T3 DAHLD One Health Malawi Concept 18.01.2023 Catherine Wood

T3 DAHLD One Health Malawi Concept
18.01.2023
Catherine Wood

Introduction

The time we live is characterized by an unprecedented increase in the emergence of new health threats in humans, animals and in the environment. Underlying this “new dynamic” of shared risk are five key “drivers” that converge at the “human-animal-ecosystem” interface namely; globalization, population growth, economic growth, food security and changing habitats. The influence of the drivers is compounded by climate change [1-3].

The impacts of climate change on human health are not limited to the increase in average temperatures and the disrupted rainfall patterns. Climate change is also the cause behind human and animal migration, the increased food insecurity, the emergence and spread of vector-borne and waterborne infectious diseases, and rises in allergens, air, water and food pollution [3,4]. Many infectious diseases, including COVID19, Rift Valley fever (RVF), Crimean Congo hemorrhagic fever (CCHF), chikungunya, yellow fever, Ebola, Rabies, Salmonella, Cysticercosis, Tuberculosis, West Nile virus and several of the severe arbovirus are transmitted from wildlife to humans, and billions of people get sick and die from these viruses that are essentially environmental viruses.

Protecting public health is primarily centered on controlling and preventing the disease agents at source, thus at the environmental level and the animal level, through the adoption of a One Health approach [3-5].

One Health approach is also instrumental in the fight against Antimicrobial resistance (AMR) which is a complex, multifaceted problem that threatens human and animal health, the global economy, and national and global security [6]. The increase in emerging human infectious diseases that have a zoonotic origin and the increasing resistance of microorganisms to antimicrobial drugs have shown the need for collaborations between the human, animal and environmental health sectors.

A frightening report on AMR from the United Nations World Health Organization (WHO) and other sister global health agencies warned on the rise of multi-drug resistant (MDR) pathogens; with suggestions that drug-resistant infections could cause 10 million deaths each year by 2050, result in disastrous economic damage similar to the 2008– 2009 global financial crisis, and that by 2030, antimicrobial resistance (AMR) could have forced up to 24 million people into extreme poverty [7-9]. The One health concept increasingly receives recognition from policy makers and researchers all over the world, Malawi inclusive [6-9].

One Health approach is an integrated, unifying approach to balance and optimize the health of people, animals and the environment. It is particularly important to prevent, predict, detect, and respond to global health threats [10]. The approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together.

This way, new and better ideas are developed that address root causes and create long-term, sustainable solutions. One Health (OH) involves the medics, veterinarians, public health experts and environmental sectors. The One Health approach is particularly relevant for food and water safety, nutrition, the control of zoonoses (diseases that can spread between animals and humans, such as flu, rabies, tuberculosis, rift valley fever, e.t.c), pollution management, and combatting antimicrobial resistance (the emergence of microbes that are resistant to antibiotic therapy).

Many of the important zoonoses relate to animals in the food production chain. Food, therefore, becomes an important vehicle for a substantial number of these zoonotic pathogens [11], and food safety and food security are major OH issues, as clearly envisaged by the Food and Agriculture Organization (FAO), the United Nations Environmental Programme (UNEP), and World Health Organization (WHO) [12 – 14]. The OH approach holds promise in mitigating public health threats [15].

The approach has been embraced by WHO, FAO, World Organization for Animal Health (OIE) and the Global Health Security Agenda (GHSA) as a strategy for promoting the collaborative effort of multiple disciplines working locally, nationally and globally, to attain optimal health for people, animals and the environment [15]. In the last 5 years, OIE, WHO and FAO have all increased their interest and activities associated with wildlife disease surveillance in recognition of the impact that these diseases can have on global trade, human health and biodiversity [12 – 14].

Further, the UN Environmental Programme (UNEP) call for prudent management of production activities to control the atmospheric levels of the three main greenhouse gases - carbon dioxide, methane, and nitrous oxide in order to prevent climate change impacts [12 – 14].

Furthermore, the Environmental Health Practitioners (EHPs) carry out several duties that contribute towards One Health. These include: inspection of animals before slaughter (antemortem) and meat in abattoirs (postmortem); inspection of meat in butcheries; destruction of condemned meat; disease surveillance; outbreak investigation and control of zoonoses; control of vectors and vermin such as rats, fleas, mosquitoes and monkeys; health education on pertinent issues such as vaccination of dogs; and food safety including meat and milk. EHPs also play an important role in prevention, detection and abatement of microbial and chemical pollution of land, air and water sources that have created new threats to the health of both animals and humans. EHPs carry out house to house inspections on water, sanitation and hygiene hence involved in abating nuisances at households that could pose a threat to public health. Such threats could be emerging from the environment including animals [12 – 14].

In recent years Malawi has reported occurrences of several zoonoses in humans and animals like Tuberculosis, Rabies, Salmonellosis, RVF, CCHF, Chikungunya, just to mention a few [16-20]. Kainga et al., [19], demonstrated occurrence of rabies virus in humans, food animals, domesticated dogs and wild animals, a typical health threat that requires OH approach to manage the rabies problem.

The majority of the surveillance of zoonotic agents are conducted at the abattoirs and slaughter slabs. Abattoirs, registered and non-registered slaughter points are areas with several stakeholders working together for a common goal, to prevent spilling over of zoonotic pathogens to humans. It was observed that most of the people in Lilongwe prefer buying meat from unregistered areas like Nathenje, Nanjiri, Njewa, Mitundu, Kanengo, and Magwero, e.t.c., because of convenience and low prices. Similarly, this practice can be observed in all districts in Malawi and the rest of the cities such as Mzuzu, Zomba and Blantyre. However, the unregistered slaughter places lack experties and facilities for food safety and hygiene, hence don`t have capacity to mitigate zoonoses or prevent spilling over of infectious agents to humans and environment. Animal effluents and condemned parts are directed to the environment untreated, subsequently distracting environmental health through contamination of drug residues, microbes, dirty water and body fluids.

The known stakeholders at an abattoir are officers from City assembly public health department, Ministry of Health Public health department, and Department of Animal Health and Livestock Development (DAHLD) under Ministry of Agriculture. Unfortunately, among the stakeholders, it is only the DAHLD that has profound knowledge and skills to carry out the assignment at an abattoir set up because of the nature of veterinary training [21, 22].

Malawi is also experiencing threats of AMR in humans and animals [21-27], although the extent of AMR in environment remain speculative. Malawi has unclear AMR surveillance in animals and the environment, despite having less stringent regulations on accessing veterinary drugs [27,28]. For effective surveillance of AMR and infectious diseases agents at the slaughter places and abattoirs, there is need to improve capacity and competency of the all stakeholders.

Effective surveillance consequently shall help to achieve environmental health. Further, the fight against AMR in humans can be supported with concerted efforts to improve surveillance in livestock production from point of veterinary drug dispensers as previously observed [23].

It is against this back ground that the stakeholder in food safety and hygiene in Malawi would like to adopt OH approach to address these challenges and improve health of humans, animals and environment.

Scope of the Program

In order to comprehensively address the gaps in public health it is imperative to adopt OH approach to achieve holistic human-livestock-ecosystem health.

The main key areas to address are

• reduction of zoonotic diseases
• reduction of AMR
• capacity building of key stakeholders at all levels

In order to strengthen the surveillance systems in the country, it is recommended to improve research infrastructure at Lilongwe University of Agriculture and Natural Resources (LUANAR) where there shall be refresher training for the stakeholders and harmonization of surveillance activities to be conducted by the stakeholders.

Further, DAHLD shall spearhead the mobilization of consumer materials and supplies for veterinary research, medical research and environmental experts. Furthermore, collaborators of LUANAR such as International Livestock Research Institute (ILRI) and University of Edinburgh shall facilitate organization of OH symposiums and workshops for sharing experiences and developing better strategies for improvements.

Goals of the Program

The One Health approach is an innovative strategy to promote multi-sectoral and interdisciplinary application of knowledge and skills of medical, public health, veterinary and environmental experts by working together to attain good animal health, human health, environmental health, access of safe and wholesome food, and reduced AMR challenges in Malawi. To achieve this main goal, the program has identified five key priority areas:

• Establish and maintain high-level commitment at all relevant levels of government and the key stakeholders including the private sector.
• Establish and organize the awareness and documentation of mechanisms for operationalization of OH among stakeholders and the people in all areas of living.
• Upscale the fight against AMR in human and animal production
• Step-up the environmental protection and monitor health hazards from the environment
• Capacity building of stakeholders and harmonization stakeholders` activities at all relevant levels.

Stakeholders for the Program

One Health is a multi-sector and multidisciplinary approach which aims to sustainably balance and optimize the health of people, animals, ecosystems and the wider environment.

It mobilizes multiple sectors, disciplines and communities to work together to foster well-being and tackle threats to health and ecosystems. And it addresses the collective need for clean water, energy and air, safe and nutritious food, action on climate change, and contributing to sustainable development.

There are five stakeholders to participate in the implementation of the program. Namely

• LUANAR
• Ministry of Agriculture and Food Security
• Ministry of Health
• Ministry of Forest and Natural resources
• International collaborators (ILRI and University of Edinburgh)

LUANAR - The Leading Institution

LUANAR is a public university which is located within the central region and it has diverse expertise from different faculties situated within the campus. LUANAR shall house the Programme Coordination Unit (PCU) within the Faculty of Veterinary Medicine. Selected roles that LUANAR shall provide include:

• Organizing the stakeholders in liaison with focal persons in line ministries and institutions of the stakeholders
• Organize and facilitate awareness and sensitization of the line ministries at high level
• Conduct training of frontline staff in surveillance of foodborne zoonoses
• Conduct research in potential infectious agents available in crops, animals, environment and humans
• Define the predisposing factors of established health hazards
• Conduct backstop and supervision of activities by the stake holders
• Conduct monitoring and evaluation activities and provide consolidated progress reports quartery, semi- annual and annually.
• Certify and quantify mobilization of consumer veterinary and medical supplies.
• Organise and facilitate dissemination meeting
• Liaise with international collaborators on areas that require special attention in technology and innovation
• Include OH approach in LUANAR curricula in order improve knowledge and skills of OH among students
• Initiate National OH hub which shall host laboratories, postgraduate training in OH, metadata and specimen bank, metagenomics capacities
• Ensure that the National OH hub is ready for emergency response with necessary Biosafety Level 1, Biosafety Level 2 and Biosafety P3 laboratories that would help to diagnose diseases in animals and control the threat at source for safe public health and environmental health

Ministry of Agriculture and Food Security

DAHLD is a key department for surveillance of infectious agents across the meat value chain. DAHLD shall ensure that all slaughter places are regulated and conform with sanitary provisions.

DAHLD shall take a lead to

• Facilitate sensitization of health hazards among food producing farmers and front-line staff within the line ministry.
• Supervise the meat inspection activity (ante and post-mortems)
• Control livestock movement and improve livestock identification process
• Ensure slaughter of health animals with update health cards and properly certified fit for slaughter for the purpose of human consumption
• Control veterinary drug mobilization, access by farmers, and drug administration following the international regulation
• Provide vaccinations of food animals and non-food animals against zoonotic diseases
• Facilitate provision of equipment in Regional Veterinary laboratories and district laboratories
• Liaison with crop department, supervise the proper use of herbicides, insecticides, and proper observation of withdrawal periods
• Liaise with Department of Extension and LUANAR to develop an extension programme to disseminate agricultural research that fit in the OH approach
• Jointly with Pharmacy and Medicine Regulatory Authority (PMRA) inspect the veterinary drug dispensers for the availability of prescriptions presented by clients and removal of expired drugs. Also to ensure that AMR Stewardship is properly provided to the client
• Provide reports of any antimicrobial non responsive cases from the field

Ministry of Health

The ministry of health shall be responsible for the generation information that shall be used as basis for follow up and investigation.

Most importantly

• It shall be responsible for the awareness of the community stakeholders that provide health services to humans
• Facilitate surveillance of diseases within the communities and provide prompt report to the PMU
• Provide vaccination to humans
• Provide information on trend of AMR in hospital set ups
• Liaise with DAHLD and Environmental officers on meat inspection and share data for continuous improvement of infectious and non-infectious agents’ surveillance

Ministry of Forest and Natural Resources

The ministry of health shall be responsible for the generation information that shall be used as basis for follow up and investigation.

Most importantly

• It shall be responsible for the awareness of the community stakeholders that provide environmental health and hygiene services to humans
• Facilitate surveillance of contaminated water pints within the communities and provide prompt report to the PMU
• Facilitate observation of the presence of nuisance like bed bags, rats, houseflies within the community and the associated predisposing factors for proper intervention
• Observe the quality of water supply, water sources, stray dogs, strange behaviors of wild animals and pollution of air and water
• Provide information on trend of AMR in hospital set ups
• Liaise with DAHLD and ministry of health on meat inspection and share data for continuous improvement of infectious and non-infectious agents’ surveillance
• Provide strict measures to poor hygienic food facilities such as slaughter places, take a way premises, butcheries, markets, bus stages and prison areas
• Monitor use of herbicides and insecticides in crop fields such as horticulture products and livestock of food producing like dairy animals

International Collaborators

The program has two international collaborators the ILRI and Edinburgh university which shall have specific roles towards strengthening the implementation of the program.

(i) ILRI

Shall facilitate the building of skills in conducting field based research in areas that require improvement of the OH approach.

Also, it shall be involved in

• Organizing symposium with UN bodies of FAO, OIE, WHO and UNEP
• Facilitate harmonization on the use of early indicators of Arbovirus zoonoses outbreaks.

(ii) Edinburgh University

Shall facilitate the building of knowledge and skills in conducting OH training and establishment of National OH hub.

Also, it shall be involved in

• Development of OH curriculum for postgraduates
• Organize establishment of OH doctorate by research program
• Nn
• N

Operationalisation

• To be completed - Webmaster

References

1. Keesing, F., et al, 2010, “Impacts of biodiversity on the emergence and transmission of infectious diseases”, Nature, 468:647-652.
2. Lancet, 2019, “The Lancet Countdown on Health and Climate”,
3. WHO, “Climate Change and Infectious Diseases”, https://iris.who.int/bitstream/handle/10665/42742/924156248X_eng.pdf
4. World Health Organisation (WHO), 2015, “Connecting global priorities: biodiversity and human health: a state of knowledge review”, https://www.cbd.int/health/stateofknowledge.shtml
5. CDC, 2018, “One Health Basics”, webpage retrieved on 11th November 2020,https://www.cdc.gov/onehealth/basics/index.html
6. Godman, B.; Egwuenu, A.; Wesangula, E.; Schellack, N.; Kalungia, A. C.; Tiroyakgosi, C.; Kgatlwane, J.; Mwita, J. C.; Patrick, O.; Niba, L. L.; Et al. Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future. Expert opinion on drug safety. 2022, 21, 1089–1111. https://doi.org/10.1080/14740338.2022.2106368
7. Antimicrobial Resistance Collaborators, Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. 2022, 629-655. https://doi: org/10.1016/S0140-6736(21)02724-0
8. World Bank. Drug-Resistant Infections: A Threat to Our Economic Future. World Bank Rep. 2016, 2, 1–132. Available online: www.worldbank.org (accessed on 26th August 2022)
9. World Health Organization (WHO). Global Action Plan on Antimicrobial Resistance. 2015, pp. 8–9. Available online: https://www.who.int/antimicrobial-resistance/publications/global-action-plan/en/ (accessed on 20 October 2022).
10. HEAL, 2020, “Over 40 Million Health Professionals Urge G20 Leaders to Ensure a Health Recovery”,https://www.env-health.org/over-40-million-health-professionals-urge-g20-leaders-to-ensure-a-healthy-recovery/
11. Wielinga PR, Schlundt J (2013) Food safety: at the center of a one health approach for combating zoonoses. Curr Topics Microbiol Immunol 366:3–17
12. Lubroth J (2013) FAO and the one health approach. Curr Topics Microbiol Immunol 366:65–72
13. FAO (2011) One health: food and agriculture organization of the United Nations strategic actionplan. http://www.fao.org/docrep/014/al868e/al868e00.pdf. Accessed 11 Jan 2014
14. Nabarro D (2012) One health: towards safeguarding the health, food security and economic welfare of communities. Onderstepoort J Vet Res 79(2):450. doi:10.4102/ojvr.v79i2.450.
15. Gibbs EPJ. The evolution of One Health: a decade of progress and challenges for the future. Vet Rec 2014;174;85–91.
16. Kapalamula, Thoko & Kawonga, Francis & Shawa, Misheck & Thapa, Jeewan & Chizimu, Joseph & Nyenje, Mirriam & Mkakosya, Rajhab & Hayashida, Kyouko & Gordon, Stephen & Nakajima, Chie & Munyeme, Musso & Hang'ombe, Mudenda & Suzuki, Yasuhiko. (2022). Prevalence and Associated Risk Factors of Bovine Tuberculosis in Slaughtered Cattle, Malawi. SSRN Electronic Journal. 10.2139/ssrn.4050417.
17. Phonera, M. et al. (2021). Seroprevalence and Risk Factors of Crimean-Congo Hemorrhagic Fever in Cattle of Smallholder Farmers in Central Malawi, Pathogens, 2021 Dec 10;10(12):1613. doi: 10.3390/pathogens10121613.
18. Kainga, H. et al. (2022). “Seroprevalence and Associated Risk Factors of Rift Valley Fever in Livestock from Three Ecological Zones of Malawi” Pathogens 2022, 11, 1349. https://doi.org/10.3390/pathogens11111349.
19. Henson Kainga, Elisha Chatanga, Marvin Collen Phonera, John Pilate Kothowa, Precious Dzimbiri, Gladson Kamwendo, Malala Mulavu, Cynthia Sipho Khumalo, Katendi Changula, Herman Chambaro, Hayato Harima, Masahiro Kajihara, Kholiwe Mkandawire, Patrick Chikungwa, Julius Chulu, Gilson Njunga, Simbarashe Chitanga, Benjamin Mubemba, Michihito Sasaki, Yasuko Orba, Yongjin Qiu, Junya Yamagishi, Edgar Simulundu, Ayato Takada, Boniface Namangala, Hirofumi Sawa and Walter Muleya. 2022. ‘Current status and molecular epidemiology of rabies virus from different hosts and regions in Malawi” Archives of Virology (2022) 168:61: https://doi.org/10.1007/s00705-022-05635-z
20. Kawonga F. et al. (2021). "Seroprevalence and Clinical Presentation of Chikungunya Virus Infection among Febrile Outpatients Seeking Health Care in Mzuzu City, Malawi. 10.20944/preprints202105.0387.v1
21. Attrey, D.P., Role of veterinary experts in food safety, Chapter 24 -Editor(s): Rajul Kumar Gupta,  Dudeja,  Singh Minhas, Food Safety in the 21st Century, Academic Press, 2017, Pages 297-310, ISBN 9780128017739, https://doi.org/10.1016/B978-0-12-801773-9.00024-8.
22. McKenzie, A. I., & Hathaway, S. C. (2006). The role and functionality of Veterinary Services in food safety throughout the food chain. Revue scientifique et technique (International Office of Epizootics), 25(2), 837–848.
23. Kainga, H.; Phonera, M.C.; Chikowe, I.; Chatanga, E.; Nyirongo, H.; Luwe, M.; Mponela, J.; Kachisi, V.; Kamanga, N.; Chulu, J.; et al. Determinants of Knowledge, Attitude, and Practices of Veterinary Drug Dispensers toward Antimicrobial Use and Resistance in Main Cities of Malawi: A Concern on Antibiotic Stewardship. Antibiotics 2023, 12, 149. https://doi.org/ 10.3390/antibiotics12010149
24. Choonara, F.E.; Haldorsen, B.C.; Ndhlovu, I.; Saulosi, O.; Maida, T.; Lampiao, F.; Simonsen, G.S.; Essack, S.Y.; Sundsfjord, A. Antimicrobial susceptibility profiles of clinically important bacterial pathogens at the Kamuzu Central Hospital in Lilongwe, Malawi. Malawi Med. J. 2022, 34, 9–16. [CrossRef]
25. Makoka, M.H.; Miller, W.C.; Hoffman, I.F.; Cholera, R.; Gilligan, P.H.; Kamwendo, D.; Malunga, G.; Joaki, G.; Martinson, F.; Hosseinipour, M.C. Bacterial infections in Lilongwe, Malawi: Aetiology and antibiotic resistance. BMC Infect. Dis. 2012, 12, 67. [CrossRef] [PubMed]
26. Lester, R.; Maheswaran, H.; Jewell, C.P.; Lalloo, D.G.; Feasey, N.A. Estimating the burden of antimicrobial resistance in Malawi: Protocol for a prospective observational study of the morbidity, mortality and economic cost of third-generation cephalosporinresistant bloodstream infection. Wellcome Open Res. 2020, 4, 29. [CrossRef] [PubMed]
27. Iroh Tam, P.Y.; Musicha, P.; Kawaza, K.; Cornick, J.; Denis, B.; Freyne, B.; Everett, D.; Dube, Q.; French, N.; Feasey, N.; et al. Emerging Resistance to Empiric Antimicrobial Regimens for Pediatric Bloodstream Infections in Malawi (1998–2017). Clin. Infect. Dis. 2019, 69, 61–68. [CrossRef] [PubMed]
28. Musicha, P.; Cornick, J.E.; Bar-Zeev, N.; French, N.; Masesa, C.; Denis, B.; Kennedy, N.; Mallewa, J.; Gordon, M.A.; Msefula, C.L.; et al. Trends in antimicrobial resistance in bloodstream infection isolates at a large urban hospital in Malawi (1998–2016): A surveillance study. Lancet Infect. Dis. 2017, 17, 1042–1052. [CrossRef]
29. Kumwenda, P.; Adukwu, E.C.; Tabe, E.S.; Ujor, V.C.; Kamudumuli, P.S.; Ngwira, M.;Wu, J.; Chisale, M. Prevalence, distribution and antimicrobial susceptibility pattern of bacterial isolates from a tertiary Hospital in Malawi. BMC Infect. Dis. 2021, 21, 34. [CrossRef]

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