Pushing back against disease with participatory epidemiology

A herd of animals can be the only source of income for many families in areas like northern Uganda or southern Africa. Farmers with poor access to infrastructure and capital struggle to address and manage disease outbreaks, which can wipe out a household’s economy. Worldwide 750 million low-income livestock farmers depend on healthy animals for their productivity and livelihood. So, yes! Animal health matters.

But so far, we know very little about how perceptive farmers are and what their response to disease outbreaks is. A seminar ‘Exploring the Whys and the Hows of epidemiology: Integrating social sciences with veterinary research for better understanding and action towards improved animal health in the Global South’  held at the Swedish University of Agricultural Sciences, SLU on the 20th of November, 2018 looked at how scientists from different disciplines see the way local farmers understand the diseases and prevention mechanisms.

Why epidemiology is important?

The role of epidemiology in animal health is to identify the risk factors and the causes of a disease outbreak. This knowledge provides a base for interventions that can ultimately prevent an outbreak or an epidemic. With that, epidemiology is crucial for poverty reduction and plays a vital role in increasing resilience to risks of epidemics in low-income countries.

Even though our scientific knowledge about animal diseases has stepped forward, disease control leaves much to be desired. For instance, African swine fever continues to spread from Africa to Europe and Asia, harming many pig farms.

Karl Ståhl, Swedish National Veterinary Institute (SVA), traced an African swine fever outbreak through a trade route in Northern Uganda. He found that local pig farmers knew very well the clinical signs of the disease and how it spreads. They could even identify the potential control mechanisms. But as soon as they noticed sick pigs, they sold them to secure their income.

It became clear for Karl and his team that what they were facing in Northern Uganda is not the lack of knowledge by the farmers, but rather the lack of information on specific needs and circumstances of pig producers and supply chain actors during the outbreak. To solve the problem, Karl suggests it is necessary to bring in societal aspect into the equation. In his opinion this will help to find solutions that fit with local socio-economic and cultural context.

Is interdisciplinarity the way forward?

Social science still remains on the periphery of disease outbreak management – social sciences are rarely integrated into epidemiology. However, it is becoming apparent that quality disease prevention isn’t possible without considering socio-cultural, economic and political dimensions. This engagement can be done through an interdisciplinary approach.

Learning from the Ebola outbreak in West Africa, Paul Richards (Wageningen University) suggests to look beyond the classic idea of epidemiological and biomedical approaches and take into account human emotions.

During the early phase of the Ebola outbreak, epidemiologists built Ebola treatment centres to bring in patients, or suspected patients, hoping to isolate the patients’ from the outside world. But this created anxiety among patients and their families. The disease continued to spread.

By 2013, Paul together with locally trained field assistants used anthropological approach to collect information through real-time action-research. Human emotion appeared to be the missing link to the treatment – families needed to be able to talk to each other and have meals together. As a result, Paul’s team recommended to build more community quarantines so that families could be close the patients. Through watchful care and close communication between patients and their communities, the epidemic was eventually brought under control.

Participatory epidemiology

Participatory epidemiology has been influenced by Participatory Rural Appraisal (PRA), an approach that puts local participation at the heart of the process. However, participatory epidemiology has been adopted largely by natural scientists, who usually focus on m research quantitative methods. Meanwhile, from the experience of social scientists, statistics do not always reflect the reality of local communities. So, well-tailored solutions require real participation form the local people.

Klara Fischer and Erika Chenais’s work in Uganda is an attempt to engage a local participation in an epidemiology study. Instead of using a top-down approach, Klara and Erika let local perspectives guide their study. They used several participatory methods, such as participatory wealth-ranking and focus group discussion to understand how a community can prioritise, understand and deal with cattle diseases.

Susanna Sternberg Lewerin confirmed the value of a participatory approach in disease prevention practices. For her, it was important to create a relaxed atmosphere during participatory discussions and recruit local facilitators who could facilitate in the local language.

So, how can disease control benefit from cross-pollination between veterinary epidemiology and social sciences? There are at least three ways:

1. Veterinary epidemiology and social science can cooperate and increase understanding of contextualised knowledge that affects decisions relating to disease control.
2. Using participatory methods to engage indigenous perspectives can improve disease prevention and control mechanisms.
3. It is key to remember that there are no ‘fixed-tools’ in epidemiology. Tools need to be adapted and adjusted to the local context, addressing local heterogeneity, power dynamics and conflicts.