WaArusha Agro-Pastoralist Experiences with Risk of Febrile Illness: An Ethnographic Study of Social Drivers of Zoonoses

Zoonoses are a major cause of febrile illness in people living with livestock in northern Tanzania. Early diagnosis and timely treatment influence the health outcomes of febrile patients, as any delay to care-seeking is significantly associated with complications leading to severe disease. However, little is known about lay experiences with zoonoses or febrile illness in these settings, and most studies tend to focus on the epidemiology of these diseases.

My PhD project is theoretically informed by studies that link zoonoses to livelihoods and health systems as drivers of infections. These studies argue for an examination of broader drivers of zoonotic disease in the context of poverty, structural violence, economic rights and social justice, which are critical of over-emphasising technical solutions as "quick fixes" for the control of zoonoses.

It also problematises purely risk-factor approaches to studying zoonotic diseases in low-resource settings that assume universalist understanding of what risks are; in reality, lay people's understanding of risk differs from expert accounts as these are products of broader socio-cultural, environmental and economic realities and experiences of local people. Therefore my intention is to explore how risk factors are framed by dominant actors (experts, including epidemiologists, veterinarians, clinicians) and by lay people, and how people's daily activities, practices and belief systems often blur the lines between them and their livestock in ways that complicate official framings of risk.

Although public health actors may frame risk factors as avoidable, if for example local people observe good hygiene practices and food habits in order to protect themselves from disease, in reality, as I demonstrate in my thesis, poor communities such as agro-pastoralists living in northern Tanzania have no choice but to share basic resources such as water and homes with their livestock, and implementing these recommendations is a challenge.
In this thesis, I explore agro-pastoralist experiences of risk of febrile illness, understandings and framing of zoonotic health risks and local health-seeking behaviours. To do this, I spent ten months living amongst WaArusha agro-pastoralists in Naiti village, northern Tanzania, conducting ethnographic research using mixed-method approaches including household surveys, interviews and focus group discussions.

The study finds that herders' perceptions of zoonotic risks are shaped by external events that threaten their culture and social relationships, rather than expert narratives about zoonotic risks. Livestock and their product are central to the perceptions and management of risks among WaArusha families. Animal products particularly milk and meat-critical for household nutrition and for their therapeutic value- mediate between complex social relationships in ways that make it difficult to categorise them as "safe" or "unsafe". Familiar zoonotic diseases such as anthrax, for example, which lead to high mortality in livestock and exhibit physical symptoms that locals can identify, are more accepted risks, whereas zoonoses that do not show physical symptoms such as brucellosis, the risks of which may be real, are less readily accepted as risks to human health. However, it does not follow that people take health-enhancing decisions to minimise harm, like changing their eating habits or visiting a doctor when illness occurs. Rather, people adopt approaches which appear, from an outsider perspective, to have both rational and irrational elements, and which are influenced by issues such as trust and practicality.

Expert framings of risk and prescriptions for managing zoonotic risk, therefore, can only work when constructed alongside and in conjunction with lay beliefs, especially if the goal is to achieve effective interventions.