Assessment of performance for a key indicator of One Health: evidence based on One Health index for zoonoses in Sub-Saharan Africa

Abstract

Background: Zoonoses are public health threats that cause severe damage worldwide. Zoonoses constitute a key indicator of One Health (OH) and the OH approach is being applied for zoonosis control programmes of zoonotic diseases. In a very recent study, we developed an evaluation system for OH performance through the global OH index (GOHI). This study applied the GOHI to evaluate OH performance for zoonoses in sub-Saharan Africa.

Methods: The framework for the OH index on zoonoses (OHIZ) was constructed including five indicators, 15 subindicators and 28 datasets. Publicly available data were referenced to generate the OHIZ database which included both qualitative and quantitative indicators for all sub-Sahara African countries (n = 48). The GOHI algorithm was used to estimate scores for OHIZ. Indicator weights were calculated by adopting the fuzzy analytical hierarchy process.

Results: Overall, five indicators associated with weights were generated as follows: source of infection (23.70%), route of transmission (25.31%), targeted population (19.09%), capacity building (16.77%), and outcomes/case studies (15.13%). Following the indicators, a total of 37 sub-Sahara African countries aligned with OHIZ validation, while 11 territories were excluded for unfit or missing data. The OHIZ average score of sub-Saharan Africa was estimated at 53.67/100. The highest score was 71.99 from South Africa, while the lowest score was 40.51 from Benin. It is also worth mentioning that Sub-Sahara African countries had high performance in many subindicators associated with zoonoses, e.g., surveillance and response, vector and reservoir interventions, and natural protected areas, which suggests that this region had a certain capacity in control and prevention or responses to zoonotic events.

Conclusions: This study reveals that it is possible to perform OH evaluation for zoonoses in sub-Saharan Africa by OHIZ. Findings from this study provide preliminary research information in advancing knowledge of the evidenced risks to strengthen strategies for effective control of zoonoses and to support the prevention of zoonotic events.

Keywords: One Health index; One Health performance; Sub-Saharan Africa; Zoonoses.

Fig. 1

Flow chart for the processes involved in the assessment of the One Health performance for zoonoses. OHIZ One Health index on zoonoses, OHi One Health index

Fig. 2

OHIZ overall scores of sub-Sahara African countries. A Sub-Sahara African countries OHIZ map. B OHIZ scores of sub-Sahara African countries. Data statistics included 37 sub-Sahara African countries. C Scores trend chart of sub-Sahara African countries for all-level indicators of OHIZ. Subindicators are denoted by standing initial as follows: SR strategy and regulation, SVR surveillance and response, SNT sanitation, DTT detection, VRI vector and reservoir interventions, VNR vaccination regulation, PCI population coverage and cost of interventions, IMS inhabitants below 5 m above sea level, HPZ health promotion for zoonoses, NPA natural protected areas, CCV cases of COVID-19, HDE human DALYs of echinococcosis; HDL human DALYs of leishmaniasis, HDR human DALYs of rabies, HDT human DALYs of tuberculosis. OHIZ One Health index on zoonoses

Fig. 3

OHIZ scores density of sub-Sahara African countries. A Score density of OHIZ indicators in sub-Saharan Africa. B–F Scores of OHIZ indicators across sub-Saharan Africa. Sub-Sahara African countries were ranked from left to right according to indicator scores. ZAF South Africa, MUS Mauritius, RWA Rwanda, BWA Botswana, MLI Mali, TZA Tanzania, NGA Nigeria, KEN Kenya, CIV Cote d’Ivoire, ETH Ethiopia, TGO Togo, BFA Burkina Faso, SYC Seychelles, CMR Cameroon, MOZ Mozambique, MDG Madagascar, GIN Guinea, COD0 Democratic Republic of Congo, SEN Senegal, NAM Namibia, ZWE Zimbabwe, UGA Uganda, GHA Ghana, SDN Sudan, MWI Malawi, SLE Sierra Leone, NER Niger, LSO Lesotho, GAB Gabon, ZAM Zambia; BDI Burundi, CPV Cabo Verde, LBR Liberia, TCD Chad, CAF Central African Republic, MRT Mauritania, BEN Benin. OHIZ One Health index on zoonoses

Fig. 4

Dataset scores of OHIZ in sub-Sahara African countries. A Score scatter of OHIZ indicators. Data statistics included 37 sub-Sahara African countries. Indicators are denoted by standing initial as follows: SI, source of infection; RT, route of transmission; TP, target population; CB, capacity building; CS, outcomes (case studies). B–F Score scatter of OHIZ datasets. Data statistics included 37 sub-Sahara African countries. Datasets are denoted by standing initial as follows: NGS National guideline for surveillance/control, NLR National legislation on animal reservoirs, ZCS Zoonoses capacity score, GSV General surveillance; VTC Vector control, WRC Wildlife reservoirs control, BSS Basic sanitation services, LTR Laboratory testing for zoonotic reservoirs (vectors and animals), PAN Policy adoption of insecticide-treated mosquito nets; PAS Policy adoption of indoor residual spraying, PCC Prevention chemotherapy coverage of zoonoses, VSR Vaccination strategy and regulation vaccination, PPF Proportion of population having basic drinking water, CCV Costs directed to chemotherapy/vaccination of humans, NIL Number of inhabitants below 5 m above sea level, LEA Legislation of zoonosis educational activities, PCZ Prevention and control of zoonoses; NPV National plan for zoonoses vaccine, ZEI Zoonotic events and human-animal interface, EWZ Early warning for zoonoses; ESS Emergency/surveillance system, NPA Proportion of natural protected areas, INC Infections number of COVID-19, VCC Vaccination coverage for COVID-19, ECD Echinococcosis DALYs, LMD Leishmaniasis DALYs, RBD Rabies DALYs, TBD Tuberculosis DALYs. OHIZ One Health index on zoonoses