The coverage of improved sanitation in Vietnam is still low, especially in rural areas. As a result, water-borne diseases remain key threats to public health. While the government has committed itself to increasing the proportion of people with access to improved sanitation, it cannot afford to subsidise sanitation for the entire population. Thus, improving rural sanitation continues to rely heavily on financial contributions from household-level private users, which depend on their willingness to pay (WTP) for such services. Knowing people's WTP is crucial when assessing the economic viability of projects, setting fees, evaluating policy alternatives, gauging financial sustainability, and designing socially equitable subsidies. However, such information on household-level demand is scarce to non-existent in Vietnam. We assessed the WTP for septic tanks among the rural population in Vietnam and identified the some factors that influence the level of WTP. The study was conducted in Hanam province, in northern Vietnam. Researchers randomly selected and surveyed 600 households, conducting personal interviews with the main breadwinners or decision-makers in each. Contingent valuation was used to obtain relevant economic data. This method consists in asking individuals how much they would be willing to pay for a change to the quantity or quality (or both) of a particular commodity. We found that 63% of the studied households were willing to pay for construction of a septic tank. The average WTP level was VND 16 million (US$ 800), which amounts to about 15% of the households' annual disposable income. Economic hardship was found to be the major reason for not installing a sanitary latrine. Health, cleanliness, and prestige were found to be three major motivating factors for constructing septic tanks. Regression analysis showed that the odds for spending money on improved sanitation services were higher in households with better income, as well as in households whose head had better knowledge of sanitation.
The Millennium Development Goal (MDG) target of halving the proportion of the population without sustainable access to basic sanitation by 2015 is still very far from being achieved. Much remains to be done particularly in Africa and Asia. Availability, accessibility, functionality, and correct and continued use and maintenance of sanitary facilities are key to sustainable improvements. Reasons for frequent failures of sanitation programmes are weak intersectoral collaboration, as well as inappropriate technical solutions that do not sufficiently consider aspects of local ownership and socio-economic, cultural, and political perspectives. Only improved practices and sustained use of improved facilities and services can lead to significant health and environmental outcomes. Integrative cross-sectoral planning of waste management is crucial in achieving a positive impact on both health and the environment. Recovery and reuse of resources from wastes while ensuring health safety, for example, can contribute to change and promote sustainable development. The links between health, waste, and the livelihood potential in waste are important elements in achieving equitable improvements that benefit the most vulnerable population segments.
Poor wastewater management that results from a lack of appropriate sanitation infrastructure contributes to increasing health risks in urban areas in Côte d'Ivoire. We assessed the health risks associated with the use of wastewater for watering salad destined for human consumption, to help local authorities in developing appropriate risk mitigation measures for Yamoussoukro, the political capital of Côte d'Ivoire. We applied a stochastic approach based on quantitative microbiological risk assessment (QMRA), focusing on wastewater for farming activities and salad consumption at the household level. Farming activities rely on a large degree on contaminated water and are conducted without any protection. The QMRA highlights that the poor quality of watering water increased the microbiological risk of the two assessed groups of urban farmers and individual households. The annual risk of infection due to watering wastewater in the city is estimated at 0.01 per person per year (pppy) for Giardia lamblia and 0.2 pppy for Escherichia coli O157:H7. The annual risk from salad consumption is 0.01 pppy for G. lamblia and 0.9 pppy for E. coli O157:H7. Both the annual risks from farming activities and salad consumption were higher than the tolerable standard of risk of 10−4 pppy as defined by the World Health Organization. There is a need to conduct a risk analysis and a cost-effectiveness study on intervention to improve public health and the livelihoods of the producers which are women in majority in Yamoussoukro. ; Programme d'Appui Stratégique à la Recherche Scientifique, Côte d'Ivoire ; National Centre for Competence in Research North-South, Switzerland ; Peer Review
Australian Centre for International Agricultural Research ; Bill & Melinda Gates Foundation ; Federal Ministry for Economic Cooperation and Development, Germany ; United Kingdom government ; International Development Research Centre ; Swedish International Development Cooperation Agency ; United States Agency for International Development
Pork is the most popular meat consumed in Vietnam and studies have shown high (28.6-44%) Salmonella contamination rates at the point of purchase, resulting in a high incidence rate of Salmonella related food borne disease. The high microbial contamination rate is attributed to poor hygiene practice in the pork value chain and the market-based approaches to improving the safety of pork in Vietnam, or SafePORK project has designed a set of interventions to improve the standard of practice which are due to be trialled in 2019. Behavioural economics and 'nudges' are defined as interventions with a low level of intrusiveness on personal choice which can be used to alter behaviour. While they have not yet been used for food safety in the pork value chain, some of the proposed interventions aim to alter actor's behaviour and thus could be amenable to 'nudging'. A previous research project to assess the potential of nudges to improve pork safety in Vietnam highlighted three main themes which could be used to influence actors within the value chain; 1) actors were most influenced by people they respected, which within the study groups were found to be veterinarians and actor's peers, 2) actor's reputation was regarded as an important incentive, and 3) salient visual methods of displaying information were found to be a commonly used method of delivering information in existing food safety interventions. A stakeholder workshop supported by the SafePORK project, the International Livestock Research Institute and the Royal Veterinary College was held in Hanoi to gain a better understanding of the slaughterhouse and retail processes to ascertain which nudges could be used to support the proposed interventions, and to discuss the practical aspects of implementing nudges. Participants included actors (n=32) from various parts of the pork value chain, including slaughterhouse workers, retailers, veterinarians, government officials, and researchers. During the workshop participants were separated into small groups and took part in group discussions to explore the slaughterhouse and retail processes and discuss the feasibility of using nudges to change actors' behaviours. Participants were shown several potential nudges (posters, arrows and footprints) and asked to evaluate these through discussion and a scoring exercise. After each activity a plenary session took place to allow dissemination of feedback to the entire group. The workshop found that the slaughterhouse workers and retailers appeared to be aware of the major issues surrounding foodborne disease in their industry, highlighting, during the discussions, many of the key points in the pork production chain where meat contamination with microorganisms can occur. The concept of using posters to display information was well received by the workshop participants. Both positive and negative framing of information were thought to be effective, the choice of which dependent on the target audience. However, when scored by participants, the negatively framed posters scored significantly higher than the positively framed posters, indicating a greater anticipated impact on actor's behaviour. All participants discussed the need to have site specific photos to reflect the real context of the setting to increase engagement with the media. When considering the effect of colour on salience; red was considered dirtiest, yellow, orange, and purple considered neutral colours, and green and blue considered the cleanest colours. The participants thought that the prospect of upscaling nudges to a broader audience of retailers and consumers could be implemented but would need to be supported by competent food safety authorities. Using the findings from this workshop, site specific nudges should be created to support specific SafePORK interventions, which at this stage are likely to be in the form of informational posters. Ideally, in addition to testing the interventions in a randomly controlled trial, the nudges would be similarly tested to allow assessment of their effectiveness. Further investigation, such as trialling the use of footprints and arrows in slaughterhouse environments, is needed to ascertain the practicality of using these nudge concepts to designate clean and dirty zones. ; Australian Centre for International Agricultural Research
This article characterizes the health risk perceptions toward excreta and wastewater management practices among waste management stakeholders in Vietnam and explores the implications of such perceptions on hygiene behaviors and preventative actions. Key informant interviews (n = 19; 12 women and 7 men) were conducted with farmers, community leaders, researchers, and government representatives in Hanoi and Ha Nam Province. Interviews were audio-recorded with permission, transcribed, and analyzed using a constant comparative method and qualitative thematic analysis. Researchers and government representatives perceived that the lack of knowledge of safe waste management practices among farmers was responsible for the use of "outdated" and often "unsafe" waste management practices. However, many farmers were aware of the health risks and safe hygienic practices but felt that safety measures were impractical and viewed susceptibility to diseases as low risk. Farmers also identified unfavorable climate and working conditions, limited financial capacity, and limited farm space as barriers to adopting safe management practices. At the broader level, inadequate communication between ministries often led to the creation of inconsistent waste management regulations. These barriers create constraints on efforts to improve sustainable waste management practices. Promoting collaboration between sectors, encouraging farmer-to-farmer knowledge sharing, and designing and implementing risk communication strategies that account for risk perceptions of stakeholders are recommended.
This forum paper proposes a reflection on the "field of ecohealth" and on how best to sustain a supportive environment that enables the evolution of diverse partnerships and forms of collaboration in the field. It is based on the results of a preconference workshop held in October 2012, in Kunming, China at the fourth biennial conference of the International Association for Ecology and Health. Attended by 105 persons from 38 countries, this workshop aimed to have a large-group and encompassing discussion about ecohealth as an emerging field, touching on subjects such as actors, processes, structures, standards, and resources. Notes taken were used to conduct a qualitative thematic analysis combined with a semantic network analysis. Commonalities highlighted by these discussions draw a portrait of a field in which human health, complex systems thinking, action, and ecosystem health are considered central issues. The need to reach outside of academia to government and the general public was identified as a shared goal. A disconnect between participants' main concerns and what they perceived as the main concerns of funding agencies emerged as a primary roadblock for the future.
Since the market-oriented Doi Moi reforms of the 1980s and 1990s, Vietnam's livestock sector has experienced rapid growth. Although policies have been implemented at the national and provincial levels to guide this growth in a sustainable manner, blind spots and implementation gaps remain. Through a review of policy documents, grey literature, peer-reviewed journal articles, and key informant interviews, this research seeks to summarize livestock-related policies at the national and provincial levels in Son La, Vietnam. Policies related to land-use, livestock feed, animal breed development, credit provision, epidemiology, agricultural extensions services, public investment, and sectoral master planning are examined. Based on this review, the authors recommend greater support for smaller actors in Son La's livestock value chains, mainly in the form of additional research and development, increased credit provision and agricultural insurance, improved agricultural extension services, and strengthened local processing capacity. These policy interventions and investments, among others, will be critical to achieving the government's ambitious livestock production targets over the coming decade. Notably, more robust public intervention and support is required to unlock this growth. Additional funding for locallevel Ministry of Agriculture and Rural Development (MARD) initiatives and improved coordination between its national and provincial offices will be a key determinant in achieving sustainable intensification in Son La's livestock sector.
Background The One Health concept promotes the enhancement of human, animal and ecosystem health through multi-sectorial governance support and policies to combat health security threats. In Vietnam, antimicrobial resistance (AMR) in animal and human health settings poses a significant threat, but one that could be minimised by adopting a One Health approach to AMR surveillance. To advance understanding of the willingness and abilities of the human and animal health sectors to undertake investigations of AMR with a One Health approach, we explored the perceptions and experiences of those tasked with investigating AMR in Vietnam, and the benefits a multi-sectorial approach offers. Methods This study used qualitative methodology to provide key informants' perspectives from the animal and human health sectors. Two scenarios of food-borne AMR bacteria found within the pork value chain were used as case studies to investigate challenges and opportunities for improving collaboration across different stakeholders and to understand benefits offered by a One Health approach surveillance system. Fifteen semi-structured interviews with 11 participants from the animal and six from the human health sectors at the central level in Hanoi and the provincial level in Thai Nguyen were conducted. Results Eight themes emerged from the transcripts of the interviews. From the participants perspectives on the benefits of a One Health approach: (1) Communication and multi-sectorial collaboration; (2) Building comprehensive knowledge; (3) Improving likelihood of success. Five themes emerged from participants views of the challenges to investigate AMR: (4) Diagnostic capacity; (5) Availability and access to antibiotics (6) Tracing ability within the Vietnamese food chain; (7) Personal benefits and (8) Managing the system. Conclusion The findings of this study suggest that there is potential to strengthen multi-sectorial collaboration between the animal and human health sectors by building upon existing informal networks. Based on these results, we recommend an inclusive approach to multi-sectorial communication supported by government network activities to facilitate partnerships and create cross-disciplinary awareness and participation. The themes relating to diagnostic capacity show that both sectors are facing challenges to undertake investigations in AMR. Our results indicate that the need to strengthen the animal health sector is more pronounced.
This article characterizes the health risk perceptions toward excreta and wastewater management practices among waste management stakeholders in Vietnam and explores the implications of such perceptions on hygiene behaviors and preventative actions. Key informant interviews (n = 19 ; 12 women and 7 men) were conducted with farmers, community leaders, researchers, and government representatives in Hanoi and Ha Nam Province. Interviews were audio-recorded with permission, transcribed, and analyzed using a constant comparative method and qualitative thematic analysis. Researchers and government representatives perceived that the lack of knowledge of safe waste management practices among farmers was responsible for the use of &ldquo ; outdated&rdquo ; and often &ldquo ; unsafe&rdquo ; waste management practices. However, many farmers were aware of the health risks and safe hygienic practices but felt that safety measures were impractical and viewed susceptibility to diseases as low risk. Farmers also identified unfavorable climate and working conditions, limited financial capacity, and limited farm space as barriers to adopting safe management practices. At the broader level, inadequate communication between ministries often led to the creation of inconsistent waste management regulations. These barriers create constraints on efforts to improve sustainable waste management practices. Promoting collaboration between sectors, encouraging farmer-to-farmer knowledge sharing, and designing and implementing risk communication strategies that account for risk perceptions of stakeholders are recommended.
Most emerging diseases of humans originate in animals, and zoonotic emerging infectious diseases (EIDs) threaten human, animal, and environment health. We report on a scoping study to assess actors, linkages, priorities, and needs related to management of these diseases from the perspective of key stakeholders in three countries in Southeast Asia. A comprehensive interview guide was developed and in-depth interviews completed with 21 key stakeholders in Vietnam, Lao People's Democratic Republic, and Cambodia. We found numerous relevant actors with a predominance of public sector and medical disciplines. More capacity weaknesses than strengths were reported, with risk analysis and research skills most lacking. Social network analysis of information flows showed policy-makers were regarded as mainly information recipients, research institutes as more information providers, and universities as both. Veterinary and livestock disciplines emerged as an important "boundary-spanning" organization with linkages to both human health and rural development. Avian influenza was regarded as the most important zoonotic EID, perhaps reflecting the priority-setting influence of actors outside the region. Stakeholders reported a high awareness of the ecological and socioeconomic drivers of disease emergence and a demand for disease prioritization, epidemiological skills, and economic and qualitative studies. Evaluated from an ecohealth perspective, human health is weakly integrated with socioeconomics, linkages to policy are stronger than to communities, participation occurs mainly at lower levels, and equity considerations are not fully considered. However, stakeholders have awareness of ecological and social determinants of health, and a basis exists on which transdisciplinarity, equity, and participation can be strengthened.
Poor waste management is a key driver of ill-health in urban settlements of developing countries. The current study aimed at assessing environmental and human health risks related to urban waste management in Yamoussoukro, the political capital of Côte d'Ivoire. We undertook trans-disciplinary research within an Ecohealth approach, comprised of a participatory workshop with stakeholders and mapping of exposure patterns. A total of 492 randomly selected households participated in a cross-sectional survey. Waste deposit sites were characterised and 108 wastewater samples were subjected to laboratory examinations. The physico-chemical parameters of the surface water (temperature, pH, conductivity, potential oxidise reduction, BOD5, COD, dissolved oxygen, nitrates, ammonia and total Kendal nitrogen) did not comply with World Health Organization standards of surface water quality. Questionnaire results showed that malaria was the most commonly reported disease. Diarrhoea and malaria were associated with poor sanitation. Households having dry latrines had a higher risk of diarrhoea (odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.2–2.7) compared to latrines with septic tanks and also a higher risk for malaria (OR = 1.9, 95% (CI) 1.1–3.3). Our research showed that combining health and environmental assessments enables a deeper understanding of environmental threats and disease burdens linked to poor waste management. Further study should investigate the sanitation strategy aspects that could reduce the environmental and health risks in the study area.
Poor waste management is a key driver of ill-health in urban settlements of developing countries. The current study aimed at assessing environmental and human health risks related to urban waste management in Yamoussoukro, the political capital of Côte d'Ivoire. We undertook trans-disciplinary research within an Ecohealth approach, comprised of a participatory workshop with stakeholders and mapping of exposure patterns. A total of 492 randomly selected households participated in a cross-sectional survey. Waste deposit sites were characterised and 108 wastewater samples were subjected to laboratory examinations. The physico-chemical parameters of the surface water (temperature, pH, conductivity, potential oxidise reduction, BOD5, COD, dissolved oxygen, nitrates, ammonia and total Kendal nitrogen) did not comply with World Health Organization standards of surface water quality. Questionnaire results showed that malaria was the most commonly reported disease. Diarrhoea and malaria were associated with poor sanitation. Households having dry latrines had a higher risk of diarrhoea (odds ratio (OR) = 1.8, 95% confidence interval (CI) 1.2–2.7) compared to latrines with septic tanks and also a higher risk for malaria (OR = 1.9, 95% (CI) 1.1–3.3). Our research showed that combining health and environmental assessments enables a deeper understanding of environmental threats and disease burdens linked to poor waste management. Further study should investigate the sanitation strategy aspects that could reduce the environmental and health risks in the study area.
To understand the overall of current veterinary hygiene situation concerning microbiological contamination of food, we have conducted a survey, interview, collecting and analyzing samples derived from poultry (alive and carcasses), slaughter environment of 36 small slaughter houses in the rural area of Hanoi. Almost all small slaughter houses (98% indoor and 100% at the bazaars/day-market) in the lowest veterinary ranking according to the government criteria. The rate of Salmonella contamination was 29.2% for the cloacal swab, 40.6% for carcasses, 2.9% for rinse water, 80.6% for waste water, 30.6% for slaughter floor and 63.9% for tools. Among the isolates from the most noticeable contamination carcasses, it was important to note that there were present of 2 serotype (S.enteritidis and S.typhimurium) that belong to the high risk group of food poisoning, originated from poultry during slaughtering processes. The Salmonella isolates had the antimicrobial resistance properties to most common antimicrobials, readily spreading along with the poultry meat chain. Water source and waste were both the highest risk factors leading to the Salmonella contamination for carcasses. There were two main recommendations to improve the hygiene condition at the time being, which were (i) to make awareness of high risk of bacterial contamination to the owners and butchers, (ii) improve the quality of water source as well as the waste treatment.
