International Journal of One Health Available at www.onehealthjournal.org/Vol.7/No.2/5.pdf RESEARCH ARTICLE Open Access Adoption of the One Health approach to improve zoonosis control in low-income countries: Insights from the case of rabies management in Burkina Faso Madi Savadogo1,2,3 , Hamidou Zangré2,4 , Sougrenoma Désiré Nana2,5 , Abdoul Kader Ilboudo1 , Laibané Dieudonné Dahourou6 , Sidwatta Guy Ilboudo7 , Virginie Simonis8 , Kongnimissom Apoline Sondo9,10 Ayayi Justin Akakpo2 , Zékiba Tarnagda1 and Rianatou Bada Alambedji2 , 1. Laboratoire National de Référence-Grippes (LNR-G), Unité des Maladies à potentiel Epidémique-Maladies Emergentes et Zoonoses, Département de Biologie Médicale et Santé Publique, Institut de Recherche en Sciences de la Santé (IRSS/CNRST), P.O. Box 7047, Ouagadougou, Burkina Faso; 2. Service de Microbiologie-Immunologie et Pathologies Infectieuses, Département de Santé Publique et Environnement, Ecole Inter-Etats des Sciences et Médecine Vétérinaires (EISMV), P.O. Box 5077, Dakar, Senegal; 3. Fundamental and Applied Research for Animals and Health, Faculty of Veterinary Medicine, University of Liege, Quartier Vallée 2 avenue de Cureghem, 6, 4000 Liege, Belgium; 4. Direction de la Santé Animale, Direction Générale des Services Vétérinaires, Ministère des Ressources Animales et Halieutiques, P.O. Box 7026, Ouagadougou, Burkina Faso; 5. Université de Montpelier, Route de Mende, 34199 Montpelier, France; 6. Institut des Sciences de l’Environnement et du Développement Rural (ISEDR), Université de Dédougou, P.O. Box 176, Dédougou, Burkina Faso; 7. International Livestock Research Institute, P.O. Box 1496, Ouagadougou, Burkina Faso; 8. Unité de Recherche Soins primaires et Santé, Département de Médecine Générale, Université de Liège, Quartier Hôpital avenue Hippocrate 13, 4000 Liège 1, Belgique; 9. Unité de Formation et de Recherche en Sciences de la Santé (UFR/SDS), Université Joseph Ki-Zerbo, P.O Box 7021, Ouagadougou, Burkina Faso; 10. Service des Maladies Infectieuses, Centre Hospitalier Universitaire Yalgado Ouedraogo, P.O Box 5234, Ouagadougou, Burkina Faso. Corresponding author: Madi Savadogo, e-mail: savadogo.madi@yahoo.fr Co-authors: HZ: zangrevet@gmail.com, SDN: sougrenomadesire@gmail.com, AKI: ilboudokader@yahoo.fr, LDD: d_dahourou@yahoo.fr, SGI: ilboudoguy@gmail.com, VS: virginie.simonis78@gmail.com, KAS: sondoapoline@yahoo.fr, AJA: ayia11612@gmail.com, ZT: zekiba@hotmail.com, RBA: rianatoub@yahoo.fr Received: 26-05-2021, Accepted: 26-08-2021, Published online: 12-10-2021 doi: www.doi.org/10.14202/IJOH.2021.182-189 How to cite this article: Savadogo M, Zangré H, Nana SD, Ilboudo AK, Dahourou LD, Ilboudo SG, Simonis V, Sondo KA, Akakpo AJ, Tarnagda Z, Alambedji RB (2021) Adoption of the One Health approach to improve zoonosis control in low-income countries: Insights from the case of rabies management in Burkina Faso, Int. J. One Health, 7(2): 182-189. Abstract Background and Aim: Rabies is a neglected zoonotic disease transmissible to humans and domestic and wild animals through biting, scratching, or licking. This study aimed to analyze the adoption of the One Health approach by the stakeholders involved in rabies control in Burkina Faso. Materials and Methods: The stakeholders involved in rabies control were from the Ministry of Livestock, Ministry of Health, Ministry of the Territory Administration, Ministry of Environment and Wildlife, and Ministry of Higher Education and Research. A structured questionnaire was used in face-to-face interviews to collect data from the stakeholders. The collected data included stakeholders’ knowledge of rabies and the One Health approach and their levels of involvement in the multisectoral collaboration. Results: Most participants could not describe rabies correctly (80%), and only 52.9% had heard of the One Health approach. In addition, there was no significant association between knowledge of rabies and participants’ characteristics, and the knowledge of the One Health approach was significantly influenced by a participant’s affiliation (place of work). Conclusion: The results call for an increase in One Health education for its effective adoption by all the rabies control stakeholders. Additional efforts should focus on continual training of the One Health workforce, from policy-makers to frontline personnel. Keywords: Burkina Faso, zoonosis, One Health, rabies control system, stakeholders, multisectoral collaboration, public health. Introduction Rabies is a neglected zoonotic disease transmissible to humans and domestic and wild animals through biting, scratching, or licking. Nevertheless, it remains a major public health problem in low- and middle-income countries, causing approximately 59,000 human Copyright: Savadogo, et al. This article is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/ by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http:// creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. International Journal of One Health, EISSN: 2455-8931 deaths annually [1]. Burkina Faso is no exception in this situation. For example, rabies has been endemic for decades in Ouagadougou, the administrative capital and the most populous city in the country [2-4]. Although underreported, the annual number of dog bites recorded in Burkina Faso is already one of the highest in the sub-region of West Africa [5,6]. Rabies is 100% preventable through appropriate post-exposure prophylaxis and mass canine vaccination [7]. However, canine vaccination coverage remains much lower than the 70% required to stop the virus transmission [7-9]. Meanwhile, the One Health approach calls for a close collaboration between the human health, animal 182 Available at www.onehealthjournal.org/Vol.7/No.2/5.pdf health, environment, and wildlife sectors to realize outcomes that are not achievable if each sector works in a silo. An example of One Health collaboration is the Tripartite Alliance established between the World Animal Health Organization (OIE), World Health Organization (WHO), and Food and Agriculture Organization (FAO) of the United Nations that led to the launch of the United Against Rabies platform in September 2020 aiming to eliminate human rabies by 2030. Since the regional One Health ministerial meeting in November 2016, all member states of the Economic Community of West African States have adopted the One Health approach to address zoonosis and other public health threats in the sub-region. However, at the national level, the actual coordination of One Health interventions by public health-related field personnel remains challenging [10-13]. The previous studies have reported similar difficulties in Burkina Faso [14,15]. Stakeholders’ preparedness and various drivers influencing the level of One Health adoption for rabies control have not been assessed in Burkina Faso. Therefore, this study aimed to make a timely contribution toward the operationalization of the One Health approach for zoonosis control in a low-income country by assessing the following: (1) The knowledge of the workforce regarding rabies as a zoonosis and (2) the workforce’s understanding of the One Health initiative in the context of rabies control. Materials and Methods Ethical approval and informed consent The study protocol was approved by the Research Ethical Committee of the Université Cheikh Anta Diop (Protocol-0322/2018/CER/UCAD), including the use of oral consent for data collection. Therefore, before the administration of questionnaire interview, each participant was informed about the background and purpose of the study, indicating that their participation was voluntary, and their answers would be kept confidential. Only participants who verbally provided consent were interviewed. Study period and area Data collection was performed in Ouagadougou in two different periods, from August to October 2018 and from August to October 2019. Ouagadougou is the administrative capital of Burkina Faso, where ministries and national public health and animal health offices, including agencies involved in rabies control, operate. In addition, animal and human rabies have been endemic in the same area for decades [2-4,6]. Per the custom in several African countries, local populations keep dogs for various socio-economic and cultural purposes, including house and property security, protection against evil schemes, companionship (especially for children), sources of protein for human consumption, and disposal of a family’s leftover food, which is prohibited from being thrown into the garbage in some local cultures [16,17]. International Journal of One Health, EISSN: 2455-8931 Sampling and questionnaire interviews Interview participants were selected following dual sampling methods: First purposive sampling and then respondent-driven sampling. Based on the literature review, institutions playing a role in rabies control were identified: The National Veterinary Office, responsible for surveillance, biting dog observation, and dog vaccination; the Veterinary Laboratory, responsible for diagnostic and surveillance; the Rabies Treatment Center, responsible for pre-exposure and post-exposure prevention; and the Referral Hospital Center, responsible for treating rabid patients. First, in each institution, one participant was interviewed (purposive sampling). Then, the initial participants introduced the interviewers to other relevant stakeholders involved in rabies control (respondent-driven sampling). Subsequently, a total of 140 participants were interviewed, corresponding to five groups concerning their involvement with the rabies control interventions: Ministry of Livestock (MoL) (n=55); Ministry of Health (MoH) (n=45); Ministry of the Territory Administration (MoA) (n=20); Ministry of Environment and Wildlife (MoEW) (n=19); and Ministry of Higher Education and Research (MoER) (n=1) (Figure-1). The employed sampling methods were effective and appropriate for the study due to logistic convenience [18]. A structured questionnaire was used to collect data during the face-to-face interviews. The obtained data included participants’ demographics, professional data (e.g., sector, affiliation, gender, employment position, and professional experience), ability to describe rabies as a zoonotic disease (e.g., its type, transmission, severity, and prevention methods), rabies control interventions in which the participant was involved, knowledge of One Health, and perceived involvement in One Health collaboration. Statistical analysis The obtained data were recorded into a Microsoft Excel 2016 database for processing and calculation. Based on their accuracy and completeness, the answers to the questions on a participant’s knowledge of rabies and the One Health approach were classified into “unable to describe,” “partially described,” or “correctly described.” A participant’s knowledge of rabies as a zoonotic disease was measured by his understanding of the following characteristics: Type, transmission, severity, and prevention methods of rabies. The participant was classified as “unable to describe” if he could not explain at least two characteristics, “partially described” if he could describe two characteristics correctly, and “correctly described” if he could describe more than two characteristics correctly. A participant’s knowledge of the One Health approach was measured by his understanding of the following characteristics: The usefulness for rabies control and categories of stakeholders to be included in the One Health system. The participant was classified 183 Available at www.onehealthjournal.org/Vol.7/No.2/5.pdf Figure-1: Conceptual framework of the multi-sectoral rabies control system, Burkina Faso. as “unable to describe” if he could not describe the usefulness or stakeholders, “partially described” when he could partially describe the usefulness or stakeholders, and “correctly described” when he could describe the usefulness and stakeholders. The statistical association between participant characteristics and dependent variables including the ability to describe rabies as a zoonotic disease, having rabies control-related interventions, having heard about the One Health approach, the ability to describe the One Health approach, and using the One Health collaboration in rabies control-related interventions was determined with Chi-square tests and Fisher’s exact tests with a 95% confidence level using the Rx64 3.6.1 software (The R Foundation for Statistical Computing, https://cran.r-project.org/bin/windows/ base/old/3.6.1/). For these tests, statistical significance was set at p<0.05. Results Description of the rabies participants’ characteristics control system and Based on the collected data, the rabies control system was conceptualized and represented to provide a better overview of rabies management in the study area (Figure-1). The participants’ characteristics are presented in Table-1. The study included participants from the MoL (39.3%), MoH (32.1%), MoA (14.3%), MoEW (13.6%), and MoER (0.7%). Most of the participants were male (69.3%) and had fewer than 10 years of work experience (50%). Control interventions and participants’ knowledge of rabies All participants were aware of rabies as a public health threat. However, only 20% of all participants could correctly describe the disease type (viral and zoonotic), transmission (vector animals and roots), clinical signs, level of severity, and prevention International Journal of One Health, EISSN: 2455-8931 Table-1: Demographic and professional characteristics of surveyed participants. Variables Gender (n=140) Female Male Professional experience (years) (n=140) <10 10-20 Over 20 Employment position (n=140) Environment officer Physician Paramedical officer Pharmacist Veterinarian Veterinary Paraprofessional Wildlife officer Sector (n=140) MoA MoEW MoH MoL MoER Affiliation (n=140) Animal health office Animal health school Rabies treatment center Environment and Wildlife office Health center Health office Pharmacy Public hygiene office Veterinary clinic Veterinary laboratory Number of Frequency observed (%) 43 97 30.7 69.3 70 35 35 50.0 25.0 25.0 15 16 41 4 36 20 8 10.7 11.4 29.3 2.9 25.7 14.3 5.7 20 19 45 55 1 14.3 13.6 32.1 39.3 0.7 19 7 16 19 34 10 1 4 14 15 13.7 5.0 11.5 13.7 24.5 7.2 0.7 2.9 10.1 10.8 MoA=Ministry of the Territory Administration; MoEW=Ministry of Environment and Wildlife; MoH=Ministry of Health; MoL=Ministry of Livestock; and MoER=Ministry of Higher Education and Research methods. In contrast, physicians (50%) and veterinarians (55.5%) were more likely to know rabies than were the participants in other professional categories. 184 Available at www.onehealthjournal.org/Vol.7/No.2/5.pdf Table-2: Participants’ level of knowledge of rabies and their involvement in rabies control. Variables Ability to describe rabies (n=140) Unable to Partially describe described (%) (%) Gender Female Male Professional experience (years) <10 10-20 Over 20 Employment position Environment officer Physician Paramedical officer Pharmacist Veterinarian Veterinary Paraprofessional Wildlife officer Sector MoA MoEW MoH MoL MoER Affiliation Veterinary office Animal health school Rabies Treatment Center Environment and Wildlife office Health center Health office Pharmacy Public hygiene office Veterinary clinic Veterinary laboratory p-value Having experience in rabies control interventions (n=140) Correctly described (%) No (%) Yes (%) p-value 46.5 40.2 39.5 36.1 14.0 23.7 0.42 20.9 13.4 79.1 86.6 0.26 52.9 28.6 34.3 28.6 48.6 42.9 18.5 22.8 22.8 0.13 15.7 17.1 14.3 84.3 82.9 85.7 0.95 100.0 12.5 63.4 50.0 13.9 30.0 37.5 0.0 37.5 34.1 50.0 30.6 70.0 62.5 0.0 50.0 2.5 0.0 55.5 0.0 0.0 NA 6.7 31.2 24.4 25.0 2.8 0.0 50.0 93.3 68.8 75.6 75.0 97.2 100.0 50.0 0.00 50.0 73.7 53.3 20.0 0.0 45.0 26.3 28.9 43.6 100.0 2.0 0.0 17.8 36.4 0.0 NA 0.0 26.3 35.6 0.0 100.0 100.0 73.7 64.4 100.0 0.0 0.00 15.8 42.9 37.5 73.7 64.7 20.0 0.0 100.0 14.3 20.0 26.3 42.9 56.2 26.3 26.5 30.0 100.0 0.0 57.1 53.3 57.9 14.3 6.2 0.0 8.8 50.0 0.0 0.0 28.6 26.7 NA 0.0 0.0 0.0 26.3 32.4 50.0 0.0 0.0 0.0 0.0 100.0 100.0 100.0 73.7 67.6 50.0 100.0 100.0 100.0 100.0 NA MoA=Ministry of the Territory Administration; MoEW=Ministry of Environment and Wildlife; MoH=Ministry of Health; MoL=Ministry of Livestock; and MoER=Ministry of Higher Education and Research Human health Animal health Prevention and control Data colle ction Laboratory testing Dog population management Policy and legal frame Aware ness work Environment and wildlife Sterilization Public hygiene Dog culling Testing Sampling Surveillance Biting dog observation Rabid person care PrEP & PEP Dog vaccination 0 5 10 15 20 25 30 35 40 45 Figure-2: Main interventions cited by the three key stakeholder groups involved in rabies prevention and control, Burkina Faso (PrEP=Preexposure prophylaxis; PEP=Postexposure prophylaxis). International Journal of One Health, EISSN: 2455-8931 185 Available at www.onehealthjournal.org/Vol.7/No.2/5.pdf Nevertheless, there was no significant association between the characteristics of the participants and their ability to describe rabies as a disease (p>0.05) (Table-2). Meanwhile, the largest number of rabies control interventions was conducted in the animal health sector, which was responsible for awareness raising, dog vaccination, surveillance, biting dog observation, laboratory testing, sample collection, sterilization of dogs, free-roaming dog culling, and policy and regulations, followed by the human health sector, which was responsible for pre-exposure and post-exposure prophylaxis, rabid person care, awareness raising, surveillance, and sample collection, and the environment and wildlife sector, which was responsible for public hygiene, awareness raising, surveillance, and sample collection (Figure-2). At the individual level, males, participants working as veterinarians or veterinary paraprofessionals, and those with more than 20 years of professional experience were more likely to be involved in rabies control interventions. However, only participants’ employment position and their affiliated sectors showed a significant association with having experience in rabies control intervention (p<0.05). Participants’ knowledge and perceived roles concerning One Health Participants’ knowledge and perceived involvement in the One Health strategy for rabies control are presented in Table-3. While 52.9% of participants (n=74) had heard of One Health before this study, only a participant’s sector of affiliation was significantly associated with the participant having heard of One Health. Indeed, participants from the MoL were more likely to be aware of the multisectoral collaboration (p<0.05). In addition, among the participants who have heard of the One Health approach, 6.8% were unable to describe it, 22.9% could partially describe it, and 70.3% could describe it correctly. Moreover, Table-3: Participants’ knowledge of the One Health approach and its perceived use in rabies prevention and control interventions. Variables Gender Female Male Professional experience (years) <10 10-20 Over 20 Employment position Environment officer Physician Paramedical officer Pharmacist Veterinarian Veterinary Paraprofessional Wildlife officer Sector MoA MoEW MoH MoL MoER Affiliation Veterinary office Animal health school Rabies Treatment Center Environment and Wildlife office Health center Health office Pharmacy Public hygiene office Veterinary clinic Veterinary laboratory Having p-value heard about One Health (n=140) Ability to describe the One Health approach (n=74) No Yes 58.1 42.3 41.9 57.7 0.08 11.1 5.4 33.3 19.6 55.6 75.0 45.7 48.6 48.6 54.3 51.4 51.4 0.09 2.6 16.6 5.6 23.7 16.7 27.7 66.7 37.5 82.9 75.0 8.3 30.0 50.0 33.3 62.5 17.1 25.0 91.7 70.0 50.0 NA 0.0 0.0 28.6 0.0 3.0 14.3 0.0 85.0 15.0 52.6 47.4 66.7 33.3 16.4 83.6 0.0 100.0 0.00 0.0 100.0 42.9 57.1 81.2 18.2 52.6 47.4 NA 79.4 20.0 100.0 100.0 35.7 6.7 p-value Use of One p-value Health collaboration (n=74) Unable to Partially Correctly describe described described (%) (%) (%) 20.6 80.0 0.0 0.0 64.3 93.3 No Yes 0.28 16.7 19.6 83.3 80.4 0.77 73.3 66.7 66.6 0.37 26.3 22.2 0.0 73.7 77.8 100.0 0.06 20.0 40.0 42.9 0.0 18.2 14.3 25.0 80.0 60.0 28.5 100.0 71.4 71.4 75.0 0.29 100.0 0.0 20.0 80.0 0.0 100.0 21.4 78.6 0.0 100.0 3.0 97.0 75.0 25.0 0.00 33.3 0.0 6.7 6.5 0.0 0.0 22.2 46.6 15.2 100.0 66.7 77.8 46.7 78.3 0.0 0.07 0.0 88.9 13.3 8.7 0.0 100.0 11.1 86.7 91.7 100.0 0.00 10.6 0.0 33.3 0.0 10.5 25.0 0.0 22.2 78.9 75.0 66.7 77.8 0.03 5.3 0.0 0.0 88.9 94.7 100.0 100.0 11.1 0.00 14.3 0.0 0.0 7.1 57.1 37.5 44.4 0.0 28.6 62.5 55.6 92.9 0.0 25.0 11.1 14.3 100.0 75.0 88.9 87.7 MoA=Ministry of the Territory Administration; MoEW=Ministry of Environment and Wildlife; MoH=Ministry of Health; MoL=Ministry of Livestock; and MoER=Ministry of Higher Education and Research International Journal of One Health, EISSN: 2455-8931 186 Available at www.onehealthjournal.org/Vol.7/No.2/5.pdf only a participant’s affiliation showed a significant influence on his ability to explain what the One Health approach meant correctly (p<0.05). In addition, the participants working in veterinary offices and laboratories were more likely to be able to describe the One Health strategy. Furthermore, most of the stakeholders (60%) familiar with the One Health approach stated that they practiced multisectoral collaboration in their daily rabies control activities based on their professional relationships. Finally, the perceived use of One Health collaboration in rabies interventions was significantly associated with a participant’s employment position, sector of origin, and affiliation (p<0.05). Discussion Rabies remains a major threat to animal and human health in Burkina Faso [1,3,6]. However, a global goal of zero animal-mediated human rabies cases by 2030 has been demonstrated achievable [19,20]. In addition, the urgent need to operationalize the One Health approach for effective rabies control is recognized by key international public health organizations OIE, WHO, FAO, and the Global Alliance for Rabies Control; thus, implementation of large-scale prevention and control programs is advocated. The One Health strategy is a cost-effective way to control rabies for low- and middle-income countries like Burkina Faso [21-23]. For example, collecting samples in humans and animals simultaneously through an integrated intervention framework decreases cost and shortens detection time [24]. In addition, the strategy contributes to improving rabies surveillance and bite case management. According to the Stepwise Approach toward rabies elimination, integrating the One Health approach into rabies control strategies can enable effective surveillance through data collection, reporting, and information sharing across sectors. Moreover, multisectoral collaboration can increase vaccination coverage in the canine population, availability of and accessibility to post-exposure prophylaxis, awareness and education of the general public, and availability of laboratory testing for humans and animals [22,25-27]. The study’s findings indicated that various stakeholders and administrative institutions, including the MoL, MoH, MoA, MoEW, and MoER, were involved in rabies control interventions in Burkina Faso. Similar results were reported in Chad [28], Guinea [29], Liberia [13], and Nepal [21]. Furthermore, Marcotty et al. [30] observed that animal health participants outnumbered stakeholders from other sectors, indicating that not all the potential One Health stakeholders were involved in or aware of the outcomes created by a close multisectoral collaboration for human health and well-being. There is also a difference between sectors in their involvement in rabies control in a country. For example, in Chad, where joint rabies control activities have been conducted for years, there is a higher participation International Journal of One Health, EISSN: 2455-8931 of human health workers in the rabies control efforts, according to Mbaipago et al. [28]. Therefore, effective participation of sectors in rabies control requires all One Health stakeholders to be aware of and understand the added value of the increased synergy between sectors and disciplines. Furthermore, beyond multisectoral collaboration, Zinsstag [31], Narrod et al. [32], AntoineMoussiaux et al. [33], and Buregyeya et al. [34] have documented the added value of effective community engagement as the key partners address the complexity of rabies elimination in a transdisciplinary way. Moreover, achieving a sustained operationalization of the One Health collaboration adds a significant value in diseases control. In other words, beyond intersectoral competencies, each stakeholder must be familiar with the problem to be addressed [30]. However, the present study showed that most participants lacked a satisfactory level of knowledge of rabies, indicating the need to increase rabies training for pre-service and in-service animal health, human health, and wildlife professionals. In addition, Mbaipago et al. [28] and Nguyen et al. [35] have reported similar knowledge gaps of the One Health approach in personnel involved in rabies control in Chad and Vietnam, respectively. In Burkina Faso, the observed low awareness in the stakeholders can also be explained by the absence of a national rabies control program that results in underreporting and neglect of the disease [5,36]. In the last decade, a high-level international commitment has been increasing to promote intersectoral collaboration as the most effective strategy to control rabies in and across countries. However, the present study found that only about half of the stakeholders were aware of the One Health approach in Burkina Faso, even though the country has recently established a national One Health platform and selected rabies as one of the five high-priority zoonotic diseases (the other four were brucellosis, anthrax, high pathogen avian influenza, and dengue) [37]. Nevertheless, integrated management of rabies remains at a nascent stage in the country, revealing the need to train stakeholders, including field workers and policy-makers, in One Health leadership and core competencies [14,38-41]. Despite the lack of a legal One Health framework in the country, animal and human health workers are practicing informal collaboration through their professional relationships. As efforts are underway to operationalize the newly developed One Health platform, further research is required to assess challenges and opportunities effectively to understand the contribution of the One Health approach to the effective management of rabies in Burkina Faso [42]. Finally, the findings have revealed an urgent need to create an integrated national control program to improve stakeholders’ engagement across sectors. Conclusion The control of rabies, a zoonosis, requires close collaboration and coordination between various sectors 187 Available at www.onehealthjournal.org/Vol.7/No.2/5.pdf and stakeholders, particularly those in veterinary and medical services. However, this study revealed that most of the stakeholders involved in rabies control in Burkina Faso lacked a satisfactory level of knowledge of rabies to implement the One Health approach effectively. In addition, there is not an effective close multisectoral collaboration for rabies control, especially between animal health and human health sectors. Therefore, there is a need to develop an integrated national strategic plan, including strengthening both rabies and One Health training for pre-service and in-service personnel to increase the country’s preparedness to reach the goal of zero human death from dog-mediated rabies by 2030. Authors’ Contributions MS, HZ, SDN, KAS, AJA, and RBA: Designed, conceptualized, and supervised the study implementation, conducted research, collected data, analyzed, and wrote the manuscript. MS, HZ, and SDN: Collected and interpreted data. SGI, LDD, AKI, VS, and ZT: Provided research material and analyzed data. SGI, LDD, VS, and ZT: Interpreted data and provided logistic support. All authors read and approved the final manuscript. 4. 5. 6. 7. 8. Acknowledgments The authors would like to thank participants who agreed to participate in this study. We are also grateful to the Direction Générale des Services Vétérinaires (Chief of Veterinary Office, Ouagadougou, Burkina Faso) for support and technical assistance provided during the study. We thank Nathalie CLIGNIEZ, Department of Clinical Sciences, Faculty of Medicine, University of Liege, Belgium, for correcting English grammar and spelling. The authors did not receive any funds for the study. Competing Interests 9. 10. 11. The authors declare that they have no competing interests. Publisher’s Note Veterinary World (Publisher of International Journal of One Health) remains neutral with regard to jurisdictional claims in published institutional affiliation. 12. References 1. 2. 3. Hampson, K., Coudeville, L., Lembo, T., Sambo, M., Kieffer, A., Attlan, M., Barrat, J., Blanton, J.D., Briggs, D.J., Cleaveland, S., Costa, P., Freuling, C.M., Hiby, E., Knopf, L., Leanes, F., Meslin, F.X., Metlin, A., Miranda, M.E., Müller, T., Nel, L.H., Recuenco, S., Rupprecht, E.E., Schumacher, C., Taylor, L., Vigilato, M.A.N., Zinsstag, J. and Dushoff, J. (2015) Estimating the global burden of endemic canine rabies. PLoS Negl. Trop. Dis., 9(4): e0003786. Nitcheman, S. (1983) Contribution à L’étude Des Zoonoses Infectieuses Majeures en République de Haute-Volta. Thèse Médecine. Veterinaire. Ecole Inter-Etats des Sciences et Médecine Vétérinaires, Dakar, Senegal. p170. Available from: http://www.beep.ird.fr/collect/eismv/index/assoc/ TD83-9.dir/TD83-9.pdf. Retrieved on 17-09-2021. Sondo, K.A., Okenga, Y.C., Diop, S.A., Kaboré, B.E., Diallo, I., Kyelem, N., Basshono, J., Thombiano, R. and International Journal of One Health, EISSN: 2455-8931 13. 14. 15. Kam, L. (2015) Rabies in children: Report of 24 cases at the Yalgado Ouedraogo university hospital center of Ouagadougou in Burkina Faso. J. Trop. Dis., 3(3): 168. Minoungou, G., Dahourou, L.D., Savadogo, M., Tialla, D., Comabari, A.H.B., Kanyala, E., Ouattara, L., Kabore, S.A., Ouedraogo, V., Taboure, Y. and Kere, I. (2021) Surveillance of animal rabies in Burkina Faso: A retrospective laboratory data from 2008 to 2012. Int. J. Vet. Sci., 10(3): 172-176. Dodet, B., Adjogoua, E.V., Aguemon, A.R., Amadou, O.H., Atipo, A.L., Baba, B.A., Bara Ada, S., Boumandouki, P., Bourhy, H., Diallo, M.K., Diarra, L., Diop, B.M., Diop, S.A., Fesriry, B., Gosseye, S., Hassar, M., Kingé, T., Nzamba, T.E., Yandoko, E., Nzengué, E., Ramahefalalao, E.F., Ratsitorahina, M., Simpore, L., Soufi, A., Tejiokem, M., Thiombano, R., Tiembré, I., Traoré, A.K. and Wateba, M.I. (2008) Fighting rabies in Africa: The Africa Rabies expert bureau. Vaccine, 26(50): 6295-6298. Savadogo, M., Koné, P., Dahourou, L.D., Manishimwe, R., Sow, A., Nébié, L., Antoine-Moussiaux, N. and BadaAlambedji, R. (2020) Epidémiologie de la rage et connaissance, attitudes et pratiques des communautés au Burkina Faso. Rev. Elev. Med. Vet. Pays Trop., 73(2): 133-144. Cleaveland, S., Kaare, M., Knobel, D. and Laurenson, M.K. (2006) Canine vaccination providing broder benefits for disease control. Vet. Microbiol., 117(1): 43-50. Savadogo, M., Tialla, D., Ouattara, B., Dahourou, L.D., Ossebi, W., Ilboudo, S.G., Combari, A.H.B., Tarnagda, Z. and Bada-Alambedji, R. (2021) Factors associated with owned-dogs’ vaccination against rabies: A household survey in Bobo Dioulasso, Burkina Faso. Vet. Med. Sci., 7(4): 1096-1106. Savadogo, M., Soré, A., Dahourou, L.D., Ossebi, W., Combari, A.H.B., Bada-Alambedji, R. and Tarnagda, Z. (2021) Assessing factors associated with owner’s individual decision to vaccinate their dogs against rabies: A house-to-house survey in Ouagadougou, Burkina Faso. Vet. World, 14(4): 1014-1019. Gebreyes, W.A., Dupouy-Camet, J., Newport, M.J., Oliveira, C.J.B., Schlesinger, L.S., Saif, Y.M., Kariuki, S., Saif, L.J., Saville, W., Wittum, T., Hoet, A., Quessy, S., Kazwala, R., Tekola, B., Shryock, T., Bisesi, M., Patchanee, P., Boonmar, S. and King, L.J. (2014) The global one health Paradigm: Challenges and opportunities for tackling infectious diseases at the human, animal, and environment interface in low-resource settings. PLoS Negl. Trop. Dis., 8(11): e3257. Mbilo, C., Coetzer, A., Bonfoh, B., Angot, A., Bebay, C., Cassama, B., De Benedictis, P., Ebou, M.H., Gnanvi, C., Kallo, V., Lokossou, R.J., Manjuba, C., Mokondjimobe,E., Mouillé, B., Mounkaila, M., Ndour, A.P.N., Nel, L., Olugasa, B.O., Pato, P., Pyana, P.P., Rerambyathm, G.A., Roamba, R.C., Sadeuh-Mba, S.A., Suluku, R., SuuIre, R.D., Tejiokem, M.C., Tetchi, M., Tiembre, I., Traoré, A., Voupawoe, G. and Zinsstag, J. (2020) Dog rabies control in West and Central Africa: A review. Acta Trop., 224 : 105459. Buregyeya, E., Atusingwize, E., Nsamba, P., Musoke, D., Naigaga, I., Kabasa, J.D., Amuguni, H. and Bazeyo, W. (2020) Operationalizing the one health approach in Uganda: Challenges and opportunities. J. Epidemiol. Glob. Health, 10(4): 250-257. Voupawoe, G., Varkpeh, R., Kamara, V., Sieh, S., Traore, A., De Battisti, C., Ango, A., Loureiro, L.F.J.L., Soumaré, B., Dauphin, G., Abebe, W., Coetzer, A., Scott, T., Nel, L., Blanton, J., Dacheux, L., Bonas, S., Bourhy, H., Gourlaouen, M., Leopardi, S., De Benedictis, P., Léchenne, M., Zinsstag, J. and Mauti, S. (2021) Rabies control in Liberia: Joint efforts towards zero by 30. Acta Trop., 216 : 105787. Coulibaly, N.D. and Yameogo, K.R. (2000) Prevalence and control of zoonotic diseases: Collaboration between public health workers and veterinarians in Burkina Faso. Acta Trop., 76(1): 53-57. Zangré, H. (2018) Enquête Sur L’approche One Health et Son Application Dans Les Stratégies de Lutte Contre la Rage au Burkina Faso. Thèse Médecine Vétérinaire, Ecole Inter-etats des Sciences et Médecine Vétérinaires, Dakar, 188 Available at www.onehealthjournal.org/Vol.7/No.2/5.pdf 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. Sénégal. p91. Jibat, T., Hogeveen, H. and Mourits, M.C.M. (2015) Review on dog rabies vaccination coverage in Africa: A question of dog accessibility or cost recovery? PLoS Negl. Trop. Dis., 9(2): e0003447. Mindekem, R., Lechenne, M., Alfaroukh, I.O., Moto, D.D., Zinsstag, J., Ouedraogo, L.T. and Salifou, S. (2017) Evaluation of knowledge-attitudes-practices of the populations in the health districts of Benoye, Laoukassy, Moundou and South N’Djamena towards canine rabies in Chad. Pan. Afr. Med. J., 27 : 24. Taha, H.J. (2020) Using Systems Thinking to Understand the Drivers of Brucellosis in Jordan, Ph.D. Thesis, The University of Queensland, Australia. p214. Cleaveland, S., Kaare, M., Tiringa, P., Mlengeya, T. and Barrat, J. (2003) A dog rabies vaccination campaign in rural Africa: Impact on the incidence of dog rabies and human dog-bite injuries. Vaccine, 21(19): 65-73. Vigilato, M.A., Clavijo, A., Knobl, T., Silva, H.M., Cosivi, O., Schneider, M.C., Leanes, L.F., Belotto, A.J. and Espinal, M.A. (2013) Progress towards eliminating canine rabies: Policies and perspectives from Latin America and the Caribbean. Philos. Trans. R. Soc. Lond. B. Biol. Sci., 368(1623): 20120143. Acharya, K.P., Acharya, N., Phuyal, S., Upadhyaya, M. and Lasee, S. (2020) One health approach: A best possible way to control rabies. One Health, 10 : 100161. Lushasi, K., Steenson, R., Bernard, J., Changalucha, J.J., Govella, N.J., Haydon, D.T., Hoffu, H., Lankester, F., Magoti, F., Mpolya, E.A., Mtema, Z., Nonga, H. and Hampson, K. (2020) One Health in practice: Using integrated bite case management to increase detection of rabid animals in Tanzania. Front. Public Health, 8 : 13. Simonis, V. (2020) Gain D’efficience Par L’approche One Health Dans La Maîtrise De La Rage à Madagascar. Master Thesis in Public Health Sciences, University of Liege, Belgium. Available from: https://matheo.uliege.be/handle/2268.2/9998?locale=fr. Retrieved on 17-09-2021. Zinsstag, J., Schelling, E., Bonfoh, B., Fooks, A.R., Kasymbekov, J., Waltner-Toews, D. and Tanner, M. (2009) Towards a ‘‘one health’’ research and application toolbox. Vet. Ital., 45(1): 121-133. Lechenne, M., Mindekem, R., Madjadinan, S., Oussiguéré, A., Moto, D.D., Naissengar, K. and Zinsstag, J. (2017) The importance of a participatory and integrated one health approach for rabies control: The case of N’Djaména, Chad. Trop. Med. Inf. Dis., 2(3): 43. Siddiqi, U.R., Tahmina, S., Penjor K., Sovann, L., Gunesekera, A., Blanton, J.D., Knopf, L. and Hyde, T.B. (2019) Overview of rabies post-exposure prophylaxis access, procurement and distribution in selected countries in Asia and Africa, 2017-2018. Vaccine, 37(1): A6-13. Lechenne, M., Traoré, A., Hattendorf, J., Kallo, V., Oussiguere, A., Tetchi, M., Moyengar, R., Traoré, A.K., Moto D.D., Ngandolo, R., Bonfoh, B. and Zinsstag, J. (2021) Increasing rabies data availability: The example of a one health research project in Chad, Cote d’Ivoire and Mali. Acta Trop., 215(1): 105808. Mbaipago, N., Mindekem, R., Oussiguere, A., Moyengar, R., Naïssengar, K., Madjadinan, A., Zinsstag, J. and Léchenne, M. (2020) Rabies knowledge and practices among human and veterinary health workers in Chad. Acta Trop., 202 : 105180. Standley, C.J., Carlin, E.P., Sorrell, E.M., Barry, A.M., Bile, E., Diakite, A.S., Keita, M.S., Koivogui, L., Mane, S., Martel, L.D. and Katza, M.R. (2019) Assessing health systems in Guinea for prevention and control of priority zoonotic diseases: A one health approach. One Health, 7 : 100093. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. Marcotty, T., Thys, E., Conrad, P., Godfroid, J., Craige, P., Zinsstag, J., Meheus, F., Boukary, A.R., Badé, M.A., Sahibi, H., Filali, H., Hendrickx, S., Pissang, C., Herp,M.V., van der Roost, D., Thys, S., Hendrickx, D., Claes, M., Demeulenaere, T., Dehoux, J.P. and Boelaert, M. (2013) Intersectoral collaboration between the medical and veterinary professions in low-resource societies: The role of research and training institutions. Comp. Immunol. Microbiol. Infect. Dis., 36(3): 233-239. Zinsstag, J. (2013) Towards a science of rabies elimination. Infect. Dis. Poverty, 2(1): 22. Narrod, C., Zinsstag, J. and Tiongco, M. (2012) A one health framework for estimating the economic costs of zoonotic diseases on society. EcoHealth, 9(2): 150-162. Antoine-Moussiaux, N., De Bisthoven, L.J., Leyens, S., Assmuth, T., Keune, H., Zinsstag, J., Jean Hugé, J. and Vanhove, M.P.M. (2019) The good, the bad and the ugly: Framing debates on nature in a one health community. Sustain. Sci., 14(10): 1729-1738. Buregyeya, E., Atusingwize, E., Nsamba, P., Nalwadda, C., Osuret, J., Kalibala, P., Nuwamanya, R., Okech, S., Ssekamatte, T., Nitumusiima, S., Wakabi, T., Bikaako, W., Yawe, A., Naigaga, I., Kagarama, J., Kabasa, J.D. and Bazeyo, W. (2021) Lessons from a community based interdisciplinary learning exposure: Benefits for both students and communities in Uganda. BMC Med. Educ., 21(1): 5. Nguyen, K.A., Nguyen, H.T., Pham, T.N., Van, K.D., Hoang, T.V. and Olowokure, B. (2016) Knowledge of rabies prevention in Vietnamese public health and animal health workers. Zoonoses Public Health, 63(7): 522-528. Winkler, A.S., Klohe, K., Schmidt, V., Haavardsson, I., Abraham, A., Prodjinotho, U.F., Ngowi, B., Sikasunge, C., Noormahomed, E., Amuasi, J., Kaducu, J., Ngowi, H., Abele-Ridder, B., Harrison, W.E. and Prazeres da Costa, C. (2018) Neglected tropical diseases-the present and the future. Tidsskr. Nor. Laegeforen., 138(3): 0678. Burkina Faso. (2017) Prioritisation Des Maladies Zoonotiques Selon L’approche Une Santé Pour Un Engagement Multisectoriel. Available from: https://www. cdc.gov/onehealth/pdfs/burkinafaso-french-508.pdf . Retrieved on 17-09-2021. Mutabaruka, E., Sawadogo, M., Tarnagda, Z., Ouédraogo, L., Sangare, L., Badolo, O., Ndjakani, Y., Namusisi, O., Mukanga, D., Evering-Watley, M., Hounton, S. and Nsubuga, P. (2011) The West Africa field epidemiology and laboratory training program, a strategy to improve disease surveillance and epidemic control in West Africa. Pan. Afr. Med. J., 10(1): 10. Available from: https://www.ajol.info/index.php/pamj/article/view/76204. Retrieved on 02-05-2021. Lubogo, M., Donewell, B., Godbless, L., Shabani, S., Maeda, J., Temba, H., Malibiche, T.C. and Berhanu, N. (2015) Ebola virus disease outbreak; the role of field epidemiology training programme in the fight against the epidemic, Liberia, 2014. Pan. Afr. Med. J., 22(1): 5. Stephen, C. and Stemshorn, B. (2016) Leadership, governance and partnerships are essential one health competencies. One Health, 2 : 161-163. Vesterinen, H.M., Dutcher, T.V., Errecaborde, K.M., Mahero, M.W., Macy, K.W., Prasarnphanich, O.O., Kassenborg, H., Yulizar, F., Fauzi, R.P., Budayanti, N.S., Suwandono, A., Artama, W.T., Valeri, L. and Pelican, K.M. (2019) Strengthening multisectoral collaboration on critical health issues: One health systems mapping and analysis resource toolkit (OH-SMART) for operationalizing one health. PLoS One, 14(7): e0219197. Hueston, W., Appert, J., Denny, T., King, L., Umber, J. and Valeri, L. (2013) Assessing global adoption of one health approaches. EcoHealth, 10 : 228-233. ******** International Journal of One Health, EISSN: 2455-8931 189