Sister project in Colombia:
“Healthy Schools – Reducing dengue and diarrheal
diseases in primary schools in Colombia”
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
*
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.
Colombia is located in the
northwest of South America and has
coasts on both the Caribbean Sea
and the Pacific Ocean.
*
Government: Democracy, with 4-
year presidential periods
Capital: Bogotá (largest city)
4°39′N 74°3′W
Ethnic groups: 58% Mestizo -
20% White - 14% Mulatto - 4% Afro
Colombian - 3% Zambo -
1% Amerindian
Area: 1,141,748 km2 -
Population:
August 2012 estimate: 45,925,397 Economy: Colombia is mainly
dependent on agriculture, coffee,
flowers, oil and coal.
*
Social inequality
Inefficient political leadership
Population displaced by violence or natural disasters
Problems of narcotraffic, guerrilla and paramilitary
Communities, especially in rural areas, with unmet basic
needs
Foto: Agencia EFE Foto: El Espectador Foto: http://auracristinperez.wordpress.com
*
Is a private university, founded by a
group of medical doctors 35 years ago,
for this reason has a general emphasis on health.
Currently has 22 undergraduate programs,
74 graduate programs, with 6700 and 1407 students respectively
Research center has
7 Research Institutes
32 research groups
International
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
National
Universidad El Bosque
Public Health Laboratory,
Cundinamarca
Local
Lazos de Calandaima Foundation
Municipality of Anapoima
Municipality of La Mesa
School principals
Community leaders
Rural schools
Pupils
Teachers
Kitchen personnel
• 3-year initiative (2010-2013)
• Funded by the Norwegian Research Council
• Partners at the international, national, and local levels
PROJECT OVERVIEW
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
National support staff
oStatistical support:
Ehidee Gómez
o Financial statement / accounts
Olga Quimbayo
Fabian Mora
Grupo contabilidad Fundación Lazos
de Calandaima
oYoung researchers
Sergio Salas
Laura Cabezas
María Fernanda Molina
Ximena Roncancio
oField Technicians
Laura Hernández
Nancy Herrera
Rosa Silva
Ana Cuéllar
oLaboratory Technician
Humberto Mosquera
oMonitoring absences
Anapoima
La Mesa
Inhabitants
27.894
Temperature average 22°C
Height
1.200 masl
Urban area:
2.75 Km2
Rural area:
145 Km2
Total area:
148 Km2
Anapoima Municipality
Inhabitants:
13.659
Temperature average:
24-28C
Height: 700 masl
Urban Area
327.96Ha
Rural Area
11636.41Ha
Total Area : 11964.37Ha
*
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
Contribute to improved health and welfare in Colombian school children by evaluating the impact of school-based diarrhea and dengue
control interventions.
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
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
COMPONENTS
ENTOMOLOGICAL
ENVIRONMENTAL
HEALTH
SOCIO
CULTURAL
Immature stages survey
Adult mosquito survey
Laboratory Identification
Aedes aegypti
INFESTATION
2011
2011
TEACHERS
PUPILS
KAP SURVEYS
METODOLOGY
RESULTS
ABSENCES REGISTER
KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - TEACHERS FROM LA MESA
VARIABLE KNOWLEDGE ATTITUDES PRACTICES
DENGUE Y
DIARRHEA Medium High High
DENGUE Medium High Medium
DIARRHEA Medium High High
KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - TEACHERS FROM ANAPOIMA
VARIABLE KNOWLEDGE ATTITUDES PRACTICES
DENGUE Y
DIARRHEA Medium High High
DENGUE Medium High Medium
DIARRHEA Low High High
KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - STUDENTS FROM LA MESA
VARIABLE KNOWLEDGE ATTITUDES PRACTICES
DENGUE Y
DIARRHEA Medium
High Medium
DENGUE Low
DIARRHEA Medium
KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - STUDENTS FROM ANAPOIMA
VARIABLE KNOWLEDGE ATTITUDES PRACTICES
DENGUE Y
DIARRHEA Medium
High Medium
DENGUE Medium
DIARRHEA Medium
Daily record of absences by
the teacher
The teacher establishes the
reason for absence
Collecting of the
registers each week in 2012
Phone call with a list of
symptoms
METHODOLOGY ABSENCES
Reason for Absence. Anapoima. July-August 2011
Reason for Sickness 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
9
13
2
2
Gripa
Otro
Faringoamigdalitis
Fractura
19
15
7
4
4
3
Fiebre
Dolor de cabeza
Diarrea
Vomito
Tos-mocos
Dolor cuerpo
30,5
6,6
12,9
18,8 22,8
8,4
0,05,0
10,015,020,025,030,035,0
INFORMANTE %
MADRE 34
PADRE 3
ABUELOS 3
HERMANO 9
PRIMOS 0
TIOS 2
MISMO NIÑO 22
AMIGO 2
SIN DATO 25
OTRO 2
Reason for Absence La Mesa. Julio-Agosto 2011
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
Microbiological analysis
Physiochemical analysis
Water
Criteria
Results
School
conditions
Total coliforms
(CFU/100 ml) E. coli
(CFU/100 ml)
Lev
el
Bacterial counts
I 1 – 10
II 11 – 100
III 101 – 1000
IV 1001 – 10000
V > 10000
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
Max 75,6
Min 13,8
Media 47,1
Mediana 35,4
Max 70,6
Min 20,0
Media 49,0
Mediana 53,2
Diarrhea Dengue Dengue
& Diarrhea
Control
Ø
Covering
tanks
pyriproxyfen
Rubbish collection campaign
Immature
forms
Curtains
impregnated
with insecticide
Adult forms
WATER
Filter
Cover and clean tanks
HYGIENE
Handwashing
Cleaning bathrooms
DIARRHEA
INTERVENTION STRATEGIES FOR THE PREVENTION OF DIARRHEA
• Educational program integrating aspects of health,water,sanitation and hygiene
Education
• Establishing mechanisms for community participation and surveillance
Social mobilizatio
n
Diana Patricia Rojas Álvarez, Grupo enfermedades transmitidas por vectores,
Subdirección de vigilancia y control en salud pública, Instituto Nacional de Salud(2011
*
Fuente: SAA oficina de epidemiologia SSC
Incidencia de casos notificados
como probables: 42 X100.000
habitantes
Registro histórico de los Casos notificados de dengue
11
58
25
69
0
10
20
30
40
50
60
70
80
2007 2008 2009 2010
Casos de dengue, Anapoima 2007-2010
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)
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
Cabecera
municipal: 71%
Centro poblado Inspecciones: 14.5
%
Rural: 14.5%
Descripción de los casos de dengue notificados. 2010
Número de casas positivas x 100% Número de casas inspeccionadas
VIGILANCIA ENTOMOLÓGICA INDICES DE INFESTACION LARVARIOS
Número de depósitos positivos x 100% Número total de depósitos inspeccionados
Índice de vivienda
Número de depósitos positivos x 100 casas Número total de casas inspeccionadas
Índice de Breteau
Índice de depósito
INTERPRETACION EPIDEMIOLÓGICA
INDICE RIESGO
BAJO ALTO
VIVIENDA < 4% ≥ 4%
DEPOSITO <3% ≥ 3%
BRETEAU <5 ≥ 5
THANK YOU