Systems-thinking approach to identify and assess feasibility of potential interventions to reduce antibiotic use in tilapia farming in Egypt.

Antibiotics are used in aquaculture to maintain the health and welfare of stocks; however, the emergence and selection of antibiotic resistance in bacteria poses threats to humans, animals and the environment. Mitigation of antibiotic resistance relies on understanding the flow of antibiotics, residues, resistant bacteria and resistance genes through interconnecting systems, so that potential solutions can be identified and issues around their implementation evaluated. Participatory systems-thinking can capture the deep complexity of a system while integrating stakeholder perspectives. In this present study, such an approach was applied to Nile tilapia (Oreochromis niloticus) production in the Nile Delta of Egypt, where disease events caused by antibiotic-resistant pathogens have been reported. A system map was co-produced with aquaculture stakeholders at a workshop in May 2018 and used to identify hotspots of antibiotic use, exposure and fate and to describe approaches that would promote fish health and thus reduce antibiotic use. Antibiotics are introduced into the aquaculture system via direct application for example in medicated feed, but residues may also be introduced into the system through agricultural drainage water, which is the primary source of water for most fish farms in Egypt. A follow-up survey of stakeholders assessed the perceived feasibility, advantages and disadvantages of potential interventions. Interventions that respondents felt could be implemented in the short-term to reduce antibiotic usage effectively included: more frequent water exchanges, regular monitoring of culture water quality parameters, improved storage conditions for feed, use of probiotics and greater access to farmer and service providers training programmes. Other potential interventions included greater access to suitable and rapid diagnostics, high quality feeds, improved biosecurity measures and genetically-improved fish, but these solutions were expected to be achieved as long-term goals, with cost being of one of the noted barriers to implementation. Identifying feasible and sustainable interventions that can be taken to reduce antibiotic use, and understanding implementation barriers, are important for addressing antibiotic resistance and ensuring the continued efficacy of antibiotics. This is vital to ensuring the productivity of the tilapia sector in Egypt. The approach taken in the present study provides a means to identify points in the system where the effectiveness of interventions can be evaluated and thus it may be applied to other food production systems to combat the problem of antibiotic resistance.

Avian Influenza Risk Environment: Live Bird Commodity Chains in Chattogram, Bangladesh.

In this paper, we identify behaviours in live bird commodity chains in Chattogram, Bangladesh, which may influence the risk of pathogen emergence and transmission: the nature of poultry trade, value appropriation and selling sick or infected birds. Examining the reasons why actors engage in these behaviours, we emphasise the politics of constraints within a context of real-world decisions, governed by existential and pragmatic agency. Focusing on contact zones and entanglement, analysing patron-client relationships and precarious circumstances, we argue that agency and structure specific to the Bangladeshi context produce a risk environment. Structural constraints may reinforce risky occupational practises and limit individual agency. Structural constraints need to be addressed in order to tackle animal and zoonotic disease risk along live animal commodity chains.

Access to health care for undocumented immigrants: rights and practice.

The purpose of this article is to analyse undocumented immigrants' right to access to health care and their access in practice. Undocumented immigrants have a right to equal access to health care. Access to more than emergency health care in Denmark is dependent on immigration status. Medical doctors' duty to treat does not apply to non-emergency health needs, and the options existing in this situation remain ambiguous. However, in practice, undocumented immigrants in Denmark are able to receive more than emergency health care through unofficial networks of health care providers.

A Systematic Review and Meta-Analysis of Practices Exposing Humans to Avian Influenza Viruses, Their Prevalence, and Rationale.

Almost all human infections by avian influenza viruses (AIVs) are transmitted from poultry. A systematic review was conducted to identify practices associated with human infections, their prevalence, and rationale. Observational studies were identified through database searches. Meta-analysis produced combined odds ratio estimates. The prevalence of practices and rationales for their adoptions were reported. Of the 48,217 records initially identified, 65 articles were included. Direct and indirect exposures to poultry were associated with infection for all investigated viral subtypes and settings. For the most frequently reported practices, association with infection seemed stronger in markets than households, for sick and dead than healthy poultry, and for H7N9 than H5N1. Practices were often described in general terms and their frequency and intensity of contact were not provided. The prevalence of practices was highly variable across studies, and no studies comprehensively explored reasons behind the adoption of practices. Combining epidemiological and targeted anthropological studies would increase the spectrum and detail of practices that could be investigated and should aim to provide insights into the rationale(s) for their existence. A better understanding of these rationales may help to design more realistic and acceptable preventive public health measures and messages.

HIV scale-up in Mozambique: exceptionalism, normalisation and global health.

The large-scale introduction of HIV and AIDS services in Mozambique from 2000 onwards occurred in the context of deep political commitment to sovereign nation-building and an important transition in the nation's health system. Simultaneously, the international community encountered a willing state partner that recognised the need to take action against the HIV epidemic. This article examines two critical policy shifts: sustained international funding and public health system integration (the move from parallel to integrated HIV services). The Mozambican government struggles to support its national health system against privatisation, NGO competition and internal brain drain. This is a sovereignty issue. However, the dominant discourse on self-determination shows a contradictory twist: it is part of the political rhetoric to keep the sovereignty discourse alive, while the real challenge is coordination, not partnerships. Nevertheless, we need more anthropological studies to understand the political implications of global health funding and governance. Other studies need to examine the consequences of public health system integration for the quality of access to health care.

[Access to health care for undocumented immigrants. Rights and practice]. / Adgang til sundhedsydelser for udokumenterede indvandrere. Rettigheder og praksis.

The purpose of this article is to illuminate undocumented immigrants' right to access to health care and their access in practice. Undocumented immigrants have a right to equal access to health care. Access to more than emergency health care in Denmark is dependent on immigration status. Medical doctors' duty to treat does not apply to non-emergency health needs, and the options existing in this situation remain ambiguous. In practice, undocumented immigrants in Denmark are able to receive more than emergency health care through unofficial networks of health care providers.