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

*

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.

Colombia is located in the

northwest of South America and has

coasts on both the Caribbean Sea

and the Pacific Ocean.

*

Government: Democracy, with 4-

year 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: El Espectador Foto: http://auracristinperez.wordpress.com

*

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

International

University of Life Sciences, Norway

Liverpool School of Tropical Medicine, UK

London School of Hygiene and Tropical

Medicine, UK

Institute for Infectious Disease Control, Sweden

National

Universidad El Bosque

Public Health Laboratory,

Cundinamarca

Local

Lazos de Calandaima Foundation

Municipality of Anapoima

Municipality of La Mesa

School principals

Community leaders

Rural schools

Pupils

Teachers

Kitchen personnel

• 3-year initiative (2010-2013)

• Funded by the Norwegian Research Council

• Partners at the international, national, and local levels

PROJECT OVERVIEW

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

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

La Mesa

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 • Reduce the incidence of diarrheal diseases (and potentially

dengue fever) in school children.

4 • Reduce the number of absence episodes and length of those

due to these illnesses

COMPONENTS

ENTOMOLOGICAL

ENVIRONMENTAL

HEALTH

SOCIO

CULTURAL

Immature stages survey

Adult mosquito survey

Laboratory Identification

Aedes aegypti

INFESTATION

2011

2011

TEACHERS

PUPILS

KAP SURVEYS

METODOLOGY

RESULTS

ABSENCES REGISTER

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 ATTITUDES PRACTICES

DENGUE Y

DIARRHEA Medium

High Medium

DENGUE Low

DIARRHEA Medium

KNOWLEDGE, ATTITUDES AND PRACTICES DENGUE AND DIARRHEA - STUDENTS FROM ANAPOIMA

VARIABLE KNOWLEDGE ATTITUDES PRACTICES

DENGUE Y

DIARRHEA Medium

High Medium

DENGUE Medium

DIARRHEA Medium

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

METHODOLOGY ABSENCES

Reason for Absence. Anapoima. July-August 2011

Reason for Sickness absence. Anapoima,July-August 2011

23,8

4,8

19

25,3

20,8

6,3

INFORMANTE %

MADRE 44.6

PADRE 3.6

ABUELOS 1.2

HERMANO 7.6

PRIMOS 1.2

TIOS 4.8

MISMO NIÑO 23.3

AMIGO 3.6

SIN DATO 8.4

OTRO 1.6

9

13

2

2

Gripa

Otro

Faringoamigdalitis

Fractura

19

15

7

4

4

3

Fiebre

Dolor de cabeza

Diarrea

Vomito

Tos-mocos

Dolor cuerpo

30,5

6,6

12,9

18,8 22,8

8,4

0,05,0

10,015,020,025,030,035,0

INFORMANTE %

MADRE 34

PADRE 3

ABUELOS 3

HERMANO 9

PRIMOS 0

TIOS 2

MISMO NIÑO 22

AMIGO 2

SIN DATO 25

OTRO 2

Reason for Absence La Mesa. Julio-Agosto 2011

Reason for Sickness absence. La Mesa, July-August 2011

7

28

1

1

2

14

48

0 10 20 30 40 50

Diarrea

Gripa

Faringoamigdalitis

Fractura

Eruptiva infancia

Otro

Dato perdido

Microbiological analysis

Physiochemical analysis

Water

Criteria

Results

School

conditions

Total coliforms

(CFU/100 ml) E. coli

(CFU/100 ml)

Lev

el

Bacterial counts

I 1 – 10

II 11 – 100

III 101 – 1000

IV 1001 – 10000

V > 10000

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 75,6

Min 13,8

Media 47,1

Mediana 35,4

Max 70,6

Min 20,0

Media 49,0

Mediana 53,2

Diarrhea Dengue Dengue

& Diarrhea

Control

Ø

Covering

tanks

pyriproxyfen

Rubbish collection campaign

Immature

forms

Curtains

impregnated

with insecticide

Adult forms

WATER

Filter

Cover and clean tanks

HYGIENE

Handwashing

Cleaning bathrooms

DIARRHEA

INTERVENTION STRATEGIES FOR THE PREVENTION OF DIARRHEA

• Educational program integrating aspects of health,water,sanitation and hygiene

Education

• Establishing mechanisms for community participation and surveillance

Social mobilizatio

n

Diana Patricia Rojas Álvarez, Grupo enfermedades transmitidas por vectores,

Subdirección de vigilancia y control en salud pública, Instituto Nacional de Salud(2011

*

Fuente: SAA oficina de epidemiologia SSC

Incidencia de casos notificados

como probables: 42 X100.000

habitantes

Registro histórico de los Casos notificados de dengue

11

58

25

69

0

10

20

30

40

50

60

70

80

2007 2008 2009 2010

Casos de dengue, Anapoima 2007-2010

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

Cabecera

municipal: 71%

Centro poblado Inspecciones: 14.5

%

Rural: 14.5%

Descripción de los casos de dengue notificados. 2010

Número de casas positivas x 100% Número de casas inspeccionadas

VIGILANCIA ENTOMOLÓGICA INDICES DE INFESTACION LARVARIOS

Número de depósitos positivos x 100% Número total de depósitos inspeccionados

Índice de vivienda

Número de depósitos positivos x 100 casas Número total de casas inspeccionadas

Índice de Breteau

Índice de depósito

INTERPRETACION EPIDEMIOLÓGICA

INDICE RIESGO

BAJO ALTO

VIVIENDA < 4% ≥ 4%

DEPOSITO <3% ≥ 3%

BRETEAU <5 ≥ 5

THANK YOU