Seasonal and geographical distribution of bacillary dysentery(shigellosis)and associated climate risk factors in Kon Tum Province in Vietnam from 1999 to 2013

Background:Bacillary dysentery(BD)is an acute bacterial infection of the intestine caused by Shigella spp.,with clinical symptoms ranging from fever to bloody diarrhoea to abdominal cramps to tenesmus.In Vietnam,enteric bacterial pathogens are an important cause of diarrhoea and most cases in children under 5 years of age are due to Shigella strains.The serogroups S.flexneri and S.sonnei are considered to be the most common.The main objective of this study was to,for the first time,assess the seasonal patterns and geographic distribution of BD in Vietnam,and to determine the climate risk factors associated with the incidence of BD in Kon Tum Province,where the highest rate of bacillary dysentery was observed from 1999 to 2013.Methods:The seasonal patterns and geographic distribution of BD was assessed in Vietnam using a seasonaltrend decomposition procedure based on loess.In addition,negative binomial regression models were used to determine the climate risk factors associated with the incidence of BD in Kon Tum Province,from 1999 to 2013.Results:Overall,incidence rates of BD have slightly decreased over time(except for an extremely high incidence in 2012 in the north of Vietnam).The central regions(north/south central coast and central highlands)had relatively high incidence rates,whereas the northwest/east and Red River Delta regions had low incidence rates.Overall,seasonal plots showed a high peak in the mid-rainy reason and a second smaller peak in the early or late rainy season.The incidence rates significantly increased between May and October(“wet season”)across the country.In Kon Tum Province,temperature,humidity,and precipitation were found to be positively associated with the incidence of BD.Conclusions:Our findings provide insights into the seasonal patterns and geographic distribution of BD in Vietnam and its associated climate risk factors in Kon Tum Province.This study may help clinicians and the general public to better understand the timings of outbreaks and therefore equip them with the knowledge to plan better interventions(such as improving water,sanitation,and hygiene conditions)during peak seasons.This can,in turn,prevent or reduce outbreaks and onwards transmission during an outbreak.

Identifying the impediments and enablers of ecohealth for a case study on health and environmental sanitation in Hà Nam, Vietnam

Background:To date,research has shown an increasing use of the term“ecohealth”in literature,but few researchers have explicitly described how it has been used.We investigated a project on health and environmental sanitation(the conceptual framework of which included the pillars of ecohealth)to identify the impediments and enablers of ecohealth and investigate how it can move from concept to practice.Methods:A case study approach was used.The interview questions were centred on the nature of interactions and the sharing of information between stakeholders.Results:The analysis identified nine impediments and 15 enablers of ecohealth.Three themes relating to impediments,in particular-integration is not clear,don’t understand,and limited participation-related more directly to the challenges in applying the ecohealth pillars of transdisciplinarity and participation.The themes relating to enablers-awareness and understanding,capacity development,and interactions-facilitated usage of the research results.By extracting information on the environmental,social,economic,and health aspects of environmental sanitation,we found that the issue spanned multiple scales and sectors.Conclusion:The challenge of how to integrate these aspects should be considered at the design stage and throughout the research process.We recommend that ecohealth research teams include a self-investigation of their processes in order to facilitate a comparison of moving from concept to practice,which may offer insights into how to evaluate the process.