title: Burden estimates and zoonotic disease prioritisation: bridging the divide from local insights to national strategies
Creators: name: Rothman-Ostrow, Peregrine
Publisher: name: University of Liverpool Repository
Year: 2024

description: Zoonoses and emerging infectious diseases of animal origin have devastating consequences and pose critical challenges to global health security. Pastoral communities in Sub-Saharan Africa, alongside their livestock, bear an ongoing burden of endemic and neglected zoonotic and non-zoonotic livestock diseases. Yet, robust epidemiological and economic burden data in these regions are scarce or incomplete. Competing priorities and finite resources necessitate prioritisation of attention, efforts, and capital. Against such a backdrop, this thesis aims to examine the importance of equitable, transparent, and justifiable disease prioritisation with particular attention to inclusion of comprehensive economic burden estimates. These estimates are crucial in areas where the importance of livestock extends beyond market value. Specifically, this study explored the advantage of a qualitative approach to mixed output data collection in support of disease surveillance and burden estimates, which may in turn inform national disease prioritisation.
A scoping review of multi-sector economic burden studies, and a comprehensive analysis of livestock population and biomass mapping strategies were conducted, followed by an extensive field study with two Maasai pastoralist communities in southwestern Kenya. The field study adopted a mixed-methods approach which integrated syndromic surveillance and participatory epidemiology techniques paired with qualitative, ethnographic methods. Data collection centred around semi-structured, in-depth interviews, augmented by participatory exercises. Analyses were undertaken in MAXQDA and R. 
The centrality of cattle in Maasai society drives management decisions and approaches within the bounds of structural and social factors. This study illustrated that the value of cattle – intrinsic, subsistence, and financial – extends beyond a purely monetary, production-centric framework, influencing herd composition, disease priority, and behaviour. Coupled with risk tolerance and aversion, as governed by the cardinal importance of cattle in livelihoods and culture, these factors shape the multi-dimensional impacts of disease. Such insights offer crucial context to increasing calls for integrated surveillance initiatives to address large gaps in knowledge of disease incidence and emergence in remote, rural areas. Forming a foundation on which to build a comprehensive epidemiological and economic assessment of disease burden, these findings highlight the value of incorporating local knowledge in the conception, design, and execution of identification, prevention and response activities, as well as in efforts to estimate disease burdens and prioritise resources at the local and national level.
In an age of heightened focus on emerging diseases of zoonotic origin, it is unclear whether national disease prioritisation strategies are equipped to capture and include the outsize impact that endemic and neglected diseases place on poor and rural communities dependent on livestock. This study demonstrated the efficacy and utility of a mixed-method, participant-driven approach to mapping livestock systems and identifying disease constraints. Specifically, it overcame challenges to generating functional data, as well as elucidating and contextualising issues faced by socially and economically marginalised communities whose livelihoods depend on small-scale and pastoralist livestock production in the Global South. Refined and scaled, this approach, supported by confirmatory diagnostics and serological analysis, could strengthen development of robust and defensible burden estimates and effective disease prioritisation strategies.