{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T19:23:48Z","timestamp":1777663428150,"version":"3.51.4"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"ICMR-Vector Control Research Centre","award":["IM2320"],"award-info":[{"award-number":["IM2320"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health (London)"],"abstract":"<jats:p>Individuals from marginalised backgrounds are often \u201cplaced\u201d 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\u2013a neglected tropical disease (NTD) of zoonotic origin\u2013as 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\u2009months, 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.<\/jats:p>","DOI":"10.1177\/13634593261428065","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T09:35:16Z","timestamp":1773740116000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding the spatiality in neglected tropical diseases: An ethnographic study of scrub typhus in Puducherry, India"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2561-2970","authenticated-orcid":false,"given":"Anoop C.","family":"Choolayil","sequence":"first","affiliation":[{"name":"ICMR-Vector Control Research Centre, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panneer","family":"Devaraju","sequence":"additional","affiliation":[{"name":"ICMR-Vector Control Research Centre, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srikanth","family":"Srirama","sequence":"additional","affiliation":[{"name":"ICMR-Vector Control Research Centre, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Waseema","family":"Arif","sequence":"additional","affiliation":[{"name":"ICMR-Vector Control Research Centre, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammed","family":"Jabir","sequence":"additional","affiliation":[{"name":"ICMR-Vector Control Research Centre, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aravindasamy","family":"Chakkravarthy","sequence":"additional","affiliation":[{"name":"ICMR-Vector Control Research Centre, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajkumar","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"ICMR-Vector Control Research Centre, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Srividya","family":"Vissvesaran","sequence":"additional","affiliation":[{"name":"Directorate of Health &amp; Family Welfare Services, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murali","family":"Ramachandiran","sequence":"additional","affiliation":[{"name":"Directorate of Health &amp; Family Welfare Services, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"e_1_3_4_2_1","doi-asserted-by":"crossref","unstructured":"Banerjee A Schuitema G (2023) Spatial justice as a prerequisite for a just transition in rural areas? The case study from the Irish peatlands. Environment and Planning C Politics and Space 41(6): 1096\u20131112. https:\/\/doi.org\/10.1177\/23996544231173210","DOI":"10.1177\/23996544231173210"},{"key":"e_1_3_4_3_1","doi-asserted-by":"crossref","unstructured":"Braveman P Gottlieb L (2014) The social determinants of health: It\u2019s time to consider the causes of the causes. Public Health Reports 129(Suppl 2): 19\u201331. https:\/\/doi.org\/10.1177\/00333549141291S206","DOI":"10.1177\/00333549141291S206"},{"key":"e_1_3_4_4_1","volume-title":"Ucinet for Windows: Software for Social Network Analysis","author":"Borgatti SP","year":"2002","unstructured":"Borgatti SP, Everett MG, Freeman LC (2002) Ucinet for Windows: Software for Social Network Analysis. Analytic Technologies."},{"key":"e_1_3_4_5_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijmr.IJMR_1390_15"},{"key":"e_1_3_4_6_1","unstructured":"Cochrane (n.d.) PROGRESS-Plus. Available at: https:\/\/methods.cochrane.org\/equity\/projects\/evidence-equity\/progress-plus (accessed 09 December 2025)"},{"key":"e_1_3_4_7_1","doi-asserted-by":"crossref","unstructured":"Devaraju P Arumugam B Mohan I et al. (2020) Evidence of natural infection of Orientia Tsutsugamushi in vectors and animal hosts - Risk of scrub typhus transmission to humans in Puducherry South India. Indian Journal of Public Health 64(1): 27\u201331. https:\/\/doi.org\/10.4103\/ijph.IJPH_130_19","DOI":"10.4103\/ijph.IJPH_130_19"},{"key":"e_1_3_4_8_1","doi-asserted-by":"crossref","unstructured":"Devasagayam E Dayanand D Kundu D et al. (2021) The burden of scrub typhus in India: A systematic review. Plos Neglected Tropical Diseases 15(7): e0009619. https:\/\/doi.org\/10.1371\/journal.pntd.0009619","DOI":"10.1371\/journal.pntd.0009619"},{"key":"e_1_3_4_9_1","doi-asserted-by":"crossref","unstructured":"D\u2019Cruz S Sreedevi K Lynette C et al. (2024) Climate influences scrub typhus occurrence in Vellore Tamil Nadu India: Analysis of a 15-year dataset. Scientific Reports 14(1): 1532. https:\/\/doi.org\/10.1038\/s41598-023-49333-5","DOI":"10.1038\/s41598-023-49333-5"},{"key":"e_1_3_4_10_1","volume-title":"The Condition of Postmodernity","author":"Harvey D","year":"1990","unstructured":"Harvey D (1990) The Condition of Postmodernity. Blackwell."},{"key":"e_1_3_4_11_1","doi-asserted-by":"crossref","unstructured":"Kelly DJ Fuerst PA Ching WM et al. (2009) Scrub typhus: The geographic distribution of phenotypic and genotypic variants of Orientia Tsutsugamushi. Clinical Infectious Diseases 48(3): S203\u2013S230. https:\/\/doi.org\/10.1086\/596576","DOI":"10.1086\/596576"},{"key":"e_1_3_4_12_1","doi-asserted-by":"crossref","unstructured":"Kusenbach M (2003) Street phenomenology: The go-along as ethnographic research tool. Ethnography 4(3): 455\u2013548. https:\/\/doi.org\/10.1177\/146613810343007","DOI":"10.1177\/146613810343007"},{"key":"e_1_3_4_13_1","doi-asserted-by":"crossref","unstructured":"Lai Q Liu W Li X et al. (2023) Spatial characteristics and cultural factors of Yi nationality traditional dwellings based on spatial syntax. Frontiers in Earth Science 11: 1330142. https:\/\/doi.org\/10.3389\/feart.2023.1330142","DOI":"10.3389\/feart.2023.1330142"},{"key":"e_1_3_4_14_1","doi-asserted-by":"crossref","unstructured":"O\u2019Neill J Tabish H Welch V et al. (2014) Applying an equity lens to interventions: Using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. Journal of Clinical Epidemiology 67(1): 56\u201364. https:\/\/doi.org\/10.1016\/j.jclinepi.2013.08.005","DOI":"10.1016\/j.jclinepi.2013.08.005"},{"key":"e_1_3_4_15_1","unstructured":"Posit team (2025) RStudio: Integrated Development Environment for R. Posit Software PBC. Available at: http:\/\/www.posit.co\/"},{"key":"e_1_3_4_16_1","unstructured":"Puducherry Climate Change Cell (n.d.) Puducherry weather dashboard. Available at: https:\/\/dste.py.gov.in\/PCCC\/2023.html (accessed 5 January 2024)"},{"key":"e_1_3_4_17_1","unstructured":"QGIS Development Team (2024) QGIS Geographic Information System. Open Source Geospatial Foundation Project. Available at: http:\/\/qgis.osgeo.org"},{"key":"e_1_3_4_18_1","doi-asserted-by":"crossref","unstructured":"Ritu GP Arif W Sihag KK et al. (2024) Comparative evaluation of different tissues and molecular techniques for the zoonotic surveillance of scrub typhus. Vector Borne and Zoonotic Diseases 24(5): 299\u2013307. https:\/\/doi.org\/10.1089\/vbz.2023.0069","DOI":"10.1089\/vbz.2023.0069"},{"key":"e_1_3_4_19_1","doi-asserted-by":"crossref","unstructured":"Rose W Kang G Verghese VP et al. (2019) Risk factors for acquisition of scrub typhus in children admitted to a tertiary centre and its surrounding districts in South India: A case control study. BMC Infectious Diseases 19(1): 665. https:\/\/doi.org\/10.1186\/s12879-019-4299-2","DOI":"10.1186\/s12879-019-4299-2"},{"key":"e_1_3_4_20_1","doi-asserted-by":"publisher","DOI":"10.5749\/minnesota\/9780816666676.001.0001"},{"key":"e_1_3_4_21_1","doi-asserted-by":"crossref","unstructured":"Stephen S Sangeetha B Ambroise S et al. (2015) Outbreak of scrub typhus in Puducherry & Tamil Nadu during cooler months. Indian Journal of Medical Research 142(5): 591\u2013597. https:\/\/doi.org\/10.4103\/0971-5916.171289","DOI":"10.4103\/0971-5916.171289"},{"key":"e_1_3_4_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s41134-024-00359-3"},{"key":"e_1_3_4_23_1","doi-asserted-by":"crossref","unstructured":"Thangaraj JWV Vasanthapuram R Machado L et al. (2018) Risk factors for acquiring scrub typhus among children in Deoria and Gorakhpur districts Uttar Pradesh India 2017. Emerging Infectious Diseases 24(12): 2364\u20132367. https:\/\/doi.org\/10.3201\/eid2412.180695","DOI":"10.3201\/eid2412.180695"},{"key":"e_1_3_4_24_1","doi-asserted-by":"crossref","unstructured":"Trowbridge P Divya P Premkumar PS et al. (2017) Prevalence and risk factors for scrub typhus in South India. Tropical Medicine & International Health 22(5): 576\u2013582. https:\/\/doi.org\/10.1111\/tmi.12853","DOI":"10.1111\/tmi.12853"},{"key":"e_1_3_4_25_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0066595"},{"issue":"1","key":"e_1_3_4_26_1","first-page":"24","article-title":"Outbreak of scrub typhus in Pondicherry","volume":"58","author":"Vivekanandan M","year":"2010","unstructured":"Vivekanandan M, Mani A, Priya YS, et al. (2010) Outbreak of scrub typhus in Pondicherry. Journal of the Association of Physicians of India 58(1): 24\u201328.","journal-title":"Journal of the Association of Physicians of India"},{"key":"e_1_3_4_27_1","unstructured":"WHO (n.d.) Neglected tropical diseases. https:\/\/www.who.int\/health-topics\/neglected-tropical-diseases#tab=tab_1 (accessed 9 December 2025)."},{"key":"e_1_3_4_28_1","author":"World Health Organization","year":"2013","unstructured":"World Health Organization (2013) The Economics of the Social Determinants of Health and Health Inequalities: A Resource Book. World Health Organization.","journal-title":"The Economics of the Social Determinants of Health and Health Inequalities: A Resource Book"},{"key":"e_1_3_4_29_1","doi-asserted-by":"crossref","unstructured":"Yoo JS Kim D Choi HY et al. (2022) Prevalence rate and distribution of eschar in patients with scrub typhus. American Journal of Tropical Medicine and Hygiene 106(5): 1358\u20131362. https:\/\/doi.org\/10.4269\/ajtmh.21-1129","DOI":"10.4269\/ajtmh.21-1129"},{"key":"e_1_3_4_30_1","doi-asserted-by":"crossref","unstructured":"Zaman K (2023) Scrub typhus a salient threat: Needs attention. Plos Neglected Tropical Diseases 17(6): e0011427. https:\/\/doi.org\/10.1371\/journal.pntd.0011427","DOI":"10.1371\/journal.pntd.0011427"}],"container-title":["Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13634593261428065","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13634593261428065","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13634593261428065","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:32:22Z","timestamp":1777447942000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13634593261428065"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,17]]},"references-count":29,"alternative-id":["10.1177\/13634593261428065"],"URL":"https:\/\/doi.org\/10.1177\/13634593261428065","relation":{},"ISSN":["1363-4593","1461-7196"],"issn-type":[{"value":"1363-4593","type":"print"},{"value":"1461-7196","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,17]]},"article-number":"13634593261428065"}}