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Globally, people living in northern Indigenous communities are at higher risk of dog bites than the rest of the population living in North America, with annual incidence ranging from 0.61 to 59.6/10,000 inhabitants. Considering that rabies is endemic in wild canid populations in certain regions of the Arctic, the prevention of dog bites and the management of dog populations are of crucial importance for public health in these contexts. Most northern communities lack access to veterinary services, mainly due to their remote geographical location and to limited financial resources. Currently, northern Indigenous communities are using different approaches and strategies to prevent dog bites and manage dog populations, but the effectiveness of these approaches sometimes lacks evidence, and their low acceptability may affect their implementation. This study aims to describe (1) the current access and uses of veterinary services, and (2) the perceived barriers and opportunities related to dog population management practices currently implemented, or that could be implemented, in a Naskapi community and an Innu community located in northern Quebec (Canada). Quantitative data were collected through a survey to inhabitants on veterinary services (n = 122). Qualitative data were collected using individual interviews to inhabitants and health professionals to describe how dog population management measures were perceived, and to identify barriers and opportunities related to their implementation (n = 37). Descriptive and inferential analysis (quantitative data) and thematic analysis (qualitative data) were performed. Results show that the two main measures implemented at the time of the study – dog culling and short-duration veterinary clinics – were not perceived as fully acceptable and sustainable. Reinforcing access to veterinary services and other dog-related services, such as shelters and training programs on dogs, was identified as a need to improve dog bites prevention and dog population management in remote Indigenous communities. The implementation of animal health measures should be decided by concerned Indigenous communities to follow decolonial practices. It includes ensuring informed consent of dog owners, improving communication before, during and after interventions, separating veterinary services from rehoming and, most importantly giving back to Indigenous communities the complete leadership over animal health in their communities.

IntroductionThe singular relationship developed over the years between northern Indigenous peoples and dogs has been profoundly changed through historical trauma, settlements and increased use of snowmobiles. Issues related to dogs have become increasingly complex and worrisome with the endemic presence of the rabies virus among Arctic fox populations, and given the fact that northern Indigenous peoples may have a higher risk of dog bites than the general population. This study aimed to investigate factors related to the risk of dog bites in Naskapi and Innu communities located in northern Quebec (Canada) by (1) describing the knowledge, attitudes and practices (KAP) regarding dogs and dog bites in these communities, and (2) analyzing experiences of inhabitants and health professionals with regard to dog bites and their management.MethodsA mixed methods study design that combined an observational cross-sectional survey and individual interviews was used. The survey collected data on KAP regarding dogs and dog bites among 122 respondents. Individual interviews (n = 37) were then conducted with victims of dog bites, owners of dogs that have bitten a person before, and health professionals. Descriptive and inferential analysis (quantitative data) and thematic analysis (qualitative data) were performed.Results and discussionResults highlighted that 21% of respondents have had a dog bite in their lifetime. Most respondents were not aware of the risk of contracting rabies following a dog bite, although rabies risk perception was associated with risk perception of dogs (linear regression: coefficient = 0.69, 95% CI = 0.36–1.02). The odds of being more knowledgeable on rabies were higher (logistic regression: OR = 2.92, 95% CI = 1.07–7.98) among young adults. Dogs were perceived as both threats and protectors by community members. When the fear of dogs was present, it affected the quality of life of some inhabitants. There was confusion about responsibilities in the management of biting dogs, although protocols to follow after a bite were clear for health care professionals. This study revealed a lack of awareness and knowledge about dog bites and rabies risks in both communities. Results provide important knowledge for the development of interventions adapted to northern Indigenous communities.

The relationship between northern Indigenous people and dogs has evolved over the past years alongside events such as colonization, settlement, proliferation of snowmobiling and other socio-cultural and environmental changes. These changes have had negative impacts on this relationship, and with the endemic presence of arctic fox rabies, dog bites have become an important public health burden. The objective of this study was to synthesize the state of knowledge regarding the occurrence of dog bites and associated risk factors in the specific context of northern Indigenous communities. A scoping review was conducted in seven bibliographic databases, from June 2018 to May 2020. From this search, 257 original studies were identified and eight papers were included for final analysis. Annual occurrence of dog bites in northern Indigenous communities ranged from 0.61 to 59.6/10,000 inhabitants. Dog bites affected 27–62.9% of the population in those regions during their lifetime. Very few studies compared the occurrence of dog bites between people living in northern communities with other populations or settings, but available evidence suggests that Indigenous people living in northern communities are at higher risk of dog bites than the rest of the population. Several individual and environmental risk factors were identified in the selected studies, although the strength of evidence varied significantly. Age (children) and gender (male) were well documented individual risk factors. Other factors, such as organizational barriers to dog management and lack of access to veterinary services, were identified and discussed by several authors. The results of this study support concerns about the higher risk of bites in northern Indigenous communities, and underscore the urgent need for more research into the contextual and environmental factors that impact the mitigation of these risks.

It is now widely acknowledged that surveillance of antimicrobial resistance (AMR) must adopt a “One Health” (OH) approach to successfully address the significant threats this global public health issue poses to humans, animals, and the environment. While many protocols exist for the evaluation of surveillance, the specific aspect of the integration of a OH approach into surveillance systems for AMR and antimicrobial Use (AMU), suffers from a lack of common and accepted guidelines and metrics for its monitoring and evaluation functions. This article presents a conceptual framework to evaluate the integration of OH in surveillance systems for AMR and AMU, named the Integrated Surveillance System Evaluation framework (ISSE framework). The ISSE framework aims to assist stakeholders and researchers who design an overall evaluation plan to select the relevant evaluation questions and tools. The framework was developed in partnership with the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS). It consists of five evaluation components, which consider the capacity of the system to: [1] integrate a OH approach, [2] produce OH information and expertise, [3] generate actionable knowledge, [4] influence decision-making, and [5] positively impact outcomes. For each component, a set of evaluation questions is defined, and links to other available evaluation tools are shown. The ISSE framework helps evaluators to systematically assess the different OH aspects of a surveillance system, to gain comprehensive information on the performance and value of these integrated efforts, and to use the evaluation results to refine and improve the surveillance of AMR and AMU globally.

The economic evaluation of health surveillance systems and of health information is a methodological challenge, as for information systems in general. Main present threads are considering cost-effectiveness solutions, minimizing costs for a given technically required output, or cost-benefit analysis, balancing costs with economic benefits of duly informed public interventions. The latter option, following a linear command-and-control perspective, implies considering a main causal link between information, decision, action, and health benefits. Yet, valuing information, taking into account its nature and multiple sources, the modalities of its processing cycle, from production to diffusion, decentralized use and gradual building of a shared information capital, constitutes a promising challenge. This work proposes an interdisciplinary insight on the value of health surveillance to get a renewed theoretical framework integrating information and informatics theory and information economics. The reflection is based on a typological approach of value, basically distinguishing between use and non-use values. Through this structured discussion, the main idea is to expand the boundaries of surveillance evaluation, to focus on changes and trends, on the dynamic and networked structure of information systems, on the contribution of diverse data, and on the added value of combining qualitative and quantitative information. Distancing itself from the command-and-control model, this reflection considers the behavioral fundaments of many health risks, as well as the decentralized, progressive and deliberative dimension of decision-making in risk management. The framework also draws on lessons learnt from recent applications within and outside of health sector, as in surveillance of antimicrobial resistance, inter-laboratory networks, the use of big data or web sources, the diffusion of technological products and large-scale financial risks. Finally, the paper poses the bases to think the challenge of a workable approach to economic evaluation of health surveillance through a better understanding of health information value. It aims to avoid over-simplifying the range of health information benefits across society while keeping evaluation within the boundaries of what may be ascribed to the assessed information system.