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Integrated One Health Zoonoses Risk in Value Chains John ALLEN

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

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Integrated One Health Zoonoses Risk in Value Chains John ALLEN

  1. 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. 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. 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. 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. 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. 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. 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. 8. Paddy rice Coffee Fallow fields NTFP collection Land-use policies Population growth Baseline Economic Livelihoods Study
  9. 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. 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. 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. 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. 13. Ethical Conditions & Informed Consent Confidentiality Modest participation gifts Village Householder feedback Support for follow up health checks
  14. 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. 15. Improved Pig Management, Feeding and Housing Demonstrations of: dried cassava & stylo plot . Improved water systems and housing
  16. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 28. THANK YOU!
  • Palneez101

    Jul. 16, 2018
  • Tapak

    Jan. 9, 2018

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

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