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Increasing Local Disease Preparedness and Surveillance Capacity for Global Health Security: A Cluster-Randomised Control Trial

20 Pages Posted: 15 Jun 2023

See all articles by Maarten Voors

Maarten Voors

Wageningen University and Research (WUR)

Kevin Grieco

University of California, Los Angeles (UCLA)

Macartan Humphreys

WZB Berlin Social Science Center

Sellu Kallon

Wageningen University and Research (WUR)

Salif Jaiteh

Columbia University

Mohammed Alpha Jalloh

KoCEPO

Niccoló Meriggi

London School of Economics & Political Science (LSE) - The International Growth Centre

Peter Van der Windt

New York University (NYU) - New York University, Abu Dhabi

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Abstract

Background: Low-income countries are often characterized by poor health infrastructures and lack systems needed to timely detect and control disease outbreaks, such as the 2014-16 Ebola Viral Disease and COVID-19. In such contexts, a “One Health” approach, which involves investing in both human and animal health systems, plausibly improves local health outcomes by enabling early detection of zoonotic diseases before they are transmitted to humans, and by timely triggering a health system response needed to mitigate possible outbreaks. There is an urgent call to translate One Health into action and create inclusive and sustainable policies. There is however limited direct evidence on the gains from One Health approaches. We contribute here by using a randomised intervention to assess the impact of a participatory community-based One Health program.

Methods: As part of a cluster-randomised control trial, government and communities recruited, trained and installed Community Animal Health Workers (CAHWs) to work alongside Community Health Workers (CHWs) in 300 randomly selected rural villages in Sierra Leone. Another 63 villages were randomly selected as control sites and had CHWs exclusively. CAHWs provided essential animal health services, disseminated information regarding animal and human health best practices, and actively participated in surveillance efforts by reporting suspected disease symptoms to government supervisors. We investigated program impacts on human health as well as key intermediary outcomes, including animal health, animal and human health-related behaviours, integration into public services, and household wealth. The trial is registered at clinicaltrialregister.nl (# 21660) and OSF (https://osf.io/9xfv3).

Findings: In July and August 2017, the community-based One Health program successfully recruited, trained and installed CAHWs across 287 villages.  Throughout the program's duration, spanning from July 2017 to July 2019, the CAHWs reported on 17,813 suspected disease-related events. Using survey data from 2,538 respondents, collected in March and April 2020, we found no evidence of impacts on human health (-0.010 standard deviation units (SDU), 95% CI -0.131, 0.111). The program did improve intermediary outcomes including animal health (0.157 SDU, 95% CI 0.022, 0.293), animal husbandry practices (0.127 SDU, 95% CI -0.022, 0.276), human health behaviours (0.137 SDU, 95% CI -0.007, 0.281), integration into public services (0.300 SDU, 95% CI 0.116, 0.484), and households’ attitudes towards disease reporting (0.263 SDU, 95% CI 0.109, 0.418).

Interpretation: Participatory community-based One Health interventions can increase preparedness against zoonotic diseases.

Trial Registration: The trial is registered at clinicaltrialregister.nl (# 21660) and OSF (https://osf.io/9xfv3).

Funding: The study was funded by NWO grant #451-14-001 and #VI.Vidi.191.154, ESRC grant ES/J017620/1, the Royal Netherlands Embassy in Ghana, the International Growth Center, New York University – Abu Dhabi and the World Bank REDISSE program.

Declaration of Interest: We declare no competing interests.

Ethical Approval: Before the onset of the program, formal approval was obtained from local authorities. We obtained verbal informed consent from all study participants. Ethics approval was obtained from the Office of the Sierra Leone Ethics and Scientific Review Committee (SLERC 16102017) and Columbia University (AAAR5175).

Keywords: One Health, Africa, Human Health, Livestock, Disease Risk, Surveilance, Cluster Randomised Control Trial

Suggested Citation

Voors, Maarten and Grieco, Kevin and Humphreys, Macartan and Kallon, Sellu and Jaiteh, Salif and Jalloh, Mohammed Alpha and Meriggi, Niccoló and Van der Windt, Peter, Increasing Local Disease Preparedness and Surveillance Capacity for Global Health Security: A Cluster-Randomised Control Trial. Available at SSRN: https://ssrn.com/abstract=4477223 or http://dx.doi.org/10.2139/ssrn.4477223

Maarten Voors (Contact Author)

Wageningen University and Research (WUR) ( email )

Hollandseweg 1
Wageningen, 6706KN
Netherlands

Kevin Grieco

University of California, Los Angeles (UCLA) ( email )

Macartan Humphreys

WZB Berlin Social Science Center ( email )

Sellu Kallon

Wageningen University and Research (WUR) ( email )

Salif Jaiteh

Columbia University ( email )

Niccoló Meriggi

London School of Economics & Political Science (LSE) - The International Growth Centre ( email )

32 Lincoln’s Inn Fields
Houghton Street
London, WC2A 2AE
United Kingdom

Peter Van der Windt

New York University (NYU) - New York University, Abu Dhabi ( email )

Abu Dhabi
United Arab Emirates

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