Rafael Ruiz de Castañeda

Introduction: Biodiversity is inextricably linked to human health. As an important area of research of the Convention on Biological Diversity and a key avenue for the dissemination of biodiversity and health knowledge, we investigated how well-embedded biodiversity and health interlinkages are in institutional higher education offerings.Methods: Using One Health education programs as a starting point, we collected a global list of institutions potentially carrying out education in the links between biodiversity and health through previously published research, academic partners of global conglomerates, and our own networks. We then analyzed the offerings from these institutions to determine the degree of integration of biodiversity and health interlinkages.Results: We found 105 educational offerings in biodiversity and health interlinkages from 89 institutions in 30 countries. These were primarily found in faculties of public health, veterinary sciences, and medicine, with varying degrees of coverage of the interlinkages.Conclusion: Education incorporating the links between biodiversity and health exists globally, but should be more widely integrated, particularly through inter-faculty and inter-institutional collaboration.

Background: Worldwide, it is estimated that snakes bite 4.5–5.4 million people annually, 2.7 million of which are envenomed, and 81,000–138,000 die. The World Health Organization reported these estimates and recognized the scarcity of large-scale, community-based, epidemiological data. In this context, we developed the “Snake-Byte” project that aims at (i) quantifying and mapping the impact of snakebite on human and animal health, and on livelihoods, (ii) developing predictive models for medical, ecological and economic indicators, and (iii) analyzing geographic accessibility to healthcare. This paper exclusively describes the methodology we developed to collect large-scale primary data on snakebite in humans and animals in two hyper-endemic countries, Cameroon and Nepal. Methodology/Principal findings: We compared available methods on snakebite epidemiology and on multi-cluster survey development. Then, in line with those findings, we developed an original study methodology based on a multi-cluster random survey, enhanced by geospatial, One Health, and health economics components. Using a minimum hypothesized snakebite national incidence of 100/100,000/year and optimizing design effect, confidence level, and non-response margin, we calculated a sample of 61,000 people per country. This represented 11,700 households in Cameroon and 13,800 in Nepal. The random selection with probability proportional to size generated 250 clusters from all Cameroonian regions and all Nepalese Terai districts. Our household selection methodology combined spatial randomization and selection via high-resolution satellite images. After ethical approval in Switerland (CCER), Nepal (BPKIHS), and Cameroon (CNERSH), and informed written consent, our e-questionnaires included geolocated baseline demographic and socio-economic characteristics, snakebite clinical features and outcomes, healthcare expenditure, animal ownership, animal outcomes, snake identification, and service accessibility. Conclusions/Significance: This novel transdisciplinary survey methodology was subsequently used to collect countrywide snakebite envenoming data in Nepal and Cameroon. District-level incidence data should help health authorities to channel antivenom and healthcare allocation. This methodology, or parts thereof, could be easily adapted to other countries and to other Neglected Tropical Diseases.

Multidisciplinary and multisectoral approaches such as One Health and related concepts (e.g., Planetary Health, EcoHealth) offer opportunities for synergistic expertise to address complex health threats. The connections between humans, animals, and the environment necessitate collaboration among sectors to comprehensively understand and reduce risks and consequences on health and wellbeing. One Health approaches are increasingly emphasized for national and international plans and strategies related to zoonotic diseases, food safety, antimicrobial resistance, and climate change, but to date, the possible applications in clinical practice and benefits impacting human health are largely missing. In 2018 the “Application of the One Health Approach to Global Health Centers” conference held at the Albert Einstein College of Medicine convened experts involved in One Health policy and practice. The conference examined issues relevant to One Health approaches, sharing examples of challenges and successes to guide application to medical school curricula and clinical practice for human health. This paper presents a synthesis of conference proceedings, framed around objectives identified from presentations and audience feedback. The following objectives provide opportunities for One Health involvement and benefits for medical schools and global health centers by: 1) Improving One Health resource sharing in global health and medical education; 2) Creating pathways for information flow in clinical medicine and global health practice; 3) Developing innovative partnerships for improved health sector outcomes; and 4) Informing and empowering health through public outreach. These objectives can leverage existing resources to deliver value to additional settings and stakeholders through resource efficiency, more holistic and effective service delivery, and greater ability to manage determinants of poor health status. We encourage medical and global health educators, practitioners, and students to explore entry points where One Health can add value to their work from local to global scale.

Background: Each year, two million people worldwide suffer snakebite envenoming (SBE), resulting in up to 138,000 deaths. The World Health Organization has added SBE to the list of Neglected Tropical Diseases, calling for stronger epidemiological evidence in highly endemic countries such as Nepal. Methods: We conducted a cross-sectional survey in 249 randomly selected clusters across Nepal’s Terai region, including 13,879 geospatially selected households. We analysed snakebite incidence rates and outcomes in humans and domestic animals. Findings :Among 63,454 human participants, 166 suffered snakebites over the previous 12 months; 48·8% were envenomed and 7·8% died. This corresponded to annual incidence rates of 262 snakebites [95% CI 225–305] , 127 envenomings [102–158], and 20 [12–35] deaths per 100,000 individuals, extrapolating into 37,661 yearly victims [32,362–43,836] and 2,949 deaths [1,728–5,053] in the Terai. Victim median age was 30 years (IQR 20–45) and 60% were female. Children younger than 15 years (n=6; 46%) and females (n=10; 77%) were over-represented among the 13 deceased. Incidence was higher in Eastern, and mortality in Central regions. Of 184,999 animals, owners reported 144 snakebites, with annual incidence rates of 42-202 and mortality of 79-100 per 100,000 varying by animal type. Spatial and seasonal incidence were similar in humans and animals. Conclusion: This first One Health study on snakebite across Nepal’s Terai shows high incidence and mortality rates in humans and animals. These results call for strengthening of preventive measures and better access to life-saving treatments. Funding: Swiss National Science Foundation project 315130_176271 (SNAKE-BYTE) Declaration of Interest: None to declare. Ethical Approval: The study was approved by the Nepal Health Research Council (NHRC Reg. 585/2018), and Commission Cantonale d’Ethique de la Recherche Scientifique in Geneva, Switzerland (CCER/SwissEthics Registry No. 2018-01331).