Human Health in Ranomafana National Park, Madagascar: Nutritional Indicators and Self-reported Diarrheal Symptoms 公开

Abstract

Purpose: This study describes the human nutritional status and prevalence of self-reported diarrhea in six villages located within the 5 km buffer zone of the Ranomafana National Park, Madagascar, and discusses components of the human-animal interface that have potential to contribute to food security and zoonotic disease transmission.

Methods: A cross-sectional cluster sample survey was performed over an eight-week period from June 14^th to August 9^th, 2013. Sixty-two households within six villages bordering the Ranomafana National Park (RNP) were randomly selected for the study. Collection methods included in-person surveys, as well as physical assessments to acquire anthropometric data. A total of 303 individual surveys were completed and 257 individual participants had anthropometric data available for analysis. Livestock ownership and frequency of animal protein intake were evaluated for association with malnutrition. Livestock husbandry practices were evaluated for association with self-reporting of diarrheal disease. Statistical analysis was conducted with SAS-callable SUDAAN 10.0.

Results: Thirty-six percent of children < 5 were underweight and 20% were stunted. Eleven percent of the adult population had a low BMI (< 18.5). Diarrhea was self-reported in 16% of the population. In multivariable regression, children who ate animal protein more than once a week had significantly lower odds [adjusted odds ratio (aOR) 0.05; 95% confidence interval (CI) 0.01, 0.26] of being underweight, and adults living in households with livestock had significantly lower odds of having a low BMI (aOR 0.32; 95% CI 0.10, 0.98). Individuals who lived in poultry-owning households and kept their poultry inside the house at night had 2.46 times the odds of reporting diarrhea (95% CI 1.09, 5.57). Individuals over 5 years of age who reported handling feces at least once a month had 2.61 times the odds of reporting diarrhea (95% CI 1.03, 6.62).

Conclusions: Investigation of the human-animal interface in this community can help generate further hypotheses on how improvements in livestock management can be directed to improve food security and decrease the risk of zoonotic disease transmission.

Table of Contents

TABLE OF CONTENTS

I. Introduction.................................... Page 1

II. Background................................... Page 2

III. Methods....................................... Page 8

IV. Results......................................... Page 18

V. Discussion...................................... Page 23

VI. Strengths and Weaknesses.............. Page 27

VII. Future Directions.......................... Page 30

VIII. References.................................. Page 31

IX. Tables........................................... Page 36

a. Table 1: Demographic and household characteristics

b. Table 2: Nutritional indicators and self-reported diarrhea

c. Table 3: Characteristics of the human-animal interface, as defined by livestock ownership, frequency of animal protein intake and animal husbandry practices

d. Table 4: Associations of frequency of animal protein intake, livestock ownership, and covariates with four nutritional indicators

e. Table 5: Associations animal husbandry practices and covariates with self-reported diarrhea within the past 6 months

f. Table 6: Associations of protein frequency intake and livestock ownership with four nutritional indicators

g. Table 7: Associations of animal husbandry practices and self-reported diarrhea

X. Figure 1: The Ranomafana National Park boundary line Page 42

XI. Appendix A: Household Survey............ Page 43

XII. Appendix B: Individual Survey........... Page 47

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
关键词	Madagascar Diarrheal Disease Human-Animal interface Nutritional Indicators One Health
Committee Chair / Thesis Advisor	Winston, Carla A., Emory University
Committee Members	Weiss, Paul, Emory University Zohdy, Sarah, Emory University
Partnering Agencies	National or regional non-profit organization (e.g., American Cancer Society)

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