Presentation at 3rd GRF One Health Summit 2015 Session OH Approaches For Sustainable Development

1. Kevin Bardosh, Phouth Inthavong, Amanda Ash
Sivilai Xayaheuang, John Allen and Anna Okello

2.  Background and Objective
 Materials and Methods
 Results and Discussion
 Added Value to the One Health
 Conclusions

3.  The study was conducted under ACIAR project
AH/2009/2001: Increased productivity and reduced
risk in pig production and market chains or
“Smallholder Pig System Project- SPSP”

4. 46.7 % 66.7 %
But some hyper-
endemic villages

5. • 26.1% (CI 18-35) taeniasis (30/115) – copro-Ag
ELISA
• 30% (CI 9-61) cysticercosis (4/13) – serum-Ag
ELISA
→ Hyper-endemic status and active human
cysticercosis: Okello et al (2014) “Investigating a hyperendemic
focus of Taenia solium in northern Lao PDR”, Parasites and Vectors
7:134 (open access)

6. • Adult stage causes
taeniasis in humans
• Larval stage causes cysts
in pigs AND humans
• NCC = leading cause of
acquired epilepsy in the
developing world
• T. solium = opportunity to
deliver an intervention
“package” that addresses
production (private good)
and public health (public
good) parameters
simultaneously

7. 1.To eliminate Tape
worm in human
(MDA)
 MDA using ABZ 400
mg, for 3 days
 1st MDA in October 2013
 2nd MDA in March 2014
 Stool samples analysed to
check intervention
effectiveness
2. To eliminate cysts in
pigs (Oxfen) and
reduce susceptibility
(TSOL18 Vacc)
1
2

8. MDA1

9.  To identify and investigate the socio-cultural drivers
and major transmission pathways of T. solium
 To assess community responses to the intervention
and explore locally-acceptable strategies for long-
term sustainable parasite control in this “hot spot”
village
 Through this locally grounded analysis will
contribute to broader policy debates about the need
to integrate disciplines and approaches in NTD
control, as motivated by the One Health concept.

10.  Study area
 Research methodology
 Data analysis
 Ethical approval

11.  The study was conducted in an
isolated village named “Ompalong”
located in Phongsali province
northern of Lao PDR.
 The Village consists of 62 HH with
330 Tai Dam people

12.  Agriculture practice includes lowland and upland
rice, cassava, maize and other crops as well as
pigs, poultry, cattle and buffalo

13.  The village is located 19 km from
Mai town and take 1 hr to drive up
 Access to the village is almost not
possible during the wet season

14.  A descriptive rapid anthropology
research was conducted over
10 days period Oct-Nov 2013
 Team consisting of 2 vets, 1
anthropologist & 1 medical
doctor
 divided into male and female
research teams
 During part of our research, the
team slept in the village and
spent much time eating and
drinking with a range of village
households
Social Research
Method
Number
conducted
FGD Male 3
FGD Female 1
FGD Mixed-gender 2
SSI Latrine-owning
HH
6
SSI Non-latrine-
owning HH
6
SSI T. solium
patients
4
SSI Cysticercosis
+ve patients
3
SSI Other (chief,
women union head,
teachers, LGOs)
15
Total: 6 FGD, 34 SSI
+ observations

15.  All data collection involved translation from Lao to English
and vise versa and manual recording
 Formal data analysis done by the first author away from
the field involved manual
 The accuracy of this analysis was then reviewed by other
team members.

16.  All approached individuals were informed of the purpose
behind the study
 The study was approved by the Animal, Food and Health
Sciences Human Research Ethics Committee (CAFHS
HREC) of Australia's Commonwealth Scientific and
Industrial Research Organisation (CSIRO); approval
number 13/10.
 The study was also approved by the Lao PDR Ministry of
Health's Council of Medical Science National Ethics
Committee for Health Research (NECHR); approval
number 013/NEHCR.

17.  Understanding parasite transmission
 Identifying locally-acceptable control options
 Pig vaccination: acceptable but logistically challenging
 Community responses to MDA

18. Poor Latrine ProvisionFree Range Pigs
Raw Pork ConsumptionInformal Pig Slaughter

19.  Domestic animals only eaten
on “special occasions”
 Dead ascend to the celestial
world where, through
ancestral worship, they act
as protectors of their
patrilineal descendants
 3 Animistic ceremonies :
1. “village spirit” (Boun Phi Ban)
2. ancestral HH ceremony linked to the
parents’ spirits (Boun Phi Hean)
3. New Year (Boun Kin Chieng).
“A man drinks, smokes,
hunts and eats raw meat!
Today I am having fun. If
I get a worm or even die I
don’t care I will still eat
this meat!”

20.  Ancestral spirits preferred the
taste of raw pork, eaten “to make
peace with the village spirits.”
 Vague idea cysts caused “some
kind of disease” but cystic pork
still consumed; “You have only
small money so you cannot throw
it away.”
 Women felt that without
electricity and men drunk =
difficult to see cysts
“A man drinks, smokes,
hunts and eats raw meat!
Today I am having fun. If
I get a worm or even die I
don’t care I will still eat
this meat!”

21.  ABZ taste “sweet like candy” - one
felt “so good afterwards I am eating a
lot now my appetite is so big”
1. minor side effects = ab pain,
headache, tiredness, coughing,
difficulty breathing, vertigo
2. Perception that medicines taken
when not actively ill are “stored” in
the body
3. Challenges of Government
sponsored School Deworming
Program (Mebendazole) - many
parents did not want children
treated (2) ~35%

22.  Our study has generated important insights into the
epidemiology and control of T. solium and other soil-
transmitted helminths in a hyper-endemic village in
northern Lao PDR
 Through our locally-grounded biosocial analysis, we
have showcased that rapid assessments based in
anthropology have important roles in engaging with
local communities in NTD control

23.  “Risk behaviours were
mediated by various social
determinants including
limited market access,
interrelationships between
alcohol, ancestral
sacrifices and the
consumption of raw pork,
seasonal variations and
poor latrine coverage”
“Showcases the relevance
of rapid anthropology in
NTD research/control as
a "first step"
methodology for
engaging and directing
longer-term social
science studies”

24.  Supporting organizations
PSL & XBL PAFO
 Project Implementing partners
XBL & Mai DAFOs , Farmers in 8 villages
 Activity Implementing partners