Reducing dengue and diarrheal diseases in primary schools in

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 4year 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: http://auracristinperez.wordpress.com Foto: El Espectador
*
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
Lazos de Calandaima
Foundation
University of Life
Sciences, Norway
Universidad El
Bosque
Liverpool School of
Tropical Medicine, UK
London School of
Hygiene and Tropical
Medicine, UK
Institute for
Infectious Disease
Control, Sweden
Local
Pupils
Municipality of
Anapoima
Municipality of La
Mesa
Public Health
Laboratory,
Cundinamarca
Rural schools
Teachers
School principals
Kitchen personnel
Community leaders
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
La Mesa
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
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
4
• Reduce the incidence of diarrheal diseases (and potentially
dengue fever) in school children.
• Reduce the number of absence episodes and length of those
due to these illnesses
ENTOMOLOGICAL
SOCIO
CULTURAL
COMPONENTS
HEALTH
ENVIRONMENTAL
Aedes
aegypti
INFESTATION
Immature
stages survey
Adult
mosquito
survey
Laboratory
Identification
2011
2011
ABSENCES
REGISTER
KAP
SURVEYS
TEACHERS
METODOLOGY
PUPILS
RESULTS
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
DENGUE Y
DIARRHEA
Medium
DENGUE
Low
DIARRHEA
Medium
ATTITUDES
PRACTICES
High
Medium
KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND
DIARRHEA - STUDENTS FROM ANAPOIMA
VARIABLE
KNOWLEDGE
DENGUE Y
DIARRHEA
Medium
DENGUE
Medium
DIARRHEA
Medium
ATTITUDES
PRACTICES
High
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
Reason for Absence. Anapoima. July-August 2011
25,3
23,8
20,8
19
6,3
4,8
%
INFORMANTE
MADRE
PADRE
ABUELOS
HERMANO
PRIMOS
TIOS
44.6
3.6
1.2
7.6
1.2
4.8
MISMO NIÑO
AMIGO
SIN DATO
OTRO
23.3
3.6
8.4
1.6
Reason for Sickness absence. Anapoima,July-August 2011
Dolor cuerpo
Fractura
Faringoamigdalitis
2
Tos-mocos
4
Vomito
4
Diarrea
Otro
7
13
Dolor de cabeza
Gripa
3
2
9
Fiebre
15
19
Reason for Absence La Mesa. Julio-Agosto 2011
35,0
30,0
25,0
20,0
15,0
10,0
5,0
0,0
30,5
22,8
18,8
12,9
8,4
6,6
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
INFORMANTE
MADRE
PADRE
ABUELOS
HERMANO
PRIMOS
TIOS
%
34
3
3
9
0
2
MISMO NIÑO
AMIGO
SIN DATO
OTRO
22
2
25
2
Water
Microbiological
analysis
Physiochemical
analysis
School
condition
s
Criteria
Results
Total coliforms
(CFU/100 ml)
Lev
el
Bacterial counts
I
1 – 10
II
11 – 100
III
101 – 1000
IV
1001 – 10000
V
> 10000
E. coli
(CFU/100 ml)
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
Min
Media
Mediana
75,6
13,8
47,1
35,4
Max
Min
Media
Mediana
70,6
20,0
49,0
53,2
Ø
Diarrhea
Dengue
Dengue
&
Diarrhea
Control
Immature
forms
Covering
tanks
pyriproxyfen
Rubbish collection
campaign
Adult forms
Curtains
impregnated
with
insecticide
DIARRHEA
INTERVENTION STRATEGIES FOR THE
PREVENTION OF DIARRHEA
WATER
HYGIENE
Filter
Handwashing
Cover
and clean tanks
Cleaning bathroom
s
Education
Social
mobilizatio
n
• Educational program
integrating aspects
of
health,water,sanitati
on and hygiene
• Establishing
mechanisms for
community
participation and
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
10
25
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
INTERPRETACION EPIDEMIOLÓGICA
INDICE
RIESGO
BAJO
ALTO
VIVIENDA
< 4%
≥ 4%
DEPOSITO
<3%
≥ 3%
BRETEAU
<5
≥5
THANK YOU