Engaging a broad network of stakeholders to support MNH services has great potential if implemented in ways that are context-appropriate and that build around full collaboration with government and civil society stakeholders.

In this study, we investigated the occurrence of direct and indirect infectious disease transmission pathways among pig farms in Switzerland, as well as their specific relevance for the spread of African swine fever, porcine reproductive and respiratory syndrome (PRRS), and enzootic pneumonia. Data were collected using an adapted mental models approach, involving initial interviews with experts in the field of pig health and logistics, semi‐structured interviews with pig farmers, and a final expert workshop, during which all identified pathways were graded by their predicted frequency of occurrence, their likelihood of spread of the three diseases of interest, and their overall relevance considering both parameters. As many as 24 disease pathways were identified in four areas: pig trade, farmer encounters, external collaborators, and environmental or other pathways. Two thirds of the pathways were expected to occur with moderate‐to‐high frequency. While both direct and indirect pig trade transmission routes were highly relevant for the spread of the three pathogens, pathways from the remaining areas were especially important for PRRS due to higher spread potential via aerosols and fomites. In addition, we identified factors modifying the relevance of disease pathways, such as farm production type and affiliation with trader companies. During the interviews, we found varying levels of risk perception among farmers concerning some of the pathways, which affected adherence to biosecurity measures and were often linked to the degree of trust that farmers had towards their colleagues and external collaborators. Our findings highlight the importance of integrating indirect disease pathways into existing surveillance and control strategies and in disease modelling efforts. We also propose that biosecurity training aimed at professionals and risk communication campaigns targeting farmers should be considered to mitigate the risk of disease spread through the identified pathways.

Background Despite the large-scale rollout of malaria rapid diagnostic tests (RDTs) in Tanzania, many healthcare providers (HCPs) continue using blood film microscopy (BFM) and clinical examination to diagnose malaria, which can increase the risk of mal-diagnosis and over-prescribing of anti-malarials. Patients disregarding negative test results and self-treating exacerbate the problem. This study explored the knowledge, attitudes and practices of HCPs and healthcare-seekers regarding RDTs in comparison to BFM testing. Methods A situational analysis was, therefore, conducted in Kondoa District, Dodoma Region, Tanzania. A multi-methodological approach was adopted including (i) a health facility inventory and screening of logbooks from May 2013 to April 2014 with 77,126 patient entries from 33 health facilities; (ii) a survey of 40 HCPs offering malaria services; and iii) a survey of 309 randomly selected household members from the facilities’ catchment area. Surveys took place in April and May 2014. Results Health facility records revealed that out of 77,126 patient entries, 22% (n = 17,235) obtained a malaria diagnosis. Of those, 45% were made with BFM, 33% with RDT and 22% with clinical diagnosis. A higher rate of positive diagnoses was observed with BFM compared with RDT (71% vs 14%). In the HCP survey, 48% preferred using BFM for malaria testing, while 52% preferred RDT. Faced with a negative RDT result for a patient presenting with symptoms typical for malaria, 25% of HCPs stated they would confirm the result with a microscopy test, 70% would advise or perform a clinical diagnosis and 18% would prescribe anti-malarials. Interviews with household members revealed a preference for microscopy testing (58%) over RDT (23%), if presented with malaria symptoms. For participants familiar with both tests, a second opinion was desired in 45% after a negative microscopy result and in 90% after an RDT. Conclusions Non-adherence to negative diagnostics by HCPs and patients continues to be a concern. Frequent training and supportive supervision for HCPs diagnosing and treating malaria and non-malaria febrile illnesses is essential to offer quality services that can instil confidence in HCPs and patients alike. The introduction of new diagnostic devices should be paired with context-specific behaviour change interventions targeting healthcare-seekers and healthcare providers.

Background: Despite the large-scale rollout of malaria rapid diagnostic tests (mRDTs) in Tanzania, many healthcare providers (HCPs) continue using blood film microscopy (BFM) and clinical examination to diagnose malaria, which can increase the risk of mal-diagnosis and over prescribing of anti-malarials. Patients disregarding negative test results and self-treating exacerbate the problem. This study explored HCPs’ and healthcare seekers’ knowledge, attitudes and practices regarding mRDTs in comparison to BFM testing. Methods: The study was located in Kondoa District, Dodoma Region, Tanzania. A multi-methodological approach was adopted including i) a health facility inventory and screening of logbooks from May 2013 to April 2014 with 77,126 patient entries from 33 health facilities; ii) a survey of 40 HCPs offering malaria services; and iii) a survey of 309 randomly selected household members from the facilities’ catchment area. Surveys took place in April and May 2014.Results: Health facility records revealed that out of 77,126 patient entries, 22% (n = 17,235) obtained a malaria diagnosis. Of those, 45% were made with BFM, 33% with mRDT and 22% with clinical diagnosis. A higher rate of positive diagnoses was observed with BMF compared with mRDT (71% vs 14%). In the HCP survey, 48% preferred using BMF for malaria testing, while 52% preferred mRDT. Faced with a negative mRDT result for a patient presenting with symptoms typical for malaria, 25% of HCPs stated they would confirm the result with a microscopy test, 70% would advise or perform a clinical diagnosis and 18% would prescribe antimalarials. Interviews with household members revealed a preference for microscopy testing (58%) over mRDT (23%), if presented with malaria symptoms. For participants familiar with both tests, a second opinion was desired in 45% after a negative microscopy result and in 90% after an mRDT.Conclusions: Non-adherence to negative diagnostics by HCPs and patients continues to be a concern. Frequent training and supportive supervision for HCPs diagnosing and treating malaria and non-malaria febrile illnesses is essential to offer quality services that can instil confidence in HCPs and patients alike. The introduction of new diagnostic devices should be paired with context-specific behaviour change interventions targeting healthcare seekers and healthcare providers.

In this study, we investigated the occurrence of direct and indirect infectious disease transmission pathways between pig farms in Switzerland, as well as their specific relevance for the spread of African swine fever (ASF), porcine reproductive and respiratory syndrome (PRRS), and enzootic pneumonia (EP). Data were collected using an adapted Mental Models Approach, involving initial interviews with experts in the field of pig health and logistics, qualitative interviews with pig farmers, and a final expert workshop, during which all identified pathways were graded by their frequency of occurrence, their likelihood of spread of the three diseases of interest, and their overall relevance considering both parameters. As many as 24 disease pathways were identified in four areas: pig trade, farmer encounters, external collaborators, and environmental or other pathways. Two thirds of the pathways occurred with fair-to-high frequency. While both direct and indirect pig trade transmission routes were highly relevant for the spread of the three pathogens, pathways from the remaining areas were especially important for PRRS due to higher spread potential via aerosols and fomites. In addition, we identified factors modifying the relevance of disease pathways, such as farm production type and affiliation to trader companies. During the qualitative interviews, we found varying levels of risk perception among farmers concerning some of the pathways, which affected adherence to biosecurity measures and were often linked to the degree of trust that farmers had towards their colleagues and external collaborators. Our findings highlight the importance of integrating indirect disease pathways in existing surveillance and control strategies, and in disease modelling efforts. We also propose that biosecurity trainings aimed at professionals and risk communication campaigns targeting farmers should be considered to mitigate the risk of disease spread through the identified pathways.

In this study, we investigated the occurrence of direct and indirect infectious disease transmission pathways among pig farms in Switzerland, as well as their specific relevance for the spread of African swine fever, porcine reproductive and respiratory syndrome (PRRS), and enzootic pneumonia. Data were collected using an adapted mental models approach, involving initial interviews with experts in the field of pig health and logistics, semi-structured interviews with pig farmers, and a final expert workshop, during which all identified pathways were graded by their predicted frequency of occurrence, their likelihood of spread of the three diseases of interest, and their overall relevance considering both parameters. As many as 24 disease pathways were identified in four areas: pig trade, farmer encounters, external collaborators, and environmental or other pathways. Two thirds of the pathways were expected to occur with moderate-to-high frequency. While both direct and indirect pig trade transmission routes were highly relevant for the spread of the three pathogens, pathways from the remaining areas were especially important for PRRS due to higher spread potential via aerosols and fomites. In addition, we identified factors modifying the relevance of disease pathways, such as farm production type and affiliation with trader companies. During the interviews, we found varying levels of risk perception among farmers concerning some of the pathways, which affected adherence to biosecurity measures and were often linked to the degree of trust that farmers had towards their colleagues and external collaborators. Our findings highlight the importance of integrating indirect disease pathways into existing surveillance and control strategies and in disease modelling efforts. We also propose that biosecurity training aimed at professionals and risk communication campaigns targeting farmers should be considered to mitigate the risk of disease spread through the identified pathways.