Presented by Jeanne L. Coffin, Fred Monje and Grace Asiimwe-Karimu at the PENAPH First Technical Workshop, Chiangmai, Thailand, 11 – 13 December 2012.

1. Using One Health and
Participatory
Epidemiology to Assess
Impacts of Anthrax on
the Human-Animal
Interface in Rural Uganda
Jeanne L Coffin, MS
Fred Monje, DVM
Grace Asiimwe-Karimu,
DVM
PENAPH First Technical Workshop
Dec. 11-13 2012, Chiang Mai, Thailand

2. Summary Slide
Conservation Medicine and Participatory
Methods
Systematic Review
Applying Participatory Epidemiology (PE)
to Anthrax in Uganda
Results and Discussion
Management Proposal

3. Background
Conservation Medicine
&
A Systematic Review of Participatory Literature

4. Conservation Medicine
Conservation medicine is an emerging,
interdisciplinary field that studies the relationship
between human and animal health and
environmental conditions, or ecosystem health.
It seeks to apply that knowledge to better the
management of One Health or Ecohealth
challenges.
Case Study for a 1 year Masters in Conservation
Medicine.

5. Systematic Review of
Literature
Standard search and coding
13 papers met the exclusionary criteria
Scoring of each accepted paper
counteracting bias
level of participation reached as in Pretty
1994
quality of study design
execution
reporting

6. Results
All but one study made adequate efforts to
counteract bias
need more integration with quantitative
methods
No paper reached the highest level5
Reporting and evaluation was highly variable
feed back to participants often not mentioned
Study design was not clearly described
example outlines or questions needed

7. Learning from
the Literature
Technical pitfalls to avoid
Slippery definitions
Avoid bias
use rigorous sampling and triangulation
cross-check with conventional methodologies
plan adequately
Evaluation and reporting
Reporting as transparently as possible
Pursuing follow up faithfully is important

8. In the Field

9. Anthrax in Uganda
Western Uganda is mixed livestock and
banana farming
Sporadic ongoing anthrax (B. anthracis)
outbreaks
wildlife in 2005 in Queen Elisabeth National
Park3 and again in 2010
cattle and people in 2011 in Sheema
District6

10. Main Aims
Understand the context surrounding the
ongoing anthrax outbreaks
Propose a management plan
Gain on the ground experience and
practice with participatory epidemiology
methods

11. Specific Objectives
Assess the impact of anthrax on humans
and domestic animals around QENP
relative to other local diseases
Assess knowledge of zoonoses
Assess knowledge of wildlife role in
anthrax life cycle
Understand attitudes about anthrax,
related veterinary services, and wildlife

12. Study Design
Study Partners
AFENET fellows with Makerere University staff
internship at Uganda Wildlife Authority
In the field in late July of 2012
pilot study
PE4 compared with conventional
questionnaires

13. Techniques Used
Formal questionnaires
Informal Interviews
semi-structured
Focus groups
semi-structured interview
participatory mapping
simple and comparative ranking
proportional piling
matrix scoring

14. Sampling
Two districts where anthrax outbreaks had
occurred (purposive)
two subcounties – one adjacent to anthrax
outbreaks, one further away (purposive)
1-2 villages in each subcounty
(convenience)
2-3 focus groups in each village
(convenience)
5+ questionnaires in each village (76 total)

15. Study Locations

16. Second Location

17. Collaborative Challenges
short timeframe of program
institutional communication
Participatory Epidemiology
time constraints
standardization gave way to flexibility
data management
bias introduced by previous studies
participant frustration with
previous lack of feedback
The Bugs

18. Results
Anthrax vs. other diseases
Not always top 3
Other diseases at top: brucellosis, tick
diseases, trypanosomiasis
Impact of disease varied
Non-disease issues also very important
Disease impact varied by experience
Economic and social impacts very
important

19. Results
Color Key:
Pink x > 50%
Purple 49% > x > 35%
Yellow 34% > x > 20%
White x < 19%
Note frequency of economic
impacts chosen in the top three
listed here by disease.
Anthrax in top 3 in 3/5 focus groups
in Kasese, and in1/6 in Sheema.

20. Results

21. Knowledge and Attitudes
Zoonoses
Knowledge of zoonosis varies
Sometimes choose not to treat carcasses
appropriately – cutting their losses
Wildlife role well known near park, unknown
elsewhere
Frequent dissatisfaction with availability of
veterinary services
Lack of veterinarians, medications, vaccines
Quarantines are unpopular

22. Management Proposal
Widen survey – beyond reported case areas
follow PE trail, wide surveys of environmental
factors
Include soil biology and chemistry
amoebas1
Domestic canine seroprevalence2
Field or local tests these could be
“immediate” feedback for participants
Use this data to tailor vaccination and
education programs to high risk areas.

23. Further Study, or Surveillance?
Research
Link to public service organizations
Scientific or mixed funding
Surveillance, either sporadic or regular
Some form of governmental support
AFENET, work with the Ugandan PE network
Non-profits
Appropriate technology

24. Recap/Conclusion
PE and other participatory methods have
room to grow
PE could enhance and inform regular
anthrax management in Uganda
Frequency of outbreaks might be
reduced if targeted vaccination and
education were implemented.

25. References
1-Dey, R., Hoffman, P.S., and Glomski, I.J. (2012)
Germination and Amplification of Anthrax Spores by Soil-
Dwelling Amoebas. Appl. Environ. Microbiol. 78(22): 8075.
2-Lembo, T., Hampson, K., Auty, H., Beesley, . . . Cleaveland,
S. (2011) Serologic surveillance of anthrax in the Serengeti
ecosystem, Tanzania, 1996-2009. Emerging Infectious
Diseases, 17(3), 387-394.
3-Mapesa, MW, Atimnedi, P, Tumwesigye C. (2008)
Managing the 2004/05 anthrax outbreak in Queen
Elizabeth and Lake Mburo National Parks, Uganda. African
Journal of Ecology, 46(1): 24-31.
4-Mariner, J.C. and Roeder, P.L. (2003) Use of participatory
epidemiology in studies of the persistence of lineage 2
rinderpest virus in East Africa. Veterinary Record 152: 641-
647.
5-Pretty, J. (1994). Alternative systems of inquiry for a
sustainable agriculture. IDS Bulletin, 25(2), 37-48.
6-Promed-mail, ISID. (2011) 2011-11-08 15:17:55. Anthrax,
human, bovine - Uganda (02): (Wester). Archive Number:
20111108.3322.
Note: For papers from the systematic review, feel free to
ask for details.

26. Acknowledgements
Dr. Hellen Amuguni for help and advice from start to finish.
Tufts Institute of the Environment and Tufts Veterinarians for
Global Solutions for funding the field research.
PENAPH for support for this workshop
Dr. Fred Monje and Dr. Grace Asiimwe Karimu, who
worked in their “free time”
Dr. Terence Odoch & Dr. David Owiny – on the ground
assistance in Uganda.
Dr. Jeffery Mariner for help with developing project ideas.
Dr. Gretchen Kaufman
Dr. Elena Naumova
Dr. Patrick Atimnedi
The Masters of Conservation Medicine class 2012
And you the audience
Thank you!