Sister project in Colombia: Healthy Schools Reducing dengue and - PowerPoint PPT Presentation

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

* 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 .

*  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 km 2 -  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

PROJECT OVERVIEW • 3-year initiative (2010-2013) • Funded by the Norwegian Research Council • Partners at the international, national, and local levels International National Local Rural schools Lazos de Calandaima University of Life Foundation Sciences, Norway Pupils Universidad El Bosque Municipality of Anapoima Liverpool School of Tropical Medicine, UK Municipality of La Teachers Mesa London School of Hygiene and Tropical Medicine, UK School principals Public Health Laboratory, Cundinamarca Institute for Kitchen personnel Infectious Disease Community leaders Control, Sweden

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 o Statistical support: o Field Technicians Ehidee Gómez Laura Hernández Nancy Herrera o Financial statement / accounts Rosa Silva Olga Quimbayo Ana Cuéllar Fabian Mora Grupo contabilidad Fundación Lazos o Laboratory Technician de Calandaima Humberto Mosquera o Young researchers o Monitoring absences Sergio Salas Anapoima Laura Cabezas La Mesa María Fernanda Molina Ximena Roncancio

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

La Mesa Anapoima No. of schools: 18 No. of schools: 17 Total teachers: 27 Total teachers: 19 Total of Students: 459 Total of Students: 262 Age: 5-16 years old Age: 5-16 years old Courses: 0-5 grade Courses: 0-5 grade Altitude: Altitude: La Vega 712 masl El Consuelo 588 masl Buenavista 1610 masl Palmichera 1089 masl

Contribute to improved health and welfare in Colombian school children by evaluating the impact of school-based diarrhea and dengue control interventions .

• Reduce exposure to dengue risk factors in schools: • Reducing dengue mosquito vector populations 1 • Reducing exposure to solid waste surrounding schools • Reduce exposure to diarrheal risk factors in schools: • Improving drinking water quality 2 • Improving hand-washing practices • Improving hygiene • Reduce the incidence of diarrheal diseases (and potentially 3 dengue fever) in school children. • Reduce the number of absence episodes and length of those 4 due to these illnesses

ENTOMOLOGICAL SOCIO ENVIRONMENTAL COMPONENTS CULTURAL HEALTH

Aedes Immature aegypti stages survey INFESTATION Adult mosquito survey Laboratory Identification

2011

2011

ABSENCES KAP REGISTER SURVEYS TEACHERS METODOLOGY RESULTS PUPILS

KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - TEACHERS FROM LA MESA VARIABLE KNOWLEDGE ATTITUDES PRACTICES DENGUE Y Medium High High DIARRHEA DENGUE Medium High Medium DIARRHEA Medium High High

KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - TEACHERS FROM ANAPOIMA VARIABLE KNOWLEDGE ATTITUDES PRACTICES DENGUE Y Medium High High DIARRHEA 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 Medium DIARRHEA High Medium DENGUE Low DIARRHEA Medium

KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - STUDENTS FROM ANAPOIMA VARIABLE KNOWLEDGE ATTITUDES PRACTICES DENGUE Y Medium DIARRHEA High Medium DENGUE Medium DIARRHEA Medium

METHODOLOGY ABSENCES 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

% INFORMANTE MADRE 44.6 Reason for Absence. Anapoima. July-August 2011 PADRE 3.6 ABUELOS 1.2 HERMANO 7.6 25,3 23,8 20,8 19 PRIMOS 1.2 TIOS 4.8 6,3 4,8 MISMO NIÑO 23.3 AMIGO 3.6 SIN DATO 8.4 OTRO 1.6 Reason for Sickness absence. Anapoima,July-August 2011 Dolor cuerpo 3 Fractura 2 Tos-mocos 4 Faringoamigdalitis 2 Vomito 4 Diarrea 7 Otro 13 Dolor de cabeza 15 Gripa 9 Fiebre 19

Reason for Absence La Mesa. Julio-Agosto 2011 % INFORMANTE 35,0 34 30,5 MADRE 30,0 3 PADRE 22,8 25,0 18,8 20,0 3 ABUELOS 12,9 15,0 HERMANO 9 8,4 6,6 10,0 0 5,0 PRIMOS 0,0 TIOS 2 22 MISMO NIÑO 2 AMIGO SIN DATO 25 2 OTRO Reason for Sickness absence. La Mesa, July-August 2011 Dato perdido 48 Otro 14 Eruptiva infancia 2 Fractura 1 Faringoamigdalitis 1 Gripa 28 Diarrea 7 0 10 20 30 40 50

School Water condition s Microbiological Criteria analysis Physiochemical Results analysis

Lev Bacterial counts el I 1 – 10 II 11 – 100 III 101 – 1000 IV 1001 – 10000 V > 10000 Total coliforms E. coli (CFU/100 ml) (CFU/100 ml)

• Water source • Water supply frequency • Albercas (Type of Low Tank) • Tanks Covered • Internal water treatment • Sinks Item / • Toilets • Toilets cleaning Criteria • 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

Ø Dengue Diarrhea Dengue & Control Diarrhea

Immature Curtains Adult forms Covering forms impregnated tanks with insecticide pyriproxyfen Rubbish collection campaign

DIARRHEA INTERVENTION STRATEGIES FOR THE PREVENTION OF DIARRHEA WATER HYGIENE Filter Handwashing Cover Cleaning bathroom and clean tanks s

• Educational program integrating aspects Education of health,water,sanitati on and hygiene • Establishing Social mechanisms for mobilizatio community participation and n surveillance

* 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 Casos de dengue, Anapoima 2007-2010 80 70 69 60 58 50 40 30 20 25 10 11 0 2007 2008 2009 2010 Incidencia de casos notificados como probables: 42 X100.000 habitantes Fuente: SAA oficina de epidemiologia SSC

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

Descripción de los casos de dengue notificados. 2010 Cabecera municipal: 71% Centro poblado Inspecciones: 14.5 % Rural: 14.5 %

VIGILANCIA ENTOMOLÓGICA INDICES DE INFESTACION LARVARIOS Índice de vivienda Número de casas positivas x 100% Número de casas inspeccionadas Índice de depósito Número de depósitos positivos x 100% Número total de depósitos inspeccionados Índice de Breteau Número de depósitos positivos x 100 casas Número total de casas inspeccionadas