Local tips, global impact: community-driven measures as avenues of promoting inclusion in the control of neglected tropical diseases: a case study in Kenya

Background:Neglected tropical diseases(NTDs)affect poor populations with little or no’’political voice’to influence control activities.While most NTDs have interventions that work,the biggest challenge remains in delivering targeted interventions to affected populations residing in areas experiencing weak health systems.Despite the upward development trends in most countries of sub-Saharan Africa(SSA),the healthcare worker to population ratio remains exceptionally low,with some areas not served at all;thus,there is a need to involve other personnel for school and community-based healthcare approaches.Nonetheless,the current community-based programs suffer from inconsistent community participation due to a lack of coordinated response,and an expanded intervention agenda that lacks context-specific solutions applicable to rural,urban,and marginalized areas.Methods:This research investigated the capacity of local communities to address the burden of NTDs.Informed by the social theory of human capability,the research collected primary qualitative data by conducting key informant interviews and focus group discussions of people infected or affected by NTDs.The interview data were collected and transcribed verbatim for thematic analysis using Nvivo version 12.Results:Our findings reveal,first,a need for intersectoral collaboration between governments and affected populations for inclusive and sustainable NTD solutions.Second,a’’bottom-up’approach that enhances capacity building,sensitization,and behaviour change for improved uptake of NTD interventions.Third,the enforcement of Public Health Legislative Acts that mandates the reporting and treatment of NTDs such as leprosy.Fourth,the establishment of support groups and counseling services to assist persons suffering from debilitating and permanent effects of NTDs.Conclusions:Our research demonstrates the importance of human agency in encouraging new forms of participation leading to the co-production of inclusive and sustainable solutions against NTDs.

On dogs, people, and a rabies epidemic: results from a sociocultural study in Bali, Indonesia

Background:Previously free of rabies,Bali experienced an outbreak in 2008,which has since caused a large number of human fatalities.In response,both mass dog culling and vaccination have been implemented.In order to assess potential community-driven interventions for optimizing rabies control,we conducted a study exploring the relationship between dogs,rabies,and the Balinese community.The objectives of this study were to:i)understand the human-dog relationship in Bali;ii)explore local knowledge,attitudes,and practices(KAPs)relating to rabies;and iii)assess potential community-driven activities to optimize rabies control and surveillance.Methods:Conducted between February and June 2011,the study combined a questionnaire(n=300;CI=95%;error margin=5%)and focus group discussions(FGDs)in 10 villages in the Denpasar,Gianyar,and Karangasem regencies.The questionnaire included a Likert scale to assess community knowledge and attitudes.For the knowledge assessment,three points were given for a correct answer,while wrong answers and uncertain answers were given zero points.For the attitudes assessment,three points were given for a positive answer,two points for a neutral answer,and one point for a negative answer.Respondent knowledge was categorized as good(score>40),fair(score 20–40),or poor(score<20),based on a maximum total score 60.Respondent attitudes were categorized as positive(score>26),neutral(score 13–26),or negative(score<13),based on a maximum total score of 39.Mixed-gender FGDs in each sub-village(banjar)were conducted,each involving 7–15 participants to complement the questionnaire results.On a follow-up research trip in mid-2013,the data analysis was triangulated and validated using semi-structured interviews.Questionnaire data were analyzed descriptively using SPSS 17.0,while qualitative data from interviews and FGDs were analyzed manually according to accepted methods of coding and memo writing.The chi-square test was then used to analyze the statistical relationships between knowledge and attitudes of the respondents.Results:Out of the total 300 respondents,most were predominantly male(82%),Hindu(99%),married(96%),older than 30 years of age(92%),and owned dogs(72%6).Dog ownership was motivated by culture,personal taste,and function,with dogs was being used as guards(85%)and companion animals(27%),and was sometimes related to religious or traditional obligations(2%).Relating to their culture and local beliefs,and eventually becoming their way of life,79%of respondents kept free-roaming dogs.with the rabies outbreak in Bali and Westerm breeds becoming more popular,more responsible dog ownership(leashing,confining,regular feeding)became more acceptable and changed community perceptions on keeping dogs,even though the sustainability of this practice cannot be gauged.In addition,the economic situation posed major problems in rural areas.The level of community knowledge about rabies and its associated control programs were generally fair and community attitudes were positive.However,community KAPs still need to be improved.A total of 74%respondents reported to have vaccinated their dogs in 2011,but only few were found to report rabid animals to livestock officers(12%)and a significant number believed that washing a bite wound was not important(62%).Moreover,free-roaming dog practices and discarding of unwanted female puppies still continue and possibly create difficulties for rabies elimination as these practices potentially increase the stray dog population.We identified three major sociocultural aspects with potential for community-driven interventions to optimize current rabies elimination efforts:integrating local notions of ahimsa(non-violence)into education campaigns,engaging communities through the local banjar sociopolitical system,and working with traditional legal structures to increase local compliance with rabies control.Conclusion:The human-dog relationship in Bali is multifaceted.Due to the uniqueness of the culture and the local beliefs,and encouraged by a socioeconomic aspect,a number of local practices were found to be constituting risk factors for continued rabies spread.Community knowledge and attitudes,which can consequently result in behavioral changes,needs to be improved across different genders,ages educational backgrounds,and roles in the commurnity,regardless of the individual village's experiences with rabies.Furthermore,community-driven activities based on sociocultural conditioning and community capacity at the banjar and village levels,such as public awareness activities,vaccination,dog registration,dog population management,and rapid response to dog bites,were identified as being able to complement the rabies control program in Bali.The program also needs recognition or acknowledgement from governments,especially local govemment as well as regular mentoring to improve and sustain community participation.