A Focused Ethnographic Study of Sri Lankan Government Field Veterinarians’ Decision Making about Diagnostic Laboratory Submissions and Perceptions of Surveillance

Abstract

The global public health community is facing the challenge of emerging infectious diseases. Historically, the majority of these diseases have arisen from animal populations at lower latitudes where many nations experience marked resource constraints. In order to minimize the impact of future events, surveillance of animal populations will need to enable prompt event detection and response. Many surveillance systems targeting animals rely on veterinarians to submit cases to a diagnostic laboratory or input clinical case data. Therefore understanding veterinarians’ decision-making process that guides laboratory case submission and their perceptions of infectious disease surveillance is foundational to interpreting disease patterns reported by laboratories and engaging veterinarians in surveillance initiatives. A focused ethnographic study was conducted with twelve field veterinary surgeons that participated in a mobile phone-based surveillance pilot project in Sri Lanka. Each participant agreed to an individual in-depth interview that was recorded and later transcribed to enable thematic analysis of the interview content. Results found that field veterinarians in Sri Lanka infrequently submit cases to laboratories – so infrequently that common case selection principles could not be described. Field veterinarians in Sri Lanka have a diagnostic process that operates independently of laboratories. Participants indicated a willingness to take part in surveillance initiatives, though they highlighted a need for incentives that satisfy a range of motivations that vary among field veterinarians. This study has implications for the future of animal health surveillance, including interpretation of disease patterns reported, system design and implementation, and engagement of data providers.

A Focused Ethnographic Study of Alberta Cattle Veterinarians’ Decision Making about Diagnostic Laboratory Submissions and Perceptions of Surveillance Programs

“…We recently undertook a similar research project with government field veterinarians in Sri Lanka [22]. It is interesting to note that while the circumstances of veterinarians in Sri Lanka were different to those in Alberta, there were similarities in the challenges to diagnostic laboratory testing across contexts, namely the availability of sufficiently timely results to inform treatment and access to desired diagnostic laboratory infrastructure.…”

“…However, in the animal and human health fields, qualitative studies are rare in comparison to the frequency of quantitative studies. The value of employing qualitative methods in understanding the human dimensions of diagnostic laboratory case submissions and participation of government veterinarians in prediagnostic disease surveillance initiatives has been demonstrated in Sri Lanka, a lower resource setting where the risk of disease emergence is deemed high [22]. However, Canada's experience with highly pathogenic avian influenza, pandemic influenza virus (H1N1) 2009, bovine spongiform encephalopathy (BSE), and severe acute respiratory syndrome (SARS) highlights that EIDs are a global phenomenon [5] and understanding the ability of surveillance systems to detect and respond to EID risks in animals is necessary across a range of resource contexts.…”

The use of animals as a surveillance tool for monitoring environmental health hazards, human health hazards and bioterrorism

“…However, because it relies heavily on reports from veterinarians who receive little incentive for reporting, the data reported is frequently incomplete and delayed. Underreporting of disease suspicions is also known to be a major cause of disease control failure (FAO, 2011) and multiple studies have been conducted to better comprehend the decisionmaking processes behind underreporting so as to develop recommendations for improved passive surveillance (Bronner et al, 2014;Delabouglise et al, 2016;Paul et al, 2013;Sawford et al, 2012;Thompson et al, 2016). In contrast, active surveillance demands more time and resources and is thus less commonly employed.…”

The Perceived Value of Passive Animal Health Surveillance: The Case of Highly Pathogenic Avian Influenza in Vietnam

“…The proposed evaluation method may be qualified as a ‘rapid surveillance appraisal’. Previous studies using sociological methods had highlighted the importance of economic and non‐economic factors in the reporting behaviour of animal farmers (Hickler, ; Elbers et al., ; Fearnley, ) and government veterinarians (Sawford et al., ; Bronner et al., ). However, this study represents the first attempt to develop a comprehensive and replicable methodology for the rapid and systematic identification of costs and benefits directly or indirectly linked to animal disease passive surveillance.…”

“…A deep understanding of the decision‐making process for the public and private actors of passive surveillance systems is required to better understand underreporting (Chilonda and Van Huylenbroeck, ). Several attempts have been made to analyse this decision‐making process by exploring individuals’ perceptions (Hopp et al., ; Elbers et al., ; Bronner et al., ) and economic, social or cultural constraints impacting their decision (Hickler, ; Fearnley, ; Sawford et al., ; Paul et al., ) using anthropological approaches or questionnaire surveys. However, these factors have not yet been integrated within an economic evaluation framework.…”