The 6 th EAHSC Communitybased one health participatory

The 6 th EAHSC Community-based one health participatory disease surveillance using digital and mobile technologies in Tanzania Calvin Sindato 1, 2, Esron Karimuribo 2, 3, Eric Beda 2, Mpoki Mwabukusi 2, Leonard Mboera 4 and Mark Rweyemamu 2 1 National Institute for Medical Research, Tabora, Tanzania African Centre for Infectious Disease Surveillance, Sokoine University of Agriculture, Morogoro, Tanzania 3 Department of Medical Sciences, College of Veterinary and Medical Sciences, Sokoine University of Agriculture, Morogoro, Tanzania 4 National Institute for Medical Research, Dar es Salaam, Tanzania 2 Southern

Background • Infectious diseases have significant impacts on humans and animals • 70% of infectious diseases of humans have an animal origin • Response to epidemics depends on appropriate and effective surveillance programs 2 • Outbreaks typically erupt in communities Ø key driver influencing the persistence and transmission dynamic of infectious diseases • Most vulnerable communities are located in areas that are hard to reach Ø Poor infrastructure Structured surveillance based on IHR Regulations and OIE codes; mandate the flow of health information from the community to the global level IDSR Animal Health Code

Problem • Disease surveillance systems in Tanzania mainly health facility-based Ø no formal strong linkage to community level thereby posing the challenges on early detection and capture major disease events occurring at the community level, timely reporting and prompt response at all levels • Human and animal surveillance systems operate in silos Ø 70% of human infections are of animal origin How surveillance systems can be improved to enhance early disease detection and response?

Approach • Establish and deploy a participatory community-based disease surveillance system • 29 Community Health Reporters (CHRs) from the community in Morogoro Urban and Ngorongoro Districts in Tanzania were trained on the use of digital technology in disease surveillance • Capture and report health events at community level using mobile phones • One Health Knowledge Repository (OHKR), which is a knowledge-based decision support tool, was developed for key endemic and epidemic prone diseases of humans (15) and animals (14) to enhance early detection of diseases • Whats. App group for active interactions

Study sites C B A Figure 1: Maps of Morogoro-Urban (A) and Ngorongoro (B) districts showing location of the study villages. The insert (C) is the map of Tanzania

Number of cases reported (August 2016 -February 2017 Livestock (75) Morogoro (U) (98) Human (23) Total cases (2, 069) Livestock (1, 881) Ngorongoro (1, 971) Human (90) Figure 2. Distribution of cases reported by CHRs in human and livestock populations in Morogoro Urban and Ngorongoro districts from August 2016 to February 2017

Clinical manifestations reported in livestock Coughing Sneezing Loss of appetite Reduced milk production Fever Rapid beathing Diarrhea Abortion Diffuculty breathing Twisted neck and circling Reluctant to walk Nasal discharge Discharge from eyes Lessions in the mouth and feet Abnormal behaviour Frothy discharge from mouth Bloody diarrhea Blood from natural body openings Swollen joints 1 Pig Chicken Sheep Dogs Cattle 10 Goats Figure 4: Clinical manifestations reported in livestock in Ngorongoro and Morogoro Urban districts 100

Clinical manifestations reported in humans Coughing Head ache Loss of appetite Diarrhea Body weaksness Fever Stomach ache Vomiting Difficulty breathing Swollen lymphnodes Sleep disorder Abortion Skin nodules Bloody coughing Rapid breathing Sunken eyes Animal bite Lessions in mouth Bloody diarrhea Swollen eyes Poor vision Discharge from eyes Convlusion Epilepsy Bloody vomiting Blood in urine Blood from natural body openings Constipation 1 Frequency in Ngorongoro Frequnecy in Morogoro Urban 10 Figure 5: Clinical manifestations reported in humans in Ngorongoro and Morogoro Urban districts 100

Most probable disease identified bu OHKR • The most probable infectious conditions identified by OHKR in goats, with likelihood percentages in parentheses, were peste des petits ruminants (90%) and contagious caprine pleuropneumonia (80%) • The most probable infectious diseases in cattle were contagious bovine pleuropneumonia (50%), brucellosis (50%) and anthrax (30%) • The most probable disease in dogs was rabies (90%) • The most probable infectious diseases in humans were malaria (65%), cholera (60%) and anthrax (30%).

Conclusion Complementing the national disease surveillance strategies with participatory engagement of local communities using digital and mobile technologies and One Health approach will enhance early detection, timely reporting and prompt response to disease outbreaks

ACKNOWLEDGEMENTS CHRs MOROGORO AND NGORO COMMUNITIES & LEADERS