Public health knowledge and attitudes in rural Vietnam and mitigation strategies

Abstract

Background: Integrated management of multiple livestock species, aquaculture, and crops has been a part of rural Vietnam for centuries and is formally promoted by the Ministry of Agriculture. However, management methods may be contributing to the emergence of zoonotic diseases of recent concern (e.g., avian influenza and coliform diseases). This suggests a need for change in public health awareness and farm management. Methods & Materials: We used farm visits, questionnaires, focus groups, and analysis of water samples to investigate the public health knowledge, livestock management, and association with presence of coliform bacteria on 600 small scale integrated farms in north (Thai Binh) and south (An Giang) Vietnam in 2013. Water samples were analyzed in national government laboratories for E. coli as an indicator organism for fecal contamination of water using culture and tryptose broth methods. Questionnaire and focus group data were analyzed using summary statistics, probit regression, and clustering techniques for qualitative data. Results: More than 80% (p < .01) of drinking and household water samples from 600 homes in the sampling frame tested positive for E. coli at unsafe levels exceeding WHO standards (0 cfu/100 ml for drinking water and 6 cfu/100 ml for household water). Presence of E. coli in drinking water ranged from 0 to 500 cfu/100 ml (mean = 10, s.d. = 39.6). Farmers expressed high level awareness (>90%) that avian influenza or parasites could spread from livestock via water but low level awareness that bacteria such as E. coli could spread from livestock to humans via water. Although a majority of farmers (>70%) indicated they filter and/or boil their drinking water, other basic mitigation strategies such hand washing or preventing mixing of livestock was not common. Conclusion: In general, the presence of E. coli in drinking water was unacceptably high in most households we sampled in Thai Binh and An Giang provinces in Vietnam. Although farmers revealed some intuitive knowledge of public health, farm management procedures such as incomplete separation of livestock are likely to contribute to cross-contamination of drinking and household water. Basic public health training is recommended to help farmers appreciate the benefits of simple mitigation strategies.