One Health Approach (OHA) in Selected Urban Settings in Tanzania: Knowledge, Attitudes, Awareness, and Practices One Health Approach (OHA) in Selected Urban Settings in Tanzania: Knowledge, Attitudes, Awareness, and Practices

Abstract

Attainment of optimal health calls for collaboration between animals, humans, and environmental health professionals together with understanding the consequences of animals, humans, and environment interactions on health. In cognizant of this, the government in Tanzania introduced One Health Strategic Plan (2015-2020), little is empirically known on how this plan has facilitated the enhancement of knowledge, awareness, attitudes, and practices (KAPs) under One Health Approach (OHA). This article analyses KAPs under OHA from a cross-sectional study conducted in Morogoro, Tanzania. Data were collected by a questionnaire from 1440 respondents obtained through a multistage sampling procedure, 80 Focus Group discussions (FGDs) participants and 16 key informant interviewees. IBM-SPSS v.20 analysed quantitative data while qualitative data were organised into themes on specific objectives. Results revealed that only 32.3% (95% CI:30.3 to 35.3) had adequate OH knowledge. Only 5% (95% CI:4.0 to 6.1) were aware of OHA concept and practices; 3.8% (CI 95%, 2.8 to 4.8) managed to identify collaborative efforts and strategies, and 2.5% (CI 95%, 1.7 to 3.4) correctly explained/ described OHA. Whereas, 38.5% (95% CI:32.6 to 37.5) had a positive (favourable) attitude towards OHA. Despite the efforts outlined in the OH Strategic Plan to promote OHA, there is little awareness and knowledge on OHA. This indicates that the One Health Strategic Plan (2015-2020) and other initiatives have not significantly facilitated the enhancement of KAPs. This study recommends strengthening efforts towards OHA information dissemination to enhance awareness and knowledge on the concept and practices.

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One Health Approach (OHA) in Selected Urban Settings in Tanzania:
Knowledge, Attitudes, Awareness, and Practices
M.I. Muhanga1*, J.R. S. Malungo 2 and K.A. Kimario3
1 Department of Development Studies, College of Social Sciences and Humanities, Sokoine University
of Agriculture, P. o. Box 3024, Morogoro, Tanzania.
2Department of Population Studies, School of Humanities and Social Sciences, The University of
Zambia, P. o. Box 32379, Lusaka, Zambia.
3Department of Community and Rural Development, Faculty of Co-operative and Community
Development, Moshi Co-operative University, P. o. Box 474, Moshi, Tanzania.
*E-mail: mikidadi@sua.ac.tz.
Proceedings of the First One Health Conference (embedding the 37th TVA Scientific
Conference)
Venue: Arusha International Conference Centre (AICC), Tanzania
Dates: 27th to 29th November 2019
TANZANIA VETERINARY JOURNAL
Volume 37 (2019): Special Issue of TVA Proceedings
ISSN: 0856 - 1451 (Print), ISSN: 2714-206X (Online)
https://tvj.sua.ac.tz
https://dx.doi.org/10.4314/tvj.v37i1.9s

https://dx.doi.org/10.4314/tvj.v37i1.9s
One Health Approach (OHA) in Selected Urban Settings in Tanzania:
Knowledge, Attitudes, Awareness, and Practices
M.I. Muhanga1*, J.R. S. Malungo 2 and K.A. Kimario3
1 Department of Development Studies, College of Social Sciences and Humanities, Sokoine University of
Agriculture, P. o. Box 3024, Morogoro, Tanzania.
2Department of Population Studies, School of Humanities and Social Sciences, The University of Zambia,
P. o. Box 32379, Lusaka, Zambia.
3Department of Community and Rural Development, Faculty of Co-operative and Community
Development, Moshi Co-operative University, P. o. Box 474, Moshi, Tanzania.
*E-mail: mikidadi@sua.ac.tz.
SUMMARY
Attainment of optimal health calls for collaboration between animals, humans, and
environmental health professionals together with understanding the consequences of animals,
humans, and environment interactions on health. In cognizant of this, the government in
Tanzania introduced One Health Strategic Plan (2015–2020), little is empirically known on how
this plan has facilitated the enhancement of knowledge, awareness, attitudes, and practices
(KAPs) under One Health Approach (OHA). This article analyses KAPs under OHA from a
cross-sectional study conducted in Morogoro, Tanzania. Data were collected by a questionnaire
from 1440 respondents obtained through a multistage sampling procedure, 80 Focus Group
discussions (FGDs) participants and 16 key informant interviewees. IBM-SPSS v.20 analysed
quantitative data while qualitative data were organised into themes on specific objectives.
Results revealed that only 32.3% (95% CI:30.3 to 35.3) had adequate OH knowledge. Only 5%
(95% CI:4.0 to 6.1) were aware of OHA concept and practices; 3.8% (CI 95%, 2.8 to 4.8)
managed to identify collaborative efforts and strategies, and 2.5% (CI 95%, 1.7 to 3.4) correctly
explained/ described OHA. Whereas, 38.5% (95% CI:32.6 to 37.5) had a positive (favourable)
attitude towards OHA. Despite the efforts outlined in the OH Strategic Plan to promote OHA,
there is little awareness and knowledge on OHA. This indicates that the One Health Strategic
Plan (2015–2020) and other initiatives have not significantly facilitated the enhancement of
KAPs. This study recommends strengthening efforts towards OHA information dissemination to
enhance awareness and knowledge on the concept and practices.
Keywords: One Health, Knowledge, Attitudes, Awareness & Practices, Tanzania.
INTRODUCTION
Ill-health and diseases are considered as an
obstruction to economic prosperity and
consequently to national development
worldwide (Bloom and Canning, 2000;
Bloom et al., 2001; Strittmatter and Sunde;
2011; WHO et al., 2013; Muhanga and
Malungo, 2019).
Apparently, attaining development goal has
to go hand in hand with improving the
health status of a nation's population;
nevertheless, there exist numerous
challenges in achieving good health (Ratzan
and Parker, 2000; Byrne, 2004; Mamdani
and Bangser, 2004; Kaseje, 2006; Sanders
and Chopra, 2006; Kaale and Muhanga,
2017). Notably, such challenges include; the
failure to recognise health as one, that there
is no dividing line between animals,
humans, and the environmental health, and
lack of understanding the consequences of
the interactions existing amongst the
environment, animals, and humans on
health.
Knowledge, attitudes, awareness, and
practices (KAPs) on the interactions of the
environment, humans, and animals, and the
consequences of animals, humans, and
environment interactions on health are very
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vital towards the attainment of optimal
health.
Obviously, environmental, animal health,
and health human health are inextricably
linked (Mbugi, 2012; URT-PMO, 2015;
Muhanga and Malungo, 2017; 2018a;
2018b) and definitely if optimal health for
animals, the environment, and humans has
to be attained, this has to be understood very
well. Livestock production, for instance,
makes the greatest contribution to
greenhouse emissions, significantly
influencing climate change.
Kayunze et al, (2012) claim that intensive
animal production practices also provide for
easy transmission of infectious diseases The
methane produced under intensive
production system also significantly
contributes to climate change. The
exploitation of wildlife, trading on wildlife
and increasing interactions between
livestock and wildlife also can lead to the
emergence of infectious diseases.
All these activities have economic
incentives underpinning them, with
infectious disease emergence and spread,
and environmental degradation being
unintended consequences (Jones et al.,
2008; Mumba et al., 2014). It, therefore,
remains crucial for the animal health, human
health, and related sectors professionals to
closely collaborate and along with it, a high-
level understanding of OHA promoted
amongst people to maintain good health.
A study by Kambarage et al.,(2003) points
out that the interaction between humans and
animals can result in a number of
consequences including diseases such as
human Brucellosis originating from both
traditional and dairy animals. This study
reports a total of 50000 detected cases,
however claiming that there is a number of
disease incidences undetected, unreported or
underreported without pointing out to any
empirical reasons for such cases. A number
of factors are attributed this: including, low
awareness on the interaction between
animals and humans (Scholz et al., 2008);
lack of a holistic systems approach to
understanding health across all species;
failure to recognize that humans and animals
health are inextricably linked (Schwabe,
1984; Rweyemamu et al., 2012), absence of
working cooperation between physicians
and veterinarians (Rweyemamu et al.,
2013).
Low awareness by itself indicates apart from
other factors lack of information on the
interaction between animals and humans and
how such interactions impact on health.
Karimuribo (2007) also reports on the
incidences of human brucellosis in northern
Tanzania. The study has been concerned
with the need for public health information
awareness creation to arrest the situation,
among others, the study recommended for a
need to formulate public health education
programmes plus building disease diagnostic
capacities.
It is obvious that there is a gap in awareness
on humans' and animals’ interaction plus its
consequences and lack of public health
education together with limited working
cooperation between physicians and
veterinarians. Despite pointing out to the
issues related to low awareness (Scholz et
al., 2008) and the need for public health
information awareness creation
(Karimuribo, 2007) these studies have not
empirically studied knowledge, attitudes,
awareness, and practices on OHA.
Obviously, for a precise interpretation of
disease dynamics and for the sake of driving
public policies, the need for substantial
knowledge on the consequences and causes
of some behaviours, human activities, and
lifestyles in ecosystems remains crucial
(Destoumieux-Garzón et al., 2018).
In cognisant of this, the government in
Tanzania introduced One Health Strategic
Plan (2015–2020). This plan is a guiding
document meant to summarize operations
and activities amongst diverse stakeholders.
It also intends to formulate and maintain
close collaboration between the sectors
towards preventing and controlling zoonotic
diseases. The plan further intends to ensure
that there is appropriate preparedness and
consistent and coordinated response in case
of a zoonotic event.
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In this context, the plan among other targets
at having One Health and related programs
to afford meeting prevailing and
approaching challenges through Training,
Advocacy, and Communication; Research
and Development; Surveillance; and,
Preparedness and Response (URT-
PMO,2015).
This strategic plan on One Health sets a
formal/institutionalized entry towards
creating and maintaining active
collaboration between the sectors. It is
worthwhile to note that the absence of a
participatory health policy that focuses on
multi-sectoral contributions has been
previously cited to be a major hurdle
towards One Health practices (Mbugi et al.,
2012). Little is empirically known on how
this plan has facilitated the enhancement of
KAPs under OHA.
This study was conducted in Morogoro
region, a region cited by The National One
Health Strategic Plan 2015 – 2020 under
potential routes of risk exposure due to the
identification of some incidences of
zoonotic diseases in the area (URT-PMO,
2015:16). In the same areas, studies
(Karimuribo, et al., 2005; Mgode et al.,
2014) have also identified the presence of
health risks. This article analyses KAPs
under OHA in selected wards in Morogoro,
Tanzania.
The study is within the context of the PEN-3
model which recognizes the role of health
education in empowering People, Extended
Family and Neighbourhood (PEN) to make
informed health decisions. Understanding
the knowledge, attitudes, awareness, and
practices of the people under OHA
contributes towards the creation of efficient
interventions to bridge knowledge gaps on
OHA. The PEN-3 cultural model comprises
of three primary domains: (1) Cultural
Identity, (2) Relationships and Expectations,
and (3) Cultural Empowerment. Each
domain includes three factors that form the
acronym PEN; Person, Extended Family,
Neighborhood (Cultural Identity domain);
Perceptions, Enablers, and Nurturers
(relationship and expectation domain);
Positive, Existential and Negative (Cultural
Empowerment domain) (Iwelunmor, 2014).
Under the Cultural identity domain, the role
of health education in empowering People,
Extended Family and Neighbourhood (PEN)
to make informed health decisions suitable
to their roles in their families and
communities is generally recognised.
Another domain of this model is
Relationships and Expectations which
encompasses Perceptions, Enablers, and
Nurturers (PEN).
Perceptions contain the knowledge,
attitudes, values, and beliefs, within a
cultural context, with the potential to
facilitate or obstruct personal, family, and
community motivation towards change.
(Airhihenbuwa, 1995; Airhihenbuwa and
Obregon, 2000; Yick and Oomen‐Early,
2009).
MATERIALS AND METHODS
Both quantitative and qualitative data were
collected in a cross-sectional study which
was conducted in Morogoro municipality
and Mvomero districts in Morogoro region
in Tanzania after institutional approval. A
structured questionnaire guide was
employed to collect data from consented
participants. The population for the study
included all households with livestock
species at Mvomero district plus the
medical, veterinary and environmental
Officers. In Morogoro district, the
population included all the households and
medical, veterinary and environmental
officers in the study area.
Data were collected from 1440 ( 729 and
711 respondents from Morogoro and
Mvomero respectively) , 80 Focus Group
discussions (FGDs) participants ( 40 from
Morogoro and the other 40 from Mvomero)
and 16 key informant interviewees (8 from
Morogoro and the other 8 from Mvomero
district).
The multi-stage sampling procedure was
used in selecting study units. The districts,
wards and villages/streets were purposively
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sampled, whereas simple random sampling
was used to select respondents.
The inclusion criteria for the wards at
Mvomero were those wards that pastoralists
were mostly residing, and for the households
are those having animals being kept and
selling of livestock products to Morogoro
urban. Those wards which were included in
the study from Morogoro were those from
areas products from Mvomeral districts were
sold, these are the wards where meat
(particularly offals – utumbo in Kiswahili)
and milk vending by Maasai from Mvomero
district has been taking place. These traders
are popular in the area as Wang’ombe and
Baba Yeyo. Four wards were purposively
selected (two per district).
The selected wards were Doma and Melela
wards in Mvomero district, also Mazimbu
and Kihonda Maghorofani in Morogoro
municipality. Thereafter two villages/streets
were purposely selected from the four wards
making a total of eight villages/streets in the
Mazimbu ward as well as at Msamvu B and
Maghorofani in Kihonda Maghorofani.
To estimate sample size, a 95% confidence
interval (CI), a margin of error of 5%, and a
design effect of 1.5 were assumed. A
statistical estimation method of Kelsey et
al., (1996) was employed to calculate the
minimum adequate sample size. A sample
size of 1440 respondents was determined by
using the formulae:-
𝑆 = 𝑋2𝑁𝑃(1 − 𝑃)
𝑑2(𝑁 − 1)+ 𝑋2𝑃(1 − 𝑃)
Where: S = required sample size, X2 = the
table value of chi-square for 1 degree of
freedom at the desired confidence level
(3.841), N = the population size, P = the
population proportion (assumed to be .50
since this would provide the maximum
sample size), d = the degree of accuracy
expressed as a proportion (.05).
Sample size was calculated from the total
population of each 2 purposive selected
villages/streets from a ward. After obtaining
the total sample for each ward, the
proportions for each village/street from the
total sample was calculated. The sample size
was then distributed in the identified study
villages/streets. IBM-SPSS v20 was used for
computing frequencies, percentages, mean
and maximum scores.
Measurement of knowledge
To assess knowledge on OHA, the
respondents were supposed to indicate their
disagreements or agreements to twenty-two
(22) attitudinal statements that described
certain aspects of OHA. Half of the
statements administered had negative
connotations while the other half had
positive connotations. From the statements,
an index score for each respondent was
constructed to measure their knowledge on
OHA.
For all positive statements, the response
“Strongly Agree” was given a weight of 5,
while “Agree” was given a weight of 4,
“Undecided” was given a weight of 3 and
“Disagree” was given a weight of 2 and
“Strongly Disagree” was given a weight of
1. For all the negative statements, the
response “Strongly Agree” was given a
weight of 1, while “Agree” was given a
weight of 2, “Undecided” was given a
weight of 3 and “Disagree” was given a
weight of 4 and “Strongly Disagree” was
given a weight of 5.
Using IBM-SPSS (v20) under percentile
values, knowledge on OHA scores were cut
into 3 equal groups. Percentile values were
used to categorise knowledge on OHA.
Knowledge on OHA was categorised into
Inadequate OHA Knowledge (IOK) for
those who scored below 106.00, Marginal
OHA Knowledge (MOK) with scores
ranging between 106.00 to 114.00 and
Adequate OHA Knowledge (AOK) with
scores above 114.00.
Attitudes towards OHA
Attitudes of individuals towards OHA were
gauged using thirty eighty (38) statements
describing various practices related to OHA
identified through literature review. To
assess the attitudes of respondents towards
OHA, the Likert scale was employed. Of the
thirty eighty (38) statements administered,
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half of the statements had negative
connotations while the other half had
positive connotations. The weighting of
scores for positive statements were 5 points
(Strongly Agree), 4 points (Agree), 3 points
(Undecided ) 2 points (Disagree) and 1 point
( Strongly Disagree) . From the statements,
an index of the score for each respondent
was constructed to measure the attitude of
respondents towards OHA.
To categorise attitudes towards OHA, IBM-
SPSS (v20) was employed to cut the scores
into 3 equal groups. For those who scored
below 112 were categorised into
unfavourable (negative), for those scoring
112 to 117 into neutral (undecided) and
those above 117 into favourable (positive)
Attitudes towards health behaviours.
Awareness on the Concept and Practices
on OHA
For the purposes of investigating
respondents’ awareness of OHA,
respondents were asked to indicate whether
they had ever come across the concept and
practices related to OHA. This required the
respondents to simply say ‘yes’ or ‘no’ to
indicate their awareness of the concept and
the practices. The responses were recorded
as 0 and 1 for No and Yes respectively. This
created a dummy variable.
The respondents were also asked about their
awareness of medical, veterinary and
environmental personnel collaborations and
technical collaboration on diagnosis and
surveillance of diseases in the study area. A
Yes or No response was recorded from this
question.
RESULTS
Socio-Demographic Characteristics of the
Respondents
Table 1 presents the respondents’ socio-
demographic characteristics. Results reveal
that the highest group 29.2% (95% CI:
23.3% to 35.0%) were between 30 to 39
years and the lowest group which formed
3.8% (95% CI: 1.7% to 6.2%) were above
70 years. The mean age was 43.7 years
(95% CI: 42.1 to 45.3 years), and the highest
age and the lowest age were 21 and 72
respectively.
It is indicated that 47.9% of the respondents
were men (95% CI: 41.3% to 53.7%) and
52.1 % were women (95% CI: 46.3% to
58.8%). Slightly more than one-third
(39.2%; 95% CI: 32.9% to 44.6%) had no
formal education, and 30.0% (95% CI:
25.0% to 36.2%) completed primary school
education.
Of the interviewed respondents, the majority
57.5% (95% CI: 50.9% to 63.8%) of the
respondents were married. The average
household size was 5 (95% CI: 4.9% to
5.4%) members, the lowest household size
(minimum) had 1 member and the highest
household size (maximum) with 10
members. About 62.9% of the interviewed
households had 1 to 5 members.
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Table 1. Socio-Demographic Characteristics of the Respondents (n=1440)
Variable
Categories
Percentage
Age in Years
21-39
40-49
50-59
60-69
>70
42.1
26.3
17.1
10.7
3.8
Level of Education
Not gone to school at all
Universal adult education
Primary school
Secondary school
Post-secondary /vocational
University
39.2
2.5
30.0
8.8
10.4
9.2
Sex
Male
Female
47.9
52.1
Marital Status
Never married/Single
Married
Separated
Widow
Widower
Cohabitating
Too young to marry
30.4
57.5
1.7
5.4
2.5
0.8
1.7
Household Size
1-3
4-7
> 8
21.7
65.9
12.4
Knowledge on OHA
Table 2 presents OHA knowledge into
categories, the results indicate that 37.8%
(95% CI: 35.7 to 40.9) of the respondents
had IOK, 29.9 % (95% CI: 26.4 to 31.3)
with MOK, and 32.3% (95% CI: 30.3 to
35.3) had AOK
Table 2. OHA Knowledge categories (n=1440)
OHA Knowledge Categories
Frequency
Per cent
95% Confidence Interval
Lower and upper bound
Inadequate OHA Knowledge (IOK)
544
37.8
35.7 40.9
Marginal OHA Knowledge (MOK)
431
29.9
26.4 31.3
Adequate OHA Knowledge (AOK)
474
32.3
30.3 35.3
Total
1440
100.0
Table 3. Awareness on OHA Concept and Practices
Response
Frequency
Per cent
95% Confidence Interval
Lower Bound
Upper Bound
Not aware
1368
95.0
93.8
96.0
Aware
72
5.0
4.0
6.2
Total
1440
100.0
100.0
100.0
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Table 4a. Medical, Veterinary, and Environmental Personnel Collaborations
Response
Frequency
Per cent
95% Confidence Interval
Lower Bound
Upper Bound
No collaboration
72
5.0
3.9
6.2
Collaborated
54
3.8
2.8
4.8
Unaware of such collaboration
1314
91.3
89.7
92.7
Total
1440
100.0
100.0
100.0
Awareness on the Concept and Practices
Related to OHA
The findings in Table 3 indicate that only
5% (CI 95%, 4.0 to 6.2) of the respondents
were aware of the concept of OHA. The
results in Table 4a reveal that only 3.8% (CI
95%, 2.8 to 4.8) of the respondents were
aware, with the majority of the respondents
(91.3%: CI 95%, 89.7 to 92.7) were not
aware on the ways in which these
professionals collaborated in the study area.
The results in Table 4b indicate that only
2.5% (CI 95%, 1.7 to 3.3%) were aware of
some technical collaboration on diagnosis
and surveillance of zoonotic or non-zoonotic
diseases.
Table 4b. Awareness on Technical Collaboration on Diagnosis and Surveillance of Diseases
(n=1440)
Responses
Frequency
Per cent
95% Confidence Interval
Lower Bound
Upper Bound
Not aware
1368
95.0
90.3
99.8
Aware
36
2.5
1.7
3.3
N/A
36
2.5
1.7
3.4
Total
1440
100.0
100.0
100.0
Attitudes towards OHA
Table 10 presents attitudes towards OHA
into categories, whereas only 38.5% (95%
CI: 32.6 to 37.5) of the respondents had a
positive (favourable) attitude towards OHA.
Table 5. Categories of Attitudes towards OHA (n=1440)
Frequency
Per cent
95% Confidence Interval
Lower Bound
Upper Bound
Favourable (positive) attitude
554
38.5
32.6
37.5
Neutral (undecided) attitude
454
31.5
32.5
37.4
Unfavourable (negative) attitude
432
30.0
27.6
32.4
Total
1440
100.0
DISCUSSION
This study identified low collaboration
between human and animal health sectors. A
similar observation has been made by
Mwinyi et al., (2015: 30) who claim that
“One Health in terms of collaboration,
particularly between human and animal
health sectors to prevent and control
zoonoses has been low while the sectors
have a lot of things in common”.
Furthermore, in line with our findings, URT-
Prime Minister’s Office (2015)
acknowledges low awareness on OHA, as it
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is revealed in One Health Strategic Plan
2015 – 2020. Low awareness on OHA is
also partly acknowledged by URT-
MoHCDGEC (2017: 18) as it reports
“limited coordination and collaboration
between the health sector and other sectors
as well as participation of non-state actors in
addressing emerging and re-emerging
diseases”. Limited collaboration among
sectors and low awareness on OHA is is not
surprising as OHA is reported to be at its
initial stages in various parts of the world
(Miller and Olea-Popelka, 2013). Other
factors likely to contributes to the limited
collaboration between sectors and
professions, is lack of institutionalization of
OHA in day to day operations
Generally, the above findings in the study
area is an indication that much has not been
realized through One Health Strategic Plan
which among others, continues to evolve,
enhance, and refocus One Health
programmes to meet current and future
challenges. Since this plan is a guiding
document aiming at summarizing operations
and activities among various stakeholders, it
is important to establish the best ways to
reach a wider audience. There are common
understanding that once common people are
aware and knowledgeable on OH issues the
burden of zoonotic diseases will be reduced.
For instances, study by Mwinyi et al (2015)
revealed that (98.5%) of the respondents
claimed that they would support OHA to a
large extent and 1.5% said that they would
just support the institutionalisation of One
Health practice.
Despite all these drawbacks, Tanzania has
already put in place enabling environment
for the effective collaboration between
various professionals towards attaining
optimal health for humans, animals and the
environment. Tanzania’s 5-year One Health
Strategic Plan (2015–2020) is the country’s
first national One Health strategic plan
developed using a multi-sectoral approach
and has drawn expertise from various
sectors reflecting a shared commitment to
enhanced collaboration among human,
animal, and wildlife health sectors to reduce
the burden of zoonotic diseases. It,
therefore, it is necessary that stakeholders
make an extra effort to realize the desired
goals in terms of scaling up collaboration
among professionals and other actors to
raise the knowledge, awareness, attitudes,
and practices (KAPs) on One Health
Approach (OHA).
ACKNOWLEDGEMENTS
This study was partly financed by European
Union through the Intra-ACP Academic
Mobility Scheme. The authors extend their
thanks to colleagues at the Department of
Development Studies at Sokoine University
of Agriculture in Tanzania and the
Department of Population Studies at the
University of Zambia who provided
numerous inputs at the preliminary level of
the study.
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