Promoting Proper Management of Zoonotic Diseases through e-based One Health Training of Frontline Healthcare Workers

Infectious diseases remain a significant cause of mortality and morbidity globally. The global economic burden due to diseases transmissible between animals and humans (zoonoses) in some countries has been estimated to be US$ 80,000,000,000 (World Bank, 2012). Approximately, 75% of emerging human diseases are of animal origin (Taylor et al., 2001; Woolhouse [&] Gaunt, 2007; Dahal [&] Kahn L, 2014). This has been largely caused by an increased interactions between animals and humans because of the increased human and animal populations, expanding agricultural systems, increased global trade and urbanization, and climate change. To address this problem, there is increasing appreciation of the relevance of One Health approaches to the detection and appropriate management of infectious diseases, especially zoonotic diseases (Karimuribo et al., 2007, John et al., 2008, Swai et al., 2009, Sambo et al, 2013).
In order to identify strengths and gaps in healthcare provision by medical and veterinary practitioners in Tanzania, self-assessment exercise in public and animal health was carried out through the WHO led Joint External Evaluation (JEE) in 2016 and the Performance of Veterinary Services (PVS) in 2008, respectively. One of the gaps identified by both JEE and PVS was low knowledge of One Health issues among frontline healthcare workers in human and animal health sectors. Information available indicates that zoonotic diseases are prevalent in Tanzania especially rabies, brucellosis, anthrax and bovine tuberculosis (John et al., 2008). Due to low knowledge on One Health concepts, most of zoonotic diseases are under-diagnosed and consequently poorly managed leading to unnecessary sufferings of affected patients.
This initiative address the challenges of delayed diagnosis and management of selected zoonotic diseases (brucellosis and rabies) attributed to low knowledge on zoonoses and One Health concepts among frontline healthcare workers. Previous studies in Tanzania indicate that brucellosis cases are managed as malaria patients due to similar signs and symptoms in affected individuals. Similarly, suspected rabies cases may be managed as normal wounds if healthcare professionals cannot link animal bites to the risk of rabies infection. Both cases can lead to unnecessary suffering and deaths attributed to low knowledge of zoonoses among healthcare workers.

Last updated in September 2023

Based on the results of the baseline survey, the e-based AfyaData brucellosis model was designed and piloted to accommodate sampling protocol and communication of laboratory testing results between different points of health system using barcode system. Twenty seven frontline healthcare workers from 16 health facilities in Kilosa were trained on how to conduct proper diagnosis and management of brucellosis cases and were provided with the developed guidelines. Eight Community Health Workers from 8 administrative wards were also trained on how to recognise clinical manifestations suggestive of brucellosis and referral of suspected cases to the primary health facilities. After training of healthcare workers and community health workers, the e-based model operated by AfyaData was deployed to link patients and primary health facilities to the confirmatory laboratory at Sokoine University of Agriculture which is located approximately 140 kilometres away from Kilosa town. The e-based model supports follow up of the patient to monitor progress and address challenges in close to real-time. A WhatsApp group network has been established between the frontline health workers, community health workers and project implementing team to enhance sharing of experiences, challenges and solutions. An abstract based on baseline data collected by the project was accepted by the Sixth World One Health Congress organising committee.

This initiative promote health education and awareness among healthcare workers so that they can achieve prompt diagnosis and hence accurate management of brucellosis-affected and high risk to rabies groups in intervention areas.
Through application of e-based intervention using AfyaData system, we aim to a significant reduction of time to manage properly brucellosis-affected patients and those individuals at high risk of developing rabies through animal bites. In addition, this initiative should reduce costs that would have been incurred by printing hard copies of training manuals through uploading training materials on AfyaData app uploaded on healthcare mobile phones. Finally, the AfyaData app will also support data collection in in-depth interviews as well as recording and reporting zoonotic disease surveillance data thus providing real time data to the epidemiology unit via routine surveillance system.

Today, the developed technology has been extended to early warning surveillance and management of infectious diseases via the launch of a national digital platform with the Office of the Prime Minister of Tanzania through its Disaster Management Department.