One Health approach for elimination of human anthrax in a tribal district of Odisha: Study protocol

Abstract

Background Anthrax is a major but neglected zoonotic disease of public health concern in India with Odisha contributing a major share to the disease burden. Bacillus anthracis spores can be found naturally in soil and commonly affect both animals and humans around the world. Domestic and wild animals such as cattle, sheep, goats, and deer can become infected when they inhale or ingest spores from contaminated soil, plants, or water. Anthrax can be fatal if patients are not treated promptly with antibiotics. This protocol aims to describe the implementation and evaluation of the ‘One Health’ intervention model based on the principles of Theory of Change (ToC) to eliminate human anthrax from a tribal district in Odisha, India. Methods This study would test the effectiveness of a complex public health intervention package developed using the ToC framework for the elimination of human anthrax in Koraput district by a comparative analysis of baseline and end-line data. We plan to enroll 2640 adults across 14 geographically divided blocks in Koraput district of Odisha for baseline and end-line surveys. After baseline, we would provide capacity building training to stakeholders from the department of health, veterinary, forest, academic and allied health institutions followed by workshops on sensitization and awareness through IEC (Information Education Communication)/BCC (Behavior Change Communication) activities in the community. We would establish a state-level laboratory facility as a robust system for timely diagnosis and management of human anthrax cases. Surveillance network will be strengthened to track the cases in early stage and risk zoning will be done for focused surveillance in endemic areas. Advocacy with district level administration will be done for maximizing the coverage of livestock vaccination in the entire district. Interdepartmental coordination would be established for the effective implementation of the intervention package. Conclusion This would be a first study applying One Health concept for the elimination of human anthrax in India. The findings from this study will offer important insights for policy-making and further replication in other endemic regions of the state and country. Trial registration The authors confirm that all ongoing and related trials for this intervention are prospectively registered with the Clinical Trials Registry of India [CTRI/2020/05/025325] on 22 May 2020.

One Health activities to reinforce intersectoral coordination at local levels in India

“…Intersectoral interactions at the village/sub-district level have occurred most frequently during disease outbreaks and have been observed across the country ( 22 , 36 , 41 , 42 ). These interactions often involve OH coordination and response between stakeholders at national, state, and district levels, usually with a top-down approach that directs, initiates, and supports response from lower-level stakeholders.…”

“…Similarly, an intersectoral collaboration featuring the MoHFW, Directorate of Health Research, Indian Council of Agricultural Research (ICAR), State Health Department, State Animal Husbandry, and District Administration, during a 2018 Nipah virus outbreak in Kerala led to zero spread and no mortality in a subsequent outbreak the following year ( 42 ). Currently, a OH approach at multiple levels is being utilized to control anthrax in several villages of a tribal district of Odisha ( 41 ); several stakeholders are involved: clinical service providers, program managers and health workers (health care sector), veterinary doctors, livestock inspectors, forest guards (animals care sector) and service utilizer clients, local governance members, non-governmental organizations (NGOs), self-help groups, cattle owners/gatherers, and village residents (community) ( 41 ).…”

Assessment of socio-behavioural correlates and risk perceptions regarding anthrax disease in tribal communities of Odisha, Eastern India

“…The sample size was calculated by using the formula stated in Bhattacharya et al [ 13 ]. Assuming the knowledge of anthrax in the community as 5% with a design effect of 1.3 and confidence interval of 95%, relative precision of 20% and non-response rate of 10% was calculated to a total of 2608 which was rounded off to 2640.…”

“…A questionnaire was developed with 85-items based on the contents described in the Bhattacharya et al [ 13 ]. The structured questionnaire primarily consisted of semi-open questions and was arranged into domains namely socio-demographic characteristics (age, sex, education level, occupation, number of people in the household, animal ownership status), information on domestic animal (type of livestock, grazing habits, years of experience in handling livestock), dead-animal handling, food habits (consumption of meat and its sources) and knowledge assessment & awareness of the respondent about anthrax disease (signs or symptoms, transmission, precaution and prevention).…”

Detection of B. anthracis from Environmental Samples during Outbreak in Tamilnadu by Molecular Methods

“…In humans, the infection is acquired from a contaminated environment or in contact with infected animals. The implementation of the 'One Health' intervention model is required to eliminate human anthrax (Bhattacharya et al, 2021).…”