Assessment for prevention and control of zoonotic causes
of acute bloody diarrhoea in rural Cambodia through an
EcoHealth approach
EcoHealth Conference, Kunming China 2012
Borin Khieu1 , Kerya Seng1, Samkol Pok1, Ty Chhay1, Chiv Phiny1, Jeffrey Gilbert2
1CelAgrid 2ILRI

Introduction
• High proportion of the population lives in poverty
and is dependent on livestock and farming for their
livelihoods.
• Families live in close contact with their livestock
increasing possibilities for zoonotic diseases.
• Acute diarrhea is an important disease and debility
in Cambodia - in terms of both deaths and DALYs.
• The study is conducted in the rural ecosystems to
understand the relationship between human
diarrheal disease and consumption of livestock
products and possible contact with animals as well
as other social and ecological factors.

Bloody Diarrhea Incidence in 2010
Source: CDC/MOH 2010

MOH reporting system
Source: CDC/MOH reporting system

Site selection
• Two provinces were selected representing two
important Cambodian Agro-Ecological Zones (AEZ) in
Cambodia.
• Kampot represents the coastal AEZ with low poverty
share (3.21%) while Prey Veng represents the lower
Mekong floodplain AEZ with high poverty share
(16.28%) but both have high population density.
• 04 ODs were selected of which 2 with highest and 2
with lowest bloody diarrhoea incidence.

Data collection and analysis
• Questionnaire was used and 400hhs
were interviewed.
• A participatory tools/techniques such as
village and land use mapping, seasonal
calendar, trend line, wealth ranking,
livelihood mapping, etc were used for
the focus group discussion.

Livelihood activities
Occupation Low incidence High incidence
Rice cultivation Main in wet season Main in wet season
Cattle keeping 60.5% 66.5%
Chicken raising 72.5% 78.5%
Duck raising 16.0% 36.5%
Pig raising 24% 45%
Village small shop 11.0% 16.5%
Unskilled labors 6.0% 22.5%
Fishing 9.0% 14.0%
Garment factory 20.5% 12.5%
workers
Construction workers 17.5% 12.5%

Management of livestock
Description Low incidence High incidence
Pig raising system
Penned 83.3% 42.2%
Free range all the time 10.4% 17.8%
Tied 0.0% 31.1%
Chicken raising system
Penned 5.5% 6.4%
Free range all the time 59.3% 63.7%
Free range in day 35.2% 29.9%
Cattle raising system
Penned 25.7% 9.02%
Graze in the day 69.9% 65.4%
Free range 2.7% 21.1%

Food consumption by HH
Food Low incidence High incidence
Pig meat
Consumption rate, % 87 64
Sources, % market 63.8 85.9
Beef
Consumption rate, % 23 32.5
Sources, % market 67.4 86.2
Chicken meat
Consumption rate, % 38.0 33.0
Sources, % market 32.1 23.9
Fish
Consumption rate, % 96.0 81.5
Sources, % market 51.7 45.7

Eating sick animals by HH
Low incidence High incidence
HH, % 9 36
Pig, % 0.5 4.5
Cattle, % 1.0 1.5
Chicken, % 7 34
Duck, % 0.0 2.5

Animal diseases
Kampot, % Prey Veng, %
Sick previous month
No 51 40
Yes 49 60
If yes, which species
Cattle 20 11
Pig 7 10
Chicken 70 71
Unrecovered animal what to do
Use as food 13 35
Sell 4 18
Give to neighbour 1 2
Through away 21 10
Burry 61 30

People awareness of zoonotic diseases
Characteristics Kampot, % Prey Veng, %
Awareness of zoonotic diseases
No 13 20
Yes 87 80
If "yes" what are the disease
Avian influenza (AI) 100 100
H1N1 9 3
Blackleg 2 2
PPRS 1 1
Parasitic disease/teniasis 1 1
Cholera 1 1
FMD 1 1
Sources: Focus group discussion in 8 villages

Period of human diseases
Diseases Kampot Prey Veng
Diarrhea Jan – Jun Mar – Jun
Stomachache None Jan – Feb
Cough and flu Nov – Dec May – Aug
Dengue fever Jun – Sept May – Oct
Cholera April – May None
Typhoid Jan to Dec Jan to Dec
Sources: Focus group discussion – Seasonal Calendar

Sickness in the households
Low incidence High incidence
Diarrhea, % 11 23.5
Opinions of sickness causes
Food, % 59.1 63.8
Water, % 9.1 25.5
Too hot, % 18.2 17.0
Types of food ate last 2 weeks
Vegetable, % 53.9 79.3
Fruits, % 15.4 0.0
Beef, % 7.7 3.5
Pork, % 7.7 0.0
Fish/seafood/shellfish, % 7.7 6.9
Snack, % 7.7 6.9

Seeking for treatment
Places Low incidence High incidence
Hospital, % 30.1 11.8
Private clinic, % 20.6 13.7
Pharmacy, % 45.6 49.0
Traditional medicine, % 7.4 6.9
Traditional healer, % 0.0 15.7
Go abroad, % 0.0 3.9

NEXT
• Continue cross sectional study in 8 new villages to
identify key risk factors – particularly consumption of
sick/dead livestock.
• Collecting sample of human, animal and environment
for the determination of specific zoonotic pathogens.

EcoZD Project
For more information about the EcoZD project, please visit:
www.ilri.org/ecozd
www.ilriasia.wordpress.com/tag/ecozd