Presented by Khieu Borin, Seng Sokerya, Teng Srey and Tan Phannara to the Progress Meeting on Ecosystem Approaches to the Better Management of Zoonotic Emerging Infectious Diseases in the South East Asian Region, Bangkok, 10-13 December 2011.
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Prevention and Control of Prevention and Control of Zoonotic Causes of Acute Bloody Zoonotic Causes of Acute Bloody Diarrhoea in rural Cambodia Diarrhoea in rural Cambodia through an EcoHealth Approach. through an EcoHealth Approach. Dr. Khieu Borin & Dr. Seng Sokerya Dr. Khieu Borin & Dr. Seng Sokerya Dr. Teng Srey et al. Dr. Teng Srey et al. Dr. Tan Phannara et al. Dr. Tan Phannara et al. EcoZD annual meeting EcoZD annual meeting Bangkok 10-12 December 2011 Bangkok 10-12 December 2011
Transcript
Prevention and Control of Zoonotic Causes Prevention and Control of Zoonotic Causes of Acute Bloody Diarrhoea in rural Cambodia of Acute Bloody Diarrhoea in rural Cambodia
through an EcoHealth Approach.through an EcoHealth Approach.
Dr. Khieu Borin & Dr. Seng SokeryaDr. Khieu Borin & Dr. Seng SokeryaDr. Teng Srey et al. Dr. Teng Srey et al.
Dr. Tan Phannara et al.Dr. Tan Phannara et al.
EcoZD annual meetingEcoZD annual meetingBangkok 10-12 December 2011Bangkok 10-12 December 2011
• Diarrhoea is the third most important disease in Diarrhoea is the third most important disease in Cambodia in terms of both deaths and DALYs*. Cambodia in terms of both deaths and DALYs*.
• Some of the most commonly isolated pathogens are Some of the most commonly isolated pathogens are zoonotic or potentially zoonotic (e.g. pathogenic E. zoonotic or potentially zoonotic (e.g. pathogenic E. coli, campylobacter spp., salmonella spp., coli, campylobacter spp., salmonella spp., cryptosporidium…).cryptosporidium…).
• Transmission may be via contaminated Transmission may be via contaminated food or water food or water or from direct contact with animals.or from direct contact with animals.
DALY= Disability-Adjusted Life YearsDALY= Disability-Adjusted Life Years
BackgroundBackground
• In the countryside a high proportion of the In the countryside a high proportion of the population lives in poverty and is dependent on population lives in poverty and is dependent on livestock and farming for their livelihoods. livestock and farming for their livelihoods.
• Close contact with their livestockClose contact with their livestock increase increase possibilities for zoonotic disease, including diarrhoeal possibilities for zoonotic disease, including diarrhoeal disease.disease.
• Limitations in human and financial resources to Limitations in human and financial resources to provide surveillance and detection of disease in man provide surveillance and detection of disease in man and livestock are not adequate to serve such large and livestock are not adequate to serve such large numbers of small-holders. numbers of small-holders.
Research objectives and general approachResearch objectives and general approach
• To appropriately target the use of human and To appropriately target the use of human and financial resources where they can potentially financial resources where they can potentially generate optimal impacts by determining the most generate optimal impacts by determining the most important zoonotic diarrhoeal diseases.important zoonotic diarrhoeal diseases.
• It is also important to investigate and evaluateIt is also important to investigate and evaluate– The interaction between humans and animals in their The interaction between humans and animals in their
systemssystems– Social and ecological factors that influence riskSocial and ecological factors that influence risk– Prevalence of disease occurrence among those livestock Prevalence of disease occurrence among those livestock
producers as well animal production, social and producers as well animal production, social and ecological factors.ecological factors.
Consideration for these objectives on Ecohealth Consideration for these objectives on Ecohealth
• The study is conducted in the rural and urban The study is conducted in the rural and urban ecosystems to understandecosystems to understand
– The relationship between human diarrheal disease and The relationship between human diarrheal disease and consumption of livestock productsconsumption of livestock products
– Possible contact with animals as well as other social and Possible contact with animals as well as other social and ecological factors.ecological factors.
• To analyse existing data on human diarrheal cases collected To analyse existing data on human diarrheal cases collected through short text messages available at the Communicable through short text messages available at the Communicable Disease Control Department at the Ministry of Health.Disease Control Department at the Ministry of Health.
• The last 12 months data were be screened and analysed to The last 12 months data were be screened and analysed to provide spatio-temporal distribution for human diarrhoea. provide spatio-temporal distribution for human diarrhoea.
• Two provinces will be selected for this study in which two Two provinces will be selected for this study in which two sites will be identified, each representing low and high risk sites will be identified, each representing low and high risk areas.areas.
• High prevalence areas were chosen for detailed prospective High prevalence areas were chosen for detailed prospective surveys. surveys.
Retrospective studyRetrospective study
Research methodologiesResearch methodologies
The MoH Communicable Surveillance SystemThe MoH Communicable Surveillance System
Remote SMS structure Remote SMS structure
Prospective studyProspective study
• Focus group discussions using some of the relevant Focus group discussions using some of the relevant PRA techniques includingPRA techniques including
1. Village Mapping1. Village Mapping 2. Farm Sketches2. Farm Sketches3. Livelihood Mapping3. Livelihood Mapping 4. Transect Walk4. Transect Walk5. Seasonal Calendar5. Seasonal Calendar 6. Venn Diagram6. Venn Diagram7. Timeline7. Timeline 8. Direct Matrix Ranking8. Direct Matrix Ranking9. Problem Trees9. Problem Trees
• MOH/CDCMOH/CDC Provincial of Health Department (Provincial of Health Department (PHDPHD) )
Operational District (Operational District (ODOD) ) Health Center Health Center (HC(HC) )
Village Health Support Group (Village Health Support Group (VHSGVHSG))
• MAFF/DAHP/VPHOMAFF/DAHP/VPHO Provincial Office of Animal Health and Production (Provincial Office of Animal Health and Production (PAHPPAHP) )
Office of Animal Health and Production District (Office of Animal Health and Production District (AHPDAHPD) ) Village Animal Health Worker (Village Animal Health Worker (VAHWVAHW))
Collaborations with boundary and strategic partnersCollaborations with boundary and strategic partners
Boundary PartnersBoundary Partners
• Commune Councils (CC)Commune Councils (CC)• Village Chief (VC)Village Chief (VC)• Village Development Committee (VDC)Village Development Committee (VDC)• Villagers Villagers (men, women and elders)(men, women and elders)
Progress madeProgress made
• Retrospective study is completed in Feb. Retrospective study is completed in Feb. 20112011
• PRA works (FGD) and assessment (structural PRA works (FGD) and assessment (structural interview) were completed in Aug. 2011interview) were completed in Aug. 2011
• Reporting results is still to be finalizedReporting results is still to be finalized
ResultsResultsRetrospective studyRetrospective study
Kampot OD:Kampot OD:
1. Toeuk Chhou district > Prey 1. Toeuk Chhou district > Prey Thnong commune > Domnak Thnong commune > Domnak Laoung villageLaoung village
2. Kampot town > Sangkat Krang 2. Kampot town > Sangkat Krang Ampil > Svay Thom villageAmpil > Svay Thom village
Angkor Chey OD:Angkor Chey OD:
1. Angkor Chey district > Phnom 1. Angkor Chey district > Phnom Kong commune > Damnak Kong commune > Damnak Chambork village Chambork village
2. Angkor Chey district > Phnom 2. Angkor Chey district > Phnom Kong commune > Pour villageKong commune > Pour village
Preah SdachPreah Sdach OD:OD:
1. Preah Sdach district > Preah 1. Preah Sdach district > Preah Sdach commune > Tnot Tol villageSdach commune > Tnot Tol village
2. Preah Sdach district > Preah 2. Preah Sdach district > Preah Sdach commune > Tuol Chey villageSdach commune > Tuol Chey village
Svay Santhor OD:Svay Santhor OD:
1. Ba phnum district > Theay 1. Ba phnum district > Theay commune > Kampong Sneh commune > Kampong Sneh
2. Ba phnum district > Theay 2. Ba phnum district > Theay commune > Torb Sdech village commune > Torb Sdech village
Summarizing dataSummarizing dataExpect to complete in Expect to complete in at the end of Dec. 2011at the end of Dec. 2011
Feedback meetings and workshopFeedback meetings and workshop 3-Oct-113-Oct-11 Delay to Jan 2012Delay to Jan 2012
Workshop - ministries and local Workshop - ministries and local authority feedbackauthority feedback 25-Oct-1125-Oct-11 DelayDelay
Output: Year 1 report - PRA training report, combine PRA and Output: Year 1 report - PRA training report, combine PRA and HH survey reportHH survey report
Activities Activities Plan to startPlan to startLongitudinal studyLongitudinal study Jan 2012Jan 2012
Participatory planning and follow up meetingsParticipatory planning and follow up meetings Jan 2012Jan 2012
Data collection and sampling - 50 farmers per Data collection and sampling - 50 farmers per village once in every three months village once in every three months Mar 2012Mar 2012
Samples analysisSamples analysis Mar 2012Mar 2012
Human manure - assuming 10% of interviewed HHsHuman manure - assuming 10% of interviewed HHs Mar 2012Mar 2012
Workshop and Policy feedbackWorkshop and Policy feedback May 2013May 2013
Output: Year 2 report - Longitudinal study and final Output: Year 2 report - Longitudinal study and final reportreport Aug 2013Aug 2013
Planned activities for 2012 and beyondPlanned activities for 2012 and beyond
Expected outputs and outcomesExpected outputs and outcomes
• Papers, reportsPapers, reports
• Conference presentation, workshop at national and Conference presentation, workshop at national and village levelvillage level
• Behavior changes of partnersBehavior changes of partners– Poloicy maker regulationPoloicy maker regulation– Household/community practicesHousehold/community practices
PerspectivesPerspectives
• Increase an understanding of health and agriculture Increase an understanding of health and agriculture to address the complexity of health problem by to address the complexity of health problem by concerned institutions.concerned institutions.
• Increasing possibility to marry health and agriculture.Increasing possibility to marry health and agriculture.
