title: Linking human health and livestock health: a "one-health" platform for integrated analysis of human health, livestock health, and economic welfare in livestock dependent communities.
abstract: BACKGROUND
  For most rural households in sub-Saharan Africa, healthy livestock play a key role in averting the burden associated with zoonotic diseases, and in meeting household nutritional and socio-economic needs. However, there is limited understanding of the complex nutritional, socio-economic, and zoonotic pathways that link livestock health to human health and welfare. Here we describe a platform for integrated human health, animal health and economic welfare analysis designed to address this challenge. We provide baseline epidemiological data on disease syndromes in humans and the animals they keep, and provide examples of relationships between human health, animal health and household socio-economic status.
  
  
  METHODS
  We designed a study to obtain syndromic disease data in animals along with economic and behavioral information for 1500 rural households in Western Kenya already participating in a human syndromic disease surveillance study. Data collection started in February 2013, and each household is visited bi-weekly and data on four human syndromes (fever, jaundice, diarrhea and respiratory illness) and nine animal syndromes (death, respiratory, reproductive, musculoskeletal, nervous, urogenital, digestive, udder disorders, and skin disorders in cattle, sheep, goats and chickens) are collected. Additionally, data from a comprehensive socio-economic survey is collected every 3 months in each of the study households.
  
  
  RESULTS
  Data from the first year of study showed 93% of the households owned at least one form of livestock (55%, 19%, 41% and 88% own cattle, sheep, goats and chickens respectively). Digestive disorders, mainly diarrhea episodes, were the most common syndromes observed in cattle, goats and sheep, accounting for 56% of all livestock syndromes, followed by respiratory illnesses (18%). In humans, respiratory illnesses accounted for 54% of all illnesses reported, followed by acute febrile illnesses (40%) and diarrhea illnesses (5%). While controlling for household size, the incidence of human illness increased 1.31-fold for every 10 cases of animal illness or death observed (95% CI 1.16-1.49). Access and utilization of animal source foods such as milk and eggs were positively associated with the number of cattle and chickens owned by the household. Additionally, health care seeking was correlated with household incomes and wealth, which were in turn correlated with livestock herd size.
  
  
  CONCLUSIONS
  This study platform provides a unique longitudinal dataset that allows for the determination and quantification of linkages between human and animal health, including the impact of healthy animals on human disease averted, malnutrition, household educational attainment, and income levels.
authors: Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America; Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors: S M
authors: SM
authors: Thumbi
authors: Centers for Disease Control and Prevention, Nairobi, Kenya.
authors: M Kariuki
authors: MK
authors: Njenga
authors: Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America; School of Economic Sciences, Washington State University, Pullman, Washington, United States of America.
authors: Thomas L
authors: TL
authors: Marsh
authors: Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America; Animal Diseases Research Unit, Agricultural Research Service, United States Department of Agriculture, Pullman, Washington, United States of America.
authors: Susan
authors: S
authors: Noh
authors: Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors: Elkanah
authors: E
authors: Otiang
authors: Centers for Disease Control and Prevention, Nairobi, Kenya.
authors: Peninah
authors: P
authors: Munyua
authors: Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors: Linus
authors: L
authors: Ochieng
authors: Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors: Eric
authors: E
authors: Ogola
authors: Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America; School of Economic Sciences, Washington State University, Pullman, Washington, United States of America.
authors: Jonathan
authors: J
authors: Yoder
authors: Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors: Allan
authors: A
authors: Audi
authors: Centers for Disease Control and Prevention, Nairobi, Kenya.
authors: Joel M
authors: JM
authors: Montgomery
authors: Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors: Godfrey
authors: G
authors: Bigogo
authors: Emory University, Atlanta, Georgia, United States of America.
authors: Robert F
authors: RF
authors: Breiman
authors: Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America.
authors: Guy H
authors: GH
authors: Palmer
authors: Paul G. Allen School for Global Animal Health, Washington State University, Pullman, Washington, United States of America.
authors: Terry F
authors: TF
authors: McElwain
mesh_terms: D000818:Animals; D005191:Family Characteristics; D005843:Geography; D006306:Health Surveys; D006801:Humans; D007630:Kenya; D058751:Livestock; D011634:Public Health; D062486:Public Health Surveillance; D012111:Residence Characteristics