title: Controlling parasites, understanding practices: the biosocial complexity of a One Health intervention for neglected zoonotic helminths in northern Lao PDR.
abstract: A parasitological survey in northern Lao PDR showed a remote ethnic minority village to be hyper-endemic for Taenia solium, a Neglected Tropical Disease (NTD) that impacts human and pig health. An intervention combining human Mass Drug Administration (MDA) with porcine vaccination and antihelmintic treatment was then implemented, targeting both T. solium and other soil-transmitted helminths. To understand the biosocial complexity of this integrated One Health intervention, we conducted a rapid ethnographic study exploring the transmission dynamics of T. solium and locally acceptable long-term control options. Informed by two years of project work in the village, this included six focus group discussions, 35 semi-structured interviews, a latrine survey, a school-based education meeting, participant observation and many unstructured interviews conducted over two weeks in October 2013. We found that risk behaviours were mediated by various social determinants including limited market access, interrelationships between alcohol, ancestral sacrifices and the consumption of raw pork, seasonal variations and poor latrine coverage. Only sixteen percent of households had latrines, attributed to the unacceptability of dry latrines, lack of water access, poor building techniques and poverty. Whilst women could explain T. solium transmission, most men and children could not, revealing that distributed posters/leaflets relied too heavily on text and ambiguous images. Compliance with MDA was high due to trust between project staff and village leaders. However understandings of pharmacology, minor side effects, human migration and children's fear of worms may lead to resistance in future programmes. Our research highlights the complexities of controlling T. solium and other soil-transmitted helminths in a remote ethnic minority village and the need to integrate biomedical and participatory approaches. Although we showcase the heuristic value of using rapid ethnography to inform intervention strategies as part of a One Health/NTD agenda, we also identify several possible paradoxes and conundrums in embedding locally-grounded biosocial analysis into NTD programmes. These need to be acknowledged and negotiated by multidisciplinary teams.
authors.affiliation: School of Social and Political Science, The University of Edinburgh, 58 George Square, Edinburgh, United Kingdom; Division of Pathway Medicine and Centre for Infectious Diseases, School of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom. Electronic address: bardosh_kevin@hotmail.com.
authors.forename: Kevin
authors.initials: K
authors.lastname: Bardosh
authors.affiliation: National Animal Health Laboratory, Ministry of Agriculture and Forestry, Department of Livestock and Fisheries, Luang Prabang Road, Ban Huanmouang, Vientiane Capital, Lao Democratic People's Republic.
authors.forename: Phouth
authors.initials: P
authors.lastname: Inthavong
authors.affiliation: CSIRO Animal, Food and Health Sciences, Australian Animal Health Laboratory (AAHL) Regional Programme, 5 Portarlington Road, East Geelong, Victoria, Australia.
authors.forename: Sivilai
authors.initials: S
authors.lastname: Xayaheuang
authors.affiliation: National Animal Health Laboratory, Ministry of Agriculture and Forestry, Department of Livestock and Fisheries, Luang Prabang Road, Ban Huanmouang, Vientiane Capital, Lao Democratic People's Republic; CSIRO Animal, Food and Health Sciences, Australian Animal Health Laboratory (AAHL) Regional Programme, 5 Portarlington Road, East Geelong, Victoria, Australia.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Okello
mesh_terms: D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006293:Health Promotion / Q000592:standards*; D006801:Humans; D006920:Hygiene; D017589:Immunization Programs; D007407:Interviews as Topic; D007812:Laos; D008297:Male; D058069:Neglected Diseases / Q000517:prevention & control*; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D012499:Sanitation; D034421:Sus scrofa / Q000469:parasitology; D041201:Taenia solium; D013622:Taeniasis / Q000517:prevention & control* / Q000635:transmission
chemical_list: D000871:Anthelmintics
keywords: Biosocial analysis; Lao PDR; Neglected Tropical Diseases; One Health; Soil-transmitted helminths; Taenia solium