Department of Agriculture, University of Reading, Reading, UK.
Research & International Development Consultancy Services (EGRID), Deventer, The Netherlands.
BMC Public Health. 2018 Mar 21;18(1):388. doi: 10.1186/s12889-018-5288-x.
Efficient A(H5N1) control is unlikely to be based on epidemiological data alone. Such control depends on a thorough understanding and appreciation of the interconnectedness of epidemiological, social, and economic factors that contribute to A(H5N1) vulnerability. To date, the control of A(H5N1) in Egypt has been challenging. The disease has been endemic for more than 10 years with a dramatic increase in human cases between December 2014 and March 2015. Part of the problem has been a lack of understanding of the inter-play of drivers, conditions and motives that influence preventive behaviours at the household level.
To address this issue, the authors developed a Composite Risk Index (CRI) to inform decision-makers of critical epidemiological, livelihood, food security and risk perception factors that were found to contribute to A(H5N1) vulnerability at the community level. The CRI consists of seven constructs that were individually scored for each community. The seven constructs included poultry sales, previous flock exposure to A(H5N1), human risk probability, sense of control over the disease, preventative actions taken, level of household food insecurity and community norms toward certain handling and disposal practices. One hundred forty female poultry keepers across four governorates were interviewed in 2010 using a mix of random and purposive sampling techniques. A mixed method approach underpinned the analysis. The study used wealth ranking in order to help decision-makers in understanding the specific constraints of different wealth groups and aid better targeting of A(H5N1) control and prevention strategies.
Poverty, widowhood and lack of education were among the factors associated with high risk scores. CRI scores in those villages where awareness raising had taken place were not significantly different compared to those villages where awareness raising had not taken place.
The aim of the tool is to enable targeting those communities that are likely to be highly vulnerable to A(H5N1) outbreaks and where control and awareness-raising efforts are expected to be most effective. In this manner, policy makers and practitioners will be able to better allocate limited resources to those communities most vulnerable to the negative impact of A(H5N1).
高效的 A(H5N1)控制不太可能仅基于流行病学数据。这种控制取决于对导致 A(H5N1)脆弱性的流行病学、社会和经济因素相互关系的透彻理解和欣赏。迄今为止，埃及的 A(H5N1)控制一直具有挑战性。该疾病已经流行了 10 多年，2014 年 12 月至 2015 年 3 月期间，人类病例急剧增加。部分问题是缺乏对影响家庭一级预防行为的驱动因素、条件和动机相互作用的理解。
为了解决这个问题，作者开发了一个综合风险指数（CRI），以告知决策者在社区层面发现的对 A(H5N1)脆弱性有贡献的关键流行病学、生计、粮食安全和风险感知因素。CRI 由七个结构组成，每个社区分别对其进行评分。这七个结构包括家禽销售、以前禽类接触过 A(H5N1)、人类风险概率、对疾病的控制感、采取的预防措施、家庭粮食不安全程度以及社区对某些处理和处置做法的规范。2010 年，在四个省对 140 名女性家禽饲养者进行了混合使用随机和有针对性抽样技术的访谈。分析采用混合方法。该研究使用财富排名，以帮助决策者了解不同财富群体的具体限制，并更好地针对 A(H5N1)控制和预防战略。
贫穷、丧偶和缺乏教育是高风险评分相关的因素之一。在已经开展了提高认识活动的村庄中，CRI 评分与没有开展提高认识活动的村庄没有显著差异。
该工具的目的是使决策者能够针对那些极有可能受到 A(H5N1)爆发影响的社区，并期望在这些社区中实施控制和提高认识的努力最有效。通过这种方式，政策制定者和从业者将能够更好地将有限资源分配给那些最容易受到 A(H5N1)负面影响的社区。
