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Teleconsultation in VPH: Fighting Zoonoses and Maintaining Public Health through Veterinary Care on São Vicente, Cape Verde

Silvia Punzo1, Rossana Raineri1 2, Paolo Tizzani3

1SIMABO - Associação para a Protecção dos Animais e do Ambiente, info@, Rua Franz Fanon 14, Mindelo, Sao Vicente, Cape Verde

2Centro Veterinario Monviso, rossanaraineri@,

via Val Pellice, San Secondo di Pinerolo (TO), Italy

3University of Turin, Department of Veterinary Sciences, paolo.tizzani@unito.it, Largo P. Braccini 2, 10095 Grugliasco (TO), Italy

Introduction

SIMABÔ - Associação para a Protecção dos Animais e do Ambiente is the only non-profit animal welfare organization based on the island of São Vicente, Cape Verde. As such, they are the only provider of veterinary services for animals living on the streets or with owners on low income. To increase the health status of Cape Verdean dog population, SIMABÔ has been implementing the project “Fighting stray dogs on Sao Vicente A pilot project for the Capeverdean Islands” from February 2012 to January 2016. SIMABO’s project is the first, and to date, the only action of this kind co-funded by the European Union [under EuropeAid/130817/L/ ACT/CV (DCI-NSAPVD)] due to its combined value for public health.

The working hypothesis of the project is that surgical sterilization of the dogs is an effective way to control population density. This may improve animal health and subsequently public health.

Background

As most cats and dogs, both owned and stray, roam freely around the streets throughout the day and night, the Municipalities of the nine Cape Verde Islands have implemented different systems to control the canine population. Amongst these, strychnine poisoning is the most commonly used. Focusing on “elimination”, this method is opposed by the WHO because it is ineffective and it is opposed also by the local population because it is dangerous and doesn't allow to discriminate between owned and stray animals. SIMABO’s aim is to provide a more humane and more effective alternative to decrease the dog popultation: surgical sterilization to reduce the overall reproductive index.

In 2013 SIMABÔ was recognized as an Organization of Public Utility by the Cape Verdean Government and in October 2014 the organisation was included in the list of the beneficiaries of Law no. 45/VI/2004 of 12.7.2004. This states that a limited number of eligible organizations can receive a percentage of the tax paid by Cape Verdean companies. Back in 2010, the local Delegation of the Ministry of Health had authorized the purchase of medications by SIMABÔ from the only Cape Verdean vendor that supplies hospitals, private clinics, and pharmacies.

Rationale

The lack of local veterinarians to help with treatment and care of neutered dogs and cats has meant that SIMABÔ must employ lay staff for these purposes. One nurse and two more lay staff (all with no formal training) take care of the neutered animals with the support of protocols prepared by the veterinarians of Centro Veterinario Monviso, Italy. The vets from CVM make also themselves available 24/7 via Skype or email when their assistance is needed for more challenging cases. The feedback obtained is used to continuously update existing protocols (Fig. 1 and 2).

In conjunction, Drs. Tizzani and Peano from the University of Turin, Department of Veterinary Sciences, Parasitology Sector, are collecting samples with the aim of preparing specific protocols for treating and preventing Microsporum canis infection in dogs. Microsporum canis is a dermatophyte fungus, and causes dermatophytosis - commonly known as ringworm or tinea. Preferential hosts are cats and dogs, and as the infection is zoonotic it is also of significant public health importance. This disease has been investigated and documented in several countries within Europe, but documentation of the disease and public awareness are lacking within Cape Verde.

Finally evaluation of the long term consequences of surgical sterilization on population dynamic and health conditions was investigated by means of specific census activities carried out at the beginning (year 2012) and at the end (year 2016) of the project.

Objective

The objective of using telemedicine in this veterinary capacity is to support remote lay staff in four main areas:

1. Post-operative care,

2. Anti-parasitic regimes,

3. Appropriate emergency care and

4. Evaluation of population dynamics.

This project "Fighting stray dogs on São Vicente – A pilot project for the Capeverdean Islands" co-financed by the European Union provides funding for the castration, microchipping, anti-parasitic treatment and post-operative care of 10,000 dogs.

The overarching aim is control of the canine population of the island, to make abandoned animals more adoptable and to make strays safer companions for those people living on the streets.

One of the problems with canine overpopulation is the resulting opinion of the general public, often being that the animals carry zoonotic diseases and have little or no value. The animals castrated under the project are thus exposed to numerous risks when put back on the streets, from poisoning to road accidents, from neglect to torture. SIMABÔ is working to improve public-animal relations through awareness and create a more harmonious human-animal bond by bettering the health of street dogs, and educating local communities, for example through educational school visits. To evaluate the impact of the sterilization on the canine population, two census campaigns were carried out at the beginning and at the end of the project, applying direct and indirect census techniques.

|[pic] |[pic] |

|Fig. 1. Taking a sample from a puppy |Fig. 2. A neurological consultation of a |

|with a very severe skin lesions |paralyzed cat via Skype |

Materials and Methods

The lay staff relies on the following limited resources:

1. A very limited list of pharmaceuticals that allow treatment of the most common conditions, such as internal and external parasite infestations (mainly round worms, tapeworms, fleas and ticks), ehrlichiosis, pyoderma, mycosis, scabies, other infections, trauma and tumors, especially Transmissible Venereal Tumour (TVT).

2. A protocol for the treatment of common conditions based on the principle “primum non nocere” (first, do no harm), that excludes for instance the use of steroids, cardio drugs, diuretics, antipyretics, if not explicitly recommended for the treatment of very specific conditions or after the web-consultation with CVM;

3. Tele-consultations with Dr. Raineri or her staff for difficult cases – here a standard form containing all the animal information and clinical parameters is completed by lay staff and sent by email to the clinic in Italy, with pictures if required. On average, two cases per week are handled in this manner including eye conditions, skin problems, systemic diseases and trauma.

During the two census campaigns carried out in 2012 (beginning of the project) and 2016 (ending of the project) the monitoring was done using direct and indirect techniques, to provide an accurate and precise estimation of the canine population (an accurate evaluation using narrow confidence intervals of the estimates). The population estimates were done in almost real time with a first team collecting field information in Cape Verde and a second team, based in Europe, that received, analyzed and elaborated the data to provide rapid evaluation of population trend.

Results

Since the beginning of the project, there has been a remarkable improvement in the health of the canine population of São Vicente, together with an appreciable increase in public awareness of the importance of animal health. Due to the very low mortality rate of the neutered animals and high recovery rate of these patients, most of whom arrive at the clinic in a very bad condition, the treatment offered by the project in conjunction with the neutering is high in demand. The rapport generated with the local owners during the process of neutering and post-operative care now, more often than not, means that SIMABO’s assistance is sought as soon as any further concerns about their animal arise. This conveys that not only is the canine population being managed, but awareness of animal health and welfare is being raised and the remaining population of dogs are better cared for. This in turn generates benefits in public health.

The most important effect of the project was the reduction in the total canine population from 11,838 animals estimated in 2012 to 8,821 in 2016 - a 25% reduction in population density within 4 years. Additionally the incidence of parasitic diseases amongst remaining animals was investigated and showed a reduction over these years.

Considering the above, the project implemented by SIMABO achieved its aims of control over canine/feline population density and net improvement in animal health and welfare, with secondary improvements at the human/animal interface. In short, the concept of Veterinary Public Health, being "the sum of all contributions to the physical, mental and social well-being of humans through an understanding and application of veterinary science", was well and successfully applied.

Acknowledgment

SIMABÔ thanks the whole staff of Centro Veterinario Monviso, Pinerolo (TO); the Department of Veterinary Sciences, University of Turin; ZOHE E-HEALTH - Promoting Healthcare Through Knowledge, Research and Innovation, Pinerolo (TO); and Dr. Yvette Bell, DMV, for their help and support.

|[pic] | |

| |Silvia Punzo, President of SIMABÔ - Associação para a Protecção dos |

| |Animais e do Ambiente Sao Vicente, Cabo Verde, West Africa, and |

| |coordinator of the project "Luta contra os animais vadios na ilha de |

| |São Vicente" (Fighting stray animals on Sao Vicente island, a pilot |

| |project for the Cape Verde Islands). |

|[pic] | |

| |Dr. Rossana Raineri, chief surgeon at Centro Veterinario Monviso, San |

| |Secondo di Pinerolo (TO), Italy, and chief surgeon at SIMABO - |

| |Associação para a Protecção dos Animais e do Ambiente, Sao Vicente, |

| |Cabo Verde, West Africa |

|[pic] | |

| |Dr. Paolo Tizzani, DVM PhD MSc, European College of Zoological |

| |Medicine, Wildlife Population Health Diplomate, Department of |

| |Veterinary Sciences, University of Turin, Italy. |

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[pic]

Fig. 3 Clinical notes

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