotic crossover-use refers to the practice of using antibiotic formulations licensed for humans in animals and vice versa.

Where Rabies Is Not a Disease. Bridging Healthworlds to Improve Mutual Understanding and Prevention of Rabies.

Deeply embedded in local social, cultural, and religious settings, traditional healing is part of dog bite and rabies management in many rabies endemic countries. Faith healing, which usually encompasses a more holistic approach to health including physical, mental and social dimensions, is rare in the context of rabies. In Gujarat, Western India, the Hindu goddess Hadkai Mata is worshiped by low-caste communities as the Mother of Rabies in the event of a dog bite to a person or their livestock.

Participatory mapping identifies risk areas and environmental predictors of endemic anthrax in rural Africa.

Disease mapping reveals geographical variability in incidence, which can help to prioritise control efforts. However, in areas where this is most needed, resources to generate the required data are often lacking. Participatory mapping, which makes use of indigenous knowledge, is a potential approach to identify risk areas for endemic diseases in low- and middle-income countries.

Population genomics of from an anthrax hyperendemic area reveals transmission processes across spatial scales and unexpected within-host diversity.

Genomic sequencing has revolutionized our understanding of bacterial disease epidemiology, but remains underutilized for zoonotic pathogens in remote endemic settings. Anthrax, caused by the spore-forming bacterium , remains a threat to human and animal health and rural livelihoods in low- and middle-income countries. While the global genomic diversity of has been well-characterized, there is limited information on how its populations are genetically structured at the scale at which transmission occurs, critical for understanding the pathogen's evolution and transmission dynamics.

How public health crises expose systemic, day-to-day health inequalities in low- and-middle income countries: an example from East Africa.

Background: The current Coronavirus disease pandemic reveals political and structural inequities of the world's poorest people who have little or no access to health care and yet the largest burdens of poor health. This is in parallel to a more persistent but silent global health crisis, antimicrobial resistance (AMR). We explore the fundamental challenges of health care in humans and animals in relation to AMR in Tanzania.

Tackling barriers to collective action for effective vaccination campaigns: rabies in rural Africa as an example.

Vaccine-based protection in populations that are vulnerable to infectious diseases represents a public good, whose successful attainment requires collective action. We investigated participation in mass domestic dog vaccination against dog-mediated human rabies endemic in Tanzania as a prototypical example of these issues. We employed advertising interventions, text messaging and/or engagement through community leaders, as well as operational adjustments to increase the saliency of rabies risks and reduce barriers to participation in vaccination campaigns.

The Power of Music to Prevent and Control Emerging Infectious Diseases.

Music is a powerful approach to engage communities and disseminate information. Specifically, health campaigns employing music have been used to promote behaviors that can prevent emerging infectious diseases (EIDs). For example, hip hop artists supported campaigns to prevent acquired immunodeficiency syndrome in the 70s in the United States, while Brazilian funk promoted vaccination to mitigate the ongoing COVID-19 pandemic.

Combining Multiple Assays Improves Detection and Serotyping of Foot-and-Mouth Disease Virus. A Practical Example with Field Samples from East Africa.

Multiple serotypes and topotypes of foot-and-mouth disease virus (FMDV) circulate in endemic areas, posing considerable impacts locally. In addition, introductions into new areas are of great concern. Indeed, in recent years, multiple FMDV outbreaks, caused by topotypes that have escaped from their original areas, have been recorded in various parts of the world.

Livestock movement informs the risk of disease spread in traditional production systems in East Africa.

In Africa, livestock are important to local and national economies, but their productivity is constrained by infectious diseases. Comprehensive information on livestock movements and contacts is required to devise appropriate disease control strategies; yet, understanding contact risk in systems where herds mix extensively, and where different pathogens can be transmitted at different spatial and temporal scales, remains a major challenge. We deployed Global Positioning System collars on cattle in 52 herds in a traditional agropastoral system in western Serengeti, Tanzania, to understand fine-scale movements and between-herd contacts, and to identify locations of greatest interaction between herds.

Antigenic Diversity in Populations From Sympatric Cattle and African Buffalo Analyzed Using Long Read Sequencing.

East Coast fever (ECF) in cattle is caused by the Apicomplexan protozoan parasite , transmitted by the three-host tick . The African buffalo () is the natural host for but does not suffer disease, whereas ECF is often fatal in cattle. The genetic relationship between populations circulating in cattle and buffalo is poorly understood, and has not been studied in sympatric buffalo and cattle.

Addressing antimicrobial resistance by improving access and quality of care-A review of the literature from East Africa.

Universal access to healthcare, including quality medicines, is a fundamental human right but is still out of reach for many in low- and middle-income countries (LMICs). An existing framework capturing variability of access to healthcare in low-resource settings includes the 5 dimensions: availability, accessibility, affordability, adequacy, and acceptability. This framework encompasses key components, including health infrastructure and means to access it as well as service organisation, costs, and factors that influence users' satisfaction.

Dog ownership practices and responsibilities for children's health in terms of rabies control and prevention in rural communities in Tanzania.

Interventions tackling zoonoses require an understanding of healthcare patterns related to both human and animal hosts. The control of dog-mediated rabies is a good example. Despite the availability of effective control measures, 59,000 people die of rabies every year worldwide.

Rate of hepatocellular carcinoma diagnosis in cirrhotic patients with ultrasound-detected liver nodules.

Ultrasound (US) detection of liver nodules in cirrhotic patients requires further radiological examinations and often a follow-up with repeated short-term evaluations to verify the presence of hepatocellular carcinoma (HCC). Aims of the study were to assess the rate of HCC diagnosis and to identify HCC predictors in a cohort of cirrhotics followed-up after US detection of the liver nodule(s). One-hundred-eighty-eight consecutive cirrhotic patients (124 males, mean age 64.

Practical and effective diagnosis of animal anthrax in endemic low-resource settings.

Anthrax threatens human and animal health, and people's livelihoods in many rural communities in Africa and Asia. In these areas, anthrax surveillance is challenged by a lack of tools for on-site detection. Furthermore, cultural practices and infrastructure may affect sample availability and quality.

GoPrime: Development of an In Silico Framework to Predict the Performance of Real-Time PCR Primers and Probes Using Foot-and-Mouth Disease Virus as a Model.

Real-time PCR (rPCR) is a widely accepted diagnostic tool for the detection and quantification of nucleic acid targets. In order for these assays to achieve high sensitivity and specificity, primer and probe-template complementarity is essential; however, mismatches are often unavoidable and can result in false-negative results and errors in quantifying target sequences. Primer and probe sequences therefore require continual evaluation to ensure they remain fit for purpose.

Enhancing livestock vaccination decision-making through rapid diagnostic testing.

•Compared to vaccination, the collective approach to diagnostic testing presents a low-fixed cost.•Existing household livestock-health behaviors increase the likelihood for uptake of preventative health practices.•Initial evidence to support household investments in livestock preventative health over therapeutic treatments.

Carnivore Parvovirus Ecology in the Serengeti Ecosystem: Vaccine Strains Circulating and New Host Species Identified.

Carnivore parvoviruses infect wild and domestic carnivores, and cross-species transmission is believed to occur. However, viral dynamics are not well understood, nor are the consequences for wild carnivore populations of the introduction of new strains into wild ecosystems. To clarify the ecology of these viruses in a multihost system such as the Serengeti ecosystem and identify potential threats for wildlife conservation, we analyzed, through real-time PCR, 152 samples belonging to 14 wild carnivore species and 62 samples from healthy domestic dogs.