A participatory epidemiological and One Health approach to explore the community's capacity to detect emerging zoonoses and surveillance network opportunities in the forest region of Guinea

Abstract

The Ebola virus disease epidemic that threatened West Africa between 2013 and 2016 was of unprecedented health magnitude. After this health crisis, studies highlighted the need to introduce community-based surveillance systems and to adopt a One Health approach. This study aimed to provide preparatory insights for the definition of a community-based surveillance system for emerging zoonoses such as viral hemorrhagic fevers in Guinea. The objective was to explore the disease detection capacity and the surveillance network opportunities at the community level in two pilot areas in the forest region of Guinea, where the epidemic emerged. Based on a participatory epidemiological and One Health approach, we conducted Focus Group Discussions with human, animal and ecosystem health actors. We used a range of participatory tools, included semi-structured interviews, ranking, scoring and flow diagram, to estimate the local knowledge and perception of diseases and clinical signs and to investigate the existing health information exchange network and its related strengths and weaknesses. The results showed that there is heterogeneity in knowledge of diseases and perception of the clinical signs among actors and that there are preferred and more effective health communication channels opportunities. This preparatory study suggests that it is necessary to adapt the case definitions and the health communication channels to the different actors who can play a role in a future community-based surveillance system and provides recommendations for future surveillance activities to be carried out in West Africa.

Fig 1. Map of the Republic of Guinea and location of the study areas.

The study areas were located in the sub-prefectures of Guendembou and Temessadou (orange area) in the prefecture of Guéckédou (orange hatched area) in the N’Zérékoré region (green area). Focus Group Discussions were conducted in the villages of Guendembou, Temessadou and Mongo (red dots). Map created using the Free and Open Source QGIS software (https://www.qgis.org) and OpenStreetMap (https://www.openstreetmap.org) and GADM (https://www.gadm.org) geographic databases.

Fig 2. Perception of the signs ranked and scored according to rarity and concern by Community Human Health Workers and women from the community.

On the x-axis: rank associated with the frequency of observation of the sign, from the least to the most frequent. On the y-axis: score associated with the threat for human health, from the least to the most health threatening. Axes are cut at their median. Red dots represent hemorrhagic signs: 1. Bleeding 2. Hematemesis 3. Bloody stools 4. Hematuria 5. Red eyes and dark yellow urine. Orange dots represent signs included in the WHO case definitions for viral hemorrhagic fever surveillance: 6. Anorexia 7. Diarrhea 8. Vomiting 9. Headache 10. Fever 11. Breathing difficulties 12. Fatigue 13. Abdominal pain 14. Muscle pain. The blue dots represent all other signs that are ranked and scored as not fitting these categories: 15. Paralysis 16. Bloating 17. Edema 18. Pimples 19. Loss of consciousness / coma 20. Neck stiffness 21. Palmar pallor 22. Cough 23. Convulsions 24. Weight loss 25. Deep-set eyes 26. Yellow eyes 27. Yellow urine 28. Pimples located on one side of the body 29. Mutilation 30. Weight gain 31. Polyuria 32. Malnutrition 33. Pyuria 34. Pallor 35. Rectal prolapse 36. Wound 37. Epilepsy 38. Loss of speech 39. Vertigo 40. Gbassama 41. Taeniasis 42. Abortion 43. Constipation 44. Opimo 45. Breast pain 46. Swelling 47. Chest pain 48. Toothache 49. Absence of menstrual period. Women from Temessadou did not assign a rank to the signs mentioned but classified them into two categories: rare and frequent.

Fig 3. Perception of the signs ranked and scored according to rarity and concern by Community Animal Health Workers and breeders.

On the x-axis: rank associated with the frequency of observation of the sign, from least to most frequent. On the y-axis: score associated with the concern for human health, from the least to the most threatening. Axes are cut at their median. Red dots represent signs included in case definitions for Rift Valley Fever surveillance: 1. Mortality 2. Abortion. Orange dots represent other non-pathognomonic signs of Rift Valley Fever: 3. Bleeding and black blood 4. Nasal discharge 5. Oral bleeding 6. Bloody stools 7. Fatigue 8. Anorexia 9. Bleeding. The blue dots represent all other signs that are ranked and scored as not fitting these categories: 10. Aggressiveness 11. Animal turning on itself, photophobia and hydrophobia 12. Falling wings and tearing in poultry 13. Hair loss 14. Salivation 15. Cough 16. Diarrhea 17. Black body part 18. Vulvar wound 19. Presence of worms in the flesh 20. Tremors and fall 21. Presence of flies 22. Bloating 23. Presence of ticks 24. Presence of venom in eyes 25. Malformation 26. Weight loss 27. Scabies 28. Cold 29. Fatigue in poultry populations 30. Presence of abdominal fat 31. Black meat 32. Hair loss, hard skin, itching and pimples 33. Cough and white lungs.

Fig 4. Perception of the signs ranked and scored according to rarity and concern by hunters from Temessadou.

On the x-axis: rank associated with the frequency of observation of the sign, from least to most frequent. On the y-axis: score associated with the concern for human health conferred by these signs, from the least to the most threatening. Axes are cut at their median. Orange dots represent non-pathognomonic signs of Rift Valley Fever: 1. Nasal discharge 2. Fatigue 3. Yellow organs. Blue dots represent all signs that are ranked and scored: 4. Presence of water in the body 5. Black blood 6. Tearing 7. Immobility 8. Adhesion of organs 9. Absence of blood 10. Atrophied organs 11. Facial hypertrophy 12. Malformation 13. Hypotrophy of gall bladder 14. Presence of worms in liver 15. Presence of external maggots 16. Presence of red worms in stomach 17. Cough 18. Red wounds 19. Weight loss 20. Hair loss 21. Diarrhea.

Fig 5. The community health information exchange network including human, animal and ecosystem health actors.

Blue boxes: human health actors; green boxes: ecosystem health actors; red boxes: animal health actors; blue arrows: human health communication channels identified by actors from Guendembou (light blue) or Temessadou (dark blue); green arrows: ecosystem health communication channels identified by actors from Guendembou (light green) or Temessadou (dark green); orange arrows: animal health communication channels identified by actors from Guendembou; purple arrows: health communication channels commonly identified by actors from Guendembou and Temessadou; dashed arrows: health communication channels identified but not triangulated by actors; circle: actors from both sub-prefectures (purple) or ecosystem health actors from Guendembou (light green) or from Temessadou (dark green) who communicate health information to local authorities.