title: Cultural drivers and health-seeking behaviours that impact on the transmission of pig-associated zoonoses in Lao People's Democratic Republic.
abstract: Pig rearing is an important income source in the Lao People's Democratic Republic (PDR), with many smallholder farmers using traditional free-range pig production systems. Despite the potentially significant health risks posed by pig production regarding pig-associated zoonoses, information on the sociocultural drivers of these zoonoses is significantly lacking. This review summarises the existing sociocultural knowledge on eight pig-associated zoonoses suspected to be endemic in Southeast Asia: brucellosis, Q fever (Coxiella burnetii), trichinellosis, hepatitis E virus, leptospirosis, Japanese encephalitis, Streptococcus suis and Taenia solium taeniasis-cysticercosis. It summarises current knowledge on these diseases grouped according to their clinical manifestations in humans to highlight the propensity for underreporting. A literature search was conducted across multiple databases for publications from 1990 to the present day related to the eight pig-associated zoonoses and the risk and impact connected with them, with Lao PDR as a case study. Many of these pig-associated zoonoses have similar presentations and are often diagnosed as clinical syndromes. Misdiagnosis and underreporting are, therefore, substantial and emphasise the need for more robust diagnostics and appropriate surveillance systems. While some reports exist in other countries in the region, information is significantly lacking in Lao PDR with existing information coming mainly from the capital, Vientiane. The disease burden imposed by these zoonoses is not only characterised by morbidity and mortality, but directly impacts on livelihoods through income reduction and production losses, and indirectly through treatment costs and lost work opportunities. Other factors crucial to understanding and controlling these diseases are the influence of ethnicity and culture on food-consumption practices, pig rearing and slaughter practices, hygiene and sanitation, health-seeking behaviours and, therefore, risk factors for disease transmission. Published information on the knowledge, attitudes and beliefs of people regarding pig zoonoses and their risk factors is also extremely limited in Lao PDR and the broader Southeast Asian region. The need for more transdisciplinary research, using a One Health approach, in order to understand the underlining social determinants of health and their impacts on health-seeking behaviours, disease transmission and, ultimately, disease reporting, cannot be more emphasized.
authors.affiliation: Division of Infection and Pathway Medicine, College of Medicine and Veterinary, Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB UK.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Burniston
authors.affiliation: Division of Infection and Pathway Medicine, College of Medicine and Veterinary, Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB UK ; CSIRO Animal Food and Health Sciences, Australian Animal Health Laboratory (AAHL), Regional Programme, 5 Portarlington Road, East Geelong, Victoria 3219 Australia.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Okello
authors.affiliation: Department for Communicable Disease Control (DCDC), Ministry of Health, Thadeua Road, Vientiane, Lao PDR.
authors.forename: Boualam
authors.initials: B
authors.lastname: Khamlome
authors.affiliation: Department of Livestock and Fisheries, Ministry of Agriculture and Forestry, Ban Sithan Nua, Luang Prabang Road, Sikhottabong District, Vientiane, 7042 Lao PDR.
authors.forename: Phouth
authors.initials: P
authors.lastname: Inthavong
authors.affiliation: International Livestock Research Institute (ILRI), Asia Programme, Kabete, Naivasha Road, Nairobi, 30709-00100 Kenya.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gilbert
authors.affiliation: Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithee Road, 10400 Bangkok, Thailand ; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LJ UK.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Blacksell
authors.affiliation: CSIRO Animal Food and Health Sciences, Australian Animal Health Laboratory (AAHL), Regional Programme, 5 Portarlington Road, East Geelong, Victoria 3219 Australia.
authors.forename: John
authors.initials: J
authors.lastname: Allen
authors.affiliation: Division of Infection and Pathway Medicine, College of Medicine and Veterinary, Medicine, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB UK.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Welburn
keywords: Brucellosis; Clinical syndromes; Health seeking behaviours; Hepatitis E; Japanese encephalitis; Leptospirosis; Pig-associated zoonoses; Q-fever; Sociocultural drivers; Streptococcus suis; Taeniasis-cysticercosis; Trichinellosis