WaArusha Agro-Pastoralist Experiences with Risk of Febrile Illness: An Ethnographic Study of Social Drivers of Zoonoses

瓦阿鲁沙农牧民的发热性疾病风险经历：人畜共患病社会驱动因素的人种学研究

• 批准号: 2299842
• 金额: --
• 依托单位: University of Sussex
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2015
• 资助国家: 英国
• 起止时间: 2015 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2299842
• 关键词: WaArusha; Agro; Pastoralist; Experiences; Risk

Zoonoses are a major cause of febrile illness in people living with livestock in northern Tanzania. Early diagnosis and timely treatment influence the health outcomes of febrile patients, as any delay to care-seeking is significantly associated with complications leading to severe disease. However, little is known about lay experiences with zoonoses or febrile illness in these settings, and most studies tend to focus on the epidemiology of these diseases. My PhD project is theoretically informed by studies that link zoonoses to livelihoods and health systems as drivers of infections. These studies argue for an examination of broader drivers of zoonotic disease in the context of poverty, structural violence, economic rights and social justice, which are critical of over-emphasising technical solutions as "quick fixes" for the control of zoonoses.It also problematises purely risk-factor approaches to studying zoonotic diseases in low-resource settings that assume universalist understanding of what risks are; in reality, lay people's understanding of risk differs from expert accounts as these are products of broader socio-cultural, environmental and economic realities and experiences of local people. Therefore my intention is to explore how risk factors are framed by dominant actors (experts, including epidemiologists, veterinarians, clinicians) and by lay people, and how people's daily activities, practices and belief systems often blur the lines between them and their livestock in ways that complicate official framings of risk. Although public health actors may frame risk factors as avoidable, if for example local people observe good hygiene practices and food habits in order to protect themselves from disease, in reality, as I demonstrate in my thesis, poor communities such as agro-pastoralists living in northern Tanzania have no choice but to share basic resources such as water and homes with their livestock, and implementing these recommendations is a challenge.In this thesis, I explore agro-pastoralist experiences of risk of febrile illness, understandings and framing of zoonotic health risks and local health-seeking behaviours. To do this, I spent ten months living amongst WaArusha agro-pastoralists in Naiti village, northern Tanzania, conducting ethnographic research using mixed-method approaches including household surveys, interviews and focus group discussions. The study finds that herders' perceptions of zoonotic risks are shaped by external events that threaten their culture and social relationships, rather than expert narratives about zoonotic risks. Livestock and their product are central to the perceptions and management of risks among WaArusha families. Animal products particularly milk and meat-critical for household nutrition and for their therapeutic value- mediate between complex social relationships in ways that make it difficult to categorise them as "safe" or "unsafe". Familiar zoonotic diseases such as anthrax, for example, which lead to high mortality in livestock and exhibit physical symptoms that locals can identify, are more accepted risks, whereas zoonoses that do not show physical symptoms such as brucellosis, the risks of which may be real, are less readily accepted as risks to human health. However, it does not follow that people take health-enhancing decisions to minimise harm, like changing their eating habits or visiting a doctor when illness occurs. Rather, people adopt approaches which appear, from an outsider perspective, to have both rational and irrational elements, and which are influenced by issues such as trust and practicality. Expert framings of risk and prescriptions for managing zoonotic risk, therefore, can only work when constructed alongside and in conjunction with lay beliefs, especially if the goal is to achieve effective interventions.

人畜共患病是坦桑尼亚北方与牲畜一起生活的人患发热性疾病的主要原因。早期诊断和及时治疗会影响发热患者的健康结果，因为任何求医延误都与导致严重疾病的并发症密切相关。然而，在这些环境中，人们对人畜共患病或发热性疾病的经验知之甚少，大多数研究倾向于关注这些疾病的流行病学。从理论上讲，我的博士项目是通过将人畜共患病与生计和卫生系统联系起来作为感染驱动因素的研究来了解的。这些研究主张在贫困、结构性暴力、经济权利和社会正义的背景下审查人畜共患病的更广泛驱动因素，这些因素对过分强调技术解决方案作为控制人畜共患病的“快速解决办法”提出了批评，还质疑了在资源匮乏的环境中研究人畜共患病的纯粹风险因素方法，这种方法假定对风险是什么具有普遍性的理解;实际上，普通人对风险理解不同于专家的叙述，因为这些叙述是更广泛的社会文化、环境和经济现实以及当地人民的经验的产物。因此，我的目的是探索风险因素是如何被主导行为者（专家，包括流行病学家，兽医，临床医生）和外行人所框定的，以及人们的日常活动，实践和信仰体系如何经常模糊他们和他们的牲畜之间的界限，使官方的风险框架复杂化。尽管公共卫生行为者可能将风险因素视为可以避免的，例如，如果当地人遵守良好的卫生习惯和饮食习惯，以保护自己免受疾病的侵害，但实际上，正如我在论文中所展示的那样，生活在坦桑尼亚北方的农牧民等贫困社区别无选择，只能与他们的牲畜分享水和家园等基本资源，在这篇论文中，我探讨了农牧民对发热性疾病风险的经验，对人畜共患病健康风险的理解和框架以及当地的健康寻求行为。为此，我在坦桑尼亚北方的Naiti村的WaArusha农牧民中生活了10个月，使用混合方法进行民族志研究，包括家庭调查，访谈和焦点小组讨论。研究发现，牧民对人畜共患病风险的看法是由威胁其文化和社会关系的外部事件形成的，而不是专家对人畜共患病风险的叙述。牲畜及其产品是WaArusha家庭认识和管理风险的核心。动物产品，特别是牛奶和肉类，对家庭营养和治疗价值至关重要，在复杂的社会关系之间起着中介作用，使人们难以将它们归类为“安全”或“不安全”。常见的人畜共患病，例如炭疽病，会导致牲畜死亡率很高，并表现出当地人可以识别的身体症状，是更容易接受的风险，而没有表现出身体症状的人畜共患病，例如布鲁氏菌病，其风险可能是真实的，不太容易被接受为对人类健康的风险。然而，这并不意味着人们会做出增进健康的决定来尽量减少伤害，比如改变饮食习惯或在生病时去看医生。相反，从局外人的角度来看，人们采用的方法似乎既有理性因素，也有非理性因素，并且受到信任和实用性等问题的影响。因此，只有在与非专业信念一起构建时，专家的风险框架和管理人畜共患病风险的处方才能起作用，特别是如果目标是实现有效的干预措施。