Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania.
Mixed Methods Survey of Zoonotic Disease Awareness and Practice among Animal and Human Healthcare Providers in Moshi, Tanzania.
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DOI：
10.1371/journal.pntd.0004476
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发表时间：
2016-03
影响因子：
3.8
通讯作者：
Halliday JE
中科院分区：
文献类型：
--
作者：
Zhang HL;Mnzava KW;Mitchell ST;Melubo ML;Kibona TJ;Cleaveland S;Kazwala RR;Crump JA;Sharp JP;Halliday JE
人畜共患病是坦桑尼亚人类和牲畜疾病的常见原因。此前的研究表明，布氏杆菌病、钩端螺旋体病和Q热在坦桑尼亚北部人类发热性疾病中占很大比例，但诊断率却很低。我们进行这项研究的目的是评估坦桑尼亚莫希医疗保健提供者对选定人畜共患病的认识和知识；确定采用哪些诊断和治疗方案；并深入了解导致人畜共患病明显诊断不足的背景因素。我们对 52 名人类健康从业者和 10 名牲畜健康提供者进行了有关人畜共患病知识、病例报告和检测的调查问卷。问卷调查结束后，我们立即对其中 60 名受访者进行了半结构化访谈，利用之前的发烧病因学研究结果来促进对话。 60 名受访者 (97%) 听说过布氏杆菌病，26 名受访者 (42%) 听说过钩端螺旋体病，20 名受访者 (32%) 听说过 Q 热。动物部门受访者报告称，在过去 12 个月内发现了动物布鲁氏菌病 (4)、狂犬病 (4) 和炭疽病 (3) 病例。人类部门受访者报告了人类布鲁氏菌病（15 例，29%）、狂犬病（9 例，18%）和炭疽病（6 例，12%）病例。没有报告钩端螺旋体病或 Q 热病例。十九名受访者了解当地针对人类布鲁氏菌病的诊断测试。关于人类钩端螺旋体病或 Q 热或任何动物研究病原体的测试报告很少。许多受访者表示认识到疟疾过度诊断和人畜共患病诊断不足，许多受访者认为知识和检测能力低是人畜共患病诊断不足的原因。这项研究揭示了对不同人畜共患病的认识存在差异，以及布鲁氏菌病、钩端螺旋体病和 Q 热的病例报告频率较低。缺乏钩端螺旋体病和 Q 热的已知诊断服务。这些发现强调需要提高诊断能力，同时进行医疗保健提供者教育，并改进基于综合征的疾病管理的临床指南，以在没有实验室确认的情况下激发对当地相关人畜共患病的诊断考虑。人畜共患疾病是在动物和人类之间自然传播的疾病。在坦桑尼亚，研究表明，包括布鲁氏菌病、钩端螺旋体病和 Q 热在内的几种人畜共患病是人类疾病的常见原因，但诊断不足。我们对坦桑尼亚莫希的医疗保健提供者进行了一项混合方法调查，结合了定量和定性研究技术。 10 名动物部门受访者中的 4 名 (40%) 和 52 名人类部门受访者中的 15 名 (29%) 报告在过去 12 个月内见过布鲁氏菌病病例，但没有人报告钩端螺旋体病或 Q 热病例。 19 名 (31%) 受访者表示了解当地的人类布鲁氏菌病诊断测试，而 1 名受访者则表示了解当地可用于人类钩端螺旋体病和 Q 热的诊断测试。一名 (2%) 受访者报告了当地可用的动物布鲁氏菌病测试，没有人报告对动物进行钩端螺旋体病或 Q 热测试。许多受访者在采访中提到缺乏诊断检测资源。我们的研究结果表明，诊断检测能力的提高以及公共卫生运动和医疗保健提供者教育是提高对这种情况下人畜共患病的认识和准确诊断的关键步骤。更好地了解医疗保健提供者对人畜共患病的认识、看法和做法对于设计有效的计划来改善这些疾病的诊断和治疗至关重要。
Zoonoses are common causes of human and livestock illness in Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever account for a large proportion of human febrile illness in northern Tanzania, yet they are infrequently diagnosed. We conducted this study to assess awareness and knowledge regarding selected zoonoses among healthcare providers in Moshi, Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain insights into contextual factors contributing to the apparent under-diagnosis of zoonoses. We conducted a questionnaire about zoonoses knowledge, case reporting, and testing with 52 human health practitioners and 10 livestock health providers. Immediately following questionnaire administration, we conducted semi-structured interviews with 60 of these respondents, using the findings of a previous fever etiology study to prompt conversation. Sixty respondents (97%) had heard of brucellosis, 26 (42%) leptospirosis, and 20 (32%) Q fever. Animal sector respondents reported seeing cases of animal brucellosis (4), rabies (4), and anthrax (3) in the previous 12 months. Human sector respondents reported cases of human brucellosis (15, 29%), rabies (9, 18%) and anthrax (6, 12%). None reported leptospirosis or Q fever cases. Nineteen respondents were aware of a local diagnostic test for human brucellosis. Reports of tests for human leptospirosis or Q fever, or for any of the study pathogens in animals, were rare. Many respondents expressed awareness of malaria over-diagnosis and zoonoses under-diagnosis, and many identified low knowledge and testing capacity as reasons for zoonoses under-diagnosis. This study revealed differences in knowledge of different zoonoses and low case report frequencies of brucellosis, leptospirosis, and Q fever. There was a lack of known diagnostic services for leptospirosis and Q fever. These findings emphasize a need for improved diagnostic capacity alongside healthcare provider education and improved clinical guidelines for syndrome-based disease management to provoke diagnostic consideration of locally relevant zoonoses in the absence of laboratory confirmation. Zoonoses are diseases that are naturally transmitted between animals and humans. In Tanzania, research has shown that several zoonoses, including brucellosis, leptospirosis, and Q fever, are common, but under-diagnosed, causes of human illness. We conducted a mixed methods survey, combining quantitative and qualitative research techniques, of healthcare providers in Moshi, Tanzania. Four (40%) of 10 animal sector respondents and 15 (29%) of 52 human sector respondents reported seeing brucellosis cases in the past 12 months, while none reported cases of leptospirosis or Q fever. Nineteen (31%) respondents reported awareness of a local diagnostic test for human brucellosis, while one reported locally available diagnostic tests for human leptospirosis and Q fever. One (2%) respondent reported a locally available animal brucellosis test, and none reported tests for leptospirosis or Q fever in animals. Many respondents mentioned a lack of diagnostic testing resources during interviews. Our findings suggest that diagnostic testing capacity improvements alongside public health campaigns and healthcare provider education are key steps toward improving recognition and accurate diagnosis of zoonoses in this setting. An improved understanding of healthcare provider awareness, perceptions, and practices regarding zoonoses is critical for the design of effective programs to improve diagnosis and treatment of these diseases.