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PMC:7017878 JSONTXT 23 Projects

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Id Subject Object Predicate Lexical cue
T1 0-86 Sentence denotes A qualitative study of zoonotic risk factors among rural communities in southern China
T2 88-96 Sentence denotes Abstract
T3 97-105 Sentence denotes Abstract
T4 107-117 Sentence denotes Background
T5 118-309 Sentence denotes Strategies are urgently needed to mitigate the risk of zoonotic disease emergence in southern China, where pathogens with zoonotic potential are known to circulate in wild animal populations.
T6 310-477 Sentence denotes However, the risk factors leading to emergence are poorly understood, which presents a challenge in developing appropriate mitigation strategies for local communities.
T7 479-486 Sentence denotes Methods
T8 487-603 Sentence denotes Residents in rural communities of Yunnan, Guangxi and Guangdong provinces were recruited and enrolled in this study.
T9 604-839 Sentence denotes Data were collected through ethnographic interviews and field observations, and thematically coded and analysed to identify both risk and protective factors for zoonotic disease emergence at the individual, community and policy levels.
T10 841-848 Sentence denotes Results
T11 849-950 Sentence denotes Eighty-eight ethnographic interviews and 55 field observations were conducted at nine selected sites.
T12 951-1107 Sentence denotes Frequent human–animal interactions and low levels of environmental biosecurity in local communities were identified as risks for zoonotic disease emergence.
T13 1108-1211 Sentence denotes Policies and programmes existing in the communities provide opportunities for zoonotic risk mitigation.
T14 1213-1224 Sentence denotes Conclusions
T15 1225-1367 Sentence denotes This study explored the relationship among zoonotic risk and human behaviour, environment and policies in rural communities in southern China.
T16 1368-1526 Sentence denotes It identifies key behavioural risk factors that can be targeted for development of tailored risk-mitigation strategies to reduce the threat of novel zoonoses.
T17 1528-1540 Sentence denotes Introduction
T18 1541-2418 Sentence denotes Emerging and re-emerging zoonotic diseases are key contributors to morbidity and mortality in southern China.1,2 This region, considered a ‘hotspot’ for emerging zoonotic diseases, harbours abundant wildlife while also undergoing land use change and natural resource overexploitation leading to intensified human–animal interactions that favour the emergence of zoonotic diseases.3 People living in the rural areas of southern China primarily cultivate rice and fruits, raise swine and poultry in households or on small farms,4 but also traditionally hunt wild animals as an alternative income source.5 The mixed landscape has abundant crops, which attracts wild animals into the communities, and livestock rearing is common.6 This brings humans and animals into close contact in dense populations, creating a wildlife–livestock–human interface for zoonotic disease emergence.7
T19 2419-3525 Sentence denotes In recognition of the challenges of emerging infectious diseases after the severe acute respiratory syndrome (SARS) outbreak in 2002 caused by a bat-origin coronavirus, the Chinese government established a national real-time hospital-based infectious disease reporting system.1 Likewise, live poultry market interventions were initiated in response to highly pathogenic avian influenza (HPAI) in southern China in 2001.8 In December 2019 (after the completion of the current study), a novel coronavirus (2019-nCoV) emerged in Wuhan, China and spread rapidly across China and the world.9,10 This virus is a group 2b coronavirus, which includes SARS-CoV and bat SARSr-CoVs, and its closest relative is a virus identified in a Rhinolophus affinis bat from Yunnan.10,11 Environmental samples positive for 2019-nCoV were found in an urban market in Wuhan where some of the earliest known human cases originated.12,13 This likely index site sold predominantly seafood, but is also thought to sell live wildlife at the market, and a temporary ban on the wildlife trade for food has been put in place across China.
T20 3526-3844 Sentence denotes These efforts in response to SARS, HPAI and 2019-nCoV represent a reaction-driven response to zoonotic disease outbreaks, whereas, apart from the new temporary ban on wildlife trade, only limited preventative measures are currently being enacted in the region to reduce the risk of future zoonotic disease outbreaks.14
T21 3845-4422 Sentence denotes However, detailed knowledge of the social and ecological mechanisms of zoonotic disease emergence in the region is limited, and therefore cannot yet inform evidence-based policies and practices for targeted surveillance programmes.15 Using a qualitative approach through ethnographic interviews and field observations, this study aimed to understand interactions among humans, animals and ecosystems, to shed light on the zoonotic risks in these presumed high-risk communities and to develop an evidence base for identifying appropriate strategies for zoonotic risk mitigation.
T22 4424-4445 Sentence denotes Materials and methods
T23 4447-4475 Sentence denotes Study sites and participants
T24 4476-4997 Sentence denotes The Yunnan, Guangxi and Guangdong provinces in southern China were selected for this study because of their historical importance in the origin of emerging infectious diseases,16 diverse wildlife population within protected forests17 and intensive wildlife farming and trade activities.18 Three sites in rural areas were identified in each province where our previous research had found numerous bat and rodent populations harbouring viruses with pathogenic potential for humans, at sites close to human communities.19–21
T25 4998-5402 Sentence denotes Enrolment criteria for participation in an ethnographic interview in this study included: individuals were residents of the target community, aged ≥18 y, with prior contact with live animals directly (e.g. by raising, hunting, trading or slaughtering live animals) or indirectly (e.g. through animals living in or entering dwellings/crops, bat roosts within roofs, animals invading stored food or crops).
T26 5403-5598 Sentence denotes We targeted a gender breakdown of 35% of participants being female and aimed to have a diverse sample of participants from different age groups and levels of power and influence in the community.
T27 5600-5624 Sentence denotes Recruitment and sampling
T28 5625-5870 Sentence denotes In each province, project investigators provided a two-day training workshop for study staff from local provincial and city-level Centres for Disease Control and Prevention who spoke the local language and were familiar with the local community.
T29 5871-6150 Sentence denotes This included a unit on the ethical conduct of human subject research, an in-depth review of the study design and objectives, and comprehensive information on the implementation of observational research, semistructured interviews and notetaking within the context of this study.
T30 6151-6615 Sentence denotes Participants were identified through key informants and the snowball sampling method because the population size at selected sites and the people who had high-risk contacts with live animals were difficult to elucidate.22 Starting with the key informants, we asked each participant to suggest people who met the inclusion criteria and who might be interested in participating in this study; we then contacted the referrals for potential participation in our study.
T31 6616-6766 Sentence denotes Local study staff visited potential participants and provided these individuals with the participant information sheet to introduce them to the study.
T32 6767-6909 Sentence denotes We aimed to obtain a minimum sample size of 20 participants from each of the three provinces, for a total sample size of over 60 participants.
T33 6910-7065 Sentence denotes At least two field observations of local markets and household environments were conducted at each study site, for a total of 18 observations at a minimum.
T34 7066-7116 Sentence denotes Participation in the study was strictly voluntary.
T35 7117-7227 Sentence denotes Study staff reviewed the information sheet with potential participants and explained the details of the study.
T36 7228-7521 Sentence denotes This included the voluntary nature of participation, inclusion and exclusion criteria, study implementation processes (e.g. that the interview would be audio-recorded), potential risks and benefits of participation, results sharing and that they could withdraw their participation at any time.
T37 7522-7714 Sentence denotes It was also explained that an item as a token would be given as appreciation for their participation, which was identified by the study team and appropriate for the context of the study sites.
T38 7715-7772 Sentence denotes Figure 1 Coding themes, subthemes and analysis framework
T39 7773-7862 Sentence denotes Figure 2 Nine study sites in the Yunnan, Guangxi and Guangdong Provinces, Southern China
T40 7864-7894 Sentence denotes Data collection and management
T41 7895-8262 Sentence denotes After completion of the informed consent process, one-on-one semistructured interviews were conducted focusing on the five core themes outlined in the interview guide related to zoonotic disease emergence: human movement, socioeconomics, biosecurity in human environments, human–animal contact and illness, and medical care/treatment and death (Supplementary Data I).
T42 8263-8370 Sentence denotes All interviews were conducted in the local language and audio-recorded without any identifying information.
T43 8371-8467 Sentence denotes Confidentiality was maintained by conducting the interviews in a private and secure environment.
T44 8468-8630 Sentence denotes At the end of the interview, each study participant received a bottle of cooking oil or laundry detergent valued at no more than US$10 as a token of appreciation.
T45 8631-8712 Sentence denotes Field observations were conducted by study staff at each study site concurrently.
T46 8713-9067 Sentence denotes Observations were general and implemented in three settings: (1) local markets where live animals were traded, (2) in and/or around the dwellings of study participants and, if applicable, (3) community centres, to obtain an overview of the study site and the communities, and supplementary data on human-animal interactions and environmental biosecurity.
T47 9068-9150 Sentence denotes The observed information was narrated by study staff and audio-recorded on site.23
T48 9151-9631 Sentence denotes To enhance saturation, efforts were made to include a large variety of people with different backgrounds, to conduct a maximized number of interviews during the 8 wk study period in each province and to cover as many themes and subthemes from the interview guide as possible in each interview.24 All data generated, including notes, audio files, digital transcripts and the interviewer checklist, were coded with an alphanumeric ID to preserve the confidentiality of participants.
T49 9632-9690 Sentence denotes Paper files were scanned electronically and then shredded.
T50 9691-9812 Sentence denotes All electronic data were encrypted and password-protected, and access was limited to the study staff conducting analyses.
T51 9814-9827 Sentence denotes Data analysis
T52 9828-9943 Sentence denotes All interviews and observations were transcribed from the local language into Mandarin and translated into English.
T53 9944-10085 Sentence denotes All transcripts were imported into MAXQDA release 12 statistical software (VERBI Software, Berlin, Germany) for data management and analysis.
T54 10086-10405 Sentence denotes The analysis process incorporated both deductive and inductive approaches, and followed a process of initial coding, identification of new themes, primary coding and identification and analysis of emerging themes.25 An initial codebook associated with the five core themes of the interview guide was developed a priori.
T55 10406-10599 Sentence denotes After a close reading of the transcripts, two authors used the initial codebook to independently code two transcripts in their entirety, making notes on emerging themes and specified subthemes.
T56 10600-10713 Sentence denotes Subsequently, the two authors adapted the codebook and used the modified codebook to code all of the transcripts.
T57 10714-10941 Sentence denotes During the coding process, the two authors met when any major new themes or concepts emerged to decide on any necessary revisions to the codebook, until no new themes emerged and no new information was obtained from the coding.
T58 10942-11177 Sentence denotes The final codebook was restructured with five sections: (1) demographics, (2) biosecurity in human environments, (3) human–animal contact, (4) illness, treatment and death and (5) animal taxa; subthemes were defined under each section.
T59 11178-11250 Sentence denotes After completion of the coding, a code report was generated from MAXQDA.
T60 11251-11984 Sentence denotes Internal reliability was assessed by comparing the coded segments from two authors on the same two transcripts to reach a minimum code interaction rate of 80%.26 A saturation grid was built using the ‘Segment Retrieval’ function in MAXQDA to ensure saturation was reached.27 Coded segments were categorized into protective factors and risk factors based on their known associations with disease transmission, and the analysis was stratified at the individual, community and policy or regulation level.28 At the individual level, both risk and protective factors were analysed in terms of the individuals' knowledge, attitudes and practices to better understand the risk factors for identifying context-based strategies.29 (Figure 1).
T61 11985-12047 Sentence denotes Table 1 Demographic characteristics of the study participants
T62 12048-12083 Sentence denotes Characteristic Participants (n=88)
T63 12084-12099 Sentence denotes Frequency, n %
T64 12100-12106 Sentence denotes Gender
T65 12107-12119 Sentence denotes Male 58 66
T66 12120-12134 Sentence denotes Female 30 34
T67 12135-12142 Sentence denotes Age (y)
T68 12143-12154 Sentence denotes 18–30 8 9
T69 12155-12168 Sentence denotes 31–50 55 63
T70 12169-12180 Sentence denotes >50 25 28
T71 12181-12189 Sentence denotes Province
T72 12190-12204 Sentence denotes Yunnan 36 41
T73 12205-12220 Sentence denotes Guangxi 25 28
T74 12221-12238 Sentence denotes Guangdong 27 31
T75 12239-12259 Sentence denotes Source of livelihood
T76 12260-12287 Sentence denotes Government employee 10 11
T77 12288-12318 Sentence denotes Private company employee 7 8
T78 12319-12339 Sentence denotes School teacher 5 6
T79 12340-12394 Sentence denotes Cash crop production (e.g. fruit tree, bamboo) 23 26
T80 12395-12442 Sentence denotes Grain crop production (e.g. corn, rice) 32 36
T81 12443-12484 Sentence denotes Household animal raising for sale 13 15
T82 12485-12513 Sentence denotes Domestic animal farmer 1 1
T83 12514-12538 Sentence denotes Wild animal farmer 2 2
T84 12539-12558 Sentence denotes Health worker 2 2
T85 12559-12586 Sentence denotes Construction worker 10 11
T86 12587-12614 Sentence denotes Nature reserve worker 8 9
T87 12615-12676 Sentence denotes Small business (e.g. restaurant, grocery store owner) 16 18
T88 12677-12690 Sentence denotes Student 1 1
T89 12691-12707 Sentence denotes Mineworker 1 1
T90 12708-12765 Sentence denotes Other casual or out-migrating work (non-specific) 30 34
T91 12766-12826 Sentence denotes Has worked or work on multiple jobs to make a living 35 40
T92 12828-12835 Sentence denotes Results
T93 12836-13021 Sentence denotes 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.
T94 13022-13130 Sentence denotes All study sites were rural locations with permanent housing structures for family dwelling or community use.
T95 13131-13276 Sentence denotes Family-owned cropland for small-scale vegetable, fruit and rice production was distributed around human dwellings, extending to nearby mountains.
T96 13277-13373 Sentence denotes New buildings and roads were under construction and live animals were sold at local wet markets.
T97 13374-13470 Sentence denotes Few wild animals were seen during our visits to all of the sites during the daytime. (Figure 2).
T98 13471-13577 Sentence denotes Box 1 Illustrative quotes: individuals' knowledge, attitudes and practices regarding human–animal contact
T99 13578-13639 Sentence denotes – ‘My family do not eat the sick animals, we will bury them.
T100 13640-13812 Sentence denotes 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).
T101 13813-13915 Sentence denotes – ‘Two bats flew into our room, so we caught them to eat’ (female peasant farmer, 60-y-old, Guangxi).
T102 13916-14119 Sentence denotes – ‘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).
T103 14120-14373 Sentence denotes – 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).
T104 14374-14467 Sentence denotes – ‘I hurt my waist very seriously, it was painful, and I could not bear the air conditioner.
T105 14468-14686 Sentence denotes 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).
T106 14687-14813 Sentence denotes – ‘I think if my chickens get sick, I will kill them before they die, and eat them’ (male peasant farmer, 80-y-old, Guangxi).
T107 14814-14935 Sentence denotes – ‘I found the chickens died, then I washed them to feed my dog’ (female janitor at a local college, 50-y-old, Guangxi).
T108 14936-15070 Sentence denotes – ‘The excrements of pig are used as fertilizer, much better than the chemical fertilizer’ (female peasant farmer, 45-y-old, Yunnan).
T109 15071-15182 Sentence denotes – ‘We usually buy live animals and kill them by ourselves at home’ (female peasant farmer, 45-y-old, Guangxi).
T110 15183-15371 Sentence denotes – 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).
T111 15372-15534 Sentence denotes – Interviewer: ‘Do you wear gloves when killing chicken?’ Interviewee: ‘No, that would be inconvenient’ (female worker at a local restaurant, 50-y-old, Guangxi).
T112 15535-15590 Sentence denotes – ‘My son wants to keep a dog, but I do not allow him.
T113 15591-15695 Sentence denotes Because dogs are not clean and they will affect human health’ (female peasant farmer, 23-y-old, Yunnan).
T114 15696-15972 Sentence denotes – 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).
T115 15973-16427 Sentence denotes – 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).
T116 16428-16643 Sentence denotes – ‘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).
T117 16644-16732 Sentence denotes – Interviewer: ‘Local people catch bats to sell to the restaurants?’ Interviewee: ‘Yes.
T118 16733-16811 Sentence denotes It's said bats can prevent cancer’ (male peasant farmer, 40-y-old, Guangdong).
T119 16812-16945 Sentence denotes – Interviewer: ‘Why do people like eating bats?’ Interviewee: ‘Nourishment for vitality’ (male peasant farmer, 65-y-old, Guangdong).
T120 16946-17023 Sentence denotes – Interviewer: ‘Will people get shot once bats bite them?’ Interviewee: ‘No.
T121 17024-17118 Sentence denotes People only get injections for snake or dog bites’ (male peasant farmer, 60-y-old, Guangdong).
T122 17119-17213 Sentence denotes – Interviewer: ‘Do you know which illness can infect animal and human?’ Interviewee: ‘Rabies.
T123 17214-17306 Sentence denotes Who was bitten by dogs needs to get an injection’ (female peasant farmer, 43-y-old, Yunnan).
T124 17308-17499 Sentence denotes 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.
T125 17500-17583 Sentence denotes Live chickens, ducks and geese are mixed and kept in cages, I can smell the faeces.
T126 17584-17788 Sentence denotes 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.
T127 17789-17873 Sentence denotes Not far away, there is a woman wearing an orange uniform who is cleaning the street.
T128 17874-18056 Sentence denotes 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.
T129 18057-18274 Sentence denotes 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).
T130 18276-18288 Sentence denotes Demographics
T131 18289-18443 Sentence denotes 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.
T132 18444-18679 Sentence denotes 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%).
T133 18680-18927 Sentence denotes 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).
T134 18929-18984 Sentence denotes Potential risks from frequent human–animal interactions
T135 18985-19189 Sentence denotes 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.
T136 19190-19353 Sentence denotes The migrant work of some participants limited the amount of time individuals had for household level animal husbandry, leading to reduced household animal raising.
T137 19354-19465 Sentence denotes However, many participants kept dogs or cats for companionship, home protection or preventing rat infestations.
T138 19466-19590 Sentence denotes Poultry, pigs and cattle were commonly raised for meat consumption and the animal waste was further used as crop fertilizer.
T139 19591-19764 Sentence denotes Few participants took protective measures when handling or slaughtering domestic animals, or sought medical treatment from a nearby clinic after getting bitten or scratched.
T140 19765-19846 Sentence denotes Vaccinating domestic animals was not widely implemented among study participants.
T141 19847-19996 Sentence denotes Sick and dead animals were usually buried, but some participants discussed consuming sick animals or feeding the carcasses to other domestic animals.
T142 19997-20312 Sentence denotes 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.
T143 20313-20495 Sentence denotes 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.
T144 20496-20700 Sentence denotes 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).
T145 20701-20769 Sentence denotes Box 2 Illustrative quotes: concerns about the community environment
T146 20770-20835 Sentence denotes – Interviewer: ‘Do they wash hands with soap?’ Interviewee: ‘No.
T147 20836-20989 Sentence denotes 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).
T148 20990-21186 Sentence denotes – 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).
T149 21187-21317 Sentence denotes – ‘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.
T150 21318-21465 Sentence denotes 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.
T151 21466-21592 Sentence denotes 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).
T152 21593-21753 Sentence denotes – ‘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).
T153 21754-21917 Sentence denotes – ‘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).
T154 21918-21998 Sentence denotes – Interviewer: ‘What kind of animals live in this area?’ Interviewee: ‘Weasels.
T155 21999-22130 Sentence denotes People often see weasels stealing chicken from their houses’ (male staff member at local forestry department, 40-y-old, Guangdong).
T156 22131-22430 Sentence denotes – 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).
T157 22431-22596 Sentence denotes – 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?
T158 22597-22724 Sentence denotes A certain place?’ Interviewee: ‘Anywhere is OK like at the roadside’ (female owner of a local grocery store, 54-y-old, Yunnan).
T159 22725-22992 Sentence denotes – 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).
T160 22993-23072 Sentence denotes Box 3 Illustrative quotes: policy/regulation level risk and protective factors
T161 23073-23411 Sentence denotes 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).
T162 23412-23562 Sentence denotes Interviewer: ‘How much you can get reimbursed for your treatment expense?’ Interviewee: ‘75% of the expenses’ (male peasant farmer, 36-y-old, Yunnan).
T163 23563-23849 Sentence denotes 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).
T164 23850-24127 Sentence denotes 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).
T165 24128-24284 Sentence denotes 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).
T166 24285-24569 Sentence denotes 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).
T167 24570-24629 Sentence denotes ‘If these animals are sick, there is a vet in the villages.
T168 24630-24734 Sentence denotes Averagely, there will be a good vet among 3 or 5 villages’ (male wildlife researcher, 47-y-old, Yunnan).
T169 24735-24959 Sentence denotes 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).
T170 24960-25146 Sentence denotes 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).
T171 25147-25340 Sentence denotes 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.
T172 25341-25381 Sentence denotes Treating regularly, they are never sick.
T173 25382-25623 Sentence denotes 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).
T174 25624-25708 Sentence denotes Wildlife hunting and trading ‘You know, catch, sell or eat wild animals is illegal.
T175 25709-25780 Sentence denotes Government will punish you’ (female peasant farmer, 40-y-old, Guangxi).
T176 25781-25944 Sentence denotes Interviewer: ‘Who is the main department to educate the public about animal conservation?’ Interviewee: ‘Mainly relies on the forest department and nature reserve.
T177 25945-26081 Sentence denotes 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).
T178 26082-26352 Sentence denotes ‘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).
T179 26353-26525 Sentence denotes Human animal conflict Interviewer: ‘Is there governmental compensation system if animals damage crops?’ Interviewee: ‘No, our winner bamboo shoots are eaten by wild boars.
T180 26526-26584 Sentence denotes Nothing will be left once they come, and they run so fast.
T181 26585-26686 Sentence denotes But there is no compensation, they sometimes run to the orchard to eat oranges and damage many trees.
T182 26687-26773 Sentence denotes Even purple yams my mum planted are eaten’ (male peasant farmer, 50-y-old, Guangdong).
T183 26775-26830 Sentence denotes Environmental biosecurity concerns in local communities
T184 26831-26945 Sentence denotes Recent infrastructural development promoted by local governments was observed and reported around all study sites.
T185 26946-27061 Sentence denotes Participants reported that this has contributed to improved hygiene and sanitation conditions in local communities.
T186 27062-27215 Sentence denotes Local wet markets provided safe pork, the most consumed meat among study communities, which had undergone inspection from designated slaughtering houses.
T187 27216-27360 Sentence denotes However, some participants were concerned about sanitation in local markets, particularly in areas where live poultry were sold and slaughtered.
T188 27361-27552 Sentence denotes 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.
T189 27553-27633 Sentence denotes Some participants raised concerns about the environment around their households.
T190 27634-27848 Sentence denotes 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.
T191 27849-27962 Sentence denotes Wild animals (e.g. bats, wild boars and deer) were also observed in croplands or orchards eating crops or fruits.
T192 27963-28146 Sentence denotes 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).
T193 28148-28195 Sentence denotes Existing opportunities for mitigating the risks
T194 28196-28396 Sentence denotes 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.
T195 28397-28614 Sentence denotes 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.
T196 28615-28837 Sentence denotes 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.
T197 28838-29035 Sentence denotes 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.
T198 29036-29227 Sentence denotes 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).
T199 29229-29239 Sentence denotes Discussion
T200 29240-29444 Sentence denotes This study provided evidence of human–animal interactions in rural communities of southern China that increase the potential for zoonotic disease emergence and suggested opportunities for risk mitigation.
T201 29445-30102 Sentence denotes Population migration from rural communities to urban areas for employment, as well as the wild animal protection policy changes in China in recent years, have led to a perceived overall reduction in activities such as household animal raising and wildlife trade.30,31 Protective attitudes, knowledge and a supportive social environment for disease prevention were reportedly being developed within the community.31 Existing local preliminary programmes and policies around human and animal health, community development and conservation are considered effective resources to begin or continue developing cost-effective strategies to mitigate zoonotic risks.
T202 30103-30343 Sentence denotes In spite of these positive changes over the long term, there is little understanding within enrolled participants of the transmission mechanisms and ecology of zoonotic pathogens that currently circulate in animal populations in the region.
T203 30344-30790 Sentence denotes This is of particular concern in rural communities where close contact with bats and rodents was reported, and zoonotic pathogens have been detected in the widely distributed animal populations with the potential to spill over into the human population.20,32–35 In addition, rural residents may face a higher risk because of their limited access to quality healthcare facilities for proper diagnosis and treatment compared with urban residents.36
T204 30791-30981 Sentence denotes Enforcement of current wildlife protection policy and continued community infrastructure development appears to significantly reduce high-risk contact between humans, wildlife and livestock.
T205 30982-31247 Sentence denotes Closer collaboration between local animal and human health authorities within the current epidemic disease prevention programmes will provide educational and training opportunities to promote risk-mitigation knowledge, skills and best practice in local communities.
T206 31248-31430 Sentence denotes For example, cave monitoring and management is a low-cost and efficient method to help restrict human activities (e.g. recreation and mining) that lead to contact with bats in caves.
T207 31431-31555 Sentence denotes This is of particular importance given the emergence of 2019-nCoV, which appears likely to be a bat-origin coronavirus.10,11
T208 31556-31761 Sentence denotes As the first qualitative study in southern China to assess risk factors for zoonotic disease emergence, our scope was limited by current knowledge, only allowing us to focus on known presumed risk factors.
T209 31762-31952 Sentence denotes With further urbanization, and subsequent increased interactions between human populations and the changing ecosystems, new risk factors for zoonotic disease transmission will likely emerge.
T210 31953-32351 Sentence denotes This might include changes to the wildlife trade following the temporary ban put in place as a response to the emergence of 2019-nCoV.9,10 Further research to identify the risk factors among different populations will help develop more locally-relevant and fine-tuned risk mitigation strategies and address the social and ecological bias to identifying recommendations for other community settings.
T211 32353-32364 Sentence denotes Conclusions
T212 32365-32585 Sentence denotes Using a qualitative approach, this study allowed us to explore a variety of risk factors at different individual, community and policy levels to contextualize the risks of zoonotic disease emergence in local communities.
T213 32586-32814 Sentence denotes The findings provide guidance for future in-depth research on specific risk factors, as well as zoonotic disease control and prevention in southern China and potentially other regions with similar ecological and social contexts.
T214 32816-32838 Sentence denotes Supplementary Material
T215 32839-32940 Sentence denotes Supplementary_Data_I_Ethnographic_Interview_Guide_Final_ihaa001 Click here for additional data file.
T216 32941-33042 Sentence denotes Supplementary_Data_II_Risk_and_Protective_Factors_Final_ihaa001 Click here for additional data file.
T217 33044-33060 Sentence denotes Acknowledgements
T218 33061-33281 Sentence denotes The authors would like to thank the Wuhan University School of Health Sciences for their generous support in reviewing the study protocol and providing local ethical approval and permission for study operations in China.
T219 33282-33388 Sentence denotes We would also like to give special thanks to Rebecca Hill for her comments and insights on the manuscript.
T220 33390-33412 Sentence denotes Authors' contributions
T221 33413-33464 Sentence denotes All authors read and approved the final manuscript.
T222 33465-33860 Sentence denotes MM, EH and AC designed the study, developed the research tools and implemented the pilot study; GZ, YZ and LZ made major contributions to study implementation; LF and SM developed the data analysis and interpretation plan; HT contributed to the initial analysis; HL contributed to the study implementation, data analysis and interpretation, and writing; PD edited and approved the final version.
T223 33862-33869 Sentence denotes Funding
T224 33870-34028 Sentence denotes This work was supported by the United States Agency for International Development (USAID) Emerging Pandemic Threats PREDICT project [Cooperative Agreement No.
T225 34029-34158 Sentence denotes AID-OAA-A-14-00102] and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health [Award No.
T226 34159-34172 Sentence denotes R01AI110964].
T227 34173-34341 Sentence denotes The contents are the responsibility of the authors and do not necessarily reflect the views of USAID, the United States Government or the National Institutes of Health.
T228 34343-34362 Sentence denotes Competing interests
T229 34363-34377 Sentence denotes None declared.
T230 34379-34395 Sentence denotes Ethical approval
T231 34396-34573 Sentence denotes This study was approved by Wuhan University School of Health Sciences Medical Ethics Committee, Institutional Review Board Administration of University of California, Davis (No.
T232 34574-34608 Sentence denotes 804522–6) and Hummingbird IRB (No.
T233 34609-34618 Sentence denotes 2014–23).