Access to this full-text is provided by CABI.
Content available from CABI One Health
This content is subject to copyright. Terms and conditions apply.
One Health
RESEARCH METHOD AND PROTOCOL
Development of a protocol for using
geo-trackers to identify zoonotic enteric
pathogen transmission pathways in a pilot
study in Kenya
Phylis J. Busienei 1* , Sheillah Simiyu 1 , Daniel K. Sewell 2 , Abisola Osinuga 3 and Kelly K. Baker 4
Abstract
Humans and animals can be exposed to fecally-transmitted pathogens in both private and public domain environments. Animals
may also acquire pathogen infections from these two environments and transmit them to humans through different pathways.
Evidence on how often and where interactions occur between the two environments could improve the effectiveness of public health
programs for preventing zoonotic disease transmission and response to disease outbreaks. This study aimed to develop a protocol
for using geo-trackers to measure the spatial-temporal movement and interaction between animals and children in households
and public areas in low- and middle-income categories of urban neighbourhoods in Kenya. It also aimed to identify opportunities
and challenges for the scale-up of these methods’ for surveillance of other zoonotic diseases of public health significance. One
commercial geo-tracker device with the best technological performance and usability that met pre-defined criteria for the study
context was identified. Community engagement meetings were then conducted to gather input on a proposed study protocol.
Afterwards, infants and animals were geo-tracked in 10 households in urban informal settlements of Kibera and Jericho, Nairobi
over two consecutive weeks with iterative improvements to protocols. The effectiveness of the geo-tracking exercise was evaluated
through in-depth interviews with Community Health Volunteers (CHVs) and infant caregivers. Animal and infant behaviour and
battery reliability of the geo-trackers were also monitored; and observed opportunities and challenges in implementing the protocol
during the exercise were documented. Community members were receptive and accepted the use of geo-trackers on animals and
children. In pilot testing, there was no change of behaviour from 10 infants tracked. Discomfort was observed for up to 30 min after
the placement for some of the seven animals tracked, but the animals quickly adjusted. The battery for all geo-tracker devices
lasted for the 24-h geo-tracking period. Some caregivers and CHVs were concerned whether the geo-trackers could record
personal information. It was shown that geo-tracker devices can be successfully deployed to study animal-child interactions and
movement in different categories of urban neighbourhoods. Recommendations have been made on the lessons learnt from the
study to help scientists who would use geo-trackers for future community-based human and animal research.
One Health impact statement
Assessing human and animal risks of acquiring enteric infections from environmental contamination, or contributing to pathogen
contamination of the environment requires understanding spatial-temporal patterns of human and animal movement between private
households and the community. Movement of domestic animals is relevant for understanding household-community spatial patterns
of pathogen transmission because animal ownership and contact with humans is common, and free-roaming animals carrying enteric
pathogens can spread diverse faecal pathogens between environments. The community-based participatory research approach of
this study evaluated implementation feasibility from the lens of technical usability and reliability of geo-tracking devices, as well as
social acceptability and ethics related to using such devices for the community-based study of human and animal subjects in urban
settings. Evidence and recommendations from this study will be useful to anyone interested in understanding human-animal-environment
interactions and their contributions to infectious disease transmission.
Keywords: geo-tracking , zoonotic enteric pathogens , human-animal-environment interfaces , One Health , urban Kenya
Busienei et al.
CABI One Health (2024) 3:1
https://doi.org/10.1079/cabionehealth.2024.0011
Affiliations: 1 African Population and Health Research Center, Population Dynamics and Urbanization Theme , Nairobi , Kenya ;
2 The University of
Iowa, Department of Biostatistics , Iowa City, IA , USA ; 3 The University of North Carolina‚ School of Medicine, Center for Health Equity Research ,
Chapel Hill, NC , USA ; 4 The University of Iowa College of Public Health, Department of Occupational and Environmental Health , Iowa City, IA , USA
* Corresponding Author: Phylis J. Busienei. Email: pbusienei@aphrc.org
Submitted: 20 November 2023. Accepted: 01 April 2024. Published: 06 May 2024
© The Authors 2024. Open Access. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits use, sharing, adaptation, distribution
and reproduction in any medium or format, as long the use is non-commercial and you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons
licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit
line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need
to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc/4.0/. 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 in a credit line to the data.
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 2
Introduction
Children can be exposed to enteric disease-causing pathogens
through multiple inter-related environmental exposure pathways
(Baker et al., 2023). However, efforts have primarily focused on
enhancing domestic hygiene practices, including safe disposal of
human waste, food hygiene, and proper handwashing techniques,
as effective measures to alleviate the global burden of diarrheal
diseases in children (Curtis et al., 2000; Ngure et al., 2014;
Bawankule et al., 2017; Cumming et al., 2019; Baker et al., 2022).
Recent studies have highlighted that existing Water, Sanitation,
and Hygiene (WASH) interventions at the household level may not
effectively address all potential pathways through which pathogens
are transmitted to infants (Medgyesi et al., 2018a). Even in multi-
armed WASH interventions, reported cases of diarrheal disease
prevalence in children persist (Cumming et al., 2019). This could
potentially be due to the transmission of pathogens through
unmanaged trash dumping and inadequate disposal of human and
animal excreta in public spaces where children often play (Curtis
et al., 2000; Medgyesi et al., 2018a). Increased spatial movement
of children around the community, such as through social play
groups, increases the probability of children ingesting new types of
pathogens species from public environmental fomites (Medgyesi
et al., 2018a, b).
Persistent enteric disease burden in children may also be due to
zoonotic transmission of pathogens. Globally, the risks of zoonoses
account for more than 60% of all human diseases (CDC, n.d.;
Taylor et al., 2001). Africa experiences a higher emergence and
re-emergence of these diseases, which are a growing concern as
communities are not always prepared to detect and prevent them
(Neiderud, 2015; Lambertini et al., 2016; Allen et al., 2017; Delahoy
et al., 2018; Asante et al., 2019). For instance, between 2012
and 2022, there was a 63% increase in the number of zoonotic
outbreaks (WHO Africa, 2022). A systematic review reported that
children younger than 5 are at high risk of acquiring zoonotic
pathogens from domestic animals, including enteric infections
(Cherniack and Cherniack, 2015). This could be attributed to
the fact that children under 5 years often play in close proximity
to animals and practice normal early childhood development
behaviours like crawling on the ground and mouthing hands or
environmental objects that could lead to pathogen ingestion (Moya
et al., 2004; Brüssow, 2023).
Domestic animals are vulnerable to enzootic and anthroponotic
transmission of the same pathogens and could play an important
role as vectors that facilitate the spatial movement of pathogens
between communities and households. In many settlements, they
are often allowed to roam freely in community areas to forage for
food, allowing them to excrete an array of pathogen species across
many different neighbourhood locations, posing a public-health
threat when humans ingest these pathogens (Jenkins et al., 2009;
Baker et al., 2018). Studies on where roaming animals acquire
enteric infections were lacking but it was plausible that they get
infected by ingesting contaminated water, food, and soil in these
public domain areas. They could then bring pathogens back into
the household, increasing the risks of pathogen transmission
to humans. Another systematic review of 29 studies found a
positive association between domestic animal exposure and
diarrhoea. Domestic exposure to poultry results in a substantial
association (three times the odds) of being infected with human
campylobacteriosis (Zambrano et al., 2014).
With increasing global urbanization, new challenges are arising
for global health and the epidemiology of infectious community-
and zoonotically-acquired diseases (Han et al., 2016). Rapid
urban growth in low- and middle-income countries (LMICs) in the
past 50 years has caused sprawling informal settlements (slums)
that are now home to more than half of the population in cities
such as Mumbai, India; Nairobi, Kenya; and Mexico City, Mexico
(UN-Habitat, 2003). Slums are typically unhealthy places with high
risks of infection and injury, with children especially vulnerable
to a combination of malnutrition and recurrent diarrhoea, which
are linked to stunted growth and longer-term effects on cognitive
development (Ezeh et al., 2017). Further, informal settlements
can be incubators for new epidemics, and with their growth in
population, zoonotic diseases can spread more rapidly and become
serious public health threats (Neiderud, 2015). Limited space in
urban areas brings domestic companion animals, livestock, and
poultry closer to human beings on a more frequent basis.
Due to environmental, cultural, and economic factors, some
households allow their animals to roam freely in the yard and sleep
within the house at night to prevent theft (Barnes et al., 2018a).
This can result in increased direct contact between animals and
people and their faeces, increasing the potential for subsequent
transmission of zoonotic enteric pathogens. In Kisumu, household
animal ownership and observation of animal waste are associated
with 30–38% higher levels of enterococcus bacteria in drinking
water, highlighting the potential role for animals in indirect microbial
transmission as well, especially among the urban poor with limited
space for separate animal and human living space (Barnes et al.,
2018b).
Efforts to identify the origins and causes of endemic disease such
as cholera and diarrhoeal diseases as well as emergent disease
transmission, and the locations from which novel diseases are
most likely to emerge, are valuable for focusing surveillance,
prevention, and control programs on early containment of infectious
diseases and limiting their subsequent spread and socio-economic
impacts (Jones et al., 2008). Unlike in rural agricultural settings,
understanding the spatial movement patterns of humans and
animals and the interactions between humans, animals, and the
private versus public domain environments that could contribute
to zoonosis transmission are relatively unknown in urban settings
(Kurowski et al., 2021). These movements and interactions could
also vary between different seasons and host species (Floyd et al.,
2019). Geo-tracker devices have recently been used in health
research to track and map the location of children and observe
animal position and behaviour, although they are used most
often in animal research (Rakhimberdiev et al., 2016; Siegford
et al., 2016). Geo-trackers enable researchers to monitor device
movements remotely and in real-time, providing objective and
accurate information about the time, distance, and place of subjects
(Wall et al., 2014). Geo-tracking wild and domestic animals has
shown how the two types of animals can spread infections (Floyd
et al., 2019). The most common approach for identifying human
interactions with domestic animals is through self-reported survey
responses or structured observation of child-animal or child-
environment interactions in person or via videography (Bauza et al.,
2018; Medgyesi et al., 2018a, b). Limitations of these approaches
include response bias to survey questions, the potential for
caregiver or child behaviour and movement range to be modified
by the presence of an observer/camera, and the limited range
of view for cameras fixed in a specific location; which provides a
unique opportunity for Global Positioning System (GPS)-based
approaches.
Although GPS-enabled devices are increasingly used for spatial
research, the technology has limitations that need to be addressed
before considering it a “gold standard” for use on humans and in
crowded, heavily developed urban communities. For instance,
some studies have reported significant problems with loss of data
due to signal loss, loss of battery power due to short battery life,
and also poor participant compliance with the study (Kerr et al.,
2011; Beekhuizen et al., 2013; Silva et al., 2017; Floyd et al., 2019;
van Harten et al., 2019). There are also reported cases of total
signal loss or poor accuracy, typically due to signal reflection off
buildings (multipath effect) or shading by buildings or tree-cover
(Michael et al., 2006; Beekhuizen et al., 2013), which can result
in a significant positional error. There are also a limited number of
suitable tools to continuously track animal mobility, and this has
hindered the study of zoonotic spill-over and disease emergence
(Brüssow, 2023). Some studies have also reported ethical issues
with collecting GPS data (Rakhimberdiev et al., 2016). The greatest
concern of GPS geo-tracking is the amount of information that can
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 3
be deduced from the analysis of a person’s or animal’s movements
and the potential misuse of identifiable data.
To understand infectious disease dynamics and pathogen
transmission, there is a need to design and deploy reliable,
easy-to-use and culturally sensitive geo-tracking devices to
characterize animal-child interactions and mobility patterns (Paz-
Soldan et al., 2014). Developing novel approaches combining
public health research and geo-tracking technology provides new
opportunities to reveal the spatiotemporal dynamics of infectious
diseases and determine the processes responsible for their spread
and prevention (Jones et al., 2008). This study was designed to
develop a protocol of using geo-trackers to map infant and animal
movements in middle-income and low-income neighbourhoods
in urban Kenya. The study was part of a parent PATHOME study
that geo-tracks the movement of children and domestic animals
to understand household and neighbourhood spatial patterns of
pathogen transmission at the animals-infant-environment interface
(Baker et al., 2023). This protocol article discusses the successful
methodological procedures tested for using geo-tracker devices
on infants and animals, addressing concerns such as safety,
national security implications, and reactions of participants. The
study also highlights observed challenges, lessons learned, and
recommendations for future adoption of this method in public
health research. The findings of this study validate the chosen geo-
tracker protocol in the parent study and provides a valuable tool for
use in a variety of other public health studies.
Methods
This mixed-methods study consisted of geo-tracking animals and
infants and stakeholder (household/community) engagement
meetings. A systematic approach for developing geo-tracking
protocol was followed to: (i) Identify and evaluate commercially
available geo-tracker devices and harness materials, geo-tracking
methods for both infants and animals that could be adopted for
the study in urban Kenya; (ii) A stakeholder engagement meetings
was conducted to introduce the geo-tracking method in health
research and gather input on the feasibility of the application of the
technology and acceptability by households and local community;
(iii) A 24-h pilot study of geo-tracking infants and domestic animals
found within the household compound to test the willingness of
infant caregivers to participate in the study, determine proper
harnessing and effective recovery of all geo-tracker devices
after 24 h, and ensuring that devices would be left on infants and
animals for at least 50% of 24 h to measure their effectiveness;
(iv) Technical and data management aspects of protocol design,
such as the operation of the device over an observed 24-h time
window, battery power upon the 24-h recovery mark, and the ability
to recover spatial data about the wearer were then evaluated.
Households were enrolled over 2 weeks, and protocols were
iteratively improved between weeks based on experiences; and
(v) Finally, exit interviews among caregivers and CHVs were
conducted to document their experiences and recommendations
for improvement.
IDENTIFICATION OF ANIMAL HARNESSES AND GEO-
TRACKING TECHNOLOGY
Geo-tracker devices were identified by first developing a list
of required eligibility criteria that would allow us to use them on
infants and domestic animals for at least 24 h in an urban low- and
middle-income study context. Eligibility criteria were defined as low
upfront and operating cost; small size and weight for the comfort of
smaller animals (less than 5% of body weight); minimal interference
with animal performance and behaviour (Paci et al., 2020); long
battery life (at least 24 h); device communicates with satellite
and cellular networks to support real-time monitoring of device
location (Bindi et al., 2011); device functions with cellular service
of 2G or better network to be usable in many geographic settings;
real-time monitoring of device geolocation supported through web
and/or mobile interface; company reports the accuracy of device
GPS coordinate estimation for indoor and outdoor locations (Frair
et al., 2010); the company offers customer service; the user can
access and retrieve stored date, time, and GPS coordinate data;
and strength of consumer reviews. The study team then searched
published literature describing the use of geo-trackers for human
and animal spatial research to identify validated geo-tracking
tools and protocols, followed by an internet search for commercial
products that met the defined criteria for the proposed study (Klune
et al., 2021).
Harnesses for fixing geo-trackers to cats, dogs, chickens, and small
ruminants were selected from commercially available products
based upon the advice of the veterinarians serving on our animal
research Institutional Animal Care and Use Committee (IACUC)
review board. The study team aimed to use harnesses rather than
collars due to the smaller size of animals to be geo-tracked and the
ability of harnesses to provide more options for placing the geo-
tracker on an animal’s body to minimize discomfort. In the case of
cats, from the literature search, animal safety regulations require
that those involved use a breakaway harness that allows a cat to
escape the harness if caught (e.g., on fencing or in small holes)
(Animal Care and Use Committee, 1998). Two different makes and
models of harnesses in different sizes were purchased for each
type of species, except dogs and goats, which can wear the same
harness for pilot testing.
A short list of harnesses and geo-trackers was tested for usability
and feasibility through a child-led educational activity at a local
primary school in Iowa, USA. The study team provided the
school with a selection of harnesses and two geo-tracker devices
identified through the literature and internet search and asked the
school to place harnesses with geo-trackers on animals that were
accustomed to being handled by humans. The children, alongside
their teacher, observed animals’ wearability experience (potential
signs of discomfort, acclimatization period), harness failures and
data recording patterns on multiple domestic animals (dogs, cats,
goats, and chicken). Through periodic listening sessions held with
the children, the pros and cons of selecting each of the harnesses
and geo-trackers were identified, including corrective actions
to deal with the inadequacies of the devices when applicable.
Their likes and dislikes of harnesses and geo-trackers and any
observations of animal species exhibiting signs of discomfort or
distress while wearing them were documented. If they disliked a
product and found an alternative or needed a different size, their
requested materials were delivered and their preferred harnesses
or geo-trackers were documented. The possible geo-trackers and
commercial harnesses to be used were evaluated according to the
criteria listed in Table 1.
STAKEHOLDER ENGAGEMENT MEETINGS
To document the views of the relevant stakeholders on the geo-
tracking exercise, three meetings (one at the national and two at
the community level) were conducted prior to the beginning of data
collection. Stakeholders from the WASH sector were identified
using a pre-existing list from the African Population and Health
Research Center (APHRC). Relevant feedback regarding the
acceptability of the geo-tracking technology by households/infant
caregivers from the stakeholder and community engagement
meetings were generated. Notes from these meetings, including
safety concerns, were documented for consideration while adopting
similar exercises in future. Following the stakeholder’s feedback,
the study team conducted a meeting to discuss and consider the
views for further refinement of the geo-tracking protocol.
TWENTY-FOUR HOUR GEO-TRACKING PILOT STUDY
AND DATA COLLECTION PROCEDURES
This pilot study was conducted in low- (Kibera) and middle-
(Jericho) income urban neighbourhoods of Nairobi, Kenya. These
two areas were selected because of their use as study sites in
the parent study comparing enteric disease transmission pathways
across neighbourhoods representing contrasts in socio-economic
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 4
development contexts. While both neighbourhoods are urban
areas of Nairobi, Kibera has much denser levels of infrastructure,
higher population density, and more households living in poverty,
all of which could influence the acceptability and feasibility of a
geo-tracking study of humans and animals (Kraff et al., 2019;
Filippi et al., 2020; Odeny, 2020). In addition, there are some public
space available in Jericho as opposed to dense environments in
Kibera which could also influence the signal.
PARTICIPANT ELIGIBILITY, RECRUITMENT, AND
INFORMED CONSENT
With the help of Community Health Volunteers (CHVs), 10
caregivers and their infants aged between 1 week and 12 months
were identified, consented and enrolled as in the parent study by
Baker et al. (2023). Other than infant age and household location
in the study neighbourhood, there were no other inclusion or
exclusion criteria. For animals, domestic animals (n = 7) likely
to come in contact with the infants or near the households were
included. These included pets such as dogs and cats, poultry such
as chicken and ducks, and livestock such as sheep or goats.
Prior to study implementation, informed consent was obtained
for collecting 24-h GPS geo-tracking data on the child and any
domestic animal owned by the child’s family and their participation
in an exit interview from all the participants. The consent form
also had an information sheet detailing the purpose of the study
and the procedures involved, including the geo-tracking exercise.
Caregivers were allowed to read and sign the consent form, and
for those unable to do so, the forms were read to them by the
enumerators in their preferred language in the presence of a
witness and signed by the caregiver with signature or thumbprint
and by their CHV representative. A copy of the consent form was
left with the caregiver for their records.
CHILD AND ANIMAL SPATIAL GEO-TRACKING
PROTOCOL
To remotely sense and measure the spatial-temporal movement
of children and animals between household and public areas,
lightweight, GPS-enabled geo-trackers were used to track the
movement of one child and one domestic animal for at least 24 h.
Before visit
The PATHOME study team conducted a series of stakeholder
engagement activities at the national and community levels in the
selected study areas to provide an overview of the study and get
stakeholder feedback before commencing the study. Feedback
was used to refine protocol details. Before visiting the selected
households to track both the infant and the animals, the enumerator
and the caregiver had to agree on the most appropriate time to start
the tracking. All the geo-tracker devices had to be fully charged
before issuing to the enumerators. They were to remain off until they
had been placed on the child or the animals to avoid the generation
of GPS coordinates that were not caused by subject movement.
First day
Upon arrival at the caregiver’s home, the enumerator was required
to inform the caregiver about the purpose of the research and the
need for placing the geo-tracker device on the infant and the animal.
The enumerator also answered any concerns of the caregiver and
reconfirmed their willingness to participate in the study. As part of
the consenting process, the caregiver was informed that the geo-
tracker would be placed on the child and recovered after 24 h for
reuse. The caregiver was asked to propose a comfortable location
where the geo-tracker would be placed on the child. If domestic
animals were present within the household, the enumerator would
request to place the geo-tracker on the child and the animal (in
cases of one animal) or ask the caregiver to identify animal that
the infants were most likely to interact with (in cases of multiple
animals). At this point, the geo-trackers were turned on, as verified
by the green light next to the button on the device.
For infants, enumerators and caregivers attached the GPS geo-
tracker within the child’s clothes, pocket or any other caregiver-
preferred location and where it would be unlikely to be removed or
cause distress to the child. After each placement, the enumerator
Table 1. Harness and geo-tracking evaluation criteria.
Harness evaluation criteria
Animal acclimatization– no animals (chicken/cat/dog/goat) exhibited
signs of distress or pain after fitting the harness and observing for 30
min.
Animals fit – harnesses are easy for the user to fit animals, including
placing them over legs, heads, or other extremities and adjusting
sizing to fit snugly to the body. Harness girth or length can be
adjusted to the shape of individual animals. Animals cannot remove or
dislodge the harness.
Harness-geo-tracker connection – the geo-tracker could be securely
attached to the harness, and no devices fell off other than user error.
Colour/pattern – harnesses are available in animal-like colours that
may attract less attention in a community
Geo-tracker device evaluation criteria
Cost – the device and data collection and storage service combined
costs <= $150 as a one-time cost or per year
Safety – company describes safety information
Wearability – animals do not perceive devices as heavy or physically
obtrusive
Usability – persons placing the device can easily turn the device on
and off, and it is obvious that the device is on or off.
Durability – the battery life of all devices lasts for at least 24 h at a
high-frequency data transmission setting; it can be recharged and
reused multiple times
Value – the device can be programmed to connect with satellites and
transmit location at a frequency for 10 min for detecting rapid changes
in location
Spatial range – the device does not require a spatially-fixed receiver
and can be used to detect movement at household and community
levels.
Geolocation reliability – devices consistently transmit geolocation data
by communication with satellites as programmed, including estimating
GPS location when in indoor and outdoor settings
Implementation reliability – devices consistently transmit geolocation
and device operating conditions (e.g., battery life, malfunctioning) to
users through cellular networks.
Usability of web/phone interface – users can interact with web and
mobile phone app platforms to remotely geolocate and monitor device
location in real time and visualize device-specific movement patterns
with stored GPS coordinates and date/time data
Type and quality of data – the device itself or a remote server collects
and stores device-specific date, time, longitude, latitude, altitude, and
estimates of geolocation coordinate accuracy; GPS coordinate
accuracy is reasonable for indoor (<=10 m) and outdoor (<=3 m)
settings;
Company reliability – customer service is quickly available for support,
is responsive to customer needs, and delivers the product as
described; customer reviews are available and overwhelmingly
positive
Source: Hebblewhite and Haydon (2010); Klune et al. (2021).
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 5
observed the infant for signs of discomfort or pain and removed
and replaced the geo-tracker, if necessary, until both caregiver and
child were comfortable. Caregivers were then requested to ensure
that the geo-trackers stayed on the child during the recommended
period except during the night when the infants were asleep. If
the caregiver wished to remove the geo-tracker from the infant,
for example, to make them comfortable for sleep or to bathe them,
they were advised to put the geo-tracker next to the child but out of
reach and to remember to place it back when possible.
For animals, the geo-tracker devices were placed on an animal
species- and size-specific harness, which was then placed
according to the manufacturer’s recommendations on domestic
animals, such as chickens, ducks, cats, and dogs. Seven animals
were tracked as follows; Four chicken species, two dogs, and one
cat. To ensure animal welfare, the harness was used to distribute
the weight of the geo-tracker (about the weight of a size D battery)
and maximize comfort for the animal. All animals were apparently
healthy adults or older adolescents of their species to ensure that
the weight of the geo-tracker was not a burden on the animal.
Geo-trackers were placed on harnesses on the thickest part of the
animals, usually the chest or back, such that it does not inhibit
the animal from normal activities. Animal owners assisted during
restraining of the animal for harness placement to reduce distress
by being handled by an unfamiliar person. Each animal owner was
also required to verbally confirm the harness was fit safely for the
animal. The enumerators then observed their behaviour for 30 min
to monitor for signs of lasting pain, illness, or distress per animal-
specific indicators as identified by IACUC (Iowa, n.d.). For animals
that showed discomfort for more than 30 min, the geo-trackers
were removed and the process was stopped if a second animal
was unavailable. Caregivers were asked to treat their animals
according to routine practice and the enumerator retrieved the
harness the next day, after geo-tracking for 24 h. Like in the case
of the infants, the animal geo-trackers were retrieved for reuse.
Second day
Enumerators returned to households the next day in the afternoon
to perform a 5-h structured observation of the infant behaviours
such as proximity to domestic animals, touching, and mouthing
behaviours (not described for this manuscript) prior to the 24-h time
point when the geo-trackers were to be removed from the infant
and animal. Upon arrival, the enumerator had to confirm that the
geo-tracking device was still placed on the child. If the device had
been removed, the enumerator documented when it was removed
and the reasons why it was removed and asked if the device could
be placed on the child again. If the device needed to be placed
newly on the child and the caregiver did not object or refuse, the
enumerator noted the date and time the device was placed on the
child or animal again. The exercise was repeated on 10 infants
to confirm that all devices could be recovered. The devices were
always checked whether they were detected by satellites during
the observation window by checking through the web app, and that
all devices could be left on infants for at least 50% of the time,
to confirm that the potential of logging the time windows when
devices and infants are not linked and that the devices were still
on with battery power upon the 24-h recovery mark. If the devices
were off at any given point, the field team checked the devices for
any issues that could have resulted in them being off.
During the second day of geo-tracking for the animals, the owners
were asked to verify whether the devices were removed (not
located within 1 m from the animal) or removed and replaced from
the animal and, if so, at what times and why. They were also asked
to identify all locations where animals were within the household,
compound, public area during the time window and whether they
observed animals attempting to remove harnesses themselves.
The exercise was repeated for the seven animals to confirm that
the researchers could recover all devices and that all devices were
left on animals for at least 50% of the time. Similar to infants, this
also confirmed that the researchers could log the time windows
when devices and animals were not linked and that the devices
were still on with battery power upon the 24-h recovery mark. The
field team were asked to check the devices if the web app showed
that they were off at any given time within the tracking period.
EXIT INTERVIEWS WITH COMMUNITY HEALTH
VOLUNTEERS AND STUDY PARTICIPANTS
Using a guide, in-depth interviews (IDIs) were conducted with
selected caregivers and CHVs a few days after the completion
of the geo-tracking exercises at the specific households. The
respondents were selected purposely based on their willingness
to participate in the study. In total, eight caregivers (n = 8) and four
CHVs (n = 4) were selected for the interviews from each study
site. The questions aimed to get insights from the respondents
on the safety of the geo-trackers in infants and animals and
recommendations for improvements (Supplementary Materials:
Additional File 3). The interviews were recorded, transcribed,
and thematically analysed to understand caregivers’ perceptions
of the geo-trackers used, experience with the geo-tracking
process, challenges faced and feedback on how to improve the
geo-tracking process for the larger study. Interview data was
coded deductively based on emerging themes. The interviewees
recommended areas of improvement to the geo-tracking process
and these were submitted to the study team for discussion and
implementation.
Results
IDENTIFICATION OF ANIMAL HARNESSES AND GEO-
TRACKER TECHNOLOGY
The pilot evaluation of wearable harnesses and geo-trackers
identified several parameters/characteristic features related to
harnesses and geo-tracking technology that are important for
selection and ensuring of the harnesses and geo-tracker use as
intended and in obtaining reliable geolocation data.
Harnesses
• Appearance: Most harnesses came in bright colours, so there
was nothing that could be done to reduce visibility and
stemming curiosity from onlookers/other community members.
• Wear mechanism: Harnesses for goats, chickens, and dogs
are typically easier to put on than harnesses for cats. It is
recommended that cat harnesses are designed to be stepped
into and fastened over the back instead of over the head to
prevent scratches or bites. However, breakaway cat
harnesses can be difficult to find and are not consistently
stocked in stores.
• Adjustability: Animals can vary a great deal in shape and size,
so the adjustability of harnesses is critical and should
contextualize to animal breeds for each setting.
Geo-trackers
Market research to identify best product features
A market research and review of geo-tracking products commonly
used in wildlife research identified the strengths and weaknesses
(location accuracy and precision, costs and feasibility for field
deployment (Bindi et al., 2011)) of the various products and
identified which products best fit our research objective (Bradshaw
et al., 2007). At first, Radio Frequency Identification (RFID) was a
consideration because of its popularity and extensive applications
in animal geo-tracking/behavioural studies (Bindi et al., 2011;
Siegford et al., 2016). However, these devices were ruled out
because of their limitations, such as needing antennas, water or
metal affecting signal strengths, animals moving fast, or immobile
animals may be difficult to detect (Siegford et al., 2016; Alba et al.,
2019) after research-grade GPS loggers was considered. On
speaking to the manufacturers, limitations were discovered with
proceeding with these devices. For instance, the cost of each
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 6
device was between US$1500–1700 and they most likely require
an additional procurement of data receivers (a base station) to
download the data, which costs around US$1000.
Comparison of pet geo-trackers
Standard commercial-grade GPS receivers that are sold to track pets
were considered since most of the animals in the parent study are
domestic animals. Additionally, market availability of products meant
anyone in the global community could benefit from the adoption
of this geo-tracking tool. The study team went through a list of the
most-used, well-reviewed pet geo-trackers comparing the pros
and cons highlighted in the article (reliability, accuracy, battery life,
good user interface, cloud data storage, geolocation history, cost of
subscription, and multinational usability). Most geo-trackers did not
offer multinational usability. Two geo-trackers met the criteria for the
study: Bartun (no longer available) and Tractive (Available at: www.
tractive.com, accessed 10 September 2023). The Bartun price was
$77 upfront plus the cost of the cellular data plan. Tractive is $50 plus
a $108 per year subscription cost.
While Bartun allowed collecting location data on a 1-min basis,
repeat testing revealed that users had difficulty determining
whether Bartun was off or on since the device would often turn
itself off with no notice. In addition, the device did not communicate
reliable data about battery life, the instructions were difficult to
understand, and while customer service was responsive to our
requests for help, they could not resolve the problems.
The Tractive device was ranked no. 1 consistently across the years
and had the following strengths over other pet geo-trackers. It lasts
over 24 hours, supports the export of data, and, upon request, gives
access to a server with datasets containing our metadata so the
study team could obtain signal accuracy info. They also have very
responsive customer service and explicitly address safety on the
website. Specifically, the geo-tracker uses local cellular networks
to send data, and therefore it generates and uses electromagnetic
fields (EMF) like a cell phone, but less frequent signalling means
exposure is 10x lower than a cell phone. Also, it complies with
European and US “SAR” regulations designed for mobile phones.
The device proved reliable and was selected for use in this pilot
study and later for the parent PATHOME study. When in an indoor
setting, the device goes into rest mode but quickly comes back on
when the accelerometer in the device detects movement. Software
which has a good user interface can be easily available on mobile
phones and on the web.
FEEDBACK FROM STAKEHOLDER AND COMMUNITY
ENGAGEMENT MEETINGS
Of the 47 identified stakeholders invited to the meeting (held
virtually due to COVID-19 restrictions at the time), 25 stakeholders
were able to attend. Supplementary Materials: Additional File 1
shows the distribution of stakeholders from different institutions
who attended the meeting. Two other meetings were done at the
community level where the research took place and was attended
by administrative staff, the sub-county Ministry of Health (MoH),
the CHVs and the field interviewers from the specific study areas
(Fig. 1). There were a total of 19 and 14 stakeholders in Kibera and
Jericho, respectively.
Following the stakeholder engagement meetings, the views from
all the stakeholders were addressed and used to adjust the pilot
protocol, such as in determining where the geo-trackers should be
placed on both infants and animals. Table 2 summarizes some of
the resolutions proposed against the concerns of the stakeholder.
More information is available in Supplementary Materials:
Additional File 2.
GEO-TRACKING PILOT STUDY
The geo-tracking activities took place on 2 consecutive days over
a period of 2 weeks with 10 households with infants below 1 year
participating in the study; Six from Kibera and four from Jericho.
None of the 10 caregivers refused the application of geo-trackers
on their infants and animals. In seven households both animals
and infants were tracked, while only infants were tracked in three
households without domestic animals.
Preferences of placing the geo-trackers on infants
Caregivers personally fitted geo-trackers on infants (especially
those between the ages of 1 week to 6 months). Since caregivers
were first asked where they would prefer the geo-trackers to be
placed on the infants, several responses were received, ranging
from inside the pockets of the clothes worn by the infants, around
the waist, around the wrist or upper arm, and in between child’s
pants and diapers. Only one caregiver suggested placing the geo-
tracker around the upper arm or waist. However, after assessing
the device, it was determined to be too big for the infant’s arm
and uncomfortable when worn around the waist. With the help
of the enumerator, the caregiver agreed that placing the geo-
tracker between the child’s pants and waist area would be more
comfortable. Other areas suggested by the caregivers include
Fig. 1. Images of community engagement sessions in Jericho and Kibera, respectively.
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 7
placing the geo-trackers either inside the pockets of the clothes
or inside the socks worn by the infants. In total, four caregivers
preferred the geo-trackers to be placed inside the infant’s pockets or
socks while six preferred the geo-trackers to be placed between the
child’s pants and waist (Table 3). All the devices were still attached
to the same infant when enumerators returned the next day.
Infants’ reaction upon putting on the geo-trackers
No form of discomfort was observed from the infants under
observation after geo-trackers were placed inside the pockets of
the clothes worn, inside their socks or between the child’s pants
and waist. When the infant’s fell asleep, caregivers were allowed
to retrieve the geo-trackers from the infant’s clothes for comfort
but advised to keep the geo-trackers besides the infant/in close
proximity to where the infants slept (Fig. 2). There was also no
concern from the caregivers that was observed by enumerators as
caregivers moved on with their daily routine activities.
Preferred places of putting the geo-trackers on animals
Animal geotracking took place simultaneously with the infant
geotracking. Field staff placed harnesses on animals with the
support of caregivers. Animals tracked in this pilot study included
two dogs, a cat and four chickens (Table 4). Most caregivers
preferred the harnesses fitted with a geo-tracker to be placed
around the thoracic and abdominal area, which was more
comfortable for the animals than the neck area (Fig. 3). There were
no concerns or any alternative placement location suggested by
the caregivers or CHVs.
Animals’ reaction upon putting on the geo-trackers
Unlike the infants, cases of discomfort were reported among
the animals tracked. Findings from the data recorded by the
enumerators after fitting the geo-trackers indicated that the
enumerators and the caregivers struggled to fit the geo-trackers on
some animals. For instance, for the two dogs tracked, the owners
had to fit the harnesses themselves instead of the enumerators
since the animals were wild. There were no reported struggles
in fitting the harnesses and the geo-trackers on the chicken. As
reported, all of them showed some discomfort for about 30 min
of observation, after which they adapted. In one instance, the
geo-tracker had to be retrieved from one chicken as it could not
move. It was noted that the device and the harness might have
been too heavy hence a second animal (a chicken) was identified,
and the geo-tracker was fitted on it.
Geo-tracker acceptability
Observations revealed varied levels of acceptance among the
caregivers, where 50% (n = 5) embraced the geo-tracking exercise
at first point of interaction, while the other 50% expressed concerns
about consequences and believed that the geo-tracker could
record other personal information. For the latter, the CHVs had to
explain the geo-tracking procedures and address their concerns
once more to allow them to decide to participate in the study, after
which all agreed for their infants and/animals being tracked. In
addition, the CHVs engaged both the caregivers and their partners
and this seemed to increase the acceptability rate. The device’s
physical form (small and portable) also appeared to influence
acceptability by the caregiver. Most agreed that the device size
and shape were not likely to cause any physical harm to the infant
or animal, provided the device was fitted correctly.
Efficiency and effectiveness of the geo-trackers
The geo-tracking was done for 24 h on all infants and animals,
with no reports of battery depletion. After switching on the geo-
trackers, there were delays in some devices detecting the GPS
signal in both study areas before geo-tracking could begin. The
enumerators were advised to move to an open area by the door
of the household (within 5 m from the animal/infant) until the geo-
trackers obtained a GPS signal before fitting them either on the
infant or the animal. All the fully charged geo-trackers could last
for the entire 24-h duration stipulated by our draft study protocol.
Table 2. Top issues raised by stakeholders about participating in geo-tracking research and used for protocol modification.
Concern Action Resolution
The CHVs had concerns, including fear of not being able to
convince the caregivers to allow us to track their animals and
infants.
Yes The CHVs would inform the caregivers about geo-tracking
activities a week in advance. Enumerators would then obtain
informed consent on the day of geo-tracking. Caregivers have
the option to participate or drop out of the study at any time.
The security of the device, i.e., loss of both the geo-tracker and
the harnesses due to theft cases.
Yes Stray animals (with no identified owners were excluded from the
exercise).
Difficulty in caregivers choosing the appropriate and most
comfortable place for putting the geo-trackers on the infants and/
or animals
Yes Enumerators allowed caregivers to choose the placement of the
geo-trackers, only suggesting options if requested.
Whether the device would pose any health risk to the infant or the
animal being tracked.
No The geo-trackers did not pose any health risks, and caregivers
were advised to remove them only in cases of distress. This
information was included in the information sheet and consent
forms.
Possibility of animals changing their movement and behaviour
when such devices were fixed on them.
No The information sheet addressed this issue as it states that the
enumerator should observe the animal’s behaviour for 30 min and
retrieve the geo-tracker if the animal continues to show signs of
distress beyond that time.
Concern about the conspicuousness of the harnesses might draw
the curiosity of passers-by, who would end up touching or chasing
the animal, thereby interfering with its mobility pattern.
No Most harnesses come in bright colours, and the study team
could not find less conspicuous ones in the market.
Table 3. Caregiver’s preferred location for placing geo-trackers on infants(N = 10).
Site
inside the
pockets/socks
between the child’s pants
and waist
Kibera 3 (30%) 3 (30%)
Jericho 1 (10%) 3 (30%)
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 8
Geo-tracker loss
The field team recovered all devices and harnesses after 24
h, except for one geo-tracker that had been placed upon a cat
and was lost late at night in an open lot near the participating
household. The reason for the device loss was not known.
However, it may have been due to a loose fit of the harness on
the cat, the breakaway harness separating upon resistant contact
with an object, or perhaps a neighbour/passer-by may have also
removed the device.
Data collection reliability
Data collection and movement of each device could be tracked
in real-time on the Tractive.com website during use, and data
captured by the remaining devices could be exported in Excel
form for analysing date, time, latitude, and longitude. Tractive
additionally built an API for direct data extraction in JavaScript
Object Notation (JSON) format, a standard text-based format for
representing structured data based on JavaScript object syntax,
to assist the study team in building an automated data report
Fig. 2. Images taken during the geo-tracking of infants.
Table 4. Summary of number and species of animals tracked and geo-tracking outcomes in both study areas.
Neighbourhood Animal type Number tracked Geo-tracker on the entire time? Distress signs? Recovery after 24hrs?
Kibera Dog 1 Yes Yes (Mild distress-1 h) Yes
Chicken 3 Yes Yes (First 30 min) Yes
Jericho Dog 1 Yes Yes (Mild distress-1 h) Yes
Chicken 1 Yes Yes (First 30 min) Yes
Cat 1 No Yes (First 30 min) No
Fig. 3. Images taken during the geo-tracking of domestic animals.
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 9
generator. Tractive consistently collected data in 5-min and rapid
2–3 s interval modes, although the battery got drained quickly,
when in rapid mode. The device went into sleep mode when
activity had not been detected for an extended period, resulting
in some datasets with large gaps in time between device-satellite
communication. These gaps in time typically occurred overnight
when activity for humans was limited. For animals, stagnant
periods of device inactivity were shorter, including during overnight
hours.
Data collection validity
A review of the patterns of coordinates data collected for infants
and animals studied in the first week revealed abnormal patterns
in the distance travelled at the beginning of the 24-h study periods
when enumerators were just beginning the device placement
periods, as well as the end of the 24-h observation time when
devices were being retrieved. It was realized that this was being
caused by the devices being turned on and off at public meeting
locations for the supervisors and enumerators each day and was
not a reflection of activity in the household. This data, therefore,
required time-intensive curation of each dataset to remove location
data that was not attributable to study households. The protocol
was modified for the second week to require enumerators to wait to
turn devices on until they were physically placing them on infants
and animals and turn devices off fully prior to leaving home at the
end of the 24-h study time.
INSIGHTS FROM INTERVIEWS WITH INFANT
CAREGIVERS AND CHVS
Privacy, change of behaviour and safety
All the caregivers who agreed to participate in the study, signed the
informed consent forms. A few (3) were concerned about the safety
of the geo-trackers and whether they could cause physical harm
or health issues to their infants, and on their privacy citing that
the devices could record sounds. These concern were resolved
by more confirmation from the CHVs and the enumerators that the
devices were not harmful in any way and cannot record sounds or
visual information. An interview with one of the CHV reported;
“Most caregivers are concerned about the geo-tracker, especially
when showing the red or the green lights and if it records them. This is
especially at night because by then the lights are more visible” CHV,
Jericho.
Moreover, an interview with one of the CHVs revealed that the
geo-tracking exercise somehow resulted in a change in animal
behaviour. This was likely due to the animals not being used to
wearing harnesses, and some were too big for their weight. Another
interview with a CHV suggested that caregivers proposed using
smaller-more sized geo-trackers as these were more comfortable
for the infants and also lightweight for the small-sized animals.
“I observed an animal in one household trying to run while scratching
the harness and device in an attempt to drop it”, {CHV, Kibera}.
One of the caregivers also reported concerns about the security
of the geo-trackers from an older sibling to the infant under
observation. In one of the households, the geo-tracker was placed
in the child’s pocket, and the older sibling was curious and wanted
to remove it from time to time, prompting her (the caregiver) to
look after the geo-tracker. This further prompted the enumerator
to retrieve the geo-tracker from the infant in the morning of the
following day to allow the caregiver to go on with her normal
activities. The caregiver was advised to retrieve the geo-tracker
from the infant and secure it in a safe place until the enumerators
picks it up in such a case.
Curiosity from non-respondents
There were reported cases of curiosity from the neighbours as
to why the animals and the infants were being tracked. The field
staff and the CHVs had to take the time to address their questions
and explain the purpose of the study to alleviate any worries. By
providing this information, they were able to build trust and ensure
that others within the neighbourhood were informed and on board
with the study activities.
Role of CHVs and enumerators in the geo-tracking pilot study
Even though the geo-tracking exercise was something new to the
caregivers, the enumerators and CHVs played a significant role in
explaining the exercise to caregivers, the process involved, and its
importance in relation to infants’ health. This made most caregivers
receptive to the geo-tracking exercise and expressed no fear or
concerns about the geo-tracker devices being placed on their
infants or animals. One caregiver reported;
“I had fear on the first day since I didn’t quite understand
why you were putting that device on the infant, but after the
explanation you [field staff] gave, I felt at ease” {Caregiver,
Kibera}.
Also, a majority (n = 7) of the eight interviewed caregivers reported
that there was no health issue reported to be associated with
the use of the devices. This statement further elaborated on the
excellent work done by the CHVs in spreading the information
about the study within the community.
Key challenges and lessons
Some of the key challenges observed and lessons learnt from
the pilot geo-tracking implementation exercise in both Kibera and
Jericho were;
i. Initially, the enumerators reported difficulty in the geo-trackers
not picking the GPS signal just after switching them on, which
was majorly attributed to the congestion of buildings in both
study areas.
ii. Second, there was a loss of one geo-tracker which resulted in
incomplete data.
iii. In addition, the geo-tracking exercise was done for 24 h, which
meant that the enumerators left the geo-trackers on the infants
and the animals until the next day. As a result, it might have
interfered with their daily routine activities. For instance, one
caregiver reported that the presence of the geo-trackers barred
other people from carrying the infant lest the device get lost.
iv. The size of the harnesses and perhaps the tractive design
features (protrusion and size) may have resulted in the animal
distress observed. These discomforts influenced the change of
behaviour or incapacitated movements of the animal tracked,
with small-bodied animals experiencing mild distress even for
up to 1 h.
v. Accidental/non-accidental switching on of the geo-trackers in a
different location before fitting them on the infants and the animals
resulted in unnecessary data being recorded. This required an
additional data processing step involving merging the geolocation
data with metadata recording implementation times.
vi. The exercise elicited some reactions from the caregivers
like fear of their infants getting harmed by the device, getting
rashes or fever, belief of the geo-tracker being capable of
sucking blood from the infants, fear of geo-trackers recording
personal information, fear of the infants and/or caregivers being
monitored, fear that the study team would relay their information
to other people, and change of behaviour. It was concluded that
some reactions were linked to ‘lack of awareness’ about the
geo-tracking exercise. For instance, two caregivers gave the
following statements:
“While the device was on my child, I really had to behave well
and do everything that the nurses recommended during my
visits to the clinic in order for the device not to record and depict
me as a bad mother.” {Caregiver, Jericho}.
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 10
Table 5. Key recommendations
Key issues Details How was it handled
Geo-tracker
placement
location
The placement location of the geo-trackers in young children, particularly
those below 3 months old, was a matter of concern since they were
perceived to be very young and putting the trackers on them could cause
discomfort.
For infants under 3 months old, the geo-trackers were placed inside their pockets. When the child was
asleep, caregivers were instructed to position the geo-trackers next to them to minimize any discomfort.
Device security
and retrieval
One of the main challenges encountered was ensuring the security of the
geo-trackers while geo-tracking stray animals.
To minimize the risk of theft or security issues with the geo-trackers, as well as prevent curiosity from
neighbours, harnesses in dull colours were used where applicable. It was decided that geo-tracking
stray animals should be avoided given the fact that stray animals could be gone for longer periods of
time and thus spending less time with the infant.
Data usability Data points that were not linked to the tracked subject was measured as a
result of geo-trackers being switched on in a different location.
To avoid collecting unnecessary data points, enumerators were instructed to switch the geo-trackers on
and off only at the household after fitting them on the infants or animals. Additionally, the on and off
buttons were designed to be small and difficult to press, reducing the chances of accidental activation or
deactivation. To further ensure the fidelity of the movement data, enumerators recorded the beginning
and ending time of deployment.
Device data
quality
Obtaining an initial GPS signal in the vicinity of the study household proved
to be a challenge in both study areas due to the nature of the settlements,
which predominantly consisted of corrugated iron-sheet roofing.
Enumerators were advised to remain outside the house, within a distance of 5 m from the infant or
animal, until the geo-trackers successfully picked up a signal. This ensured that the initial connection
between the geo-trackers and the data collection system was established accurately. The enumerators’
presence at the household during this time helped monitor and troubleshoot any potential issues that
could have arisen concerning signal loss.
Acceptability There was a concern about whether caregivers would be willing to have
the geo-trackers fitted on their infants or animals.
The CHVs were assigned the responsibility of explaining the study to the caregivers before data
collection. This proactive step significantly improved the acceptability rate among the participants.
Privacy and
safety
The caregivers raised concerns about privacy and safety, particularly if the
geo-trackers recorded sounds.
CHVs had to explain to the caregivers that the device does not record personal information and that the
study was approved by Kenya Ethics and Licensing authorities for research with the potential of
improving child health outcomes, especially addressing enteric infection outcomes.
CHVs were responsible for clarifying the data being collected by the geo-trackers. They reassured the
caregivers about the safety and privacy of their information, emphasizing that the geo-trackers were only
recording the location of the infants or animals and not collecting any personal data. This helped build
trust and increased the caregivers’ understanding and acceptance of the study. When sharing subject
geolocation maps, the study team ensured that names of identifiable streets and businesses were
removed from images.
Infant discomfort Caregivers expressed concerns about the size and weight of the devices,
especially for infants below 3 months. They were worried that the devices
could potentially cause physical harm to the infants. Additionally, there
were concerns about the risk of infections since the geo-trackers were
used among multiple infants.
To ensure the comfort and safety of the infants, two locations were deemed appropriate for placing the
geo-trackers: inside the child’s clothes (between the diaper and pants) and inside pockets or socks.
Enumerators and CHVs were permitted to suggest these locations to the caregivers, taking into
consideration the practicality and ease of use. For the animals, harnesses fitted with geo-trackers were
secured across their abdomens instead of their necks. This precautionary measure aimed to reduce the
risk of animals choking or experiencing discomfort while wearing the geo-trackers. All the harnesses and
the devices should also be disinfected after every use, thus preventing the risk of infections.
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 11
Animal
discomfort
For smaller animals like chickens and cats, caregivers expressed concerns
about the weight and size of the harnesses or geo-trackers. They worried
that these devices could potentially cause physical harm or discomfort to
the animals.
Additionally, fitting the geo-trackers on the neck could increase the risk of
choking, which was another significant concern raised by caregivers.
The animal research ethical approval required the use of breakaway
harnesses for cats to prevent cats from being caught and harmed by
fences and other objects during climbing and leaping activities. However,
breakaway harnesses were difficult to find on the commercial market and
maybe available for short periods of time. This required reapproval of new
designs by the ethics committee.
Smaller harnesses were used for geo-tracking smaller animals, and if the animals’ movements were
hindered in any way, the geo-trackers were removed. In such cases, if available, a second animal was
fitted with a geo-tracker.
Enumerators were instructed to closely monitor for any signs of discomfort in the animals. If discomfort
persisted beyond 30 min, the geo-trackers were promptly retrieved to ensure the welfare of the animals,
unless it was a mild distress that was observed again up to 1 h. This step was required for compliance
with ethical animal research guidelines in the United States.
Due to the volatility of breakaway cat harness supplies on the commercial market, the approved designs
were bought in large bulk in anticipation of loss or damage.
Sharing of study
findings
The caregivers expressed a strong interest in learning about the findings
from the exercise.
As this study was a pilot, the enumerators and CHVs informed the participants that the dissemination of
analysed data was scheduled to take place after the completion of the study. This transparency helped
manage expectations and ensured that participants were aware of the timeline for sharing the findings.
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 12
“My child developed fever some few days after the geo-tracking
activity, and the first thought that came to my mind was that it
might have been due to the device that was placed on his body
during the geo-tracking exercise. However, a visit to the hospital
revealed otherwise, and he has prescribed drugs for the fever,”
{Caregiver, Jericho}.
For this reason, the CHVs were instructed to give complete details
of the study to the caregivers three or two days before the study
began to allow them to make decisions to participate or not.
Caregivers were assured of their safety, privacy and that the geo-
trackers were not recording any personal information apart from
the location of the infants and/or the animals.
Discussion and recommendation
for future use
GPS technology is increasingly used in public health surveillance
studies (Beekhuizen et al., 2013). The use of low-cost, remotely
monitored GPS technology, like commercial pet geo-trackers,
is an effective way to measure animal and human movements
and interactions in relation to disease transmission pathways.
Acquiring and analysing good quality data from such devices in
community settings requires first assessing feasibility and ethics
of implementation and optimizing uptake and compliance in
device use among study subjects. The factors that influence the
success of geo-tracking studies differ between animal and human
subjects, and researchers must be particularly conscious of how
such studies practices affect vulnerable populations and their
interaction with devices. Human subjects who consent to wear
devices or place devices on their animals, but then choose to not
comply with instructions when unobserved generate unreliable
data. Understanding and mitigating those concerns upfront is
critical for high quality science. This pilot study presents a guideline
of recommendations (Table 5) based upon the challenges and
learnings from the use of geo-trackers in monitoring children and
a variety of domestic animals in a community with high zoonotic
disease transmission.
Some of the observations from the geo-tracking exercise were
similar to those reported from other studies. For instance,
McCluskey et al. (2012) reported difficulty in the trackers not
picking the GPS signal after starting the geo-tracking activity. The
dense urban development, particularly in study sites like Kibera,
contributed to poor signal reception for the trackers. This was due
to blockage caused by narrow streets and closely spaced buildings.
To address this issue, the trackers were placed in an open area,
keeping them at a distance of 5 m from the infants or animals. This
allowed for the establishment of an initial connection between the
geo-trackers and the data collection system.
Furthermore, some wearable devices that were marketed as
“animal friendly” could actually impact the behaviour of animals.
Similar findings were observed by Paci et al. (2020) where the
size and design features of the harnesses caused distress in the
animals. For instance, the animals exhibited behaviours such as
attempting to remove the harness by cuffing it with their forepaws
while standing on their hind legs, which aligns with the observations
reported by Paci et al. (2020). To mitigate this, smaller harnesses
were used for geo-tracking smaller animals, and were closely
monitored for signs of distress for a maximum of 30 min before
leaving them with the tracker.
The involvement of CHVs in the study proved beneficial in
addressing several concerns raised by caregivers and the
community at large. These concerns included worries about
personal data being recorded by the geo-tracker devices, the safety
and security of the devices, appropriate placement on infants, and
managing the concerns of neighbours. Additionally, the use of
CHVs helped increase overall knowledge about the purpose of the
geo-tracking exercise and the research as a whole. As a result, the
community fully embraced and accepted the geo-tracking exercise,
with a 100% acceptability rate. CHVs had been successfully utilized
in previous research studies, demonstrating their effectiveness
in the community through various outcomes such as increasing
knowledge related to health maintenance and disease prevention,
promoting behaviour change, and achieving high acceptability
rates for health programs among the target population (Swider,
2002; Brownstein et al., 2007; Singh et al., 2016).
Implementing these recommendations will help address the
challenges faced during the exercise and improve the effectiveness
and efficiency of similar work in the future. Other limitations of
this study include the small number of study subjects, limited
demographic focus on low- and middle-income urban Kenyans.
Only one geo-tracker technology and few harnesses were tested.
Additionally, this article does not discuss the reliability and quality
of the spatial data collected during the 24-h observation window
in this urban environment with known impediments to the use of
satellite-dependent technology. The protocol developed through
this study was being implemented at scale in a larger cohort
of households with infants and animals for detecting spatial
and zoonotic contributions to enteric disease transmission in
Kenya (Baker et al., 2023). This new evidence will help test the
generalizability of observations that may be influenced by sample
size. A forthcoming second manuscript will describe results from
a statistical assessment of spatial data quality and reliability and
provide recommendations for the analytical use of logged geo-
tracker data. The proposed guidelines are practical, flexible,
and adaptable to a broad range of One Health-centred research
questions about the role of human and animal environmental
movement and interactions that could cause disease transmission
between humans and animals. The spatial-temporal dynamics
of environment-human-animal interactions for other infectious
disease priorities in Kenya and countries worldwide, like Q-fever,
histoplasmosis, and corona viruses could also be characterized
with geo-trackers (Munyua et al., 2016). Thus, replication of geo-
tracking studies by other researchers, including in rural settings,
will test the generalization of this approach to different populations
and study contexts. These studies could explore different geo-
tracker devices and their fitting options. The market for technology
that allows for detailed spatial geo-tracking of people, animals, and
objects is growing, and improvements in data quality and usability
of this technology in the future is promising.
Conclusion
This study provides recommendations on the use of geo-trackers
to identify zoonotic disease-transmission pathways between
animals and humans particularly in countries like in Kenya, where
close interactions between animals and humans are common.
This resulting geo-tracking protocol was further scaled-up to a
larger One Health study of enteric disease transmission called
PATHOME. Discussions with the stakeholders, infant caregivers
and CHVs revealed a positive acceptability rate of the use of the
technology with constructive suggestions such as purchasing
and use of smaller devices to avoid any physical harm and overt
distress. Overall, it was concluded that the use of geo-tracker
devices provides a new approach for studying disease transmission
pathways between infants, animals, and their living environments.
The guidelines from this study can aid other studies in adopting
this methodology and technology to address other public health
concerns in human-animal-environment interfaces.
CONFLICT OF INTEREST
The authors declare no conflicts of interests.
ETHICS STATEMENT
The protocols for human subject’s research for the PATHOME study
were approved by Institutional Review Boards at the University of
Iowa, USA (ID – 202004606), the African Population and Health
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 13
Research Center (APHRC) (ID – DOR/2020/027), AMREF (ID –
ESRC P887/2020), and the Kenya National Committee for Science
Technology and Innovation (ID# P-21-8441). The parent study is
also registered on Clinicaltrials.gov (Identifier: NCT05322655).
Chickens, cats, dogs, goats, and sheep species utilized in this
study were treated in accordance with all Public Health Service
(PHS) policies and the Guide for the Care and Use of Laboratory
Animals, NIH Publication No. 85-23, the year 2010. The protocol
(ID 0042302) for placing harnesses and geo-trackers was reviewed
and approved by the University of Iowa, USA (PHS Assurance No.
D16-00009 (A3021-01)). Written Informed consent was obtained
from all the participants following the provision of the information
sheet detailing the purpose of the study and the procedures
involved.
ACKNOWLEDGEMENT
We would like to thank all the participants in the two communities
(Kibera and Jericho) who took part in this study by making time
for us. We send our deepest gratitude to the Community Health
Volunteers (CHVs) and the field staff in Jericho and Kibera who
supported the implementation of data collection activities. We also
thank the project team which includes Prof. Blessing Mberu, John
Agira, Bonphace Okoth, Dr. Fanta Gutema, David Wanambwa,
Alexis Kapanka, Christine Amondi, Dr. Innocent Tumwebaze
and Prof. Collins Ouma for their invaluable support during study
implementation and/or for reviewing and providing substantial
feedback to improve this manuscript.
AUTHOR CONTRIBUTIONS
AMO, PJB, SS and KKB designed the geo-tracking protocols. KKB
and DS acquired funding. SS and PJB facilitated human subjects
and animal research approvals and stakeholder engagement
in Kenya. KKB oversaw human subjects and animal research
protocol approvals in Iowa. SS and PJB oversaw data collection in
Kenya. DS, AMO and KKB oversaw data management and quality
control. PBJ wrote the original draft of this manuscript with input
from all authors.
FUNDING STATEMENT
The PATHOME study is funded by the National Institutes of Health
Fogarty Institute Grant Number 01TW011795 to the University of
Iowa, USA. The first draft of the proposal was submitted to the
National Science Foundation Evolution and Ecology of Infectious
Disease mechanism in November 2019, with notice of award and
study launch occurring in July 2020. The content is solely the
responsibility of the authors and does not necessarily represent the
official views of the National Institutes of Health. The funders had
no role in study design, data collection and analysis, the decision
to publish, or the preparation of the manuscript.
DATA AVAILABILITY
Not applicable.
References
Alba, A.C., Breeding, S., Valuska, A.J., Sky, C., Dunn, M. et al. (2019)
Use of passive radio frequency identification technologies to monitor nest
usage in the northern carmine bee-eater (Merops n. nubicus). Zoo Biology
38(6), 498–507. DOI: 10.1002/zoo.21514.
Allen, T., Murray, K.A., Zambrana-Torrelio, C., Morse, S.S., Rondinini,
C. et al. (2017) Global hotspots and correlates of emerging zoonotic
diseases. Nature Communications 8(1), 1–10. DOI: 10.1038/
s41467-017-00923-8.
Animal Care and Use Committee (1998) Guidelines for the capture,
handling, and care of mammals as approved by the american society of
mammalogists. American Society of Mammalogists 79(4), 1416–1431.
Asante, J., Noreddin, A. and El Zowalaty, M.E. (2019) Systematic review
of important bacterial zoonoses in Africa in the last decade in light of the
“One Health” concept. Pathogens 8, 16.
Baker, K.K., Senesac, R., Sewell, D., Sen Gupta, A., Cumming, O. and
Mumma, J. (2018) Fecal fingerprints of enteric pathogen contamination in
public environments of Kisumu, Kenya, associated with human sanitation
conditions and domestic animals. Environmental Science and Technology
52(18), 10263–10274. DOI: 10.1021/acs.est.8b01528.
Baker, K.K., Mumma, J.A.O., Simiyu, S., Sewell, D., Tsai, K. et al. (2022)
Environmental and behavioural exposure pathways associated with
diarrhoea and enteric pathogen detection in 5-month-old, periurban
Kenyan infants: a cross-sectional study. BMJ Open 12(10), 1–13. DOI:
10.1136/bmjopen-2021-059878.
Baker, K.K., Simiyu, S., Busienei, P.J., Gutema, F.D., Okoth, B. et al.
(2023) Protocol for the PATHOME Study: A Cohort Study on Urban
Societal Development and the Ecology of Enteric Disease Transmission
among Infants, Domestic Animals, and the Environment.
Barnes, A.N., Anderson, J.D., Mumma, J., Mahmud, Z.H. and Cumming,
O. (2018a) The association between domestic animal presence and
ownership and household drinking water contamination among peri- urban
communities of Kisumu, Kenya. PloS One 13(6), e0197587.
Barnes, A.N., Mumma, J. and Cumming, O. (2018b) Role, ownership and
presence of domestic animals in urban households of Kisumu, Kenya.
Zoonoses Public Health 65, 202–214. DOI: 10.1111/zph.12429.
Bauza, V., Byrne, D.M., Trimmer, J.T., Lardizabal, A., Atiim, P., Asigbee,
M.A.K. and Guest, J.S. (2018) Child soil ingestion in rural Ghana –
frequency, caregiver perceptions, relationship with household floor material
and associations with child diarrhoea. Tropical Medicine and International
Health 23(5), 558–569. DOI: 10.1111/tmi.13050
Bawankule, R., Singh, A., Kumar, K. and Pedgaonkar, S. (2017) Disposal
of children’s stools and its association with childhood diarrhea in India.
BMC Public Health 17(1), 1–9. DOI: 10.1186/s12889-016-3948-2.
Beekhuizen, J., Kromhout, H., Huss, A. and Vermeulen, R. (2013)
Performance of GPS-devices for environmental exposure assessment.
Journal of Exposure Science and Environmental Epidemiology 23(5),
498–505. DOI: 10.1038/jes.2012.81.
Bindi, T., Holland, J.D. and Minot, E.O. (2011) Wildlife tracking technology
options and cost considerations. Wildlife Research 38(8), 653–663. DOI:
10.1071/WR10211.
Bradshaw, C.J., Sims, D.W. and Hays, G.C. (2007) Measurement error
causes scale-dependent threshold erosion of biological signals in animal
movement data author (s): Corey J.A. Bradshaw, David W. Sims and
Graeme C. Hays Published by: Wiley on behalf of the Ecological Society
of America Stable U. Ecological Society of America 17(2), 628–638.
Available at: https://www.jstor.org/stable/40061884.
Brownstein, J.N., Chowdhury, F.M., Norris, S.L., Horsley, T., Jack, L.,
Zhang, X. and Satterfield, D. (2007) Effectiveness of community health
workers in the care of people with hypertension. American Journal of
Preventive Medicine 32(5), 435–447. DOI: 10.1016/j.amepre.2007.
01.011.
Brüssow, H. (2023) Viral infections at the animal–human interface—
Learning lessons from the SARS-CoV-2 pandemic. Microbial
Biotechnology 16(7), 1397–1411. DOI: 10.1111/1751-7915.14269.
CDC (n.d.) Zoonotic Diseases. Available at: https://www.cdc.gov/
onehealth/basics/zoonotic-diseases.html (accessed 5 September 2023).
Cherniack, E.P. and Cherniack, A.R. (2015) Assessing the benefits and
risks of owning a pet. Cmaj 187(10), 715–716. DOI: 10.1503/cmaj.150274.
Cumming, O., Arnold, B.F., Ban, R., Clasen, T., Esteves Mills, J. et al.
(2019) The implications of three major new trials for the effect of water,
sanitation and hygiene on childhood diarrhea and stunting: A consensus
statement. BMC Medicine 17(1), 1–9. DOI: 10.1186/s12916-019-1410-x.
Curtis, V., Cairncross, S. and Yonli, R. (2000) Review: Domestic
hygiene and diarrhoea – Pinpointing the problem. Tropical Medicine and
International Health 5(1), 22–32. DOI: 10.1046/j.1365-3156.2000.00512.x.
Delahoy, M.J., Wodnik, B., McAliley, L., Penakalapati, G., Swarthout, J.,
Freeman, M.C. and Levy, K. (2018) Pathogens transmitted in animal
feces in low- and middle-income countries. International Journal of
Hygiene and Environmental Health 221(4), 661–676. DOI: 10.1016/j.
ijheh.2018.03.005.
Ezeh, A., Oyebode, O., Satterthwaite, D., Chen, Y.F., Ndugwa, R. et al.
(2017) The history, geography, and sociology of slums and the health
problems of people who live in slums. The Lancet 389(10068), 547–558.
DOI: 10.1016/S0140-6736(16)31650-6.
Busienei et al. CABI One Health (2024) 3:1 https://doi.org/10.1079/cabionehealth.2024.0011 14
Filippi, F.D., Cocina, G.G. and Martinuzzi, C. (2020) Integrating different
data sources to address urban security in informal areas. The case study
of Kibera, Nairobi. Sustainability (Switzerland) 12(6). DOI: 10.3390/
su12062437.
Floyd, J.R., Ruktanonchai, N.W., Wardrop, N., Tatem, A.J., Ogola, J. and
Fèvre, E.M. (2019) Exploring fine-scale human and livestock movement
in western Kenya. One Health 7(Dec 2018), 100081. DOI: 10.1016/j.
onehlt.2019.100081.
Frair, J.L., Fieberg, J., Hebblewhite, M., Cagnacci, F., DeCesare, N.J.
and Pedrotti, L. (2010) Resolving issues of imprecise and habitat-biased
locations in ecological analyses using GPS telemetry data. Philosophical
Transactions of the Royal Society B: Biological Sciences 365(1550),
2187–2200. DOI: 10.1098/rstb.2010.0084.
Han, B.A., Kramer, A.M. and Drake, J.M. (2016) Global patterns of
zoonotic disease in mammals. Trends in Parasitology 32(7), 565–577.
DOI: 10.1016/j.pt.2016.04.007.
Hebblewhite, M. and Haydon, D.T. (2010) Distinguishing technology from
biology: A critical review of the use of GPS telemetry data in ecology.
Philosophical Transactions of the Royal Society B: Biological Sciences
365(1550), 2303–2312. DOI: 10.1098/rstb.2010.0087.
Iowa (n.d.) Vertebrate Animal Research. Available at: https://animal.
research.uiowa.edu/office-institutional-animal-care-and-use-committee
(accessed 5 September 2023).
Jenkins, M.W., Tiwari, S., Lorente, M., Gichaba, C.M. and Wuertz, S.
(2009) Identifying human and livestock sources of fecal contamination in
Kenya with host-specific Bacteroidales assays. Water Research 43(19),
4956–4966. DOI: 10.1016/j.watres.2009.07.028.
Jones, K.E., Patel, N.G., Levy, M.A., Storeygard, A., Balk, D., Gittleman,
J.L. and Daszak, P. (2008) Global trends in emerging infectious diseases.
Nature 451(7181), 990–993. DOI: 10.1038/nature06536.
Kerr, J., Scott, D. and Schipperjin, J. (2011) Using global positioning
systems in health research: A practical approach to data collection and
processing. American Journal of Preventive Medicine 41(5), 532–540.
DOI: 10.1016/j.amepre.2011.07.017.
Klune, J., Arhant, C., Windschnurer, I., Heizmann, V. and Schauberger, G.
(2021) Tracking devices for pets: Health risk assessment for exposure to
radiofrequency electromagnetic fields. Animals 11(9), 1–22. DOI: 10.3390/
ani11092721.
Kraff, N.J., Taubenbock, H. and Wurm, M. (2019) How dynamic are slums?
EO-based assessment of Kibera’s morphologic transformation. 2019
Joint Urban Remote Sensing Event, JURSE 2019, 6–9. DOI: 10.1109/
JURSE.2019.8808978.
Kurowski, K.M., Marusinec, R., Amato, H.K., Saraiva-Garcia, C., Loayza,
F. et al. (2021) Social and environmental determinants of community-
acquired antimicrobial-resistant Escherichia coli in children living in
semirural communities of Quito, Ecuador. American Journal of Tropical
Medicine and Hygiene 105(3), 600–610. DOI: 10.4269/ajtmh.20-0532.
Lambertini, E., Buchanan, R.L., Narrod, C. and Pradhan, A.K. (2016)
Transmission of Bacterial zoonotic pathogens between pets and humans:
The role of pet food. Critical Reviews in Food Science and Nutrition 56(3),
364–418. DOI: 10.1080/10408398.2014.902356.
McCluskey, A., Ada, L., Dean, C.M. and Vargas, J. (2012) Feasibility and
validity of a wearable GPS device for measuring outings after stroke. ISRN
Rehabilitation 2012, 1–8. DOI: 10.5402/2012/823180.
Medgyesi, D., Brogan, J.M., Sewell, D.K., Creve-Coeur, J.P., Kwong,
L.H. and Baker, K.K. (2018a) Where children play: Young child exposure
to environmental hazards during play in public areas in a transitioning
internally displaced persons community in Haiti. International Journal of
Environmental Research and Public Health 15(8), 1–21. DOI: 10.3390/
ijerph15081646.
Medgyesi, D., Sewell, D., Senesac, R., Cumming, O., Mumma, J. and
Baker, K.K. (2018b) The landscape of enteric pathogen exposure of young
children in public domains of low-income, urban Kenya: The influence of
exposure pathway and spatial range of play on multi-pathogen exposure
risks. PLoS Neglected Tropical Diseases 13(3), 1–21. DOI: 10.1371/
journal.pntd.0007292.
Michael, K., McNamee, A. and Michael, M.G. (2006) The emerging ethics
of humancentric GPS tracking and monitoring. International Conference on
Mobile Business, ICMB 2006, 0–9. DOI: 10.1109/ICMB.2006.43.
Moya, J., Bearer, C.F. and Etzel, R.A. (2004) Children’s behavior and
physiology and how it affects exposure to environmental contaminants.
Pediatrics 113(4 II), 996–1006. DOI: 10.1542/peds.113.s3.996.
Munyua, P., Bitek, A., Osoro, E., Pieracci, E.G., Muema, J. et al. (2016)
Prioritization of zoonotic diseases in Kenya, 2015. PLoS ONE 11(8), 1–11.
DOI: 10.1371/journal.pone.0161576.
Neiderud, C.J. (2015) How urbanization affects the epidemiology of
emerging infectious diseases. African Journal of Disability 5(1), 5–6.
DOI: 10.3402/iee.v5.27060.
Ngure, F.M., Reid, B.M., Humphrey, J.H., Mbuya, M.N., Pelto, G.
and Stoltzfus, R.J. (2014) Water, sanitation, and hygiene (WASH),
environmental enteropathy, nutrition, and early child development: Making
the links. Annals of the New York Academy of Sciences 1308(1), 118–128.
DOI: 10.1111/nyas.12330.
Odeny, M.A. (2020) The Relation Between Access to Water, Poverty, and
Patriarchy: The Case of Women Slum Dwellers in Kibera, Kenya. A Thesis
Submitted in fulfillment of the requirement of an award of The Degree of
Doctor of Laws (LLD) in the Faculty of Law at The Uni. February. Available
at: https://repository.up.ac.za/bitstream/handle/2263/76755/Odeny_
Relation_2020.pdf?sequence=1 (accessed 20 August 2023).
Paci, P., Mancini, C. and Price, B.A. (2020) Understanding the interaction
between animals and wearables: The wearer experience of cats. DIS
2020 – Proceedings of the 2020 ACM Designing Interactive Systems
Conference, pp. 1701–1712. DOI: 10.1145/3357236.3395546.
Paz-Soldan, V.A., Reiner, R.C., Morrison, A.C., Stoddard, S.T., Kitron, U.
et al. (2014) Strengths and weaknesses of global positioning system
(GPS) data-loggers and semi-structured interviews for capturing fine-scale
human mobility: Findings from iquitos, Peru. PLoS Neglected Tropical
Diseases 8(6), 4–10. DOI: 10.1371/journal.pntd.0002888.
Rakhimberdiev, E., Senner, N.R., Verhoeven, M.A., Winkler, D.W., Bouten,
W. and Piersma, T. (2016) Comparing inferences of solar geolocation data
against high-precision GPS data: Annual movements of a double-tagged
black-tailed godwit. Journal of Avian Biology 47(4), 589–596. DOI: 10.1111/
jav.00891.
Siegford, J.M., Berezowski, J., Biswas, S.K., Daigle, C.L., Gebhardt-
Henrich, S.G. et al. (2016) Assessing activity and location of individual
laying hens in large groups using modern technology. Animals 6(2),
10–17. DOI: 10.3390/ani6020010.
Silva, R., Afán, I., Gil, J.A. and Bustamante, J. (2017) Seasonal and
circadian biases in bird tracking with solar GPS-tags. PLoS ONE 12(10),
1–19. DOI: 10.1371/journal.pone.0185344.
Singh, D., Cumming, R., Mohajer, N. and Negin, J. (2016) Motivation of
community health volunteers in rural Uganda: The interconnectedness
of knowledge, relationship and action. Public Health 136, 166–171. DOI:
10.1016/j.puhe.2016.01.010.
Swider, S.M. (2002) Outcome effectiveness of community health workers:
An integrative literature review. Public Health Nursing 19(1), 11–20.
Taylor, L.H., Latham, S.M. and Woolhouse, M.E.J. (2001) Risk factors
for human disease emergence. Philosophical Transactions of the Royal
Society B: Biological Sciences 356(1411), 983–989. DOI: 10.1098/
rstb.2001.0888.
UN-Habitat (2003) The Challenge of the Slums. Global Report on Human
Settlements 2003. Earthscan Publications Ltd, London.
van Harten, E., Reardon, T., Lumsden, L.F., Meyers, N., Prowse, T.A.A.,
Weyland, J. and Lawrence, R. (2019) High detectability with low impact:
Optimizing large PIT tracking systems for cave-dwelling bats. Ecology and
Evolution 9(19), 10916–10928. DOI: 10.1002/ece3.5482.
Wall, J., Wittemyer, G., Klinkenberg, B. and Douglas-Hamilton, I. (2014)
Novel opportunities for wildlife conservation and research with real-time
monitoring. Ecological Applications 24(4), 593–601.
WHO Africa (2022) Africa: In Africa, 63 Percent Jump in Diseases Spread
From Animals to People Seen in Last Decade – allAfrica.com. Available at:
https://allafrica.com/stories/202207170206.html (accessed 20 August 2023).
Zambrano, L.D., Levy, K., Menezes, N.P. and Freeman, M.C. (2014)
Human diarrhea infections associated with domestic animal husbandry:
A systematic review and meta-analysis. Transactions of the Royal Society
of Tropical Medicine and Hygiene 108(6), 313–325. DOI: 10.1093/trstmh/
tru056.
