KeyBio pipeline for bioinformatics and data science
Welcome to the Kenya One Health Conference
1. Welcome to the Kenya
One Health Conference
6th December 2021
Bernard Bett & Lian Thomas
2. Who is ILRI?
CGIAR global partnership for a food secure
future
• Poverty alleviation through agricultural
research
• 15 research centres
• More than 8,000 scientists,researchers,
technicians and support staff
https://www.cgiar.org
3. What does OHRECA do?
Established to significantly enhance
human, animal and environment health
by:
• Supporting One Health networks
• Developing capacityin One Health
• Undertaking applied One Health research
• Strengthen pathwaysfrom evidence to
policy and practice
Click to add text
4. OHRECA Activities
• Applied research within Food Safety,
Emerging Infectious Diseases, Neglected
Zoonoses & Antimicrobial Resistance
• Capacity Strengthening at different levels
• Cohorts of Graduate Fellows
• Community level outreach
• Behavior change for value chain actors
• National and Regional Network Building
7. Visit the OHRECA page on ILRI website
• Visit our website:
ilri.org/research/facilities/one-health-centre
• Subscribe to our newsletter:
http://eepurl.com/hn8DEX
• Follow us on Twitter: @ohreca_ilri
8. House Keeping
• Please mute your mics when joining
• Turn on video’s when speaking unless
bandwidth issues
• Please contribute your thoughts in the chat
function
• This session is being recorded
9. Why have a Kenya One Health
Conference?
• Showcase One Health related work in Kenya
• Develop a framework for One Health Research that is
appropriate to the Kenyan context
• Identify initial elements to a demand driven OH research
agenda and capacity building strategy based on the needs
of policy makers in the countries
10. Conference process
• Through a combination of keynote speakers and selected
presentations we will explore many aspects of One Health in Kenya
• Audience participation will be vital in identifying the key messages
which we can use to build our One Health Research Framework
• Messages will be disseminated through blogs, on social media and on
our dedicated website (https://www.ilri.org/kenya-one-health-
conference)
• Join in with your thoughts on www.mentimeter.com
• Share tweets, retweet and tag us in your posts @Ohreca_ilri and use
the #KOHC2021
17. 17
Mentimeter
Download on App store or go to
www.menti.com
…an interactive presentation
tool that allows users to engage
their audiences in real time
• Multiple choice
• Open ended questions
• Spectrum questions
• Quiz competitions
• Word clouds
Using in OH Kenya conference to
get participant feedback and
engagement so as to develop an
inclusive OH research agenda
18. 3-minute flash talks
Dr Keli Gerken
Mr Ackson Tyson Mwale
Dr Dennis Makau
Mr James Akoko
Mr Titus Mutwiri
22. Antimicrobial resistance in
slaughterhouses in western Kenya
Kenya One Health Conference
6th December 2021
Katie A. Hamilton, Sam M. Njoroge, Kelvin Momanyi, Maurice K. Murungi, Christian O.
Odinga, Nicholas Bor, Allan Ogendo, Josiah Makhandia, Joseph G. Ogola, Eric M. Fèvre,
Laura C. Falzon
24. Antimicrobial resistance
Antimicrobial resistance(AMR) in bacteriais regarded as one of:
• The most serious globalpublic health threats of this century.
• Over the last decade, increasing levels of resistance to clinicallyrelevantantibiotics–
includingcarbapenems and colistinwhich are considered antibioticsof last resort –
have been reported in both human and animalpopulations.
• Focus on Escherichia coli, as an exemplar emerging pathogen, which exists in a
diversity of hosts, in the environment,on food, in waste, etc.
• Escherichia coli can be a harmless gut commensal, some pathogenicstrainscan
cause life-threateningbloodstream infectionsand common illnesses.
• Escherichia coli can also cause disease in animals, leading to severe economic losses
due to mortalityand morbidity.
• Escherichia coli was categorized by the World Health Organizationasa priority
pathogen due to its widespread antibioticresistance.
25. Slaughterhouses
Hotspots for pathogen transmission given frequent interactions between people,
animals, and the surrounding environment
Risk to slaughterhouse workers and meat consumers
Optimal sentinel sites for surveillance and interventions
Study objectives:
Microbiological assessmentof the slaughterhouse
working environment
Engage stakeholders in discussionson AMR
28. Focus group discussions and workshops
County Veterinary Officers (CVO)
Sub-County Veterinary Officers (SCVO)
Meat Inspectors (MI)
Slaughterhouse Workers (SHW) from
Busia, Bungoma & Kakamega counties
29. Results of the biological sampling
We collected 193 samples from 13 slaughterhouses (9 ruminant & 4 pig) in 11 sites
Isolates were identified in 101 (52.3%) of the samples
• Isolates present in samples taken in all slaughterhouses
• No difference between pig and ruminant slaughterhouse samples
Highest proportion of isolates in samples from:
• Carcass (67.5%)
• Boot socks (63.6%)
• Meat box (63.2%)
30. AntimicrobialSusceptibility Tests done on 98 isolates (21 pig and 77 ruminant)
Highest frequency of resistance:
- Streptomycin (73.5%)
- Ampicillin (55.1%)
- Tetracycline (50.0%)
- Tri-sulfa (45.9%)
31. Multi-Drug Resistance (MDR)
(i.e. resistanceto 3 or more classes)
in 50/98 (51.0%) of the isolates
tested
No significant difference between
isolates from ruminant and pig
slaughterhouse samples
Highest proportion of MDR isolates
in boot socks (62.5%)
32. ExtendedSpectrum Beta-Lactamase
are enzymes that confer resistanceto
most beta–lactamantibioticsincluding
penicillins and cephalosporins
Expressed by 16/98(16.3%) of the
isolates tested
11 ruminant samples
5 pig samples
Identified in 8 of the 11 sites sampled
Highest proportion in boot sock
(37.5%) and meat box (30.8%) samples
Extended Spectrum Beta-Lactamase Enzymes
34. Inadequate use
of drugs
Under/over-dosing
Withdrawal periods
Indiscriminate prescriptions by professionals
CVO: “If we vets also continue looking at all animals like they are ‘antibiotic deficient’,
that is the disease we treat, this problem will continue escalating.”
35. Infrastructure
Inadequate clothing – lack of protective clothing
Underinvestment in infrastructure and equipment
Reliable water source
Perimeter fence
Waste disposal
Laboratory capacity and surveillance
Inadequate
funding & staff
37. Drug advice
Drug failure
Anti-malarials [humans]
Ectoparasitic & anthelmintic drugs [livestock]
Counterfeit drugs
Amoxicillin and Alalmycin
Self-diagnosis
Hospital in case of complications
Drugs are freely available
Muloi et al. doi: 10.7189/jogh.09.020412
38. Reasons for
resistance
Incorrect drug usage, e.g. under-dosing
SHW: “Sometimes you visit the chemist or clinic where a dose is prescribed for you but you don’t
have enough cash so maybe the drugs cost like 600 and you have 200. So because the doctor wants
money they tell you to go with a little drug and ask after how many days will you get the money?
You tell him tomorrow. You take the drugs for a few days and notice a change then stop, which also
contributes because you have not finished the dose."
39. Transmission
of resistance
Occupational risk
SHW: “So, maybe there are diseases that affect the animals and is undergoing treatment. The
animal is taken to the slaughterhouse without completing the treatment, when slaughtering the
animal, there is the interaction between human and the animal. In case there are injury to the
human, there may be mixing of blood of the animal and human blood and hence we can also be
affected."
40. SHW: “Educate us on how we would be handling maybe the meat before it reaches…
Which other ways are we handling where, educating us on getting a knife, cutting meat,
how to hang the meat so that it doesn’t get bacteria from the ground, like you said, dust
usually contains bacteria, so you educate us before undertaking the work.”
An educational video that we produced and shared with all participants taking part in the study:
https://youtu.be/T472S-zYZf0
Dealing with
resistance
Education
Training
Hygiene
46. 46
Why Nairobi?
• It is a rapidly urbanizing city
• Annual population growth rate of 3.96%
• 60% of Nairobi’s residents live in informal settlements
• High infectious and non-communicable diseases burden
• Fragmented landscapes – few green spaces, concrete
jungles, polluted waterways, Nairobi National Park
Relationship betweeneconomic
development(illustrated byGNP)and
causesof death
47. 47
• Literature review
• Theory of change
• Identify relevant stakeholders
• Contact stakeholders
• Key informant interviews
• Snowballing
• 30 institutions
• 18 responded, 12 meetings done
• 4 research institutions
• 3 urban planning
• 3 public health
• 3 ecosystem health
• Data collection
• Transcription
• Thematic analysis
• Generate and validate hypotheses
with government planning
authorities
• Test hypotheses in the field and lab
Data analysis plan
Approach
31%
23%
23%
23%
Urban Health Sectors
Research
Urban planning
Public health
Ecosystem
health
49. 49
Emerging Themes
❑ Weak coordination
• Clear individual roles but ill-defined
linkages between sectors
• Competing priorities
❑ Minimal operationalisation
• Frameworks exist, but poor
implementation
• Political changes
• Little accountability
• Funding
❑ Weak research-policy interface
• Researchers are consulted
❑ Unintegrated surveillance systems
50. 50
Research
Ecosystem
health
Public health Urban planning
Weak coordination 100% 100% 100% 67%
Research incoorporation 100% 67% 67% 67%
Challenge with implementation 0% 33% 100% 67%
Surveillance system 75% 33% 0 0
0%
20%
40%
60%
80%
100%
Respondents
Themes
Themes/Sector
• 75% - existing partnerships but weak
linkages.
• 83% - govt involves research in planning
decisions, 50% challenge with implementation
(NGOs & private sector)
• 75% - research should be incorporated
into urban planning decisions (100%
research institutions consulted)
• 33% carried out surveillance
• Nairobi Urban Health Demographics
Surveillance System (NUHDSS)
Emerging Themes
51. 51
Conclusions
Future work
• Series of meetings/workshops
• Generate and validate hypotheses
• Major stakeholder meeting
• Build a fundable research programme
• Weak linkages exist within the urban health sectors
• Challenge with implementation and operationalisation of
policies and frameworks
• There is need to form new and strengthen existing urban
health surveillance systems
58. Seroprevalence of Crimean Congo Hemorrhagic Fever Virus (CCHFV) among
Livestock, Wildlife and Ticks in Kenya
By
*B. Agwanda, #V. Obanda, € I.Blanco and ¥O. Lwande
*Zoology Dept. National Museums of Kenya
#Kenya Wildlife Research and Training Institute
€ Clinical sciences Dept, Uppsala University Sweden
¥Clinical Microbiology Dept, Umea University Sweden
59. Introduction
▪ CCHFV is a tick-borne zoonotic disease, with high-case fatality rate-40%.
▪ No Licensed vaccine and medicine currently
▪ Previous reports in Kenya include:
▪ PCR-confirmed fatal human case,
▪ CCHFV antibodies detection in humans and
▪ virus isolations from Hyalomma ticks.
Yet, basic information about its epidemiology is lacking.
Dunster et al (2002).Emerg. Infect. Dis.; 8(9): 1005–1006
Lwandeet al. (2012)Vector-Borneand Zoonotic Diseases. 1;12(9):727-32.
Sang et al. (2011)Emerging infectious diseases;17(8):1502.
60. Seroepidemiology of CCHFV in Wildlife-Livestock management systems
▪ Aim: To determine the prevalence of CCHFV in cattle and
buffalo in different wildlife-livestock managementsystems
✓ Wildlife closed system (Lake Nakuru N Park- LNNP)
✓ Closed wildlife-livestock system(Olpejeta conservancy-OC)
✓ Open wildlife-livestock (Maasai Mara Ecosystem-MME)
▪ Seroepidemiological study of the sera of 148 cattle, 23 sheep
and 17 goats from 18 households from the three ecosystems in
2014, 2016, and 2019.
▪ Sera were analysed for the presence of antibodies to CCHFV
using the commercially available double-antigen ELISA kit
Blanco-Penedoet al., 2021. Dairy 2021, 2(3), 425-434
Map of Kenya showing the locationof study area
61. LivestockPresence Influences the Seroprevalence of CCHFV on SympatricWildlife in Kenya
Obandaet al., 2021. . Vector-Borne and Zoonotic DiseasesVol. 21, No. 10 21(10):809-816
Map of Kenya showing the location of study area and Crimean-Congo
hemorrhagic fever (CCHF).
Results
62. Results
Obandaet al., 2021. . Vector-Borne and Zoonotic DiseasesVol. 21, No. 10 21(10):809-816
Seropositivity in Cattle and buffalo in differentmanagement systems
64. Results
Overall, 31.5% CCHFV seropositivity was observed
Blanco-Penedoet al., 2021. Dairy 2021, 2(3), 425-434
CCHF IgG-positive cases among the sampled cattle by different ecosystems in
Kenya.
65. Discussion
▪ Apparently high CCHFV exposure among buffaloes shows natural circulates in the wild in
Kenya in spatially disconnectedfoci
▪ Habitat overlap between cattle and buffalo makes cattle a ‘‘bridge species’’ or super
spreader host for CCHFV raising transmission risks to humans
▪ The effect of animal management system on prevalence is depended on tick control on
the cattle and not the animal per se
▪ Buffalo, a host with a longer life span than livestock, is a reservoir and may serve as a
sentinel population for longitudinal surveillance of CCHFV
▪ Elevated exposure rate in adult cattle points to longer period of exposure to CCHF vector-
ticks
Obandaet al., 2021. . Vector-Borne and Zoonotic DiseasesVol. 21, No. 10 21(10):809-816
66. Summary
▪ High prevalence CCHFV-specific antibodies in discrete cattle populations points to CCHFV circulation in the region
▪ The role of environmental and managementfactors in the transmission of CCHFV among dairy species requires
further studies
▪ Surveillance in ticks and human still wanting especially among livestock keepers and handlers
▪ PCR and genomic surveillance needed to understand epidemiological bridges between wildlife, cattle, human,
ticks and places
Blanco-Penedoet al., 2021. Dairy 2021, 2(3), 425-434
67. Acknowledgements
Umeå University
Prof. Clas Ahlm
Assoc Prof. Olivia Wesula Lwande
SwedishUniversity of Agricultural Sciences
Dr. IsabelBlanco Penedo
ResearchPermitting andCompliance Wildlife ResearchandTraining Institute
Dr. Vincent Obanda
The project was funded by
the Swedish Research
Council
(2019-04366)
The study (on going)leverages on strengths and opportunitiesfrom Swedish and Kenyan(SWED-KEN) researchers
through capacity buildingand institutionaldevelopmentin research on prevalenceand distributionof CCHFV in
humans, ticks, livestockand wild mammals in Kenya
74. One Health studies at the
animal-human-
environmental interface in
Oloisukut conservancy,
Narok County
Dr Erastus Mulinge, Zipporah Gitau
and Christina Trabanco
75. One Health Studies at the Human-
Animal-Environment interface in the
Oloisukut Conservancy, Narok County
Presenters: Erastus Mulinge
Zipporah Gitau and Christina Trabanco
Other members: Malika Kachani, Eberhard Zeyhle, David Odongo,
Deanna Overton, Peter Gathura , Jackson Mpario & Japhet
Magambo
77. Introduction - One Health
• “An integrative effort of multiple
disciplines working locally, nationally, and
globally to attain optimal health for
people, animals, and the environment”.
• In 2012, Kenya implemented the One Health
approach and created the Zoonotic Disease Unit
(ZDU)
• Collaborative inter-ministerial unit.
• 5-year implementation plan.
• Created a list of 17 priority zoonotic diseases
to better guide policy and prioritization of
resources.
http://www.zoonotic-diseases.org/zdu-road-
map-to-one-health/
78. Study Site: Oloisukut Conservancy
• Established in 2006.
• Trans Mara West, Narok County, Kenya, part
of the greater Mara – Serengeti ecosystem.
• Covers an area of 23,000 acres, 51
individually owned and registered parcels.
• Membership of 109 heads (12, 500 residents)
• Average of 10 to 15 individuals per household
• The livestock population included:
• 21,200 cattle
• 35,850 sheep and goats
• 881 dogs
79. PROJECT ACTIVITIES
One Health: people, animals, environment.
One Health approach: funding, data collection, analysis, implementation of control
interventions as opposed to separate budget and health professionals working in silos
- Incentives:
- 881 dogs vaccinated and treated against intestinal parasites
- Adults and children treated against soil-transmitted helminths
- Samples collected from people, dogs, livestock and wildlife for disease prevalence.
- Intestinal helminths in dogs: Dr. Erastus Mulinge.
- Prevalence of intestinal parasitic infections in humans:
Zipporah Gitau
- Knowledge, Attitudes and Practices: Dr. Christina Trabanco.
82. Cystic Echinococcosis, Cysticercosis & Coenurosis
8
Source: Eberhard Zeyhle, Dr. Alex Sabuni and Internet
- Dogs are reservoirs of several zoonotic
parasites of public health significance
worldwide.
- Dogs are associated with mechanical
transmission of intestinal parasites to
humans mainly through coprophagy or
contact with other body parts.
83. Other zoonotic infections caused by dog parasites
Cutaneous larva migrans, Ocular larva
migrans, visceral larva migrans
Sparganosis
Cryptosporidiosis and giardiasis
9
Sources: Internet
84. Materials and methods
• Vaccination against rabies/canine
distemper and deworming
• 100 dog faecal samples collected
and processed (microscope, PCR)
• 76/109 households sampled
86. Conclusions
• Nine genera of intestinal helminths were detected in dogs
• Ancylostoma Spp. was the most common helminth
• The first molecular detection of S. theileri, D. caninum and Mesocestoides sp. in
Kenya
• Zoonotic helminths in dogs pose a public health risk to residents of the
conservancy
• The helminths reported here confirm the interaction of domestic dogs with
wildlife
• The control of helminth infections in dogs, humans and wildlife calls for
collaborative effort from the human, animal and environment health
professionals in the context of the One Health approach.
12
87. Prevalence of intestinal parasitic
infections in humans.
Zipporah Gitau, MSc student,
University of Nairobi
Contributing authors:
Erastus Mulinge, Eberhard Zeyhle, Jackson Mpario, Tabitha
Irungu, Joyce Nyambura, Japhet Magambo, Malika Kachani,
David O. Odongo
88. Introduction
• Parasitic worms are of major public health importance.
• Globally, 3.5 billion affected.
• Focus: intestinal parasites: soil-transmitted helminths, Schistosoma,
protozoa.
• Common in areas with poor sanitation and hygienic practices.
• Transmission: fecal-oral, food, water, insects and animals (zoonotic).
• Control: WHO Global Strategy is based on regular deworming.
89. National school-based deworming
Program in Kenya
• Begun in 2012.
• Aim: reduce infection and associated
morbidity.
• Main target: areas with high
worm infections.
• Challenges
• Deworming does not protect
children from re-infection.
• School-based rather than
community treatment.
• Drug resistance.
• Environmental contamination.
• Importance of Animal- Human
transmission
90. Materials and methods
• Recruitment of participants
• Fecal sample collection
• Sample processing
91. Results: Prevalence of intestinal parasitic infections among the community
Intestinal Parasites
Helminths
Formal ether
concentration method
Kato-Katz technique
Trichiuris trichiura 111 (28.3%) 125 (30.4%)
Ascaris lumbricoides 20 (5.1%) 18 (4.4%)
Ancylostoma duodenale/Nectar americanus 5 (1.3%) 6 (1.5%)
Hymnelopsis nana 4 (1.0%) 1 (0.2%)
Taenia spp. 1 (0.3%) 2 (0.5%)
Strongyloides stercoralis 1 (0.3%) 0
Protozoa
Entamoeba histolytica/dispar/moshkovskii 130 (33.2%) 0
Entamoeba coli 96 (24.5%) 0
Giardia lamblia 40 (10.2%) 0
Iodamoeba butschlii 32 (8.2%) 0
Chilomastix mesnili 4 (1.0%) 0
Total parasites count 444 152
Total population sampled 392 411
Total population infected 226 132
Overall Prevalence of intestinal parasites 57.65% 32.12%
92. Prevalence by age and gender
Age group ( years) Total sampled Positive males Positive females Positive (%)
2-4 59 10 9 32.2
5-14 208 48 45 44.71
15-24 54 3 7 18.52
25-39 46 1 6 15.22
>40 44 1 5 13.64
Total 411 63 (15.33%) 72 ( 17.52%) 32.85
• Infections were generally more prevalent in females than males, 17.52% and 15.33%
respectively.
• Age groups between 5-14 years were more infected 44.71%.
• Infections decrease with age.
93. Discussion and recommendation
• The high prevalence of intestinal protozoan infections suggests poor
water, sanitation and hygiene conditions.
• The high prevalence of helminth infections among the non-targeted
population requires a greater focus of interventions.
• The presence of Taenia spp. confirms the occurrence of zoonoses in the
community.
It is recommended that the entire community is included in a
comprehensive helminth and protozoan control program.
94. Knowledge, Attitude, and Practices
relating to risk factors for zoonotic
diseases in the Oloisukut Conservancy:
A One Health Approach
Christina Trabanco, Western University of Health Sciences
Contributing authors: Deanna Overton, Eberhard Zeyhle,
Erastus Mulinge, Peter Gathura, Jackson Mpario, Fanglong
Dong, Japhet Magambo, Malika Kachani
95. Materials and Methods
• 15 households out of 109 included in final analysis.
• One Health Approach and Participatory Epidemiology used to collect data about
people, animals and their environment.
• Goals
• Highlight the major risk factors and dire needs that perpetuate the
transmission of 7 neglected zoonotic diseases prioritized by WHO and ZDU.
• Understand the cultural norms specific to conservancy residents.
• Tailor culturally sensitive and sustainable control strategies that will be
recommended for implementation at the local level.
• Knowledge, Attitudes and Practices (KAP) surveys assessed the degree of:
• Knowledge of zoonotic diseases, transmission, treatment, and prevention.
• Attitudes towards zoonotic diseases.
• Practices or general behaviors that impact the risk of exposure.
97. Focus Group Discussion (an example)
• Coenurus cerebralis / Taenia multiceps larvae
(Ormilo): disease that many pastoralists were
concerned about and dealt with.
• An adult goat presented with clinical signs:
• Isolation from the herd
• Circling, ataxia
• Necropsy conducted, with permission of
owner.
• Parasite shown to community members.
• Members were educated on the route of
transmission and the prevention measures,
including not feeding brains to dogs.
Coenurus cerebralis cyst found in the brain of a goat.
The community was educated on the transmission factors and prevention measures
98. Disease transmission / prevention
• Rabies: close contact with dogs
• Anthrax: eating infected meat
• Tuberculosis: and Brucellosis:
drinking raw milk
• Sleeping sickness: tsetse flies
brought by elephants
• Cystic echinococcosis: infected
dogs and infected meat
• Foot and Mouth Disease: wildlife
• Malignant Catarrhal Fever:
wildebeests
• East Coast Fever: ticks/wildlife
Vaccines
dewormers
health
education
water
health center
99. Conclusion
• Limited awareness of zoonotic diseases.
• Limited understanding of transmission routes.
• Most familiar with rabies and diseases that affect
livestock production: TB, brucellosis.
• Improper water, sanitation, and hygiene practices,
cohabitation with animals, and presence of wildlife
increase risks of transmission.
• Factors that contribute to perpetuating diseases:
• Lack of access to clean water
• Lack of health education
• Lack of access to health care
• Lack of access veterinary health care
• Lack of access to education (adults, children)
• This pilot study provided baseline
data and identified adapted
control measures for the
implementation of sustainable
interventions.
• The proposed combination of
the One Health approach and
the participatory epidemiology
could be used in other pastoral
communities for disease control
and prevention.
100. Community projects initiated
• Rain-water harvesting to provide a continuous water supply.
• Ministry of Water pledged to assist in the construction of additional dams.
• The County Director of Health deployed a clinical officer, a lab technician and
provided additional equipment and supplies to the local health center.
• The County Veterinary Services implemented vector control programs and
selective livestock breeding programs to increase meat and milk yield.
• Veterinary officer made available and livestock vaccination implemented.
• Local agrovet company planned a certified veterinary drug depot.
• Community recommended implementation of preventive measures against
predators: protective fences and lion lights.
Intersectoral collaboration and the community participation
were crucial to the implementation of these interventions
101. Acknowledgments
• Jackson Mpario, Director Conservancy
• County Director of Health, Narok
• County Director of Veterinary services,
Narok
• Ministry of Water, Narok County
• All those who helped make this research
possible including:
• Household heads in the Oloisukut Conservancy
• Officers of the conservancy including Bernard
Sankale, Leonard Kinanta, and Charles Ntiayai
• Staff at the University of Nairobi, Kenya and the
Kenya Medical Research Institute (KEMRI)
• Tonny Teya and Mathews Mutinda, KEMRI
106. ‘What is One Health
Research and how can we
do it better? A round table
discussion’
Panelists: Prof Eleanor Opondo, Dr
Jeanette Dawa, Prof Salome Bukachi,
Dr JasonSircely and Prof Eric Fevre
Moderator: Dr Ekta Patel