Epidemiology and Diseases Control Section, Ministry of Health, Community Development, Gender, Elderly and Children, P. O. Box. 9083, Dar es Salaam, Tanzania.
Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, P. O. Box. 3021, Chuo Kikuu Morogoro, Tanzania.
BMC Public Health. 2018 Jan 5;18(1):106. doi: 10.1186/s12889-017-5007-z.
Anthrax outbreaks in Tanzania have been reported from the human, livestock and wildlife sectors over several years, and is among the notifiable diseases. Despite frequent anthrax outbreaks, there is no comprehensive dataset indicating the magnitude and distribution of the disease in susceptible species. This study is a retrospective review of anthrax outbreaks from the human, livestock, and wildlife surveillance systems from 2006 to 2016. The objectives were to identify hotspot districts, describe anthrax epidemiology in the hotspot areas, evaluate the efficiency of the anthrax response systems and identify potential areas for further observational studies.
We prepared a spreadsheet template for a retrospective comprehensive record review at different surveillance levels in Tanzania. We captured data elements including demographic characteristics of different species, the name of health facility, and date of anthrax diagnosis. Also, we collected data on the date of specimen collection, species screened, type of laboratory test, laboratory results and the outcome recorded at the end of treatment in humans. After establishing the database, we produced maps in Quantum GIS software and transferred cleaned data to Stata software for supportive statistical analysis.
Anthrax reported incidences over 4 years in humans were much higher in the Arusha region (7.88/100,000) followed by Kilimanjaro region (6.64/100,000) than other regions of Tanzania Mainland. The health facility based review from hotspot districts in parts of Arusha and Kilimanjaro regions from 2006 to 2016, identified 330 human anthrax cases from the selected health facilities in the two regions. Out of 161 livestock and 57 wildlife specimen tested, 103 and 18 respectively, were positive for anthrax.
This study revealed that there is gross under-reporting in the existing surveillance systems which is an obstacle for estimating a true burden of anthrax in the hotspot districts. Repeated occurrences of anthrax in livestock, wildlife and humans in the same locations at the same time calls for the need to strengthen links and promote inter-disciplinary and multi-sectoral collaboration to enhance prevention and control measures under a One Health approach.
坦桑尼亚多年来已从人类、牲畜和野生动物领域报告炭疽病爆发事件，且该病属于应报告疾病。尽管炭疽病频繁爆发，但目前尚无全面的数据组来显示易感染物种中该病的规模和分布情况。本研究对 2006 年至 2016 年期间来自人类、牲畜和野生动物监测系统的炭疽病爆发情况进行了回顾性审查。目的是确定热点地区，描述热点地区炭疽病的流行病学情况，评估炭疽病应对系统的效率，并确定进一步开展观测研究的潜在领域。
我们为坦桑尼亚不同监测水平的回顾性综合记录审查制定了电子表格模板。我们记录了不同物种的人口统计学特征、医疗机构名称和炭疽病诊断日期等数据元素。此外，我们还收集了标本采集日期、筛查物种、实验室检测类型、实验室结果以及人类治疗结束时记录的结果等数据。在建立数据库后，我们在 Quantum GIS 软件中生成了地图，并将清理后的数据转移到 Stata 软件中进行支持性统计分析。
在过去 4 年中，阿鲁沙地区（7.88/100000）和乞力马扎罗地区（6.64/100000）的人类炭疽病报告发病率明显高于坦桑尼亚大陆的其他地区。来自阿鲁沙和乞力马扎罗部分热点地区的基于医疗机构的审查显示，2006 年至 2016 年期间，从这两个地区选定的医疗机构中发现了 330 例人类炭疽病病例。在检测的 161 份牲畜和 57 份野生动物样本中，炭疽阳性分别为 103 份和 18 份。
本研究表明，现有监测系统存在严重的漏报情况，这是估计热点地区炭疽病真实负担的障碍。在同一地点、同一时间反复发生牲畜、野生动物和人类炭疽病，需要加强联系，促进跨学科和多部门合作，以加强大流行防范和控制措施，采用“同一健康”方法。
