Schlüsselwörter
(Deutsch)
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Pastoralnomaden, Tschad, Mauretanien, Perzeption, molekulare Epidemiologie, Tuberkulose, Gesundheitssysteme, Forschungspartnerschaft, Linderung von Syndromen, globaler Wandel
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Schlüsselwörter
(Englisch)
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Nomadic pastoralists, Chad, Mauritania, perception, molecular epidemiology, tuberculosis, health systems, research partnership, mitigating syndromes, global change
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Kurzbeschreibung
(Englisch)
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In general, health initiatives at national level exclude nomadic populations because of their geographic isolation/remoteness, poor communications, logistic requirements and their perceived low priority. Nomadic pastoralists experience similar health problems, though detailed specific health data are largely unavailable. The pastoral way of life involves close contact between people and animals, and there is inevitably a high risk of transmission of zoonotic diseases such as tuberculosis (TB) or anthrax. It is not known how many of the 2 million cases of overt human TB that occur each year in sub-Saharan Africa are due to M. bovis, but it seems likely that some of them are, especially as high rates of infection have been found in some animal populations, and there is evidence for the transmission of M. bovis to people who care for livestock or consume non-pasteurised milk. Population-based molecular studies could describe the transmission patterns of particular strains of Mycobacterium, and this could lead to the identification of new methods of control. Certain chronic and acute zoonotic diseases/infections are clearly important as are several major non-zoonotic communicable diseases such as human tuberculosis, acute respiratory and gastrointestinal infections, sexually transmitted infections, and, increasingly, HIV. The situation is exacerbated by poor access to health services and problematic follow-up. Children are vulnerable to malnutrition and infectious diseases, many of which are vaccine-preventable. The lack of maternal health services is associated with a high pregnancy-related morbidity and mortality. The obvious options for health delivery revolve around use of mobile medical clinics, or static clinics/hospitals in towns close to or within pastoral regions.
The key to the problem may not be solely through health initiatives, but rather via the single most important factor respected by all nomads - their livestock. Schwabe`s 'one-medicine' concept recognized that human and veterinary medicine share the same paradigms and involve similar interdependencies and interactions. An intersectoral approach to human and animal health is a cost-effective strategy that will contribute to the alleviation poverty and disease and is particularly suited to nomadic populations. This project is part of the National Centre of Competence in Research "Research Partnerships for Mitigating Syndromes of Global Change" (NCCR North-South) and the Invidual Project 4 "Health and Well-being".
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Projektziele
(Englisch)
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Assess and compare the frequency and distribution dynamics of the most relevant health problems and their estimated disease burden among nomadic populations in relation to the demographic, environmental and epidemiological transitions
Genotyping and resistance-typing of the major pathogens and consequently establishing and modelling the population and transmission dynamics emphasising zoonoses
Analyses of the perception of illness, well-being, priorities and coping strategies by the different population and the impact of ill-health on the household economy- Description and comparative analyses of the patterns and factors that govern health- and help-seeking patterns of different population groups in different social, cultural and economic settings
Identify and validate intervention strategies to improve health and well-being of different population groups
Review the concepts of "risks" and "vulnerability" in a transdisciplinary context and their applicability to guide intervention strategies
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Abstract
(Englisch)
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The pastoral way of life involves close contact between people and animals, and there is inevitably a high risk of transmission of zoonotic diseases such as tuberculosis (TB) or anthrax. It is not known how many of the 2 million cases of overt human TB that occur each year in sub-Saharan Africa are due to M. bovis, but it seems likely that some of them are, especially as high rates of infection have been found in some animal populations, and there is evidence for the transmission of M. bovis to people who care for livestock or consume non-pasteurised milk. This public health threat requires urgent investigation through collaborative veterinary/medical research programmes . Population-based molecular studies could describe the transmission patterns of particular strains of Mycobacterium, and this could lead to the identification of new methods of control.
The delivery of health care to nomadic populations faces special difficulties, and though governments have been urged to develop primary health care for them, none of the concepts proposed has been validated for sustainable long-term use. The nomadic way of life makes access to dispensaries in villages difficult, since groups with animals have to avoid areas with crops, and visits to markets often exclude the most vulnerable - women and children. Discrimination against nomads when drugs were in short supply has been documented. Movement from place to place jeopardises treatment over a long period, for example for TB. Mobile dispensaries are costly. Programmes adapted to the nomadic way of life, using community health workers (CHWs) from nomad communities are promising, since they are less expensive, and women need no special permission to consult a CHW as they would for outside practitioners.
Another promising strategy is collaboration between human and veterinary health services. Veterinarians already visit remote pastoral zones. Collaboration would mean that the available infrastructure and personnel would be more fully capitalised.
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Publikationen / Ergebnisse
(Englisch)
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Zinsstag J. (2002)Nord-Süd Forschungspartnerschaft zur Gesundheit von Pastoralnomaden im Tschad. Eine Herausforderung für die Natur- und Geisteswissenschaften In: Forschungspartnerschaft mit Entwicklungsländern. Schweiz. Akademie der Geistes- und Sozialwissenschaften, Bern, ISBN 3-907835-37-9 103 pp.
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