Evaluation of an Ecohealth Approach to Public Health Intervention in Ha Nam, Vietnam.

CONTEXT: Ecohealth is a transdisciplinary research approach that considers socio-economic, cultural, and environmental factors. Ecohealth program assessment is sometimes unable to capture the process of change, especially when the evidence is not well documented. As such, there is a need to better understand how ecohealth approaches are understood, integrated, and adapted in practice to support the sustainability of the approach. OBJECTIVE: To evaluate the use of an ecohealth approach to a community-based intervention to improve environmental sanitation and draw lessons learned for similar public health initiatives. DESIGN: An iterative evaluation approach involving 27 in-depth interviews and 9 focus group discussions was used to gather feedback on the intervention activities and outcomes from all participants. SETTING AND PARTICIPANTS: The study site was Hoang Tay commune, Kim Bang district, Ha Nam province. The participants included 12 farmers, 4 local policy makers, and 7 researchers from Hanoi University of Public Health. RESULTS: The farmers provided specific shortcomings of the biogas procedure steps, while the local authorities identified new and more effective ways to promote sanitation guidelines. Outcomes, as behavior changes, in 3 participant groups were captured. CONCLUSION: Participation in ecohealth interventions should be collegial to give opportunities for all related stakeholders to build capacity, support, and achieve the transdisciplinary principle. This also helps ensure that the community-based solutions are incorporated in public health interventions. Participatory monitoring and evaluation should support the understanding of the implementation process to capture intervention outcomes.

Community Participatory Interventions to Improve Farmer Knowledge and Practices of Household Biogas Unit Operation in Ha Nam Province, Vietnam.

CONTEXT: The use of biogas systems to treat livestock waste is a common practice in Vietnam. However, farmers' knowledge and practices of the safe and appropriate use of household biogas units (HBUs) are still limited and could negatively impact human, animal, and environmental health. OBJECTIVE: To assess the effectiveness of an intervention to improve knowledge and practices of biogas operation among farmers in 2 communes of Ha Nam Province, Vietnam. DESIGN: A community-based intervention approach. SETTING: This study was conducted from 2015 to 2016 in 2 communes of Ha Nam Province, Vietnam. PARTICIPANTS: Only farmers with HBUs (N = 399) participated in this research. Farmers were assigned to either an intervention group or a control group at a ratio of 1:2. INTERVENTION: Two intervention steps were implemented over a 6-month period as follows: (i) the core farmer group trained in 6 steps of HBU safe handling practice; and (ii) the core farmer group conducted peer-to-peer communication with its neighbors in the commune using the provided material. MAIN OUTCOME MEASURE(S): Farmers' knowledge and practices in biogas operation were assessed by a structured questionnaire. The questionnaire was administered before (baseline) and after the intervention (follow-up) to both the control and intervention groups. RESULTS: There was a significant difference in the knowledge and practices of biogas operation between the 2 groups, in which farmers in the intervention group demonstrated better understanding of the related topic than the control group (P < .05, t test). A linear regression model indicated that baseline and follow-up scores in both knowledge and practices of the intervention group were higher than those of the control group. After the intervention, the mean difference score in knowledge and practices between the intervention and control groups was 5.0 and 2.0 points, respectively (P < .01). CONCLUSION: A community-based intervention approach could be applied to improve knowledge and practices among farmers in using biogas systems. However, further studies should be conducted to assess the sustainability and effectiveness of this model.

International, Transdisciplinary, and Ecohealth Action for Sustainable Agriculture in Asia.

Sustainably intensifying agriculture to secure food for people, while minimizing the human, animal, and environmental health impacts is an unprecedented global food security challenge. Action research is needed to understand and mitigate impacts, with Ecosystem approaches to health (Ecohealth) emerging as a promising framework to support such efforts. Yet, few have critically examined the application of Ecohealth principles in an agricultural context, particularly in Southeast Asia where agricultural intensification is rapidly expanding. In this paper, we evaluate the strengths, challenges, and opportunities of agriculture-related Ecohealth projects in low-resource settings of Vietnam, Thailand, Indonesia, and China, drawing on a case study of the Field Building Leadership Initiative (FBLI). To do this, we used a developmental evaluation framework involving several iterative cycles of document reviews, interviews, focus groups, and outcome harvesting with researchers, partners, and community members involved in FBLI. Results highlight the importance of transdisciplinarity, participation, and knowledge-to-action principles in co-generating knowledge and co-developing practical solutions. Implementing such principles presents challenges in terms of coordinating regional collaborations, managing high workloads, meaningfully engaging communities, and ensuring ongoing monitoring and evaluation. To address these challenges, there is a need to strengthen capacity in integrated approaches to health, improve institutionalization of Ecohealth, foster community engagement, and systematically monitor and evaluate efforts. Ecohealth holds significant promise in improving food security, but only when considerable time is spent developing and implementing projects with communities.

A Stakeholder Survey on Live Bird Market Closures Policy for Controlling Highly Pathogenic Avian Influenza in Vietnam.

Extensive research in Vietnam and elsewhere has shown that live bird markets (LBMs) play a significant role in the ecology and zoonotic transmission of avian influenzas (AIs) including H5N1 and H7N9. Vietnam has a large number of LBMs reflecting the consumer preferences for live poultry. Under pressure to mitigate risks for H7N9 and other zoonotic AIs, Vietnam is considering, among other mitigation measures, temporary closures of LBMs as a policy to reduce risk of AI outbreaks. However, the efficacy of market closure is debated, particularly because little is known about how poultry traders may react, and whether trading may emerge outside formal marketplaces. Combining efforts of anthropologists, economists, sociologists, and veterinarians can be useful to elucidate the drivers behind poultry traders' reactions and better understanding the barriers to implementing risk mitigation measures. In this paper, we present results from a stakeholder survey of LBM stakeholders in Vietnam. Our qualitative data show that trading outside formal markets is very likely to occur in the event of a temporary LBM market closure. Our data show that the poultry value chain in Vietnam remains highly flexible, with traders willing and able to trade poultry in many possible locations. Our results indicate that simplification of the poultry value chain along with strict enforcement, engagement of stakeholders, and adequate communication would be a necessary prerequisite before market closure could be an effective policy.