Establishment of Disease Surveillance Systems in Rural Communities of Sierra Leone

Introduction

With the high level of animal-human interaction, there was a strong justification for the establishment of Surveillance sentinels for monitoring zoonotic diseases and the Animal health club ( AHC) for raising awareness on disease prevention and control, good animal husbandry practices, and environmental sanitation as a means to reduce of contracting diseases from these sources. During setting up AHCs, the people interviewed in the study identified the following sources humans can contract diseases; water, garbage dump, toilets, crops, humans, poultry, ruminants, pets, and wildlife. With this information. The zonal heads of AHCs were mandated to appoint two persons per each source of disease identified to monitor and report to the zonal moderator. These monitors were referred to as sentinel site monitors.

The study recorded stories from the people who have been directly affected by the Ebola virus, a zoonotic disease whose spread could have been quickly curbed had surveillance and AHC been fully functional in Sierra Leone. As reported by the people, the impact of Ebola included the death of their relatives, loved ones, and breadwinners and the adverse effects quarantines had on group work, food production, livelihood, education, business, and social activities.

The information generated by the study was documented and kept at the MAFFS wildlife department and Njala University Zoonotic Laboratory for future reference.

• Humans
• Ruminants
• Poultry
• Pets
• Wildlife
• Crops
• Water
• Garbage dumps
• Toilet Emerging and endemic zoonotic diseases pose a more significant disease burden in the developing world, with a significant societal impact on resource-poor rural communities [1, 2]. Rural communities in low-income countries carry the most critical responsibility for zoonotic and neglected zoonotic diseases [3]. Over the past hundred years, multiple disease outbreaks have occurred worldwide. Countries with the best health facilities have managed to contain diseases such as SAR, Ebola, Salmonella Typhimurium, and Avian influenza, but persist in rural communities of low-income countries [3].

These outbreaks occur mainly due to complicated changes occurring in the natural world and its ecosystems threatening the foundation of human health and survival, such as food yield, water availability, the constraint on infectious disease outbreaks, and buffers against extreme weather environmental challenges [4]. These are likely to increase poverty, decrease food intake and compromise the rural poor’s immune system.

People living around forest edge communities, mountainous terrain, and islands constantly interact with domestic and wildlife animals. Many such communities are hard-to-reach areas with vehicles and bikes [5]. Moreover, the people also find it extremely difficult to travel to medical centers for treatment due to a lack of funds. Surveillance systems established in most countries hardly reach such communities [5]. The inability of surveillance systems to reach such communities results in exponential exposure to the pandemic and the death of both animals and humans.

In Sierra Leone, the majority of the population, 58% [6], lives in rural communities engaged in subsistence farming and constantly interacting with livestock and wildlife, thereby increasing the risk of contracting diseases such as rabies and Lassa fever. Wildlife from Ivory Coast, Guinea, Liberia, and Sierra Leone interact around Kailahun, Pujehun, Kono, and Koinadugu districts. The 2013 Ebola outbreak in Sierra Leone started around forest edge communities in the Kailahun district, sharing borders with Liberia, Guinea, and Sierra Leone. Surveillance systems in Sierra Leone do not cover most of the communities in this district. Surveillance systems are limited to towns with health posts and villages within five miles radius [7].

Rural communities in Sierra Leone are at high risk of exposure to zoonotic and neglected diseases. Rural communities in this context are geographical areas located outside towns and cities and face challenges relating to demographic changes, workforce development, capital access, infrastructure, health, land use, environment, and community development strategies. Establishing a surveillance system in these hard-reach communities will drastically reduce exposure morbidity and mortality and hence pandemic.

Reporting Procedure

The reporting procedure for disease surveillance from community level to national levels is in Figure 1 below.

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Figure1: Proposed reporting structure for disease monitoring and surveillance.

Results

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Discussion

Animal Health Clubs complement the efforts of Human health, environment, and veterinary services in Sierra Leone, particularly in hard-to-reach communities. Animal Health club brings and unites people to restore peace and security, leading to improved health, livelihood, food, and human safety. People formulate bye-laws that bind them to achieve the common good for their villages and town. Community Conflict is reduced as they work for the common good or mutual benefits.

The Animal Health club team first identified sentinel sites with diversified wildlife and a high level of animal- human interaction [5, 13]. The club engaged communities in focus group discussions to identify domestic and wildlife (Table 1), diseases associated with these animals (Tables 2 & 3), and the point of interaction between domestic, wildlife, and humans, as seen in Figure 2 & Table 4. Sources of infection identified include toilets, Garbage dumps, water, crops, humans, pets and wildlife, Ruminants, and poultry [14]. The AHC team and community people list these animals and the likely zoonotic diseases (Tables 2 & 3). Indigenous people, hunters, and farmers provided this vital information. Zoonotic diseases which pose a threat to the communities were selected. The team developed a manual containing all these diseases with signs and symptoms to train people on disease surveillance in their communities [15].

Executive members were selected and appointed to establish the surveillance system. The executive committee divides the towns or villages into zones depending on the size. The people or committee nominate or select the zonal heads, who appoint people in each zone. Animal Health Club trains them on passive and active surveillance, including syndromic, evident-based management, integrated, and categorical surveillance. In this case, every community becomes a sentinel site. Nine trained people in each zone are appointed for two weeks to watch the nine sources of diseases in their zones and report to the zonal head daily. The zonal head collates and sends information generated to the chairman, who sends it to the town chief. They scrutinize the information received before submitting it to the relevant authorities in Ministries of Agriculture and health or nongovernmental organizations working with animals and humans in their areas, as in Figure 1.

Community people affirmed that multiple factors drive the point of interaction between domestic animals, wildlife, and humans. Thirgood, et al. [16] stated that various social factors allow humans and wildlife to interact across different landscapes. One such factor is their social hierarchy of needs, including food or prey, shelter, health, and recreation. Man and animals (domestic and wild) search for what they can eat daily, herbs to cure themselves when sick, and look for places to sleep and exercise when fed. Another indirect contact is when they ran into traps, hunted by hunters, and chased by wild animals.

Domestic animals search for food and come into contact with wildlife or, by walking in the same path, touch their saliva, feces, mucus, urine, or hair and blood. They contract diseases from the wild animals in the bush and come to town through this interaction. In some instances, they fight with wildlife and contract diseases. Domestic animals interact directly with humans by catching and putting them into pens or houses, feeding and playing with them. Indirectly, domestic animals lie in places where the humans sit, drink the same water, and lick their utensils. In this way, domestic animals transfer diseases to men and other animals in the community.

Wildlife animal interacts with domestic animals as above. Wildlife animals come to towns to catch domestic animals as prey. They fight with domestic animals, rub their saliva, mucus, hair, or blood on the animals or spill their shed blood on the ground. They may also defecate or urinate in towns. Humans and domestic animals step on the feces and urine, thereby contracting diseases. Humans, in turn, go to the bush to farm, find food, set a trap, hunt, and walk. Contact the urine, feces, and mucus hair of wildlife and walk in their path. Sometimes, they catch wildlife in their traps, touching them directly. Man, in turn, returns and connects with humans and domestic animals, thereby transferring diseases contracted from the wild.

Man contracts diseases from these sources and transfers them to the wild, domestic, and human beings. Community people have been able to name some of these animals and the likely zoonotic diseases associated with them, as seen in Tables 2 & 3 for a list of animals and conditions related to these animals. There is, therefore, a high level of interaction between humans and humans than between domestic and wildlife. During the focus group discussions, the community people confirmed this statement by reiterating that the human-to-human transfer of diseases is more than that of human-to-animals. This statement was evident during the Ebola crisis in 2013.

Animal Health Club is needed to fight disease outbreaks and use it as a surveillance tool to control and prevent diseases in rural communities. People will not conceal important information as they are an integral part of every activity and stage of disease surveillance in the community. Villages or towns should be motivated, as work is voluntary. Such motivating incentives include vegetable seeds and livestock that the community can raise and use proceeds to develop their communities—the clubs work with the communities to establish surveillance systems. The club’s constant attention and vigilance reduce disease incidence, morbidity, and mortality.

Conclusion

Animal Health Club brings people together in a town or village to achieve a common goal and objective. Such unity increases peace and security in the community and improves health, livelihood, food, and human safety, in a cheap, long- lasting, and self-sustainable manner. Establishing sentinel sites in hard-to-reach communities utilizes the rich indigenous knowledge and native intelligence of rural people to identify domestic and wild animals, diseases associated with these animals, and how infection transfers from humans, animals, and wildlife. Training rural communities on the wealth of knowledge obtained to establish surveillance systems will increase their understanding of disease control and prevention in their environment, thus protecting their animals, wildlife, environment, and themselves from high morbidity and mortality.

Contributors

All authors contributed to writing subsequent drafts, editing, and approving the final manuscript.

Declaration of Interests

We declare no competing interests

Acknowledgement

Thanks to the country representative of the United Nations Food and Agricultural Organization of Sierra Leone, Dr. Gabriel Ragalema, and program manager David Mwesigwa who provided the fund to identify how people contract Disease. Special thanks to all the staff in the Freetown office who, in diverse ways, supported the work. The team also acknowledges the valuable contributions of the rural people of Sierra Leone who provide the information contained in this manuscript. The researchers are grateful to all Njala University One Health Serology and Molecular Diagnostic Laboratory staff, who assisted in the pretesting of the questionnaire.