key: cord-0856322-oofio99b authors: Yousuf, Abdilahi; Arifin, Siti Roshaidai Mohd; Musa, Ramli; Isa, Muhammad Lokman Md. title: Prevention and control of COVID-19 in pastoral community through One Health Approach date: 2020-10-13 journal: One Health DOI: 10.1016/j.onehlt.2020.100181 sha: 13fdb34757ecebca197788feb2843773f854f588 doc_id: 856322 cord_uid: oofio99b The vast majority of its population being a pastoralist community, the Somali region in Ethiopia shares the longest border with its neighboring east African countries. These communities face a high risk for transmission of imported COVID-19 cases and remain vulnerable due to lack of access to health delivery and low utilisation of services. Valuable lessons from other countries, has placed the One Health Approach as an appropriate, feasible and applicable preventive and control measure for COVID-19. This paper discusses the epidemiological and social susceptibility of pastoral communities in the transmission of COVID-19 and the introduction of One Health Approach as an effective inter-disciplinary response and management. frequent cough and shortness of breath. The other clinical manifestations also include muscle ache, myalgia, sore throat, chest pain, diarrhea, nausea and vomiting (3) . Based on the WHO situational report, this infection is responsible for the morbidity of more than 20,439,814 people and 744,385 deaths globally. Across national authorities, more than 916,644 cases and 17,557 deaths have been reported in the African regions. In Ethiopia, a total of 25,136 confirmed cases and an estimated 463 deaths have been reported (4) . Despite the less number of cases reported from the region and the alternative case management, the potential spread of this outbreak in less developed countries, like Africa would pose a serious challenges to control due to the shortage of health professionals, less functional health facilities, lack of diagnostic tests kits, lack of protective equipment and overall weak health service delivery system. Moreover, these less developed countries contain large populations who exercise different lifestyles and cultures. One such situation is where these communities live in over-crowded conditions with restricted implementation of physical distancing. Apart from these challenges, the operating health facilities that exist in small numbers are already overcrowded by patients with pneumonia, malaria, Tuberculosis, acute diarrhoea and malnutrition. There would be insufficient capacity to accommodate such an epidemic as COVID-19 (5) . Moreover, citizens of these countries who are mostly uneducated are less likely to follow the public health advice on prevention and control of the infection. Besides that, cultural and traditional barriers associated with controversial health myths and low health-seeking behaviors remain challenging in such trying times (6) . The pastoral communities contain people with high mobility due to their means of livelihood, which is largely dependent on rearing livestock. The livestock mainly includes camels, cattle, goats and sheep. In Africa, more than 268 million people live as pastoralists or nomads. These lifestyles remain the most feasible options of livelihood for these vulnerable and under-served communities. However, some developing countries have stepped-up to curb the spread of the infection into their countries by taking different preventive measure like closing the borders and limiting the inter-country mobility of the population. As it is a matter of livelihood which depends on the extent and magnitude of the transmission. The pastoral way of life and mode of production is extremely threatened by the newly emerging diseases and recurrent natural disasters. Having said that, these communities are vulnerable to spread of infections, malnutrition and injuries. Most of the health emergencies occur in these community due to the low utilisation of services, living in far-to-reach areas and lack of infrastructure. J o u r n a l P r e -p r o o f Journal Pre-proof Moreover, due to their high mobility and frequent movements, access to health services is challenging and disease surveillance is minimum or absent. Therefore, detection of cases and response mechanisms is often delayed leading to the rapid spread of the infection. Such public health threats could exacerbate the health conditions of these population particularly in a time of drought when these communities relocate to semi-urban areas and villages in search for better life. A large pastoral community that lives in Sub-Saharan Africa, is more likely to spread the infection to the agrarian population or city dwellers due to high crowdedness in urban areas (5) . The eastern lowland of Ethiopia is also a home for millions of a pastoral community where their main source of food security, nutrition, wellbeing and most importantly financial income depend on livestock. Due to climate change, these communities are facing serious food insecurity and frequent famines. They are also suffering from a wide range of health problems including infectious diseases, acute malnutrition, injuries and loss of life due to conflicts on scarce rangelands and water resources. Their sufferings are due to low awareness, poor health-seeking behavior, limited access to health services and lack of public infrastructures are the main challenges. Thus, to address the existing main knowledge gaps and identify research priorities, the World Health Organization (WHO) has initiated global research and innovation. WHO, thereby, proposed to conduct a feasibility study in the most needed and privileged far-to-reach areas for prevention and control of this epidemic (7). Therefore, this paper aims to highlight the possible gaps, control and practical management of COVID-19 from the pastoralist perspectives in Ethiopia, as little is known about the vulnerability of these people to this infection. The sickness and wellbeing of human and animal are inter-linked and associated with each other. Globally, some of the outbreaks that have emerged in the last few decades reflected in a rise of infections among humans contracted to in contact from animals (8) . The pastoral community are at a higher risk of contracting zoonotic diseases for various reasons. There is no recently established evidence that reveals the acquisition of SARS-CoV from dromedary animals, yet gene isolates obtained from these viruses indicate that such animals could remain a host (9) . The risk of such zoonotic infections remains very high due to the close and direct contact of animal herders with their livestock during milking, slaughtering, assisting delivery and feeding or indirectly through consumption of the animal products. In general, a study on Middle East Respiratory Syndrome Coronavirus has identified dromedary camels which is the primary livestock for pastoral people as the main reservoir for coronaviruses (10) . Since prior evidence suggested that camels were the J o u r n a l P r e -p r o o f Journal Pre-proof presumed reservoir for MERS-CoV (11) , hence, possibilities of SARS-CoV evolving from animals is inevitable. Recent evidence suggested that intensive animal husbandry and uncontrolled food consumption of animal origin could be a major contributor to the spread of the infection (9) . Moreover, the direct contact with these animal husbandry like camels by the pastoral community is accounted as a major exposure and risk factor for the viral transmission to humans (10) . Although the number of predicted cases due to the exposure to infected livestock could be less in Table 1 . Table 1 : Potential challenges of prevention and control of COVID-19 in developing countries Limited public awareness The existence of other health myths and misconceptions that are commonly practiced (6) Lacking information about treatment (5) Poor access to health services Accessibility to medical facilities (13) High mobility and remoteness to reach (14) Practice to follow alternative and traditional medicine (15) Low physical health service coverage Poor sanitation and hygiene (21) Over-crowded conditions (22) Lack of clean water Thus, this approach holds supplemental importance for the pastoralist community whose main livelihood depends on livestock which is severely threatened by climate change and impacts on the environment. Considering the seriousness of COVID-19 outbreak, its public health importance is taken into account by implementing the following the proposed prevention and control mechanisms. The emergence and development of this epidemic require effective and relevant strategic disease prevention and control measures. Recent calls have been made for the application of One Health Approach for different justified reasons. This approach attempts to mitigate and coordinate the strategies from multi-sectorial and overlapping disciplines. Several studies have suggested the application of this approach due to its comprehensive and holistic features (24, 25) . Hence, it is substantially more applicable for the proposal of preventive measures on pastoral communities taking in to account the One Health research frame-work (26) . (1) An improved surveillance system in domestic and livestock animals through the active engagement of pastoral health extension workers and mobile health teams with a proficient orientation on One Health Approach. This was profoundly recommended in some studies that suggested the application of One Health for enhancing COVID-19 surveillance (27) . 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