Sister project in Colombia:Healthy Schools: Reducing dengue and diarrheal diseases

in primary schools in Colombia -HEALTHPLATFORMin primary schools in Colombia -HEALTHPLATFORM

Maria Ines MatizHealth and Environment Institute

El Bosque UniversityBogota, Colombia

Diarrhea and Dengue (DIADEN) Midterm Workshop 201225-27 January, 2012, Khon Kaen, Thailand

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.

COLOMBIAØ 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.

COLOMBIA

Ø Social inequalityØ Inefficient political leadershipØ Population displaced by violence or natural disastersØ Problems of narcotraffic, guerrilla and paramilitaryØ Communities, especially in rural areas, with unmet basic needsØ Communities, especially in rural areas, with unmet basic needs

Foto: Agencia EFEFoto: El EspectadorFoto: http://auracristinperez.wordpress.com

UNIVERSIDAD EL BOSQUEØ Is a private university, founded by agroup 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 respectivelyØ Research center has7 Research Institutes32 research groups

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

Colombia”

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 InfectiousDisease Control, Sweden

Universidad El Bosque

Public HealthLaboratory,

Cundinamarca

Lazos de Calandaima Foundation

Municipality of Anapoima

Municipality of La Mesa

School principals

Community leaders

Pupils

Teachers

Kitchen personnel

Research Team

INTERNATIONALThor-Axel Stenstrom

Hans Overgaard

Audrey Lenhart

Razak Seidu

Neal Alexander

NATIONALSandra Vargas

Víctor Alberto Olano

Juan Felipe Jaramillo

Diana Sarmiento

María Inés Matiz

National support staff

o Field TechniciansLaura HernándezNancy HerreraRosa SilvaAna Cuéllar

Laboratory Technician

o Statistical support:Ehidee Gómez

o Financial statement / accountsOlga QuimbayoFabian Mora Grupo contabilidad Fundación o Laboratory Technician

Humberto Mosquera

o Monitoring absencesAnapoimaLa Mesa

Grupo contabilidad Fundación Lazos de Calandaima

o Young researchersSergio Salas Laura CabezasMaría Fernanda Molina Ximena Roncancio

STUDY AREA

La Mesa Municipality

Inhabitants

27.894

Temperature average 22°C

HeightHeight

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 24-28C

Height: 700 masl

Urban Area

327.96Ha

Rural Area

11636.41Ha

Total Area : 11964.37Ha

Rural schools

Rural schools

Rural schools

Rural schools

Rural schools

Anapoima

No. of schools: 17Total teachers: 19

Total of Students: 262Age: 5-16 years oldCourses: 0-5 grade

Altitude:El Consuelo 588 maslPalmichera 1089 masl

La Mesa

No. of schools: 18Total teachers: 27

Total of Students: 459 Age: 5-16 years oldCourses: 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.

MAIN PROJECT OBJECTIVE

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

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

PROJECT COMPONENTS -BASELINE RESULTS-

ENTOMOLOGICAL

COMPONENTS ENVIRONMENTAL

HEALTH

SOCIO

CULTURAL

ENTOMOLOGICAL RESULTS

Immaturestages survey

Aedes aegypti

INFESTATION

Adultmosquito survey

LaboratoryIdentification

Aedes aegypti , Breeding Sites

2011

2011

SOCIAL/HEALTH RESULTS

KAP SURVEYS

ABSENCES REGISTER

TEACHERS

PUPILS

METODOLOGY

RESULTS

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

DIARRHEA Medium High High

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

VARIABLE KNOWLEDGE ATTITUDES PRACTICES

DENGUE Y DIARRHEA

Medium High HighDIARRHEA

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 MediumDENGUE Low

DIARRHEA Medium

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

VARIABLE KNOWLEDGE ATTITUDES PRACTICES

DENGUE Y DIARRHEA

Medium

High MediumDENGUE Medium

DIARRHEA Medium

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

Reason for Absence. Anapoima. July-August 2011

23.8

4.8

19

25.320.8

6.3

INFORMANTE %MADRE 44.6PADRE 3.6

ABUELOS 1.2HERMANO 7.6

PRIMOS 1.2TIOS 4.8

MISMO NIÑO 23.3AMIGO 3.6

SIN DATO 8.4OTRO 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

30.5

6.6

12.918.8

22.8

8.4

0.05.0

10.015.020.025.030.035.0

INFORMANTE %MADRE 34PADRE 3

ABUELOS 3HERMANO 9

PRIMOS 0TIOS 2

Reason for Absence La Mesa. Julio-Agosto 2011

Reason for Sickness absence. La Mesa, July-August

MISMO NIÑO 22

AMIGO 2SIN 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

ENVIRONMENTALRESULTS

Microbiologicalanalysis

water

Criteria

school

conditions

Physiochemicalanalysis Results

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

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 75,6Min 13,8

Media 47,1Mediana 35,4

Max 70,6Min 20,0

Media 49,0Mediana 53,2

SCHOOLS INTERVENTIONS

Dengue

Ø

Diarrhea DengueDengue

& Diarrhea

Control

DENGUEINTERVENTION STRATEGIES FOR MOSQUITO CONTROL

Aedes aegypti

Covering

tanks

Immature

formsCurtains

impregnated

with insecticide

Adult forms

pyriproxyfen

Rubbish collectioncampaign

with insecticide

WATER

Filter

HYGIENE

Handwashing

DIARRHEAINTERVENTION STRATEGIES FOR THE PREVENTION OF

DIARRHEA

Coverand clean tanks Cleaning bathrooms

INTERVENTIONEducation and social mobilization

• Educational programintegrating aspects of health,water,sanitationand hygiene

Education

• Establishingmechanisms forcommunityparticipation and surveillance

Social mobilization

THANK YOU

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

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

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/2008/09http://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 %

Descripción de los casos de dengue notificados. 2010

Rural: 14.5%

Número de casas positivas x 100%

Número de casas inspeccionadas

VIGILANCIA ENTOMOLÓGICAINDICES 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

Índice de Breteau

Índice de depósito

INTERPRETACION EPIDEMIOLÓGICA

INDICERIESGO

BAJO ALTO

VIVIENDA < 4% ≥ 4%VIVIENDA < 4% ≥ 4%

DEPOSITO <3% ≥ 3%

BRETEAU <5 ≥ 5