Sister project in Colombia: Healthy Schools: Reducing dengue and diarrheal diseases in primary schools in Colombia -HEALTHPLATFORM in primary schools in Colombia -HEALTHPLATFORM

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Sister project in Colombia:

Healthy Schools: Reducing dengue and diarrheal diseases in primary schools in Colombia -HEALTHPLATFORM in primary schools in Colombia -HEALTHPLATFORM

Maria Ines Matiz

Health and Environment Institute El Bosque University

Bogota, Colombia

Diarrhea and Dengue (DIADEN) Midterm Workshop 2012 25-27 January, 2012, Khon Kaen, Thailand

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COLOMBIA

Colombia is located in the northwest of South America and has coasts on both the Caribbean Sea and the Pacific Ocean.

The striking variety in temperature and precipitation results principally from

differences in elevation. Temperatures range from very hot at sea level to relatively cold at higher parts of the Andes.

Colombia is among the 17 mega-diverse countries according with United Nations Environment Programme UNEP.

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COLOMBIA

Ø Government: Democracy, with 4-year presidential periods

Ø Capital: Bogotá (largest city) 4°39′N 74°3′W

Ø Ethnic groups: 58% Mestizo -

20% White - 14% Mulatto - 4% Afro 20% White - 14% Mulatto - 4% Afro Colombian - 3% Zambo -

1% Amerindian

Ø Area: 1,141,748 km² - Ø Population:

August 2012 estimate: 45,925,397

Ø ^Economy: Colombia is mainly dependent on agriculture, coffee, flowers, oil and coal.

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COLOMBIA

Ø Social inequality

Ø Inefficient political leadership

Ø Population displaced by violence or natural disasters Ø Problems of narcotraffic, guerrilla and paramilitary

Ø Communities, especially in rural areas, with unmet basic needs Ø Communities, especially in rural areas, with unmet basic needs

Foto: Agencia EFE

Foto: El Espectador Foto: http://auracristinperez.wordpress.com

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UNIVERSIDAD EL BOSQUE

Ø Is a private university, founded by a group of medical doctors 35 years ago,

for this reason has a general emphasis on health.

Ø Currently has 22 undergraduate programs,

74 graduate programs, with 6700 and 1407 students respectively Ø Research center has

7 Research Institutes

32 research groups

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Diarrhea and Dengue HEALTHPLATFORM

“Healthy Schools – Reducing dengue and diarrheal diseases in primary schools in diarrheal diseases in primary schools in

Colombia”

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International National Local Rural schools

• 3-year initiative (2010-2013)

• Funded by the Norwegian Research Council

• Partners at the international, national, and local levels

PROJECT OVERVIEW

University of Life Sciences, Norway

Liverpool School of Tropical Medicine, UK

London School of Hygiene and Tropical

Medicine, UK

Institute for Infectious Disease Control, Sweden

Universidad El Bosque

Public Health Laboratory, Cundinamarca

Lazos de Calandaima Foundation

Municipality of Anapoima

Municipality of La Mesa

School principals

Community leaders

Pupils

Teachers

Kitchen personnel

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Research Team

INTERNATIONAL

Thor-Axel Stenstrom Hans Overgaard

Audrey Lenhart Razak Seidu Neal Alexander

NATIONAL

Sandra Vargas

Víctor Alberto Olano Juan Felipe Jaramillo Diana Sarmiento María Inés Matiz

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National support staff

o Field Technicians Laura Hernández Nancy Herrera Rosa Silva

Ana Cuéllar

Laboratory Technician o Statistical support:

Ehidee Gómez

o Financial statement / accounts Olga Quimbayo

Fabian Mora

Grupo contabilidad Fundación o Laboratory Technician Humberto Mosquera o Monitoring absences

Anapoima La Mesa Grupo contabilidad Fundación

Lazos de Calandaima o Young researchers

Sergio Salas Laura Cabezas

María Fernanda Molina Ximena Roncancio

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STUDY AREA

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La Mesa Municipality

Inhabitants 27.894

Temperature average 22°C

Height Height 1.200 masl Urban area:

2.75 Km2 Rural area:

145 Km2 Total area:

148 Km2

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Anapoima Municipality

Inhabitants:

13.659

Temperature average:

24-28C 24-28C

Height: 700 masl

Urban Area 327.96Ha Rural Area 11636.41Ha Total Area : 11964.37Ha

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Rural schools

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Rural schools

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Rural schools

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Rural schools

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Rural schools

Anapoima

No. of schools: 17 Total teachers: 19 Total of Students: 262

Age: 5-16 years old Courses: 0-5 grade

Altitude:

El Consuelo 588 masl Palmichera 1089 masl

La Mesa

No. of schools: 18 Total teachers: 27 Total of Students: 459

Age: 5-16 years old Courses: 0-5 grade

Altitude:

La Vega 712 masl Buenavista 1610 masl

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Contribute to improved health and welfare in Colombian school children by evaluating the impact of school-based diarrhea and dengue control interventions .

MAIN PROJECT OBJECTIVE

control interventions .

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1

• Reduce exposure to dengue risk factors in schools:

• Reducing dengue mosquito vector populations

• Reducing exposure to solid waste surrounding schools

2

• Reduce exposure to diarrheal risk factors in schools:

• Improving drinking water quality

• Improving hand-washing practices

• Improving hygiene

SPECIFICS PROJECT OBJECTIVES

2

• Improving hygiene

3

• Reduce the incidence of diarrheal diseases (and potentially dengue fever) in school children.

4

• Reduce the number of absence episodes and length of those due to these illnesses

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PROJECT COMPONENTS -BASELINE RESULTS-

ENTOMOLOGICAL

COMPONENTS ENVIRONMENTAL

HEALTH SOCIO

CULTURAL

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ENTOMOLOGICAL RESULTS

Immature

stages survey

Aedes aegypti INFESTATION

Adult

mosquito survey

Laboratory

Identification

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Aedes aegypti , Breeding Sites

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2011

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2011

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SOCIAL/HEALTH RESULTS

KAP SURVEYS

ABSENCES REGISTER

TEACHERS

PUPILS

METODOLOGY

RESULTS

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KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - TEACHERS FROM LA MESA

VARIABLE KNOWLEDGE ATTITUDES PRACTICES

DENGUE Y DENGUE Y

DIARRHEA Medium High High

DENGUE Medium High Medium

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KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - TEACHERS FROM ANAPOIMA

DENGUE Y

DENGUE Medium High Medium

DIARRHEA Low High High

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KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - STUDENTS FROM LA MESA

DENGUE Y

DIARRHEA Medium

High Medium

DENGUE Low

DIARRHEA Medium

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KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - STUDENTS FROM ANAPOIMA

DENGUE Y

DIARRHEA Medium

High Medium

DENGUE Medium

DIARRHEA Medium

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Daily record of absences by

the teacher

The teacher establishes the

reason for

METHODOLOGY ABSENCES

reason for absence

Collecting of the registers each

week in 2012

Phone call with a list of

symptoms

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Reason for Absence. Anapoima. July-August 2011

23.8

4.8

19

25.3

20.8

6.3

INFORMANTE %

MADRE 44.6

PADRE 3.6

ABUELOS 1.2

HERMANO 7.6

PRIMOS 1.2

TIOS 4.8

MISMO NIÑO 23.3

AMIGO 3.6

SIN DATO 8.4

OTRO 1.6

Reason for Sickness absence. Anapoima,July-August 2011

OTRO 1.6

9

13 2

2

Gripa Otro Faringoamigdalitis Fractura

19 15

7 4

4 3

Fiebre Dolor de cabeza Diarrea Vomito Tos-mocos Dolor cuerpo

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30.5

6.6

12.9

18.8 22.8

8.4 0.0

5.0 10.0 15.0 20.0 25.0 30.0 35.0

INFORMANTE %

MADRE 34

PADRE 3

ABUELOS 3

HERMANO 9

PRIMOS 0

TIOS 2

Reason for Absence La Mesa. Julio-Agosto 2011

Reason for Sickness absence. La Mesa, July-August

MISMO NIÑO 22

AMIGO 2

SIN DATO 25

OTRO 2

Reason for Sickness absence. La Mesa, July-August 2011

7

28 1

1 2

14

48

0 10 20 30 40 50

Diarrea Gripa Faringoamigdalitis Fractura Eruptiva infancia Otro Dato perdido

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ENVIRONMENTAL RESULTS

Microbiological analysis

water

Criteria

school conditions

Physiochemical

analysis

Results

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Total coliforms and E. coli results in

drinking water

Total coliforms

(CFU/100 ml) E. coli

(CFU/100 ml)

Level Bacterial counts

I 1 – 10

II 11 – 100

III 101 – 1000 IV 1001 – 10000

V > 10000

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Item / Criteria

• Water source

• Water supply frequency

• Albercas (Type of Low Tank)

• Tanks Covered

• Internal water treatment

• Sinks

• Toilets

• Toilets cleaning

• Waste water disposal

• Solid waste disposal

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Max 75,6 Min 13,8 Media 47,1 Mediana 35,4

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Max 70,6 Min 20,0 Media 49,0 Mediana 53,2

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SCHOOLS INTERVENTIONS

Dengue

Ø

Diarrhea Dengue

Dengue

&

Diarrhea

Control

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DENGUE

INTERVENTION STRATEGIES FOR MOSQUITO CONTROL Aedes aegypti

Covering tanks

Immature forms

Curtains impregnated with insecticide

Adult forms

pyriproxyfen

Rubbish collection campaign

with insecticide

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WATER

Filter

HYGIENE

Handwashing

DIARRHEA

INTERVENTION STRATEGIES FOR THE PREVENTION OF DIARRHEA

Cover

and clean tanks Cleaning bathrooms

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INTERVENTION

Education and social mobilization

• Educational program integrating aspects of health,water,sanitation and hygiene

Education

• Establishing

mechanisms for community

participation and surveillance

Social

mobilization

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THANK YOU

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Diana Patricia Rojas Álvarez, Grupo enfermedades transmitidas por vectores, Subdirección de vigilancia y control en salud pública, Instituto Nacional de Salud(2011)

Diana Patricia Rojas Álvarez, Grupo enfermedades transmitidas por vectores, Subdirección de vigilancia y control en salud pública, Instituto Nacional de Salud(2011

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Registro histórico de los Casos notificados de dengue

58

69

30 40 50 60 70 80

Casos de dengue, Anapoima 2007-2010

Fuente: SAA oficina de epidemiologia SSC

Incidencia de casos notificados como probables: 42 X100.000 habitantes

11

25

0 10 20 30

2007 2008 2009 2010

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Descripción de los casos de dengue notificados. 2010

Dengue 95.7% (66) dengue grave 4.3 % (3)

Edad:

15 a 44 años 60.9% (42), 45 y más años 29.% (20),

5 a 14 años 8.7% (6) 5 a 14 años 8.7% (6)

1 a 4 años 1.4% (1)

Sexo: femenino 60.9% y masculino 39.1%

Procedencia de los casos:

cabecera municipal 71%, centro poblado 14.5 %

rural disperso 14.5%.

Fuente:http://www.google.com.co/imgres?imgurl=http://elpoderdemiami.com/wp-content/uploads/2008/09 http://www.google.com.co/imgres?imgurl=http://www.culsans.com.ar/wp-content/uploads/2009/03/dengue_charata05.jpg&imgrefurl http://www.google.com.co/imgres?imgurl=http://www.talcualdigital.com/imagesbank/avances/27720102527200.jpg&imgrefurl

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Cabecera municipal:

71%

Centro poblado Inspecciones: 14.5 %

Descripción de los casos de dengue notificados. 2010

Rural: 14.5%

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Número de casas positivas x 100%

Número de casas inspeccionadas

VIGILANCIA ENTOMOLÓGICA

INDICES DE INFESTACION LARVARIOS

Índice de vivienda

Índice de depósito

Número de depósitos positivos x 100%

Número total de depósitos inspeccionados

Número de depósitos positivos x 100 casas Número total de casas inspeccionadas