Assessing the performance of a key One Health indicator: evidence based on the One Health Index for zoonoses in sub-Saharan Africa | Infectious diseases of poverty

One Health (OH) is an integrated and unifying approach that aims to sustainably balance and optimize the health of humans, animals and ecosystems. Therefore, the OH performance index is called the ability to prevent or respond to health threats to humans, animals and the environment. [1]. The OH approach involves multidisciplinary efforts with common goals to achieve better public health outcomes by aiding in the prediction, prevention, and preparedness for disease at the interface between humans, animals, and their environments. [2].

In 2018, three major international organizations, the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE), put into practice the vision of occupational health by consolidating a formal partnership and strengthening their joint action to combat human-animal-environmental health risks [3]. This culminated in the FAO-OIE-WHO (tripartite) guide on zoonoses, entitled “Taking a Multisectoral, One Health Approach: A Tripartite Guide for Addressing Zoonoses in Countries” (2018 TZG), which provides principles and best practices to help countries achieve sustainable and functional collaboration at the human-animal-environment interface [4]. In May 2021, the OH High Level Expert Panel (OHHLEP) was launched to address the emergence and spread of zoonotic diseases [5]. The group aims to advise four international organizations – the FAO, the OIE, the United Nations Environment Program (UNEP) and the WHO – on the development of a long-term global action plan to prevent epidemics. To this end, 26 international experts have been appointed to launch the OHHLEP, followed by a joint tripartite (FAO, OIE, WHO) and UNEP statement that advocates for maintaining occupational health so that they are better prepared to prevent, predict, detect and react. to global health threats and promote sustainable development [6, 7].

Zoonoses are infections that are naturally transmitted between humans and other vertebrates and can be spread directly from food, water or the environment. Zoonoses alone account for 60% of known infectious diseases worldwide, with a high proportion (70%) of pathogens originating from wild hosts [8]. With accelerating globalization, emerging and re-emerging zoonotic infectious diseases seriously harm human health, livestock development and food security [9]. Throughout history, several epidemics and pandemics have been associated with zoonotic origins, with rapid spatial and temporal spread around the world. These include, but are not limited to, bubonic plague in the 14th century, the 1918 influenza pandemic, Acquired Immune Deficiency Syndrome (AIDS) since 1959, Severe Acute Respiratory Syndrome (SARS) in 2003, Middle East respiratory syndrome (MERS) in 2012, and novel coronavirus disease (COVID-19) in 2019 [10]. According to the types of pathogens, zoonoses are classified as bacterial zoonoses, for example, tuberculosis and brucellosis; viral zoonoses, for example AIDS and rabies; helminthic zoonoses, for example schistosomiasis and echinococcosis; protozoan zoonoses, for example malaria and leishmaniasis; fungal zoonoses; rickettsial zoonoses; chlamydial zoonoses; mycoplasmosis; and exceptions, such as mad cow disease [11]. Zoonoses have different modes of transmission, including animal bites or scratches, airborne, aerosol or dust particles, sexual contact or mother-to-child transmission, and other modes of transmission including oral transmission, indirect animal or environmental transmission. [10]. Serious zoonoses threaten the safety of life, public health and economic construction worldwide. For example, tuberculosis, leishmaniasis, and echinococcosis are major zoonotic diseases with high prevalence and disability-adjusted life years (DALYs), which were 1,829,729,478 and 47,030,118 respectively for tuberculosis. , 4,575,092 and 696,703 for leishmaniasis and 900,005 and 122,457 for cystic echinococcosis. according to the 2019 Global Charge Diseases (GBD) report.

The degree of development of a country or area is of great importance for its capacity to govern zoonoses. Developed countries have enormous advantages in medical treatment, public health, economic construction, contribution to scientific research and social welfare that most developing countries lack. [9]. Sub-Saharan Africa has long been considered a low-economy region with low- and middle-income countries. This would have resulted in low capacity/capacity to respond to zoonotic events [12, 13]. In addition, global climate change, deforestation and poor husbandry methods are accelerating the risks of zoonotic diseases, especially in sub-Saharan Africa. [14, 15]. According to the GBD report, in 2020, sub-Saharan Africa alone recorded a point prevalence and DALYs of 257,082,412 and 17,547,387, respectively, for tuberculosis and were estimated at 168,633,396 and 43,197,058, respectively, for malaria.

The One Health initiative on zoonoses, including governance capacity in surveillance and research activities, has been carried out in many countries/territories across the African continent [16]. In Kenya and Uganda, a global disease detection division [17] and a multidisciplinary platform [18], respectively, have been established for the control and prevention of zoonoses under the OH approach. In the Horn of Africa (Ethiopia, Kenya, Uganda, Sudan, South Sudan, Somalia, Djibouti and Eritrea) and in Chad, Côte d’Ivoire and Mali, international cooperation on the OH approach has been established for capacity building to support zoonoses control and prevention [19, 20]. However, these activities lack effective inter-ministerial collaboration mechanisms, or few results are adequate to be implemented in local communities. [18, 21].

In this study, we formulated indicators for zoonoses and applied the OH principles [22, 23] to data extracted from publicly available repositories to systematically analyze the OH index of zoonoses in sub-Saharan Africa. In addition, five major zoonotic diseases of global public health importance such as tuberculosis, COVID-19, echinococcosis, leishmaniasis and rabies [24], were selected as case studies for the evaluation. The results of these aforementioned studies suggest imperative needs of the OH approach not only to consolidate existing gains but also to implement integrative strategies in zoonotic event control programs in sub-Saharan Africa.

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