CASE NOTES
CROSS-SECTORAL DISEASE SURVEILLANCE AND CONTROL: RABIES IN UGANDA AS A CASE STUDY
Siobhan M. Mor, Faculty of Veterinary Science, University of Sydney, Australia
Posted Flock & Herd April 2013
Abstract
Between January 28 and February 2, 2013 delegates from around the world will descend on Bangkok for the Prince Mahidol Award Conference. This year's theme is "A world united against infectious diseases: cross-sectoral solutions." The conference combines the 1st Global Conference on Regional Surveillance Networks and the 2nd International One Health Congress, both of which aim to improve the health of humans, animals and the environment through improved collaboration between sectors.
In this presentation I will share the highlights from the PMA Conference as well as the findings from our ongoing work on rabies in Uganda. Rabies provides a unique opportunity to consider proof of concept for cross-sectoral approaches to disease surveillance and control since: (1) There is high public interest in the disease in endemic areas; (2) The Ministry of Health (MOH) and Ministry of Agriculture (MOA) (or equivalent) in each country are obligated to report on rabies status to WHO and OIE, respectively, and tend to operate parallel surveillance systems for this disease; and (3) Both line ministries experience costs related to rabies control and have vested interest in reducing incidence in humans and the domestic dog reservoir.
Our work highlights the challenges, particularly on the animal health side (see Figure), of maintaining surveillance activities in light of limited budgetary allocations and decentralized animal disease control policy.
Figure: Incidence of animal-bite injury as reported to the Ministry of Health (MOH) and Ministry of Agriculture, Animal Industry and Fisheries (MOA) in Uganda, 2003 - 2009
Recommendations stemming from this work include: (1) Joint investigation and outreach activities by district health and veterinary officials - to enhance animal diagnosis and avoid un-necessary use of post-exposure prophylaxis in bite victims that were not exposed to the virus; (2) Improved sharing of routine data between line ministries - to facilitate allocation of resources to districts based on risk of animal-bite injury; and (3) Unifi ed WHO/ OIE policies that promote complimentary rather than duplicative surveillance activities.