Ecohealth Program Raises Incomes and Nutrition in Bangladesh

Daniel M. Keller, PhD

August 02, 2012

August 2, 2012 (Bangkok, Thailand) — In a region of Bangladesh where inhabitants are landless and extremely poor, where food shortages are exacerbated by flooding and drought, and where zoonotic emerging infectious diseases are common, several aspects of "ecohealth" have helped to increase household incomes, improve nutrition, and possibly decrease disease outbreaks.

David Hall, DVM, PhD, from the faculty of medicine at the University of Calgary in Alberta, Canada, and from Veterinarians Without Borders, explained the concept of ecohealth here at the 15th International Congress on Infectious Diseases.

Ecohealth comprises 6 "pillars," as defined by Canada's International Development Research Centre: transdisciplinarity, community participation, gender and social equity, recognition of complexity, sustainability, and knowledge to action.

Dr. Hall described a study centered on chars in northern Bangladesh. Chars are large, low-lying islands in a river, in some cases inhabited by up to 1000 households. The people are extremely poor, landless, and prone to food shortages.

Although the intention was to increase livestock production, and thereby improve livelihoods, "one of the almost incidental outcomes was reduction of the risk factors for emerging infectious disease," Dr. Hall said. He explained that many of the problems with food security stem from infectious diseases. "When you look at the impact on food, that is often overlooked, particularly in developing countries," he noted.

These people were facing zoonotic and emerging infectious diseases, particularly from exposure to animal and human waste.

"Livestock are often kept in the house, so they're defecating inside the house.... There's a high risk of transmission of disease that way," Dr. Hall explained. Livestock are also defecating into waterways, as are humans; latrines were not built in these communities until very recently.

Dr. Hall's team, with the aid of several cooperating agencies and nongovernmental organizations, helped residents manage manure, soil, and water with an integrated system of agriculture. Manure has become a valuable commodity for agriculture, so it is being managed better, which has led to less exposure to it in households, he noted.

Structural changes were made in the homes and villages. Houses were raised off the ground, latrines were constructed, and access to healthcare was facilitated, as was access to markets, education, and microcredit plans.

Demonstrated Beneficial Effects of Interventions

The investigators closely monitored 300 of the approximately 1500 households in the study area for livestock production, household income from dairy sales, and market access. They collected data before, during, and after their intervention to track market activity, behavior change, agricultural practices, environmental conditions, and the use of health services.

Dr. Hall said it was fairly easy to monitor and evaluate agricultural productivity and economics and to validate the effectiveness of interventions. "However, when it comes to some of the environmental monitoring and some of the human health interventions that we're claiming, the data are...a lot less robust," he admitted. For example, there were no good preintervention data on exposure to coliform bacteria in households, and data sharing between agencies "hasn't been what we would like," he said.

In terms of economics, household incomes increased by 50% to 240%. Weekly cash income from milk production went up by 60% to 70%.

Earners have committed some of their profits to public health and some to food, increasing their intake of energy and protein and increasing the variety of foods they eat.

The management of manure and human waste has become much better. Dr. Hall said that "probably the weakest link in the study" is access to public-health data to monitor the impact on coliform load and outbreaks of disease, although anecdotal evidence suggests reductions.

He concluded that "integrated transdisciplinary approaches to preventing emerging infectious diseases tend to be underemphasized" and that "policy-based change could do more to address food-security benefits." Finally, he noted that the monitoring and evaluation of ecohealth approaches and interventions is challenging in many ways; a separate study is currently looking at tools that might be useful in this regard.

He noted that villagers have asked for more services and training about livestock production and for more public-health interventions, such as information on keeping houses cleaner and on when to get babies vaccinated. "When villagers see small changes, small improvements, and understand that they have economic empowerment, suddenly things move forward at a very rapid pace," Dr. Hall said.

Session moderator Teshome Gebre, PhD, regional representative for Africa of the Task Force for Global Health International Trachoma Initiative in Addis Ababa, Ethiopia, who was not involved in the study, told Medscape Medical News that the ecohealth approach of combining agricultural and public-health initiatives is valuable, but not necessarily all that new.

He advised that any initiatives of this kind must be culturally sensitive, especially where income and economics are concerned. "In some states...in Africa, and in my country especially, people are always skeptical or not very happy when you come with questions related to their economy, to their household income level, and so on," he said. "In some instances, they don't even tell the true story. Once they openly declare what they have, the government might not really support them or [might even tax them]. Therefore...they don't give you the true story unless you come up with a very innovative and indirect way of approaching them."

There was no commercial funding for the study. Dr. Hall and Dr. Gebre have disclosed no relevant financial relationships.

15th International Congress on Infectious Diseases (ICID): Abstract 21.010. Presented June 15, 2012.

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