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

人畜共患病是坦桑尼亚北部与牲畜生活在一起的人患发热性疾病的主要原因。早期诊断和及时治疗影响发烧患者的健康结果，因为任何延误求医都与导致严重疾病的并发症显著相关。然而，对这些环境中人畜共患病或发热性疾病的外行经验知之甚少，大多数研究倾向于集中在这些疾病的流行病学上。从理论上讲，我的博士项目是由将人畜共患病与生计和卫生系统作为感染驱动力的研究联系起来的。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考察人畜共患病的更广泛的驱动因素，这些研究批评过度强调技术解决方案是控制人畜共患病的“速效方案”。它还使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产生问题，这些方法假定普遍主义理解风险是什么；实际上，普通人对风险的理解与专家描述不同，因为这些是更广泛的社会文化、环境和经济现实以及当地人经验的产物。因此，我的目的是探索主要参与者(专家，包括流行病学家、兽医、临床医生)和普通人是如何确定风险因素的，以及人们的日常活动、做法和信仰体系如何经常模糊他们和他们的牲畜之间的界限，从而使官方的风险框架复杂化。尽管公共卫生行为者可能认为风险因素是可以避免的，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侵袭，但在现实中，正如我在论文中所展示的那样，生活在坦桑尼亚北部的贫穷社区，如农牧民，别无选择，只能与他们的牲畜分享基本资源，如水和家园，而实施这些建议是一个挑战。在这篇论文中，我探索了农牧民关于发烧疾病风险的经验，对人畜共患病健康风险和当地寻求健康行为的理解和框架。为了做到这一点，我花了十个月的时间生活在坦桑尼亚北部奈提村的瓦阿鲁沙农牧民中，使用包括家庭调查、访谈和焦点小组讨论在内的混合方法进行人种学研究。研究发现，牧民对人畜共患病风险的认知是由威胁他们的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描述。牲畜及其产品是瓦阿鲁沙家庭感知和管理风险的核心。动物产品，尤其是牛奶和肉类--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，使得人们很难将其归类为“安全”或“不安全”。例如，炭疽等常见的人畜共患病会导致牲畜高死亡率，并表现出当地人可以识别的身体症状，是更容易被接受的风险，而没有表现出布鲁氏菌病等身体症状的人畜共患病，其风险可能是真实的，则不太容易被接受为对人类健康的风险。然而，这并不意味着人们为了将伤害降到最低而做出了增进健康的决定，比如改变饮食习惯或在疾病发生时去看医生。相反，从局外人的角度来看，人们采用的方法似乎既有理性的因素，也有非理性的因素，而且受到信任和实用性等问题的影响。因此，专家制定的风险框架和管理人畜共患病风险的处方只有在与普通信念一起构建并与之结合时才能发挥作用，特别是如果目标是实现有效的干预措施。

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.