Sharing public health data and information across borders: lessons from Southeast Asia.

BACKGROUND: The importance of data and information sharing for the prevention and control of infectious diseases has long been recognised. In recent years, public health emergencies such as avian influenza, drug-resistant malaria, and Ebola have brought renewed attention to the need for effective communication channels between health authorities, particularly in regional contexts where neighbouring countries share common health threats. However, little empirical research has been conducted to date to explore the range of factors that may affect the transfer, exchange, and use of public health data and expertise across borders, especially in developing contexts. METHODS: To explore these issues, 60 interviews were conducted with domestic and international stakeholders in Cambodia and Vietnam, selected amongst those who were involved in regional public health programmes and networks. Data analysis was structured around three categories mapped across the dataset: (1) the nature of shared data and information; (2) the nature of communication channels; and (3) how information flow may be affected by the local, regional, and global system of rules and arrangements. RESULTS: There has been a great intensification in the circulation of data, information, and expertise across borders in Southeast Asia. However, findings from this study document ways in which the movement of data and information from production sites to other places can be challenging due to different standards and practices, language barriers, different national structures and rules that govern the circulation of health information inside and outside countries, imbalances in capacities and power, and sustainability of financing arrangements. CONCLUSIONS: Our study highlights the complex socio-technical nature of data and information sharing, suggesting that best practices require significant involvement of an independent third-party brokering organisation or office, which can redress imbalances between country partners at different levels in the data sharing process, create meaningful communication channels and make the most of shared information and data sets

Diarrhea illness in livestock keeping households in Cambodia: An analysis using a One Health framework

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

Diarrhea illness in livestock keeping households in Cambodia: An analysis using a One Health framework

BackgroundMost 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 methodsWe 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.ResultsHousehold-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.ConclusionsIt 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

Human H5N1 influenza infections in Cambodia 2005-2011: case series and cost-of-illness.

BACKGROUND: Southeast Asia has been identified as a potential epicentre of emerging diseases with pandemic capacity, including highly pathogenic influenza. Cambodia in particular has the potential for high rates of avoidable deaths from pandemic influenza due to large gaps in health system resources. This study seeks to better understand the course and cost-of-illness for cases of highly pathogenic avian influenza in Cambodia. METHODS: We studied the 18 laboratory-confirmed cases of avian influenza subtype H5N1 identified in Cambodia between January 2005 and August 2011. Medical records for all patients were reviewed to extract information on patient characteristics, travel to hospital, time to admission, diagnostic testing, treatment and disease outcomes. Further data related to costs was collected through interviews with key informants at district and provincial hospitals, the Ministry of Health and non-governmental organisations. An ingredient-based approach was used to estimate the total economic cost for each study patient. Costing was conducted from a societal perspective and included both financial and opportunity costs to the patient or carer. Sensitivity analysis was undertaken to evaluate potential change or variation in the cost-of-illness. RESULTS: Of the 18 patients studied, 11 (61%) were under the age of 18 years. The majority of patients (16, 89%) died, eight (44%) within 24 hours of hospital admission. There was an average delay of seven days between symptom onset and hospitalisation with patients travelling an average of 148 kilometres (8-476 km) to the admitting hospital. Five patients were treated with oseltamivir of whom two received the recommended dose. For the 16 patients who received all their treatment in Cambodia the average per patient cost of H5N1 influenza illness was US$300 of which 85.0$45 per patient (15.0%) of total economic cost. CONCLUSION: Cases of avian influenza in Cambodia were characterised by delays in hospitalisation, deficiencies in some aspects of treatment and a high fatality rate. The costs associated with medical care, particularly diagnostic testing and pharmaceutical therapy, were major contributors to the relatively high cost-of-illness