Participatory Epidemiology in Animal and Human Health<br />Participatory Epidemiology Network for Animal and Public Health...
Presentation outline<br />Introduction to Participatory Epidemiology (PE)<br />PE in Animal & Human Health:<br />A Win-Win...
Participatory Epidemiology<br />The use of participatory rural appraisal techniques to collect epidemiological knowledge a...
Participatory Rural Appraisal (PRA)<br />Qualitative data gathering process<br />Key informants <br />Problem solving with...
Quantitative versus QualitativeEpidemiology<br />Quantitative<br />Objective<br />Numerical estimates<br />Data intensive<...
Flexible
Rapid
Discovery
Simple
Sensitive
Skilled field personnel
Analytical challenges</li></li></ul><li>Qualitative data checking <br />Probing<br />Internal consistency<br />Triangulati...
Scoring of evidence<br />First hand reports<br /><ul><li>Directly observed
Own family</li></ul>First hand reports<br /><ul><li>Directly observed
Community</li></ul>Reports obtained from inquiry<br />Second hand reports<br /><ul><li>Hearsay
Intelligence but not evidence</li></li></ul><li>Existing Medical & Veterinary Knowledge<br />Communities know a lot!<br />...
PE applications<br />Can be used for variety purposes: <br />Needs Assessments<br />Research<br />Disease Reporting<br />D...
PE tools<br />Secondary sources<br />Direct observations<br />Semi-structured interviews<br />Participatory mapping<br />R...
Added value of PE <br />Better understanding of local terminologies, perceptions, local treatment and health seeking behav...
Example 1: Timeline of outbreaks constructed by PDS teams in Egypt<br />
Example 2: RVF outbreak in Kenya<br />	RVF outbreak reported in Kenya (and Tanzania) in October 2006 - February 2007. <br ...
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Participatory epidemiology in animal and human health

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Hendrickx, S. and Pissang, C. 2010. Participatory epidemiology in animal and human health. Paper presented at a symposium on intersectoral collaboration between the medical and veterinary professions in low-resource societies, "Where medics and vets join forces”, Institute of Tropical Medicine, Antwerp, Belgium, 5 November 2010.

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  • What we are going to describe is a qualitative approach to epidemiology. This is probably very different from the approaches you have been trained in and practice on a daily basis. Some of you may not like what you hear, others will be intrigued. It has a lot to do with how each of us views information and knowledge.
  • The pictures here shows a Pakistani PE practitioner talking to a traditional healer. The man had a lot of information about rinderpest cases for which livestock keepers had asked his assistance in stead of that from the vet services despite that RP was notifiable. The reason? The clinical presentation of the disease was different from what people knew as RP and they had therefore not recognized it as such…
  • As outlined here, there are both pros and cons to quantitative and qualitative epidemiology methods which vary from the way data is obtained, the sustainability of the programs and the data analysis. In this presentation we will not advocate for the exclusive use of qualitative epidemiological methods such as Participatory Epidemiology (PE) instead, we believe that surveillance systems both human and animal should be a combination of methods to get to a win-win situation.
  • In PE we do a lot of data checking in order to ensure data quality and better understand the data collected and its context.
  • An example of a first hand report is when the mother tells you that the child pictured here had measles 3 months ago. Sometimes it may not have happened in their family but the community members agree that several measles cases occurred among young children in the village 3 months ago. Reports obtained from inquiry: you’re conducting participatory disease surveillance for measles but when asking about the most common childhood diseases measles is not mentioned… in that case you may want to probe if indeed they have not had measles cases. In this case the community did not volunteer the information itself only when you asked and therefore this should be taken into account when scoring evidence.
  • SSI: Checklists &gt;&lt; questionnairesOpen-ended questionsDiscoveryNon-leadingProbingDiagnostics: field kits supported by laboratory support
  • These timelines developed by the community illustrate the chronology of the different events in their villages and was used to inform a decision support tool that would further inform policy makers.
  • PE in animal and human health goes beyond zoonoses. We work with communities to understand the challenges and problems and try to work towards a viable solution. Often to address one aspect you need to approach it via a different angle. An example is linking the polio vaccination with RP vaccination.
  • Ongoing study in West Kenya by multidisciplinary team (vets, MPH, environmental health and a sociologist).Team members recruited from the people we trained during the past 2 years. For more information on GEMS and GEMS-ZED: ask Darryn Knobel.
  • Participatory epidemiology in animal and human health

    1. 1. Participatory Epidemiology in Animal and Human Health<br />Participatory Epidemiology Network for Animal and Public Health (PENAPH) <br />Saskia Hendrickx, International Livestock Research Institute (ILRI) <br />Cyrille Pissang, Vétérinaires Sans Frontières - Belgium(VSF-B)<br />Antwerp, November 5th 2010<br />
    2. 2. Presentation outline<br />Introduction to Participatory Epidemiology (PE)<br />PE in Animal & Human Health:<br />A Win-Win combination<br />PENAPH: a Network to promote PE and One Health concept<br />Conclusion<br />
    3. 3. Participatory Epidemiology<br />The use of participatory rural appraisal techniques to collect epidemiological knowledge and intelligence<br />
    4. 4. Participatory Rural Appraisal (PRA)<br />Qualitative data gathering process<br />Key informants <br />Problem solving with community<br />Multiple methods<br />Multiple perspectives<br />Triangulation<br />
    5. 5. Quantitative versus QualitativeEpidemiology<br />Quantitative<br />Objective<br />Numerical estimates<br />Data intensive<br />Expensive<br />Logistically complex<br />Long-time frames<br />Difficult to sustain<br />Information gaps<br />Qualitative<br /><ul><li>Subjective
    6. 6. Flexible
    7. 7. Rapid
    8. 8. Discovery
    9. 9. Simple
    10. 10. Sensitive
    11. 11. Skilled field personnel
    12. 12. Analytical challenges</li></li></ul><li>Qualitative data checking <br />Probing<br />Internal consistency<br />Triangulation<br />Multiple methods and sources<br />Patterns and coherence<br />Understanding bias<br />Understanding conflict of interest<br />On the spot analysis<br />Evolving hypotheses and data collection<br />Weighing of evidence<br />
    13. 13. Scoring of evidence<br />First hand reports<br /><ul><li>Directly observed
    14. 14. Own family</li></ul>First hand reports<br /><ul><li>Directly observed
    15. 15. Community</li></ul>Reports obtained from inquiry<br />Second hand reports<br /><ul><li>Hearsay
    16. 16. Intelligence but not evidence</li></li></ul><li>Existing Medical & Veterinary Knowledge<br />Communities know a lot!<br />Traditional terms and case definitions<br />Clinical presentation<br />Pathology<br />Vectors<br />Reservoirs<br />Epidemiologic features<br />
    17. 17. PE applications<br />Can be used for variety purposes: <br />Needs Assessments<br />Research<br />Disease Reporting<br />Disease Surveillance<br />Impact Assessment<br />It can inform Strategy and Policy Reform<br />
    18. 18. PE tools<br />Secondary sources<br />Direct observations<br />Semi-structured interviews<br />Participatory mapping<br />Ranking & Scoring techniques<br />Diagnostics<br />
    19. 19. Added value of PE <br />Better understanding of local terminologies, perceptions, local treatment and health seeking behavior <br />Better understanding of the true epidemiological situation in certain areas since many diseases remain unreported. <br />Better understanding of an outbreak situation thanks to the use of PE tools (mapping, timeline…) <br />Quick way of understanding of important health issues within the community and coming up community sustainable solutions.<br />
    20. 20. Example 1: Timeline of outbreaks constructed by PDS teams in Egypt<br />
    21. 21. Example 2: RVF outbreak in Kenya<br /> RVF outbreak reported in Kenya (and Tanzania) in October 2006 - February 2007. <br />Immediately after this outbreak, ILRI conducted a participatory survey to estimate the incidence and impact on livelihoods of the disease in North-eastern and Coast provinces of Kenya. <br /> We also characterised the type and timing of the responses executed by the government and other agencies for the purposes of suggesting ways of improving surveillance systems for related outbreaks in future.<br />
    22. 22. Time line developed in villages in NE province <br />
    23. 23. Example 3: HPAI outbreak in Indonesian village<br />
    24. 24. PE, animal & human health<br />Joint Animal and Human Health Services for Remote Rural/Pastoral Communities<br /> Combine programs, combine means, common strategy for mobile populations. Example: childhood vaccination was linked to Rinderpest vaccination in Sudan<br /> Currently with resurgence of polio in some areas  combine polio vaccination & PPR or FMD vaccination<br /> Other examples: VSF work in: Sudan, Liberia, Chad<br />
    25. 25. PE and One health…<br />Ongoing study in Western Kenya with the following objectives:<br />Determine the perceived causes of childhood diarrhea and the perceived relative contribution of enteric zoonoses in childhood morbidity and mortality using participatory epidemiology<br />Compare and contrast the results of the participatory epidemiological study with those of the ongoing CDC/KEMRI case-control studies (GEMS & GEMS ZED)<br />Last phase of the work planned for December 2010<br />
    26. 26. Participatory Epidemiology Network for Animal and Public Health (PENAPH) <br />9 core partner institutions:<br />AFENET: African Field Epidemiology Network<br />AU-IBAR: African Union – Inter African Bureau for Animal Resources<br />FAO: UN Food and Agriculture Organization, <br />ILRI: International Livestock Research Institute<br />OIE: World Organization for Animal Health<br />Royal Veterinary College / United Kingdom<br />US-CDC: United States Centres for Disease Prevention & Control<br />2 VSF (Belgium & Canada)<br />In addition: Universities & individual members<br />
    27. 27. Participatory Epidemiology Network for Animal and Public Health (PENAPH) <br />The PENAPH was set up to facilitate capacity building, research and information sharing among professionals interested in participatory approaches to epidemiology. <br />Aims to promote minimum training guidelines, good practice and continued advancement of methods. <br />Advocates for inclusion of PE modules into medical & veterinary schools<br />Already included in Chiang Mai University (Thailand) Veterinary Public Health MSc <br />In progress: inclusion in AFENET’s FELTP program <br />
    28. 28. Conclusion<br />PE is an approach to epidemiology that is sensitive to and benefits local communities <br /><ul><li>Conducted by professionals
    29. 29. Incorporates diagnostic testing</li></ul>It’s flexible, semi-structured and adaptable to changing situations. Data from multiple sources is rapidly analysed for quick feedback and response.<br /><ul><li>Research and active surveillance applications </li></ul> PENAPH is a growing network designed to build communication between those working on PE across the world in all health related fields. <br />
    30. 30. Thank you!For more information: www.penaph.net <br />

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