Needs for Establishment and Adoption of Regional One Health Approach for Preparedness and Response to Public Health Threats in the East African Community

Introduction: One Health approach integrates human, animal, and environmental health, recognizing their intricate relationship. It is an important approach to address complex public health challenges such as zoonoses, anti-microbial resistance (AMR), food safety and security, the impact of climate change, biodiversity degradation and many other health challenges that require collaborative efforts. East African Community (EAC) is among the regions that face such challenges. Hence, there is a dire need to adopt the One Health approach to prevent and control many of the public health threats. Aim and objectives: To develop and implement a comprehensive regional One Health approach for the East African Community (EAC) that enhances collaborative efforts in addressing public health threats through an integrated approach to human, animal, and environmental health. The objectives of the work were to assess and strengthen current One Health initiatives, to assess the status of One Health implementation in the region and to recommend the best approach to develop a Regional One Health Strategy that would enhance the sustainable One Health approach in the EAC. Data Collection: Data was collected through consultations with sector representatives from the EAC Partner States, the EAC Secretariat, and the EAC Expert Working Group (EWG). Between October 2020 and May 2022, documents and reports from the EAC secretariat and Partner States were also extensively reviewed. Findings: The EAC has been facing numerous public health threats due to several factors, including its geographical location, high population density and movements, limited access to healthcare, limited disease surveillance and control, etc. Although a formal regional One Health strategy was lacking during the time of the data collection exercise, key initiatives like contingency plans development, risk analysis and communication, development of Standard Operating Procedures (SOPs) as well as capacity-building efforts for various health risks had been carried out, all under the umbrella of One Health. Some EAC Partner States have developed national One Health strategies and created multi-sectoral platforms to address public health challenges. Including the Democratic Republic of Congo (DRC) in the EAC region in April 2023 emphasized the need for a more comprehensive regional approach due to the DRC's vast tropical forests and history of infectious disease outbreaks Conclusion: Most public health threats do not recognize borders. Hence, there is a need to unify EAC Partner States’ efforts to effectively and efficiently address regionally evolving public health threats. This requires implementing a One Health approach, thereby emphasizing the significance of a regional One Health strategy. The unified approach will safeguard the well-being of human and animal health, the ecosystems in the region, and the socio-economy. Challenges may include securing adequate, sustainable resources, harmonizing efforts among Partner States, and aligning regulatory frameworks and resource capacities

Low prevalence of laboratory-confirmed malaria in clinically diagnosed adult women from the Wakiso district of Uganda

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Dipeptidyl peptidase-1 inhibition in patients hospitalised with COVID-19: a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial

Background Neutrophil serine proteases are involved in the pathogenesis of COVID-19 and increased serine protease activity has been reported in severe and fatal infection. We investigated whether brensocatib, an inhibitor of dipeptidyl peptidase-1 (DPP-1; an enzyme responsible for the activation of neutrophil serine proteases), would improve outcomes in patients hospitalised with COVID-19. Methods In a multicentre, double-blind, randomised, parallel-group, placebo-controlled trial, across 14 hospitals in the UK, patients aged 16 years and older who were hospitalised with COVID-19 and had at least one risk factor for severe disease were randomly assigned 1:1, within 96 h of hospital admission, to once-daily brensocatib 25 mg or placebo orally for 28 days. Patients were randomly assigned via a central web-based randomisation system (TruST). Randomisation was stratified by site and age (65 years or ≥65 years), and within each stratum, blocks were of random sizes of two, four, or six patients. Participants in both groups continued to receive other therapies required to manage their condition. Participants, study staff, and investigators were masked to the study assignment. The primary outcome was the 7-point WHO ordinal scale for clinical status at day 29 after random assignment. The intention-to-treat population included all patients who were randomly assigned and met the enrolment criteria. The safety population included all participants who received at least one dose of study medication. This study was registered with the ISRCTN registry, ISRCTN30564012. Findings Between June 5, 2020, and Jan 25, 2021, 406 patients were randomly assigned to brensocatib or placebo; 192 (47·3%) to the brensocatib group and 214 (52·7%) to the placebo group. Two participants were excluded after being randomly assigned in the brensocatib group (214 patients included in the placebo group and 190 included in the brensocatib group in the intention-to-treat population). Primary outcome data was unavailable for six patients (three in the brensocatib group and three in the placebo group). Patients in the brensocatib group had worse clinical status at day 29 after being randomly assigned than those in the placebo group (adjusted odds ratio 0·72 [95% CI 0·57–0·92]). Prespecified subgroup analyses of the primary outcome supported the primary results. 185 participants reported at least one adverse event; 99 (46%) in the placebo group and 86 (45%) in the brensocatib group. The most common adverse events were gastrointestinal disorders and infections. One death in the placebo group was judged as possibly related to study drug. Interpretation Brensocatib treatment did not improve clinical status at day 29 in patients hospitalised with COVID-19

Co-creation of a Scalable Climate Service for Kenyan Smallholder Farmers

Climate change is already impacting the horticulture sector in Kenya. Even though the effects of climate change will be severe, adaptation to climate change still has little priority at the local and county level. This paper discusses the development of the agricultural climate atlas for Kajiado and Kiambu counties in Kenya as a climate information service to support the horticulture sector. This climate service for smallholder farmers aims to bridge the gap between climate research and data provision and the uptake by farmers and farmer organizations on the ground. Rather than developing a generic service for the whole of the country, we followed a local, bottom-up approach. Working at the county level, we tried to capture local needs. The result is a co-created atlas for two counties, for specific crops. The approach can be scaled up to other counties and other crops. We elaborate on our approach, and discuss lessons learned, challenges, and future work opportunities. The development of the climate atlas shows the importance of co-creation and user engagement. In addition, flexibility in the output and process was crucial. The main challenge remains to keep engagement high after completion of the project.</jats:p

Co-creation of a Scalable Climate Service for Kenyan Smallholder Farmers

Climate change is already impacting the horticulture sector in Kenya. Even though the effects of climate change will be severe, adaptation to climate change still has little priority at the local and county level. This paper discusses the development of the agricultural climate atlas for Kajiado and Kiambu counties in Kenya as a climate information service to support the horticulture sector. This climate service for smallholder farmers aims to bridge the gap between climate research and data provision and the uptake by farmers and farmer organizations on the ground. Rather than developing a generic service for the whole of the country, we followed a local, bottom-up approach. Working at the county level, we tried to capture local needs. The result is a co-created atlas for two counties, for specific crops. The approach can be scaled up to other counties and other crops. We elaborate on our approach, and discuss lessons learned, challenges, and future work opportunities. The development of the climate atlas shows the importance of co-creation and user engagement. In addition, flexibility in the output and process was crucial. The main challenge remains to keep engagement high after completion of the project

Climate-resilient horticulture for sustainable county development in Kenya

Climate change presents one of the greatest challenges to the productivity and sustainable growth of the agricultural sector in Kenya due to extreme events such as droughts and floods as well as changes in temperature. Horticultural crops are particularly sensitive to climate change because of their high water demand and strict temperature requirements. Increased or decreased rainfall and increased temperature result in drought or flooding, lack of water for irrigation, and pests and diseases epidemic can affect the suitability of areas for growing horticultural crops. Understanding the impacts of climate for a given crop under specific conditions is key to supporting further development of the horticulture sector. While horticulture is a priority economic subsector in many counties, it is not known how the counties position themselves with regard to dealing with climate change threats in the sector. A review of the literature shows how climate change significantly affects the performance of horticultural crops across a variety of climatic zones and that counties need to be better prepared to address these effects. Horticulture covers myriad crops (including fruits and vegetables), which are affected by climate change in different ways. Seasonal patterns, both for temperature as well as (onset of) rainfall are changing. Temperature thresholds for specific crops are being exceeded, while some areas are now more favourable for growing certain crops where previously temperatures were too low. Suboptimal temperatures affect both the yield and quality of produce. The horticulture sector has also experienced incidences of pests, such as Tuta absoluta on tomato; climate change is a confounding factor to the spread and establishment of these pests. Agriculture which is highly affected by climate change is devolved to counties; as such, policies relevant to it are expected to be implemented at county level. An analysis of the County Integrated Development Plans showed that horticulture is a high-value subsector that plays a major role in generating revenue for county development. Most counties have prioritized horticulture and made substantial investments. Climate change is acknowledged as a threat to different sectors, but there is only scant analysis of the factors causing it, effects it will have and proposed responses to it. Farmers and crop officers from Kiambu and Kajiado counties are aware of climate change and its effects on horticulture. However, understanding of the relationship between cause and effect and of possible mitigating actions is weak. We observed that at all levels, in the field as well as at county level, preparedness for climate change is low and government support to the farmers is also limited. Due attention and informed decision-making based on, for example the Kenya Climate Atlas that is currently being developed, is required