Special issue introduction: Capacity building in Integrated Management of Trans-boundary Animal Diseases and Zoonoses (CIMTRADZ)

Special issue introduction: Capacity building in Integrated Management of Trans-boundary Animal Diseases and Zoonoses (CIMTRADZ)

Margaret Loy Khaitsa^1,&, John Baligwamunsi Kaneene², John David Kabasa³

¹Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, USA, ²Center for Comparative Epidemiology Michigan State University, Room A-109, East Lansing, USA, ³College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda

^&Corresponding author
Margaret Loy Khaitsa, Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, USA

Introduction    

Today´s world has increasingly interconnected economic, political, cultural, and scientific systems, resulting in rapid movement of goods, people, and ideas. This offers unprecedented opportunities for many countries especially those in sub-Saharan Africa whose wealth in human and natural resources has only begun to be appreciated. However, there are considerable challenges to be overcome before these opportunities can be realized. While any point on the globe could be the origin of the next global pandemic, at least 70% of the known human and animal pathogens affecting production, public health, global trade, and security are resident in sub-Saharan Africa and, in particular, Eastern & Central Africa (ECA) [1]. This region has, therefore, become a risk incubator for Africa and the world [2]. To realize its potential for economic and human capital development, ECA must first build the capacity to manage this risk. Recent global pandemic threats have revealed that developing regions of the world especially sub-Saharan Africa and Southeast Asia, appear to be more prone to emerging and re-emerging disease threats, and strengthening their public health systems has become a recognized priority globally [3, 4]. For instance, the 2014 Ebola outbreak in Western Africa was the most devastating outbreak witnessed in recent times with over 28,000 people inflicted with the condition, and over 11,000 died [5]. Sustainable interventional strategies focussing on these hotspot regions are necessary to counter the new threats. A potential key element in building global capacity to respond and counter animal and public health threats is education and research. Globalization of research and education has however failed to keep pace with current global threats posed by transboundary pandemics, food insecurity and bioterrorism [6]. Higher education institutions (HEIs) are among the most stable and sustainable institutions in Africa, with tremendous untapped resources of human skills and infrastructure [6]. In 2010, the United States Agency for International Development (USAID), The American Council on Education (ACE), The Association of Public and Land-grant Universities (APLU), and Higher Education for Development (HED) awarded 11 Africa-United States (US) higher education partnership grants to universities in Africa and the US to address national and regional priorities in sub-Saharan Africa. Each partnership had two lead institutions (one in Africa and one in the US) and was focused on developing collaborative research and academic programs to build the capacity of the African and US institutions to affect change in Africa [6]. The Africa -US Integrated Disease Management (AFRUS-IDM) network is one of the 11 partnerships that was awarded funding to develop human and institutional capacity to manage transboundary animal diseases and zoonoses in ECA through a project entitled “Capacity Building in Integrated Management of Transboundary Animal Diseases and Zoonoses (CIMTRADZ)”. The CIMTRADZ project is predicated on the first guiding principle of the One World, One Health concept to “recognize the essential link between human, domestic animal, and wildlife health and the threat disease poses to people, their food supplies, and economies, and the biodiversity essential to maintaining the healthy environments and functioning ecosystems we all require” [7]. The AFRUS-IDM network (Figure 1) is a strong collaboration of HEIs in Africa and North America (US and Canada) that was established to advance higher education-led development in Africa. The African partners include: Makerere University, Uganda (Lead Africa institution), University of Nairobi, (Kenya), Sokoine University of Agriculture (Tanzania), Mekelle University (Ethiopia), University of Rwanda (Rwanda), Sheik Technical Veterinary School (Somali land), Africa Epidemiology Network (Non- Governmental Organization (NGO)), Terra Nuova - Eastern Africa (NGO), and Conservation Through Public Health (NGO). The US partners include: North Dakota State University (Lead US Institution 2011-2013), Mississippi State University (Lead US Institution 2014-2015), Michigan State University, Columbus State University, Washington State University, University of Minnesota, and Kansas State University. The network also includes the University of Saskatchewan at Saskatoon (Canada). Capacity building in Integrated Management of Transboundary Animal Diseases and Zoonoses (CIMTRADZ) project was made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents of this journal are the responsibility of the CIMTRADZ project partners and do not necessarily reflect the views of USAID or the United States Government.

Key themes of CIMTRADZ Special Issue Journal     

The papers in this special issue journal have been assembled in five major themes related to the various approaches and major accomplishments of the project - CIMTRADZ - as follows: 1) Partnership Models of CIMTRADZ; 2) The CIMTRADZ approach to Teaching, Curriculum Development, and the cultural Boma; 3) Original Scientific Research Conducted in CIMTRADZ; 4) Surveillance and Outbreak Investigations in CIMTRADZ; 5) CIMTRADZ Approach to Outreach and Service Learning.

Partnership models of CIMTRADZ

This theme has four papers. The first paper, “CIMTRADZ: A Collaborative Higher Education Initiative for Sustainable Capacity Development in Transboundary Diseases and Zoonoses Management in East and Central Africa” by Prof. Khaitsa and colleagues, provides the overview of CIMTRADZ by describing the genesis, rationale and organizational and Management structure of CIMTRADZ.

The second paper “Joint Research and Training Initiatives between North American and East African Universities” by Prof. Kaneene and colleagues describes faculty exchange and collaborative research conducted under CIMTRADZ partner institutions.

The third paper “Higher Education Resource Services, East Africa (HERS-EA): A Leadership and Development Model for women in higher education” by Prof. Khaitsa and colleagues describes an inter-institutional faculty initiative that provides leadership and management development for women. Objectives of HERS-EA are to: 1) Advance women leaders in HEIs in Eastern Africa and 2) Empower women at multi-tiers of leadership while integrating the results to change systems. HERS-EA was one of the sustainable outcomes of CIMTRADZ.

The fourth paper “RUMPELHA- Regional Universities Mediated Partnerships for Enhancing Livelihood and Health in Africa” by Prof. Kabasa and colleagues describes a partnership model involving academic-community-public-private partnerships that aims to provide trans-national higher education-mediated partnership services for accelerating sustainable livelihood, health, equitable growth and aspirations of Africa. RUMPELHA is one of the sustainable outcomes of CIMTRADZ approved by The Africa Union Inter Africa Bureau for Animal Resources (AU-IBAR).

CIMTRADZ approach to teaching, curriculum development, and the cultural boma

This theme has six papers which describe different approaches of training implemented under CIMTRADZ. The first paper, “Tropical Veterinary Medicine and One Health: A case study of a successful study abroad experience integrating One Health Principles into Veterinary Medical Training” by Prof. Khaitsa and colleagues, describes a study abroad course developed jointly by Makerere University and Mississippi State University. This course focuses on One Health, international animal production and health management, disease surveillance, public health systems, food safety and security, and multi-national cultural exposure - with joint training of students from the US and ECA.

The second paper, “Africa & United States Joint Curriculum Development of a Master of Science in International Infectious Disease Management (IDM): A successful joint academic program” by Dr. Majalija, describes the first Africa-US dual degree developed by Makerere University and North Dakota State University. This unique program involves student exchange and joint mentorship of graduate students from both institutions and an international project before graduation. Students incorporate research conducted in both institutions into their final scholarly papers.

The third paper, “Engaging Intergovernmental Organizations in Training Students on Global Animal Health, Public Health and Food Security” by Dr. Isiko, discusses various ways Intergovernmental Organizations (IGOs) and higher education institutions could collaborate towards global animal health, public health and food security. The paper describes a multi-institutional collaborative course offered in CIMTRADZ that engaged IGOs and HEIs in the US and Uganda in jointly training students from both countries as part of the joint MS degree in International Infectious Disease Management (IDM).

The fourth paper, “Integrating One Health Principles into Veterinary Medical Education using the Model African Union (MAU) Simulation Approach” by Dr. Wakoko, provides an overview of the role of One Health in the global environment and incorporates One Health core competencies into the Veterinary Medical Curriculum. The course engages students in simulating the policies and procedures of the African Union (i.e., the Model African Union - MAU) as one innovative way of learning One Health competencies.

The fifth paper, “Gender Mainstreaming in Veterinary Programs: Using gender audits to foster capacity building and women´s empowerment in Higher Education” by Dr. Wakoko, and colleagues examines gender-based issues surrounding the retention and graduation rates for female students in the College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB) at Makerere University. A gender audit tool was used to generate questions for focus-group interviews with COVAB students regarding their perceptions of gender inequality in the college academic and administrative programs. The study provides important information about structural policy changes needed, recommends a mentoring program in COVAB, and a leadership training program for women in higher education.

The sixth paper, “International Cultural Boma: a mentorship model for capacity building in One Health” by Dr. Okech et al describes the BOMA (interactive knowledge sharing workshops) and Conferences conducted under CIMTRADZ. The objectives of the CIMTRADZ Boma were (1) To provide opportunity for presentations, brainstorming, meditations and discussions that would yield research and development ideas for collaborative initiatives, (2) To showcase achievements of CIMTRADZ to funding agencies, academia, industry, community and public sector, (3) To disseminate research findings, and share unique experiences from which best practices would be derived, (4) To provide mentorship opportunities between students, junior faculty, field practitioners, technicians, researchers, practitioners and distinguished academicians, (5) To broaden and strengthen training, research and community outreach networks, (6) To provide opportunity for skills and knowledge transfer and acquisition, and (7) To enhance inter-regional and international networking between participants from various institutions. The Cultural Boma also provided a forum for partner institutions to discuss the sustainability strategies of CIMTRADZ achievements.

Original Scientific Research Conducted in CIMTRADZ

This theme has seven papers that summarize the original scientific research conducted in CIMTRADZ. This research was completed by several graduate students (MS and Ph. D) from ECA that were supported by CIMTRADZ project.

The first paper “Evaluation of a “Stamp Out Sleeping Sickness” Campaign In Uganda to Control Human African Trypanosomiasis (2004 - 2009)” by Dr. Mukiibi et al evaluates the overall effect of a project “Stamp Out Sleeping Sickness” or SOS on the incidence of Human African Trypanosomiasis (HAT) cases reported at Lwala hospital in Kaberamaido district, Uganda. The paper compares the incidence of HAT cases in 2006 (intervention year) with that of pre-intervention period (2004-2005) and post-intervention period (2007-2010).

The second paper “The Prevalence of Gross Lesions of Bovine Tuberculosis in Slaughtered Cattle and Assessment of the Pastoralists´ Knowledge of the disease in Hoima District, Uganda” by Dr. Ndorwa et al established the prevalence of bovine tuberculosis in slaughtered cattle and pastoralists´ knowledge of the disease in Hoima district, Uganda. Data were collected using postmortem inspections conducted in designated slaughter places in the study area and through a survey conducted among pastoralist using structured questionnaires, Focus Group Discussions and Key Informants Interviews. The paper highlights the significance of meat inspection in the identification of possible infected carcasses with bovine tuberculosis. Also, the level of education of pastoralists was significantly associated with the level of the knowledge about the disease, thus underscoring the importance of including this factor when designing tuberculosis control strategies.

The third paper “Epidemiological and Clinical Aspects of the 2007-2008 Ebola Hemorrhagic Fever Outbreak in Bundibugyo, Western Uganda” by Ms. Gemmeda is a retrospective case series conducted to investigate the clinical signs and symptoms that were associated with the prognosis of Ebola patients in the 2007/2008 Ebola Virus Disease outbreak in Western Uganda.

The fourth paper “Temporal and spatial distribution of anthrax outbreaks in cattle and wild animals in Uganda, between 1956 to 2010” by Dr. Tendo, is a review paper describing the temporal and spatial distribution of anthrax outbreaks in Uganda and the associated risk factors.

The fifth paper “Spatial and Temporal Trends of Contagious Bovine Pleuro-Pneumonia in Uganda (1956-2011) ” by Mr. Ssemaddali is a retrospective case series that describes the temporal and spatial distribution of contagious bovine pleuro-pneumonia in Uganda (1956-2011), and factors associated with its occurrence.

The sixth paper “Seroprevalence of Hepatitis E Virus in Slaughter Pigs and Practices of Abattoir Workers in Kampala, Uganda” by Dr. Katagwa is a cross-sectional study to determine the seroprevalence of HEV in slaughter pigs and assess the knowledge and practices regarding zoonotic HEV of abattoir workers at Wambizzi pig abattoir.

The seventh paper “Status on aflatoxin levels in groundnuts in Uganda” by Dr. Muzoora evaluated total aflatoxin levels in groundnuts from eight districts in Uganda. The study reports an increased trend in aflatoxin contamination levels in groundnuts in Uganda than earlier reported thereby underscoring the need for continuous monitoring of aflatoxin levels in staple foodstuffs in order to assess the level of human exposure. Aflatoxins have carcinogenic, immunosuppressive and growth retardation effects in animals and humans and are of global concern.

Surveillance and outbreak investigations in CIMTRADZ

This theme has three papers that focus on animal and human disease surveillance systems in ECA. Emerging and re-emerging infectious diseases are of major public health concern in many regions of Africa. In addition, common infectious diseases that have been controlled in developing countries still cause burden on the health systems. Efficient surveillances systems are essential in any health system. The first paper: Assessment of human disease surveillance systems in the East-Central Africa infectious disease hotspot: A case study of Uganda” by Drs. Muleme, Nguna, Mafigiri, Birungi, and Prof. Kaneene, assesses the extent of human disease surveillance systems in ECA´s infectious disease hotspot using Uganda as a case study to identify gaps that can be used to establish a robust regional surveillance system. This paper discusses the types of available surveillance systems, the gaps in the systems, and recommendations for improvements. Timely management of communicable diseases in developing countries is evidently affected by limitations of public health systems which should be highlighted and addressed for establishment of holistic surveillance plans. The second paper: A comparative assessment of the animal and human disease surveillance systems in the East-Central Africa infectious disease hot-spot, 2013: A case study of Uganda” by Drs. Muleme, Mafigri, Nguna, Birungi, Prof. Kabasa, and Prof. Kaneene, aimed to compare the status of the veterinary surveillance system to the human surveillance system as well as to assess the suitability of the two systems in dealing with emerging infectious diseases relative to the Integrated Disease Surveillance and Response core targets and the zoonotic disease surveillance in both human and animal health services. The paper compares the structure of the two systems, content, efficiency, and provides recommendations for strengthening the two system in order to respond to Zoonotic diseases efficiently. Brucellosis is a zoonotic disease that affects humans and many animal species. While there are more than eight species of Brucella, five species of brucellosis (B. abortus, B. Melitensis, B. suis, B. ovis, and B. Canis) causes abortions, arthritis, and orchitis in animals. In humans the disease, causes undulating fever, neurological disease, endocarditis, and arthritis, and is commonly misdiagnosed as malaria in developing countries. Thus, brucellosis is both a public health and economic concern in many countries of the world. The third paper “One Health Approach for Outbreak Investigation in Animal and Human Populations: A case example of Brucellosis in Uganda” by Prof. Kaneene, illustrates One Health approaches used in conducting outbreak investigations in Uganda. The paper discusses the planning, implementation, findings, communication of the results, and the benefits of a One Health approach.

CIMTRADZ approach to outreach and service learning

This theme is comprised of four papers which describe outreach, service learning and community engagement activities under CIMTRADZ. The first paper “The Intersectionality of Sociology and Health: Case Studies of the Effect of Culture on Disease” by Prof. Khaitsa and colleagues, discusses the sociological approach to health and how a society´s culture shapes its understanding of health, and the relevance of this discipline to One Health. Case studies of the intersection of culture and health from the “Capacity building in Integrated Management of Trans-boundary Animal Diseases and Zoonoses” (CIMTRADZ) project and beyond are provided including, the effect of cultural practices on Brucellosis and Tuberculosis in Uganda, and Ebola spread in West Africa.

The second paper “One Health Outreach and Service Learning Case Studies Conducted under the CIMTRADZ Project” by Dr. Okech, and colleagues summarizes a series of case studies conducted under CIMTRADZ using One Health and service learning pedagogy. The paper describes various service learning activities conducted during the CIMTRADZ project including integrated approach to Rocky Mountain spotted fever in Arizona - in collaboration with the US Centers for Disease Control & Prevention (CDC); community interventions against New Castle disease, radio talk shows in Soroti regarding brucellosis control and One Health Project at The Abattoir.

The third paper “Service-Learning and community engagement yields benefits in zoonotic disease control: the case of rabies control in Mbuya II Zone in Kampala, Uganda” by Isiko, describes student engagement in rabies vaccinations in Uganda using service learning pedagogy. Rabies is a neglected zoonotic disease in Africa and its incidence is steadily increasing in Uganda. This is a sign that traditional control measures may not be effective hence the need to assess the impact of alternative approaches. Student-led community education exercises and mass vaccinations of dogs and cats against rabies were administered in two suburbs of Kampala city. The impact of student efforts in transforming community health was assessed through focus-groups with the community leaders. The paper concludes that an integrated, multidisciplinary service-learning pedagogy combined with community-based support is an effective strategy to rabies control.

The fourth paper “Practical experiences of an NGO implementing One Health Initiatives in the Albertine, Ecosystem, Hoima, Uganda” by Drs. Mugisha, Travis and Pelican discusses how a growing number of community health initiatives have failed to address infectious diseases at human-wildlife-livestock interface. Using the Conservation & Ecosystem Health Alliance (CEHA), they describe how CEHA has applied the One Health paradigm since 2012 to manage and control infectious diseases in the Albertine Ecosystem communities of Hoima, Uganda. The authors recommend more research on the application of One Health in African contexts, and collaborations between university researchers and NGOs to strengthen capacity for addressing the complex interaction among human, domestic animal and wildlife systems.

Conclusion     

The concluding paper in this volume ties this material together. Three highly experienced collaborators on the CIMTRADZ project - Profs Kaneene, Khaitsa and Kabasa, - distill what they consider the key lessons emerging from the institutional and human capacity development under the CIMTRADZ project and their implications for Africa and other institutions that may consider implementing similar projects in Africa. Drawing on a wealth of experience and evidence, this final paper summarizes key issues to consider and lessons learned in implementing human and institutional capacity development projects in sub-Saharan Africa.

Competing interests     

The authors declare no competing interests.

Authors´ contributions     

Profs Khaitsa, Kaneene and Kabasa contributed to writing the article, reviewed several drafts, and approval of the version to be published. Additionally, all authors were collaborators on the CIMTRADZ project and played a significant role in its implementation. All authors have read and agreed to the final version of this manuscript and have equally contributed to its content and to the management of the case.

Acknowledgments     

The authors wish to acknowledge valuable financial support provided by the United States Agency for International Development (USAID) under The Africa-US Higher Education Initiative of American Council on Education (ACE), Association of Public and Land grant Universities (APLU) and Higher Education for Development (HED). The authors are similarly grateful for additional funding provided by partnerships with the Government of Uganda and other regional networks such as One Health Central and East Africa and Emerging Pandemic Threats Program for supporting additional empirical work Finally, the authors would like to recognize the invaluable contribution of partner institutions in ECA, the US, and Canada who contributed their various expertise to successfully implement the CIMTRADZ objectives.

Figure     

Figure 1: the Africa-US Integrated Disease Management Network (AFRUS-IDM)

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