Establishment of an indicator framework for the transmission risk of the mountain-type zoonotic visceral leishmaniasis based on the Delphi-entropy weight method

Background: Visceral leishmaniasis (VL) is one of the most important neglected tropical diseases. Although VL was controlled in several regions of China during the last century, the mountain-type zoonotic visceral leishmaniasis (MT-ZVL) has reemerged in the hilly areas of China in recent decades. The purpose of this study was to construct an indicator framework for assessing the risk of the MT-ZVL in China, and to provide guidance for preventing disease.Methods: Based on a literature review and expert interview, a 3-level indicator framework was initially established in November 2021, and 28 experts were selected to perform two rounds of consultation using the Delphi method. The comprehensive weight of the tertiary indicators was determined by the Delphi and the entropy weight methods.Results: Two rounds of Delphi consultation were conducted. Four primary indicators, 11 secondary indicators, and 35 tertiary indicators were identified. The Delphi-entropy weight method was performed to calculate the comprehensive weight of the tertiary indicators. The normalized weights of the primary indicators were 0.268, 0.261, 0.242, and 0.229, respectively, for biological factors, interventions, environmental factors, and social factors. The normalized weights of the top four secondary indicators were 0.122, 0.120, 0.098, and 0.096, respectively, for climatic features, geographical features, sandflies, and dogs. Among the tertiary indicators, the top four normalized comprehensive weights were the population density of sandflies (0.076), topography (0.057), the population density of dogs, including tethering (0.056), and use of bed nets or other protective measures (0.056).Conclusions: An indicator framework of transmission risk assessment for MT-ZVL was established using the Delphientropy weight method. The framework provides a practical tool to evaluate transmission risk in endemic areas.

Assessing food security performance from the One Health concept:an evaluation tool based on the Global One Health Index

Background Food systems instantiate the complex interdependencies across humans,physical environments,and other organisms.Applying One Health approaches for agri-food system transformation,which adopts integrated and unifying approaches to optimize the overall health of humans,animals,plants,and environments,is crucial to enhance the sustainability of food systems.This study develops a potential assessment tool,named the global One Health index-Food Security(GOHI-FS),aiming to evaluate food security performance across countries/territories from One Health perspective and identify relevant gaps that need to be improved for sustainable food systems.Methods We comprehensively reviewed existing frameworks and elements of food security.The indicator framework of GOHI-FS was conceptualized following the structure-process-outcome model and confirmed by expert advisory.Publicly available data in 2020 was collected for each indicator.The weighting strategy was determined by the Fuzzy Analytical Hierarchy Process.The data for each indicator was normalized and aggregated by weighted arithmetic mean.Linear regressions were performed to evaluate the associations of GOHI-FS with health and social-economic indicators.Results The GOHI-FS includes 5 first-level indicators,19 second-level indicators and 45 third-level indicators.There were 146 countries/territories enrolled for evaluation.The highest average score of first-level indicators was Nutrition(69.8)and the lowest was Government Support and Response(31.3).There was regional heterogeneity of GOHI-FS scores.Higher median scores with interquartile range(IQR)were shown in North America(median:76.1,IQR:75.5-76.7),followed by Europe and Central Asia(median:66.9,IQR:60.1-74.3),East Asia and the Pacific(median:60.6,IQR:55.5-68.7),Latin America and the Caribbean(median:60.2,IQR:57.8-65.0),Middle East and North Africa(median:56.6,IQR:52.0-62.8),South Asia(median:51.1,IQR:46.7-53.8),and sub-Saharan Africa(median:41.4,IQR:37.2-46.5).We also found significant associations between GOHI-FS and GDP per capita,socio-demographic index,health expenditure and life expectancy.Conclusions GOHI-FS is a potential assessment tool to understand the gaps in food security across countries/territories under the One Health concept.The pilot findings suggest notable gaps for sub-Saharan Africa in numerous aspects.Broad actions are needed globally to promote government support and response for food security.