In spite of these positive changes over the long term, there is little understanding within enrolled participants of the transmission mechanisms and ecology of zoonotic pathogens that currently circulate in animal populations in the region. This is of particular concern in rural communities where close contact with bats and rodents was reported, and zoonotic pathogens have been detected in the widely distributed animal populations with the potential to spill over into the human population.20,32–35 In addition, rural residents may face a higher risk because of their limited access to quality healthcare facilities for proper diagnosis and treatment compared with urban residents.36