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He J, Guo Z, Yang P, Cao C, Xu J, Zhou X, Li S. Social insights on the implementation of One Health in zoonosis prevention and control: a scoping review. Infect Dis Poverty 2022; 11:48. [PMID: 35505361 PMCID: PMC9063255 DOI: 10.1186/s40249-022-00976-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background The One Health (OH) concept has been promoted widely around the globe. OH framework is expected to be applied as an integrated approach to support addressing zoonotic diseases as a significant global health issue and to improve the efficiency and effectiveness of zoonosis prevention and control. This review is intended to overview the social impact of the implementation of OH on zoonosis prevention and control. Methods A scoping review of studies in the past 10 years was performed to overview the integration feature of OH in zoonosis prevention and control and the social impacts of OH. PubMed and Web of Science were searched for studies published in English between January 2011 and June 2021. The included studies were selected based on predefined criteria. Results Thirty-two studies were included in this review, and most of them adopted qualitative and semi-qualitative methods. More than 50% of the studies focused on zoonosis prevention and control. Most studies were conducted in low- and middle-income countries in Africa and Asia. Applying OH approach in diseases control integrates policymakers, stakeholders, and academics from various backgrounds. The impact of OH on economic is estimated that it may alleviate the burden of diseases and poverty in the long term, even though more financial support might be needed at the initial stage of OH implementation. OH implementation considers social and ecological factors related to zoonosis transmission and provides comprehensive strategies to assess and address related risks in different communities according to regions and customs. Conclusions Based on reviewed literature, although there seems to be a lack of guidelines for assessing and visualizing the outcomes of OH implementation, which may limit the large-scale adoption of it, evidence on the contributions of implementing OH concepts on zoonosis prevention and control indicates long-term benefits to society, including a better integration of politics, stakeholders and academics to improve their cooperation, a potential to address economic issues caused by zoonosis, and a comprehensive consideration on social determinants of health during zoonosis prevention and control.
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Affiliation(s)
- Junyi He
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Zhaoyu Guo
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Pin Yang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Chunli Cao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Jing Xu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Xiaonong Zhou
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China.,School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Shizhu Li
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Centre for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China. .,School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Mahero MW, Pelican KM, Waila JM, Namusisi S, Rwego IB, Kajura C, Nyatuna C, Boulware DR, Hartter J, Mugisha L, Robertson C, Travis DA. "There are many fevers": Communities' perception and management of Febrile illness and its relationship with human animal interactions in South-Western Uganda. PLoS Negl Trop Dis 2022; 16:e0010125. [PMID: 35192636 PMCID: PMC8929701 DOI: 10.1371/journal.pntd.0010125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/17/2022] [Accepted: 12/22/2021] [Indexed: 11/19/2022] Open
Abstract
Diagnosing the causative agent of febrile illness in resource-limited countries is a challenge in part due to lack of adequate diagnostic infrastructure to confirm cause of infection. Most febrile illnesses (>60%) are non-malarial, with a significant proportion being zoonotic and likely from animal origins. To better characterize the pathways for zoonotic disease transmission and control in vulnerable communities, adequate information on the communities' experiences and lexicon describing fever, and their understanding and perceptions of risk pathways is required. We undertook an ethnographic study to understand behaviors, exposures, and attitudes toward fever at the community level. Our hope is to better elucidate areas of priority surveillance and diagnostic investment. A focused ethnography consisting of participant observation, informal conversations, 4 barazas (community meetings), and formal ethnographic interviews (13 Focus group discussions and 17 Key informant interviews) was conducted between April and November 2015 in Kasese and Hoima Districts in Uganda. Perception of illness and associated risk factors was heavily influenced by the predominant livelihood activity of the community. The term "fever" referred to multiple temperature elevating disease processes, recognized as distinct pathological occurrences. However, malaria was the illness often cited, treated, or diagnosed both at the health facilities and through self-diagnosis and treatment. As expected, fever is as an important health challenge affecting all ages. Recognition of malarial fever was consistent with a biomedical model of disease while non-malarial fevers were interpreted mainly through ethno etiological models of explanation. These models are currently being used to inform education and prevention strategies and treatment regimens toward the goal of improving patients' outcomes and confidence in the health system. Development of treatment algorithms that consider social, cultural, and economic contexts, especially where human-animal interaction is prevalent, should factor animal exposure and zoonotic illnesses as important differentials.
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Affiliation(s)
- Michael Wandanje Mahero
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota United States of America
| | - Katherine M. Pelican
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota United States of America
| | - Jacinta M. Waila
- Makerere University, School of Public Health, Kampala, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Shamilah Namusisi
- Makerere University, School of Public Health, Kampala, Uganda
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Innocent B. Rwego
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota United States of America
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | | | - David R. Boulware
- Dept. of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Joel Hartter
- Environmental Studies Program, University of Colorado, Boulder, Colorado, United States of America
| | - Lawrence Mugisha
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
- EcoHealth Research Group, Conservation & Ecosystem Health Alliance (CEHA), Kampala, Uganda
| | - Cheryl Robertson
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA United States of America
| | - Dominic A. Travis
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, Minnesota United States of America
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Understanding hard-to-reach communities: local perspectives and experiences of trachoma control among the pastoralist Maasai in northern Tanzania. J Biosoc Sci 2020; 53:819-838. [PMID: 32981544 DOI: 10.1017/s0021932020000553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
As progress to eliminate trachoma is made, addressing hard-to-reach communities becomes of greater significance. Areas in Tanzania, inhabited by the Maasai, remain endemic for trachoma. This study assessed the effectiveness of Mass Drug Administration (MDA) through an ethnographic study of trachoma amongst a Maasai community. The MDA experience in the context of the livelihoods of the Maasai in a changing political economy was explored using participant observation and household interviews. Factors influencing MDA effectiveness within five domains were analysed. 1) Terrain of intervention: Human movement hindered MDA, including seasonal migration, domestic chores, grazing and school. Encounters with wildlife were significant. 2) Socio-cultural factors and community agency: Norms around pregnancy led women to accept the drug but hide refusal to swallow the drug. Timing of Community Drug Distributor (CDD) visits conflicted with livestock grazing. Refusals occurred among the ilmurrani age group and older women. Mistrust significantly hindered uptake of drugs. 3) Strategies and motivation of drug distributors: Maa-speaking CDDs were critical to effective drug delivery. Maasai CDDs, whilst motivated, faced challenges of distances, encounters with wildlife and compensation. 4) Socio-materiality of technology: Decreases in side-effects over years have improved trust in the drug. Restrictions to swallowing drugs and/or water were relevant to post-partum women and the ilmurrani. 5) History and health governance: Whilst perceptions of the programme were positive, communities questioned government priorities for resources for hospitals, medicines, clean water and roads. They complained of a lack of information and involvement of community members in health care services. With elimination in sight, hard-to-reach communities are paramount as these are probably the last foci of infection. Effective delivery of MDA programmes in such communities requires a critical understanding of community experiences and responses that can inform tailored approaches to trachoma control. Application of a critical social science perspective should be embedded in planning and evaluation of all NTD programmes.
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Bardosh KL, Hussein JW, Sadik EA, Hassen JY, Ketema M, Ibrahim AM, McKune SL, Havelaar AH. Chicken eggs, childhood stunting and environmental hygiene: an ethnographic study from the Campylobacter genomics and environmental enteric dysfunction (CAGED) project in Ethiopia. ONE HEALTH OUTLOOK 2020; 2:5. [PMID: 33829128 PMCID: PMC7993501 DOI: 10.1186/s42522-020-00012-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 02/20/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND Childhood stunting and malnutrition condemn millions of people globally to a life of disadvantage and cognitive and physical impairment. Though increasing egg consumption is often seen as an important solution for low and middle income countries (including Ethiopia), emerging evidence suggests that greater exposure to poultry feces may also inhibit child growth due to the effects of enteric bacteria, especially Campylobacter, on gut health. METHODS In this rapid ethnographic study, we explored village poultry production, child dietary practices, and environmental hygiene conditions as they relate to Campylobacter risk and intervention in 16 villages in Haramaya Woreda, Eastern Ethiopia. RESULTS In the study area, we found that women assumed primary responsibility to care for both chickens and children: in feeding, housing, and healthcare. Most chickens were free-range local indigenous breeds, and flock sizes were small and unstable due to epidemics, seasonal trends, reproductive patterns, and lack of food. Generally, eggs were seen as "too luxurious" to be eaten, and were predominantly sold at local markets for scarce cash, despite high malnutrition rates. Local narratives of extreme poverty, social dietary norms, parental fatalism, and lack of "dietary consciousness" (as it was called) were invoked to explain this. We found that homesteads were highly contaminated with human and animal feces. Although community members viewed chicken feces and poultry gastrointestinal contents as particularly noxious in comparison to other animals because of their feeding behaviour, they did not relate them to any particular disease. Shared human-animal housing and childcare practices place children at high risk of exposure to enteric bacteria from animal manure, despite daily routines designed to manage the domestic landscape. CONCLUSIONS Addressing childhood stunting and malnutrition through egg production in rural landscapes like Haramaya must navigate three distinct health and care regimes: for children, chickens, and home environments. Interventions should be based on a holistic approach to social and economic empowerment, one that considers both women and men and integrates nutrition, health, and community change as its overarching goal.
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Affiliation(s)
- Kevin Louis Bardosh
- Department of Anthropology, University of Florida, Gainesville, USA
- Center for One Health Research, School of Public Health, University of Washington, Seattle, USA
| | | | - Elias Ahmed Sadik
- College of Social Sciences and Humanities, Haramaya University, Dire Dawa, Ethiopia
| | - Jemal Yousuf Hassen
- Department of Rural Development and Agricultural Extension, Haramaya University, Dire Dawa, Ethiopia
| | - Mengistu Ketema
- School of Agricultural Economics and Agribusiness Management, Haramaya University, Dire Dawa, Ethiopia
| | | | | | - Arie Hendrik Havelaar
- Department of Animal Sciences, Emerging Pathogens Institute, Institute for Sustainable Food Systems, University of Florida, Gainesville, USA
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Abstract
Programs for neglected tropical diseases (NTDs) such as sleeping sickness increasingly involve patients and community workers in syndromic case detection with little exploration of patient understandings of symptoms. Drawing on concepts from sensorial anthropology, I investigate peoples' experiences of sleeping sickness in South Sudan. People here sense the disease through discourses about four symptoms (pain, sleepiness, confusion and hunger) using biomedical and ethnophysiological concepts and sensations of risk in the post-conflict environment. When identified together, the symptoms interlock as a complete disease, prompting people to seek hospital-based care. Such local forms of sense-making enable diagnosis and help control programs function.
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Affiliation(s)
- Jennifer J Palmer
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine , London, United Kingdom
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Galière M, Peyre M, Muñoz F, Poupaud M, Dehove A, Roger F, Dieuzy-Labaye I. Typological analysis of public-private partnerships in the veterinary domain. PLoS One 2019; 14:e0224079. [PMID: 31671123 PMCID: PMC6822735 DOI: 10.1371/journal.pone.0224079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 10/05/2019] [Indexed: 01/09/2023] Open
Abstract
Public-Private Partnerships (PPPs) are defined as a collaborative approach in which the public and private sector share resources, responsibilities and risks to achieve common objectives and mutual benefits in a sustainable manner. PPPs are identified as a key solution to reinforce Veterinary Services. However only limited information is available on the scope, added value and enabling factors of PPPs in this sector. The aims of this study were to develop a typology of PPPs in the veterinary field and to identify key success factors and obstacles to their implementation. A structured questionnaire was sent to all 181 World Organisation for Animal Health (OIE) Member Countries and to 47 private contacts. 36 different variables characterizing PPP initiatives were collected. 97 examples of PPPs were retrieved from 76 countries. Dimensionality reduction techniques were combined with clustering and discrimination methods to establish a typology of PPPs and to derive a set of simple rules to classify new instances of PPPs. Three clusters were identified, separated according to two main variables: the type of private partners and the type of interaction. Cluster 1, transactional PPPs, represented the traditional understanding of PPPs by Veterinary Services, initiated and funded by the public sector, giving service delivery accreditation to mostly private veterinarians; cluster 2, collaborative PPPs, included partnerships between producer associations and public Veterinary Services, driven by trade interests; cluster 3, transformational PPPs, represented joint programs initiated and funded by private companies and initially driven by business development objectives. Specific success factors and key obstacles affecting the performances and sustainability of these initiatives were identified for each cluster. This study represents the first practical attempt to develop a meaningful typology of PPPs in the field of animal health and to identify fundamental obstacles currently inhibiting the development of PPPs, and suggests ways to support national Veterinary Services in overcoming these obstacles.
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Affiliation(s)
- Margot Galière
- World Organisation for Animal Health (OIE), Paris, France
| | - Marisa Peyre
- CIRAD, UMR ASTRE, Montpellier, France, ASTRE, CIRAD, INRA, Univ Montpellier, Montpellier, France
- * E-mail: (MP); (IDL)
| | - Facundo Muñoz
- CIRAD, UMR ASTRE, Montpellier, France, ASTRE, CIRAD, INRA, Univ Montpellier, Montpellier, France
| | - Mariline Poupaud
- CIRAD, UMR ASTRE, Montpellier, France, ASTRE, CIRAD, INRA, Univ Montpellier, Montpellier, France
| | - Alain Dehove
- World Organisation for Animal Health (OIE), Paris, France
| | - François Roger
- CIRAD, UMR ASTRE, Montpellier, France, ASTRE, CIRAD, INRA, Univ Montpellier, Montpellier, France
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Bardosh KL. Towards a science of global health delivery: A socio-anthropological framework to improve the effectiveness of neglected tropical disease interventions. PLoS Negl Trop Dis 2018; 12:e0006537. [PMID: 30024887 PMCID: PMC6053127 DOI: 10.1371/journal.pntd.0006537] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the last decade, implementation research and a science of global health delivery have emerged as important vehicles to improve the effectiveness of interventions. Efforts to control neglected tropical diseases (NTD) operate in challenging circumstances and with marginalized populations, making attention to context-specific details particularly relevant. Socio-anthropological insights have much to offer a science of NTD delivery. In this paper, an accessible and actionable framework for understanding NTD intervention effectiveness, based on socio-anthropological research, is presented and its utility for program planning and monitoring and evaluation is outlined. METHODOLOGY/PRINCIPAL FINDINGS The framework was developed inductively by comparatively analyzing three rapid ethnographic studies undertaken in Eastern Africa (2010-2013) on three different large-scale NTD interventions: rabies elimination in Tanzania, sleeping sickness control in Uganda and the prevention of parasitic worms in Zambia. The framework includes five "intervention domains" where the effectiveness of these interventions was negotiated and determined at the local level. This involves: 1) the terrain of intervention (including seasonality and geographical variability); 2) community agency (including local knowledge, risk perceptions, behaviors, leadership and social pressure); 3) the strategies and incentives of field staff (skills, motivations, capabilities and support); 4) the socio-materiality of technology (characteristics of intervention tools and the adoption process itself); and 5) the governance of interventions (policy narratives, available expertise, bureaucracy, politics and the utilization of knowledge). The paper illustrates the importance of each of these domains by drawing on the case study research, presenting lessons learnt and practical recommendations for how such insights could improve intervention delivery. CONCLUSIONS/SIGNIFICANCE To help close the gap between efficacy and effectiveness in NTD programs, it is important that field staff: 1) generate meaningful knowledge about contextual factors; 2) use this knowledge to tailor field strategies; and 3) create routine mechanisms to account for the dynamic process of implementation itself. The framework presented here offers a simple analytical tool to strengthen these knowledge-to-action relationships existing project planning tools, drawing on the insights of socio-anthropology.
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Affiliation(s)
- Kevin Louis Bardosh
- Department of Anthropology, University of Florida, Gainesville, Florida, United States of America
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
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Bardosh KL, Scoones JC, Grace D, Kalema-Zikusoka G, Jones KE, de Balogh K, Waltner-Toews D, Bett B, Welburn SC, Mumford E, Dzingirai V. Engaging research with policy and action: what are the challenges of responding to zoonotic disease in Africa? Philos Trans R Soc Lond B Biol Sci 2018; 372:rstb.2016.0172. [PMID: 28584180 PMCID: PMC5468697 DOI: 10.1098/rstb.2016.0172] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 01/09/2023] Open
Abstract
Zoonotic diseases will maintain a high level of public policy attention in the coming decades. From the spectre of a global pandemic to anxieties over agricultural change, urbanization, social inequality and threats to natural ecosystems, effectively preparing and responding to endemic and emerging diseases will require technological, institutional and social innovation. Much current discussion emphasizes the need for a 'One Health' approach: bridging disciplines and sectors to tackle these complex dynamics. However, as attention has increased, so too has an appreciation of the practical challenges in linking multi-disciplinary, multi-sectoral research with policy, action and impact. In this commentary paper, we reflect on these issues with particular reference to the African sub-continent. We structure the themes of our analysis on the existing literature, expert opinion and 11 interviews with leading One Health scholars and practitioners, conducted at an international symposium in 2016. We highlight a variety of challenges in research and knowledge production, in the difficult terrain of implementation and outreach, and in the politicized nature of decision-making and priority setting. We then turn our attention to a number of strategies that might help reconfigure current pathways and accepted norms of practice. These include: (i) challenging scientific expertise; (ii) strengthening national multi-sectoral coordination; (iii) building on what works; and (iv) re-framing policy narratives. We argue that bridging the research-policy-action interface in Africa, and better connecting zoonoses, ecosystems and well-being in the twenty-first century, will ultimately require greater attention to the democratization of science and public policy.This article is part of the themed issue 'One Health for a changing world: zoonoses, ecosystems and human well-being'.
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Affiliation(s)
- Kevin Louis Bardosh
- Department of Anthropology and Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL 32610, USA
| | | | - Delia Grace
- International Livestock Research Institute, PO Box 30709, Nairobi, Kenya
| | - Gladys Kalema-Zikusoka
- Conservation Through Public Health, Plot 3 Mapeera Lane, Entebbe PO Box 75298 Clock Towers, Kampala, Uganda
| | - Kate E Jones
- Centre for Biodiversity and Environment Research, Department of Genetics, Evolution and Environment, University College London, Gower Street, London WC1E 6BT, UK.,Institute of Zoology, Zoological Society of London, Regent's Park, London NW1 4RY, UK
| | - Katinka de Balogh
- Regional Office for Asia and the Pacific, Food and Agriculture Organization of the United Nations (FAO), 39 Phra Atit Road, Phranakon, Bangkok 10200, Thailand
| | - David Waltner-Toews
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1
| | - Bernard Bett
- International Livestock Research Institute, PO Box 30709, Nairobi, Kenya
| | - Susan C Welburn
- Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Elizabeth Mumford
- Department of Country Health Emergency Preparedness and IHR, World Health Organization, 1211 Geneva 27, Switzerland
| | - Vupenyu Dzingirai
- Centre for Applied Social Science, University of Zimbabwe, MP167 Mt Pleasant, Harare, Zimbabwe
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Bardosh KL, Ryan SJ, Ebi K, Welburn S, Singer B. Addressing vulnerability, building resilience: community-based adaptation to vector-borne diseases in the context of global change. Infect Dis Poverty 2017; 6:166. [PMID: 29228986 PMCID: PMC5725972 DOI: 10.1186/s40249-017-0375-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/15/2017] [Indexed: 11/14/2022] Open
Abstract
Background The threat of a rapidly changing planet – of coupled social, environmental and climatic change – pose new conceptual and practical challenges in responding to vector-borne diseases. These include non-linear and uncertain spatial-temporal change dynamics associated with climate, animals, land, water, food, settlement, conflict, ecology and human socio-cultural, economic and political-institutional systems. To date, research efforts have been dominated by disease modeling, which has provided limited practical advice to policymakers and practitioners in developing policies and programmes on the ground. Main body In this paper, we provide an alternative biosocial perspective grounded in social science insights, drawing upon concepts of vulnerability, resilience, participation and community-based adaptation. Our analysis was informed by a realist review (provided in the Additional file 2) focused on seven major climate-sensitive vector-borne diseases: malaria, schistosomiasis, dengue, leishmaniasis, sleeping sickness, chagas disease, and rift valley fever. Here, we situate our analysis of existing community-based interventions within the context of global change processes and the wider social science literature. We identify and discuss best practices and conceptual principles that should guide future community-based efforts to mitigate human vulnerability to vector-borne diseases. We argue that more focused attention and investments are needed in meaningful public participation, appropriate technologies, the strengthening of health systems, sustainable development, wider institutional changes and attention to the social determinants of health, including the drivers of co-infection. Conclusion In order to respond effectively to uncertain future scenarios for vector-borne disease in a changing world, more attention needs to be given to building resilient and equitable systems in the present. Electronic supplementary material The online version of this article (doi: 10.1186/s40249-017-0375-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kevin Louis Bardosh
- Department of Anthropology, University of Florida, Gainesville, USA. .,Emerging Pathogens Institute, University of Florida, Gainesville, USA.
| | - Sadie J Ryan
- Emerging Pathogens Institute, University of Florida, Gainesville, USA.,Department of Geography, University of Florida, Gainesville, USA
| | - Kris Ebi
- Department of Global Health, University of Washington, Seattle, USA
| | - Susan Welburn
- Centre of Infectious Disease, University of Edinburgh, Edinburgh, UK
| | - Burton Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, USA
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Bardosh KL, Murray M, Khaemba AM, Smillie K, Lester R. Operationalizing mHealth to improve patient care: a qualitative implementation science evaluation of the WelTel texting intervention in Canada and Kenya. Global Health 2017; 13:87. [PMID: 29208026 PMCID: PMC5717811 DOI: 10.1186/s12992-017-0311-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/08/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) applications have proliferated across the globe with much enthusiasm, although few have reached scale and shown public health impact. In this study, we explored how different contextual factors influenced the implementation, effectiveness and potential for scale-up of WelTel, an easy-to-use and evidence-based mHealth intervention. WelTel uses two-way SMS communication to improve patient adherence to medication and engagement in care, and has been developed and tested in Canada and Kenya. METHODS We used a comparative qualitative case study design, which drew on 32 key informant interviews, conducted in 2016, with stakeholders involved in six WelTel projects. Our research was guided by the Consolidated Framework for Implementation Research (CFIR), a meta-theoretical framework, and our analysis relied on a modified approach to grounded theory, which allowed us to compare findings across these projects. RESULTS We found that WelTel had positive influences on the "culture of care" at local clinics and hospitals in Canada and Kenya, many of which stretched beyond the immediate patient-client relationship to influence wider organizational systems. However, these were mediated by clinician norms and practices, the availability of local champion staff, the receptivity and capacity of local management, and the particular characteristics of the technology platform, including the ability for adaptation and co-design. We also found that scale-up was influenced by different forms of data and evidence, which played important roles in legitimization and partnership building. Even with robust research evidence, scale-up was viewed as a precarious and uncertain process, embedded within the wider politics and financing of Canadian and Kenyan health systems. Challenges included juggling different interests, determining appropriate financing pathways, maintaining network growth, and "packaging" the intervention for impact and relevance. CONCLUSIONS Our comparative case study, of a unique transnational mobile health research network, revealed that moving from mHealth pilots to scale is a difficult, context-specific process that couples social and technological innovation. Fostering new organizational partnerships and ways of learning are paramount, as mHealth platforms straddle the world of research, industry and public health. Partnerships need to avoid the perils of the technological fix, and engage the structural barriers that mediate people's health and access to services.
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Affiliation(s)
- Kevin Louis Bardosh
- Department of Anthropology & Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL 32610 USA
| | - Melanie Murray
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, E600B – 4500 Oak Street, Vancouver, BC Canada
- Women’s Health Research Institute, British Columbia Women’s Hospital, Vancouver, BC Canada
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, BC Canada
| | - Antony M. Khaemba
- WelTel International mHealth Society, PO Box 50197 00100, Nairobi, Kenya
| | - Kirsten Smillie
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, E600B – 4500 Oak Street, Vancouver, BC Canada
| | - Richard Lester
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, E600B – 4500 Oak Street, Vancouver, BC Canada
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Connolly J. Governing Towards 'One Health': Establishing Knowledge Integration in Global Health Security Governance. GLOBAL POLICY 2017; 8:483-494. [PMID: 32336994 PMCID: PMC7165607 DOI: 10.1111/1758-5899.12505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Recent global threats (e.g. Ebola, avian influenza, the Zika virus) have demonstrated the need for policy makers to focus on the detection of risks at the animal-human interface. Yet epistemic knowledge across these domains is not sufficiently joined-up. The article argues that, despite some progress, in order for the policy agenda for global health security to develop towards a 'One Health' model there is a need for integration across public and animal health domains. This article sets out an evaluation framework for establishing knowledge integration across these sectors. The article concludes that although 'One Health may seem utopian, given there are key challenges when it comes to reaching integration, there are important steps that can be taken the short to medium-term. These include reforms to education and training programmes and interdisciplinary research collaborations. A key determinant of whether One Health becomes a paradigm which frames public policy, and leads to policy and institutional changes to enable public value creation and sustainability, is the presence of an 'epistemic community' that bridges health networks.
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Polisye Kont Moustik: A Culturally Competent Approach to Larval Source Reduction in the Context of Lymphatic Filariasis and Malaria Elimination in Haiti. Trop Med Infect Dis 2017; 2:tropicalmed2030039. [PMID: 30270896 PMCID: PMC6082096 DOI: 10.3390/tropicalmed2030039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/12/2017] [Accepted: 08/13/2017] [Indexed: 11/17/2022] Open
Abstract
Community engagement has become an increasingly important focus of global health programs. Arbovirus emergence in the Americas (Zika and chikungunya virues), and global goals for malaria and lymphatic filariasis elimination, mean that community-based mosquito control has taken on a new salience. But how should mosquito control initiatives be designed and implemented in ways that best engage local people? What are the challenges and trade-offs of different strategies, not only for effectiveness but also for scale-up? In this paper, we describe the social and political dynamics of a pilot study in a small town in northern Haiti. With the aim of developing a culturally-competent approach to larval source management (LSM), our pilot project combined larval surveillance with environmental management, social engagement, community education, and larvicide application. Orientated around a network of 'Mosquito Police' (Polisye Kont Moustik, in Haitian Creole), our approach integrated elements of formative research, social learning, and community participation. Here, we reflect on the challenges we encountered in the field, from larval mapping, staff management, education and behavior change, engagement with formal and informal leaders, and community-based environmental cleanup. We discuss how these programmatic efforts were influenced and shaped by a complex range of social, cultural, political, and economic realities, and conclude by discussing the implications of our community-based approach for the elimination of lymphatic filariasis and malaria, and other vector-borne diseases, in Haiti.
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Hamill L, Picozzi K, Fyfe J, von Wissmann B, Wastling S, Wardrop N, Selby R, Acup CA, Bardosh KL, Muhanguzi D, Kabasa JD, Waiswa C, Welburn SC. Evaluating the impact of targeting livestock for the prevention of human and animal trypanosomiasis, at village level, in districts newly affected with T. b. rhodesiense in Uganda. Infect Dis Poverty 2017; 6:16. [PMID: 28162093 PMCID: PMC5292814 DOI: 10.1186/s40249-016-0224-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 12/15/2016] [Indexed: 11/24/2022] Open
Abstract
Background Uganda has suffered from a series of epidemics of Human African Trypanosomiasis (HAT), a tsetse transmitted disease, also known as sleeping sickness. The area affected by acute Trypanosoma brucei rhodesiense HAT (rHAT) has been expanding, driven by importation of infected cattle into regions previously free of the disease. These regions are also affected by African Animal Trypanosomiasis (AAT) demanding a strategy for integrated disease control. Methods In 2008, the Public Private Partnership, Stamp Out Sleeping Sickness (SOS) administered a single dose of trypanocide to 31 486 head of cattle in 29 parishes in Dokolo and Kaberamaido districts. This study examines the impact of this intervention on the prevalence of rHAT and AAT trypanosomes in cattle from villages that had (HAT+ve) or had not (HAT-ve) experienced a recent case of rHAT. Cattle herds from 20 villages were sampled and screened by PCR, pre-intervention and 6-months post-intervention, for the presence or absence of: Trypanosoma brucei s.l.; human infective T. b. rhodesiense; Trypanosoma vivax; and Trypanosoma congolense savannah. Results Post-intervention, there was a significant decrease in the prevalence of T. brucei s.l. and the human infective sub-species T. b. rhodesiense in village cattle across all 20 villages. The prevalence of T. b. rhodesiense was reduced from 2.4% to 0.74% (P < 0.0001), with the intervention showing greater impact in HAT-ve villages. The number of villages containing cattle harbouring human infective parasites decreased from 15/20 to 8/20, with T. b. rhodesiense infection mainly persisting within cattle in HAT+ve villages (six/eight). The proportion of T. brucei s.l. infections identified as human infective T. b. rhodesiense decreased after the intervention from 8.3% (95% CI = 11.1–5.9%) to 4.1% (95% CI = 6.8–2.3%). Villages that had experienced a recent human case (HAT+ve villages) showed a significantly higher prevalence for AAT both pre- and post-intervention. For AAT the prevalence of T. vivax was significantly reduced from 5.9% to 0.05% post-intervention while the prevalence of T. congolense increased from 8.0% to 12.2%. Conclusions The intervention resulted in a significant decrease in the prevalence of T. brucei s.l., human infective T. b. rhodesiense and T. vivax infection in village cattle herds. The proportion of T. brucei s.l. that were human infective, decreased from 1:12 T. brucei s.l. infections before the intervention to 1:33 post-intervention. It is clearly more difficult to eliminate T. b. rhodesiense from cattle in villages that have experienced a human case. Evidence of elevated levels of AAT in livestock within village herds is a useful indicator of risk for rHAT in Uganda. Integrated veterinary and medical surveillance is key to successful control of zoonotic rHAT. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0224-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise Hamill
- Edinburgh Infectious Diseases, Division of Infection and Pathway Medicine, Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Kim Picozzi
- Edinburgh Infectious Diseases, Division of Infection and Pathway Medicine, Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Jenna Fyfe
- Edinburgh Infectious Diseases, Division of Infection and Pathway Medicine, Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Beatrix von Wissmann
- Edinburgh Infectious Diseases, Division of Infection and Pathway Medicine, Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Sally Wastling
- Edinburgh Infectious Diseases, Division of Infection and Pathway Medicine, Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Nicola Wardrop
- Edinburgh Infectious Diseases, Division of Infection and Pathway Medicine, Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Richard Selby
- Edinburgh Infectious Diseases, Division of Infection and Pathway Medicine, Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Christine Amongi Acup
- Edinburgh Infectious Diseases, Division of Infection and Pathway Medicine, Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Kevin L Bardosh
- Edinburgh Infectious Diseases, Division of Infection and Pathway Medicine, Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Dennis Muhanguzi
- Department of Pharmacy, Clinical and Comparative Medicine, School of Veterinary Medicine and Animal Resources, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - John D Kabasa
- Department of Pharmacy, Clinical and Comparative Medicine, School of Veterinary Medicine and Animal Resources, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Charles Waiswa
- Department of Pharmacy, Clinical and Comparative Medicine, School of Veterinary Medicine and Animal Resources, Makerere University, P.O. Box 7062, Kampala, Uganda.,The Coordinating Office for Control of Trypanosomiasis in Uganda (COCTU), Wandegeya, Plot 76/78 Buganda Road, P.O. Box 16345, Kampala, Uganda
| | - Susan C Welburn
- Edinburgh Infectious Diseases, Division of Infection and Pathway Medicine, Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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