Diarrhea and Dengue (DIADEN) Midterm Workshop 2012
Health risk assessment on dengue and diarrhoea in sub-urban and rural area of
Thailand and Laos
Nanthasane VANNAVONG
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Outline
1. Introduction
2. Rationale
3. Goal and objectives
4. Research hypotheses
5. Data collection
6. Preliminary results
7. Discussion and next activities
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Sub-urban village
Laos (260 houses) Thailand (260 houses)
Rural village
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DW practices : mode of fetching water to drink from the rainwater containers
Using hose
4Using tap
Using container
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in the study villages
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1. Introduction
Diarrhea:
– Globally, there are approximately 4 billion cases of diarrhoea worldwide each year [14]
• Killed 2.2 M, mostly children in developing countries
• Causes 4% of all deaths and 5% of health loss to disability
• Causes 8.5% of all death in Southeast Asia and 7.7% in Africa
– 88% of diarrhea is attributed to unsafe water supply, inadequate sanitation and hygiene [2]
• 1.1 billion lack access to improved water sources and 2.4 billion
have no basic sanitation.
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Introduction
Dengue:
- Incidence has increased 30 folds in the last 50 ys [3]
- ~ 2.5 billion are at risk (over 40% of the world's
population), particularly in tropics and subtopics [4]
- ~ 50 -100 million infections [4]
• ~ 500 000 require hospitalization mostly children and 2.5% of those die
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Introduction
Dengue and diarrhea in Thailand & Laos:
[Data from the National surveillance]
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In 2009 Incidence/100.000
Dengue Diarrhoea
Thailand 89 2047
Laos 129 248
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Emergence of dengue
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Distribution of Ae. Aegypti in America
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Geography of Ae. aegypti globally
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2. Rationale
Why household water management with dengue & diarrhea?:
– Ae. Aegypti mosquito breeds in water containers:
• Predominant domestic breeding sites: Jar, drum, tank...
• Estimated breeding sites in Laos: 80% is jar and tank [13]
– Water quality could have faecal contamination or being deteriorated [11],[12 ] through the course of:
• Collection, transportation, storage etc
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Makeshift well
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Household water management pre-survey in March 2010
(Drinking water source) Traditional household water
management In-adequate
environmental management
(Un-protective well)
Risk!
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3. Study goal
The goal of this study is to assess the potential effect of household water
management and other risk factors
related to dengue and diarrheal disease
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Study objectives
To assess the health risk of dengue and diarrhoea due to household water management
To assess the incidence of dengue and diarrhoeal disease and its burden on DALYs and the treatment cost in Laos and Thailand
To evaluate the trend of dengue and diarrhoea due to the impact of rainfall, temperature and humidity in these studied areas
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4. Research hypotheses
1. Laos may have a lot of diarrhoea cases due to less developing than Thailand
2. Diarrhea may occur more in the area where no pipe water supply is not available
3. Sur-urban areas have more cases of dengue compare to rural
areas
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5. Data collection
– Household interview x 2 (dry + wet season):
• Socioeconomic and health status
• People’s knowledge on dengue and diarrheal disease (dry season)
• Household water management for drink and non-drinking water
• Sanitation and hygiene status
• Household observation
– Longitudinal survey : weekly record of dengue & diarrhea incidence:
• blood and stool sample collection if the case is present at the household and the hospital level
– Measure of precipitation, temperature and humidity level
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measure of rainfall and temperature data Field assistant training
and household interview
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Weekly record: case detection at the village
& hospital level
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Passive surveillance teams Active surveillance teams
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Sample collection, storage and test
For dengue:
– Collect blood on to the NOBUTO filter paper
– Sample storage at: -20 C freezer
– RT-PCR : detect all 4 serotypes (DEN 1-4)
For diarrhea:
– Collect stool sample into the sterile box – Sample storage at: -20 C freezer
– RT-PCR : Detect for bacteria: Salmonella spp, Shigella spp, Vibrio spp, Campylobacter spp, E. coli 0157:H7
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Preliminary results
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6. Preliminary results
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Thailand Laos
0,00 20,00 40,00 60,00 80,00 100,00 120,00
Han Wailum Lakhonsy Okad
Occupations
agriculture
commerce
service
others
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0,00 10,00 20,00 30,00 40,00 50,00 60,00 70,00 80,00 90,00 100,00
Han Wailum Lakhonsy Okad
Education levels
primary
junior secondary school senior secondary school tertiary
others
Thailand Laos
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0,00 20,00 40,00 60,00 80,00 100,00
Han Wailum Lakhonsy Okad
Household income
≤ 2000 Baht
>2000 - 4000 Baht
>4000 - 20.000 Baht
>20.000 Baht
0,00 50,00 100,00 150,00
Han Wailum Lakhonsy Okad
Household expenditure
≤ 2000 Baht
>2000 - 4000 Baht
>4000 - 20.000 Baht
>20.000 Baht
Thailand Laos
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0,0 20,0 40,0 60,0 80,0 100,0 120,0
Han Wailum Lakhonsy Okad
knowledge of dengue and diarrhoea
Heard of diarrhoea Heard of dengue
Thailand Laos
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10,00 0,00 20,00 30,00 40,00 50,00 60,00 70,00 80,00 90,00
using
mosquito net mosquito
coils bug zapper insecticide
spray repellant air
conditioner mosquito protection
net
Dengue protection and control, Thailand
Han Wailum
0,00 20,00 40,00 60,00 80,00 100,00 120,00
using
mosquito net mosquito
coils bug zapper insecticide
spray repellant air
conditioner mosquito protection
net
Dengue protection and control, Laos
Lakhonsy
Okad
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0,00 20,00 40,00 60,00 80,00 100,00 120,00
fermented fish raw Lap-beef roast beef raw Lap-fish others
Behaviour of poorly food consumption, Thailand
Han Wailum
0,00 20,00 40,00 60,00 80,00 100,00
fermented fish raw Lap-beef roast beef raw Lap-fish others
Behaviour of poorly food consumption, Laos
Lakhonsy
Okad
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0,00 20,00 40,00 60,00 80,00 100,00 120,00
Han Wailum Han Wailum
Main source of drinking water in dry and wet season, Thailand
rainwater bottled water others
0,00 20,00 40,00 60,00 80,00 100,00
Lakhonsy Okad Lakhonsy Okad
Main source of drinking water in dry and wet season, Laos
rainwater
bottled water
unprotected well
others
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0 20 40 60 80 100 120
Han Wailum Han Wailum
Main source of non-drinking water in dry and wet season, Thailand
piped water borehole
unprotected well others
0 20 40 60 80 100 120
Lakhonsy Okad Lakhonsy Okad
Main source of non-drinking water in dry and wet season, Laos
piped water borehole
unprotected well
others
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Unprotected well used as a drinking water in rural area mostly in dry season, Laos
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collecting from the beginning of April
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0
2 4 6 8 10 12 14 16 18 20
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Mean of rain fall level (mm)per month at both study sites in Laos and Thailand -2011
Thailand Laos
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Humidity and Temp profiles in Lakhonpheng, Laos
Max Mix
Humidity (%) 92.6 34.1
Temp (*C) 42.8 22.5
34 0
10 20 30 40 50 60 70 80
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Mean value of humidity and temperature in Lakhonpheng, Laos - 2011
Humidity (%) Temperature (*C)
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No. of dengue and diarrhoea cases collected weekly :
Suspected
dengue Diarrhoea
Laos 30 8 Sub-urban> rural
Thailand 5 21 Rural> Sub-urban
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Note: The incidence rate for diarrhoea will be
calculated in the unit of ‘person-day’ at the end
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7. Discussions
The correlation will be found out and run using logistic regression after
Diarrhoea cases remain present with very low number in both area of Thailand and Laos
Weekly record of disease incidence will be continue until the end of the project, Dec 2012
– Extension of ethical clearance in Thailand is neeeded
Chickunkanya is not reported and still unwell known in Laos, blood sample collection for this disease will be considerable in the wet season of this year ?
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Thank you very much for your amiable attentions!
Questions and comment please!
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References
1. “WHO | diarrheal disease,” n.d., http://www.who.int/mediacentre/factsheets/fs330/en/index.html.
2. http://www.who.int/water_sanitation_health/publications/facts2004/en/
3. Bennett SN, Holmes EC, Chirivella M, et al. Selection-Driven Evolution of Emergent Dengue Virus. Mol Biol Evol. 2003;20(10):1650-1658.
4. WHO | Dengue and dengue haemorrhagic fever. Available at:
http://www.who.int/mediacentre/factsheets/fs117/en/ [Accessed May 9, 2010].
5. Gupta I, Guin P. Communicable diseases in the South-East Asia Region of the World Health Organization:
towards a more effective response. Bull World Health Org. 2010;88(3):199-205.
6. WHO | Water-related diseases. Available at: http://www.who.int/water_sanitation_health/diseases/diarrhea/en/
[Accessed May 15, 2010].
7. Dengue_dengue-SEAR-2008.pdf. Available at: http://www.searo.who.int/LinkFiles/Dengue_dengue-SEAR- 2008.pdf [Accessed May 24, 2010].
8. WHO | The world health report 2004 - changing history. Available at:
http://www.who.int/whr/2004/en/index.html [Accessed June 14, 2010].
9. S. Khun and L. Manderson, “Community and school-based health education for dengue control in rural Cambodia: a process evaluation,” PLoS Neglected Tropical Diseases, vol. 1, 2007.
10. J. Vallée, A. Dubot-Pérès, P. Ounaphom, C. Sayavong, J.E. Bryant, and J. Gonzalez, “Spatial distribution and risk factors of dengue and Japanese encephalitis virus infection in urban settings: the case of Vientiane, Lao PDR,”
Tropical Medicine & International Health, vol. 14, 2009, pp. 1134-1142.
11. W. J. van Zijl, “Studies on diarrheal diseases in seven countries by the WHO diarrheal diseases advisory team.,”
Bulletin of the World Health Organization 35, no. 2 (1966): 249-261.
12. B Hoque et al., “Rural drinking water at supply and household levels: Quality and management,” International Journal of Hygiene and Environmental Health 209, no. 5 (9, 2006): 451-460.
13. Anon. n.d. 42190-REG-TAR.pdf. http://www.adb.org/Documents/TARs/REG/42190-REG-TAR.pdf.
14. WHO/UNICEF joint monitoring report 2010: Progress on Sanitation and Drinking Water
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Quite many cases of S. dengue compare to diarrhoea in Laos so far.
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0
2 4 6 8 10 12 14 16 18 20
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Rain fall level (mm) by No. of suspected dengue and diarrhoea cases in Lakhonpheng, Laos-2011
Rain fall Suspected dengue Diarrhoea
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dengue in Thailand so far
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0
1 2 3 4 5 6 7 8
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Rain fall level (mm) by No. of suspected dengue, diarrhoea cases in Munja, Thailand-2011
Rain fall suspected dengue Diarhhoea
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Humid and Temp profiles in Munja, Thailand
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0 10 20 30 40 50 60 70 80
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
