WaArusha agro-pastoralist experiences with risk of febrile illness: an ethnographic study of social drivers of zoonoses and rural health-seeking behaviours in Monduli district, Northern Tanzania

Zoonoses are a major cause of febrile illness in people living with livestock in northern Tanzania. Early diagnosis and timely treatment influence the health outcomes of febrile patients, as any delay to care-seeking is significantly associated with complications leading to severe disease. However, little is known about lay experiences with zoonoses or febrile illness in these settings, and most studies tend to focus on the epidemiology of these diseases. In this thesis, I explore agro-pastoralist experiences of risk of febrile illness, understandings and framing of zoonotic health risks and local health-seeking behaviours. To do this, I spent ten months living amongst WaArusha agro-pastoralists in Naiti village, northern Tanzania, conducting ethnographic research using mixed-method approaches including household surveys, interviews and focus group discussions. The study finds that herders’ perceptions of zoonotic risks are shaped by external events that threaten their culture and social relationships, rather than expert narratives about zoonotic risks. Livestock and their product are central to the perceptions and management of risks among WaArusha families. Animal products particularly milk and meat-critical for household nutrition and for their therapeutic value- mediate between complex social relationships in ways that make it difficult to categorise them as “safe” or “unsafe”. Familiar zoonotic diseases such as anthrax, for example, which lead to high mortality in livestock and exhibit physical symptoms that locals can identify, are more accepted risks, whereas zoonoses that do not show physical symptoms such as brucellosis, the risks of which may be real, are less readily accepted as risks to human health. However, it does not follow that people take health-enhancing decisions to minimise harm, like changing their eating habits or visiting a doctor when illness occurs. Rather, people adopt approaches which appear, from an outsider perspective, to have both rational and irrational elements, and which are influenced by issues such as trust and practicality. Expert framings of risk and prescriptions for managing zoonotic risk, therefore, can only work when constructed alongside and in conjunction with lay beliefs. Not doing so results in parallel worlds where lay people are blamed by experts for “causing” their own sickness whilst at the same time expert authorities continue to be distrusted by local people, which in turn results in ineffective interventions