Assessing the effectiveness and feasibility of implementing mitigation measures for an influenza pandemic in remote and isolated First Nations communities: a qualitative community-based participatory research approach.
The next influenza pandemic is predicted to disproportionately impact marginalized populations, such as those living in geographically remote Aboriginal communities, and there remains a paucity of scientific literature regarding effective and feasible community mitigation strategies. In Canada, current pandemic plans may not have been developed with adequate First Nations consultation and recommended measures may not be effective in remote and isolated First Nations communities.
This study employed a community-based participatory research approach. Retrospective opinions were elicited via interview questionnaires with adult key healthcare informants (n=9) regarding the effectiveness and feasibility of implementing 41 interventions to mitigate an influenza pandemic in remote and isolated First Nations communities of sub-Arctic Ontario, Canada. Qualitative data were manually transcribed and deductively coded following a template organizing approach.
The results indicated that most mitigation measures could potentially be effective if modified to address the unique characteristics of these communities. Participants also offered innovative alternatives to mitigation measures that were community-specific and culturally sensitive. Mitigation measures were generally considered to be effective if the measure could aid in decreasing virus transmission, protecting their immunocompromised population, and increasing community awareness about influenza pandemics. Participants reported that lack of resources (eg supplies, monies, trained personnel), poor community awareness, overcrowding in homes, and inadequate healthcare infrastructure presented barriers to the implementation of mitigation measures.
This study highlights the importance of engaging local key informants in pandemic planning in order to gain valuable community-specific insight regarding the design and implementation of more effective and feasible mitigation strategies. As it is ethically important to address the needs of marginalized populations, it is recommended that these findings be incorporated in future pandemic plans to improve the response capacity and health outcomes of remote and isolated First Nations communities during the next public health emergency.
A community-based participatory approach and engagement process creates culturally appropriate and community informed pandemic plans after the 2009 H1N1 influenza pandemic: remote and isolated First Nations communities of sub-arctic Ontario, Canada.
Public health emergencies have the potential to disproportionately impact disadvantaged populations due to pre-established social and economic inequalities. Internationally, prior to the 2009 H1N1 influenza pandemic, existing pandemic plans were created with limited public consultation; therefore, the unique needs and characteristics of some First Nations communities may not be ethically and adequately addressed. Engaging the public in pandemic planning can provide vital information regarding local values and beliefs that may ultimately lead to increased acceptability, feasibility, and implementation of pandemic plans. Thus, the objective of the present study was to elicit and address First Nations community members' suggested modifications to their community-level pandemic plans after the 2009 H1N1 influenza pandemic.
The study area included three remote and isolated First Nations communities located in sub-arctic Ontario, Canada. A community-based participatory approach and community engagement process (i.e., semi-directed interviews (n?=?13), unstructured interviews (n?=?4), and meetings (n?=?27)) were employed. Participants were purposively sampled and represented various community stakeholders (e.g., local government, health care, clergy, education, etc.) involved in the community's pandemic response. Collected data were manually transcribed and coded using deductive and inductive thematic analysis. The data subsequently informed the modification of the community-level pandemic plans.
The primary modifications incorporated in the community-level pandemic plans involved adding community-specific detail. For example, 'supplies' emerged as an additional category of pandemic preparedness and response, since including details about supplies and resources was important due to the geographical remoteness of the study communities. Furthermore, it was important to add details of how, when, where, and who was responsible for implementing recommendations outlined in the pandemic plans. Additionally, the roles and responsibilities of the involved organizations were further clarified.
Our results illustrate the importance of engaging the public, especially First Nations, in pandemic planning to address local perspectives. The community engagement process used was successful in incorporating community-based input to create up-to-date and culturally-appropriate community-level pandemic plans. Since these pandemic plans are dynamic in nature, we recommend that the plans are continuously updated to address the communities' evolving needs. It is hoped that these modified plans will lead to an improved pandemic response capacity and health outcomes, during the next public health emergency, for these remote and isolated First Nations communities. Furthermore, the suggested modifications presented in this paper may help inform updates to the community-level pandemic plans of other similar communities.
To retrospectively examine the barriers faced and opportunities for improvement during the 2009 H1N1 pandemic response experienced by participants responsible for the delivery of health care services in 3 remote and isolated Subarctic First Nation communities of northern Ontario, Canada.
A qualitative community-based participatory approach.
Semi-directed interviews were conducted with adult key informants (n=13) using purposive sampling of participants representing the 3 main sectors responsible for health care services (i.e., federal health centres, provincial hospitals and Band Councils). Data were manually transcribed and coded using deductive and inductive thematic analysis.
Primary barriers reported were issues with overcrowding in houses, insufficient human resources and inadequate community awareness. Main areas for improvement included increasing human resources (i.e., nurses and trained health care professionals), funding for supplies and general community awareness regarding disease processes and prevention.
Government bodies should consider focusing efforts to provide more support in terms of human resources, monies and education. In addition, various government organizations should collaborate to improve housing conditions and timely access to resources. These recommendations should be addressed in future pandemic plans, so that remote western James Bay First Nation communities of Subarctic Ontario and other similar communities can be better prepared for the next public health emergency.
Avian influenza virus (AIV) prevalence has been associated with wild game and other bird species. The contamination of these birds may pose a greater risk to those who regularly hunt and consumed infected species. Due to resident concerns communicated by local Band Council, hunter-harvested birds from a remote First Nation community in subArctic Ontario, Canada were assessed for AIV. Hunters, and especially those who live a subsistence lifestyle, are at higher risk of AIV exposure due to their increased contact with wild birds, which represent an important part of their diet.
Cloacal swabs from 304 harvested game birds representing several species of wild birds commonly hunted and consumed in this First Nation community were analyzed for AIV using real-time reverse transcription polymerase chain reaction. Subtyping was performed using reverse transcription polymerase chain reaction. Sequences were assembled using Lasergene, and the sequences were compared to Genbank.
In total, 16 of the 304 cloacal swab samples were positive for AIV. Of the 16 positive samples, 12 were found in mallard ducks, 3 were found in snow geese (wavies), and 1 positive sample was found in partridge. The AIV samples were subtyped, when possible, and found to be positive for the low pathogenic avian influenza virus subtypes H3 and H4. No samples were positive for subtypes of human concern, namely H5 and H7.
This work represents the first AIV monitoring program results of hunter-harvested birds in a remote subsistence First Nation community. Community-level surveillance of AIV in remote subsistence hunting communities may help to identify future risks, while educating those who may have the highest exposure about proper handling of hunted birds. Ultimately, only low pathogenic strains of AIV were found, but monitoring should be continued and expanded to safeguard those with the highest exposure risk to AIV.
There is concern of avian influenza virus (AIV) infections in humans. Subsistence hunters may be a potential risk group for AIV infections as they frequently come into close contact with wild birds and the aquatic habitats of birds while harvesting. This study aimed to examine if knowledge and risk perception of avian influenza influenced the use of protective measures and attitudes about hunting influenza-infected birds among subsistence hunters.
Using a community-based participatory research approach, a cross-sectional survey was conducted with current subsistence hunters (n = 106) residing in a remote and isolated First Nations community in northern Ontario, Canada from November 10-25, 2013. Simple descriptive statistics, cross-tabulations, and analysis of variance (ANOVA) were used to examine the distributions and relationships between variables. Written responses were deductively analyzed.
ANOVA showed that males hunted significantly more birds per year than did females (F1,96 = 12.1; p = 0.001) and that those who hunted significantly more days per year did not perceive a risk of AIV infection (F1,94 = 4.4; p = 0.040). Hunters engaged in bird harvesting practices that could expose them to AIVs, namely by cleaning, plucking, and gutting birds and having direct contact with water. It was reported that 18 (17.0%) hunters wore gloves and 2 (1.9%) hunters wore goggles while processing birds. The majority of hunters washed their hands (n = 105; 99.1%) and sanitized their equipment (n = 69; 65.1%) after processing birds. More than half of the participants reported being aware of avian influenza, while almost one third perceived a risk of AIV infection while harvesting birds. Participants aware of avian influenza were more likely to perceive a risk of AIV infection while harvesting birds. Our results suggest that knowledge positively influenced the use of a recommended protective measure. Regarding attitudes, the frequency of participants who would cease harvesting birds was highest if avian influenza was detected in regional birds (n = 55; 51.9%).
Our study indicated a need for more education about avian influenza and precautionary behaviours that are culturally-appropriate. First Nations subsistence hunters should be considered an avian influenza risk group and have associated special considerations included in future influenza pandemic plans.
Cadmium (Cd), a nonessential toxic metal present in the environment, accumulates in the organs of herbivorous mammals which typically are consumed by Aboriginal populations. The relative contribution of this potential exposure source to concentrations of blood Cd was investigated in 1429 participants (age >7 years) residing in the nine Cree First Nations communities of Eeyou Istchee, northern Quebec, Canada. Analysis of variance identified significant Cd concentration differences between communities, sex, and age groups, although these were complicated by significant 2-way interactions. The percentage of participants with Cd concentrations within the adopted health-based guideline categories of 'acceptable', 'concern' and 'action' pertaining to kidney damage was 56.2%, 38.3%, and 5.5%, respectively. Partial correlations (controlling for age as a continuous variable) did not show a significant association between consumption of traditional foods and Cd concentrations (r = 0.014, df = 105, p = 0.883). A significant and positive partial correlation (r = 0.390, df = 105, p