Health and environmental impact of agricultural intensification: Translating Ecohealth program-derived knowledge into practice

International Development Research Centr

Ecohealth research to regionally address agriculture intensification impacts on health and the environment in Southeast Asia and China

Ecohealth Field Building Leadership Initiative is a regional operational research network in Southeast Asia and China that focuses on solving human health problems associated with agricultural intensification. FBLI has 3 focus areas, namely research, capacity building and knowledge translation. FBLI gathers researchers, policy makers, community members and other stakeholders from 4 focused countries (China, Indonesia, Thailand and Vietnam). Here we describe the operational research component that focuses on aspects of agriculture intensification on health and the environment including animal waste from pig production (Vietnam), dairy production (Indonesia), pesticide use in vegetable production (China), and health risks in rubber plantation (Thailand). Integrated approaches to the research component including survey, participatory and cross-cutting methods are discussed. The research results from Vietnam and Indonesia showed health and environmental impacts of manure management options, in particular the biogas system and turning waste to value. In Hanam of Vietnam, the health risks from biogas effluent reuse include E. coli infection (19–22% of population exposed) and G. lamblia infection (45–55% of population exposed). In Pangalengan, Indonesia, the Ecohealth approach was used to promote the production of medicinal worm and casting biofertilizer from cow manure as an environmentallyfriendly fertilizer alternative. In Chachoengsao Province of Thailand, key findings include evidences for higher risk of vectorborne diseases (dengue and chikungunya) in rubber plantation areas as well as higher microbial and heavy metal contamination of water and soil. In six villages of three townships in a County of Yunnan Province, China, issues identified were lack of farmer knowledge of pesticides, pesticide abuse, and ineffective policy to reduce pesticide abuse. Pesticide contamination was recorded from 6.1% to 12.7% of vegetables depending on sampling location in the field or market. The findings from 4 countries illustrate how Ecohealth research has been applied in health and agriculture and serve as basis for interventions for reduce health and environmental risks

Helminth eggs die-off and nutrients : human excreta storage experiment

Are the current practices of handling human excreta for agricultural purposes by farmers in Vietnam good enough?This study set up an excreta storage experiment to research how to inactivate Ascaris lumbricoides eggs and stillmaintain the nutrient value of human excreta

Intestinal parasite infections and associated risk factors in communities exposed to wastewater in urban and peri-urban transition zones in Hanoi, Vietnam

BACKGROUND: Infections with intestinal parasites (helminths and intestinal protozoa) are endemic in Southeast Asia and inappropriate management and reuse of wastewater might exacerbate the risk of human infections. In rapidly growing urban settings, little is known about the extent of intestinal parasite infections. We assessed the point-prevalence and risk factors of intestinal parasite infections in population groups differently exposed to wastewater in urban and peri-urban transition zones in Hanoi, the capital of Vietnam. METHODS: A cross-sectional survey was carried out between April and June 2014 in people aged ≥ 18 years at risk of wastewater exposure from To Lich River: workers maintaining wastewater treatment facilities; urban farmers reusing wastewater; and urban dwellers at risk of flooding events. For comparison, two peri-urban population groups living in close proximity to the Red River were chosen: farmers using river water for irrigation purposes; and people living in the same communities. A single stool sample was subjected to Kato-Katz and formalin-ether concentration methods for the diagnosis of helminth and intestinal protozoa infections. A questionnaire was administered to determine risk factors and self-reported signs and symptoms. RESULTS: A total of 681 individuals had complete data records. Highest point-prevalence rates of intestinal parasite infections were observed for peri-urban farmers (30 %). Hookworm and Trichuris trichiura were the predominant helminth species (25 % and 5 %, respectively). Peri-urban farmers were at higher odds of infection with intestinal parasites than any other groups (adjusted odds ratio 5.8, 95 % confidence interval 2.5 to 13.7). Lack of access to improved sanitation and not receiving deworming within the past 12 months were associated with higher infection risk, while higher educational attainment and socioeconomic status were negatively associated with intestinal parasite infections. CONCLUSIONS: Our results suggest that exposure to wastewater was not directly associated with infection with helminths and intestinal protozoa in different population groups in Hanoi. These findings might be explained by a high level of awareness of health risks and access to safe sanitary infrastructure in urban areas. The high prevalence rates observed in peri-urban farmers call for specific interventions targeting this population group

Field Building Leadership Initiative (FBLI): Advancing ecohealth in Southeast Asia

In response to global environmental health challenges, multi-disciplinary research and training are becoming popular among several countries in the world. However, systemic degree training programmes emphasizing integration of multi-disciplines are still not existed in the Asian Region. With approval from the University Council of Mahidol University, the Degree Programmes in "One Health and Ecosystem Management" are currently under development in collaboration with the University of Indonesia, Kunming Medical University and Hanoi School of Public Health. This will be one big step in integrating One Health/Ecohealth concept and system thinking into university curricula. The main objective is to produce high quality and competent graduates, who have background in multi-disciplinary research aiming at healthy environment and healthy living, to work in either government or private sectors. The research-based topics will be emphasized on an application of One Health/Ecohealth approach to human and animal health, environmental health, emerging and re-emerging infectious diseases, and social science, economics and policy in One Health/Ecohealth. It is expected that the students resulting from these programmes should help bringing One Health/Ecohealth practice into their professional work which hopefully will improve disease management and, hence, improve well-being in the long-term

Rapid integrated assessment of food safety and nutrition related to pork consumption of regular consumers and mothers with young children in Vietnam

Pork is the most common and widely consumed meat product in Vietnam. The study aimed to assess nutrition and food safety risks and opportunities associated with pork value chains in Vietnam. Twenty-nine focus group discussions (FGD) were conducted in Hung Yen and Nghe An provinces with 164 participants who were both regular pork consumers and mothers with young children. In each province, three districts were selected, and in each district we selected one commune. To assess the quality of pork, we took 30 swab samples of pig carcasses at slaughterhouses, 90 pork samples at slaughterhouses and markets and analysed all samples for total bacterial count (TBC), coliforms, water holding capacity and pH. The results showed that pork was the main livestock product consumed and women are responsible for buying and preparing food for daily meals. Pork was the main animal sourced food (ASF) for Vietnamese consumers, for 50–60% of ASF. There was little knowledge of zoonotic diseases. The findings suggest further studies to address consumers’ concern on chemical contamination. Most market pork samples were not within the allowable range of limits standards of Vietnam for bacterial contamination: 90% of samples were above the official permissible limit for TBC and 98% did not meet standards for coliforms. Fifty percent of samples had acceptable pH but only 5% had acceptable water holding capacity. There were no significant differences in pork quality between intensifying Hung Yen and traditional Nghe An provinces, although there was a tendency for samples from Hung Yen to have better compliance. This rapid assessment revealed considerable interest and knowledge on pork nutrition and safety and found some behavioural but few quality and safety differences between traditional and intensifying systems. This indicated marketed pork is of low quality and safety, and a lack of support to consumers in making good choices

Knowledge of Antiretroviral Treatment and Associated Factors in HIV-Infected Patients

This study aimed to assess the knowledge of antiretroviral (ARV) treatment and the associated factors in HIV-infected patients in Vietnam. We conducted a cross-sectional descriptive study of 350 human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients being treated with ARV at outpatient clinics at Soc Trang, Vietnam, from June 2019 to December 2019. Using an interview questionnaire, patients who answered at least eight out of nine questions correctly, including some required questions, were considered to have a general knowledge of ARV treatment. Using multivariate logistic regression to identify factors associated with knowledge of ARV treatment, we found that 62% of HIV-infected patients had a general knowledge of ARV treatment, with a mean score of 8.2 (SD 1.4) out of 9 correct. A higher education level (p < 0.001); working away from home (p = 0.013); getting HIV transmitted by injecting drugs or from mother-to-child contact (p = 0.023); the presence of tension, anxiety, or stress (p = 0.005); self-reminding to take medication (p = 0.024); and a high self-evaluated adherence (p < 0.001) were found to be significantly associated with an adequate knowledge of ARV treatment. In conclusion, education programs for patients, as well as the quality of medical services and support, should be strengthened

奥付

This chapter discusses a conceptual framework for integrated health and environmental assessment that combines health status, and the physical, socioeconomic and cultural environments in order to improve human health and minimize environmental impact. This concept's application in the management of human and animal excreta in Vietnam is then described