One Health Outreach and Service Learning Case Studies Conducted under the CIMTRADZ Project

One health outreach and service learning case studies conducted under the CIMTRADZ project

Samuel George Okech¹, Gabriel Tumwine¹, Samuel Majalija¹, Patrick Vudriko¹, Kokas Ikwap¹, Paul Lochap², Margaret Loy Khaitsa^3,&, Florence Wakoko⁴, John David Kabasa¹

¹College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda, ²Karamoja Livestock Development Forum, Moroto, Karamoja, Uganda, ³Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA, ⁴Department of Criminal Justice and Sociology, Columbus State University, Columbus, Georgia, USA

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

Introduction    

University´s primary missions are education, research, and outreach [1]. Outreach has been defined as “a reaching out from the university to the people and organizations a university serves” [2], including transfer of knowledge and technology from the university to its constituents. Leading scholars have eloquently described the societal need for a more intense and direct engagement of universities with their external constituencies [1]. The internal benefits of outreach to universities are immense and strong faculty engagement in outreach is needed by the university as much as it is by its societal partners [1]. Each engagement in outreach is likely to have an element of inquiry and discovery, leading to creation of new knowledge which flows in both directions. First-hand faculty involvement in the field provides new academic insights and understanding, which provide new directions for controlled research in laboratories; findings, in turn, lead to ideas that can be brought to the place of application [1]. Outreach is needed for the optimal generation of knowledge; it provides bridges between theory and practice which benefit the teaching and learning process both directly and indirectly. Direct student involvement in faculty-outreach projects has the potential of providing considerably more mentoring and learning than an external experience in which faculty are not engaged. Universities and colleges are increasingly encouraging faculty and staff involvement in community-based research and service-learning projects [3]. Studies have shown that community-based projects energized the participating faculty, helped them make their academic work relevant in communities, created formal and informal university-community partnerships, and elevated the University´s public image [3]. Most of the diseases addressed in the case studies presented by this paper (e.g. rabies, brucellosis) fall under the category of Neglected Tropical Diseases (NTDs). NTDs are a group of diseases often affecting the world´s poorest people living in remote and rural areas of low income countries in sub-Saharan Africa and South America. NTDs blight the lives of a billion poor people globally [4]. These diseases cause lifelong disability, disfigurement, reduced economic productivity and social stigma [5]. Rabies, cysticercosis and echinococcosis are among NTDs that exert their greatest impact in developing countries with limited economic resources in Asia and sub-Saharan Africa [6]. NTDs significantly impact food safety, food security and public health. In Uganda, for instance, the Karimojong are a pastoralist community who keep large numbers of sheep, goats, and cattle and smaller populations of donkeys and camels [5]. There is a very close association between dogs and the herdsmen who play with them, and thereafter eat food with unclean or unwashed hands [7]. Cystic echinococcosis is, therefore, a serious public health and economic problem in Karamoja sub-region. The Karimojong pastoral system, cultural practices, and generally their way of life seem to comprise major epidemiological factors that aid the transmission of Echinococcus granulosus to humans [7]. Also, in Uganda, rabies is a big public health issue where 99% of all cases of human rabies are contracted through a dog bite from an infected animal. Vaccination of animals is one of the most important ways to reduce the incidence in humans, yet rabies vaccination coverage for dogs and cats in Uganda is poor. In Karamoja, rabies is one of the major public health concerns, yet few veterinary services are available to address the challenge posed by it and other NTDs in Uganda. The One Health approach, applied through service learning, provides an arguably useful method for dealing with these disease challenges. According to the American Veterinary Medical Association (AVMA) One Health is defined as, “the collaborative effort of multiple disciplines-working locally, nationally, and globally to attain optimal health for people, animals and our environment” [8]. Gibbs (2014) [9] posits that teamwork, multi-disciplinarity, community participation, pooling resources, shared diseases between humans and animals (zoonoses) and multi-sectoral involvement are the common themes that run through the definitions of One Health. These themes are also key elements of service learning whose definition is summarized by Seifer (1998) [10] as, “a structured learning experience that combines community service with explicit learning objectives, preparation, and reflection." These approaches were applied variously in the implementation of the activities of the “Capacity Building in Integrated Management of Transboundary Animal Diseases and Zoonoses” (CIMTRADZ)" project. CIMTRADZ participating universities espouse community engagement, and the project focused on developing capacity in East-Central Africa (ECA) to manage transboundary animal diseases and zoonoses using One Health approach.

Methods     

The Capacity Building in Integrated Management of Transboundary Animal Diseases & and Zoonoses (CIMTRADZ) partner institutions conducted 17 outreach/extension activities between 2013 and 2015, including: One Health field attachments, radio talk shows, community vaccinations and One Health training sessions at the abattoir. The One Health field attachments exposed students to the practices of One Health concept and their practical application. It created an environment for students to improve their communication skills with stakeholders, apply their technical knowledge, while practicing skills to solve community problems, and identify community problems and opportunities and categorize them appropriately. The students and faculty traveled to rural communities (such as Nakapelimoru and Kapithinyang villages in Kotido District) to administer vaccinations to their pastoral communities´ sheep, goats, dogs and cats.

Results     

Outreach/Extension activities

The CIMTRADZ partners conducted 17 outreach/extension activities between 2013 and 2015 (Table 1), including: One Health field attachments, radio talk shows, community vaccinations and One Health training on abattoir hygiene and occupational health.

Service learning using rabies vaccinations

Rabies vaccination was piloted in 2012 in Mbuya Primary School and a local women´s organization in Mbuya, and Kiswa, the suburbs of Kampala, Uganda. Students enrolled into the Master of Science (MS) degree in International Infectious Diseases Management (MS-IDM) and other students from the College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), e.g. fourth year Bachelor of Veterinary Medicine students were involved in this community work where more than 100 dogs were vaccinated and the public educated on the dangers of rabies. In addition, in 2014 and 2015 students who enrolled in the Tropical Veterinary Medicine and One Health summer course in Uganda vaccinated dogs and cats against rabies in Soroti district and Kotido district, Karamoja region, respectively. The first day in Kotido, students dewormed and vaccinated 30 dogs and 3 cats against rabies. In Soroti district, students vaccinated over 50 dogs and cats against rabies. Below is a personal testimony of one of the MS-IDM students from Makerere University (Mak), (Julia Kabajurizi), that participated in this experiential learning exercise.

Vaccination of dogs and cats against rabies: a One Health service-learning community outreach in Soroti District in Uganda, by Ms. Julia Kabajurizi

"I was one of the beneficiaries of Summer School 2014 Eastern Route. I was given an opportunity to interact with both local and international participants from Rwanda, Canada, USA, Kenya, Tanzania and Uganda. It was really a global knowledge sharing platform where different participants from different regions or countries shared their experiences and socio-culture. We got involved in many activities, like the introduction to livestock production systems, visit to small holder farmers, culture and society. We also participated in One Health activities like Brucellosis radio talk show; carrying out vaccination of dogs and cats against rabies and poultry against New Castle Disease; district hospital visits; cattle market visits, among others. My interesting activity was the Rabies Vaccination One Health outreach activity in Kamuda sub-county in Soroti District in Eastern Uganda, given that my undergraduate degree was in Biomedical Laboratory Technology and now I am a Graduate student of International Infectious Disease Management (IDM) in Makerere University. Through HED-USAID, under summer school, I got to come closer to dogs and later I realized that I have a role to play in line with One Health. Rabies being a zoonotic disease, I appreciated community concerns about dog bites and likelihood of rabies that was reported to be a problem in the communities especially where dogs were not vaccinated routinely and their welfare not well managed by the owners. In this activity we were engaged in community mobilization, community sensitization about Rabies (how humans and animals get infected, how it is prevented and what should be done in case of dog bite) and also later in the next day vaccination of the animals. The team involved veterinarians from the district, health inspectors, clinicians, nurses and other stakeholders like community leaders and elders. It was so fascinating how people in rural Uganda treasure their dogs and how they were willing to learn more about other diseases a man can get from dogs. I got to know the values of restraint in dogs when administering any treatment, also learned that Rabies is a killer disease that is controllable. We vaccinated dogs of all breeds and origin. I remember one of the dog owners wishing to be vaccinated also using human vaccine and when I asked my Veterinary colleagues they just laughed and advised me not to. It was really great as I valued team work and appreciated professionalism, specialization and the benefits of multidisciplinary approach to contributing solutions to community problems."

Rocky Mountain Spotted Fever Intervention in Arizona, USA

Four exchange students from Mak that were enrolled into the Master of Science degree in International Infectious Disease Management (MS-IDM) at North Dakota State University (NDSU) (2012-2013), together with Dr. Prof. Margaret Khaitsa, participated in the United States (US) Centers for Disease Control and Prevention (CDC) Veterinary Students Day that was held in January, 2012 at the CDC, Atlanta, Georgia (GA). As a result of networking with CDC scientists, the four exchange students from Uganda were able to participate in a One Health Outreach activity to control Rocky Mountain Spotted fever in Arizona. This outreach activity was led by The CDC, Rickettsial Zoonoses Branch, Division of Vector-borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Office of Infectious Diseases, Atlanta, GA 30333, in collaboration with CDC Foundation, faculty and students from Virginia Tech University and NDSU. The activities involved: spay and neuter of over 300 dogs to reduce the dog population, dogs being fitted with Bayer Seresto Flea and Tick Collars that offered protection against ticks for 8 months, application of acaricides to the lawn to kill ticks, and education of the community members on the epidemiology of Rocky Mountain Spotted fever.

One Health Radio Talk Show on Brucellosis in Soroti district, Uganda- June, 2014 and June, 2015

Through support from US Agency for International Development (USAID), partner institutions in the CIMTRADZ project implemented a community service initiative as part of a multidisciplinary One Health student training approach. The initiative involved community education through a live radio talk show about zoonotic diseases, vaccination of dogs and cats against rabies, and vaccination of poultry against Newcastle Disease in Soroti district, Uganda. The radio is one of the most commonly used media to reach or engage communities. Therefore, a radio talk show was organized in Soroti to discuss zoonoses particularly brucellosis, tuberculosis, and rabies. A popular radio station (Veritas FM) with wide coverage in the Teso sub-region, was used. This activity was a community outreach program organized collaboratively by universities in ECA (Mekelle University, Ethiopia; Sokoine University of Agriculture, Tanzania; University of Nairobi, Kenya; University of Rwanda, Rwanda) led by Mak, Uganda and the US (Mississippi State University, College of Veterinary Medicine). The main objective was to disseminate information on zoonoses to the community and to expose participants to the mass medium for dissemination of information on livestock and human health using radio. The local District Veterinary Officer and District Medical Officer participated in the activity. Below is a personal testimony of one of the MS-IDM students (Patrick King) that participated in the radio talk show.

Brucellosis Radio Talkshow, by Mr. Patrick King

"It was my first time to participate in a radio talk show; moreover a live broadcast. It was in the evening when a team of experts from Makerere University and summer school participants were involved in the talk show. It involved two main languages i.e. English and Ateso. It covered a talk time of more than one hour on a live call-in popular evening radio program whose topic of focus was brucellosis. We talked about brucellosis as a disease, how it is transmitted in animals and humans, clinical signs of the disease in animals and humans and how the disease can be prevented. It was interesting to hear the version in the local language. After our elaborate introductory presentation, the public was invited to call in. It was interesting that many calls came in. Initially I thought people would not understand the subject that easily but many people called in and asked relevant questions which showed that people understood. I learnt from their questions that the public was eager to know more information about their livelihood as well as animal welfare. One caller was so excited that he asked “should people now stop eating meat since no one can see the disease and it is dangerous?” To me I had a mixed feeling that either the caller was genuinely worried or just joking. He was told that he handles delivering animals with care as well as eating well cooked milk and meat. Many called to appreciate the program and requested for more related programs. Prof. Margaret Khaitsa informed the public that the talk show was sponsored by USAID-HED through Makerere University and partner universities from America led by Mississippi State University. She requested the concerned local leaders to embrace the innovation and talk it since the people are interested in knowing about their lives and of their livestock. The program was very exciting to me and I am sure it was to my fellow participants as well. Special thanks to USAID-HED and all the partner universities in the CIMTRADZ project for working together with Soroti District professionals; district leaders; management and staff of Caritas Radio to organize this wonderful talk show."

One health outreach at the abattoir: the role of abattoirs in public health: a training on abattoir hygiene and occupational health

With financial support from the CIMTRADZ project and material support from Kampala Capital City Authority, students enrolled in the MS-IDM program together with the One Health Students´ Club at Mak and the One Health residency program held a Community Sensitization outreach at Kalerwe abattoir, Kampala, Uganda on 6^th December, 2014. Abattoir workers are at very high risk of acquiring zoonotic diseases, such as brucellosis and tuberculosis, in the course of their day-to-day activities. The main aim of the outreach was to create awareness among abattoir workers on possible zoonotic diseases associated with handling and slaughter of animals. The mobilization for the campaign was done by the area local chairperson, while that for the students was done by the student leaders. Assoc. Prof. Samuel Majalija led the team, which was comprised of students from College of Veterinary Medicine Animal Resources and Biosecurity (COVAB) and the School of Public Health. With respect to disease transmission, food safety, environmental conservation and public health issues, this community engagement activity focused on the health for abattoir workers in regards to zoonoses, animal welfare, production of quality meat and sanitation and hygiene in abattoirs. This workshop attracted over 150 participants, among which were cattle traders, butcher-men, local leaders, and meat consumers. Opening remarks were given by the managing director of the Kalerwe abattoir, Haji Ahmed Kezaala, who shared on the public health concerns in abattoirs, challenges faced in regards to diseases. He asked the abattoir workers to cooperate with the students and declared the exercise open. The students started by cleaning the various compartments of the abattoir to set an example in improvement of abattoir sanitary conditions. Thereafter, a sensitization workshop involving discussions and sharing of information on zoonotic diseases was held. Dr. Nkuranga Charles started by highlighting the importance of meat inspection, Dr. Bugeza James and Dr. Kankya Clovice shared the risk factors to zoonotic diseases with a main focus on tuberculosis and brucellosis. This was then followed by Dr. Tayebwa Dickson who talked about issues to deal with animal welfare, such as animal handling, transportation and slaughter. Mr. James Muleme, a student from School of Public Health, shared on sanitation and hygiene in abattoirs. Closing remarks were given by Assoc. Prof. Samuel Majalija, who thanked the entire team for working together during the activities despite varying backgrounds. Thereafter, he announced the activity closed.

Vaccination of Goats, and Sheep, against Peste des petits ruminants (PPR) in Kotido district, Karamoja region

In summer 2015, with collaboration of the Uganda Ministry of Agriculture, Animal Industry and Fisheries, The Food and Agricultural Organization (FAO), Uganda Country office, Karamoja Livestock Development Forum (KLDF) non-government organization, Jie Community-based Animal Health Workers Association (JICAHWA), students from Mississippi State University (MSSTATE) and CIMTRADZ institutions in ECA led by Mak and local veterinarians spent two days in Kotido, Karamoja sub-region vaccinating goats and sheep against Peste des petits ruminants (PPR) or goat plague. PPR is a highly contagious viral disease of sheep and goats and results in heavy losses to a farmer´s herd when infected. PPR is controlled by vaccination and immunity can last up to four years. In addition to administering the PPR vaccine to sheep and goats, the students dewormed a total of 521 goats and sheep in the Kotido community.

Discussion     

The CIMTRADZ partners conducted several outreach activities between 2013 and 2015, including One Health field attachments, radio talk shows, community vaccinations and One Health abattoir training sessions. These activities exposed students to practical applications of One Health, and created an environment for students to improve their communication skills with stakeholders, apply their technical knowledge while practicing skills to solve community problems. Several scholars have expressed the need for university community engagement citing the internal benefits of outreach to universities as much as it is to its societal partners [1]. It has been determined that outreach creates new knowledge, which flows in both directions. It also provides bridges between theory and practice, which benefit the teaching and learning process both directly and indirectly. Additionally, direct student involvement in faculty-outreach projects has the potential of providing considerably more mentoring and learning than an external experience in which faculty are not engaged. The faculty outreach also indirectly benefits all other students that may not participate directly [1]. The MS-IDM students and faculty traveled to Kotido and Kaleburr in Karamoja region where they dewormed livestock and vaccinated sheep, goats, dogs and cats. These two communities are especially prone to livestock disease outbreaks because of their pastoral way of life which commonly results in livestock crossing international borders. The Karimojong keep large numbers of cattle, sheep, goats, and also donkeys and camels [5]. It has also been reported that there is a close association between dogs and the herdsmen who play with them and thereafter eat food with unclean or unwashed hands [7]. Therefore cystic echinococcosis is a serious public health and economic problem in Karamoja sub-region [7]. The outreach activities contributed to control of transboundary animal diseases and zoonoses in the two communities served. Interdisciplinary training through One Health provided an opportunity for faculty to generate interdisciplinary research questions and also enhance international collaboration between students from MSSTATE and ECA. For instance, a student from MSSTATE (Robert Stenger) conducted research in 2016 with joint supervision from faculty at MSSTATE and Conservation Through Public Health in Uganda. Several faculty from Mak obtained collaborative research grants with faculty from MSSTATE and other CIMTRADZ participating institutions. Table 2 summarizes a sample of collaborative grants obtained. The outreach activities fulfilled the goal of Land Grant Universities of “Serving people globally”.

Conclusion     

The One Health service learning approach provides appropriate opportunity for participants to gain deeper understanding of the One Health concept in reciprocation of relevant services provided to the community.

Competing interests     

The authors declare no competing interest.

Authors´ contributions     

All authors contributed to writing drafts of the article, reviewed several drafts, provided important intellectual content, and approved the version to be published. Additionally, all authors participated in the One Health outreach activities described. 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 financial support provided by the United States Agency for International Development (USAID) under The Africa-US Higher Education Initiative of the Association of Public and Land Grant Universities (APLU) and Higher Education for Development (HED) through CIMTRADZ project.

Tables     

Table 1: summary of CIMTRADZ Outreach/Extension activities conducted, 2012-2015

Table 2: sample collaborative grants obtained between Makerere University Faculty and CIMTRADZ partners

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