collaborative response to 2010 foot and mouth disease outbreak in miyazaki, japan between veterinary...
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Collaborative response to 2010 Foot-and-mouth disease outbreak in Miyazaki, Japan between
veterinary and psychiatry experts
Makita K1,2, Tsutsumi A3, Kadowaki H1, Tsuji A4, Nogami T5, Matsuo Y5, Watari M6, Kim Y6, Ishida Y7
1 Veterinary Epidemiology, Rakuno Gakuen University, Japan
2 International Livestock Research Institute (ILRI), Kenya
3 United Nations University International Institute for Global Health, Malaysia
4 Farmers Association, Miyazaki
5 Miyazaki Prefecture Center for Mental Health and Welfare
6 National Center for Psychiatry and Neurological Research, Japan
7 Miyazaki University, Japan
Overview
Miyazaki, Japan
• FMD outbreak in Miyazaki, Japan in 2010
• How veterinary and mental health teams collaborated
• Mental health status of
– farmers
– local civilians
• Description of psychological stress of
– farmers
– vets
• Barriers against restarting farming
2010 FMD outbreak in Miyazaki, Japan
Tsuno
Kawa- Minami
Takanabe
Shintomi
Fig. Map showing FMD outbreak in Miyazaki
Miyazaki
Number of outbreaks (cattle and swine)
Modified from NARO, Japan Vaccination
started
Vaccination
finished
Culling of vaccinated
animals started
Finishing culling of
all animals vaccinated
Containment of
last case
The numbers of suspect animals, culled and to be culled
x 10,000 animals
New cases and suspects
Culled
To be culled
Vaccination started
Damage caused by 2010 FMD outbreak
• Economic loss
– 1362 farmers, 297,808 animals
– Total economic loss USD 3 billions
• Were the damages limited to economy?
• Restarting of farming
– Farmers resumed 59%
– Planning to resume 9%
– Stopped farming 30%
– Unknown 2%
Miyazaki Prefecture Centre for Mental Health and Welfare Faculty of Medicine, Miyazaki University Miyazaki Prefecture Health Centers Local Health Posts
Veterinary Epidemiologist (Rakuno Gakuen Univ.)
Farmer’s Association Field vets
Affected farmers
Establishment of collaborative framework for mental health research
Psycho-Epidemiologist (JICA)
2010 Oct 2011 Aug
2011 May
2012 Jan
Since 2010
2010 June
Vets wanted mental health experts Mental health experts wanted vets
Methods
• 2010
– First mental health screening • Farmers- telephone screening
• Vets and local population- postal survey
• 2011
– Participatory appraisals • Farmers and local vets
– Second mental health screening • Farmers- direct visits
• Including barriers preventing re-starting of farming
• Vets and local population- postal survey
Measurement of depression Kessler 6 (K6)
• Questions
– During the past 4 weeks, how much of the time did you feel? • …so sad nothing could cheer you up?
• …nervous?
• …restless or fidgety?
• …hopeless?
• …worthless?
– Scoring • All the time (4) – none of the time (0)
• Cut-off: total score 15 points (severe disorder)
• Explanatory variables
– Personal, agricultural, FMD and health associated factors
Kessler RC, Barker PR, Colpe LJ, et al. Screening for serious mental illness in the general population. Arch Gen Psychiatry. 2003;60(2):184-9.
Mental health screening for farmers
78.5%
80.2%
21.5%
19.8%
女性(N=590)
男性(N=646)
追跡不要 何らかの対応あり
81.6%
85.1%
18.4%
14.9%
女性(N=217)
男性(N=302)
追跡不要 何らかの対応あり
Male
Male
Female
Female
2011: Direct visits
2010: Telephone survey Follow up not required
Follow up not required
Follow up required
Follow up required
Comparison with 2010: x2=3.01, df=1, p=0.08
Comparison with 2010: x2=0.75, df=1, p=0.39
x2=0.45, df=1, p=0.5
x2=0.91, df=1, p=0.34
Proportions of mental health high risk farmers by K6 cut-off
94.2%
96.6%
5.8%
3.4%
女性(N=590)
男性(N=646)
ローリスク ハイリスク
2010: Telephone survey
2011: Direct visits
98.6%
98.7%
1.4%
1.3%
女性(N=219)
男性(N=301)
ローリスク ハイリスク
Male
Male
Female
Female
High risk
High risk
Not high risk
Not high risk
Comparison with 2010: x2=2.58, df=1, p=0.11
Comparison with 2010: x2=6.09, df=1, p=0.14
x2=3.48, df=1, p=0.06
Risk factors for scoring more than K6 cut-off points (Farmers in 2010)
Odds ratios (95% CI)
Total studied Kawaminami
Family relationship problem
5.2 (2.2 - 12.2) 13.1 (2.0 - 86.8) **
Human relationship problem
5.0 (2.0 - 12.7) 25.9 (3.4 - 197.7) **
History of illness 2.5 (1.2 - 5.1) 6.9 (1.5 - 11.1) *
**p<0.01, *p<0.05
All the risk factors were existence of the problems before the outbreaks
Economic situations of local civilians - Change of income compared with before the FMD outbreak -
2010 Apr-Sep (N=422)
Unchanged 8% (34)
Increased 2% (7)
Decreased 90% (381)
2011 Apr-Sep (N=335)
Unchanged 25.7% (86)
Increased 5.4% (18)
Decreased 69% (231)
Proportions of K6 high score (<15 points) (Local civilians)
89.4%
84.8%
86.9%
10.6%
15.2%
13.1%
国民生活基礎調査
(H19宮崎県、N=8457)
H22 (N=395)
H23(N=320)
ローリスク ハイリスク High risk Not high risk
National survey
(2007, Miyazaki, N=8457)
(2010, N=395)
(2011, N=320)
Significant increase after the FMD outbreak
(x2=7.76, df=1, p=0.005)
Mental stress for farmers
• From outbreak to infection • Lack of information: geography, type of effective disinfectant
• Stop of veterinary clinical services
• Anxiety against virus infection
• Helplessness of disinfectant due to expanding outbreak
• After infection at the farm • Surprise of remote infections • Anxiety towards inexperienced culling • Long lasting feeding for animals to be culled • Massive deaths of piglets • Voluntary self-confinement
– Inconvenience of daily life
– Effects on children (stay home without going to school, bullying in a class)
Mental health for farmers
• Culling at the infected premises – Searching lands for burial
– Affection towards loved animals
– Pay-for-work organized by Prefecture Government: farmers whose animals were culled aided other farmers
• Vaccination – Co-existence of vaccinating and non-vaccinating zones in a community
– Regret to cull healthy animals
Transition of stress: field vets Mental stress (3.1) > Physical stress (2.0, p<0.001: Wilcoxon matched pair)
Stand by
Mental
Physical
Announcement of use of vaccine
Finding efficient culling methods
Dispatch
Shift started
Fatigue
Nightmare
Desperation
Peak of animals to be culled
High temp.
Cull completed
Vanity Friends started calling
Transition of stress: supervisors Mental
Physical
0
0.5
1
1.5
2
2.5
3
3.5
4
4/20 - 4/25 4/26 - 5/2 5/3 - 5/9 5/10 - 5/16 5/17 - 5/23 5/24 - 5/30 5/31 - 6/6 6/7 - 6/13 6/14 - 6/20 6/21 - 6/28 6/29 - 7/4
Dispatch Announcement of use of vaccine Cull completed
Unpredictability Lack of information
Concern on vets’ health
Organisation of vaccination teams
Difference between vaccinated and non-vaccinated farms on compensation for culling Fall of local
livestock farming
Mental stress for veterinarians during culling
• Contradiction against the motivation as a field vets
• Chaos in a culling team
• Improper hygiene management
• Voluntary confinement in a house including family members during off days
• Gender issue
Barriers preventing restart of farming
• Outcome variable
– Restarting or not
• Explanatory variables
– Personal, agricultural, FMD and health associated factors
• Multiple logistic regression (GLMs)
Beef cattle and dairy farms
Owners’ age
Restart
Family owned farm
K6>15
Farm size
OR=0.97 95%CI (0.94-0.99)
P=0.006
OR=0.07 95%CI (0.01-0.69)
P=0.023
OR:17.4 95%CI (1.02-296.8)
P=0.048
OR=1.01 95%CI (1.003-1.01)
P=0.006
Pig farmers
Restart
Farm size
OR=1.01 95%CI (1.003-1.01)
P=0.006
Total mental risk
score
OR=0.4 95%CI (0.18-0.9)
P=0.026
Vaccinated farms
Restart
Satisfaction on
the information
from
Government
OR=0.3 95%CI (0.1-0.6)
P<0.001
Infected farms
Restart
Satisfaction on
the information
from
Government
Helping culling
at other farms
OR=0.7 95%CI (0.5-0.9)
P=0.02
OR=3.8 95%CI (0.8-18.1)
P=0.09
Overall farmers
Restart of farming
Satisfaction on the supports
from Government
Satisfaction on the information
from Government
K6>15 points
OR:0.6 95%CI(0.5-0.8)
P<0.001
OR:1.3 95%CI(1.0-1.6)
P=0.03
OR:0.1 95%CI(0.01-0.6)
P=0.02
Conclusion
• Importance of trans-disciplinary approach in responding acute animal diseases
• Psychological effects from FMD persisting
• Local civilians are most affected
• Mental stress of local vets and farmers changed dynamically as the outbreak situation changes
• Mental stress is one of the reasons of hesitating restarting
• Keen commercial farmers tend to restart
After the field vets experienced participatory appraisals, they started using PLAs in improving farm management. PLAs showed healing effects among those who participated. Thank you for your attention
We thank Japan Ministry of Health, Labour and Welfare and Rakuno Gakuen University for research funding
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