Target Populations/Communities and Mitigations

An important strategy toward achieving community mobilization is the active engagement of the population/community of interest. These engagements will include periodical community outreaches involving sensitization and health aware­ness talks on zoonotic diseases.

In Africa, participation of three principal stakeholders/communities is important to stem the tide of BTB and its zoonotic implications, namely, the pastoralist community (the livestock producers), livestock marketers, and butchers (livestock processors) (Adesokan et al. 2012). These groups are the populations at risk and are most vulnerable to zoonotic infections due to M. bovis. Fundamentally, they are unlikely to have the education and awareness of important health and hygiene precautions, and they engage in habits and practices that expose them to infection with M. bovis. These risky practices and activities include:

1. Living closely with infected animals

2. Consumption of unpasteurized dairy products and of improperly cooked, con­taminated meat products

3. Lack of the use of protective clothing/equipment during slaughtering

4. Other unhygienic habits during milk and meat processing

Consequently, to reduce the spread of zTB in Africa, the activities and actions to be implemented based on the One Health approach should be directed at these neglected and at-risk populations.

The implementable actions that will promote activities to reduce the problem currently being experienced by Africans as a result of BTB using the One Health approach are discussed below.

4.7.1 Intergovernmental Collaboration

To make meaningful progress in the fight against BTB in Africa from both the animal and human perspective, the heads of government of the entire region must first be made to appreciate the enormity of the problem (through local and interna­tional policy briefings as well as joint summits) and accept that BTB is a major challenge to animal productivity and human health.

4.7.2 Global Inter-sectoral Support and Collaboration for Africa by the WHO-FAO-OIE Tripartite

Similar global efforts, coordination, and funding to stem the tide of M. tuberculosis in humans in Africa should be established to deal with zTB. In this regard, for effective prevention and control of BTB in the animal and human populations, the tripartite initiative involving the WHO, FAO, and the OIE must be strengthened to chart and coordinate a “practical and cost-effective” roadmap that can be implemented in all African countries. This tripartite collaboration must be seen to be working with individual African countries, taking into consideration key issues like prevalence and burden of the disease in both the animal and the human populations. This was reflected in the submission made by teams of experts at the June 2016 WHO-STAG-TB meeting (WHO 2016b). Other fundamental consider­ations that must be implemented should include the establishment of prevention and control policies and guidelines dealing with the movement of cattle and humans within countries and across their borders, the cattle trade, and clarifying the epide­miology of BTB.

4.7.3 Joint Veterinary-Medical EducationZTraining

To promote One Health in relation to BTB and zTB prevention and control in Africa, there is a need for the development of joint One Health curricula in medical and veterinary faculties on the continent (Zinsstag et al. 2005; Monath et al. 2010). This should involve programs that can be conducted jointly focusing on pastoralist communities, livestock markets, and abattoirs for the purpose of training and community interventions. A practical example is the initiative of the MacArthur Foundation for Higher Education in Africa in establishing Centers of Excellence. Through this initiative, a Center of Excellence for the Control and Prevention of Zoonoses (CCPZ) was established at the University of Ibadan, Ibadan, Nigeria, with the aim of prevention and control of endemic, emerging, and reemerging zoonoses (including BTB and brucellosis) in Nigeria, Ghana, Sierra Leone, and Liberia. Through this platform, among other things, active surveillance and screening for BTB in cattle and livestock workers at the abattoirs and livestock markets were conducted by a team of veterinarians, community health physicians, and related disciplines. It is expected that similar initiatives will help to establish teams that can be mobilized to conduct tuberculin tests screening cattle for BTB. Following con­firmation of BTB in a specific group of cattle, the medical team can then be invited to investigate possible zoonotic infections and to determine the burden of the disease in the affected human population. Such initiatives will further help to promote public awareness of the risk of consuming unpasteurized or non-heat-treated dairy products and contaminated meat and food products.

4.7.4 Public-Private Partnerships (PPPs)

In most African countries, the private sector plays a key role in TB control.

4.7.5 Clinical Research and Scientific Investigation

To achieve optimal care for patients with suspected zTB, clinical care is better achieved when there is cooperation and collaboration between the veterinary and medical investigators.

4.8