Publications by authors named "Flemming Konradsen"

122 Publications

Obstacles and Opportunities for Diffusion of Integrated Pest Management Strategies Reported by Bolivian Small-Scale Farmers and Agronomists.

Environ Health Insights 2017 12;11:1178630217703390. Epub 2017 Apr 12.

Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.

Integrated pest management (IPM) with an increased used of ecological farming methods and less and safer use of pesticides offers solutions to reduce risks of developing pest resistance, human poisoning, and environmental pollution. Despite being promoted by Food and Agriculture Organization and others, it has not spread readily in low-income countries. This article presents the opinions of Bolivian farmers and agronomists on perceived obstacles and opportunities for a diffusion of IPM. Focus group discussions revealed an increased workload without certainty of higher yields or better prices for products grown with IPM compared with traditional agriculture being hindrances for a spread of IPM. Moreover, IPM requires some new practices not that easy to learn by farmers. In favor of IPM was an increasing awareness of the importance of a healthy and sustainable food production, easiness to try out without expensive investments needed, and a higher quality of the products. A healthy and sustainable agricultural production should be promoted by support to farmers through IPM training, a certification, and better prices. Finding allies to such a promotion is not easy, though, according to both farmers and agronomists.
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http://dx.doi.org/10.1177/1178630217703390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397278PMC
April 2017

Obstacles and Opportunities for Diffusion of Integrated Pest Management Strategies Reported by Bolivian Small-Scale Farmers and Agronomists.

Environ Health Insights 2017 12;11:1178630217703390. Epub 2017 Apr 12.

Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.

Integrated pest management (IPM) with an increased used of ecological farming methods and less and safer use of pesticides offers solutions to reduce risks of developing pest resistance, human poisoning, and environmental pollution. Despite being promoted by Food and Agriculture Organization and others, it has not spread readily in low-income countries. This article presents the opinions of Bolivian farmers and agronomists on perceived obstacles and opportunities for a diffusion of IPM. Focus group discussions revealed an increased workload without certainty of higher yields or better prices for products grown with IPM compared with traditional agriculture being hindrances for a spread of IPM. Moreover, IPM requires some new practices not that easy to learn by farmers. In favor of IPM was an increasing awareness of the importance of a healthy and sustainable food production, easiness to try out without expensive investments needed, and a higher quality of the products. A healthy and sustainable agricultural production should be promoted by support to farmers through IPM training, a certification, and better prices. Finding allies to such a promotion is not easy, though, according to both farmers and agronomists.
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http://dx.doi.org/10.1177/1178630217703390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397278PMC
April 2017

Obstacles and Opportunities for Diffusion of Integrated Pest Management Strategies Reported by Bolivian Small-Scale Farmers and Agronomists.

Environ Health Insights 2017 12;11:1178630217703390. Epub 2017 Apr 12.

Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.

Integrated pest management (IPM) with an increased used of ecological farming methods and less and safer use of pesticides offers solutions to reduce risks of developing pest resistance, human poisoning, and environmental pollution. Despite being promoted by Food and Agriculture Organization and others, it has not spread readily in low-income countries. This article presents the opinions of Bolivian farmers and agronomists on perceived obstacles and opportunities for a diffusion of IPM. Focus group discussions revealed an increased workload without certainty of higher yields or better prices for products grown with IPM compared with traditional agriculture being hindrances for a spread of IPM. Moreover, IPM requires some new practices not that easy to learn by farmers. In favor of IPM was an increasing awareness of the importance of a healthy and sustainable food production, easiness to try out without expensive investments needed, and a higher quality of the products. A healthy and sustainable agricultural production should be promoted by support to farmers through IPM training, a certification, and better prices. Finding allies to such a promotion is not easy, though, according to both farmers and agronomists.
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http://dx.doi.org/10.1177/1178630217703390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397278PMC
April 2017

Obstacles and Opportunities for Diffusion of Integrated Pest Management Strategies Reported by Bolivian Small-Scale Farmers and Agronomists.

Environ Health Insights 2017 12;11:1178630217703390. Epub 2017 Apr 12.

Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.

Integrated pest management (IPM) with an increased used of ecological farming methods and less and safer use of pesticides offers solutions to reduce risks of developing pest resistance, human poisoning, and environmental pollution. Despite being promoted by Food and Agriculture Organization and others, it has not spread readily in low-income countries. This article presents the opinions of Bolivian farmers and agronomists on perceived obstacles and opportunities for a diffusion of IPM. Focus group discussions revealed an increased workload without certainty of higher yields or better prices for products grown with IPM compared with traditional agriculture being hindrances for a spread of IPM. Moreover, IPM requires some new practices not that easy to learn by farmers. In favor of IPM was an increasing awareness of the importance of a healthy and sustainable food production, easiness to try out without expensive investments needed, and a higher quality of the products. A healthy and sustainable agricultural production should be promoted by support to farmers through IPM training, a certification, and better prices. Finding allies to such a promotion is not easy, though, according to both farmers and agronomists.
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http://dx.doi.org/10.1177/1178630217703390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397278PMC
April 2017

Molecular Evidence of Malaria and Zoonotic Diseases Among Rapid Diagnostic Test-Negative Febrile Patients in Low-Transmission Season, Mali.

Am J Trop Med Hyg 2017 02 7;96(2):335-337. Epub 2016 Nov 7.

Centre for Medical Parasitology, Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.

From November to December 2012 in Sélingué-Mali, blood samples from 88 febrile patients who tested negative by malaria Paracheck rapid diagnostic tests (RDTs) were used to assess the presence of sub-RDT as well as , , and applying molecular tools. sp. was present among 57 (60.2%) of the 88 malaria RDT-negative patients, whereas the prevalence of , , and were 3.4% ( = 3), 1.1% ( = 1), and 0.0%, respectively. The additional diagnostic use of polymerase chain reaction (PCR) identified a high proportion of sp.-positive samples and although this may be a concern for malaria control, the respective PCR-identified malaria infections were less likely responsible for the observed fevers given the low parasite density. Also, the low infection levels of and and lack of among the febrile patients call for further studies to assess the causes of fever among malaria RDT-negative patients in Sélingué.
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http://dx.doi.org/10.4269/ajtmh.16-0700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303032PMC
February 2017

Updated Bionomics of Toxorhynchites aurifluus and Toxorhynchites manicatus in Taiwan.

J Am Mosq Control Assoc 2016 Jun;32(2):152-5

Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, DK-1353 Copenhagen K.

The larvae of the genus Toxorhynchites are typically found in sylvatic habitat environments. They have been proposed as potential biocontrol agents against disease vectors such as Aedes, specifically the larvae of Ae. aegypti and Ae. albopictus. The only 2 species of Toxorhynchites identified in Taiwan are Tx. aurifluus and Tx. manicatus, but there have been no published records of either species since 1984. In January 2014, we identified 2 4th-stage Tx. aurifluus larvae and 2 4th-stage Tx. manicatus larvae in artificial habitats close to dwellings in Guichong village, Pingtung County, Taiwan. Here we update the bionomics of the larvae of both species, including coexisting aquatic fauna, the physicochemical parameters of the larval habitats, and developmental time. We further compare the findings with past records.
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http://dx.doi.org/10.2987/moco-32-02-152-155.1DOI Listing
June 2016

Insecticidal Paints: A Realistic Approach to Vector Control?

PLoS Negl Trop Dis 2016 Apr 21;10(4):e0004518. Epub 2016 Apr 21.

Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

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http://dx.doi.org/10.1371/journal.pntd.0004518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839634PMC
April 2016

Seasonality and shift in age-specific malaria prevalence and incidence in Binko and Carrière villages close to the lake in Selingué, Mali.

Malar J 2016 Apr 18;15:219. Epub 2016 Apr 18.

Malaria Research and Training Centre-Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, BP 1805, Mali.

Background: Malaria transmission in Mali is seasonal and peaks at the end of the rainy season in October. This study assessed the seasonal variations in the epidemiology of malaria among children under 10 years of age living in two villages in Selingué: Carrière, located along the Sankarani River but distant from the hydroelectric dam, and Binko, near irrigated rice fields, close to the dam. The aim of this study was to provide baseline data, seasonal pattern and age distribution of malaria incidence in two sites situated close to a lake in Selingué.

Methods: Geographically, Selingué area is located in the basin of Sakanrani and belongs to the district of Yanfolila in the third administrative region of Mali, Sikasso. Two cross-sectional surveys were conducted in October 2010 (end of transmission season) and in July 2011 (beginning of transmission season) to determine the point prevalence of asymptomatic parasitaemia, and anaemia among the children. Cumulative incidence of malaria per month was determined in a cohort of 549 children through active and passive case detection from November 2010 through October 2011. The number of clinical episodes per year was determined among the children in the cohort. Logistic regression was used to determine risk factors for malaria.

Results: The prevalence of malaria parasitaemia varied significantly between villages with a strong seasonality in Carrière (52.0-18.9 % in October 2010 and July 2011, respectively) compared with Binko (29.8-23.8 % in October 2010 and July 2011, respectively). Children 6-9 years old were at least twice more likely to carry parasites than children up to 5 years old. For malaria incidence, 64.8-71.9 % of all children experienced at least one episode of clinical malaria in Binko and Carrière, respectively. The peak incidence was observed between August and October (end of the rainy season), but the incidence remained high until December. Surprisingly, the risk of clinical malaria was two- to nine-fold higher among children 5-9 years old compared to younger children.

Conclusions: A shift in the peak of clinical episodes from children under 5-9 years of age calls for expanding control interventions, such as seasonal malaria chemoprophylaxis targeting the peak transmission months.
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http://dx.doi.org/10.1186/s12936-016-1251-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4836195PMC
April 2016

Overdose of oral contraceptive pills as a means of intentional self-poisoning amongst young women in Sri Lanka: considerations for family planning.

J Fam Plann Reprod Health Care 2017 Apr 22;43(2):147-150. Epub 2016 Mar 22.

Professor in Community Medicine, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka.

Objective: Oral contraceptive pills (OCPs) are one of the most popular family planning methods in Sri Lanka. As part of two hospital-based studies on self-harm, the use of OCPs was identified, from yet unpublished results, as a means of intentional self-poisoning. To inform future guidelines for better OCP promotion, this article aims to describe the extent, patient characteristics and outcomes of OCP self-poisoning in the North Central Province of Sri Lanka.

Methods: A secondary analysis was carried out on two hospital-based self-harm case series, from January 2011 to June 2014.

Results: Fifty-four patients (52 women and two men) with an overdose of OCP as a means of intentional self-poisoning were admitted to one of the surveyed hospitals. The median age of the patients was 19 (interquartile range, 5) years. None of the patients were severely sick from their overdose and two-thirds of the patients were discharged within a day of admission. Intentional self-poisoning with OCPs represented less than 5% of all types of intentional medicine self-poisonings recorded at the hospitals. Information available for a subset of female patients indicates that many cases (13/23, 56.5%) were in their first year of marriage.

Conclusions: More research is required to understand why young women in rural Sri Lanka overdose with OCPs as a means of intentional self-poisoning. Although the toxicity of OCPs is low and the public health significance of OCP poisoning remains minor, reproductive health service providers should be attentive to OCP overdose, monitor the development of this problem, and ensure appropriate information to OCP users.
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http://dx.doi.org/10.1136/jfprhc-2015-101171DOI Listing
April 2017

Impact of Training Bolivian Farmers on Integrated Pest Management and Diffusion of Knowledge to Neighboring Farmers.

J Agromedicine 2016 ;21(2):200-8

a Clinic of Occupational and Environmental Medicine , Odense University Hospital , Odense , Denmark.

Teaching farmers integrated pest management (IPM) in farmer field schools (FFS) has led to reduced pesticide use and safer handling. This article evaluates the long-term impact of training farmers on IPM and the diffusion of knowledge from trained farmers to neighboring farmers, a subject of importance to justify training costs and to promote a healthy and sustainable agriculture. Training on IPM of farmers took place from 2002 to 2004 in their villages in La Paz County, Bolivia, whereas dissemination of knowledge from trained farmer to neighboring farmer took place until 2009. To evaluate the impact of the intervention, self-reported knowledge and practice on pesticide handling and IPM among trained farmers (n = 23) and their neighboring farmers (n = 47) were analyzed in a follow-up study and compared in a cross-sectional analysis with a control group of farmers (n = 138) introduced in 2009. Variables were analyzed using χ2 test and analysis of variance (ANOVA). Trained farmers improved and performed significantly better in all tested variables than their neighboring farmers, although the latter also improved their performance from 2002 to 2009. Including a control group showed an increasing trend in all variables, with the control farmers having the poorest performance and trained farmers the best. The same was seen in an aggregated variable where trained farmers had a mean score of 16.55 (95% confidence interval [CI]: 15.45-17.65), neighboring farmers a mean score of 11.97 (95% CI: 10.56-13.38), and control farmers a mean score of 9.18 (95% CI: 8.55-9.80). Controlling for age and living altitude did not change these results. Trained farmers and their neighboring farmers improved and maintained knowledge and practice on IPM and pesticide handling. Diffusion of knowledge from trained farmers might explain the better performance of the neighboring farmers compared with the control farmers. Dissemination of knowledge can contribute to justify the cost and convince donors and governments in low-income countries to prioritize farmers training.
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http://dx.doi.org/10.1080/1059924X.2016.1143428DOI Listing
January 2017

Multiple Origins of Mutations in the mdr1 Gene--A Putative Marker of Chloroquine Resistance in P. vivax.

PLoS Negl Trop Dis 2015 Nov 5;9(11):e0004196. Epub 2015 Nov 5.

Centre for Medical Parasitology, Institute of Immunology, and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark.

Background: Chloroquine combined with primaquine has been the recommended antimalarial treatment of Plasmodium vivax malaria infections for six decades but the efficacy of this treatment regimen is threatened by chloroquine resistance (CQR). Single nucleotide polymorphisms (SNPs) in the multidrug resistance gene, Pvmdr1 are putative determinants of CQR but the extent of their emergence at population level remains to be explored.

Objective: In this study we describe the prevalence of SNPs in the Pvmdr1 among samples collected in seven P. vivax endemic countries and we looked for molecular evidence of drug selection by characterising polymorphism at microsatellite (MS) loci flanking the Pvmdr1 gene.

Methods: We examined the prevalence of SNPs in the Pvmdr1 gene among 267 samples collected from Pakistan, Afghanistan, Sri Lanka, Nepal, Sudan, São Tomé and Ecuador. We measured and diversity in four microsatellite (MS) markers flanking the Pvmdr1 gene to look evidence of selection on mutant alleles.

Results: SNP polymorphism in the Pvmdr1 gene was largely confined to codons T958M, Y976F and F1076L. Only 2.4% of samples were wildtype at all three codons (TYF, n = 5), 13.3% (n = 28) of the samples were single mutant MYF, 63.0% of samples (n = 133) were double mutant MYL, and 21.3% (n = 45) were triple mutant MFL. Clear geographic differences in the prevalence of these Pvmdr mutation combinations were observed. Significant linkage disequilibrium (LD) between Pvmdr1 and MS alleles was found in populations sampled in Ecuador, Nepal and Sri Lanka, while significant LD between Pvmdr1 and the combined 4 MS locus haplotype was only seen in Ecuador and Sri Lanka. When combining the 5 loci, high level diversity, measured as expected heterozygosity (He), was seen in the complete sample set (He = 0.99), while He estimates for individual loci ranged from 0.00-0.93. Although Pvmdr1 haplotypes were not consistently associated with specific flanking MS alleles, there was significant differentiation between geographic sites which could indicate directional selection through local drug pressure.

Conclusions: Our observations suggest that Pvmdr1 mutations emerged independently on multiple occasions even within the same population. In Sri Lanka population analysis at multiple sites showed evidence of local selection and geographical dispersal of Pvmdr1 mutations between sites.
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http://dx.doi.org/10.1371/journal.pntd.0004196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634971PMC
November 2015

Redefining shared sanitation.

Bull World Health Organ 2015 Jul 28;93(7):509-10. Epub 2015 Apr 28.

Dodowa Health Research Center and School of Public Health, University of Ghana, Accra, Ghana .

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http://dx.doi.org/10.2471/BLT.14.144980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490809PMC
July 2015

Redefining shared sanitation.

Bull World Health Organ 2015 Jul 28;93(7):509-10. Epub 2015 Apr 28.

Dodowa Health Research Center and School of Public Health, University of Ghana, Accra, Ghana .

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http://dx.doi.org/10.2471/BLT.14.144980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490809PMC
July 2015

Redefining shared sanitation.

Bull World Health Organ 2015 Jul 28;93(7):509-10. Epub 2015 Apr 28.

Dodowa Health Research Center and School of Public Health, University of Ghana, Accra, Ghana .

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http://dx.doi.org/10.2471/BLT.14.144980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490809PMC
July 2015

Indirect causes of maternal death.

Lancet Glob Health 2014 Oct;2(10):e566

Department of International Health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark.

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http://dx.doi.org/10.1016/S2214-109X(14)70297-9DOI Listing
October 2014

Indirect causes of maternal death.

Lancet Glob Health 2014 Oct;2(10):e566

Department of International Health, Immunology and Microbiology, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark.

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http://dx.doi.org/10.1016/S2214-109X(14)70297-9DOI Listing
October 2014

Global and local genetic diversity at two microsatellite loci in Plasmodium vivax parasites from Asia, Africa and South America.

Malar J 2014 Oct 2;13:392. Epub 2014 Oct 2.

Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1 4HT, UK.

Background: Even though Plasmodium vivax has the widest worldwide distribution of the human malaria species and imposes a serious impact on global public health, the investigation of genetic diversity in this species has been limited in comparison to Plasmodium falciparum. Markers of genetic diversity are vital to the evaluation of drug and vaccine efficacy, tracking of P. vivax outbreaks, and assessing geographical differentiation between parasite populations.

Methods: The genetic diversity of eight P. vivax populations (n=543) was investigated by using two microsatellites (MS), m1501 and m3502, chosen because of their seven and eight base-pair (bp) repeat lengths, respectively. These were compared with published data of the same loci from six other P. vivax populations.

Results: In total, 1,440 P. vivax samples from 14 countries on three continents were compared. There was highest heterozygosity within Asian populations, where expected heterozygosity (He) was 0.92-0.98, and alleles with a high repeat number were more common. Pairwise FST revealed significant differentiation between most P. vivax populations, with the highest divergence found between Asian and South American populations, yet the majority of the diversity (~89%) was found to exist within rather than between populations.

Conclusions: The MS markers used were informative in both global and local P. vivax population comparisons and their seven and eight bp repeat length facilitated population comparison using data from independent studies. A complex spatial pattern of MS polymorphisms among global P. vivax populations was observed which has potential utility in future epidemiological studies of the P. vivax parasite.
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http://dx.doi.org/10.1186/1475-2875-13-392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200131PMC
October 2014

Do Bolivian small holder farmers improve and retain knowledge to reduce occupational pesticide poisonings after training on Integrated Pest Management?

Environ Health 2014 Oct 1;13:75. Epub 2014 Oct 1.

Department of Occupational and Environmental Medicine, Odense University Hospital, and University of Southern Denmark, Odense, Denmark.

Background: Pesticide consumption is increasing in Bolivia as well as pest resistance, pesticide poisonings and pollution of the environment. This survey evaluates the training of small holder farmers on pesticide handling and ecological alternatives to reduce the negative pesticide effects.

Method: A baseline survey was performed in 2002 and follow-up surveys in 2004 and 2009. Farmers were selected and trained on Integrated Pest Management (IPM) from 2002 to 2004 in Farmer Field Schools (FFS). After exclusions and drop outs, 23 FFS trained farmers could be compared to 47 neighbor farmers for changes in 'knowledge, attitude and practice' (KAP) on IPM and symptoms of poisoning when handling pesticides. Statistical analysis was performed with SPSS version 21.0 using χ2-test, Cochran's Q test and Student's T-test.

Results: Improvements were seen in both groups but most significant among the FFS farmers. At baseline no difference were seen between the two groups apart from a more frequent use of personal protection among the FFS farmers. After the training was finished significant differences were seen between FFS farmers and neighbor farmers on all KAP variables, a difference reduced to six of the KAP variables in 2009. No difference was seen in self-reported poisonings after pesticide handling. FFS farmers improved their KAP scores markedly during training and there after retained their knowledge, while neighbor farmers improved during the entire period. Ecological farming without the use of pesticides increased most among the FFS farmers.

Conclusion: The study showed a sustained improvement among Farmers Field School trained farmers on personal protection and hygiene when handling pesticides, knowledge and use of IPM and ecological alternatives and a reduction in self-reported symptoms after pesticide handling. Similar though less pronounced improvements was seen among neighbor farmers having had less training and information on pesticide handling and alternatives than the FFS trained farmers. Training of farmers on IPM and good agricultural practices has positive effects, but is scarce in Bolivia as in most low-income countries and must be encouraged to support an improved and sustainable food production and to protect the health of farmers and consumers as well as the environment.
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http://dx.doi.org/10.1186/1476-069X-13-75DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196016PMC
October 2014

Do Bolivian small holder farmers improve and retain knowledge to reduce occupational pesticide poisonings after training on Integrated Pest Management?

Environ Health 2014 Oct 1;13:75. Epub 2014 Oct 1.

Department of Occupational and Environmental Medicine, Odense University Hospital, and University of Southern Denmark, Odense, Denmark.

Background: Pesticide consumption is increasing in Bolivia as well as pest resistance, pesticide poisonings and pollution of the environment. This survey evaluates the training of small holder farmers on pesticide handling and ecological alternatives to reduce the negative pesticide effects.

Method: A baseline survey was performed in 2002 and follow-up surveys in 2004 and 2009. Farmers were selected and trained on Integrated Pest Management (IPM) from 2002 to 2004 in Farmer Field Schools (FFS). After exclusions and drop outs, 23 FFS trained farmers could be compared to 47 neighbor farmers for changes in 'knowledge, attitude and practice' (KAP) on IPM and symptoms of poisoning when handling pesticides. Statistical analysis was performed with SPSS version 21.0 using χ2-test, Cochran's Q test and Student's T-test.

Results: Improvements were seen in both groups but most significant among the FFS farmers. At baseline no difference were seen between the two groups apart from a more frequent use of personal protection among the FFS farmers. After the training was finished significant differences were seen between FFS farmers and neighbor farmers on all KAP variables, a difference reduced to six of the KAP variables in 2009. No difference was seen in self-reported poisonings after pesticide handling. FFS farmers improved their KAP scores markedly during training and there after retained their knowledge, while neighbor farmers improved during the entire period. Ecological farming without the use of pesticides increased most among the FFS farmers.

Conclusion: The study showed a sustained improvement among Farmers Field School trained farmers on personal protection and hygiene when handling pesticides, knowledge and use of IPM and ecological alternatives and a reduction in self-reported symptoms after pesticide handling. Similar though less pronounced improvements was seen among neighbor farmers having had less training and information on pesticide handling and alternatives than the FFS trained farmers. Training of farmers on IPM and good agricultural practices has positive effects, but is scarce in Bolivia as in most low-income countries and must be encouraged to support an improved and sustainable food production and to protect the health of farmers and consumers as well as the environment.
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http://dx.doi.org/10.1186/1476-069X-13-75DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196016PMC
October 2014

Challenges and opportunities of a paperless baseline survey in Sri Lanka.

BMC Res Notes 2014 Jul 15;7:452. Epub 2014 Jul 15.

School of Social and Community Medicine, University of Bristol, Bristol, UK.

Background: Personal digital assistants (PDAs) have been shown to reduce costs associated with survey implementation and digitisation, and to improve data quality when compared to traditional paper based data collection. Few studies, however, have shared their experiences of the use of these devices in rural settings in Asia. This paper reports on our experiences of using a PDA device for data collection in Sri Lanka as part of a large cluster randomised control trial.

Findings: We found that PDAs were useful for collecting data for a baseline survey of a large randomised control trial (54,000 households). We found that the PDA device and survey format was easy to use by inexperienced field staff, even though the survey was programmed in English. The device enabled the rapid digitisation of survey data, providing a good basis for continuous data quality assurance, supervision of staff and survey implementation. An unexpected advantage was the improved community opinion of the research project as a result of the device, because the use of the technology gave data collectors an elevated status amongst the community. In addition the global positioning system (GPS) functionality of the device allowed precise mapping of households, and hence distinct settlements to be identified as randomisation clusters. Future users should be mindful that to save costs the piloting should be completed before programming. In addition consideration of a local after-care service is important to avoid costs and time delays associated with sending devices back to overseas providers.

Discussion: Since the start of this study, PDA devices have rapidly developed and are increasingly used. The use of PDA or similar devices for research is not without its problems; however we believe that the universal lessons learnt as part of this study are even more important for the effective utilisation of these rapidly developing technologies in resource poor settings.
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http://dx.doi.org/10.1186/1756-0500-7-452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4118630PMC
July 2014

Teaching minority children hygiene: investigating hygiene education in kindergartens and homes of ethnic minority children in northern Vietnam.

Ethn Health 2015 29;20(3):258-72. Epub 2014 May 29.

a Department of International Health, Immunology and Microbiology , University of Copenhagen , Copenhagen , Denmark.

Objectives: Ethnic minority children in Vietnam experience high levels of hygiene- and sanitation-related diseases. Improving hygiene for minority children is therefore vital for improving child health. The study objective was to investigate how kindergarten and home environments influence the learning of hygiene of pre-school ethnic minority children in rural Vietnam.

Design: Eight months of ethnographic field studies were conducted among four ethnic minority groups living in highland and lowland communities in northern Vietnam. Data included participant observation in four kindergartens and 20 homes of pre-school children, together with 67 semi-structured interviews with caregivers and five kindergarten staff. Thematic analysis was applied and concepts of social learning provided inputs to the analysis.

Findings: This study showed that poor living conditions with lack of basic sanitation infrastructures were important barriers for the implementation of safe home child hygiene. Furthermore, the everyday life of highland villages, with parents working away from the households resulted in little daily adult supervision of safe child hygiene practices. While kindergartens were identified as potentially important institutions for improving child hygiene education, essential and well-functioning hygiene infrastructures were lacking. Also, hygiene teaching relied on theoretical and non-practice-based learning styles, which did not facilitate hygiene behaviour change in small children. Minority children were further disadvantaged as teaching was only provided in non-minority language.

Conclusions: Kindergartens can be important institutions for the promotion of safe hygiene practices among children, but they must invest in the maintenance of hygiene and sanitation infrastructures and adopt a strong practice-based teaching approach in daily work and in teacher's education. To support highland minority children in particular, teaching styles must take local living conditions and caregiver structures into account and teach in local languages. Creating stronger links between home and institutional learning environments can be vital to support disadvantaged highland families in improving child health.
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http://dx.doi.org/10.1080/13557858.2014.921887DOI Listing
November 2015

Estimating the costs of implementing the rotavirus vaccine in the national immunisation programme: the case of Malawi.

Trop Med Int Health 2014 Feb 9;19(2):177-85. Epub 2013 Dec 9.

Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Objectives: Worldwide, rotavirus infections cause approximately 453,000 child deaths annually. Two licensed vaccines could be life- and cost-saving in low-income countries where the disease burden is highest. The aim of our study was to estimate the total cost of implementing the rotavirus vaccine in the national immunisation programme of a low-income country. Furthermore, the aim was to examine the relative contribution of different components to the total cost.

Methods: Following the World Health Organization guidelines, we estimated the resource use and costs associated with rotavirus vaccine implementation, using Malawi as a case. The cost analysis was undertaken from a governmental perspective. All costs were calculated for a 5-years period (2012-2016) and discounted at 5%. The value of key input parameters was varied in a sensitivity analysis.

Results: The total cost of rotavirus vaccine implementation in Malawi amounted to US$ 18.5 million over a 5-years period. This translated into US$ 5.8 per child in the birth cohort. With GAVI Alliance financial support, the total cost was reduced to US$ 1.4 per child in the birth cohort. Approximately 83% of the total cost was attributed to vaccine purchase, while 17% was attributed to system costs, with personnel, transportation and cold chain as the main cost components.

Conclusion: The total cost of rotavirus vaccine implementation in Malawi is high compared with the governmental health budget of US$ 26 per capita per year. This highlights the need for new financing opportunities for low-income countries to facilitate vaccine implementation and ensure sustainable financing.
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http://dx.doi.org/10.1111/tmi.12233DOI Listing
February 2014

Estimating the costs of implementing the rotavirus vaccine in the national immunisation programme: the case of Malawi.

Trop Med Int Health 2014 Feb 9;19(2):177-85. Epub 2013 Dec 9.

Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Objectives: Worldwide, rotavirus infections cause approximately 453,000 child deaths annually. Two licensed vaccines could be life- and cost-saving in low-income countries where the disease burden is highest. The aim of our study was to estimate the total cost of implementing the rotavirus vaccine in the national immunisation programme of a low-income country. Furthermore, the aim was to examine the relative contribution of different components to the total cost.

Methods: Following the World Health Organization guidelines, we estimated the resource use and costs associated with rotavirus vaccine implementation, using Malawi as a case. The cost analysis was undertaken from a governmental perspective. All costs were calculated for a 5-years period (2012-2016) and discounted at 5%. The value of key input parameters was varied in a sensitivity analysis.

Results: The total cost of rotavirus vaccine implementation in Malawi amounted to US$ 18.5 million over a 5-years period. This translated into US$ 5.8 per child in the birth cohort. With GAVI Alliance financial support, the total cost was reduced to US$ 1.4 per child in the birth cohort. Approximately 83% of the total cost was attributed to vaccine purchase, while 17% was attributed to system costs, with personnel, transportation and cold chain as the main cost components.

Conclusion: The total cost of rotavirus vaccine implementation in Malawi is high compared with the governmental health budget of US$ 26 per capita per year. This highlights the need for new financing opportunities for low-income countries to facilitate vaccine implementation and ensure sustainable financing.
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http://dx.doi.org/10.1111/tmi.12233DOI Listing
February 2014

The role of private pesticide vendors in preventing access to pesticides for self-poisoning in rural Sri Lanka.

Inj Prev 2014 Apr 4;20(2):134-7. Epub 2013 Jun 4.

South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, , University of Peradeniya, Peradeniya, Sri Lanka.

In 15% to 20% of self-poisoning cases, the pesticides used are purchased from shops just prior to ingestion. We explored how pesticide vendors interacted with customers at risk of self-poisoning to identify interventions to prevent such poisonings. Two strategies were specifically discussed: selling pesticides only to farmers bearing identity cards or customers bearing pesticide 'prescriptions'. Vendors reported refusing to sell pesticides to people thought to be at risk of self-poisoning, but acknowledged the difficulty of distinguishing them from legitimate customers; vendors also stated they did want to help to improve identification of such customers. The community did not blame vendors when pesticides used for self-poison were purchased from their shops. Vendors have already taken steps to restrict access, including selling low toxic products, counselling and asking customer to return the next day. However, there was little support for the proposed interventions of 'identity cards' and 'prescriptions'. Novel public health approaches are required to complement this approach.
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http://dx.doi.org/10.1136/injuryprev-2012-040748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963527PMC
April 2014

Teaching handwashing with soap for schoolchildren in a multi-ethnic population in northern rural Vietnam.

Glob Health Action 2013 04 24;6:1-12. Epub 2013 Apr 24.

Department of Environmental Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Background: In Vietnam, initiatives have been started aimed at increasing the practice of handwashing with soap (HWWS) among primary schoolchildren. However, compliance remains low.

Objective: This study aims to investigate responses to a teacher-centred participatory HWWS intervention in a multi-ethnic population of primary schoolchildren in northern rural Vietnam.

Design: This study was implemented in two phases: a formative research project over 5 months (July-November 2008) and an action research project with a school-based HWWS intervention study in two rural communes during 5 months (May, September-December 2010). Based upon knowledge from the formative research in 2008, schoolteachers from four selected schools in the study communes actively participated in designing and implementing a HWWS intervention. Qualitative data was collected during the intervention to evaluate the responses and reaction to the intervention of teachers, children and parents. This included semi-structured interviews with children (15), and their parents (15), focus group discussions (FGDs) with schoolchildren (32) and school staff (20) and observations during 15 HWWS involving children.

Results: Observations and interview data from children demonstrated that children were visibly excited and pleased with HWWS sessions where teachers applied active teaching methods including rewards, games and HWWS demonstrations. All children, schoolteachers and parents also viewed the HWWS intervention as positive and feasible, irrespective of ethnicity, gender of schoolchildren and background of schoolteachers. However, some important barriers were indicated for sustaining and transferring the HWWS practice to the home setting including limited emphasis on hygiene in the standard curriculum of schools, low priority and lack of time given to practical teaching methods and lack of guidance and reminding HWWS on a regular basis at home, in particular by highland parents, who spend most of their time working away from home in the fields. Access to soap and water at the household level did not seem a barrier for the uptake of HWWS but continuous access to these might be a challenge at schools.

Conclusions: This study demonstrated that it is feasible to engage teachers and implement active teaching methods for behaviour change of HWWS in a group of multi-ethnic primary schoolchildren without the need for major investments in water and hygiene infrastructures. However, in those areas there was limited transfer of practice from school promotion to home. Continuous access to soaps at schools needs to be invested.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636419PMC
http://dx.doi.org/10.3402/gha.v6i0.20288DOI Listing
April 2013

Dengue outbreaks in high-income area, Kaohsiung City, Taiwan, 2003-2009.

Emerg Infect Dis 2012 Oct;18(10):1603-11

University of Copenhagen, Copenhagen, Denmark.

Kaohsiung City, a modern metropolis of 1.5 million persons, has been the focus of dengue virus activity in Taiwan for several decades. The aim of this study was to provide a temporal and spatial description of dengue virus epidemiology in Kaohsiung City by using data for all laboratory-confirmed dengue cases during 2003-2009. We investigated age- and sex-dependent incidence rates and the spatiotemporal patterns of all cases confirmed through passive or active surveillance. Elderly persons were at particularly high risk for dengue virus-related sickness and death. Of all confirmed cases, ≈75% were detected through passive surveillance activities; case-patients detected through active surveillance included immediate family members, neighbors, and colleagues of confirmed case-patients. Changing patterns of case clustering could be due to the effect of unmeasured environmental and demographic factors.
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http://dx.doi.org/10.3201/eid1810.111929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3471615PMC
October 2012

Reduced price on rotavirus vaccines: enough to facilitate access where most needed?

Bull World Health Organ 2012 Jul;90(7):554-6

Department of International Health, Immunology and Microbiology, University of Copenhagen, Oester Farimagsgade 5, bd. 9, PO Box 2099, Copenhagen 1014, Denmark.

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http://dx.doi.org/10.2471/BLT.11.094656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3397702PMC
July 2012

Reduced price on rotavirus vaccines: enough to facilitate access where most needed?

Bull World Health Organ 2012 Jul;90(7):554-6

Department of International Health, Immunology and Microbiology, University of Copenhagen, Oester Farimagsgade 5, bd. 9, PO Box 2099, Copenhagen 1014, Denmark.

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http://dx.doi.org/10.2471/BLT.11.094656DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3397702PMC
July 2012

Sanitation behavior among schoolchildren in a multi-ethnic area of Northern rural Vietnam.

BMC Public Health 2012 Feb 21;12:140. Epub 2012 Feb 21.

Department of Environmental Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Background: In Vietnam, efforts are underway to improve latrine use in rural and remote areas with particular focus on increasing coverage of sanitation in schools. However, there is a lack of information on how the school program affects latrine use by schoolchildren and at community level. This paper analyzes sanitation use among schoolchildren in a multi-ethnic area to inform future school-based sanitation promotion programmes.

Methods: A combination of quantitative and qualitative methods was applied during a 5 months period in six primary and secondary schools and in the homes of schoolchildren in four different ethnic villages in Northern rural Vietnam. Using a structured questionnaire, 319 children were interviewed face-to-face to collect quantitative data. Qualitative methods included extensive observations at schools and in the homes of 20 children, a single day's diary writings of 234 children, in-depth interviews with children (20), their parents (20) and school staff (10), and focus group discussions with parents (4) and teachers (6), and picture drawing with children (12).

Results: All surveyed schools had student latrines. However, the observed schoolchildren most commonly urinated and defecated in the open. Main barriers for latrine use included inadequate number of latrines, limited accessibility to latrines, lack of constant water supply in latrines and lack of latrine maintenance by school management. Programs promoting latrine use for children were not conducted in either schools or communities and were not established as a preferred social norm in such settings. Children perceived existing school latrines as unappealing and expressed a wish to have basic, functional, clean, and colorful school latrines with privacy.

Conclusions: The paper shows that the current school based sanitation promotion is insufficient to change sanitation behavior of school children irrespective of their ethnicity. It is important that schools, households and communities work more closely together to increase use and uptake of latrine use among schoolchildren. Also, the contractors of latrine facilities must work more closely with local school management when constructing latrines, including identifying location, design and appropriate systems of water supply. A separate budget needs to be allocated to allow the school to maintain the sanitation infrastructure and keep it hygienic and appealing for users.
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http://dx.doi.org/10.1186/1471-2458-12-140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305623PMC
February 2012
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