One Health in Action: Operational Aspects of an Integrated Surveillance System for Zoonoses in Western Kenya
One Health in Action: Operational Aspects of an Integrated Surveillance System for Zoonoses in Western Kenya
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DOI：
10.3389/fvets.2019.00252
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发表时间：
2019-07-31
影响因子：
3.2
通讯作者：
Fevre, Eric M.
中科院分区：
文献类型：
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作者：
Falzon, Laura C.;Alumasa, Lorren;Fevre, Eric M.
肯尼亚和东非其他地区的疾病监测目前由人类和动物卫生部门进行。然而，最近的一项评价突出表明，这些部门之间缺乏整合，导致疾病报告不足和效率低下。该项目旨在为15种人畜共患疾病建立一个具有成本效益的综合监测和报告系统，在肯尼亚西部的Bungoma、Busia和卡卡梅加等县进行试点。具体而言，在本文中，我们描述了这样一个监视系统的操作方面。对关键的举报人进行了访谈，随后进行了实地访问，以确定监控地点并与相关利益攸关方联络。根据这一信息，制定了一项抽样战略，包括12个哨点，每个州4个。每个哨点包括一个牲畜市场，1-2个邻近的屠宰场/屠宰场和附近的一家医院; 12个哨点中的每个哨点包括12 x 3 = 36个采样点，每4周访问一次，共20个周期。在每个研究中心，动物或患者采样包括临床检查和血液、粪便和鼻拭子采集;在屠宰的动物中，还采集了肠系膜淋巴结、包虫囊肿和吸虫。在每次实地访问结束时，记录了有关工作人员和遇到的挑战的数据，同时在肯尼亚布西亚的实地实验室处理和检测了生物样本，以确定是否存在15种人畜共患病。我们在每个监测点举行公众参与会，分享初步结果，并向持份者和参与研究的人士提供意见。牲畜市场访问持续了3个多小时，最常见的挑战是动物主人经常拒绝参与研究。在屠宰场，访问持续了不到4小时，挑战包括肉类检查员的参与不足或屠宰过程太快而无法取样。最后，医院访视持续约4小时，最常见的挑战包括患者出勤率低、工作人员频繁更替导致机构记忆差以及难以获得患者粪便样本。我们的经验凸显了与当地持份者在实地接触的重要性，同时也通过公众参与会议及时提供反馈，以确保持续合规。
Surveillance of diseases in Kenya and elsewhere in East Africa is currently carried out by both human and animal health sectors. However, a recent evaluation highlighted the lack of integration between these sectors, leading to disease under-reporting and inefficiencies. This project aimed to develop an integrated and cost-effective surveillance and reporting system for 15 zoonotic diseases piloted in the counties of Bungoma, Busia, and Kakamega in western Kenya. Specifically, in this paper we describe the operational aspects of such a surveillance system. Interviews were carried out with key informants, and this was followed by field visits to identify sentinel sites and liaise with relevant stakeholders. Based on this information, a sampling strategy comprising 12 sentinel sites, 4 in each county, was developed. Each sentinel site comprised of a livestock market, 1-2 neighboring slaughter houses/slabs, and a hospital in the vicinity; each of the 12 sites, comprising 12 x 3 = 36 sampling locations, was visited every 4 weeks for 20 cycles. At each site, animal or patient sampling included a clinical examination and collection of blood, feces, and nasal swabs; in slaughtered animals, mesenteric lymph nodes, hydatid cysts, and flukes were also collected. At the end of each field visit, data on staff involved and challenges encountered were recorded, while biological samples were processed and tested for 15 zoonotic diseases in the field laboratory in Busia, Kenya. Public engagement sessions were held at each sentinel site to share preliminary results and provide feedback to both stakeholders and study participants. A livestock market visit lasted just over 3 h, and the most common challenge was the frequent refusals of animal owners to participate in the study. At the slaughterhouses, visits lasted just under 4 h, and challenges included poorly engaged meat inspectors or slaughter processes that were too quick for sampling. Finally, the hospital visits lasted around 4 h, and the most frequent challenges included low patients turn-out, frequent staff turn-over leading to poor institutional memory, and difficulty in obtaining patient stool samples. Our experiences have highlighted the importance of engaging with local stakeholders in the field, while also providing timely feedback through public engagement sessions, to ensure on-going compliance.