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A model of animal-human brucellosis transmission in Mongolia
Zinsstag, Jakob
"We developed a dynamic model of livestock-to-human brucellosis transmission in Mongolia. The compartmental model considers transmission within sheep and cattle populations and the transmission to humans as additive components. The model was fitted to demographic and seroprevalence data (Rose Bengal test) from livestock and annually reported new human brucellosis cases in Mongolia for 1991–1999 prior to the onset of a mass livestock-vaccination campaign (S19 Brucella abortus for cattle and Rev1 Brucella melitensis for sheep and goat). The vaccination effect was fitted to livestock- and human-brucellosis data from the first 3 years of the vaccination campaign (2000–2002). Parameters were optimized on the basis of the goodness-of-fit (assessed by the deviance). The simultaneously fitted sheep–human and cattle–human contact rates show that 90% of human brucellosis was small-ruminant derived. Average effective reproductive ratios for the year 1999 were 1.2 for sheep and 1.7 for cattle." Preventive Veterinary Medicine 2005, Vol. 69, Issues 1-2, pp. 77-95 Available from: Science Direct
Potential of cooperation between human and animal health to strengthen health systems
Zinsstag, Jakob
"The WHO ministerial summit held in Mexico City, Mexico, on Nov 16–20, 2004, recognised the pivotal role of strengthened health systems in achieving the Millennium Development Goals (MDGs) in an equity-effective manner. Its resolutions encourage health systems research to include broad societal dimensions. One extension involves closer interaction between human and animal health, for which the US epidemiologist Calvin Schwabe coined the term “one medicine”, to focus attention on the similarity between human and veterinary health interests. [...]" The Lancet 2005, Vol. 366, Issue 9503, pp. 2142-2145 Available online from: The Lancet Download PDF from: The Lancet
Approche novatrice des vaccinations en santé publique et en médecine vétérinaire chez les pasteurs au Tchad
Béchir, Mahamat
This report describes a network of public health care workers, veterinarians and nomadic pastoralists that was set up in Chad to increase vaccination coverage to nomadic children and women who had rarely been vaccinated before. The objectives of the project were to provide human vaccination in conjunction with existing veterinary services, to evaluate the feasibility and limitations of such campaigns, to determine what other services could be provided concurrently, and to estimate the savings for public health care cases in comparison with carrying out vaccination separately. The joint vaccination campaign approach is innovative, appreciated by nomadic pastoralists and less expensive than separate vaccination. By using the mobility of veterinarians in remote zones far from health care facilities, vaccination can be provided to nomadic children and women in countries with limited resources. Médecine Tropicale 2004, Vol. 64, No. 5, pp. 497-502 Download
A la recherche des déterminants institutionnels du bien-être des populations sédentaires et nomades dans la plaine du Waza-Logone de la frontière camerounaise et tchadienne
Fokou, Gilbert
"Cette contribution présente les articulations d’une étude actuellement en cours dans la région du Logone et Chari au Cameroun et dont le but est d’oeuvrer pour l’élaboration des savoirs et des connaissances pour le développement pastoral. De nombreux groupes de populations sédentaires et nomades vivent dans cette localité et dépendent des plaines inondées du Sud du lac Tchad pour leur subsistance. Or, les ressources naturelles connaissent de grandes variations saisonnières et deviennent parfois la propriété des groupes sédentaires. De ce fait, les éleveurs nomades éprouvent de nombreuses difficultés pour accéder non seulement aux pâturages et à l’eau, mais aussi aux services de santé de qualité (centres hospitaliers, médicaments efficaces). L’ambition ici est de définir de nouvelles conditions institutionnelles d’accès aux soins de santé pour les populations sédentaires et nomades. En fait, la plupart des problèmes auxquels sont confrontés les nomades de nos jours seraient dus à l’inadaptation des règles formelles en vigueur aux stratégies de survie des populations rurales. Celles mises en place à l’époque pré-coloniale ne sont plus opérationnelles. L’on pourrait conclure, sous forme d’hypothèse à vérifier, que la définition de nouveaux cadres institutionnels de gestion des ressources naturelles pourrait contribuer à l’amélioration des conditions de santé des pasteurs nomades." Médecine Tropicale 2004, Vol. 64, No. 5, pp. 1-5 Download
Comment combattre les inégalités en matière de santé?
Wyss, Kaspar
In: Schneider J, Roost Vischer L, Péclard P. editors. 2003.Werkschau Afrikastudien 4 - Le forum suisse des africanistes 4, Schweizerische Afrikastudien - Etudes africaines suisses. Münster, LIT Verlag, pp. 151-167 Order from: LIT Verlag
Access to Health Care among Transhumant Fulani Pastoralists in Mauritania: Using the Health Access Livelihood Approach
Corradi, Corinne
The focus of this study was set on pastoralist's livelihood capitals as well as qualitative dimensions of access. Available resources were identified and impeding factors when mobilising those were described. The financial means for health care were found to be limited by pastoralists themselves, despite the possession of cattle and a milk selling contract to a dairy plant. Further, insufficient and unreliable transport possibilities, as well as certain shortcomings in the quality of health services were pointed out by pastoralists. Mutual understanding and communication between Fulani pastoralist and health care personnel was also found to be insufficient and impeding for accessing health care. Limited access was also related to economic structures on the market, social norms within Fulani society and individual strategies, depending for example on pulaaku, the Fulani code of conduct. The lack of infrastructure and medical supplies further did not contribute to the utilisation of health services, either. Master's Thesis at University of Zurich Download
Distribution and Transmission of Medicinal Plant Knowledge in the Andean Highlands
Mathez-Stiefel, Sarah-Lan
This paper presents a study of patterns in the distribution and transmission of medicinal plant knowledge in rural Andean communities in Peru and Bolivia. Interviews and freelisting exercises were conducted with 18 households at each study site. The amount of medicinal plant knowledge of households was compared in relation to their socioeconomic characteristics. Cluster analysis was applied to identify households that possessed similar knowledge. The different modes of knowledge transmission were also assessed. Our study shows that while the amount of plant knowledge is determined by individual motivation and experience, the type of knowledge is influenced by the community of residence, age, migratory activity, and market integration. Plant knowledge was equally transmitted vertically and horizontally, which indicates that it is first acquired within the family but then undergoes transformations as a result of subsequent contacts with other knowledge sources, including age peers. Evidence-Based Complementary and Alternative Medicine doi:10.1155/2012/959285 Download
Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia
Mathez-Stiefel, Sarah-Lan
This paper presents a study of patterns in the distribution and transmission of medicinal plant knowledge in rural Andean communities in Peru and Bolivia. Interviews and freelisting exercises were conducted with 18 households at each study site. The amount of medicinal plant knowledge of households was compared in relation to their socioeconomic characteristics. Cluster analysis was applied to identify households that possessed similar knowledge. The different modes of knowledge transmission were also assessed. Our study shows that while the amount of plant knowledge is determined by individual motivation and experience, the type of knowledge is influenced by the community of residence, age, migratory activity, and market integration. Plant knowledge was equally transmitted vertically and horizontally, which indicates that it is first acquired within the family but then undergoes transformations as a result of subsequent contacts with other knowledge sources, including age peers. Mathez-Stiefel SL, Vandebroek I, Rist S. 2012. Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia. Journal of Ethnobiology and Ethnomedicine 8:26. doi:10.1186/1746-4269-8-26
This article is open access at http://www.ethnobiomed.com/content/8/1/26
Synergy between public health and veterinary services to deliver human and animal health interventions in rural low income settings
Schelling, Esther
This article argues that the collaboration between public health and veterinary services could increase coverage of essential health interventions for people and livestock in remote rural areas. British Medical Journal BMJ 2005, No. 331, pp. 1264-1267 Download from: British Medical Journal BMJ
Editorial: Health of nomadic pastoralists
Zinsstag, Jakob
Tropical Medicine & International Health 2006, Vol. 11, Issue 5, pp. 565-772 Download PDF from: Blackwell Synergy
Medicalization and morality in a weak state
Obrist, Brigit
"Inspired by Foucault, many studies have examined the medicalization of everyday life in Western societies. This paper reconsiders potentials and limitations of this concept in an African city. Grounded in ethnographic research in Dar es Salaam, Tanzania, it concentrates on cleanliness, health and water in a lower middle-class neighbourhood. The findings show that women are familiar with professional health development discourses emphasizing cleanliness as a high value linked to bodily and domestic health. These discourses have been diffused in schools, clinics and other institutions during the colonial and socialist period. Women not only refer to these discourses, they try to reproduce them in daily practice and even demand them. This coercive yet voluntary nature of institutionalized discourses points to 'paradoxes of medicalization' also found in Western societies. It acquires, however, different meanings in a weak state like contemporary Tanzania which hardly manages to institutionalize medicalization through professional practice. Under such conditions, women who choose to follow health development discourses suffer a heavier practical, intellectual and emotional burden than those who are less committed. This may at least partly explain why many women assume a pragmatic stance towards the medicalization of everyday life." Anthropology & Medicine 2004, Vol. 11, No. 1, pp. 43-57 Available for purchase from: Informaworld
Human health benefits from livestock vaccination for brucellosis
Roth, F.
"Objective: To estimate the economic benefit, cost-effectiveness, and distribution of benefit of improving human health in Mongolia through the control of brucellosis by mass vaccination of livestock. [...] Findings: In a scenario of 52% reduction of brucellosis transmission between animals achieved by mass vaccination, a total of 49 027 DALYs could be averted. Estimated intervention costs were US$ 8.3 million, and the overall benefit was US$ 26.6 million. This results in a net present value of US$ 18.3 million and an average benefit–cost ratio for society of 3.2 (2.27–4.37). If the costs of the intervention were shared between the sectors in proportion to the benefit to each, the public health sector would contribute 11%, which gives a cost-effectiveness of US$ 19.1 per DALY averted (95% confidence interval 5.3–486.8). If private economic gain because of improved human health was included, the health sector should contribute 42% to the intervention costs and the costeffectiveness would decrease to US$ 71.4 per DALY averted. Conclusion: If the costs of vaccination of livestock against brucellosis were allocated to all sectors in proportion to the benefits, the intervention might be profitable and cost effective for the agricultural and health sectors." Bulletin of the World Health Organization 2003, Vol. 81, Number 12, pp. 867-876 Download PDF from: The World Health Organization
Quality and comparison of antenatal care in public and private providers in the United Republic of Tanzania
Boller, Christoph
"Objective To compare the quality of public and private first-tier antenatal care services in Dar es Salaam, United Republic of Tanzania, using defined criteria. Methods Structural attributes of quality were assessed through a checklist, and process attributes, including interpersonal and technical aspects, through observation and exit interviews. A total of 16 health care providers, and 166 women in the public and 188 in the private sector, were selected by systematic random sampling for inclusion in the study. Quality was measured against national standards, and an overall score calculated for the different aspects to permit comparison. Findings The results showed that both public and private providers were reasonably good with regard to the structural and interpersonal aspects of quality of care. However, both were poor when it came to technical aspects of quality. For example, guidelines for dispensing prophylactic drugs against anaemia or malaria were not respected, and diagnostic examinations for the assessment of gestation, anaemia, malaria or urine infection were frequently not performed. In all aspects, private providers were significantly better than public ones. Conclusion Approaches to improving quality of care should emerge progressively as a result of regular quality assessments. Changes should be introduced using an incremental approach addressing few improvements at a time, while ensuring participation in, and ownership of, every aspect of the strategy by health personnel, health planners and managers and also the community." Bulletin of the World Health Organization 2003, Vol. 81, Number 2, pp. 116-122 Available from: The World Health Organization
Prioritization of prevention activities to combat the spread of HIV/AIDS in resource constrained settings
Hutton, G.
"In Chad, as in most sub-Saharan Africa countries, HIV/AIDS poses a massive public health threat as well as an economic burden, with prevalence rates estimated at 9% of the adult population. In defining and readjusting the scope and content of the national HIV/AIDS control activities, policy makers sought to identify the most cost-effective options for HIV/AIDS control. The cost-effectiveness analysis reported in this paper uses a mixture of local and international information sources combined with appropriate assumptions to model the cost-effectiveness of feasible HIV prevention options in Chad, with estimates of the budget impact. The most cost-effective options at under US$100 per infection prevented were peer group education of sex workers and screening of blood donors to identify infected blood before transfusion. These options were followed by mass media and peer group education of high risk men and young people, at around US$500 per infection prevented. Anti-retroviral therapy for HIV infected pregnant women and voluntary counselling and testing were in the order of US$1000 per infection prevented. The paper concludes with recommendations for which activities should be given priority in the next phase of the national HIV/AIDS control programme in Chad." The International Journal of Health Planning and Management 2003, Vol. 18, No. 2, pp. 117-136 Available from: Wiley InterScience
Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad
Schelling, Esther
"As a part of a research-and-action partnership between public health and veterinary medicine, the relationships between the seroprevalences of brucellosis and Q-fever in humans and livestock were evaluated in three nomadic communities of Chad (Fulani cattle breeders, and Arab camel and cattle breeders). Nomad camps were visited between April 1999 and April 2000. A total of 860 human and 1637 animal sera were tested for antibodies against Brucella spp., and 368 human and 613 animal sera for Coxiella burnetii. The same indirect ELISA was used for livestock and human sera, and the test characteristics for its use on human sera were evaluated. Twenty-eight people were seropositive for brucellosis (seroprevalence 3.8%). Brucella seroprevalence was higher in cattle (7%) than other livestock, and brucellosis seropositivity was a significant factor for abortion in cattle (OR=2.8). No correlation was found between human brucellosis serostatus and camp proportions of seropositive animals. [...]" Preventive Veterinary Medicine 2003, Vol. 61, No. 4, pp. 279-293 Available from: ScienceDirect
Livestock Diseases and Human Health
Zinsstag, Jakob
"Two decades ago, the U.S. epidemiologist Calvin Schwabe coined a phrase--"the one medicine"--to focus attention on the commonality of human and veterinary health interests.* The underlying concept is traceable to the late 19th century, in contributions of the German pathologist and architect of social medicine Rudolf Virchow. Recent events have brought the relationship between animal and human health into much sharper focus than even public health and veterinary health specialists might have predicted. [...]" >>more Science 2001, Vol. 294. no. 5542, p. 477 Available from: Science Magazine
Effect of an armed conflict on human resources and health systems in Côte d'Ivoire
Betsi, Alain Nicolas
"In September 2002, an armed conflict erupted in Côte d'Ivoire which has since divided the country in the government-held south and the remaining territory controlled by the 'Forces Armées des Forces Nouvelles' (FAFN). There is concern that conflict-related population movements, breakdown of health systems and food insecurity could significantly increase the incidence of HIV infections and other sexually-transmitted infections, and hence jeopardize the country's ability to cope with the HIV/AIDS epidemic. Our objective was to assess and quantify the effect this conflict had on human resources and health systems that provide the backbone for prevention, treatment and care associated with HIV/AIDS. We obtained data through a questionnaire survey targeted at key informants in 24 urban settings in central, north and west Côte d'Ivoire and reviewed relevant Ministry of Health (MoH) records. We found significant reductions of health staff in the public and private sector along with a collapse of the health system and other public infrastructures, interruption of condom distribution and lack of antiretrovirals. On the other hand, there was a significant increase of non-governmental organizations (NGOs), some of which claim a partial involvement in the combat with HIV/AIDS. The analysis shows the need that these NGOs, in concert with regional and international organizations and United Nations agencies, carry forward HIV/AIDS prevention and care efforts, which ought to be continued through the post-conflict stage and then expanded to comprehensive preventive care, particularly antiretroviral treatment." AIDS Care 2006, Vol. 18, No. 4, pp. 356-365 Available to purchase from: Informaworld
Access to Health Care in Contexts of Livelihood Insecurity
Obrist, Brigit
Access to health care is a major health and development issue. Most governments declare that their citizens should enjoy universal and equitable access to good quality care. However, even within the developed world, this goal is difficult to achieve, and there are no internationally recognized standards on how to define and measure “equitable access”. This article presents a framework for analysis and action to explore and improve access to health care in resource-poor countries, especially in Africa. The framework links social science and public health research with broader development approaches to poverty alleviation. PLoS Medicine 4(10):1584-1588. Download
Quels types de services de santé pour les populations nomades?
Wyss, Kaspar
"To overcome barriers of access to health care of nomadic people and to alleviate inequities in health, a transdisciplinary team has initiated research and intervention activities among three nomadic groups of Chad: Foulbé, Arabes and Gouranes. A regular and consistent communication among all actors involved (nomadic groups, researchers, planners and administrators of health and veterinary services, etc.) through repetitive meetings and workshops showed to be a crucial element for success. Differences between ethnic nomadic groups made it necessary to develop specific communication strategies adapted to each group. As to interventions to improve the vaccination coverage, mixed teams combining health and veterinary specialists were able to vaccinate an important number of children and women and showed to have a high potential in terms of organisational and logistic feasibility, acceptability as well as good cost-effectiveness. With regard to improving access to health care, Information – Education and Communication approaches adapted to the intervention context and linked to the provision of essential services and generic drugs showed to be crucial." Médecine Tropicale 2004, Vol. 64, No. 5, pp. 493-496 Download
Constraints to scaling-up health related interventions
Wyss, Kaspar
"This analysis of constraints to scaling-up health-related interventions in Chad shows that emphasis has to be put on systemic approaches which address absorptive capacity, on removal of structural constraints, and on efficient and equitable production of health services. In the production of services the development of infrastructure must not exceed the development of human resources. If the millennium development goals are to be achieved, major investments in basic and in-service training and in management skills are crucially needed. In addition, the study shows the importance of promoting health services which actively seek to fulfil community demands and those of disadvantaged groups." Journal of International Development 2003, Vol. 15, No. 1, pp. 87-100 Available from: Wiley InterScience
Disparities in parasitic infections, perceived ill health and access to health care among poorer and less poor schoolchildren of rural Côte d'Ivoire
Raso, Giovanna
"Differences in the state of health between rural and urban populations living in Africa have been described, yet only few studies analysed inequities within poor rural communities. We investigated disparities in parasitic infections, perceived ill health and access to formal health services among more than 4000 schoolchildren from 57 primary schools in a rural area of western Côte d'Ivoire, as measured by their socioeconomic status. [...] Our study provides evidence for inequities among schoolchildren's parasitic infection status, perceived ill health and access to health care in a large rural part of Côte d'Ivoire. These findings call for more equity-balanced parasitic disease control interventions, which in turn might be an important strategy for poverty alleviation." Tropical Medicine & International Health 2005, Vol. 10, Issue 1, pp. 42–57 Available from: Blackwell Synergy