Bovine tuberculosis (bTB) is a disease of cattle that is transmitted through direct contact with an infected animal or ingestion of contaminated food or water. This study seeks to explore the local knowledge on bTB, obtain information on social and cultural practices regarding risk of bTB transmission to cattle and humans (zoonotic TB) in a traditional livestock farming community with a history of bTB diagnosis in cattle and wildlife. Information was collected using a qualitative approach of Focus Group Discussions (FGDs) targeting household members of livestock farmers that owned bTB tested herds. We conducted fourteen FGDs (150 individuals) across four dip tanks that included the following categories of participants from cattle owning households: head of households, herdsmen, dip tank committee members and women. The qualitative data was managed using NVivo Version 12 Pro software. Social and cultural practices were identified as major risky practices for bTB transmission to people, such as the consumption of undercooked meat, consumption of soured /raw milk and lack of protective measures during slaughtering of cattle. The acceptance of animals into a herd without bTB pre-movement testing following traditional practices (e.g. lobola, 'bride price', the temporary introduction of a bull for 'breeding'), the sharing of grazing and watering points amongst the herds and with wildlife were identified as risky practices for M. bovis infection transmission to cattle. Overall, knowledge of bTB in cattle and modes of transmission to people and livestock was found to be high. However, the community was still involved in risky practices that expose people and cattle to bovine TB. An inter-disciplinary 'One Health' approach that engages the community is recommended, to provide locally relevant interventions that allows the community to keep their traditional PLOS NEGLECTED TROPICAL DISEASES

Abstract.Early diagnosis and treatment is the principal strategy to control visceral leishmaniasis (VL), or kala-azar in East Africa. As VL strikes remote rural, sparsely populated areas, kala-azar care might not be accessed optimally or timely. We conducted a qualitative study to explore access barriers in a longstanding kala-azar endemic area in southern Gadarif, Sudan. Former kala-azar patients or caretakers, community leaders, and health-care providers were purposively sampled and thematic data analysis was used. Our study participants revealed the multitude of difficulties faced when seeking care. The disease is well known in the area, yet misconceptions about causes and transmission persist. The care-seeking itineraries were not always straightforward: “shopping around” for treatments are common, partly linked to difficulties in diagnosing kala-azar. Kala-azar is perceived to be “hiding,” requiring multiple tests and other diseases must be treated first. Negative perceptions on quality of care in the public hospitals prevail, with the unavailability of drugs or staff as the main concern. Delay to seek care remains predominantly linked to economic constraint: albeit treatment is for free, patients have to pay out of pocket for everything else, pushing families further into poverty. Despite increased efforts to tackle the disease over the years, access to quality kala-azar care in this rural Sudanese context remains problematic. The barriers explored in this study are a compelling reminder of the need to boost efforts to address these barriers.

Gambiense Human African Trypanosomiasis (g-HAT) is a neglected tropical disease caused by trypanosomes transmitted by tsetse flies. 70% of cases in 2019 (604/863) occurred in the Democratic Republic of Congo (DRC). The national programme for g-HAT elimination in DRC includes a large-scale deployment of Tiny Targets which attract and kill tsetse. This intervention is directed by vector-control specialists with small teams, moving in canoes, deploying Tiny Targets along riverbanks where tsetse concentrate. While the targets are deployed in communal areas, and the method is cheap and easy-to-use, local people have little involvement. This study aimed to evaluate if a community-led vector control programme was feasible in the context of DRC's g-HAT elimination programme. In 2017, a community-led intervention was implemented in three villages in the Kwilu province of DRC. This intervention was evaluated through an Action Research with qualitative data collected through 21 focus group discussions and 289 hours of observation. Also the geographical location and quality of each Tiny Targets were collected (total number deployed = 2429). This research revealed that community-based approach largely worked: people were motivated and proactive, showed a good application of the acquired knowledge resulting in an effective deployment of Tiny Targets. In addition, our study provided evidence that acceptability of the targets by the community can improve deployment quality by reducing target loss and damage. The approach was feasible in places where canoe-based teams could not reach. Against these advantages, a community-based approach was time-consuming and had to adapt to the seasonal and daily rhythms of the community. A community-based approach for tsetse control is technically feasible and recommended but limits to the speed and scale of the approach restraints its application as a standalone strategy in a large-scale national programme aiming to eliminate g-HAT in a short timeframe.

. Human African trypanosomiasis is close to elimination in several countries in sub-Saharan Africa. The diagnosis and treatment is currently rapidly being integrated into first-line health services. We aimed to document the perspective of stakeholders on this integration process. We conducted 12 focus groups with communities in three health zones of the Democratic Republic of the Congo and held 32 interviews with health-care providers, managers, policy makers, and public health experts. The topic guide focused on enabling and blocking factors related to the integrated diagnosis and treatment approach. The data were analyzed with NVivo (QSR International, Melbourne, Australia) using a thematic analysis process. The results showed that the community mostly welcomed integrated care for diagnosis and treatment of sleeping sickness, as they value the proximity of first-line health services, but feared possible financial barriers. Health-care professionals thought integration contributed to the elimination goal but identified several implementation challenges, such as the lack of skills, equipment, motivation and financial resources in these basic health services. Patients often use multiple therapeutic itineraries that do not necessarily lead them to health centers where screening is available. Financial barriers are important, as health care is not free in first-line health centers, in contrast to the population screening campaigns. Communities and providers signal several challenges regarding the integration process. To succeed, the required training of health professionals, as well as staff deployment and remuneration policy and the financial barriers in the primary care system need to be addressed, to ensure coverage for those most in need.

21Bovine tuberculosis (bTB) is a disease of cattle that is transmitted through direct contact 22 with an infected animal or ingestion of contaminated food or water. This study seeks to 23 explore the local knowledge on the disease and establish the risk practices that lead to 24 its transmission to cattle and humans (zoonotic TB) in a traditional livestock farming 25 community with a history of bTB diagnosis in cattle and wildlife. Information was 26 collected using a qualitative approach of Focus Group Discussions (FGDs) targeting 27 household members of livestock farmers that owned either bTB infected or uninfected 28 herds. We conducted fourteen FGDs (150 individuals) across four dip tanks that 29 included the following categories of participants from cattle owning households: heads 30 of households, cattle keepers, dip tank committee members and women. The qualitative 31 data was managed using NVivo Version 12 Pro ® software. Social and cultural practices 32 were identified as major risky practices for bTB transmission to people, such as the 33 consumption of undercooked meat, consumption of soured /raw milk and lack of 34 protective measures during slaughtering of cattle. The acceptance of animals into a 35 herd without bTB pre-movement testing following traditional practices (e.g. lobola, 'bride 36 price', the temporary introduction of a bull for 'breeding'), the sharing of grazing and 37 watering points amongst the herds and with wildlife were identified as risky practices for 38 bTB transmission to cattle. Overall, knowledge of bTB in cattle and modes of 39 transmission to people and livestock was found to be high. However, the community 40 was still involved in risky practices that expose people and cattle to bovine TB. An inter-41 disciplinary 'One Health' approach that engages the community is recommended, to 42 provide locally relevant interventions that allows the community to keep their traditional 43 3 practices and socio-economic systems whilst avoiding disease transmission to cattle 44 and people. 45 Author summary 46 Bovine tuberculosis (bTB) is a respiratory disease of cattle that is transmitted to 47 other animals as well as humans (zoonotic TB) through direct contact with infected 48 animals, and consumption of contaminated food (animal products) or water. The study 49 explains the complexities of human-animal relations, reflects on how people understand 50 and conceptualize risk of bovine tuberculosis (bTB) in an endemic area considering the 51 economic value of livestock keeping as well as social and cultural practices of 52 importance to the community. The results of this study identified socio-cultural practices 53 that involved consumption of raw or undercooked animal products and handling of 54 infected animal products during animal slaughter as major risky practices for bTB 55 transmission to people. Introduction of animals into a herd without bTB testing for socio-56 cultural purposes and sharing of resources amongst the communal herd and with 57 wildlife were identified as risky p...