Local disease concepts relevant to the design of a community-based surveillance program for influenza in rural Guatemala.
BACKGROUND
Early detection of emergent influenza strains is a global health priority. However, maintaining active surveillance is economically and logistically challenging. While community-based surveillance is an attractive alternative, design and operation of an effective epidemiological surveillance program requires community engagement that can be linked to public health reporting and response. We report the results of a study in rural Guatemalan communities aimed at identifying opportunities for and barriers to community engagement in disease surveillance.


METHODS
Using an ethnographic approach followed by a descriptive cross-sectional survey, we documented local terms and ideas about animal illnesses, including the possibility of animal-human transmission.


RESULTS
The community perceived disease causation principally in terms of changes in the physical environment and weather and categorized illnesses using local terminology based on observable clinical signs. Knowledge about prevention and treatment was derived predominantly from local networks of family and friends without evidence of professionally-based knowledge being regularly introduced into the community.


CONCLUSIONS
Bridging the divide between professional and community-based descriptive disease terminology, incorporating animal and human health responsiveness to common illnesses, and providing professional knowledge into the community-based networks were identified as addressable challenges to effective implementation of community-based surveillance.
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala. alejandro.ceronvaldes@du.edu.|Department of Anthropology, University of Denver, Sturm Hall Room 131, 2000 E. Asbury Ave, Denver, CO, 80208, USA. alejandro.ceronvaldes@du.edu.
Alejandro
A
Cerón
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
Maria Renee
MR
Ortiz
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
Danilo
D
Álvarez
Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, USA.
Guy H
GH
Palmer
Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala.
Celia
C
Cordón-Rosales
D019058:Community Networks / Q000639:trends*; D003430:Cross-Sectional Studies; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology*; D011159:Population Surveillance / Q000379:methods*; D012424:Rural Population / Q000706:statistics & numerical data
Community Participation; Epidemiologic Surveillance; Guatemala; Influenza in birds; Influenza in humans; Surveillance; Zoonosis