Prevention and control of zoonotic causes of acute bloody diarrhoea in rural Cambodia through an EcoHealth approach
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Prevention and control of zoonotic causes of acute bloody diarrhoea in rural Cambodia through an EcoHealth approach

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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 ...

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 zoonotic causes of acute bloody diarrhoea in rural Cambodia through an EcoHealth approach Presentation Transcript

  • 1. Prevention and Control of Zoonotic Causes of Acute Bloody Diarrhoea in rural Cambodia through an EcoHealth Approach. Dr. Khieu Borin & Dr. Seng Sokerya Dr. Teng Srey et al. Dr. Tan Phannara et al. EcoZD annual meeting Bangkok 10-12 December 2011
  • 2.
    • Diarrhoea is the third most important disease in Cambodia in terms of both deaths and DALYs*.
    • Some of the most commonly isolated pathogens are zoonotic or potentially zoonotic (e.g. pathogenic E. coli, campylobacter spp., salmonella spp., cryptosporidium…).
    • Transmission may be via contaminated food or water or from direct contact with animals.
    • DALY= Disability-Adjusted Life Years
    Background
  • 3.
    • In the countryside a high proportion of the population lives in poverty and is dependent on livestock and farming for their livelihoods.
    • Close contact with their livestock increase possibilities for zoonotic disease, including diarrhoeal disease.
    • Limitations in human and financial resources to provide surveillance and detection of disease in man and livestock are not adequate to serve such large numbers of small-holders.
  • 4.  
  • 5. Research objectives and general approach
    • To appropriately target the use of human and financial resources where they can potentially generate optimal impacts by determining the most important zoonotic diarrhoeal diseases.
    • It is also important to investigate and evaluate
      • The interaction between humans and animals in their systems
      • Social and ecological factors that influence risk
      • Prevalence of disease occurrence among those livestock producers as well animal production, social and ecological factors.
  • 6. Consideration for these objectives on Ecohealth
    • The study is conducted in the rural and urban ecosystems to understand
      • The relationship between human diarrheal disease and consumption of livestock products
      • Possible contact with animals as well as other social and ecological factors.
  • 7.
    • To analyse existing data on human diarrheal cases collected through short text messages available at the Communicable Disease Control Department at the Ministry of Health.
    • The last 12 months data were be screened and analysed to provide spatio-temporal distribution for human diarrhoea.
    • Two provinces will be selected for this study in which two sites will be identified, each representing low and high risk areas.
    • High prevalence areas were chosen for detailed prospective surveys.
    Retrospective study Research methodologies
  • 8. The MoH Communicable Surveillance System Remote SMS structure
  • 9. Prospective study
    • Focus group discussions using some of the relevant PRA techniques including
    • 1. Village Mapping 2. Farm Sketches
    • 3. Livelihood Mapping 4. Transect Walk
    • 5. Seasonal Calendar 6. Venn Diagram
    • 7. Timeline 8. Direct Matrix Ranking
    • 9. Problem Trees
    • Structured questionnaires
  • 10. Collaborations with boundary and strategic partners
    • Strategic partners
    • CelAgrid
    • MOH/CDC
      • Provincial of Health Department ( PHD )
        • Operational District ( OD )
          • Health Center (HC )
            • Village Health Support Group ( VHSG )
    • MAFF/DAHP/VPHO
      • Provincial Office of Animal Health and Production ( PAHP )
        • Office of Animal Health and Production District ( AHPD )
          • Village Animal Health Worker ( VAHW )
  • 11. Collaborations with boundary and strategic partners
    • Boundary Partners
    • Commune Councils (CC)
    • Village Chief (VC)
    • Village Development Committee (VDC)
    • Villagers (men, women and elders)
  • 12. Progress made
    • Retrospective study is completed in Feb. 2011
    • PRA works (FGD) and assessment (structural interview) were completed in Aug. 2011
    • Reporting results is still to be finalized
  • 13. Results Retrospective study Kampot OD: 1. Toeuk Chhou district > Prey Thnong commune > Domnak Laoung village 2. Kampot town > Sangkat Krang Ampil > Svay Thom village Angkor Chey OD: 1. Angkor Chey district > Phnom Kong commune > Damnak Chambork village 2. Angkor Chey district > Phnom Kong commune > Pour village Preah Sdach OD: 1. Preah Sdach district > Preah Sdach commune > Tnot Tol village 2. Preah Sdach district > Preah Sdach commune > Tuol Chey village Svay Santhor OD: 1. Ba phnum district > Theay commune > Kampong Sneh 2. Ba phnum district > Theay commune > Torb Sdech village
  • 14. Prospective study Village mapping
  • 15. Farm sketch
  • 16. Institutional diagram Institutions involved when diarrhea outbreak in Damnak Chambork village.
  • 17. Planned activities for 2012 and beyond Activities Plan to start Remark Village work - PRA Completed Household survey Completed Analysis In progress Summarizing data Expect to complete in at the end of Dec. 2011 Feedback meetings and workshop 3-Oct-11 Delay to Jan 2012 Workshop - ministries and local authority feedback 25-Oct-11 Delay Output: Year 1 report - PRA training report, combine PRA and HH survey report
  • 18. Planned activities for 2012 and beyond Activities Plan to start Longitudinal study Jan 2012 Participatory planning and follow up meetings Jan 2012 Data collection and sampling - 50 farmers per village once in every three months Mar 2012 Samples analysis Mar 2012 Human manure - assuming 10% of interviewed HHs Mar 2012 Environmental samples - 3 places Mar 2012 Workshop and Policy feedback May 2013 Output: Year 2 report - Longitudinal study and final report Aug 2013
  • 19. Expected outputs and outcomes
    • Papers, reports
    • Conference presentation, workshop at national and village level
    • Behavior changes of partners
      • Poloicy maker regulation
      • Household/community practices
  • 20. Perspectives
    • Increase an understanding of health and agriculture to address the complexity of health problem by concerned institutions.
    • Increasing possibility to marry health and agriculture.