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Abstract：
Plague remains a public health problem in specific areas located in Bolivia, Brazil, Ecuador and Peru. Its prevention and control encompasses adequate clinical management and timely laboratory diagnosis. However, understanding communities\' interaction with its surrounding ecosystem as well as the differences between community members and institutional stakeholders regarding the root causes of plague might contribute to understand its endemicity. We aim at bridging the traditionally separate biological and social sciences by elucidating communities\' risk perception and identifying knowledge gaps between communities and stakeholders. This approach has been used in other areas but never in understanding plague endemicity, nor applied in the Latin American plague context. The objectives were to identify (i) plague risk perception at community level, (ii) perceived social and environmental determinants of plague endemicity, and (iii) institutions that need to be involved and actions needed to be taken as proposed by stakeholders and community members. The study was performed in 2015 and took place in Ascope rural province, La Libertad Region, in Peru, where the study areas are surrounded by intensive private sugarcane production.
We propose using a multi-level discourse analysis. Community households were randomly selected (n = 68). Structured and semi-structured questionnaires were applied. A stakeholder analysis was used to identify policy makers (n = 34). In-depth interviews were performed, recorded and transcribed. Descriptive variables were analyzed with SPSS®. Answers were coded following variables adapted from the Commission on Social Determinants of Health and analyzed with the assistance of ATLAS.ti®.
Results showed that risk perception was low within the community. Policy-makers identified agriculture and sugarcane production as the root cause while community answers ranked the hygiene situation as the main cause. Stakeholders first ranked governmental sectors (education, housing, agriculture and transport) and the community prioritized the health sector. Social surveillance and improving prevention and control were first cited by policy-makers and community members, respectively.
The determinants of plague endemicity identified by the two groups differed. Similarly, actions and sectors needed to be involved in solving the problem varied. The gaps in understanding plague root causes between these two groups might hinder the efficiency of current plague prevention and control strategies.
We propose using a multi-level discourse analysis. Community households were randomly selected (n = 68). Structured and semi-structured questionnaires were applied. A stakeholder analysis was used to identify policy makers (n = 34). In-depth interviews were performed, recorded and transcribed. Descriptive variables were analyzed with SPSS®. Answers were coded following variables adapted from the Commission on Social Determinants of Health and analyzed with the assistance of ATLAS.ti®.
Results showed that risk perception was low within the community. Policy-makers identified agriculture and sugarcane production as the root cause while community answers ranked the hygiene situation as the main cause. Stakeholders first ranked governmental sectors (education, housing, agriculture and transport) and the community prioritized the health sector. Social surveillance and improving prevention and control were first cited by policy-makers and community members, respectively.
The determinants of plague endemicity identified by the two groups differed. Similarly, actions and sectors needed to be involved in solving the problem varied. The gaps in understanding plague root causes between these two groups might hinder the efficiency of current plague prevention and control strategies.
摘要：
鼠疫仍然是玻利维亚特定地区的公共卫生问题，巴西,厄瓜多尔和秘鲁。其预防和控制包括适当的临床管理和及时的实验室诊断。然而,了解社区与周围生态系统的互动以及社区成员和机构利益相关者之间关于鼠疫根本原因的差异可能有助于了解其地方性。我们的目标是通过阐明社区的风险认知和确定社区与利益相关者之间的知识差距来弥合传统上分开的生物学和社会科学。这种方法已用于其他领域，但从未用于了解鼠疫的流行，也不适用于拉丁美洲瘟疫。目标是确定（i）社区层面的鼠疫风险感知，(ii)认为鼠疫流行的社会和环境决定因素，以及(iii)利益攸关方和社区成员提议的需要参与的机构和需要采取的行动。这项研究是在2015年进行的，在阿采尔农村省进行的，LaLibertadRegion,在秘鲁,研究区域被密集的私人甘蔗生产所包围。
我们建议使用多层次的语篇分析。随机选择社区家庭(n=68)。采用结构化和半结构化问卷。利益相关者分析用于确定决策者(n=34)。进行了深入访谈，记录和转录。用SPSS®分析描述性变量。根据健康社会决定因素委员会改编的变量对答案进行编码，并在ATLAS的协助下进行分析。ti®。
结果显示，社区内的风险认知较低。政策制定者将农业和甘蔗生产确定为根本原因，而社区答案将卫生状况列为主要原因。利益相关者排名第一的政府部门(教育，住房,农业和运输)和社区优先考虑卫生部门。政策制定者和社区成员首先提到了社会监督和改善预防和控制，分别。
两组确定的鼠疫流行的决定因素不同。同样，需要参与解决问题的行动和部门各不相同。这两组之间在了解鼠疫根本原因方面的差距可能会阻碍当前鼠疫预防和控制策略的效率。
我们建议使用多层次的语篇分析。随机选择社区家庭(n=68)。采用结构化和半结构化问卷。利益相关者分析用于确定决策者(n=34)。进行了深入访谈，记录和转录。用SPSS®分析描述性变量。根据健康社会决定因素委员会改编的变量对答案进行编码，并在ATLAS的协助下进行分析。ti®。
结果显示，社区内的风险认知较低。政策制定者将农业和甘蔗生产确定为根本原因，而社区答案将卫生状况列为主要原因。利益相关者排名第一的政府部门(教育，住房,农业和运输)和社区优先考虑卫生部门。政策制定者和社区成员首先提到了社会监督和改善预防和控制，分别。
两组确定的鼠疫流行的决定因素不同。同样，需要参与解决问题的行动和部门各不相同。这两组之间在了解鼠疫根本原因方面的差距可能会阻碍当前鼠疫预防和控制策略的效率。
