NIHR Global Health Research Group on Zoonotic Causes of Acute Febrile Illness (GHRG-ZAFI)

Acute febrile illnesses (AFI) account for 40% of child deaths in sub-Saharan Africa, and an unknown level of morbidity and mortality in adults. Growing awareness of the animal origins of many human diseases (zoonoses) has highlighted their importance as causes of AFI. However, diagnosis of zoonoses is not widely pursued in low resource settings. This contributes to low awareness of zoonoses which hinders early detection and effective clinical management of AFI.

Our Global Health Research Group (GHRG) unites experts in paediatrics, epidemiology, microbiology, social science, diagnostics development, infectious diseases and zoonoses/arboviral research. Our overall aim is to improve the diagnosis and management of zoonotic causes of acute febrile illness (ZAFI) in children in sub-Saharan Africa. These patients face well-recognised problems getting diagnosed and treated properly, given the tendency of healthcare workers to over diagnose malaria and/or prescribe penicillin (which is ineffective against many zoonoses) following a negative malaria test.

Our GHRG will: i) Determine the common causes of ZAFI and associated factors in paediatric patients; ii) Develop and test novel technologies and approaches for diagnosing ZAFI that are suitable for use in low resource and field settings; iii) Involve communities and the health sector in defining improved approaches to diagnosing, managing and preventing ZAFI; and iv) Strengthen capacity and capability for research on diagnosis and management of zoonotic diseases.

Our research, capacity strengthening, and engagement activities will take place in Uganda, Kenya and Ethiopia and will target rural areas and informal urban settlements where livestock-keeping and environmental conditions contribute to enhanced zoonotic disease risk. Activities will be delivered through four interlinked work packages (WP) over four years:

WP1 Understanding epidemiology: Conducting cross-sectional (observational) studies in health facilities to gather evidence on key zoonotic causes of AFI at two sites in each country.

WP2 Improving diagnosis: Undertaking laboratory and clinical studies to evaluate a suite of point-of-care (PoC) tests and pilot prototype molecular diagnostic platforms and determine feasibility of expanding uptake of molecular tools for diagnosis of key zoonotic pathogens.

WP3 Engaging communities and end-users: Engaging communities, healthcare workers and decision-makers in knowledge sharing on the causes of AFI, barriers to care seeking and clinical management of AFI; soliciting feedback and input on our approaches and findings; developing and validating a practical tool for diagnosing and managing ZAFI in clinical settings; and conducting community conversations to expand awareness on the prevention of zoonoses.

WP4 Strengthening capacity and capability: Assessing baseline capacity to undertake zoonoses diagnosis in select laboratories; developing tailored capacity strengthening plans consistent with laboratory priorities; developing a cohort of clinical and laboratory researchers; and promoting learning opportunities for developing countries in the Global South.

Combined, these activities provide a coordinated, multi-country evidence generation and training effort, enabling us to develop and install state of the art tools for clinical and laboratory researchers conducting applied global health research on the causes, diagnosis, and management of ZAFI.