SYMPOSIUM | December 6th 2017, Bangkok, Thailand
Global Health Group International organises together with the Malaria Consortium a symposium during the Joint International Tropical Medicine Meeting to be held in Bangkok in December 2017. The social-ecological systems & resilience framework (SESR) developed on the basis of findings in ecology and environmental management has been suggested as applicable to vector borne diseases (VBDs). As with environmental and natural resource management problem-solving, vector management requires taking into account natural and human ecological factors, systems thinking, and transdisciplinarity. The latter provides the philosophical and practical basis for local or community as well as cross-sectoral participation, consideration of socio-economic factors, and gender equity as called for by various agencies sponsoring VBDs programs. Application of SESR, which includes the so-called ecosystem approach to VBDs, remains at an early stage and comprehensive case examples are lacking.
PROGRESS AND PROSPECTS FOR APPLICATION OF SOCIAL-ECOLOGICAL SYSTEMS APPROACH FOR VECTOR BORNE DISEASES
Bruce A.Wilcox, Carsten H. Richter, Jennifer A. Steele, Bernadette Ramirez, Jeffrey Hii, and Pierre Echaubard
The social-ecological systems & resilience framework (SESR) developed on the basis of findings in ecology and environmental management has been suggested as applicable to vector borne diseases (VBDs). As with environmental and natural resource management problem-solving, vector management requires taking into account natural and human ecological factors, systems thinking, and transdisciplinarity. The latter provides the philosophical and practical basis for local or community as well as cross-sectoral participation, consideration of socio-economic factors, and gender equity as called for by various agencies sponsoring VBDs programs. Application of SESR, which includes the so-called ecosystem approach to VBDs, remains at an early stage and comprehensive case examples are lacking. In this presentation we (i) illustrate what could be an “ideal” SESR-framed VBD intervention, (ii) describe, based on our experience with specific projects, the potential and limitations of SESR for VBD applications, and (iii) suggest how these may be overcome drawing on recent and ongoing efforts in this regard.
PROSPECTS AND CHALLENGES TOWARDS SUSTAINABLE LIVER FLUKE CONTROL
Pierre Echaubard & Bruce A. Wilcox
The liver fluke Opisthorchis viverrini (Ov) is endemic in Southeast Asia where more than 10 million people are estimated to be infected. The infection is associated with several hepatobiliary diseases including cholangiocarcinoma (CCA). Northeast Thailand is a hotspot of Ov transmission and despite extensive public health prevention campaigns led by the government, Ov infection prevalence is still high. The persistence of high Ov infection rates in the region is due to (1) cultural behaviors associated with fishing, food preparation, and eating practices that are deeply embedded as part of the local rice-fish culture of this region; (2) wetland ecosystem-dependent livelihood and an ancient co-evolutionary relationship of Ov, natural hosts and humans; (3) a complex set of pathological consequences associated with infection and treatment; (4) historically unprecedented environmental change, including those caused by regional and local water resources management and flood control projects that lead to the disruption of natural ecological regulatory mechanisms with consequences on hosts abundance and patterns of exposure ; and, (5) possibly the most important, lack of knowledge integration at the policy level, discontinuity in government support including reduction in geographic coverage and lack of community-based control activities. We review here the state of our knowledge regarding the social-ecological determinants of Ov transmission and then attempt to describe an integrative research rationale based on transdisciplinarity, pointing to the needs to enhance collaborative research and education as well as provide a broader human health and sustainable development framework in the context of the rapidly changing Southeast Asia waterscape.
SOCIAL-ECOLOGICAL SYSTEMS APPROACH TO RESIDUAL MALARIA TRANSMISSION IN THE GREATER MEKONG SUB-REGION
Jeffrey Hii, Edwards H, Sattabongkot J, Sriwichai P, Kiattibutr K, Phuanukoonnon S Chinh VD, Duy BL, Thang ND, Xa NX, Trang DM, Shafique M
Thailand and Vietnam aims to eliminate malaria by 2024 and 2030 respectively. Elimination in many of the remaining districts and provinces is hindered by the continuing presence of malaria infections in workers with ‘high risk’ occupations, for example farming communities, rubber plantation, seasonal and forest workers. These groups often belong to migrant or mobile populations with lower access to health care and greater exposure to malaria vectors in forest/plantation areas. Sibling species of malaria vectors with different ecological traits and vector competencies further complicate transmission patterns. Poor understanding of the ecological and behavioural attributes of vector and human populations, and their interactions, in these localities makes focal vector control difficult to design.
We combined entomological, epidemiological, geo-spatial and qualitative research methods to understand the bio-socio-ecological determinants of residual malaria transmission (RMT) in three ecological niches – village, farm huts, and forest.
The magnitude of RMT comprised outdoor biting (49-90% of all night-biting) plus indoor biting that occurred outside of sleeping hours (24% of all-night biting indoors) if universal coverage and usage of insecticide-treated nets (ITNs) were achieved. Furthermore, ownership did not translate into usage. Many ITNs were old or damaged, therefore affecting the risk of biting exposure. Given the heterogeneity of human behaviour and the variation of vector densities and biting behaviours and the under-achievement of community level universal coverage of ITN, additional efforts in improving bednet use may take into account natural and human ecological factors, systems thinking, and transdisciplinarity.
THE REALITY OF USING TRANSDISCIPLINARITY AND ECOSYSTEM APPROACHES FOR VECTOR BORNE DISEASES
Jennifer Steele, Pierre Echaubard, Carsten Richter, Bruce Wilcox
Though the concept and importance of using a transdisciplinary ecosystem approach for global health problems have been elaborated for over a decade, the practice of using them for real-world application to problems has been difficult. Issues including how to implement an ecosystem approach, how to evaluate its effectiveness, and how to overcome challenges encountered have not been adequately described, creating uncertainty amongst health professionals seeking to move from theory to action. Vector borne diseases present especially complex problems with intricate connections among the environment, vectors, pathogens, reservoirs, animal hosts, and human communities in affected areas. Problems involved in vector borne disease control span far outside of the overt human clinical medical realm, requiring transdisciplinarity to create sustainable, effective interventions. In this presentation we seek to provide our knowledge and experience with concrete examples for how to implement an ecosystem approach to problem, including the process of using transdisciplinarity, systems thinking, and adaptive management to guide action on vector borne disease problems.
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