Veterinary Laboratory Diagnosis: A Missed Opportunity in the Continuum of Care for Veterinarians in Selected Countries in Sub-Sahara Africa ()
1. Introduction
Improved veterinary diagnosis is a requirement for effective control and management of endemic cattle diseases in sub-Saharan Africa (SSA), however this is currently constrained due to different factors such as limited availability of suitably trained professional staff, field based diagnostic tests and a general lack of knowledge about disease among livestock farmers [1]. Veterinary Laboratories that rapidly identify, respond to and control rapidly spreading and emerging (or re-emerging) infectious and zoonotic diseases are critical to: 1) The financial performance of animal agriculture and international trade; 2) livelihoods of animal related industries; 3) Nutritional status, food security, and the socio-economic well-being of a country [2]. In Nigeria, majority of the private veterinary diagnostic laboratories are owned by veterinary drugs and biologics companies who offer the diagnostic services to their customers on a complimentary basis, only few private laboratories are operated by private veterinarians or biomedical scientists engaged in for-profit services [3]. Although different governments in Sub-Sahara and development partners like Food and Agriculture Organization (FAO) have over the last decade invested in supporting disease control and strengthening animal disease diagnostics through establishment and support of veterinary laboratories, most of these laboratories continue to struggle to provide diagnostic services to their clients while others have collapsed or have remained dormant due to underutilization. An online questionnaire surveillance with veterinarians in 4 selected countries of sub-Sahara Africa (Uganda, Tanzania, Nigeria and Ethiopia) was undertaken in order to assess the status of utilization of veterinary diagnostic services and challenges faced in utilization. The objectives of the study where to identify the number of veterinarians who submitted samples for veterinary diagnosis, the rate of utilization of labs for veterinary diagnosis and the challenges faced in utilizing labs for veterinary diagnosis.
2. Methods
2.1. Study Area
Nigeria, Uganda, Tanzania and Ethiopia were selected from other sub-Sahara countries because they form important livestock hubs in sub-Sahara Africa and with increasing livestock productivity and investments made in the livestock sector by the governments and development partners, a study in these countries would give important feedback on the veterinary diagnosis utilization in these countries for the period of January, 2018 to January, 2022.
2.2. Study Approach and Population
A qualitative study using an online questionnaire was used to collect data from the different animal health practitioners predominantly veterinarians in these countries. The questionnaire was shared through the different social group networks of veterinarians in the selected countries. Local veterinarians helped in sharing the questionnaire. The questions were structured to capture the data relevant for the objectives of the study, thereafter, it was used in a cross-sectional survey designed to measure qualitative and quantitative responses,
2.3. Data Collection and Analysis
Data was collected through a cross sectional online survey, analysed, and presented in form of frequency tables, and graphs.
2.4. Ethical Consideration
A consent note highlighting the purpose of the study was included in the questionnaire and this was first consented to by the veterinarian before going ahead to fill in the online questionnaire. All participants who consented first, took part in the study and their details where anonymized in the analysis.
3. Results
3.1. Veterinarians Who Submitted Samples for Lab Diagnosis between January 2018 and January 2022
Out of the 87% respondents from the 4 countries who consented to the study (51 respondents from Uganda, 17 respondents from Tanzania, 11 respondents where from Nigeria, while 8 respondents where from Ethiopia), 74% (64/87) responded to having submitted a sample in the period of January 2018 to January 2022 (Figure 1). The significant difference could refer to the fact that diagnosis is indeed a service utilized by many veterinarians in the SSA region.
3.2. Laboratories Used for Veterinary Diagnosis between January, 2018 and January, 2022
The labs that were utilized with in the period of January 2018 and January 2022 were government labs (54%), private veterinary labs (37%) and human health labs (9%) (Figure 2). Government labs being the most utilized in this study, could highlight the fact they offer free services and hence the veterinarians find it easy to send samples to these labs compared to private veterinary and human health labs.
3.3. Challenges Faced by Veterinarians Utilizing Labs between January 2018 and January 2022
The challenges faced by veterinarians utilizing the labs were failure to submit samples to a lab as it was far (52%), Results did not match the clinical condition (29%), Failed to get my results back (16%) and those that did not understand the results (3%) (Figure 3). The regions where farms are in the SSA region are far from the government labs as well as other private labs. Therefore, this could explain the reason why the most reported challenges was failure to submit samples because of the distance.
4. Discussion
The number of veterinarians who submitted samples in this study was higher compared to those who never submitted samples despite the low number of respondents from selected countries. This finding was higher compared to that reported in a single state of Mississippi on 55% (12/22) of licensed practioners who submitted a sample for veterinary diagnosis [4]. The finding in this study could be explained by the fact that veterinary diagnosis is a need for veterinarians
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Figure 1. Number of veterinarians who submitted a sample to a lab between 2018 and 2022.
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Figure 2. Rate of utilization of labs by veterinarians in selected countries in sub-Sahara Africa between January, 2018 and January, 2022.
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Figure 3. Challenges faced by veterinarians utilizing labs in the selected sub-Sahara countries.
in SSA and it contributes to the continuum of care in the day-to-day activities of veterinarians. The number of respondents was low compared to the many field practicing veterinarians in the selected SSA countries and this could be explained by the fact that despite the need of diagnosis not many utilize the need to practice it in their daily activities but as well the low turn up could be explained by the fact that the period of study involved a global covid-19 pandemic that could have slowed down the service by most veterinarians hence hesitation to consent to the study. Determining the reasons that influence sample submission and value proposition of sample submission by veterinarians in sub-Sahara Africa is important to strengthen disease monitoring in the livestock hubs of sub-Sahara Africa with the bigger aim of improving communication with and use of laboratories by veterinarians.
The government veterinary labs are the most utilized for diagnosis and this is because most governments in SSA have invested in setting up lab infrastructure in different regions of their countries. Most of these set ups have been facilitated by development partners like FAO. The government labs to some extent face challenges of sustainability in some of the countries like Uganda but if well facilitated could play a big role in upscaling diagnostic services [5]. The rate of utilization of private labs signifies the need for continual public-private partnerships in improving the livestock industry in selected countries in SSA. The private players through different initiatives have set up labs in the selected countries most notably the Zoetis ALPHA initiative which has contributed to funding of 16 laboratories in the different selected SSA countries [6]. Such initiatives will continue a long way to support and improve veterinary diagnosis in sub-Sahara Africa. The utilization of human health labs in this study demonstrates the exodus of one health collaborative approaches and this should not be taken lightly by different stakeholders in the livestock industry. Human health labs have faced and learnt from challenges of utilization by health practioners in the past and could use these learnings to improve or extend services of veterinary diagnosis in sub-Sahara countries. The utilization of human health labs in this study could also be explained by the fact that the human health labs where mostly active in the covid pandemic which happened in the time frame of this study. Further studies on the integration of veterinary diagnosis in human health labs need to be studied so as to develop a clear framework for support on veterinary diagnosis in sub-Sahara Africa.
This study reported that the biggest challenge faced by veterinarians in utilizing labs was that they are located far, and they face issues in submitting samples. This could be explained by the geographical location of the agro ecological zones or cattle corridors in the selected countries where most farms are located far from the field labs and some countries have national reference labs as the active ones, where sending a sample to such labs is limiting because of the distance. Active logistical infrastructure needs to be set up in such countries to aid the movement of samples or one health collaborations with human labs could be a possible solution to such challenges in some countries. Digital solutions to facilitate results sharing could solve challenges of failing to get results back from some labs and different development partners have developed animal health digital tools but very few like lab cards [7] digital tool have been developed to facilitate lab result sharing. Other challenges such as failure to understand results or result-condition mismatch could be addressed by more trainings like result interpretation, reasons, or indications for sampling for veterinarians and also lab personnel. A number of these trainings have been facilitated by development partners like FAO and private players like Zoetis in the selected countries.
5. Conclusion and Recommendations
Veterinary diagnosis is still underutilized in sub-Sahara Africa and therefore a missed opportunity in Sub-Sahara Africa despite the different approaches by different stakeholders and the challenges seem to be eminent. This study concludes that veterinary diagnosis is needed by veterinarians in the day-to-day continuum of care, the governments have also ensured that government labs are set up and used by veterinarians but with the challenges of location where most labs are set up far from practicing vets and farms, sample logistics networks have to be set up to ensure sample in flows into the labs. As well, more studies on factors for sample submission, public private partnerships as well as one health collaborative approaches need to be studied further to ensure sustainable veterinary diagnosis in the livestock industry. Trainings of veterinarians on laboratory results interpretation and sampling could also improve the utilization of labs in sub-Sahara Africa.
Author’s Contributions
Francis Kalule: Conceptualization, methodology, investigation, formal analysis, writing original draft, writing review and editing
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The author alone is responsible for the views expressed in this publication.
Acknowledgements
The author is grateful to the volunteers from the selected SSA countries who took the time and used their internet data to respond to the online questionnaire survey.
The author is an employee of Zoetis, but the employer had no role in the design of the study, in the collection, analysis or interpretation of data, in the writing of the manuscript or the decision to publish the results. The questions where not evaluated for validity, but the outcome of this study was to act as information to implementing partners as well as governments to formulate measures to upscale diagnostic services.