Community engagement and education: Missing link in One Health approach

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A student’s account of how the One-Health approach motivated her to study public health

One Health approach recognizes the links between environmental health, human health and animal health, but these approaches can be more successful with bottom-up community engagement, education and collaborations.

As an undergraduate student at Makerere University in Uganda, I undertook a two-month summer internship at a national park. While there, a large-scale outbreak of Anthrax occurred, killing over 200 wild animals, 7 cattle, 2 people and temporarily halting local beef sales. Additional case reports continued to emerge in other pockets of the country.

Author (second from right) poses for a photo with other Makerere University students during their internship (Photo by Sarah Lebu)

Public health experts deployed a response plan immediately. A multi-sectoral national taskforce was set up to contain the disease at source and halt further spread. At the national park, surveillance followed by appropriate disposal of carcasses was the operative management strategy. For the next weeks following the onset of the outbreak, I joined public health officials and wildlife rangers in removing carcasses of hippopotamuses from lakes, rivers and streams within the park. We spent our days canvassing water bodies using motorboats and transporting carcasses to a disposal site located far from the water sources. Carcasses were disposed of by burying in a 12m-deep pit in the ground and the site was decontaminated by 10% formaldehyde.

Anthrax is a highly fatal infectious zoonotic disease caused by the spore-forming, gram-positive bacterium Bacillus anthracis. Animals become infected when they ingest B.anthracis spores while grazing in contaminated areas. When an infected animal dies, the contaminated carcass can re-contaminate the environment. The sporulated bacteria can persist in the environment for extended periods of time—even withstanding wildfires. New outbreaks often start near former disposal sites. Human cases occur when people are exposed to infected animals.

Park rangers on a boat trip to remove infected carcasses from a lake in Queen Elizabeth Protected Area, Uganda (Photo by Sarah Lebu)

In Uganda, all historical outbreaks have occurred in locations where people commonly keep livestock. Mingling with wildlife increases the risk of infection in livestock. Human cases, on the other hand, are associated with direct contact with dead animals through handling or consumption of meat and products from suspected anthrax-infected livestock. Despite this known association between animal and human cases, and the current outbreak in wildlife, the authorities had not launched any community surveillance/awareness campaign.

Households were burying dead livestock without any proper protective gear. In some cases, when a domestic animal started showing early symptoms of being ill, it was quickly slaughtered and consumed. Soon, human cases of Anthrax were reported. However, no laboratory diagnoses were made. Using how the response toward the animal population was coordinated and resourced as an example, I teamed up with other students to share some of the lessons with the communities around the park.

Dead animals are buried deeply in 12m X 12m holes and the site is decontaminated (Photo by Sarah Lebu)

We met up with residents and together, we formulated a community response plan. After a few sessions, residents were able to identify signs and symptoms of Anthrax in humans, livestock and wildlife, and they understood whom to contact whenever there was a suspected case. We demonstrated effective ways of disposing of dead livestock. We also advocated for a budgetary allocation for purchasing protective gear for community members. A disease outbreak response committee was formed to oversee the community response plan. These changes have since become standard practice in subsequent disease outbreak investigations in the country.

The lessons from my experience in Uganda are one prime example of the partnership between a local community, public health, veterinary health and environmental experts for promoting one health approaches. In order to manage global and local health threats at the human-animal-environment interface, a multisectoral One Health approach that actively engages the community is required. Community involvement can help translate the growing interest in One Health into real-world applications, and doing so with full understanding of local culture, assets and limitations. 

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