Objective 1

Risk mapping tools

Develop criteria for identifying high risk villages for FBPD involving production animals in northern Laos.

Risk mapping tools can help governments and other partners identify where they should focus their initial interventions and research when large scale surveys are not feasible.

Three provinces were selected for research activities

• Luang prabang

• Phongsali

• Oudamxai.

A preliminary risk rating of High and Low was assigned to villages within each district of each of these three provinces. From this list one high risk district was selected and 14 villages (7 high and 7 low risk rating) were randomly selected from each for further investigation. A total of 42 villages.

A rapid and an in-depth field-based risk assessment was conducted in each of the 42 villages using our project developed tool.

The tool considered 8 risk factors:

1) high levels of poverty; 2) low coverage oflatrines and the associated practice of open defecation; 3) consumption of unpotable water; 4) high levels of pig ownership; 5) the practice of free-ranging pigs; 6) consumption of raw pork; 7) cases of epilepsy as a proxy for T. solium infections; and, 8) village inaccessibility.

Application of the risk assessment tool consisted of four steps designed to explore and assess each risk factor at the village level: 1) participatory village mapping, 2) walk and talk (observations and interviews), 3) validation interview; 4) determination of risk village risk rating. In the final step, the data collected was used by the field team (rapid assessment) or qualitative researcher (in-depth assessment) to assign the final rating. The rapid assessment resulted in an overall risk rating based on the consensus of the field-team. The in-depth assessment involved systematic thematic coding of transcribed data to assess and categorise each risk factor as high or low. In-depth risk ratings for each village were established by counting the number of risk factors that were categorised as high risk. Villages with ratings of six or higher were categorised as high risk for T. solium.

OBJECTIVE 2

Targeted use

Describe the unique characteristics of a T. solium hot spot to enable targeted use of the risk factor mapping strategy and provide an understanding of the context for subsequent intervention

In addition to the data collected during the rapid risk assessments, a case series was conducted in selected villages confirmed to have T. solium positive persons. The methods employed were designed to gather specific data on behaviours associated with the sustained transmission of T. solium which could be used for future interventions. These included behaviours influencing the consumption of raw pork, behaviours of persons confirmed to be infected with T. solium, and husbandry practices associated with pig farming and parasite control.

Objective 3a

Burden evaluation

Assess the burden of FBPD on people and production animals in high-risk villages

Faecal samples were collected from a proportion of village members during rapid risk assessment activities. Information sessions were held in each village and individuals had the opportunity to return faecal samples 12–24 hours after each session. 

Microscopic analysis of all samples was done at the Lao Ministry of Health using the Formol ethyl-acetate concentration technique (FECT). Random duplicates (approximately 20%) were tested by a novel modified-McMaster (McMaster2) method and Malachite green smear at Murdoch University (see Larkins et al., 2024).

Microscopy analysis was used to detect all gastrointestinal parasites with a focus on Taenia sp. and soil transmitted helminths (hookworm, Ascaris and Trichuris).

Molecular assays were used to determine species of Taenia (T. solium, T. saginata. T. asiatica) and was undertaken at Murdoch University.

Blood samples collected during an unrelated national study and stored at the Tropical Public Health Institute were used to test for the presence cysticercosis. These samples werecouriered to collaborators at the University of Ghent (Belgium) and were analysed using an antigen ELISA.

Objective 3B

Burden evaluation

Assess the burden of FBPD on people and production animals in high-risk villages

Prevalence of pig parasites

Faecal samples were collected from a proportion of pigs in villages in Viengkham and Mai districts. Microscopic analysis of all samples was done at the National University of Laos by Veterinary staff and students using the modified McMaster technique. The prevalence of gastrointestinal parasites and intensity of infection was ascertained. The results which were generated by 4th year veterinary students was used as part of their research study units.

Cascade of care for people with epilepsy

A qualitative study to examine the management of epilepsy was conducted in the three study districts (Mai, Nga and Vienghkam). The methodology employed key informant interviews, focus group discussions and participant observations with a range of people associated with epilepsy including patients with epilepsy, family/community members, biomedical practitioners and traditional healers.

Key themes investigated were the sociocultural beliefs and attitudes related to epilepsy, such as health seeking behaviours, disease burden, illness management and experiences with clinical care; biomedical and traditional medicine beliefs and practices related to epilepsy and, clinical practices, norms and barriers to diagnosis, treatment case management and quality of care. The study was conducted by a project supported TPHI master’s student and the results generated were used in their final thesis.