Protective practices against zoonotic infections among rural and slum communities from South Central Chile

Prevention of exposure to zoonoses in rural Latin America: Social ecological factors in a diverse regional context

Zoonotic diseases have serious impacts on human health and well-being, but they are often overlooked in rural Latin America. The design of effective preventive interventions is complex and requires an integrative approach from evidence-based information analyzed through robust theoretical frameworks. We conducted a systematized literature review and qualitative framework-guided thematic analysis to identify social ecological factors affecting the prevention and exposure to zoonotic diseases. Although resources for research are limited in Latin America, we found several studies with relevant results. We extracted and interpreted 8 themes as factors affecting the prevention, transmission, and exposure to zoonosis. These themes included knowledge and misconceptions, low risk perception, gaps in knowledge and communication, psychological effect of diseases, culture and traditions, inequality, disarticulated prevention programs, and organizational responsibility. Alongside this, we compiled and present the recommendations for actions to reduce the impact of zoonoses in these populations. The factors and recommendations here presented can be adapted to inform the design and improvement of preventive programs, focused on One Health and aiming to reduce the impact of zoonotic diseases in rural settings.

•

We identified relevant social and behavioural factors affecting the prevention of Zoonotic diseases in Latin America.

•

Knowledge, risk perceptions, and communication quality were relevant individual factors.

•

Inequity and unarticulated programs were relevant social factors.

•

Characterization of the context-specific social ecology can improve the development of effective interventions.

Eco-epidemiological scaling of Leptospirosis: Vulnerability mapping and early warning forecasts

Infectious disease epidemics are plaguing the world and a lot of research is focused on the development of models to reproduce disease dynamics for eco-environmental and biological investigation, and disease management. Leptospirosis is an example of a neglected zoonosis strongly mediated by ecohydrological dynamics with emerging endemic and epidemic patterns worldwide in both animal and human populations. By accounting for large heterogeneities of affected areas we show how exponential endemics and scale-free epidemics are largely predictable and linked to common socio-environmental features via scaling laws with different exponents that inform about vulnerability factors. This led to the development of a novel pattern-oriented integrated model that can be used as an early-warning signal (EWS) tool for endemic-epidemic regime classification, risk determinant attribution, and near real-time forecast of outbreaks. Forecasts are grounded on expected outbreak recurrence time dependent on exceedance probabilities and statistical EWS that sense outbreak onset. A stochastic spatially-explicit model is shown to comprehensively predict outbreak dynamics (early sensing, timing, magnitude, decay, and eco-environmental determinants) and derive a spreading factor characterizing endemics and epidemics, where average over maximum rainfall is the critical factor characterizing disease transitions. Dynamically, case cross-correlation considering neighboring communities senses 2-weeks in advance outbreaks. Eco-environmental scaling relationships highlight how predicted host suitability and topographic index can be used as epidemiological footprints to effectively distinguish and control Leptospirosis regimes and areas dependent on hydro-climatological dynamics as the main trigger. The spatio-temporal scale-invariance of epidemics - underpinning persistent criticality and neutrality or independence among areas - is emphasized by the high accuracy in reproducing sequence and magnitude of cases via reliable surveillance. Further investigations of robustness and universality of eco-environmental determinants are required; nonetheless a comprehensive and computationally simple EWS method for the full characterization of Leptospirosis is provided. The tool is extendable to other climate-sensitive zoonoses to define vulnerability factors and predict outbreaks useful for optimal disease risk prevention and control.

Knowledge, attitudes and practices (KAP) regarding leptospirosis among residents of riverside settlements of Santa Fe, Argentina

BACKGROUND

Leptospirosis is a global and re-emerging zoonotic disease caused by Leptospira spirochetes that are shed into the environment by infected animals. Humans can get infected via contact with animal hosts or contaminated environment. In Argentina, the highest annual incidences were reported in the province of Santa Fe, where epidemic outbreaks occurred during flooding events. This study examined the knowledge, attitudes and practices (KAP) regarding leptospirosis among residents of riverside slum settlements from Santa Fe after a major flood.

METHODS AND FINDINGS

A cross-sectional questionnaire was administered to 113 residents of 3 riverside settlements from Santa Fe. The influence of knowledge and attitudes regarding leptospirosis on the likelihood that an individual will use preventive practices were evaluated using linear mixed-effects models. The majority of respondents (83.2%) had previously heard about leptospirosis; however specific knowledge about leptospirosis was limited. The results of the modeling efforts, show that the likelihood of using preventive practices was associated with having greater knowledge score, but not with more positive attitudes. We also found that females were more likely to use safer practices than males.

CONCLUSIONS

Even though the majority of respondents had heard about leptospirosis, a high percentage of them had limited knowledge regarding the severity of the disease and its prevalence in the region. Our results suggest that public health interventions in these riverside communities should focus on educating the public on the multiple dimensions of leptospirosis in order to attain greater adherence to preventive practices instead of intending to change the perceptions or attitudes towards the disease, which did not have a significant influence. The key challenge lies in identifying effective strategies to reach the high risk group for leptospirosis here that is male fishermen, who spend most of the time in precarious campsites on the river islands.

Development and validation of a new knowledge, attitude, belief and practice questionnaire on leptospirosis in Malaysia

Background

In Malaysia, leptospirosis is considered an endemic disease, with sporadic outbreaks following rainy or flood seasons. The objective of this study was to develop and validate a new knowledge, attitude, belief and practice (KABP) questionnaire on leptospirosis for use in urban and rural populations in Malaysia.

Methods

The questionnaire comprised development and validation stages. The development phase encompassed a literature review, expert panel review, focus-group testing, and evaluation. The validation phase consisted of exploratory and confirmatory parts to verify the psychometric properties of the questionnaire. A total of 214 and 759 participants were recruited from two Malaysian states, Kelantan and Selangor respectively, for the validation phase. The participants comprised urban and rural communities with a high reported incidence of leptospirosis. The knowledge section of the validation phase utilized item response theory (IRT) analysis. The attitude and belief sections utilized exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

Results

The development phase resulted in a questionnaire that included four main sections: knowledge, attitude, belief, and practice. In the exploratory phase, as shown by the IRT analysis of knowledge about leptospirosis, the difficulty and discrimination values of the items were acceptable, with the exception of two items. Based on the EFA, the psychometric properties of the attitude, belief, and practice sections were poor. Thus, these sections were revised, and no further factor analysis of the practice section was conducted. In the confirmatory stage, the difficulty and discrimination values of the items in the knowledge section remained within the acceptable range. The CFA of the attitude section resulted in a good-fitting two-factor model. The CFA of the belief section retained low number of items, although the analysis resulted in a good fit in the final three-factor model.

Conclusions

Based on the IRT analysis and factor analytic evidence, the knowledge and attitude sections of the KABP questionnaire on leptospirosis were psychometrically valid. However, the psychometric properties of the belief section were unsatisfactory, despite being revised after the initial validation study. Further development of this section is warranted in future studies.

Disease and Human/Animal Interactions

Understanding pathogen exchange among human, wildlife, and livestock populations, and the varying ecological and cultural contexts in which this exchange takes place, is a major challenge. The present review contextualizes the risk factors that result from human interactions with livestock, companion animals, animal exhibits, wildlife through nature-based tourism, and wildlife through consumption. Given their phylogenetic relatedness to humans, primates are emphasized in this discussion; primates serve as reservoirs for several human pathogens, and some human pathogens can decimate wild primate populations. Anthropologists must play a central role in understanding cultural variation in attitudes toward other species as well as perceived risks when interacting with animals. I argue that the remediation of emerging infectious diseases will be accomplished primarily through human behavioral changes rather than through efforts in pathogen discovery. Given the history of human interactions with wildlife, candid discussions on zoonotic diseases will be increasingly important for our combined survival.