Table 2 Frequencies of Social Mechanisms of Transmission among included articles
Category | Theme | Description | No. (%) |
|---|---|---|---|
Policies | Occupation-specific freedom of movement | Ability to leave base premises and/or country of military training despite outbreak or symptoms of disease Bypassing host country laws (e.g., criminal/civil charge immunity, lack of airport screenings) due to a Status of Forces Agreement (SOFA), i.e., agreement between host nation and foreign nation outlining rights and privileges of foreign military personnel stationed in host nation | 26 (14) |
Vaccination programs | Exclusion of specific ranks from obtaining vaccinations Limited supply of pharmaceuticals or vaccines Discontinuation of vaccines Lack of vaccination program Substandard expectations of immunization for incoming recruits | 18 (10) | |
Institutional | Living conditions | High population density within military bases, crowded barracks, crowded shared living spaces (e.g., dining halls, lavatories) Rats, bats, or other vector carriers sharing living quarters Poor hygiene/sanitation conditions Semi-open living environments allowing greater than usual freedom of movement Living conditions that promote presence of microorganisms | 76 (42) |
Training conditions1 | High-intensity military exercise contributing to increased mental and physical stress Military exercise increasing exposure to contaminated areas Training schedules (e.g., long hours, nocturnal activities) Environmental conditions limiting access to resources (e.g., clean water, healthcare) or which adversely impact health (e.g., low air quality) | 43 (24) | |
Working conditions2 | Serving in endemic, rural, remote, or unmaintained areas Serving in environmental conditions which limit access to resources (e.g., clean water, healthcare) or which adversely impact health (e.g., low air quality) Combat duty exposing personnel to greater risk (e.g., terrain, contact with combatants) Requirement of frequent movement | 42 (23) | |
Poor public health management and services | Lack of regular testing for HIV/STIs Lack of implementation of sufficient preventative measures in at-risk environments Lack of implementation of sufficient post-outbreak measures (i.e., isolation of personnel with symptoms) Insufficient or lack of health education Insufficient or lack of communication of risk by military officers to subordinates Absence of protective equipment or resources Medical resources which are not adequate for fulfilling the needs of personnel Lack of monitoring of compliance status with public health advice | 36 (20) | |
Poor infrastructure | Structural building problems, mould within living space(s), inadequate ventilation system(s) in buildings, poor facilities (e.g., lack of sufficient lavatories for the number of personnel in building, lack or insufficient access to clean drinking water) | 28 (16) | |
Food contamination3 | Inadequate or irresponsible hygiene practices leading to food/water contamination Inadequate medical attention for ill staff Infrastructure issues which lead to food contamination Delivery of contaminated food | 19 (11) | |
Contractor mismanagement3 | Action(s) by outsourced company/individual that may adversely impact military personnel’s health | 7 (4) | |
Pressure from military leadership | Fear of disciplinary action for missing training or work to seek medical care Implicit expectation to continue duties despite feeling ill Explicit intimidation from superiors | 4 (2) | |
Individual | Ignoring public health advice | Non-compliance or poor adherence with protective health measures Delay or failure to seek medical care out of negligence or unspecified reasons | 42 (23) |
High risk behaviour | Substance abuse Unprotected sexual relations, sexual relations with commercial sex workers, visits to brothels or bawdy houses | 21 (12) |