Assessment for prevention and control of zoonotic causes

of acute bloody diarrhoea in rural Cambodia through an

EcoHealth approach

Borin Khieu1 , Kerya Seng1, Samkol Pok1, Ty Chhay1, Chiv Phiny1, Jeffrey Gilbert2

1CelAgrid 2ILRI

EcoHealth Conference, Kunming China 2012

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 workers

20.5% 12.5%

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