Affected by unprecedented urban growth, overcrowding, poverty, and health inequalities, Bangladesh has remained hyperendemic for dengue since 2000. Considering the complexities involved with dengue transmission, I argued that understanding transmission requires encapsulating different disciplinary knowledge as well as non-academic knowledge. I have applied an Ecohealth approach to investigate dengue transmission dynamics in Dhaka, Bangladesh. Using the Delphi method, all 90 Wards of Dhaka were classified into ‘high’, ‘medium’, and ‘low’ Socio-Economic Status (SES) zones. A total of 1,200 households were randomly selected which represented the SES zones. During 2011-2012, these sampled households were repeatedly inspected for Aedes mosquitoes and to collect blood samples from residing members. This transdisciplinary investigation focused on: i) the rates of human exposure to dengue virus (DENV) by identifying individuals with IgM and IgG antibodies in the serosurvey samples; ii) abundance of dengue vector mosquitoes (Aedes aegypti) in the same households; iii) risk perception, and Knowledge, Attitude and Practice (KAP) regarding dengue among community members and experts. KAP survey results indicated that 93.7% of the community members knew that mosquitoes act as the primary vector of its transmission; 87.3% were unaware that Aedes mosquitoes prefer to lay their eggs in water containers. The entomological survey results showed that 26.7% of all surveyed houses in the city were infested with Aedes aegypti mosquitoes. The ornamental functional categories of containers were most significant containers in producing maximum number of Aedes pupae; this was found to be a significant risk factor for seroprevalence and seroconversion. The examination of IgG seroprevalence revealed that seropositivity was strongly correlated with increased age and number of indoor potted plants. The serosurvey findings showed that seroprevalence was high (79.9%), revealing that most dwellers had been exposed DENV. However, there was no significant association between Aedes positive houses and houses with seroconverted persons, indicating that people were being infected in distant areas outside their houses. A persistently high rate of dengue infection in Dhaka is being influenced by the lack of knowledge and awareness of the eco-bio-social factors. Improvement in intersectoral coordination to formulate and implement dengue epidemic prevention and control interventions is necessary. / May 2015

Vector borne-diseases make up a significant portion of morbidity and mortality worldwide, being responsible for around 700,000 deaths annually according to the World Health Organization. Neglected, tropical diseases such as Chagas disease have a significant impact on people in Latin America, affecting millions, and especially those residing in rural areas. Chagas disease is the number one cause for heart disease in Latin America, and is caused by the Trypanosoma cruzi parasite, carried by Triatominae insect vectors. The intricate life cycle of the parasite, ecology and behavior of the vector, and lack of disease treatment options, make Chagas disease challenging to control. Prevention measures are highly sought after, and implementation science approaches such as Ecohealth management engage affected communities in disease prevention. Knowing what insect vectors are feeding on sheds light on vector ecology and behavior, aiding in vector management which is pivotal in disease prevention. While DNA-based methods have traditionally been used to study vector blood meals, they come with limitations and challenges, such as the need for fresh, high abundance blood meals. Therefore, the goal of this research was to evaluate Chagas vector blood meal sources using an innovative protein mass spectrometry-based approach. We demonstrate first the ability to utilize liquid chromatography tandem mass spectrometry (LC-MS/MS) to correctly identify hemoglobin protein peptides from mouse blood and subsequently identify Chagas vector blood meal sources from field-collected insect vectors where blood meal identification is compared with traditional DNA-based methods as a control. An experimental feeding study allowed us to then demonstrate the longevity of hemoglobin protein peptides for blood meal detection, showing LC-MS/MS-based blood meal identification outperforms DNA-based polymerase chain reaction (PCR) at least 4 weeks post-feeding and 12 weeks post-molting. This allowed us to test the limits of our innovative detection method experimentally and comparatively. Finally, we evaluated blood meals in field-caught insect vectors collected as part of a large collaborative Ecohealth project in Central America. LC-MS/MS identified two times as many blood meals in insect vectors, including those that did not have blood meals detected with DNA-based PCR. As single vectors often feed on multiple sources, we also validated our ability to decipher multiple blood meals from an individual vector and showed the ability to quantify a blood meal using synthetic AQUA (Absolute QUAntification) peptides, a first step in using quantification data for identifying blood meals not currently in our underlying database. Furthermore, we show that lower resolution mass spectrometers are able to identify blood meals from taxa correctly, an important and strong attribute of our LC-MS/MS-based method, opening the door to using proteomics in countries where Chagas disease is endemic and resources are limited. Even though expertise and resources of research labs differ in locations across the globe, herein is described how LC-MS/MS is a valuable additional tool for fighting neglected tropical diseases. Ultimately, hemoglobin-based LC-MS/MS vector blood meal identification is a complementary technique to available molecular methods and can confidently identify Chagas vector blood meal sources to aid in understanding vector biology and ecology, and aid in developing appropriate Ecohealth vector control measures.

Background The renewed interest in community participation in health research is linked to its potential for bridging gaps between research and practice. Its main attributes are the generation of knowledge that can lead to socially robust, long-lasting solutions and the creation of a colearner relationship between researchers and research users. Following this philosophy, Ecohealth has evolved into a specialized framework for participatory research on the impact of pollution on ecosystems and human health. However, its principles pose considerable challenges. Its outcomes are strongly influenced by contextual factors that are impossible to control for ahead of time. This paper describes how the Ecohealth principles were applied to an epidemiological study of heavy metals exposure among indigenous communities of the Peruvian Amazon. It illustrates how knowledge generated from participatory research does not necessarily imply solving a public health problem. This study aimed to contribute to the understanding of the benefits and barriers of following the basic principles of the Ecohealth approach, and assist researchers working in similar contexts. Research process Based upon their personal experience as participant observers, the authors describe the research process; then, they discuss the most important challenges faced, their implications, and the attempted strategies for resolution. Challenges Challenges were grouped into four themes: (1) building trust; (2) one partnership, many stakeholders, multiple agendas; (3) being a researcher; and (4) communicating complex and unexpected findings. Conclusions Integrating the principles of transdisciplinarity and participation posed a series of challenges to the research process that were difficult, and sometimes impossible to overcome. However, positive outcomes from this experience were the lessons learned by the different actors. Despite the lack of immediate action, it is expected that useful interventions to prevent and control lead exposure in the Corrientes population will be implemented in the medium term. / <p>Funding for the epidemiological study described in this paper came from the Comprehensive Health Care Plan for the Corrientes Native Communities (PEPISCO) and a grant from FAS, the Swedish Council for Working Life and Social Research (grant 2006–1512).</p>

Objective: Assess the effectiveness of an ecological approach to promote healthy food choices in early childhood education through an educational workshop series. Design: Utilizing play-based learning, the workshops emphasized an ecological approach to health and food choice by letting children explore and experience healthy foods through various play-based and experiential activities. Data were collected and analyzed using grounded theory of semi-structured interviews with children, parents, and early childhood educators (ECEs), thematic analysis of children’s drawings, and quantitative food preference and food categorization surveys conducted with the children. Setting: The work was undertaken in three YMCA child care centres located in the Greater Toronto Area: Newcastle, Unionville, and inner-city Toronto. Participants: Participants comprised of 19 children, 5 parents, and 9 ECEs. Conclusions: The ecological approach to the promotion of healthy food choices in early childhood education was demonstrated to be an effective health promotion strategy for children aged 3 to 5.

The purpose of this study was to explore and describe the EcoHealth markers and health promotion interventions in the behaviour and practices of vegetables growers in Addis Ababa. The objectives were to assess the urban and peri-urban community members’ knowledge and practices on the existing environmental health policies/regulations/guidelines, assess the perspectives of women and youth on urban and peri-urban EcoHealth promotions and protections and evaluate the development and implementation of the health promotion activities on waste water use by applying an ecological model aimed at changing behaviour and by providing Bio-sand filter to promote hand wash practice which helps to reduce potential health risks among urban vegetable growers. Both quantitative and qualitative descriptive researches were conducted to identify the urban and peri urban community members’ knowledge and practices of the existing environmental health regulators and the perspectives of women and the youth on EcoHealth. Additional quasi experimental method; multiple baseline survey along with the EcoHealth Stress Process promotion method was employed to identify stressors, measure changes in environmental health promotion intervention and use of hand wash (biosand filter for hand wash). Six woredas from two subcities of the Addis Ababa City Administration were purposely selected, and a total of 845 (98.9% response rate) households participated in the quantitative study, while 142 community members (public sector offices, factories and establishments’ management and employee), participated in the qualitative survey. For quasi experimental method, six settings/blocks (of which 3 sites were provided with a bio-sand filter for hand washing) cultivated by 6 to 8 vegetable growers and their family members, were included in the intervention (multiple baseline survey). The findings revealed that about 77 percent of participants reported, knowledge of one or more of the selected environmental health and EcoHealth regulations. Ownership of assets and education tend to influence the public awareness of selected EcoHealth and environmental health regulations. Women and youth found to be significant contributors to better urban and peri-urban EcoHealth conditions and were the ones primarily affected by environmental hazards. The intervention study results also indicated evidence-based IEC interventions and ecological health promotion methods proved useful in promoting EcoHealth in an urban environment. Moreover, the biosand filter used to provide evidence of health promotion was found to be valuable for wastewater treatment and significantly reduced chemical, physical and biological contaminates from the wastewater. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to explore and describe the EcoHealth markers and health promotion interventions in the behaviour and practices of vegetables growers in Addis Ababa. The objectives were to assess the urban and peri-urban community members’ knowledge and practices on the existing environmental health policies/regulations/guidelines, assess the perspectives of women and youth on urban and peri-urban EcoHealth promotions and protections and evaluate the development and implementation of the health promotion activities on waste water use by applying an ecological model aimed at changing behaviour and by providing Bio-sand filter to promote hand wash practice which helps to reduce potential health risks among urban vegetable growers. Both quantitative and qualitative descriptive researches were conducted to identify the urban and peri urban community members’ knowledge and practices of the existing environmental health regulators and the perspectives of women and the youth on EcoHealth. Additional quasi experimental method; multiple baseline survey along with the EcoHealth Stress Process promotion method was employed to identify stressors, measure changes in environmental health promotion intervention and use of hand wash (biosand filter for hand wash). Six woredas from two subcities of the Addis Ababa City Administration were purposely selected, and a total of 845 (98.9% response rate) households participated in the quantitative study, while 142 community members (public sector offices, factories and establishments’ management and employee), participated in the qualitative survey. For quasi experimental method, six settings/blocks (of which 3 sites were provided with a bio-sand filter for hand washing) cultivated by 6 to 8 vegetable growers and their family members, were included in the intervention (multiple baseline survey). The findings revealed that about 77 percent of participants reported, knowledge of one or more of the selected environmental health and EcoHealth regulations. Ownership of assets and education tend to influence the public awareness of selected EcoHealth and environmental health regulations. Women and youth found to be significant contributors to better urban and peri-urban EcoHealth conditions and were the ones primarily affected by environmental hazards. The intervention study results also indicated evidence-based IEC interventions and ecological health promotion methods proved useful in promoting EcoHealth in an urban environment. Moreover, the biosand filter used to provide evidence of health promotion was found to be valuable for wastewater treatment and significantly reduced chemical, physical and biological contaminates from the wastewater. / Health Studies / D. Litt. et Phil. (Health Studies)

Current and potential future trends in the burden of acute gastrointestinal illness (AGI) in Rigolet, Nunatsiavut and Iqaluit, Nunavut, Canada were investigated in the context of climate change. A concurrent mixed methods design was used in which quantitative and qualitative data were concurrently collected and analyzed and then combined to better understand the burden of AGI. In-depth interviews with government stakeholders (n=11), PhotoVoice workshops (n=11), and two community surveys (n=185) were conducted to identify and characterize climate-sensitive health priorities in the Nunatsiavut region. Then, four cross-sectional retrospective surveys in Rigolet (two community censuses, n=462) and Iqaluit (two surveys with randomly selected households, n=1,055), as well as in-depth interviews with cases (n=9) were conducted to examine the incidence, risk factors, and healthcare seeking behavior of AGI. Finally, a scenario planning approach was used to identify and rank trends and conditions driving changes in future waterborne disease in Nunatsiavut. This involved in-depth interviews with national and international experts (n=20) and community focus group discussions (n=29). Climate-sensitive health priorities identified in Nunatsiavut included food security, water security, mental health, new hazards and safety concerns, and health services and delivery. The annual estimated incidence of self-reported AGI ranged from 2.9-3.9 cases/person/year in Rigolet and Iqaluit, which are the highest published estimates globally. Significant risk factors for AGI included food, water, animal exposure, and socio-economic conditions; while community interviewees perceived hygiene, retail food, tap water, boil water advisories, and personal stress to be important risk factors. The proportion of AGI cases seeking medical services ranged from 3-19%, which are among the lowest published rates globally. In the scenario planning process, critical drivers of AGI included ‘extreme weather events’; ‘technology development’; and ‘global interest in Northern resources’. These results provided information about AGI-related exposures and sensitivities to climate change, which can be used to provide information for public health planning, prioritization, and programming in Inuit regions. The improved understanding of AGI in two Canadian Aboriginal communities sheds light on the need to better understand the burden in sub-sets of the population that might be at higher risk, including Aboriginal populations in the context of climate change. / Vanier Canada Graduate Scholarship (CIHR); Public Health Agency of Canada; IRIACC initiative (CIHR, NSERC, SSHRC, IDRC); Nasivvik Centre for Inuit Health and Changing Environments

A scoping study of the published literature was used to describe the concept and practice of ecosystem approaches to health (ecohealth) in the context of public health. Analysis of commentaries identified 24 themes, expressed in a mind map showing interconnections between themes, with a table of explanations. Most (27 of 29) primary research articles did not explicitly explain how ecohealth was applied in their research, suggesting a need for some standardization in reporting ecohealth. Additionally, a case study approach was undertaken to identify enablers and impediments of ecohealth and how concepts were integrated into a research project of health and environmental sanitation in Vietnam. The project’s conceptual framework was aligned with ecohealth concepts, but in practice, a variety of challenges were identified. In future, ecohealth research teams should include a self-investigation of their ecohealth process to facilitate a comparison of theory-to-practice; this may serve as a best practice for ecohealth. / Public Health Agency of Canada (PHAC), Community of Practice in Ecosystem Approaches to Health - Canada (CoPEH-Can)