The role of social vulnerability in improving interventions for neglected zoonotic diseases: The example of Kyasanur Forest Disease in India.
The role of social vulnerability in improving interventions for neglected zoonotic diseases: The example of Kyasanur Forest Disease in India.
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DOI：
10.1371/journal.pgph.0000758
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Oommen, Meera A
中科院分区：
文献类型：
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作者：
Asaaga, Festus A;Purse, Bethan V;Rahman, Mujeeb;Srinivas, Prashanth N;Kalegowda, Suresh D;Seshadri, Tanya;Young, Juliette C;Oommen, Meera A
以森林为基础的社区管理着许多健康和社会经济福利方面的风险，包括新出现的人畜共患病的威胁日益增加，预计这些疾病将不成比例地影响贫困和边缘化群体，并进一步损害他们不稳定的生计，特别是在中低收入环境中。然而，对于贫困和边缘化群体面对新出现的人畜共患病的脆弱性和适应途径的实证研究相对缺乏。根据对西高止山脉229户家庭的调查和一系列关键信息提供者的访谈，我们研究了影响小农和部落家庭对Kyasanur森林病（KFD）的脆弱性的因素，KFD是印度南部一种致命的蜱传病毒性出血热流行病。具体而言，我们调查不同的社会人口和制度因素如何相互作用，以塑造KFD的脆弱性和家庭采用的战略，以适应疾病的后果。虽然被调查的家庭普遍认为KFD是一个重要的健康问题，在研究区域，有变异的关注感染疾病。总体结果表明，土地获取困难（AOR = 0.373，95%CI：0.152-0.916），处于或低于贫困线（AOR = 0.253，95% CI：0.094-0.685），由老年人领导（AOR = 1.038，95%CI：1.006-1.071）均为感知KFD脆弱性的显著决定因素。此外，KFD脆弱性还受到重要的家庭外因素的影响，包括靠近私立医院（AOR = 3.281，95% CI：1.220-8.820），主要道路（AOR = 2.144，95% CI：1.215-3.783）和研究地点（AOR = 0.226，95% CI：0.690-0.743）。我们的研究结果强调了小农和部落社区的同质化特征以及现有干预措施的“技术导向”方法可能会进一步边缘化最弱势群体并加剧现有的不平等。这些研究结果对于设计针对具体情况的适当卫生干预措施（包括优先考虑提高认识，知识网络，生计多样化），增强风险社会群体在KFD背景下的复原力非常重要。更广泛地说，我们的研究结果强调了关注社会脆弱性如何帮助国家和国际卫生规划人员改善卫生干预措施，并在被忽视的地方性人畜共患病方面优先考虑疾病。
Forest-based communities manage many risks to health and socio-economic welfare including the increasing threat of emerging zoonoses that are expected to disproportionately affect poor and marginalised groups, and further impair their precarious livelihoods, particularly in Low-and-Middle Income (LMIC) settings. Yet, there is a relative dearth of empirical research on the vulnerability and adaptation pathways of poor and marginalised groups facing emerging zoonoses. Drawing on a survey of 229 households and a series of key-informant interviews in the Western Ghats, we examine the factors affecting vulnerability of smallholder and tribal households to Kyasanur Forest Disease (KFD), an often-fatal tick-borne viral haemorrhagic fever endemic in south India. Specifically, we investigate how different socio-demographic and institutional factors interact to shape KFD vulnerability and the strategies employed by households to adapt to disease consequences. Although surveyed households generally perceived KFD as an important health issue in the study region, there was variability in concern about contracting the disease. Overall results showed that poor access to land (AOR = 0.373, 95% CI: 0.152–0.916), being at or below the poverty line (AOR = 0.253, 95% CI: 0.094–0.685) and being headed by an older person (AOR = 1.038, 95% CI: 1.006–1.071) were all significant determinants of perceived KFD vulnerability. Furthermore, KFD vulnerability is also modulated by important extra-household factors including proximity to private hospitals (AOR = 3.281, 95% CI: 1.220–8.820), main roads (AOR = 2.144, 95% CI: 1.215–3.783) and study location (AOR = 0.226, 95% CI: 0.690–0.743). Our findings highlight how homogenous characterisation of smallholder and tribal communities and the ‘techno-oriented’ approach of existing interventions may further marginalise the most vulnerable and exacerbate existing inequalities. These findings are important for designing context-specific and appropriate health interventions (including the prioritisation of awareness raising, knowledge networks, livelihood diversification) that enhances the resilience of at-risk social groups within the KFD context. More broadly, our findings highlight how a focus on social vulnerability can help national and international health planners improve health interventions and prioritise among diseases with respect to neglected endemic zoonoses.