Presentation at 3rd GRF One Health Summit 2015 Session Focus on Behaviours

1. Integrated Market Chain and Zoonoses Risk Assessments in
Cross Border Pork Value Chains in Lao PDR
Okello A, Tiemann T, Inthavong P, Okello W, Phengvilaysouk A,
Keonouchanh S, Khamlome B, Newby J, Blaszak K and John Allen

2. Population:
 6.5 M
 Approx 7,000 rural villages
 An estimated 85% of the population are
agriculturist
GDP - composition by sector:
 agriculture: 27.8%
 industry: 34.8%
 services: 37.4%
Lao PDR – very much a rural based population

3. Pig production in Lao PDR
Background
- Pigs kept by up to 75% of rural households
- Pork 2nd most consumed meat in country
- Smallholder (seasonal free range) pig production
accounts > 80%
-Informal slaughter practices
Rational for the Study
- Lack of technical knowledge and poor access to pig
market chains results in poor motivation for villagers
to invest in improved production inputs
- Human health impacts from pig associated zoonotic
diseases exist
- Recommendations for control of zoonoses need to
be evidence based, realistic and cost effective

4. • Conduct Market Chain Study
• Conduct Economic Livelihood Study
• Improve Pig Health & Production Systems - forage crops, pig housing,
vaccination and de-worming
• Conduct Sero-prevalence Disease Study and Targeted Health Messages
and Interventions - humans and pigs (using PPS on human population
data) and Risk Factor Questionnaires for selected pig associated zoonotic
diseases
Essentially a One Health - One System Approach
Multi-disciplinary teams established to:

5. Study areas: 4 representative villages selected in each area
Phongsaly Province (Upland)
Mai District – 88 villages, half of which
are accessible by road with pop. of 25,448
• Borders Vietnam & China
• Multiple ethnicities
• Mountains limit crop-production
therefore pig-rearing common
Xayabouri Province (Lowland)
Xayabouri District – 77 villages with
pop. of 70,000
• Borders Thailand
• Large rice producer (floodplains)

6. General Characteristics of the 8 Study Villages
Village Distance from
District HQ Town
(km)
Represented Ethnicities Number of
people in Village
Mai District (Upland Area)
A 18 Tai Dam 372
B 15 Khmu 147
C 11 Tai Deng/Khmu/Tai
Dam/Lao
528
D 6 Khmu/Tai Dam 247
Xayabouri District (Lowland Area)
E 18 Khmu/Lao 1,115
F 16 Khmu/Hmong 905
G 15 Hmong 275
H 10 Hmong/Lao/Mian 812

7. Village Characteristics
• Some communities isolated in wet
season - other villages with good all-year
road access
• All villagers have remote fields
(sanaams) with remote accommodation as
well as family house in the village
• Low proportion of HHs had latrines
• Free range local breed (Moo Lath) Pigs

8. Paddy rice
Coffee
Fallow fields
NTFP collection
Land-use policies
Population growth
Baseline Economic Livelihoods Study

9. Percentage of Households with Livestock in the 8 Study Villages
Village Cattle Buffalo Pig Goat Poultry
Mai District (Upland Area)
A 0% 79% 100% 0% 63%
B 87% 93% 93% 0% 67%
C 5% 62% 90% 0% 43%
D 10% 67% 86% 0% 52%
Xayabouri District (Lowland Area)
E 19% 0% 76% 14% 43%
F 39% 43% 100% 9% 13%
G 93% 27% 93% 33% 67%
H 57% 24% 90% 5% 52%
Total 35% 48% 91% 7% 48%

10. Interprovincial traders
Provincial traders
Local traders
Farmers in Houay Oun
Farmers in Om Ka
Nang
Farmers in Na Kham
Farmers in Paung
Khao
Farmers in Sop Houn
Farmers in Mok Ja La
Farmers in
Om Pha Long
Farmers in Houay
Xong Tai
Traders from Ban Houay
Vang
Traders from Nam Nga
Trader from Mueang
Khua
Trader from Oudomsai
Retailer from
Mueang Mai
Vietnamese
Traders
Vietnamese
Restaurants
?
Market chain in Mai District

11. Koum Ban Na Tark
Farmers in Nong
Nong
Farmers in Houay
Loun
Koum Ban Na Sam
Farmers in Houay
Dok
Farmers in Pha
Xang
Farmers in Na Sam
Farmers in Houay
Kang
Local traders
Traders from XB town
Traders from XB
district
Provincial traders
Traders from XB town
Retailers from LP
and XB (town) *
Direct sale at
market
Vendors at XB
marketKoum Ban Na Mon
Koum Ban Lak 14
Koum Ban Lak 18
Koum Ban Houay Sa Ngam
Koum Ban Khad Nam Lap
Phoeng district
Koum Ban Khad Nam Jap
Market chain in Xayabouri District
Increasing Competition
from Thailand - contract
pig producers using
European exotic breeds

12. Selection of diseases for sero-prevalence study
Planning meeting with all partners
– Interpretation of serology diagnostic tests available
Transmission routes considered:
– Raw / undercooked pork consumed
– Open defecation practiced many villages
– Direct contact with pigs common
Previous ACIAR funded work in Laos (Conlan et al, 2008)
Dept of Health – listed Lao priority diseases
7 priority Pig associated zoonotic & 4 pig production disease chosen:
Japanese Encephalitis virus, Trichinella, Hepatitis E virus, Taenia solium
cysticercosis/taeniases, Coxiella burnetti (Q fever) & Brucellosis
Classical Swine Fever (CSF), Porcine Respiratory & Reproductive Syndrome
(PRRS), Erysipelas & FMD

13. Ethical Conditions & Informed Consent
Confidentiality
Modest participation
gifts
Village Householder
feedback
Support for follow up
health checks

14. Key Results and Outcomes
• Pig Production Improvements
• Access to Market Chains
• Pig Health Improvements
• Human Pig Associated Zoonotic Disease Sero-
prevalence and Key Risk Factors Identified

15. Improved Pig Management, Feeding and Housing
Demonstrations of: dried cassava & stylo plot . Improved water systems and housing

16. Regular weighing of village pigs gave
immediate feedback to farmers and
also helped farmers in negotiating
prices with visiting pig traders
Monitoring Pig Performance Data

17. 0
100
200
300
400
500
600
0 20 40 60
Ageatsale[days]
Pig weight [kg]
Outsiders
0
100
200
300
400
500
600
0 20 40 60
Ageatsale[days]
Pig weight [kg]
Champions
Pig age and weight at sale for “Outsider” and “Champion” pig farmers

18. Improved Pig Health Outcomes through access to “cold
chain” vaccinations and village biosecurity practices
Based on sero-conversion detected by ELISA, it was demonstrated
that the Lao produced CSF and the Vietnamese PRRS vaccines were
providing excellent sero-conversions
Pig deaths from CSF and PRRS were greatly reduced
Percentage of Pigs with
Positive Abs
Pre Vaccination Post Vaccination
Post Booster
Vaccination
CSF 5% 97% 90%
PRRS 7% 96% NA

19. Access to Larger Cross Border Pig Value Chains was Critical
Mai District
•Local market demand only 2 to 3 pigs per day.
• Linking farmers to Vietnamese market chains in the City of Dien Bien Phu proved
very successful
• Project facilitated discussions with Provincial Government – led to approval for
Vietnamese traders to operate legally inside Phongsali Province, Laos
• Resulted in 10% price increase for farmers. Market chain into Vietnam
increased to 15 pigs per day
• Led to development of input value chains – i.e. farmers arranged for traders to
bring in concentrate pig feed and piglets from Vietnam for fattening
Process was originally facilitated through the project but
progressively handed over the local farmers and cross border
traders – a good sustainable outcome

20. Income from agricultural endeavours in 3 of the (road accessible)
villages in Mai District in 2011 (Original) and 2014 (ReSurvey)
0
5
10
15
20
25
Original ReSurvey Original ReSurvey Original ReSurvey
Omkaneng Paungkao Sophoun
Mai
LAK[millions] Average of NTFP Count of Rubber
Count of Coffee Average of Otherlivestock
Average of Pigs Average of Vegetable
Average of Annual Crop Average of Paddy
* Souphon village has access to main road from Lao to Vietnam – visits by Vietnamese Pig traders
initially encouraged and now established with Provincial approval
*

21. Baseline Sero-prevalence of Pig Associated Zoonotic
and Pig Health Diseases in Villagers and Village Pigs
Disease Humans % Prevalence
(95%CI)
Pigs % Prevalence
(95% CI)
Japanese Encephalitis IgM 3.1 (1.2, 7.8) 4.7 (2.2, 9.9)
Japanese Encephalitis IgG Not Tested 73.3 (64.9, 80.9)
Hepatitis E IgG 66.6 (57.1, 73.3) 76.6 (68.5, 83.1)
Trichinella IgG 58.6 (49.9, 66.8) 23.4 (16.9, 31.5)
Taenia solium IgG 4.7 (2.2, 9.9)*(“hotspot” village) Not Tested
Cysticercosis IgG 9.4 (5.5, 15.7)*(“hotspot” village) Not Tested
Brucella suis 0 0.8 (0.1, 4.3)
Coxiella burnetti 0 1.6 (0.4, 5.5)
Erysipelas Not Tested 58.8 (49.6, 67.2)
Classical Swine Fever (CSF) Not Tested 5.3 (2.2, 10.9)
PRRS Not Tested 6.9 (3.3, 12.9)
FMD (non structural ELISA) Not Tested 1.5 (0.2, 5.5)

22. Human Cysticercosis Sero-prevalence
Overall Human Cysticercosis Ab Prev 4.7% (with “hot spot “ villages as indicated) Om Phalong
*Refer to presentation under GRF Mon 5.1

23. Risk Factors Analysis for Pig Associated Zoonotic Diseases
in the studied villages
Disease Risk Factor Odds ratio (95% CI)
Hep E IgG humans Not boiling water 4.01 (1.87, 8.56)
Living <50 m from pigs 2.28 (1.72, 3.00)
Slaughtering Pigs 2.49 (1.17, 5.28)
Lower household education levels 1.74 (1.7, 2.39)
Hep E IgG pigs Pigs confined in pens 2.70 (1.72, 4.23)
Trichinella IgG Ethnicity – Hmong 1.77 (1.00, 3.12)
Ethnicity - Lao Loum 1.53 (1.14, 2.06)
Eating raw pork or blood 3.79 (1.02, 13.79)
Lower household education
levels
0.38 (0.27, 0.54)
Taenia/cysticercosis IgG
humans
Low usage of toilets and free
ranging pigs
2.65 (1.37, 5.12)
Ethnicity – Thai Dam 1.33 (1.06, 1.68)

24. Conclusions and Implications for Policy Consideration
Hepatitis E Virus
Two Hep E virus genotypes are pig-human adapted and we confirmed that
one of those genotypes (Genotype 3) is present in the Lao villages.
The high antibody prevalence in pigs and humans reflects the large
proportion of pig raising households and contamination of water sources
and crops from pig faeces, especially after wet season run-off
Further Investigations required to assess the health impact by matching
with Jaundice syndromic case reports in rural hospitals and health clinics

25. Conclusions and Implications for Policy Consideration
(Continued)
Taenia Solium & Cysticercosis
Presents significant challenges for certain rural Lao villages:
- Toilet provision and personal hygiene may be low and customs may involve
consumption of raw or undercooked pork
Further work is needed to validate the most efficient methods to identify
those “Hot Spot” villages with hyper-endemicity
An Integrated pig-human intervention was undertaken in one of the selected
villages to reduce the impact of taeniasis and cysticercosis and soil
transmitted helminths (STHs) [refer to separate presentation under Mon 5.1]

26. Conclusion
By using a One Health – One System Approach that complemented:
- market chain information and improved market access,
- pig production improvements;
- serological and risk analyses for several pig-associated zoonotic diseases
we felt that sustainable outcomes could be achieved for poverty alleviation
and improved public health
Greater access is required to cross-border Market Chains from Laos into the
much larger population centres in Vietnam and China
Strong market pull encourages village farmers to invest in improved pig
production inputs (feed, housing, vaccination) leading to improved household
income

27. Acknowledgements
The project team wishes to:
- Gratefully acknowledge the support of all village and district based staff involved in the
field collection and laboratory testing – a tremendous effort!
-Thank the Lao Ministry of Agriculture and Ministry of Health
The Research was funded by the Australian Centre for International Agricultural
Research (ACIAR) Animal Health program grants AH/2009/001 and AH/2010/019
For Further Information contact: Dr John Allen
Phone: +61 3 5227 5162
Email: john.allen@csiro.au

28. THANK YOU!