Results
Eighty-eight individuals from community sites were enrolled in the study from nine sites in the Yunnan (n=36), Guangxi (n=25) and Guangdong (n=27) provinces from March to December 2015. All study sites were rural locations with permanent housing structures for family dwelling or community use. Family-owned cropland for small-scale vegetable, fruit and rice production was distributed around human dwellings, extending to nearby mountains. New buildings and roads were under construction and live animals were sold at local wet markets. Few wild animals were seen during our visits to all of the sites during the daytime. (Figure 2).
Box 1  Illustrative quotes: individuals' knowledge, attitudes and practices regarding human–animal contact
–  ‘My family do not eat the sick animals, we will bury them. But some other people are not willing to throw them away, for example, they use the dead pigs to make preserved meat’ (male worker at a local restaurant, 23-y-old, Yunnan).
–  ‘Two bats flew into our room, so we caught them to eat’ (female peasant farmer, 60-y-old, Guangxi).
–  ‘I work at this restaurant, my daughter works in Guangdong, my husband also works outside, nobody has time to take care of the raised animals’ (female worker at a local restaurant, 45-y-old, Guangxi).
–  Interviewer: ‘Why do people not catch wild animals now?’ Interviewee: ‘There are few wild animals now, you cannot make much money by catching them, so there are just a few people who are doing this for fun’ (male peasant farmer, 40-y-old, Guangdong).
–  ‘I hurt my waist very seriously, it was painful, and I could not bear the air conditioner. One day, one of my friends made some snake soup and I had three bowls of it, and my waist obviously became better, otherwise, I cannot sit here for such a long time with you’ (male peasant farmer, 67-y-old, Guangdong).
–  ‘I think if my chickens get sick, I will kill them before they die, and eat them’ (male peasant farmer, 80-y-old, Guangxi).
–  ‘I found the chickens died, then I washed them to feed my dog’ (female janitor at a local college, 50-y-old, Guangxi).
–  ‘The excrements of pig are used as fertilizer, much better than the chemical fertilizer’ (female peasant farmer, 45-y-old, Yunnan).
–  ‘We usually buy live animals and kill them by ourselves at home’ (female peasant farmer, 45-y-old, Guangxi).
–  Interviewer: ‘Do people take special protections when they handle wild animals?’ Interviewee: ‘No, they just handle them as raised animals’ (male wild animal farmer, 56-y-old, Guangxi).
–  Interviewer: ‘Do you wear gloves when killing chicken?’ Interviewee: ‘No, that would be inconvenient’ (female worker at a local restaurant, 50-y-old, Guangxi).
–  ‘My son wants to keep a dog, but I do not allow him. Because dogs are not clean and they will affect human health’ (female peasant farmer, 23-y-old, Yunnan).
–  Interviewer: ‘Do you know what animals will infect human?’ Interviewee: ‘Dead animals.’ Interviewer: ‘Details?’ Interviewee: ‘Dogs and rats.’ Interviewer: ‘Do you know how they infect human?’ Interviewee: ‘Some contact, like bite’ (female peasant farmer, 62-y-old, Yunnan).
–  Interviewer: ‘Many people would catch animals they find, you think different?’ Interviewee: ‘That's not good, I did not know anything when I was young, when there were many birds and animals in the forest, but now there are few, the only reason is people are destroying the ecosystem, and also many eucalyptus trees were planted, which affect the water, soils, and worms grow up in the trees that birds eat’ (male peasant farmer, 40-y-old, Guangdong).
–  ‘Local people now pay more attentions to viruses carried by animals, they worry about it and they do not want to get infected, our government spend a lot of time on conservation’ (policeman, 50-y-old, Guangdong).
–  Interviewer: ‘Local people catch bats to sell to the restaurants?’ Interviewee: ‘Yes. It's said bats can prevent cancer’ (male peasant farmer, 40-y-old, Guangdong).
–  Interviewer: ‘Why do people like eating bats?’ Interviewee: ‘Nourishment for vitality’ (male peasant farmer, 65-y-old, Guangdong).
–  Interviewer: ‘Will people get shot once bats bite them?’ Interviewee: ‘No. People only get injections for snake or dog bites’ (male peasant farmer, 60-y-old, Guangdong).
–  Interviewer: ‘Do you know which illness can infect animal and human?’ Interviewee: ‘Rabies. Who was bitten by dogs needs to get an injection’ (female peasant farmer, 43-y-old, Yunnan).  I am on the way to interview a potential participant, currently going through a small local market, here they sell fresh vegetables, fruits, pork and live poultry on both sides of the street. Live chickens, ducks and geese are mixed and kept in cages, I can smell the faeces. A vendor (female) is slaughtering a chicken for her customer who just selected one from the cage, she seems very proficient, only wears an apron but no gloves, the ground is covered by blood and feathers. Not far away, there is a woman wearing an orange uniform who is cleaning the street. After 5 minutes, I turn my way into a cropland, surrounded by Karst mountains, there are mostly rice and some vegetables planted, small birds are flying, two cattle are eating grass. I see a house across the cropland, which is the home of our potential participant, I hear a dog barking when I approach the house (observation made in Xiaolou County, Guangzhou, Guangdong province, 25 September 2015).

Demographics
The majority of study participants were males (n=58, 68%), local residents aged 31–50 y (n=55, 63%) and making a living in grain and cash crop production. Small business (n=16, 18%), household livestock production (n=13, 15%) and other migrant and casual work (n=30, 34%) were the other main contributors to local incomes, and many participants reported multiple income sources (n=35, 40%). Without sharing detailed income or education information, participants who discussed socioeconomic status generally indicated low levels of education (e.g. ‘I didn't go to school that much’) or a low economic status (e.g. ‘We are poor’) (Table 1).

Potential risks from frequent human–animal interactions
Most participants reported contact with domestic animals in their daily routine of animal raising, slaughtering and meat preparation for consumption, including cats, dogs, poultry, pigs, cattle and goats. The migrant work of some participants limited the amount of time individuals had for household level animal husbandry, leading to reduced household animal raising. However, many participants kept dogs or cats for companionship, home protection or preventing rat infestations. Poultry, pigs and cattle were commonly raised for meat consumption and the animal waste was further used as crop fertilizer. Few participants took protective measures when handling or slaughtering domestic animals, or sought medical treatment from a nearby clinic after getting bitten or scratched. Vaccinating domestic animals was not widely implemented among study participants. Sick and dead animals were usually buried, but some participants discussed consuming sick animals or feeding the carcasses to other domestic animals.
On the whole, many participants reported that wild animal hunting, trading or consumption activities have decreased in recent years; however, local communities were still reporting hunting or consumption of some wild animals (e.g. rodents, bats, civets, frogs, snakes and birds) for recreation or additional income. Some participants indicated a preference for wild over domestic animals for consumption; many also held a belief in the purported curative power of wild animals or their by-products. Most participants were fully informed about rabies and the link to dog bites, as well as the postexposure treatment; however, few were aware of other zoonotic diseases and their origin in animals (Box 1).
Box 2  Illustrative quotes: concerns about the community environment
–  Interviewer: ‘Do they wash hands with soap?’ Interviewee: ‘No. The places to kill chickens and ducks are usually dirty and smelly, especially during the summer’ (male chef at a local restaurant, 24-y-old, Guangdong).
–  Interviewer: ‘Are there toilets in your house?’ Interviewee: ‘Yes, but they are all squat-style toilets which we need to transfer the faeces out of the house’ (male handyman, 51-y-old, Yunnan).
–  ‘Once a person died, his or her children will clean the body, put on the cloth, and put the body into a coffin to stay at home. Then they inform relatives and friends to have a meeting to select a date for the burial, when there will be cemetery ritual activities and dinner. When my father-in law and mother-in law died, their bodies stay at home for 3 days’ (female peasant farmer, 43-y-old, Yunnan).
–  ‘There is a cave behind our house, there are always some people going inside the cave and catching bats for food’ (female peasant farmer, 60-y-old, Guangxi).
–  ‘We almost see deer every winter when its snowing around this village, so our dogs pursued deer’ (male staff member of local nature reserve, 45-y-old, Guangxi).
–  Interviewer: ‘What kind of animals live in this area?’ Interviewee: ‘Weasels. People often see weasels stealing chicken from their houses’ (male staff member at local forestry department, 40-y-old, Guangdong).
–  Interviewer: ‘When you see rats or dead rats, would you call the infection sanitary department for help?’ Interviewee: ‘There are too many rats in the village, we only call the infection sanitary department for help when someone is infected’ (male worker at a local restaurant, 23-y-old, Yunnan).
–  Interviewer: ‘How do you deal with the wastes, like the organs you do not eat from the chicken?’ Interviewee: ‘Throw them away.’ Interviewer: ‘Where do you throw? A certain place?’ Interviewee: ‘Anywhere is OK like at the roadside’ (female owner of a local grocery store, 54-y-old, Yunnan).
–  Interviewer: ‘Do people worry about the well water quality?’ Interviewee: ‘Yes, so many people are buying water for drinking, but I am old, I do not care, and I feel the well water is better, sweet, and I drink well water’ (male peasant farmer, 80-y-old, Guangxi).
Box 3  Illustrative quotes: policy/regulation level risk and protective factors
Healthcare  Interviewer: ‘Is the town's hospital far away from you home?’ Interviewee: ‘About 100 meters.’ Interviewer: ‘How much do you pay one time?’ Interviewee: ‘30 yuan for normal diseases.’ Interviewer: ‘Do you have any subsidies?’ Interviewee: ‘Yes, we have medical insurance’ (female cook at a local restaurant, 46-y-old, Yunnan).
Interviewer: ‘How much you can get reimbursed for your treatment expense?’ Interviewee: ‘75% of the expenses’ (male peasant farmer, 36-y-old, Yunnan).
National immunization programme  Interviewer: ‘Does your child get vaccine regularly?’ Interviewee: ‘Yes, some people will inform us.’ Interviewer: ‘Free charge of vaccine?’ Interviewee: ‘Almost free, only pay very small amount of injection fee’ (male peasant farmer, 36-y-old, Yunnan).
Gun control policy  ‘There were many hunters, distributed in almost every village, but after the government announced it was illegal to have guns, there are no hunter anymore, but a few people still hunt secretly’ (male staff member of local nature reserve, 30-y-old, Guangxi).
Animal health  ‘Vaccine for foot and mouth disease cost 1 RMB per shot, vaccine of sheep pox cost 2 RMB per shot’ (female peasant farmer, 27-y-old, Yunnan).
Interviewer: ‘Did you give them vaccine?’ Interviewee: ‘No, of course not in this rural area, the epidemic prevention station staff go to villages to distribute vaccines, but here is not included in the village, that's why I did not get it’ (male peasant farmer, 40-y-old, Guangdong).
‘If these animals are sick, there is a vet in the villages. Averagely, there will be a good vet among 3 or 5 villages’ (male wildlife researcher, 47-y-old, Yunnan).
Disease prevention  Interviewer: ‘Does Yunnan CDC have systems to report the sudden death cases?’ Interviewee: ‘No, but we will investigate for young people's sudden death’ (male staff member of local CDC, 42-y-old, Yunnan).
Interviewer: ‘How to control mouse at home?’ Interviewee: ‘The village committee give out rat poison each year and I also buy sticky rat board’ (female peasant farmer, 43-y-old, Yunnan).
Rabies prevention  Interviewer: ‘Are there many people who got sick after being bitten by dogs?’ Interviewee: ‘Not so many, since 2011, our state has monitored and treated more than 100 people. Treating regularly, they are never sick. But some people refused injection, as a result, they were dead.’ Interviewer: ‘Are there some policies that domestic dogs must be vaccinated?’ Interviewee: ‘Yes, but it's hard to implement’ (male staff member of local CDC, 42-y-old, Yunnan).
Wildlife hunting and trading  ‘You know, catch, sell or eat wild animals is illegal. Government will punish you’ (female peasant farmer, 40-y-old, Guangxi).
Interviewer: ‘Who is the main department to educate the public about animal conservation?’ Interviewee: ‘Mainly relies on the forest department and nature reserve. We go to village in a specific month every year to educate local people’ (male staff member of local nature reserve, 30-y-old, Guangxi).
‘They do not collect samples for transportation licence of farmed animals; for Inspection and quarantine certificate, they will sampling everything, including water, feeding stuff, oral, blood and rectal of animals regularly’ (male bamboo rat farmer, 56-y-old, Guangxi).
Human animal conflict  Interviewer: ‘Is there governmental compensation system if animals damage crops?’ Interviewee: ‘No, our winner bamboo shoots are eaten by wild boars. Nothing will be left once they come, and they run so fast. But there is no compensation, they sometimes run to the orchard to eat oranges and damage many trees. Even purple yams my mum planted are eaten’ (male peasant farmer, 50-y-old, Guangdong).

Environmental biosecurity concerns in local communities
Recent infrastructural development promoted by local governments was observed and reported around all study sites. Participants reported that this has contributed to improved hygiene and sanitation conditions in local communities. Local wet markets provided safe pork, the most consumed meat among study communities, which had undergone inspection from designated slaughtering houses. However, some participants were concerned about sanitation in local markets, particularly in areas where live poultry were sold and slaughtered. Sterilized tap water was reported to be available in local communities, but anxiety was expressed by some participants regarding water sources shared with animals or polluted by animal waste.
Some participants raised concerns about the environment around their households. In addition to wild animals (e.g. rats, bats and birds) observed entering or living inside human dwellings and contaminating stored food, bat caves or roosts were reported in the community close to human dwellings. Wild animals (e.g. bats, wild boars and deer) were also observed in croplands or orchards eating crops or fruits. Some participants reported that rearing domestic animals as free-range allowed interactions between domestic and wild animals (e.g. wild boars, chickens, dogs and wild birds) (Box 2).

Existing opportunities for mitigating the risks
Many participants indicated that the recent enforcement of wildlife protection laws, as well as gun control policies, has significantly reduced the wildlife hunting, trading or consumption activities. Free or low-priced vaccines for domestic animals were provided by the government, but a lack of access to vaccines in rural areas was reported as one of the main risks associated with raising animals in the household. Participants discussed community healthcare facilities and health insurance, including the national immunization programme for children, as providing accessible protection and preventative services to the local population. Public education about rabies was reported as an example of a zoonotic disease prevention programme that had improved local awareness of the need for protective measures and postexposure treatment. However, the lack of management plans to address human animal conflicts in local communities as discussed by some participants brings potential zoonotic risks (Box 3) (Supplementary Data II).