Access to food markets, household wealth and child nutrition in rural Cambodia: Findings from nationally representative data.

Access to informal fresh food markets plays a vital role in household food security and dietary quality in transitioning rural economies. However, it is not well understood if market access also improves child nutrition and if the improvement applies to all socioeconomic groups. In this secondary research study, we combined a national listing of food markets (n = 503) with a national household survey to examine the associations of market access with diet and height across wealth groups in children aged 6 to 23 months in rural Cambodia. All children under two years of age with dietary data (n = 1537) or anthropometry data (n = 989) were selected from the household survey. Food markets were geocoded using Google Maps or villages' geographical coordinates publicly available in the Open Development Mekong data platform. Regression calibration was then used to estimate household distance to the nearest market. Descriptive results indicated a highly uneven distribution of food markets with median household distance to the nearest markets ranging between 4 km (IQR: 3-8 km) in the lowland areas and 9 km (IQR: 4-17 km) in the highland areas. Results from the multivariate linear regressions showed that distance to the nearest market was modestly associated with child dietary diversity score (ß: -0.17; 95% CI: -0.29, -0.05) but it was not related to child height-for-age z-score, and that household wealth did not modify the associations between distance to markets and child dietary diversity score. These findings suggest that improving access to food markets alone might not lead to meaningful improvement in child diet. Detailed surveys on household food acquisition are needed to clarify the role of food markets relative to other food sources such as subsistence fisheries, subsistence gardening and mobile food traders.

An Assessment of the Economic Impacts of the 2019 African Swine Fever Outbreaks in Vietnam.

The 2019 African swine fever (ASF) outbreaks in Vietnam imposed considerable impacts on the pig sector in Vietnam, resulting in the death or culling of nearly six million pigs, or more than 20% of the country's pig population. In order to assess the magnitude of the outbreak at sector level (both on farm and at value chain level), on livelihoods, and on the broader national economy, a comprehensive impact assessment was conducted using a mixed methods approach that integrated a value chain assessment with the use of quantitative modeling tools at sector and national levels. The results showed that the outbreak caused severe direct and indirect economic losses among farmers, particularly medium- and large-farmers whose livelihoods are largely derived from pig production. The outbreaks also affected other value chain actors due to a halving in the volume of pigs traded. At sector level, the outbreaks posed adverse impacts on the domestic supply and demand for pork, especially in the traditional sector. Meanwhile, the modern sector with higher levels of biosecurity and high technology growth was less likely to be affected and even benefited from the outbreak, which was evidenced by increased supply and income throughout the simulation period in this sector. At national level, different model simulation scenarios showed a sharp reduction in total gross domestic product (GDP) and a substantial loss of jobs. Improvements in the system of ASF compensation scheme are needed, both in terms of its administration, but also in its targeting, with greater emphasis needed on developing improved risk-sharing and funding mechanisms across national and local levels.

Microbial contamination and associated risk factors in retailed pork from key value chains in Northern Vietnam.

Pork and pork products are important staple food in the diet of Vietnamese consumers. The safety of pork, including biological contamination, is a concern to several public authorities and value chain actors. This cross-sectional study aimed to identify Salmonella and total bacterial count (TBC) contamination of cut pork sold in different outlets, and determine the potential factors leading to contamination. A total of 671 pork samples were collected from different retail channels in three provinces in Northern Vietnam. Hygiene conditions and practices at pork vending premises were also observed and recorded. Data analysis used descriptive statistics and regression analysis. Overall, Salmonella prevalence in retailed pork was 58.1%. Salmonella contamination in pork from traditional retail, modern retail and food services were 60.5%, 50.9% and 80.5%, respectively. Eighty percent and 68% of fresh pork in canteen and street food was contaminated with Salmonella. Only a small proportion of a subset of the pork samples (6.2%) tested met the Vietnamese standard requirement for TBC contamination. Average concentration of TBC in fresh pork in traditional retail, modern retail and food services were 6.51 (SD: 0.64), 6.38 (0.65), and 6.96 (0.85) LogCFU/g, respectively. Transport time, use of the same tools for pork and other types of meat, storage temperature, and environment hygiene are important factors that might affect microbial contamination. The findings underline the high level of microbial contamination, which requires practical interventions to improve food safety hygiene practices and behavior of pork retailers.

The challenges of investigating antimicrobial resistance in Vietnam - what benefits does a One Health approach offer the animal and human health sectors?

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.

Microbiological risk infection assessment using QMRA in agriculture systems in Côte d'Ivoire, West Africa.

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.

Food safety in Vietnam: where we are at and what we can learn from international experiences.

Food-borne diseases are attracting a lot of attention in Vietnam as a result of repeated episodes of adulterated and unsafe food. In this paper, we provide some perspectives on food safety in Vietnam from the point of view of an international research institution working on food safety with partners in the country. We argue that one of the key issues of food safety in Vietnam is that certain food value chain stakeholders lack ethics, which leads to the production and trading of unsafe foods in order to make profits irrespective of adverse health effects on consumers. In turn, the shortfall in ethical behaviours around food can be attributed to a lack of incentives or motivating factors.Although food safety causes panic in the population, it is unclear how much contaminated food contributes to the burden of food-borne diseases and food poisonings in Vietnam. However, globally, the biggest health problem associated with food are infections from consuming food contaminated with viruses, bacteria or parasites. A major food safety challenge is the inappropriate way of communicating food risks to the public. Another key constraint is the inherent difficulty in managing food in wet markets and from smallholder production. On the other hand, local foods, and local food production and processing are an important cultural asset as well as being essential to food safety, and these aspects can be put at risk if food safety concerns motivate consumers to purchase more imported foods.In this paper, we also discuss good experiences in food safety management from other countries and draw lessons learnt for Vietnam on how to better deal with the current food safety situation.

Diarrhea risks by exposure to livestock waste in Vietnam using quantitative microbial risk assessment.

OBJECTIVES: The aim of this paper was to assess the diarrhea risks caused by various pathogens among those exposed to biogas wastewater through different activities. METHODS: Application of quantitative microbial risk assessment (QMRA) of biogas wastewater was conducted in Hanam Province, Vietnam. A total of 451 representatives from households that use biogas were interviewed about their practices of handling biogas plant and reuse of biogas effluent for irrigation. In addition, 150 samples of biogas wastewater were analyzed for Escherichia coli, Cryptosporidium parvum, and Giardia lamblia. Risk characterization was calculated using Monte Carlo simulation. RESULTS: The annual diarrhea risk caused by exposure to biogas effluent through irrigation activities ranged from 17.4 to 21.1% (E. coli O157:H7), 1.0 to 2.3% (G. lamblia), and 0.2 to 0.5% (C. parvum), while those caused through unblocking drains connected to biogas effluent tanks were 22.0% (E. coli), 0.7% (G. lamblia), and 0.5% (C. parvum). CONCLUSIONS: Further measures are needed to reduce the risk by either improving the microbial quality of biogas effluent or by ensuring the use of personal protective measures when exposed to biogas wastewater.

Quantitative risk assessment of human salmonellosis in the smallholder pig value chains in urban of Vietnam.

OBJECTIVES: To quantify salmonellosis risk in humans through consumption of boiled pork in urban Hung Yen Province, Vietnam, using a quantitative microbial risk assessment. METHODS: We collected 302 samples along the pork value chain in Hung Yen between April 2014 and February 2015. We developed a model in @Risk, based on microbiological, market, and household surveys on cooking, cross-contamination and consumption, and conducted sensitivity analysis. RESULTS: Salmonella prevalence of pen floor swabs, slaughterhouse carcasses and cut pork were 33.3, 41.7 and 44.4%, respectively. The annual incidence rate of salmonellosis in humans was estimated to be 17.7% (90% CI 0.89-45.96). Parameters with the greatest influence risk were household pork handling practice followed by prevalence in pork sold in the central market. Wide confidence interval in the incidence estimate was mainly due to the variability in the degree of reduction in bacteria concentration by cooking, and pork consumption pattern. CONCLUSIONS: The risk of salmonellosis in humans due to boiled pork consumption appears to be high. Control measures may include improving the safety of retailed pork and improving household hygiene.

Exposure assessment of chemical hazards in pork meat, liver, and kidney, and health impact implication in Hung Yen and Nghe An provinces, Vietnam.

OBJECTIVES: This study assesses the risk of exposure to hazardous chemical residues in pork meat, liver, and kidney collected at wet markets in Nghe An and Hung Yen provinces and discusses health impact implication. METHODS: 514 pig feed, kidney, liver, and pork samples were pooled and qualitatively and quantitatively analyzed for tetracyclines, fluoroquinolones, sulphonamide, chloramphenicol, ß-agonists, and heavy metals. We compare the results with current regulations on chemical residues and discuss health implications. RESULTS: Legal antibiotics were found in feed. Tetracycline and fluoroquinolones were not present in pork, but 11% samples were positive with sulfamethazine above maximum residue limits (MRL); 11% of packaged feed and 4% of pork pooled samples were positive for chloramphenicol, a banned substance; two feed, two liver, and one pork samples were positive for ß-agonists but did not exceed current MRL; 28% of pooled samples had lead, but all were below MRL; and all samples were negative for cadmium and arsenic. Thus, the health risks due to chemical hazards in pork in Hung Yen and Nghe An seemed not as serious as what were recently communicated to the public on the mass media. CONCLUSIONS: There is potential exposure to sulphonamide, chloramphenicol, and ß-agonists from pork. Risk communication needs to focus on banned chemicals, while informing the public about the minimal risks associated with heavy metals.

Cost of Hospitalization for Foodborne Diarrhea: A Case Study from Vietnam.

Vietnam is undergoing a rapid social and economic developments resulting in speedy urbanization, changes in methods for animal production, food marketing systems, and food consumption habits. These changes will have major impacts on human exposures to food poisoning. The present case study aimed to estimate hospitalization costs of foodborne diarrhea cases in selected health facilities in Vietnam. This is a facility-based cost-of-illness study conducted in seven health facilities in Northern Vietnam. All suspect cases of foodborne diarrhea, as diagnosed by doctors, who admitted to the studied health facilities during June-August, 2013 were selected. Costs associated with hospitalization for foodborne diseases were estimated from societal perspective using retrospective approach. We included direct and indirect costs of hospitalization of foodborne diarrhea cases. During the study period, 87 foodborne diarrhea cases were included. On average, the costs per treatment episode and per hospitalization day for foodborne diarrhea case were US$ 106.9 and US$ 33.6 respectively. Indirect cost (costs of times to patient, their relatives due to the patient's illness) made up the largest share (51.3%). Direct medical costs accounted for 33.8%; direct non-medical costs (patient and their relatives) represented 14.9%. Cost levels and compositions varied by level of health facilities. More attentions should be paid on prevention, control of foodborne diarrhea cases in Vietnam. Ensuring safety of food depends on efforts of everyone involved in food chain continuum, from production, processing, and transport to consumption.

Assessing willingness to pay for improved sanitation in rural Vietnam.

OBJECTIVE: The willingness to pay (WTP) for the construction of bathrooms with a flush toilet was assessed in households in a rural community in northern Vietnam. We also examined the effects of socio-economic factors on the WTP. METHODS: The contingent valuation method, an economic survey technique, was used. We used the iterative bidding game technique to elicit household WTP that involved a sequence of dichotomous choice questions followed by a final open-ended question. A total of 370 households that did not have toilets were selected for this study. Respondents to the questionnaire were the primary income earners and decision-makers of their respective household. RESULTS: Of those responding to the questionnaire, 62.1 % reported being willing to pay for the construction of bathrooms with a flush toilet. The mean and median of maximum WTP amounts were Viet Nam Dong (VND) 15.6 million and VND 13.0 million, respectively (minimum VND 2.0 million; maximum VND 45.0 million). Significant correlates of the WTP rate were: (1) gender of the head of household, (2) age of the head of household, (3) economic status of household, (4) type of current toilet, (5) satisfaction with existing toilet, and (6) knowledge of health effects of poor sanitation. The significant determinants of WTP amount were (1) geographic location and (2) economic status of household. CONCLUSION: About two-third of the households in the study area were willing to pay for an improvement in their current sanitation arrangements. Both WTP rate and WP amount were strongly influenced by the economic status of the households and health knowledge of the study respondents.

Economic aspects of sanitation in developing countries.

BACKGROUND: Improved sanitation has been shown to have great impacts on people's health and economy. However, the progress of achieving the Millennium Development Goals (MDGs) on halving the proportion of people without access to clean water and basic sanitation by 2015 has thus far been delayed. One of the reasons for the slow progress is that policy makers, as well as the general public, have not fully understood the importance of the improved sanitation solutions. This paper, by gathering relevant research findings, aims to report and discuss currently available evidence on the economic aspects of sanitation, including the economic impacts of unimproved sanitation and the costs and economic benefits of some common improved sanitation options in developing countries. METHODS: DATA USED IN THIS PAPER WERE OBTAINED FROM DIFFERENT INFORMATION SOURCES: international and national journal articles and reports, web-based statistics, and fact sheets. We used both online search and hand search methods to gather the information. RESULTS: Scientific evidence has demonstrated that the economic cost associated with poor sanitation is substantial. At the global level, failure to meet the MDG water and sanitation target would have ramifications in the area of US$38 billion, and sanitation accounts for 92% of this amount. In developing countries, the spending required to provide new coverage to meet the MDG sanitation target (not including program costs) is US$142 billion (US$ year 2005). This translates to a per capita spending of US$28 for sanitation. Annually, this translates to roughly US$14 million. The evidence complied in this paper demonstrates that investing in sanitation is socially and economically worthwhile. For every US$1 invested, achieving the sanitation MDG target and universal sanitation access in the non-OECD countries would result in a global return of US$9.1 and US$11.2, respectively. CONCLUSION: Given the current state of knowledge, sanitation is undeniably a profitable investment. It is clear that achieving the MDG sanitation target not only saves lives but also provides a foundation for economic growth.

Improving environmental sanitation, health, and well-being: a conceptual framework for integral interventions.

We introduce a conceptual framework for improving health and environmental sanitation in urban and peri-urban areas using an approach combining health, ecological, and socioeconomic and cultural assessments. The framework takes into account the three main components: i) health status, ii) physical environment, and iii) socioeconomic and cultural environment. Information on each of these three components can be obtained by using standard disciplinary methods and an innovative combination of these methods. In this way, analyses lead to extended characterization of health, ecological, and social risks while allowing the comprehensive identification of critical control points (CCPs) in relation to biomedical, epidemiological, ecological, and socioeconomic and cultural factors. The proposed concept complements the conventional CCP approach by including an actor perspective that considers vulnerability to risk and patterns of resilience. Interventions deriving from the comprehensive analysis consider biomedical, engineering, and social science perspectives, or a combination of them. By this way, the proposed framework jointly addresses health and environmental sanitation improvements, and recovery and reuse of natural resources. Moreover, interventions encompass not only technical solutions but also behavioral, social, and institutional changes which are derived from the identified resilience patterns. The interventions are assessed with regards to their potential to eliminate or reduce specific risk factors and vulnerability, enhance health status, and assure equity. The framework is conceptualized and validated for the context of urban and peri-urban settings in developing countries focusing on waste, such as excreta, wastewater, and solid waste, their influence on food quality, and their related pathogens, nutrients, and chemical pollutants.