Ecosystem approaches to the better management of zoonotic emerging infectious diseases in the Southeast Asia region (EcoZd)

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Diarrhea illness in livestock keeping households in Cambodia: An analysis using a One Health framework
(Journal Article, 2023-03-30) Asakura, Shingo; Khieu, B.; Seng, S.; Pok, S.; Ty, C.; Phiny, C.; Srey, T.; Blacksell, S.D.; Gilbert, Jeffrey; Grace, Delia; Alonso, Silvia
Background: Most of human diarrheal pathogens are zoonotic, and transmission of the pathogens can occur by contaminated food, water, environment and direct contact with animals especially for livestock keepers. Yet little is known of the relative importance of different risk factors especially in under-studied countries. The objectives of this study were to identify risk factors for diarrhea in livestock keepers in Cambodia and detect diarrhea-causing pathogenic bacteria in both humans and livestock within a One Health approach. Of special interest were the links between diarrhea and food consumption and livestock-keeping. Materials and methods: We used an existing dataset from a questionnaire survey conducted in 400 livestock farms in Prey Veng and Kampot Prefectures between February and March 2013 as well as laboratory results on bacterial isolation from fecal and swab samples from livestock and poultry, and human stool samples. Laboratory results were available for up to three animals of each species kept by a household, and for up to three human samples from households reporting at least one case of human diarrhea in the previous 2 weeks. Presence of Escherichia coli, Shigella spp. and Salmonella spp. was investigated in both animal and human samples, in addition to Aeromonas spp., Vibrio spp. and Plesiomonas spp. in animal samples and Campylobacter spp. in human samples. Univariable and multivariable risk factor analyses were performed by generalized linear mixed model. Results: Household-level diarrhea incidence rate was 9.0% (36/400). The most statistically significant factor associated with diarrhea in multivariable analysis was water treatment for drinking and cooking (OR = 0.33, 95%CI: 0.16–0.69, p = 0.003), followed by number of days consuming egg within 2 weeks (OR = 1.16, 95%CI: 1.04–1.29, p = 0.008), number of children under 5 years old (OR = 1.99, 95%CI: 1.14–3.49, p = 0.016) and keeping poultry (OR = 0.36, 95%CI: 0.14–0.92, p = 0.033). Animal samples for bacterial culture test were collected at 279 cattle, 165 pig and 327 poultry farms, and bacteria were detected from 6 farms with the isolation of Escherichia coli O157 (non H7) from 1 cattle and 1 pig sample, Aeromonas caviae from 1 pig sample and Salmonella spp. from 3 chicken samples. In human samples, 17 out of 67 individual samples were positive for the culture test, detecting Escherichia coli O157 (non H7) from 7 samples and Shigella spp. from 10 samples. None of the households where target bacteria were detected from animal samples had human samples collected due to lack of diarrhea episodes in the household. Conclusions: It has often been hypothesized that keeping livestock may increase the incidence of diarrhea through multiple pathways. Contrary to this, we found livestock-keeping was not associated with increased risk, but food-related behavior and children under 5 years of age were strongly associated with increased risk. We discuss mediating and confounding factors and make recommendations for reducing the burden of diarrheal disease in Cambodia and more widely in low- and middle-income countries.
A glance into traditional pig slaughtering practices in Vietnam and opportunities for zoonotic disease prevention
(Journal Article, 2023-02-21) Ting, N.I.; Sinh Dang-Xuan; Gilbert, Jeffrey; Nguyen Thao Thi Nguyen; Lam, S.; Hung Nguyen-Viet
Introduction: African swine fever in Vietnam is contributing to existing concerns over zoonotic disease transmission from sick pigs to humans. While slaughterhouses are key sites of occupational hazards to workers and contamination of meat, the specific slaughtering practices contributing to zoonotic occupational and foodborne disease risks remain under-researched. Our objective is to identify and characterize aspects of pig slaughtering processes that contribute to such risks. Methods: We draw on qualitative observations, photos, and videos from three mobile slaughterhouses and seven abattoirs in Hung Yen, Vietnam. Results: Based on our analysis, areas likely leading to zoonotic disease risks include slaughtering procedures, personal hygiene of workers, equipment sanitation, and facility sanitation. Within the small-scale swine industry, slaughtering practices are long-standing and difficult to change. Conclusion: Our study underscores the importance of hygiene training of workers, improvements to equipment and facilities, and awareness-building activities targeting consumers to reduce the burden of zoonotic disease risks in small-scale pig slaughter settings.
Participatory and transdisciplinary studies of Brucella infection in humans and animals in Yunnan Province, China—Lessons learned
(Journal Article, 2021-07-15) Wengui Li; Xiangdong Yang; Lindahl, Johanna F.; Guorong Yang; Gilbert, Jeffrey; Unger, Fred
Brucellosis is an important zoonosis occurring globally. In addition to the risk for disease in humans, the disease causes production losses, since the disease in livestock is characterized by abortion and other reproductive failures. The disease is a public health concern in China, but no information is available on knowledge, perception and awareness of potential risk groups such as farmers, butchers and animal health workers; yet successful control requires compliance of those affected groups to be effective. Following the principles of the Ecohealth approach, emphasis was given to participation of all relevant stakeholders, use of qualitative and quantitative tools, and cross-sectorial collaboration. Data collection included on-farm questionnaires (N = 192) and collection of bulk milk samples of goat (N = 40), cattle (N = 45) and buffalo (N = 41) from farms, as well as serum samples (N = 228) from humans. Milk samples were tested with an ELISA for presence of antibodies, while a serum agglutination test was used for human samples. Qualitative work included 17 focus group discussion (FGD) with villagers and 47 in-depth interviews (IDI) with village animal health workers, doctors, and butchers, focused on knowledge, perception and awareness on zoonoses including brucellosis. Results from questionnaires indicate that abortions are a common problem; cattle with abortion history are kept for further insemination and the milk still consumed or sold. Antibodies against Brucella were detected in cows’ (5/45) and goats’ (1/40) milk samples, and in human samples (5/126) in Yiliang, while in Mangshi, all buffalo (N = 41) and humans (N = 102) were negative. FGD and IDI results showed an alarmingly low knowledge and awareness on zoonoses; particularly, low awareness about brucellosis was noted, even among the professional groups. Collaboration between village animal health workers and doctors was uncommon. No confirmed brucellosis cases were found in retrospective investigation of hospital and veterinary stations. This study demonstrates the presence of brucellosis in livestock and humans in Yunnan, indicating a non-negligible risk for humans. It is also made apparent that there is a need for increased awareness among both farmers and professionals in order to reduce the risk of zoonotic transmissions.
Leptospirosis in ruminants in Yogyakarta, Indonesia: A serological survey with mixed methods to identify risk factors
(Journal Article, 2021-05-20) Widiasih, D.A.; Lindahl, Johanna F.; Artama, W.T.; Sutomo, A.H.; Kutanegara, P.M.; Mulyani, G.T.; Widodo, E.; Djohan, T.S.; Unger, Fred
Leptospirosis is a zoonotic disease occurring worldwide with reproductive symptoms and production losses in livestock, while humans can suffer fatal renal failure. In Yogyakarta Special Province, Indonesia, there have been several outbreaks with high case fatality, demonstrating the public health importance, but there is limited understanding of the epidemiology. This study used an EcoHealth approach to ensure transdisciplinarity and community participation. Seroprevalence of Leptospira in animals was studied between October 2011 and May 2013 in 15 villages. Serum samples from 1404 cattle and 60 small ruminants were screened by a Microscopic Agglutination Test (MAT), first in pools, and then the individual positive samples were identified. Focus group discussions including farmers, village officials, and official stakeholders were used to explore knowledge and behavior of zoonotic diseases, particularly leptospirosis. Two small ruminants were seropositive for Leptospira icterohemorrhagiae. From the cattle, 3.7% were seropositive, and the most common serovars were Leptospira hardjo, followed by L. icterohemorrhagiae. Out of all farms, 5.6% had at least one positive cattle. Risk factor analyses showed that the risk of the farm being seropositive increased if the farmer used water from an open source, or if farming was not the main occupation. This study showed the presence of Leptospira spp. in ruminants in Yogyakarta and identified use of open water as a risk factor for the livestock. We also observed that the knowledge related to leptospirosis was low, and risky farm management practices were commonly employed.
Twenty-first Century disease threats, epidemiology and One Health
(Presentation, 2017-07-12) Unger, Fred
Ecohealth and One Health research in Southeast Asia: Examples, challenges, successes and outlook
(Presentation, 2017-03) Unger, Fred; Hung Nguyen-Viet; Grace, Delia
Determinants of vaccination coverage and consequences for rabies control in Bali, Indonesia
(Journal Article, 2017-01-09) Arief, R.A.; Hampson, Karen J.; Jatikusumah, A.; Widyastuti, M.D.W.; Sunandar; Basri, C.; Putra, A.A.G.; Willyanto, I.; Estoepangestie, A.T.S.; Mardiana, I.W.; Kesuma, I.K.G.N.; Sumantra, I.P.; Doherty, Peter F.; Salman, M.D.; Gilbert, Jeffrey; Unger, Fred
Maintaining high vaccination coverage is key to successful rabies control, but mass dog vaccination can be challenging and population turnover erodes coverage. Declines in rabies incidence following successive island-wide vaccination campaigns in Bali suggest that prospects for controlling and ultimately eliminating rabies are good. Rabies, however, has continued to circulate at low levels. In the push to eliminate rabies from Bali, high coverage needs to be maintained across all areas of the island. We carried out door-to-door (DTD) questionnaire surveys (n = 10,352 dog-owning households) and photographic mark–recapture surveys (536 line transects, 2,597 observations of free-roaming dogs) in 2011–2012 to estimate dog population sizes and assess rabies vaccination coverage and dog demographic characteristics in Bali, Indonesia. The median number of dogs per subvillage unit (banjar) was 43 (range 0–307) for owned dogs estimated from the DTD survey and 17 (range 0–83) for unconfined dogs (including both owned and unowned) from transects. Vaccination coverage of owned dogs was significantly higher in adults (91.4%) compared to juveniles (<1 year, 43.9%), likely due to insufficient targeting of pups and from puppies born subsequent to vaccination campaigns. Juveniles had a 10–70 times greater risk of not being vaccinated in urban, suburban, and rural areas [combined odds ratios (ORs): 9.9–71.1, 95% CI: 8.6–96.0]. Free-roaming owned dogs were also 2–3 times more likely to be not vaccinated compared to those confined (combined Ors: 1.9–3.6, 95% CI: 1.4–5.4), with more dogs being confined in urban (71.2%) than in suburban (16.1%) and rural areas (8.0%). Vaccination coverage estimates from transects were also much lower (30.9%) than household surveys (83.6%), possibly due to loss of collars used to identify the vaccination status of free-roaming dogs, but these unconfined dogs may also include dogs that were unowned or more difficult to vaccinate. Overall, coverage levels were high in the owned dog population, but for future campaigns in Bali to have the highest chance of eliminating rabies, concerted effort should be made to vaccinate free-roaming dogs particularly in suburban and rural areas, with advertising to ensure that owners vaccinate pups. Long-lasting, cheap, and quick methods are needed to mark vaccinated animals and reassure communities of the reach of vaccination campaigns.
One Health studies of pig associated zoonoses in smallholder pig production in Lao PDR
(Poster, 2016-12-07) Inthavong, Phouth; Khamlome, Boualam; Solomon, V.; Vongxay, K.; Allen, J.; Okello, A.; Conlan, J.; Gilbert, Jeffrey; Unger, Fred
Most people in rural areas of Lao PDR are living in close proximity to their livestock which may increase risk of being infected with pig zoonoses, either via direct contact with livestock, via consumption of contaminated pig products or mosquito vectors. Between 2006 and 2015 two ACIAR and one ILRI funded research projects were implemented in collaboration with animal and human health authorities of the Lao Government to study seroprevalence of pig production diseases and zoonoses. Overall 2341 human and 1356 pig serum samples were randomly collected from 81 villages in 8 provinces as well as from slaughterhouses. Pig samples were tested for zoonoses (Hepatitis E, Trichinella, Japanese Encephalitis and Cysticercosis) and some production pathogens; while human samples were tested for Hepatitis E, Trichinella, Japanese Encephalitis, Cysticercosis and Taeniasis. Results demonstrated the presence of in some cases high sero-prevalence of targeted pathogens among sampled human and pigs. Series of statistical analysis were performed to assess the risk factors and their association with any pathogens among pigs and human. The projects generated recommendations for control and future research, produced IEC materials, conducted public awareness and communication campaigns, and implemented intervention models for some diseases, and a number of articles published.
Brucellosis in ruminants in two counties of Yunnan, China and the use of an integrated approach for effective control
(Poster, 2016-09-19) Unger, Fred; Yang Shibao; Li Wengui; Yang Xiangdong; Yang Guorong
Brucellosis is an increasing production and public health concern in many countries of Asia including China. Challenges for an effective control include lack of collaboration between sectors or uncontrolled animal movement (among others). Yunnan might be at particular risk as ruminants are increasingly introduced from other parts of China e.g. Inner Mongolia, a known high prevalence area in a response to a higher demand for milk. To face this challenges, new integrated approaches are needed such as Ecohealth to support transdisciplinary collaboration versus silo thinking, the latter rather common in the top down animal health control system of China. In the presented research, which was part of an IDRC funded ILRI-Ecozd project, veterinary, public health, animal science experts from five provincial institutions, practitioners from the project sites, and policy authorities worked together to achieve a more effective control of brucellosis. The research was carried out between 2011 and 2013 in two counties of Yunnan, Mangshi and Yiliang and consisted of a historical data review, biological sampling (milk) in herds/households with dairy ruminants and people at risk (serum). Questionnaires were used to collect management data (N=192) from farmers; focus group discussions (villagers) and in depth interviews (village vets and human doctors) gained information on perception and awareness on zoonoses in general and more specifically on the targeted disease. Results from the biological sampling indicate brucellosis as an existing and potentially emerging public health concern depending on the production system. Risk factors for the spread of brucellosis were reported and included risky handling of aborted fetus among others. Awareness and perception on zoonoses (including brucellosis) of all interviewed groups was in general low. The use of a “learning by doing” EcoHealth approach led to improve team member's capacity on Ecohealth and its practical realisation in a field study, e.g. by building up collaboration between those institutions but also stakeholders. Crucial was the support by the Agriculture Department and Health Department of Yunnan. Outcome mapping indicated a change of behaviour in the targeted groups in particular on zoonoses knowledge and willingness to share of information between sectors (vet and public health).
Endemicity of zoonotic diseases in pigs and humans in lowland and upland Lao PDR: Identification of socio-cultural risk factors
(Journal Article, 2016-04-12) Holt, H.R.; Inthavong, Phouth; Boualam, K.; Blaszak, Kate; Keokamphe, C.; Somoulay, V.; Phongmany, A.; Durr, P.A.; Graham, K.; Allen, J.; Donnelly, B.; Blacksell, Stuart D.; Unger, Fred; Grace, Delia; Alonso, Silvia; Gilbert, Jeffrey
In Lao People’s Democratic Republic pigs are kept in close contact with families. Human risk of infection with pig zoonoses arises from direct contact and consumption of unsafe pig products. This cross-sectional study was conducted in Luang Prabang (north) and Savannakhet (central-south) Provinces. A total of 59 villages, 895 humans and 647 pigs were sampled and serologically tested for zoonotic pathogens including: hepatitis E virus (HEV), Japanese encephalitis virus (JEV) and Trichinella spiralis; In addition, human sera were tested for Taenia spp. and cysticercosis. Seroprevalence of zoonotic pathogens in humans was high for HEV (Luang Prabang: 48.6%, Savannakhet: 77.7%) and T. spiralis (Luang Prabang: 59.0%, Savannakhet: 40.5%), and lower for JEV (around 5%), Taenia spp. (around 3%) and cysticercosis (Luang Prabang: 6.1, Savannakhet 1.5%). Multiple correspondence analysis and hierarchical clustering of principal components was performed on descriptive data of human hygiene practices, contact with pigs and consumption of pork products. Three clusters were identified: Cluster 1 had low pig contact and good hygiene practices, but had higher risk of T. spiralis. Most people in cluster 2 were involved in pig slaughter (83.7%), handled raw meat or offal (99.4%) and consumed raw pigs’ blood (76.4%). Compared to cluster 1, cluster 2 had increased odds of testing seropositive for HEV and JEV. Cluster 3 had the lowest sanitation access and had the highest risk of HEV, cysticercosis and Taenia spp. Farmers which kept their pigs tethered (as opposed to penned) and disposed of manure in water sources had 0.85 (95% CI: 0.18 to 0.91) and 2.39 (95% CI: 1.07 to 5.34) times the odds of having pigs test seropositive for HEV, respectively. The results have been used to identify entry-points for intervention and management strategies to reduce disease exposure in humans and pigs, informing control activities in a cysticercosis hyper-endemic village.
Assessment of hygienic practices among pig slaughterhouses and markets in Chiang Mai Province, Thailand
(Presentation, 2015-08-03) Jenpanich, C.; Unger, Fred; Alter, T.; Chaisowwong, W.
Insufficient hygienic practices of food handlers such as poor personal hygiene associated with foodborne illness can lead to crosscontamination along food chains. This study aimed to assess knowledge, attitudes and practices (KAP) of food handlers regarding food safety and hygienic practices in addition to assess the level of microbiological hygiene indicators. A cross-sectional study was conducted in 16 slaughterhouses and 31 markets in Chiang Mai province. Overall 32 slaughterhouse workers and 51 pork sellers were assessed to determine their KAP by questionnaires including likert-scales. Microbiological hygiene indicators were determined by conventional cultural methods. KAP results indicated a high level of knowledge (80 to 100%) concerning cross contamination, personal hygiene and time-temperature control but hold medium level (50 to 75%) for foodborne illness. Eighty-five percent of food handlers knew that good personal hygiene could prevent foodborne disease. Identified gaps between attitudes and practices indicated that some hygiene measures are inappropriate in the context of their practical implementation and some of these hygiene practices are not in accordance with their socioeconomic status. There were variations of knowledge between slaughterhouse workers and sellers. Mean of aerobic bacteria count from carcass swabs at slaughterhouses and pork samples at markets were 3.09±1.34 log10 cfu/cm2 and 5.50±0.39 log10 cfu/g. respectively. The mean Enterobacteriaceae count was 0.03±1.08 log10 cfu/cm2 and 2.55±1.43 log10 cfu/g respectively. Existing hygiene recommendations should be revised and adjusted according to their practical implementation considering also socio-economics and other factors of food handlers. Our results provide basic information for educational programs in order to improve knowledge of food safety and hygiene practices and narrow down the gaps between attitudes and practices.
Assessment of hygienic practices among pig slaughterhouses and markets in Chiang Mai Province, Thailand
(Poster, 2015-08) Jenpanich, C.; Unger, Fred; Alter, T.; Chaisowwong, W.
Insufficient hygienic practices of food handlers such as poor personal hygiene associated with foodborne illness can lead to crosscontamination along food chains. This study aimed to assess knowledge, attitudes and practices (KAP) of food handlers regarding food safety and hygienic practices in addition to assess the level of microbiological hygiene indicators. A cross-sectional study was conducted in 16 slaughterhouses and 31 markets in Chiang Mai province. Overall 32 slaughterhouse workers and 51 pork sellers were assessed to determine their KAP by questionnaires including likert-scales. Microbiological hygiene indicators were determined by conventional cultural methods. KAP results indicated a high level of knowledge (80 to 100%) concerning cross contamination, personal hygiene and time-temperature control but hold medium level (50 to 75%) for foodborne illness. Eighty-five percent of food handlers knew that good personal hygiene could prevent foodborne disease. Identified gaps between attitudes and practices indicated that some hygiene measures are inappropriate in the context of their practical implementation and some of these hygiene practices are not in accordance with their socioeconomic status. There were variations of knowledge between slaughterhouse workers and sellers. Mean of aerobic bacteria count from carcass swabs at slaughterhouses and pork samples at markets were 3.09±1.34 log10 cfu/cm2 and 5.50±0.39 log10 cfu/g. respectively. The mean Enterobacteriaceae count was 0.03±1.08 log10 cfu/cm2 and 2.55±1.43 log10 cfu/g respectively. Existing hygiene recommendations should be revised and adjusted according to their practical implementation considering also socio-economics and other factors of food handlers. Our results provide basic information for educational programs in order to improve knowledge of food safety and hygiene practices and narrow down the gaps between attitudes and practices.
Practical application of One Health principles to field-based multidisciplinary undergraduate training
(Presentation, 2015-07-23) Unger, Fred
EcoHealth and One Health—Moving from concepts to implementation: “Learning by doing” through case studies
(Presentation, 2015-05-27) Unger, Fred
A decade of capacity building on Ecohealth/One Health in Southeast Asia: Challenges and perspectives
(Presentation, 2015-04-22) Unger, Fred; Hung Nguyen-Viet
Ecohealth perspectives: From Ecohealth theory to practice (case studies)
(Presentation, 2015-07-15) Unger, Fred
Understanding food safety awareness and practices along smallholder pig value chains in Vietnam using participatory approaches
(Poster, 2015-09-15) Sinh Dang Xuan; Unger, Fred; Hung Nguyen-Viet; Fries, R.; Phuc Pham Duc; Meeyam, T.
Pig production plays an important role in both food supply and economic development in Vietnam. We assessed the food safety awareness and practice of involved key actors along the smallholder pig value chains in Hung Yen, Vietnam using participatory approaches. Data collection included quantitative (checklists, questionnaires) and qualitative (in-depth interviews and focus group discussions-FGD) tools and was done in three districts of Hung Yen. All survey tools were developed and pre-tested. Checklists (n=22) and questionnaires (n=12) followed random sampling procedures. The respondents for in-depth interviews (n=24) were randomly selected, while the participants for FGDs (n=5) were recruited by convenience. Data collection was done between January and June, 2013. Descriptive statistic was used for quantitative data, while content analysis was used for qualitative data. The outline for data collection for included groups and stakeholders (slaughterhouse workers, pork sellers, veterinary and public health staff, people living around slaughterhouses, pork consumers) was structured around food safety, diseases and health risks. Differences in what some groups found important or unsafe, based on their occupational priorities or labour focus were identified by using ranking tables and analysed accordingly. Analyses show that for slaughterhouse workers and pork sellers the food safety risks were highest and linked to lack of training, or relying only on “learning by doing” an experience provided by other workers or sellers. People living around slaughterhouses expressed concerns about health effects but also pointed out the advantages of their proximity to slaughterhouses, such as job opportunities and easy access to fresh pork. Pork consumer groups were more concerned about sensorial criteria (e.g. freshly looking, bright red colour) and expressed also some awareness on pork quality. Veterinary and public health staff emphasised the gap between existing legislation and food safety practices. Findings provide information on food safety awareness and practices along various actors and stakeholders. There is a need for improved standards, targeted training and collaborative mechanisms between veterinary and public health authorities to better manage the food production chain.
A decade of One Health and Ecohealth in Southeast Asia: Inventory and perspectives
(Poster, 2015-09-30) Unger, Fred; Gilbert, Jeffrey; Hung Nguyen-Viet; Grace, Delia
South East Asia (SEA) is a hot spot for diseases emergence as demonstrated for HPAI and SARS. To address challenges on disease emergence in livestock and human such as urbanisation, agriculture intensification, land use changes and others new integrated approaches have been increasingly introduced to the region to facilitated collaboration across disciplines, groups and stakeholders. Those approaches include the ‘ecohealth’ (EH) and ‘onehealth’ (OH) concept, both focusing on integrated research but having a different history and characteristics. The EH approach was pioneered over the last decades by the International Development Research Centre, Canada (IDRC). The OH concept builds up on Schwabe’s One Medicine and is currently institutionalised by the World Organisation for Animal Health (OIE) and FAO. To promote EH in the region, ILRI implemented an EH capacity building project (EcoZD) funded by IDRC between 2008 and 2013. The project targeted six Southeast Asian countries. In each country an across-disciplines research team was formed and implemented an EH case study aligned with capacity building on transdisciplinary research. In a subsequent step, ‘onehealth-ecohealth’ resource centres were established in three universities/institutions in Thailand, Vietnam and Indonesia. For this paper we also screened selected other OH/EH initiatives implemented since 2004 in SEA for their focus and impact. Most initiatives emphasised on capacity building others mainly on research or both. Challenges are various and complex, such as ‘loose’ or overlapping defi- nitions of OH/EH, cultural barriers, silo thinking, lack of qualitative research skills. While the use of integrated research has been successfully demonstrated in case studies (e.g. for Brucellosis in Yunnan) donor dependency, limited impact assessments of the added value of used integrated approaches and coordination gaps among the various initiatives remain a challenges and need more attention in the future.
Knowledge, attitudes and practices study on pig meat hygiene at slaughterhouses and markets in Chiang Mai province, Thailand
(Thesis, 2015-07-30) Jenpanich, C.
The aims of this study were to assess the level of knowledge, attitudes and practices (KAP) of food handlers and to assess the level of microbiological hygiene indicators at slaughterhouses and markets. Cross-sectional study was conducted during December 2014 to May 2015 in 16 slaughterhouses and 31 markets in Chiang Mai province, Thailand. A total of 32 slaughterhouse workers and 51 pork sellers were assessed KAP using questionnaires combining likert scales. Two focus group discussions were performed in slaughterhouse workers and in-depth interviews were conducted for animal health and public health authority, market and slaughterhouse managers, and consumers regarding food hygiene and food safety issues. Knowledge which assessed from the questionnaire indicated higher scores in personal hygiene and cross contamination and lower scores in foodborne illness. This result is in accordance with the result from focus group discussion. There are some contract finding between attitudes and practices; for example food handlers agreed that protective equipment can reduce cross contamination, but they practically do not wear gloves and mask and still work when they got sick. The qualitative data indicated that some good hygiene measures are inappropriate in the context of their practical implementation and some of these hygiene practices are not in accordance with their socio-economic status.
Cultural drivers and health-seeking behaviours that impact on the transmission of pig-associated zoonoses in Lao People’s Democratic Republic
(Journal Article, 2015-12) Burniston, S.; Okello, A.L.; Khamlome, Boualam; Inthavong, Phouth; Gilbert, Jeffrey; Blacksell, Stuart D.; Allen, J.; Welburn, S.C.
Pig rearing is an important income source in the Lao People’s Democratic Republic (PDR), with many smallholder farmers using traditional free-range pig production systems. Despite the potentially significant health risks posed by pig production regarding pig-associated zoonoses, information on the sociocultural drivers of these zoonoses is significantly lacking. This review summarises the existing sociocultural knowledge on eight pig-associated zoonoses suspected to be endemic in Southeast Asia: brucellosis, Q fever (Coxiella burnetii), trichinellosis, hepatitis E virus, leptospirosis, Japanese encephalitis, Streptococcus suis and Taenia solium taeniasis-cysticercosis. It summarises current knowledge on these diseases grouped according to their clinical manifestations in humans to highlight the propensity for underreporting. A literature search was conducted across multiple databases for publications from 1990 to the present day related to the eight pig-associated zoonoses and the risk and impact connected with them, with Lao PDR as a case study. Many of these pig-associated zoonoses have similar presentations and are often diagnosed as clinical syndromes. Misdiagnosis and underreporting are, therefore, substantial and emphasise the need for more robust diagnostics and appropriate surveillance systems. While some reports exist in other countries in the region, information is significantly lacking in Lao PDR with existing information coming mainly from the capital, Vientiane. The disease burden imposed by these zoonoses is not only characterised by morbidity and mortality, but directly impacts on livelihoods through income reduction and production losses, and indirectly through treatment costs and lost work opportunities. Other factors crucial to understanding and controlling these diseases are the influence of ethnicity and culture on food-consumption practices, pig rearing and slaughter practices, hygiene and sanitation, health-seeking behaviours and, therefore, risk factors for disease transmission. Published information on the knowledge, attitudes and beliefs of people regarding pig zoonoses and their risk factors is also extremely limited in Lao PDR and the broader Southeast Asian region. The need for more transdisciplinary research, using a One Health approach, in order to understand the underlining social determinants of health and their impacts on health-seeking behaviours, disease transmission and, ultimately, disease reporting, cannot be more emphasized.

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