Table_13_One Health in Action: Operational Aspects of an Integrated Surveillance System for Zoonoses in Western Kenya.pdf

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 × 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.

目前，肯尼亚及东非其他地区的疾病监测工作由人类卫生与动物卫生两大部门共同开展。然而，近期一项评估显示，两部门间缺乏协同整合，导致疾病漏报与运行效率低下。本项目旨在开发一套整合化且具成本效益的疾病监测与报告系统，并在肯尼亚西部的邦戈马（Bungoma）、布西亚（Busia）和卡卡梅加（Kakamega）三个郡开展15种人畜共患病（zoonotic diseases）的试点应用。本文具体阐述该监测系统的实操运作细节。研究团队首先对关键信息提供者开展访谈，随后通过实地走访遴选监测哨点（sentinel sites）并联络相关利益相关方。基于上述调研信息，研究制定了抽样策略：共设置12个监测哨点，每个郡各4个。每个监测哨点包含1个牲畜交易市场、1-2家毗邻的屠宰场/屠宰点，以及附近的一所医院；12个哨点共计36个采样点位，每4周对每个点位开展1次采样，共计完成20个采样周期。在每个采样点位，研究人员会对动物或就诊患者进行临床检查，并采集血液、粪便及鼻腔拭子；对于屠宰动物，还会额外采集肠系膜淋巴结、棘球蚴囊肿及吸虫样本。每次实地走访结束后，研究人员会记录参与人员及遇到的各类挑战，同时将采集的生物样本送至肯尼亚布西亚的野外实验室进行处理，并针对15种人畜共患病开展检测。研究团队还在每个监测哨点举办公众参与座谈会，分享初步研究结果，并向利益相关方及研究参与者反馈相关信息。牲畜交易市场的单次走访时长约3小时，最常见的挑战为牲畜所有者频繁拒绝参与本研究。屠宰场的单次走访时长略不足4小时，面临的挑战包括肉类检疫人员参与度较低，或屠宰流程过快导致无法完成采样。最后，医院单次走访时长约4小时，最常见的挑战包括就诊患者人数较少、人员流动频繁导致机构记忆缺失，以及难以获取患者粪便样本。本次研究经验表明，与当地利益相关方开展实地沟通，并通过公众参与座谈会及时反馈信息，对于确保研究的持续合规性至关重要。