Applying participatory approaches in the evaluation of surveillance systems: A pilot study on African swine fever surveillance in Corsica

An assessment of the operationality and factors influencing the effectiveness of rabies surveillance in Gombe State, Nigeria

Rabies remains a burden in Africa, disproportionately affecting the most vulnerable despite the availability of effective vaccines. Nigeria, the most populous African country, needs rapid disease control actions and commitments to achieve the goal of eliminating dog-mediated rabies by 2030. Surveillance is an essential element of effective disease control strategies. This study examined the current state of operationality of the rabies surveillance system for early case detection and management in Gombe state, Nigeria, through a One Health lens. It further examined the barriers impeding the effectiveness of the surveillance based on the perception of surveillance workers. Qualitative and quantitative methods were used to assess the structure of the system and its functioning. Data on dog bite and rabid cases obtained from the veterinary services in Gombe state were analysed descriptively. A total of 13 key informants were interviewed using a semi-structured interview guide. Qualitative data were analysed using thematic analysis to explore in depth the factors that influenced the operationality of the system. A total of 157 potential human exposures to rabies were identified in this study, out of which two people reportedly died at the health facility after showing symptoms highly suggestive of rabies. In terms of rabies surveillance and control, cross-sectoral collaboration was found between the human health and veterinary sectors for risk assessment of potential rabies exposures and its management. Some identified factors affecting the operations of the surveillance were inadequate funding, lack of infrastructure, lack of feedback from higher authorities and insufficient knowledge of rabies prevention and management. To improve the capacity for case detection and management within the state, the appropriate authorities may focus on increasing awareness about the disease to the populace to increase the number of cases identified by the system, employ more workers and strengthen the surveillance capability of existing workers.

A combined methodological approach to characterize pig farming and its influence on the occurrence of interactions between wild boars and domestic pigs in Corsican micro-regions

The pig sector in Corsica is based by a wide range of farming systems, mainly characterized on traditional extensive practices, which favor contacts between domestic and wild individuals. These contacts are suspected to influence the maintenance and the transmission of shared infectious diseases between both populations. Therefore, it is important to develop methods that allow to understand and anticipate their occurrence. Modeling these interactions requires accurate data on the presence, location and use of land on pig farms and farming practices, but such data are often unavailable, incomplete or outdated. In this study, we suggest a method to collect and analyze pig farming information that combines approaches from social sciences and epidemiology and enables a spatial representation of an index of potential interaction (IPI) between wild and domestic pigs at municipality level in the Corsican territory. As a first step of the process, interviews were conducted to gather information from 103 pig farms. Then, using hierarchical clustering, we identified five different clusters of pig farming practices which were evaluated and validated by local experts using participatory tools. The five pig farming clusters with their respective estimated levels of direct and indirect interactions with wild boars were combined in a linear equation with pig density to estimate a hypothetical index of potential interaction (IPI) in 155 municipalities. Our results revealed the diversity of pig farming practices across the island of Corsica and pointed out potential hotspots of interaction. Our method proved to be an effective way to collect and update information on the presence and typology of pig farms which has the potential to update official livestock production statistics. The spatial representation of an IPI between wild boars and domestic pigs in the Corsican territory could help design regional disease management strategies and policies to improve the control of certain shared pig pathogens in pig farms from Corsica.

Understanding Smallholder Pigkeepers' Awareness and Perceptions of African Swine Fever and Its Control Measures in Ukraine

African swine fever (ASF) has posed a significant threat to Ukrainian pig farming since its identification in 2012. In this study, recognising the pivotal role of pigkeepers in disease control, we conducted ten focus groups involving 52 smallholders across eight regions in Ukraine. Using participatory methods, we revealed their awareness of ASF signs, transmission routes, preventive measures, and the perceptions of stakeholders involved in ASF control. Furthermore, we identified the smallholders' acceptance of eradication and restriction measures, the perceived impact of zoning consequences, and their main sources of ASF information. Smallholders identified fever and skin haemorrhage as the most indicative signs of ASF and highlighted rodents as a primary transmission concern. Disinfection was seen as the most effective measure for preventing the introduction of ASF. Pigkeepers who perceived their stakeholder role in ASF control showed more trust in themselves and veterinarians than in central veterinary authorities. Farm-level ASF eradication measures were generally accepted; however, culling within the protection zone was least accepted, with economic losses listed as the most impactful consequence for pigkeepers. For ASF information, pigkeepers favour web searches and veterinarians, as well as traditional media and word-of-mouth news. This study provides valuable insights into refining the ASF communication strategies in Ukraine.

Active Participatory Regional Surveillance for Notifiable Swine Pathogens

We evaluated an active participatory design for the regional surveillance of notifiable swine pathogens based on testing 10 samples collected by farm personnel in each participating farm. To evaluate the performance of the design, public domain software was used to simulate the introduction and spread of a pathogen among 17,521 farms in a geographic region of 1,615,246 km2. Using the simulated pathogen spread data, the probability of detecting ≥ 1 positive farms in the region was estimated as a function of the percent of participating farms (20%, 40%, 60%, 80%, 100%), farm-level detection probability (10%, 20%, 30%, 40%, 50%), and regional farm-level prevalence. At 0.1% prevalence (18 positive farms among 17,521 farms) and a farm-level detection probability of 30%, the participatory surveillance design achieved 67%, 90%, and 97% probability of detecting ≥ 1 positive farms in the region when producer participation was 20%, 40%, and 60%, respectively. The cost analysis assumed that 10 individual pig samples per farm would be pooled into 2 samples (5 pigs each) for testing. Depending on the specimen collected (serum or swab sample) and test format (nucleic acid or antibody detection), the cost per round of sampling ranged from EUR 0.017 to EUR 0.032 (USD 0.017 to USD 0.034) per pig in the region. Thus, the analysis suggested that an active regional participatory surveillance design could achieve detection at low prevalence and at a sustainable cost.

Evaluation of 17 years of MERIN (Meningitis and Encephalitis register in Lower Saxony, Germany) surveillance system: participants acceptability survey, completeness and timeliness of data

BACKGROUND

A Meningitis and Encephalitis Surveillance (MERIN) was implemented in 2003 in Lower Saxony, Germany as an alternative to acute flaccid paralyses surveillance, as the latter did not reach WHO sensitivity criteria. The system provides information on circulating enterovirus (EV) serotypes by focussing on patients with suspected aseptic meningitis, encephalitis or acute flaccid paralysis and contributes to the national surveillance in documenting polio free status. MERIN is based on voluntary participation of hospitals. Therefore, our evaluation focusses on acceptability of the system's objectives and performance, and identifying areas for improvement.

METHODS

To assess acceptability, 32 contributing hospitals were invited to an online-based survey (11/2021 to 01/2022) to rate the MERIN objectives, laboratory's performance, their workload, modes of processes and communication. Ideas for improvement were collected in open fields. In addition, data completeness and timeliness of laboratory diagnostics were assessed.

RESULTS

Of 32 hospitals, 21 responded (66% response rate), sending 30 questionnaires, 25 from pediatric and 5 from neurological departments. High levels of satisfaction with the communication (≥ 96%), timeliness (≥ 81%), and distribution of the results (≥ 85%) were reported, 97% of participants judged the required workload as adequate. The median proportion of eligible patients included in MERIN was 75%. Participants gave rapid and reliable diagnostic testing the highest priority (96%), while monitoring of Germany's polio-free status was rated the lowest (61%). Providing medical reports digitally as well as regular updates about circulating EV serotypes were identified as areas for improvement. Data completeness of selected variables ranged from 78.3 to 99.9%. Median time between sample collection and arrival at laboratory was 2 days [IQR 1-3], EV diagnostics via PCR took one day [IQR 0-6] and EV isolation on cell culture 11 days [IQR 10-13].

CONCLUSION

MERIN is a highly accepted surveillance system. Its quality was enhanced further by addressing the suggested improvements such as regular reports on circulating EV serotypes and facilitating digital access to laboratory results. Our results emphasise the importance of recognizing and considering participants' motivations and expectations, and addressing their priorities, even if this is not the surveillance system's main focus. This approach can be applied to surveillance systems of other non-mandatory notifiable diseases.

African Swine Fever in Wild Boar: German Hunters' Perception of Surveillance and Control-A Questionnaire Study

Since the first occurrence of African swine fever (ASF) in wild boar in Germany in 2020, the disease has primarily affected the wild boar population in the eastern part of the country close to the border with Poland. Local hunters play a crucial role in implementing surveillance and control. To evaluate their perceptions of existing control measures and analyze regional differences between hunters from ASF-affected and non-affected regions, a questionnaire study was conducted among the German hunting community. Hunters from non-affected areas held a more optimistic view regarding the effectiveness of control measures compared to hunters from affected areas. However, control measures that hinder hunting were generally perceived as ineffective. Measures that collided with hunters' understanding of fair hunting practices were regarded as controversial. Financial incentives and reducing bureaucracy were the most favored approaches to increase hunters' participation. Moreover, the possibility of eating or selling the meat of hunted wild boar and the provision of infrastructure for implementing ASF control were considered motivating. Thus, this study highlights the importance of compensating hunters and addressing their concerns to maintain their engagement in ASF control. To enhance compliance with controversial measures, thoughtful communication and raising awareness are essential.

The perceptions of Lithuanian hunters towards African swine fever using a participatory approach

Background

African swine fever (ASF) has been present in Lithuania since 2014. The disease affects mainly the wild boar population. Thus, hunters play a key role in the performance of disease surveillance and control measures. We used participatory methods to gain insight into the knowledge of hunters and to include their perceptions in the design and the implementation of surveillance and control measures to increase their effectiveness.

Results

The willingness and the interest of hunters to participate was high, but only eight focus group meetings with 33 hunters could be held due to the COVID-19 pandemic. The overall knowledge of Lithuanian hunters regarding ASF, investigated by semi-structured interviews, was sufficient to understand their part in ASF control and surveillance. However, their knowledge did not necessarily lead to an increased acceptance of some ASF control measures, like the targeted hunting of female wild boar. Participating hunters showed a good understanding of the processes of the surveillance system. Their trust in the performance within this system was highest towards the hunters themselves, thus emphasizing the importance of acknowledging their role in the system. Hunters refused measures including the reduction of hunting activities. They feared a complete elimination of the wild boar population, which in turn demonstrates the necessity to increase professional information exchange.

Conclusions

The perceptions of Lithuanian hunters regarding ASF surveillance and control in wild boar resembled those obtained in neighboring countries. It is imperative to communicate the results with decision-makers, to consider the views of hunters, when designing or adapting measures to control ASF in wild boar and to communicate with hunters on these measures and their justification.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-022-03509-9.

A participatory epidemiological and One Health approach to explore the community’s capacity to detect emerging zoonoses and surveillance network opportunities in the forest region of Guinea

The Ebola virus disease epidemic that threatened West Africa between 2013 and 2016 was of unprecedented health magnitude. After this health crisis, studies highlighted the need to introduce community-based surveillance systems and to adopt a One Health approach. This study aimed to provide preparatory insights for the definition of a community-based surveillance system for emerging zoonoses such as viral hemorrhagic fevers in Guinea. The objective was to explore the disease detection capacity and the surveillance network opportunities at the community level in two pilot areas in the forest region of Guinea, where the epidemic emerged. Based on a participatory epidemiological and One Health approach, we conducted Focus Group Discussions with human, animal and ecosystem health actors. We used a range of participatory tools, included semi-structured interviews, ranking, scoring and flow diagram, to estimate the local knowledge and perception of diseases and clinical signs and to investigate the existing health information exchange network and its related strengths and weaknesses. The results showed that there is heterogeneity in knowledge of diseases and perception of the clinical signs among actors and that there are preferred and more effective health communication channels opportunities. This preparatory study suggests that it is necessary to adapt the case definitions and the health communication channels to the different actors who can play a role in a future community-based surveillance system and provides recommendations for future surveillance activities to be carried out in West Africa.

Viral hemorrhagic diseases have a high risk of emergence in tropical regions. The consequences on public health are often disastrous in the low- and middle-income countries that face difficulties to control epidemics. This scenario has unfortunately occurred in West Africa between 2013 and 2016 with the Ebola virus disease epidemic. There is an urgent need to increase the capacity for rapid detection of the emergence of such diseases and adopting a One Health approach since most of them are zoonotic. Community-based surveillance seems appropriate to address this issue in the context of these countries. We collected preparatory data through semi-structured interviews of community actors in human health, animal health and ecosystem health in Guinea. We used participatory epidemiology that appears to be a consistent method to assess local knowledge and perceptions of diseases and clinical signs and to identify health information exchange network opportunities. We aimed to provide relevant recommendations for the design of adapted case definitions and surveillance network in the prospect of implementing a community-based surveillance system of viral hemorrhagic fevers in Guinea and future surveillance activities to be carried out in West Africa.

Evaluation of Public–Private Partnership in the Veterinary Domain Using Impact Pathway Methodology: In-depth Case Study in the Poultry Sector in Ethiopia

Public–private partnerships (PPPs) in the veterinary domain are joint approaches in which public veterinary services and private actors such as private veterinarians, producers' associations, or private companies work together to address complex animal health challenges. They are implemented worldwide and can help to strengthen the capacities of veterinary services, but few have been evaluated. None of the evaluations developed in the veterinary domain explicitly addressed PPPs, their complex program design, their evolving governance, and coordination system, and their impacts. This work represents the first application of the participatory impact pathway methodology for the evaluation of a PPP in the veterinary domain. The PPP evaluated aimed at developing the poultry sector in Ethiopia and improving poultry health service coverage, particularly in remote areas. The combination of semi-structured interviews (n = 64) and collective reflection during three workshops (n participants = 26, 48, 18), captured the viewpoints of public and private partners, actors who influenced the partnership, and actors impacted by it. The context of the PPP was analyzed, and the causal relationships between the PPP and its impacts were investigated. This work showed that collaboration between the public and private sector occurred at several administrative levels. The actors considered a variety of impacts, on the economy, business, trust, and health, which were then measured through different indicators. The actors also identified the added value of the PPP to enrich those impacts. The participatory impact pathway methodology helped to strengthen the engagement of actors in the PPP and to formulate recommendations at the policy level to favor positive results. This case study represents a milestone in building a participatory evaluation framework of PPP in the veterinary domain.

Evaluation of the collaborative integrated surveillance system (ViCo) in Guatemala: a qualitative study on lessons learned and future perspectives

Background

The collaborative integrated surveillance system known as Vigilancia Integrada Comunitaria (ViCo) was implemented in 2007 to better understand and characterize the burden of diarrheal, respiratory and febrile illnesses in Guatemala.

Methods

To evaluate the usefulness of ViCo and inform a redesign of the system and new surveillance activities in the Central American region, personnel from the United States Centers for Disease Control and Prevention (CDC) conducted thirty-nine in-depth interviews from June—December 2018 with key stakeholders responsible for the design and implementation of ViCo in Guatemala. A semi-structured questionnaire adapted from the Updated CDC Guidelines for Evaluating Public Health Surveillance Systems was used for data collection. We used a grounded theory approach to explore stakeholder perceptions of ViCo and generate recommendations for improvement. Primary qualitative findings were organized based on thematic areas using ATLAS.ti version 8 software.

Results

Emergent themes relevant to the usefulness of ViCo were organized across strengths, weaknesses, and recommendations pertaining to the: (1) Size and Complexity of ViCo, (2) Stakeholder Expectations About the Objectives of ViCo, (3) Data Management and Structure of the Information System, (4) Local Control of Data, (5) Integration of ViCo within the Ministry of Health, and, (6) Improvement of the Operational and Design Aspects of ViCo across System, Process, and Output levels.

Conclusions

Stakeholders perceived ViCo to be useful. They recommended measures to improve system performance and quality, including simplifying the surveillance system, routine data analysis and feedback, and channeling efforts towards integrating surveillance data into the national health information system. To create a well-performing surveillance system and achieve the intended objective of surveillance for public health action, ongoing evaluation and assessment of surveillance activities are necessary.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12719-7.

From National Biosecurity Measures to Territorial ASF Preparedness: The Case of Free-Range Pig Farming in Corsica, France

In response to African swine fever (ASF) outbreaks in wild boars in Belgium in 2018, the French authorities issued national biosecurity measures for all pig farms, regardless of their geographical and socio-technical scale. Considering the Corsican pig farmers' demonstrations against these measures (for geographical, cultural, and economic reasons), this article questions the suitability of standardized top-down national measures that potentially endanger traditional breeding systems, which are increasingly marginalized in relation to the dominant industrial model. From an action-research approach, the article analyzes how local stakeholders go beyond usual classical biosecurity issues to propose a territorialized preparedness. Mediating between Corsican farmers and the government representatives, a technical committee made up of actors from various regional research and development bodies drew up a socially acceptable preparedness proposal. Viewing the health risk from a local standpoint, the committee provided arguments for maintaining the extensive grazing that is non-negotiable for the farmers, while getting the farmers to agree to change other practices (reproduction control) as a measure against health hazards already present. Analysis of the preparedness process and the mediation process shows that a territorialized bottom-up approach to the governance of health risks can make biosecurity measures more acceptable to farmers. It also points to the legitimacy of a set of alternatives to top-down measures that standardize farming systems and may lead to the disappearance of small farmers and their traditional systems.

An evaluation tool to strengthen the collaborative process of the public-private partnership in the veterinary domain

Public-private partnerships (PPPs) in the veterinary domain are widely implemented worldwide and can help to strengthen the capacities of Veterinary Services. Few analyses have been made of these initiatives. This study is aimed at developing an evaluation tool based on participatory approaches and focusing on the quality of PPP processes in the veterinary domain. The tool was divided into ten sections relevant to PPP process organisation and activities. The 44 evaluation criteria and six quality attributes (operationality, relevance, acceptability, inclusiveness, adaptability, and stability) were identified based on literature review and case-study application. The tool was adjusted during four regional PPP training workshops bringing together stakeholders from both public and private sectors. Finally, the tool was validated through an experts' elicitation process and applied in the field in Paraguay. The tool was developed in a non-normative perspective to help the partners adapt the PPP to their specific context, to maximize the opportunities and minimize the risks of such collaborations, and to formulate adapted recommendations to strengthen and improve the PPP collaborative process and thus the outcomes. In an ex-ante perspective, this tool would also help public and private actors to engage and develop a PPP process following the best possible practices. The aim of this tool is to help decision making in terms of PPP development and implementation in the veterinary domain to ensure the added value and relevance of such a collaborative approach in different countries worldwide.

A Comparison of Perceptions of Estonian and Latvian Hunters With Regard to the Control of African Swine Fever

Since the first detected African swine fever (ASF) cases in Lithuanian wild boar in 2014, the virus has occurred in many other member states of the European Union (EU), most recently in Belgium in 2018 and in Germany in 2020. Passive surveillance and various control measures are implemented as part of the strategy to stop disease spread in the wild boar population. Within this framework, hunters perform important activities, such as the removal of carcasses, fencing or hunting. Therefore, the successful implementation of these measures largely depends on their acceptability by hunters. Methods of participatory epidemiology can be used to determine the acceptance of control measures. The use of participatory methods allows the involvement of key stakeholders in the design, the implementation and the analysis of control and surveillance activities. In the present study, two studies that had been conducted using participatory epidemiology with hunters in Estonia and Latvia were compared on the topics recruitment, participants, facilitators, focus group discussion (FGDs) and their contents. The aim was to evaluate similarities and differences in the two studies and to identify a broader spectrum of possibilities to increase the willingness of hunters supporting the fight against ASF. Evaluating all conducted FGDs in both countries showed primarily similarities in the perceptions and opinions of the hunters in Estonia and Latvia. One notable difference was that passive surveillance in Latvia was perceived mostly as topic of duty and ethics rather than an issue driven by incentives. Participatory methods have proven to be an effective tool in the evaluation of the acceptance of established ASF control systems. The results of this study point out further chances for improving the cooperation with hunters in the future. Nevertheless, the importance of gathering and analyzing the opinions of hunters in all ASF affected countries individually is highlighted.

What Do Lithuanian Hunters Think of African Swine Fever and Its Control-Perceptions

Simple Summary

Effectiveness and successful implementation of control measures greatly depend on hunters’ willingness and motivation to carry out these measures. Therefore, assessing their opinions regarding the current system is paramount in order to achieve the best possible results. The present study provides insights of hunters’ attitudes and perceptions about measures to control African swine fever (ASF) in wild boar in Lithuania. This study highlights several measures that are not supported by hunters (i.e., restriction of hunting, selective female hunting, ban of supplementary feeding, involvement of additional forces in ASF control) and possible motivational options (i.e., reduction of work, financial incentives and improved feedback and relationships with government officials). Considering these findings when planning and altering control measures for ASF could improve their successful implementation in the field.

Abstract

After the introduction of African swine fever (ASF) into Lithuania in 2014, continuous spread of the disease resulted in infection of the wild boar populations in most parts of Lithuania. The virus has been moving closer to other Western European countries where pig density is high. An efficient surveillance system detecting ASF cases early in domestic and wild animals is necessary to manage this disease. To make surveillance appropriate and effective, it is critical to understand how key players perceive the implemented control measures. This study investigated the attitudes and beliefs of hunters in Lithuania regarding currently implemented or proposed measures for the control of ASF in the wild boar population. Study data were collected through questionnaires distributed via the internet and by hunting associations in Lithuania. In total, 621 fully completed questionnaires were received and analyzed. All measures interfering with extensive hunting, like ban of driven or individual hunting or ban of supplementary feeding were considered as unacceptable and as ineffective measures to control ASF in wild boar. However, selective hunting of female wild boar was generally considered as an unethical act and therefore rejected. Some measures that seem to have been successful in other countries, like involvement of additional forces, were rejected by Lithuanian hunters, thus implementation of these measures could be difficult. The study highlighted that there is a need for improving important relationships with other stakeholders, since many hunters expressed a lack of trust in governmental institutions and regarded cooperation with them as insufficient. Hunters emphasized that their motivation to support passive surveillance measures could be improved with financial compensation and reduction of workload. The present study provides insights into hunters’ perceptions, which may be used as a foundation for additional discussions with these important stakeholders and for adapting measures to improve their acceptance if appropriate.

Hunters' view on the control of African swine fever in wild boar. A participatory study in Latvia

African swine fever (ASF) has massively spread in recent years and threatens the global pig industry. ASF has been present in Latvia since 2014. Hunters play a major role in the implementation of measures to control ASF and in passive disease surveillance. The probability to detect an ASF-positive wild boar is much higher in animals found dead than in hunted animals. Thus, the willingness and the motivation of hunters to support passive surveillance is of utmost importance. Using participatory methods, this study aimed to assess the acceptability of control measures for ASF in wild boar among hunters. In addition, new approaches to increase hunters' motivation to report wild boar found dead were investigated. A total of ten focus group discussions with hunters from different regions in Latvia were conducted. To assess the quantity and quality of contacts between hunters and stakeholders involved in the control of ASF, relation diagrams were used. Using ranking tools, the trust of the participants in stakeholders to implement control measures successfully was evaluated. Defined control measures were presented to the hunters and their acceptability investigated. An impact diagram and a list of defined motivation options for passive surveillance were offered to identify new ways to increase the willingness of hunters to support passive surveillance actively. A satisfactory and regular relationship was identified between the hunters, the Food and Veterinary Service (FVS) and the State Forest Service (SFS). The hunters' trust in these authorities was high. Although there is no vaccine against ASF, hunters were convinced of the potential of vaccination in controlling ASF. However, building fences was considered as useless and ineffective. To increase the willingness of hunters to support passive surveillance, reducing the infection pressure in the forests was regarded as most motivating. Furthermore, hunters would appreciate a decrease in their costs and workload. The study provides new insight into the concerns and experiences of hunters. Including their views and expectations in the further design and implementation of control and surveillance activities may help to improve current efforts to control ASF in wild boar populations. Although representing the perceptions of Latvian hunters, the main conclusions may be adaptable to adjust ASF control and surveillance in other countries.

Hunters' Acceptance of Measures against African Swine Fever in Wild Boar in Estonia

African swine fever (ASF) was first identified in Estonia in 2014, initially detected in wild boar and spreading to affect almost the whole country from late 2016 onwards. Passive surveillance and the control measures applied in Estonia are the main actions in the attempt to control the wild boar population and therefore limit the spread of ASF. Implementation and success of both activities depend mainly on the involvement and commitment of the executing force: the Estonian hunters. Thus, their acceptance of the measures is of utmost importance and with the help of participatory methods, their acceptability can be assessed. Participatory epidemiology allows the involvement of key stakeholders in planning control measures and surveillance strategies and gathering information otherwise inaccessible. By conducting focus group discussions and utilizing participatory tools, this study aimed to assess the acceptance of ASF control measures by hunters in Estonia. Furthermore, the study aimed to detect means to improve the motivation of hunters to support passive surveillance. Among hunters, the results ranked the trust in lower authorities (e.g. local official veterinarians) towards implementing control measures as high (in contrast to higher officials e.g. 'Ministry of Rural Affairs'), while perceiving themselves as the most trustworthy group among those implementing ASF control measures. Hunting and every measure supporting increased hunting, for example selective hunting, bait feeding and incentives for hunting wild boar, were deemed favourable for hunters. These measures also received the highest trust for controlling ASF. All measures hindering hunting and the movement of wildlife, for example fencing or involvement of the army in ASF control, were described as unpleasant or even unethical and trust in these measures to control the disease successfully was lacking. When assessing the perceived consequences for hunters of finding a dead wild boar, arising financial costs, additional workload and time consumption were highlighted. In line with these results, the two tools with the strongest motivational effect for taking part in passive surveillance were: (1) higher monetary incentives as compensation for the hunters' work, and (2) the reduction of the negative consequences by limiting the hunters' duties to solely reporting found dead wild boar. In conclusion, participatory methods can be used as a highly suitable tool for the evaluation of acceptance of measures and surveillance systems. Potentially, the results can help to improve control and passive surveillance in Estonia, as well as functioning as an example for other countries battling or awaiting ASF.

The importance of understanding end user acceptability of new technology to support animal health management

This pilot study investigates the acceptability of a mobile application (app) developed to assist livestock producers make better animal health decisions with the support of a local veterinarian. With the increase in new technologies available for producers, acceptability evaluation is important to ensure that technology is designed considering end users' needs. An acceptability qualitative study, using semi-structured interviews, was designed including a purposive selection of sheep producers and livestock veterinarians. Eleven producers and six veterinarians participated in the study. Results suggest that producers would use such a tool to contact private veterinarians in non-emergency situations to obtain animal health advice. From veterinarians' perspective, while features of the app, such as messaging and notifications, were considered useful, concerns were raised about its capacity to enhance business opportunities and potential privacy implications. This study highlights the importance of engaging with end users in the early stages of the design and the introduction of new technology to maximise potential for adoption.

Participatory assessment of paid vaccination campaigns for village chickens against Newcastle disease in Kongo Central province

In the Democratic Republic of Congo (DRC), where state-driven animal vaccination campaigns are organized only in response to epidemics, the organization of a permanent animal vaccination service is urgently needed. A non-governmental organization has set up an experimental paid vaccination service for village chickens against Newcastle Disease (ND) in the Kongo Central province. This mixed-method study presents a participatory assessment of this experiment, identifying socio-economic factors that influence the decision of chicken keepers to adopt vaccination. The study was conducted in four territories of the province. Qualitative and quantitative data were collected through 12 focus group discussions (FGDs) with professionals of animal health and chicken keepers and 160 semi-structured interviews with chicken keepers, sampled by snowball technique. This participatory process has resulted in the design of a grid for assessing animal vaccination service's performance. Here translating the narratives into a preliminary structured assessment, this grid is an output of the study, to be mobilized for future rapid assessments of the vaccination service in a quantitative prospect. The grid consisted of nine criteria, further composed by 16 items, translated into questions to be asked to chicken keepers and vaccinators. In our study area, fieldworkers enumerated four animal vaccination campaigns during a period of 21 years (except those subject to the present assessment). Around 13% of chicken keepers of our sample had participated in ND vaccination programs. Almost 96% of interviewed chicken keepers expressed their willingness to pay for ND vaccination, and 87% of chicken keepers that vaccinated their chickens perceived the vaccine as effective. Vaccinators estimated that 56% of the chicken keepers who were contacted had actually paid for the vaccination of their chickens. The assessment grid highlighted four points in favor of the sustainability of this service, i.e. the general interest of chickens keepers, vaccine efficacy, vaccine availability and ease of use of the vaccine. Two weak points were identified, viz. the poor access of chicken keepers to information and the weak motivation of vaccinators. The vaccine coverage was calculated within the sample at 13.1%. Paid vaccination campaign for village chicken in Kongo Central obtained a performance score of 62.8%, with the highest score in Kwilu-Ngongo (73.1%) and the lowest in Kasangulu (52.4%). Two factors of adoption of vaccination were identified as statistically significant, i.e. chicken housing and territory. Significant differences appeared between territories in access to information for chicken keepers and in vaccinators motivation. The priorities for the improvement of this service appear to be awareness raising among chicken keepers and increasing vaccinators' motivation.

The RISKSUR EVA tool (Survtool): A tool for the integrated evaluation of animal health surveillance systems

Information about infectious diseases at the global level relies on effective, efficient and sustainable national and international surveillance systems. Surveillance systems need to be regularly evaluated to ensure their performance, the quality of the data and information provided, as well as to allocate resources efficiently. Currently available frameworks for evaluation of surveillance systems in animal or human health often treat technical, process and socio-economic aspects separately instead of integrating them. The surveillance evaluation (EVA) tool, a support tool for the evaluation of animal health surveillance systems, was developed to provide guidance for integrated evaluation of animal health surveillance including economic evaluation. The tool was developed by international experts in surveillance and evaluation in an iterative process of development, testing and revision taking into account existing frameworks and guidance, scientific literature and expert opinion. The EVA tool encompasses a web interface for users to develop an evaluation plan, a Wiki classroom to provide theoretical information on all required concepts and a generic evaluation work plan to facilitate implementation and reporting of outputs to decision makers. The tool was tested by planning and conducting epidemiological and economic evaluations of surveillance for classical and African swine fever, bovine virus diarrhoea, avian influenza, and Salmonella Dublin in five European countries. These practical applications highlighted the importance of a comprehensive evaluation approach to improve the quality of the evaluation outputs (economic evaluation; multiple attributes assessment) and demonstrated the usefulness of the guidance provided by the EVA tool. At the same time they showed that comprehensive evaluations might be constrained by practical issues (e.g. confidentiality concerns, data availability) and resource scarcity. In the long term, the EVA tool is expected to increase professional evaluation capacity and help optimising animal health surveillance system efficiency and resource allocation for both public and private actors of the surveillance systems.

Perceptions and acceptability of some stakeholders about the bovine tuberculosis surveillance system for wildlife (Sylvatub) in France

Bovine tuberculosis (bTB) is a common disease of cattle and wildlife, with economic repercussions and implications for animal and human health. The surveillance of bTB in wildlife is particularly important, to shed light on the epidemiological role of wild species and for the adaptation of control measures. In France, a bTB surveillance system for free-ranging wildlife, the Sylvatub system, was launched in 2011 on wild boars, red deer, roe deer and badgers. It relies on active and passive surveillance activities, constrained by practical difficulties, such as the accessibility of wild animals, and regulatory rules for the trapping of badgers, for example. We report here the first assessment of stakeholders’ perceptions of the Sylvatub system and its acceptability, based on 20 individual semi-structured interviews with three types of stakeholder (collectors, coordinators, officers) in areas with different rates of bTB infection. With the caveat that these findings cannot be assumed to be representative of the national situation, we found that the Sylvatub system was considered useful by all the stakeholders interviewed. Those from the world of hunting participate in surveillance mostly to help livestock farmers, who are not systematically involved in bTB surveillance in wildlife. Many practical and regulatory constraints were raised, which could be offset by recognition of the work done by the “hunting community”, to maintain the willingness of these individuals to participate. We also identified a need for improvements in communication and information. Qualitative information, such as that collected here, is essential to improve our understanding of the reasons favoring and disfavoring participation in surveillance, and should be taken into account in the evaluation process. These results are relevant to hunters and to veterinary authorities wishing to identify the determinants of participation in the Sylvatub system. They could provide support for decision-making processes to improve surveillance strategies.

Combining Participatory Influenza Surveillance with Modeling and Forecasting: Three Alternative Approaches

BACKGROUND

Influenza outbreaks affect millions of people every year and its surveillance is usually carried out in developed countries through a network of sentinel doctors who report the weekly number of Influenza-like Illness cases observed among the visited patients. Monitoring and forecasting the evolution of these outbreaks supports decision makers in designing effective interventions and allocating resources to mitigate their impact.

OBJECTIVE

Describe the existing participatory surveillance approaches that have been used for modeling and forecasting of the seasonal influenza epidemic, and how they can help strengthen real-time epidemic science and provide a more rigorous understanding of epidemic conditions.

METHODS

We describe three different participatory surveillance systems, WISDM (Widely Internet Sourced Distributed Monitoring), Influenzanet and Flu Near You (FNY), and show how modeling and simulation can be or has been combined with participatory disease surveillance to: i) measure the non-response bias in a participatory surveillance sample using WISDM; and ii) nowcast and forecast influenza activity in different parts of the world (using Influenzanet and Flu Near You).

RESULTS

WISDM-based results measure the participatory and sample bias for three epidemic metrics i.e. attack rate, peak infection rate, and time-to-peak, and find the participatory bias to be the largest component of the total bias. The Influenzanet platform shows that digital participatory surveillance data combined with a realistic data-driven epidemiological model can provide both short-term and long-term forecasts of epidemic intensities, and the ground truth data lie within the 95 percent confidence intervals for most weeks. The statistical accuracy of the ensemble forecasts increase as the season progresses. The Flu Near You platform shows that participatory surveillance data provide accurate short-term flu activity forecasts and influenza activity predictions. The correlation of the HealthMap Flu Trends estimates with the observed CDC ILI rates is 0.99 for 2013-2015. Additional data sources lead to an error reduction of about 40% when compared to the estimates of the model that only incorporates CDC historical information.

CONCLUSIONS

While the advantages of participatory surveillance, compared to traditional surveillance, include its timeliness, lower costs, and broader reach, it is limited by a lack of control over the characteristics of the population sample. Modeling and simulation can help overcome this limitation as well as provide real-time and long-term forecasting of influenza activity in data-poor parts of the world.

Pig empire under infectious threat: risk of African swine fever introduction into the People's Republic of China

Pig production and pork consumption are very important to the People's Republic of China for both economic and cultural reasons. The incursion and spread of a disease such as African swine fever (ASF), which emerged in Eastern Europe in 2007, could have devastating socioeconomic consequences for both the Chinese and the global pig industry. The Chinese government consequently attributes a very high priority to ASF and is actively seeking to improve its preparedness. This paper discusses different drivers and pathways of potential emergence of ASF in China in light of the country's specificities, including international movements of people, pigs and pig products, swill feeding practices and wild boar populations. It suggests that effective ASF risk management in China will require a comprehensive and integrated approach linking science and policy and will need to involve all relevant stakeholders to develop realistic policies.

Surveillance strategies for Classical Swine Fever in wild boar - a comprehensive evaluation study to ensure powerful surveillance

Surveillance of Classical Swine Fever (CSF) should not only focus on livestock, but must also include wild boar. To prevent disease transmission into commercial pig herds, it is therefore vital to have knowledge about the disease status in wild boar. In the present study, we performed a comprehensive evaluation of alternative surveillance strategies for Classical Swine Fever (CSF) in wild boar and compared them with the currently implemented conventional approach. The evaluation protocol was designed using the EVA tool, a decision support tool to help in the development of an economic and epidemiological evaluation protocol for surveillance. To evaluate the effectiveness of the surveillance strategies, we investigated their sensitivity and timeliness. Acceptability was analysed and finally, the cost-effectiveness of the surveillance strategies was determined. We developed 69 surveillance strategies for comparative evaluation between the existing approach and the novel proposed strategies. Sampling only within sub-adults resulted in a better acceptability and timeliness than the currently implemented strategy. Strategies that were completely based on passive surveillance performance did not achieve the desired detection probability of 95%. In conclusion, the results of the study suggest that risk-based approaches can be an option to design more effective CSF surveillance strategies in wild boar.

Qualitative Research to Design Sustainable Community-Based Surveillance for Rabies in Northern Australia and Papua New Guinea

Given the proximity and recent spread of rabies in Indonesia, effective rabies surveillance in dogs is a priority in Northern Australia and Papua New Guinea (PNG). Reporting of potential cases requires community engagement; therefore, the value and acceptability of such a system is critical to ensure sustainable surveillance. We used qualitative research methods to identify factors that influence the acceptability and value of community-based rabies surveillance. Thirty-two semi-structured interviews were conducted with informants in 16 communities in East Arnhem, the Northern Peninsula Area, the Torres Strait in Australia, and in Western Province, PNG. Thematic analysis identified common themes including the importance of verbal communication, particularly via radio, community meetings, and direct conversation. We also found that dogs have high value to community members through connection to culture, economic (especially hunting), and companionship. The greatest barrier to the reporting of sick dogs was insufficient veterinary services and the subsequent lack of treatment response. In some regions, acceptance that sick dogs are a normal daily occurrence and lack of trust of authorities were also barriers to reporting. The findings from this study will be used to design sustainable rabies surveillance in Northern Australia and PNG by utilizing traditional communication channels and building on existing and valued animal-management services. The methods and findings of this study complement previous quantitative research, so as to target surveillance to high-risk areas within these regions.

Hunters' acceptability of the surveillance system and alternative surveillance strategies for classical swine fever in wild boar - a participatory approach

BACKGROUND

Surveillance measures can only be effective if key players in the system accept them. Acceptability, which describes the willingness of persons to contribute, is often analyzed using participatory methods. Participatory epidemiology enables the active involvement of key players in the assessment of epidemiological issues. In the present study, we used a participatory method recently developed by CIRAD (Centre de Coopération Internationale en Recherche Agronomique pour le Développement) to evaluate the functionality and acceptability of Classical Swine Fever (CSF) surveillance in wild boar in Germany, which is highly dependent on the participation of hunters. The acceptability of alternative surveillance strategies was also analyzed. By conducting focus group discussions, potential vulnerabilities in the system were detected and feasible alternative surveillance strategies identified.

RESULTS

Trust in the current surveillance system is high, whereas the acceptability of the operation of the system is medium. Analysis of the acceptability of alternative surveillance strategies showed how risk-based surveillance approaches can be combined to develop strategies that have sufficient support and functionality. Furthermore, some surveillance strategies were clearly rejected by the hunters. Thus, the implementation of such strategies may be difficult.

CONCLUSIONS

Participatory methods can be used to evaluate the functionality and acceptability of existing surveillance plans for CSF among hunters and to optimize plans regarding their chances of successful implementation.

The Added-Value of Using Participatory Approaches to Assess the Acceptability of Surveillance Systems: The Case of Bovine Tuberculosis in Belgium

CONTEXT AND OBJECTIVE

Bovine tuberculosis (bTB) surveillance in Belgium is essential to maintain the officially free status and to preserve animal and public health. An evaluation of the system is thus needed to ascertain the surveillance provides a precise description of the current situation in the country. The evaluation should assess stakeholders' perceptions and expectations about the system due to the fact that the acceptability has an influence on the levels of sensitivity and timeliness of the surveillance system. The objective of the study was to assess the acceptability of the bTB surveillance in Belgium, using participatory tools and the OASIS flash tool ('analysis tool for surveillance systems').

METHODS

For the participatory process, focus group discussions and individual interviews were implemented with representatives involved with the system, both from cattle and wildlife part of the surveillance. Three main tools were used: (i) relational diagrams associated with smileys, (ii) flow diagrams associated with proportional piling, and (iii) impact diagrams associated with proportional piling. A total of six criteria were assessed, among which five were scored on a scale from -1 to +1. For the OASIS flash tool, one full day meeting with representatives from stakeholders involved with the surveillance was organised. A total of 19 criteria linked to acceptability were scored on a scale from 0 to 3.

RESULTS AND CONCLUSION

Both methods highlighted a medium acceptability of the bTB surveillance. The main elements having a negative influence were the consequences of official notification of a bTB suspect case in a farm, the low remuneration paid to private veterinarians for execution of intradermal tuberculin tests and the practical difficulties about the containment of the animals. Based on the two evaluation processes, relevant recommendations to improve the surveillance were made. Based on the comparison between the two evaluation processes, the added value of the participatory approach was highlighted.