Understanding the spatiality in neglected tropical diseases: An ethnographic study of scrub typhus in Puducherry, India.

Individuals from marginalised backgrounds are often "placed" in spatial planes marked by disadvantages and poor resource availability, impacting their health outcomes. This study explored the role of spatiality in shaping health outcomes, with scrub typhus-a neglected tropical disease (NTD) of zoonotic origin-as an illustrative case. Employing a spatial justice framework, the study investigated the intersection of geospatial and socio-spatial factors influencing health and illness experience in Puducherry, India. An interdisciplinary mixed-methods approach was employed, involving geospatial hotspot mapping of 256 individuals who were diagnosed with scrub typhus over a period of 12 months, vector studies in the hotspots and a go-along ethnography with participants selected from the hotspots. Quantitative findings revealed a higher incidence during cooler months and post-rainfall among households proximate to vegetation and agricultural land, and the vector studies confirmed the presence of mite vectors in these areas, reinforcing the geospatial links to vulnerability. Qualitative findings highlighted how socio-spatial factors like housing conditions, decaying infrastructure, systemic neglect, poor patient education, and mobility create disproportionate vulnerability to the marginalised. The study underscores the importance of addressing the spatiality of health in its geo-spatial and socio-spatial dimensions to reduce the disease burden and the need for spatially informed public health interventions to address NTDs.