It is widely recognized that zoonotic diseases control and elimination require a joint approach by animal and human health sectors [
Similar to other developing countries, one sector approach and weak preexisting animal and human health surveillance system is widely practiced in Ethiopia in general and in Jimma Zone in particular. This approach is characterized by delayed outbreak detection and management of two of the most important zoonotic diseases (rabies and anthrax) in both humans and animal population in Jimma. Such case detection is often after massive loss of human and animal lives and probably after occurrence of several outbreaks detected/undetected in both humans and animals population. Apart from delayed outbreak detection and management, the preexisting weak surveillance system in the countries can jeopardize rabies and anthrax control and eradication efforts of the Sub-Saharan African countries [
Jimma Zone, Southwest of Ethiopia, is home to rabies and anthrax, the two common zoonotic diseases. Studies showed that on average three victims visit Jimma town antirabies health centre per day for postexposure prophylaxis excluding victims going to traditional healers. Thirteen deaths due to rabies were reported from Jimma health centre between mid-October 2012 and mid-January 2013 [
Joint zoonotic diseases surveillance approach is not yet formally established in low income countries like Ethiopia. However, there are informal joint practices usually limited on outbreak management. For the realization of the joint zoonotic disease surveillance approach, health care providers in human and animal health sectors play a crucial role. However, there is limited evidence on providers’ knowledge and practice related opportunities and challenges towards joint surveillance for zoonotic disease. Hence, this study was aimed at determining knowledge and practice gap towards such surveillance approach among health care providers in both sectors of the district.
The research was carried out in Gomma district of Jimma Zone of Oromia Region. Agaro is a capital town of Gomma district located at altitude ranging from 1,380 to 1,680 meters above sea level. However, some points along the Southern and Western boundaries have altitudes ranging from 2,229 to 2,870 meters. The projected total population of the district from the 2007 national census in 2014 is 246, 381 (which is 51,652 households) of which 3,094 (5.99%) were urban households and 48558 (94.01%) rural households [
A community based cross-sectional study design was conducted on all health care providers in Gomma district (351 animal and human health service providers). One hundred thirty health care providers from Agaro health centre, 82 health extension workers from all Kebeles of the district, 9 human health surveillance focal persons from Gomma district level and animal health service providers 1 veterinary doctor, 9 animal health surveillance focal persons, 65 development agents (these are professionals deployed at Kebele level to promote development through primary prevention of disease in animals), and 55 animal health assistants (these are professionals who provide curative care for sick animals at animal clinics) in all Kebeles of the district constitute study population.
Interviewer administered structured questionnaire was adapted [
Data were checked, edited, and entered into Epi-data version 3.1. Data were then cleaned for outliers and missing values and analyzed using SPSS version 20. Descriptive analysis was done to generate summary values for variables on background characteristics, knowledge, and practice of service providers.
Ethical clearance was obtained from both Health Sciences College and School of Veterinary Medicine Institutional Review Boards of Jimma University. Permission letter was sought from both human and animal Gomma district health offices to conduct the research. Before data collection, the objective of the study was explained to the participants and data collection was commenced only after obtaining verbal consent. Finally, the data were used for the research purpose only.
From a total of 351 human and animal health service providers, 323 (92.02%) participated in the study, among which 91.9% were human health providers. The majority (65.6%) of the respondents were females with median age of 29 years. Similarly, most (52.9%) respondents served for 61 and above months with a median of 72 months. Nearly three-fourths (74.0%) and one in ten (11.5%) of the participants were working in health centres and health posts, respectively. Most of the participants had B.S. degree (56.3%) followed by diploma (36.2%) holders (Table
Sociodemographic characteristics of health service providers, Gomma district, Jimma Zone, 2015.
Variable | Number ( |
Percent (100%) | |
---|---|---|---|
Sex | Male | 111 | 34.4 |
Female | 212 | 65.6 | |
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Age in years | 20–30 | 178 | 55.1 |
31–40 | 123 | 38.1 | |
41–50 | 18 | 5.6 | |
51–58 | 4 | 1.2 | |
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Profession | B.S. nurse | 48 | 14.9 |
Diploma nurse | 75 | 23.2 | |
Developmental agents | 9 | 2.8 | |
Health officer | 22 | 6.8 | |
Laboratory technologist | 111 | 34.4 | |
Pharmacist | 10 | 3.1 | |
Health extension workers | 28 | 8.7 | |
Environmental Health | 3 | .9 | |
Animal science practitioners | 17 | 5.3 | |
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Institution | Human district office | 21 | 6.5 |
Animal district office | 7 | 2.2 | |
Health centre | 239 | 74.0 | |
Health post | 37 | 11.5 | |
Veterinary clinic | 19 | 5.8 | |
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Marital status | Married | 114 | 35.3 |
Single | 203 | 62.8 | |
Widowed | 4 | 1.2 | |
Other | 2 | .60 | |
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Education level | Certificate | 8 | 2.5 |
Diploma | 117 | 36.2 | |
B.S. degree | 182 | 56.3 | |
Other | 16 | 4.9 | |
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Religion | Orthodox | 79 | 24.5 |
Catholic | 1 | .3 | |
Protestant | 141 | 43.7 | |
Islam | 102 | 31.6 | |
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Ethnicity | Amhara | 25 | 7.7 |
Oromo | 253 | 78.3 | |
Other | 45 | 13.9 | |
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Work experience (in months) | 1–12 | 36 | 11.1 |
13–24 | 23 | 7.1 | |
25–36 | 30 | 9.3 | |
37–48 | 27 | 8.4 | |
49–60 | 36 | 11.1 | |
≥61 | 171 | 52.9 |
Almost all (99.7%) respondents heard about rabies; however, 29 (9%) and 3 (0.9%) health care providers replied that rabies do not attack dogs and humans, respectively. Most of the respondents mentioned that rabies can be transmitted from sick animal to human (98.1%) and from sick animal to animal (96.6%). Similarly, more than seven out of ten respondents mentioned that vaccination of animals (73.9%), isolation of sick animals (80.7%), creating community awareness (93.5%), and conducting active surveillance (87.6%) can prevent the acquisition and transmission of rabies in humans and animals (Table
Knowledge gap of health service providers on rabies and joint surveillance, Gomma district, Jimma Zone, 2015.
Variable | Number ( |
Percent (100%) | ||
---|---|---|---|---|
Heard about rabies? ( |
Yes | 322 | 99.7 | |
No | 1 | .3 | ||
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Rabies attack ( |
Dogs | Yes | 293 | 91.0 |
No | 27 | 8.4 | ||
Not sure | 2 | .6 | ||
Human | Yes | 319 | 99.1 | |
No | 3 | .9 | ||
Cats | Yes | 162 | 50.3 | |
No | 135 | 41.9 | ||
Not sure | 25 | 7.8 | ||
Other animals | Yes | 136 | 42.2 | |
No | 182 | 56.5 | ||
Not sure | 4 | 1.2 | ||
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Rabies transmission ( |
Sick animal to human | Yes | 316 | 98.1 |
No | 4 | 1.2 | ||
Not sure | 2 | .6 | ||
Sick animal to animal | Yes | 311 | 96.6 | |
No | 8 | 2.5 | ||
Not sure | 3 | .9 | ||
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Rabies prevention ( |
Vaccination of animals | Yes | 238 | 73.9 |
No | 73 | 22.7 | ||
Not sure | 11 | 3.4 | ||
Isolation of sick animals | Yes | 260 | 80.7 | |
No | 58 | 18.0 | ||
Not sure | 4 | 1.2 | ||
Creating community awareness | Yes | 301 | 93.5 | |
No | 16 | 5.0 | ||
Not sure | 5 | 1.6 | ||
Conducting active surveillance | Yes | 282 | 87.6 | |
No | 28 | 8.7 | ||
Not sure | 12 | 3.7 |
Almost all (97.5%) respondents heard about anthrax; however, 104 (33%), 109 (34.7%), and 251 (79.7%) of health care providers replied that anthrax do not attack domestic animals, humans, and wild animals, respectively. More than two-thirds (68.3%) of the respondents replied that anthrax can be transmitted from sick animal to human. Similarly, more than half of the respondents mentioned that vaccination of animals (64.1%), isolation of sick animals (62.9%), creating community awareness (65.1%) and conducting active surveillance (55.6%), wearing protective clothing (55.6%), disinfection of contacts/materials (62.2%), and proper burial of dead animal/human (63.2%) can prevent the acquisition and transmission of anthrax in humans and animals (Table
Knowledge gap of health service providers on anthrax, Gomma district, Jimma Zone, 2015.
Variable | Number ( |
Percent (%) | ||
---|---|---|---|---|
Heard about anthrax? ( |
Yes | 315 | 97.5 | |
No | 5 | 1.5 | ||
Not sure | 3 | .9 | ||
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Anthrax attacks ( |
Domestic animals | Yes | 211 | 67.0 |
No | 99 | 31.4 | ||
Not sure | 5 | 1.6 | ||
Human | Yes | 206 | 65.4 | |
No | 106 | 33.7 | ||
Not sure | 3 | 1.0 | ||
Wild animals | Yes | 64 | 20.3 | |
No | 221 | 70.2 | ||
Not sure | 30 | 9.5 | ||
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Anthrax transmission ( |
Sick animal to human | Yes | 216 | 68.3 |
No | 95 | 30.2 | ||
Not sure | 6 | 1.6 | ||
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Anthrax prevention ( |
Vaccination of animals | Yes | 202 | 64.1 |
No | 107 | 34.0 | ||
Not sure | 6 | 1.9 | ||
Isolation of sick animals | Yes | 198 | 62.9 | |
No | 108 | 34.3 | ||
Not sure | 9 | 2.9 | ||
Creating community awareness | Yes | 205 | 65.1 | |
No | 108 | 34.3 | ||
Not sure | 2 | .6 | ||
Conducting active surveillance | Yes | 175 | 55.6 | |
No | 131 | 41.6 | ||
Not sure | 9 | 2.9 | ||
Wearing protective clothing | Yes | 175 | 55.6 | |
No | 130 | 41.3 | ||
Not sure | 10 | 3.2 | ||
Disinfection of contacts/materials | Yes | 196 | 62.2 | |
No | 116 | 36.8 | ||
Not sure | 3 | 1.0 | ||
Properly burial of dead animal/human | Yes | 199 | 63.2 | |
No | 112 | 35.6 | ||
Not sure | 4 | 1.3 | ||
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Are human rabies and/or anthrax reportable diseases in Ethiopia? | Yes | 316 | 97.8 | |
No | 2 | .6 | ||
Not sure | 5 | 1.5 | ||
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Are animal rabies and/or anthrax reportable diseases in Ethiopia? | Yes | 310 | 96.0 | |
No | 6 | 1.9 | ||
Not sure | 7 | 2.2 | ||
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Do you think that human and animal sectors can | Work together for zoonotic diseases | Yes | 316 | 97.8 |
No | 5 | 1.5 | ||
Not sure | 2 | .6 | ||
Jointly conduct surveillance on zoonotic diseases | Yes | 313 | 96.9 | |
No | 6 | 1.9 | ||
Not sure | 4 | 1.2 |
More than 96% of the respondents replied that occurrence of both rabies and anthrax in human and animal population is reportable in Ethiopia. The finding revealed that 97.8% of the respondents reported that both human and animal health sectors can work together for zoonotic diseases and similarly 96.9% of them replied that both human and animal sectors can jointly conduct surveillance on zoonotic diseases like rabies and anthrax (Tables
Just over a third (36.2%) of health care providers reported that their respective sectors had conducted joint surveillance for zoonotic diseases of public health importance in the past; however, almost all (99.1%) of the respondents who had joint surveillance experience reported that their involvement was limited to outbreak response. Only less than 11% of the respondents mentioned that they were involved in joint surveillance planning, surveillance data exchange, monitoring, and evaluation of surveillance activities. Seven respondents (2.2%) reported that their sectors have joint surveillance structure for zoonotic disease of which only 5 reported that level of integration between human and animal sectors was between health extension workers and development agents (DAs), health centres and veterinary clinics, and human and animal surveillance focal persons, respectively. Similarly, only six respondents reported that they had joint surveillance manual for zoonotic diseases in their respective health institutions (Table
Practice gap of health service providers and their respective sectors on joint surveillance, Gomma district, Jimma Zone, 2015.
Variable | Number ( |
Percent (100%) | ||
---|---|---|---|---|
Conducted joint surveillance on zoonotic diseases with human or animal sector | Yes | 117 | 36.2 | |
No | 194 | 60.1 | ||
Not sure | 12 | 3.7 | ||
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Joint surveillance activity experience ( |
Planning | Yes | 11 | 9.4 |
No | 106 | 90.6 | ||
Surveillance data exchange | Yes | 13 | 11.1 | |
No | 103 | 88.0 | ||
Not sure | 1 | .9 | ||
Outbreak response | Yes | 116 | 99.1 | |
No | 1 | .9 | ||
Monitoring and evaluation | Yes | 12 | 10.3 | |
No | 105 | 89.7 | ||
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Did your sector have integrated surveillance structure? | Yes | 7 | 2.2 | |
No | 299 | 92.6 | ||
Not sure | 17 | 5.2 | ||
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Level of integration was between ( |
Health extension workers and DAs | Yes | 5 | 71.4 |
No | 2 | 28.6 | ||
Health centre and veterinary clinic | Yes | 5 | 71.4 | |
No | 2 | 28.6 | ||
Human and animal focal persons | Yes | 5 | 71.4 | |
No | 2 | 28.6 | ||
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Integrated surveillance manual in your institution | Yes | 6 | 1.9 | |
No | 302 | 93.5 | ||
Not sure | 15 | 4.6 |
More than nine in ten of the respondents replied that both human and animal health sectors can jointly conduct surveillance on rabies and anthrax. However, only a third of health care providers reported that their respective sectors had conducted joint surveillance for zoonotic diseases of public health importance in the past one year preceding the survey and their involvement was limited to joint outbreak response. The respondents also mentioned that there is formal joint surveillance structure even during outbreak response in the district.
Almost all (99.7%) respondents heard about rabies and this was higher than (45.8%) what was reported by Tanzanian animal health workers [
More than 96% of the respondents mentioned that rabies can be transmitted from sick animal to human or vice versa. This is similar to study conducted among medical practitioners (94.3%) in Tanzania [
Though the majority of the respondents heard about anthrax, significant number of them replied that anthrax do not attack human and animals. This implies that health care providers in the district can easily miss anthrax cases that can in turn contribute to a number of needless human and animal deaths and delayed outbreak detection and allow the disease to persist in the population. As a result, there could be difficulty in exporting animal products and the consequence is detrimental to the national economy. As high as fifty percent of the respondents did not know that anthrax can be transmitted from sick animal to human. Similarly half of the respondents did not know that anthrax can be prevented through vaccination, isolation of sick animals, creating community awareness, conducting active surveillance, wearing protective clothing, disinfection of contacts, and proper burial of dead animal/human from anthrax. This may be explained by the fact that, unlike other national priority infectious diseases, there are no national/international zoonotic disease prevention and control programs in the district. Such significant number of health care providers may not be able to advise on the method of anthrax transmission/acquisition prevention and this will lead to the persistent occurrence of anthrax outbreak in human and animal population.
The majority of the respondents replied that occurrence of rabies and anthrax in either population is reportable and both sectors can jointly conduct surveillance on the diseases. This implies that there is a fertile ground for establishment of joint surveillance system for zoonotic disease in the district.
Just over a third of health care providers reported that their respective sectors had conducted joint surveillance for zoonotic diseases of public health importance; nevertheless, their involvement was limited to joint outbreak response. In other words, the focus was on zoonotic disease outbreak control rather than zoonotic disease outbreak prevention. The need for joint response only during outbreaks of zoonotic disease in low income countries is to reduce the far reaching consequences of the outbreak. If such approach remains unresolved, there will be persistent occurrence of outbreaks, economic loses, and threatening lives of humans and animals. In addition, joint surveillance structure and manual at all levels were absent in both sectors. All of these issues imply a challenge for the realization of the new approach.
However, the finding for this study should be interpreted with the following limitations: health care providers from animal health sector were not adequately represented in our sample. Hence, the findings might not represent the knowledge and practice of these health care providers.
Almost all respondents replied that occurrence of both diseases in human and animals is reportable and the sectors can conduct joint surveillance on the two zoonotic diseases. A few respondents had past experience of joint zoonotic disease surveillance but it was only during outbreak response for such diseases. It was further revealed that there were no formal joint surveillance structure and its implementation manual in the district. Therefore, formal joint surveillance structure for rabies and anthrax should be in place for optimal implementation of all surveillance components.
The authors declare that they have no competing interests.
Tsegaye Tewelde Gebrehiwot, Abiot Girma Sime, Desta Hiko Gemeda, Benti Deresa Gelalacha, Wubit Tafese, and Kifle Woldemichael Hajito conceived and designed the experiment; Tsegaye Tewelde Gebrehiwot, Abiot Girma Sime, Desta Hiko Gemeda, Benti Deresa Gelalacha, Wubit Tafese, and Kifle Woldemichael Hajito performed the experiments; Tsegaye Tewelde Gebrehiwot, Abiot Girma Sime, and Desta Hiko Gemeda analyzed the data; Tsegaye Tewelde Gebrehiwot, Abiot Girma Sime, and Desta Hiko Gemeda contributed analysis tools; Tsegaye Tewelde Gebrehiwot, Abiot Girma Sime, and Desta Hiko Gemeda wrote the paper; and Abiot Girma Sime and Wubit Tafese got permission letter from human and animal health offices.
The authors would like to thank One Health Central and Eastern Africa (OHCEA) for the realization of this research, Jimma Zone Human and Animal Health Offices for their valuable support by giving information, and all workers of the two health offices, data collectors, and study participants for their cooperation and assistance.