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Background: Persistent challenges of fragmented, food safety management in low- and middle-income countries underscore the need for more robustly coordinated mechanisms. National food safety technical working groups, operating under a One Health framework, offer potential in streamlining coordination efforts to effectively address these challenges. However, more clarity regarding their formation and functioning is important for understanding how to best establish and support such groups. The aim of this study is to systematically document the development process of established groups in Vietnam and Ethiopia., Methods: We assess the process used to establish and support the technical working groups against six critical success factors for multisectoral collaboration: drive change, define, design, realise, relate, and capture success. To do so, we review meeting minutes, Terms of Reference, and other related publications., Results: The analysis underscores the importance of financial and technical support by development partners in initiating working groups while also highlighting the challenge posed by the absence of legal frameworks to secure government commitment. Embedding the technical working groups within existing government structures - such as One Health platforms - from the outset could help to ensure the active participation and sustainability of such groups., Conclusion: Both Vietnam and Ethiopia have established operational and institutionalized technical working groups to bolster national food safety efforts under a One Health framework. The approaches employed in these countries could serve as valuable models for others seeking to establish comparable multisectoral collaborative mechanisms to address emerging health risks., (© 2024. The Author(s).)

Livestock is a strategic part of the small-farm economy in Southeast Asia's society, providing food income, clothing, fertilizer, and draught power. However, incidences or outbreaks of transboundary animal diseases (TADs) are due to converging factors such as the natural hazards' aftermath, climate change, deforestation, urban growth, changing production conditions, and market chains. Therefore, this affects productivity and impacts farmers' livelihoods with small holdings. The literature review was carried out to understand the current situation of TADs in Southeast Asia, identifying knowledge gaps to provide actions for disease control and prevention in the region. We have attempted to summarise the scientific literature in English on the prevalence data of TADs in Southeast Asia between 2011 and March 2022. Relatively few studies evaluated the distribution of TAD, where most of the studies focused on diseases that are important for international trade, such as avian influenza (AI), African swine fever (ASF), classical swine fever (CSF), foot-and-mouth disease (FMD) and Newcastle disease (ND). Traditional production systems have received little attention in such studies as they belonged to mainly smallholders. The outbreaks of ASF and lumpy skin disease (LSD) in 2019 resulted in increased research activity between 2019-2022, while the other TADs were ignored in this period. For new emerging TADs diseases such as ASF and LSD, there is only information about the first detection without prevalence information. Therefore, further epidemiological investigations are necessary to reduce the gaps in disease surveillance reporting systems and support the prevention and reduction of further outbreaks.

As COVID-19 has shown, pandemics and outbreaks of emerging infections such as Zika, Nipah, monkeypox and antimicrobial-resistant pathogens, especially emerging zoonotic diseases, continue to occur and may even be increasing in Southeast Asia. In addition, these infections often result from environmental changes and human behaviour. Overall, public health surveillance to identify gaps in the literature and early warning signs are essential in this region. A systematic review investigated the prevalence of emerging zoonotic diseases over 11 years from 2011 to 2022 in Southeast Asia to understand the status of emerging zoonotic diseases, as well as to provide necessary actions for disease control and prevention in the region. During the 2011-2022 period, studies on pigs, poultry, ruminants, companion animals and wildlife in Southeast Asia were reviewed thoroughly to assess the quality of reporting items for inclusion in the systematic review. The review was performed on 26 studies of pigs, 6 studies of poultry, 21 studies of ruminants, 28 studies of companion animals and 25 studies of wildlife in Southeast Asia, which provide a snapshot of the prevalence of the emerging zoonotic disease across the country. The findings from the review showed that emerging zoonotic diseases were prevalent across the region and identified a few zoonotic diseases associated with poultry, mainly stemming from Cambodia and Vietnam, as high priority in Southeast Asia. Clinical relevance : Appropriate prevention and control measures should be taken to mitigate the emerging zoonotic diseases in Southeast Asia.

Background: In recent years, Vietnam has suffered multiple epizootics of influenza in poultry., Methods: From 10 January 2019 to 26 April 2021, we employed a One Health influenza surveillance approach at live bird markets (LBMs) and swine farms in Northern Vietnam. When the COVID-19 pandemic permitted, each month, field teams collected oral secretion samples from poultry and pigs, animal facility bioaerosol and fecal samples, and animal worker nasal washes at 4 LBMs and 5 swine farms across 5 sites. Initially samples were screened with molecular assays followed by culture in embryonated eggs (poultry swabs) or Madin-Darby canine kidney cells (human or swine swabs)., Results: Many of the 3493 samples collected had either molecular or culture evidence for influenza A virus, including 314 (37.5%) of the 837 poultry oropharyngeal swabs, 144 (25.1%) of the 574 bioaerosol samples, 438 (34.9%) of the 1257 poultry fecal swab samples, and 16 (1.9%) of the 828 human nasal washes. Culturing poultry samples yielded 454 influenza A isolates, 83 of which were H5, and 70 (84.3%) of these were highly pathogenic. Additionally, a positive human sample had a H9N2 avian-like PB1 gene. In contrast, the prevalence of influenza A in the swine farms was much lower with only 6 (0.4%) of the 1700 total swine farm samples studied, having molecular evidence for influenza A virus., Conclusions: This study suggests that Vietnam's LBMs continue to harbor high prevalences of avian influenza A viruses, including many highly pathogenic H5N6 strains, which will continue to threaten poultry and humans., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Adopting One Health approaches is key for addressing interconnected health challenges. Yet, how to best put One Health into practice in research-for-development initiatives aiming to 'deliver impacts' remains unclear. Drawing on the CGIAR Initiative on One Health - a global initiative to address zoonotic diseases, antimicrobial resistance, and food and water safety - we reflect on challenges during program conception and implementation, prompting us to suggest improvements in multisectoral collaboration, coordination, and communication. Our approach involves conducting a researcher-centered process evaluation, comprising individual interviews that are subsequently thematically analyzed and synthesized. The key takeaway is that limited time for planning processes and short program timelines compared to envisioned development impacts may impede research-for-development efforts. Yet, collaborative work can be successful when adequate time and resources are allocated for planning with minimal disruption throughout implementation. Additionally, due to the multifaceted nature of One Health initiatives, it is important to pay attention to co-benefits and trade-offs, where taking action in one aspect may yield advantages and disadvantages in another, aiding to identify sustainable One Health development pathways. Forming close partnerships with national governments and local stakeholders is essential not only to promote sustainability but also to ensure local relevance, enhancing the potential for meaningful impact. Finally, regularly assessing progress toward development goals is critical as development stands as an overarching objective., Competing Interests: No conflict of interest is stated., (© 2024 The Authors.)

Traditional pork value chains dominate the production and distribution of pork in Vietnam; however, the high level of microbiological contamination in pork may increase the risk of food-borne disease for consumers. There is limited evidence about how to feasibly and scalably reduce microbial contamination in pork sold in traditional markets. This study aimed to assess the effectiveness of light-touch interventions for changing worker behaviour in small-scale slaughterhouses and vendors at traditional pork shops, as well as to identify risk factors for pork contamination. The intervention packages consisted of providing hygiene tools and delivering a food safety training which had been designed in a participatory way and covered 10 small-scale slaughterhouses and 29 pork shops. Pig carcasses, retailed pork, contact surfaces, and hands were sampled to measure the total bacterial count (TBC) and Salmonella contamination before, three and six weeks after the intervention, and trainee practices were observed at the same time. Linear and generalized linear mixed effects models were constructed to identify risk factors for TBC and Salmonella contamination at the slaughterhouses and pork shops. The interventions at slaughterhouses and pork shops both showed a slight reduction of TBC contamination in pig carcasses and Salmonella prevalence in retailed pork, while the TBC in retailed pork decreased only marginally. For slaughterhouses, the regression model indicated that smoking or eating during slaughtering (indicating poor hygienic practices) was associated with TBC increasing, while cleaning floors and wearing boots reduced TBC contamination. For pork shops, using rough materials (cardboard or wood) to display pork was the only factor increasing TBC contamination in pork, whereas cleaning knives was associated with lower TBC. Besides, the presence of supporters and wearing aprons reduced the probability of Salmonella contamination in pork. The findings highlight the effectiveness of light-touch interventions in reducing microbial contamination in pig carcasses at small-scale slaughterhouses and pork at traditional shops over the study period., Competing Interests: Declaration of competing interest The authors declare they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Access to informal fresh food markets plays a vital role in household food security and dietary quality in transitioning rural economies. However, it is not well understood if market access also improves child nutrition and if the improvement applies to all socioeconomic groups. In this secondary research study, we combined a national listing of food markets (n = 503) with a national household survey to examine the associations of market access with diet and height across wealth groups in children aged 6 to 23 months in rural Cambodia. All children under two years of age with dietary data (n = 1537) or anthropometry data (n = 989) were selected from the household survey. Food markets were geocoded using Google Maps or villages' geographical coordinates publicly available in the Open Development Mekong data platform. Regression calibration was then used to estimate household distance to the nearest market. Descriptive results indicated a highly uneven distribution of food markets with median household distance to the nearest markets ranging between 4 km (IQR: 3-8 km) in the lowland areas and 9 km (IQR: 4-17 km) in the highland areas. Results from the multivariate linear regressions showed that distance to the nearest market was modestly associated with child dietary diversity score (β: -0.17; 95% CI: -0.29, -0.05) but it was not related to child height-for-age z-score, and that household wealth did not modify the associations between distance to markets and child dietary diversity score. These findings suggest that improving access to food markets alone might not lead to meaningful improvement in child diet. Detailed surveys on household food acquisition are needed to clarify the role of food markets relative to other food sources such as subsistence fisheries, subsistence gardening and mobile food traders., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Duong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

While evaluations play a critical role in accounting for and learning from context, it is unclear how evaluations can take account of climate change. Our objective was to explore how climate change and its interaction with other contextual factors influenced One Health food safety programs. To do so, we integrated questions about climate change into a qualitative evaluation study of an ongoing, multi-sectoral program aiming to improve pork safety in Vietnam called SafePORK. We conducted remote interviews with program researchers ( n  = 7) and program participants ( n  = 23). Based on our analysis, researchers believed climate change had potential impacts on the program but noted evidence was lacking, while program participants (slaughterhouse workers and retailers) shared how they were experiencing and adapting to the impacts of climate change. Climate change also interacted with other contextual factors to introduce additional complexities. Our study underscored the importance of assessing climate factors in evaluation and building adaptive capacity in programming., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Improving diet quality of preschool children is challenging in countries undergoing food environment and nutrition transition. However, few studies have sought to understand how mothers in these countries decide what and how to feed their children. This study aims to explore maternal experiences, perspectives and beliefs when making food choice decisions for preschool children in urban, peri-urban and rural areas in northern Vietnam. Two focus group discussions and 24 in-depth interviews were carried out and analysed using thematic analysis. The results showed that mothers across the urban-rural spectrum shared the intention to feed children safe, nutritious food for better health and weight gain while satisfying child food preferences to improve appetite and eating enjoyment. These food choice intentions were embedded within family food traditions, whereby mothers emphasised nutritious food and adopted strict feeding styles during lunch and dinner but were flexible and accommodating of child preferences during breakfast and side meals. These intentions were also embedded within the physical food environment, which provided a mix of healthy and unhealthy food through informal food retailers. Despite these intentions, mothers faced financial constraints and difficulties in managing children's refusal to chew, changes in eating mood and strong eating temperament. These findings support policies to limit the presence of unhealthy food in informal food retail and encourage meal-specific feeding strategies to help children enjoy nutritious food, transition from soft to textured food and become more cooperative during mealtime., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

This work proposed a novel procedure of Water Quality Index (WQI) development that could be used for practical applications on a local or regional scale, based on available monitoring data. Principal component analysis (PCA) was applied to the monthly data of 11 water quality parameters (pH, conductivity (EC), total suspended solid (TSS), dissolved oxygen (DO), five -day biological oxygen demand (BOD), chemical oxygen demand (COD), ammonia (N-NH4), nitrate (N-NO3), phosphate (P-PO4), total coliform, and total dissolved iron monitored at 11 sites at Huong river in the years 2014-2016. From the PCA, the three extracted principal components explained 67% of the total variance of original variables. From the set of communality values, the weight (wi) for each parameter was determined. Linear sub-index functions were established based on the permissible limits from the National Technical Regulations on Surface Water Quality set up by the Vietnam Environment Agency (VEA) to derive the sub-index (qi) for each parameter. The multiplicative formula that is the product of the sub-indices (qi) raised to the respective weights (wi), was used for calculation of the final WQI values. The proposed index (WQI) was then applied to the river with quarterly data of the 11 parameters monitored at ten sites in the years 2017-2020. The WQI representatively reflected the actual status of the river overall water quality, of which 97.8% of the WQI values belonged to grades of EXCELLENT and GOOD, and 2.2% of grade MODERATE. Comparison between the river water quality evaluations resulting from the developed WQI with the WQI adopted by National Sanitation Foundation (NSF-WQI) and the index issued by Vietnam Environment Agency (VN-WQI) indicated that the proposed WQI was more suitable for river quality assessment., Competing Interests: The authors have declared that no competing interests exist.

The COVID-19 pandemic affected the food supply chain, retailers, and consumers owing to infection awareness. This study evaluated the impacts COVID-19 on ASF retailers' businesses and consumers' livelihoods, as well as their knowledge toward the disease, attitudes, and food safety practices to prevent infections. The study includes a cross-sectional component that was conducted in urban/peri-urban (U/PU) and rural areas in Chiang Mai province. In another part of the study, a structured questionnaire was developed for animal source food (ASF) retailers and consumers, with three primary parts for data analysis: general information, COVID-19 impacts, and knowledge, attitudes, and practices (KAP) assessment. Data corresponding to three periods of interest (before the COVID-19 outbreak, during partial lockdown, and present) were gathered and analyzed. In this study, 155 retailers and 150 consumers participated, of which the majority of the respondents were female (70.3% and 82.7%, respectively) with average ages of 47.4 and 44.9 years, respectively. The most noticeable effect of COVID-19 was a decline in income for retailers and consumers. The KAP scores of consumers in both areas were not significantly different, whereas the retailer attitudes toward COVID-19 prevention and food safety practices scored more highly in rural areas than in U/PU. During the partial lockdown, food safety practices significantly improved relative to the time preceding the outbreak, and these practices have remained constant to the present day. The results revealed that gender, age group, business type, and type of ASF retailers were associated with the KAP of the retailers, whereas gender, age group, education, number of family members, and occupation were associated with the KAP of the consumers. Our findings provide in-depth information about the effects of COVID-19 on ASF retailers and consumers, as well as their KAP regarding the outbreak and food safety, which may serve as support in developing policies for improved health and food safety.

Gender influences participation in food value chains (VCs) with implications for VC upgrading. This study investigated roles as well as differences in production activities, awareness, training, and attitudes between men and women in Vietnam's smallholder pig VCs. Data were gathered from a survey of 1,014 actors in different nodes along the chain, and the results showed that both men and women participated in all nodes of the VCs. Women were mainly in charge of routine husbandry activities (e.g., preparing feed, feeding animals, and cleaning pig pens) and participated in input supply (34.7%), pig production (60.2%), pork processing (63.6%), retailing (93.1%), and home preparation and cooking (100%). Men were more often responsible for tasks requiring strength, knowledge, and skills (e.g., disease management) and had greater involvement in larger-scale farming (60-80%) and slaughtering activities (98.0%). Selling of pigs was handled by both genders, but mainly men (73-80%), especially in larger farms. Likely challenges for upgrading pig VCs include limited training for producers, low concern for occupational health risks in all nodes, and misperceptions about food safety. In general, this study found no clear evidence of perceived gender inequality in the smallholder pig VCs in lowland Vietnam. Gendered upgrading in pig VCs should focus on improving women's ability to access veterinary services and animal disease management and on educating relevant VC actors about occupational health risks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nguyen-Thi-Duong, Pham-Van, Duong-Nam, Nguyen-Thi-Thu, Ninh-Xuan, Dang-Xuan, Unger, Nguyen-Viet and Grace.)

Non-typhoidal Salmonellae are common foodborne pathogens that can cause gastroenteritis and other illnesses in people. This is the first study to assess the transfer of Salmonella enterica from raw chicken carcasses to ready-to-eat chicken salad in Cambodia. Twelve focus group discussions in four Cambodian provinces collected information on typical household ways of preparing salad. The results informed four laboratory experiments that mimicked household practices, using chicken carcasses inoculated with Salmonella. We developed four scenarios encompassing the range of practices, varying by order of washing (chicken or vegetables first) and change of chopping utensils (same utensils or different). Even though raw carcasses were washed twice, Salmonella was isolated from 32 out of 36 chicken samples (88.9%, 95% CI: 73.0-96.4) and two out of 18 vegetable samples (11.1%, 95% CI: 1.9-36.1). Salmonella was detected on cutting boards (66.7%), knives (50.0%) and hands (22.2%) after one wash; cross-contamination was significantly higher on cutting boards than on knives or hands (p-value < 0.05). The ready-to-eat chicken salad was contaminated in scenario 1 (wash vegetables first, use same utensils), 2 (wash vegetables first, use different utensils) and 3 (wash chicken first, use same utensils) but not 4 (wash chicken first, use different utensils) (77.8%, 11.1%, 22.2% and 0%, respectively). There was significantly higher Salmonella cross-contamination in scenario 1 (wash vegetables first, use same utensils) than in the other three scenarios. These results show how different hygiene practices influence the risk of pathogens contaminating chicken salad. This information could decrease the risk of foodborne disease in Cambodia and provides inputs to a quantitative risk assessment model., Competing Interests: The authors have declared that no competing interests exist.

Since facing outbreaks of severe acute respiratory syndrome and avian influenza A in 2003, Vietnam has increasingly applied a One Health approach to address emerging infectious diseases of animal origin. Here, we reflect on the challenges and opportunities of One Health in the context of zoonoses, food safety, and antimicrobial resistance, drawing on a stocktake of One Health training, policy, and research in Vietnam. We also report on the results of a virtual consultation workshop held on July 2021 with representatives from 32 institutions in Vietnam to explore future One Health directions. As Vietnam approaches nearly two decades of disease preparedness and response, we hope our experiences can provide practical insights to support countries in developing coordination mechanisms and moving the One Health agenda forward toward better public health outcomes., Competing Interests: No conflict of interest is stated., (© 2021 The Authors.)

Mosquito-borne diseases (MBDs), including those caused by flaviviruses, remain human health problems for developing and urbanizing economies. This cross-sectional study examined risks of flavivirus exposure through a survey regarding knowledge and practices of pig farmers, and serological analysis of pigs in peri-urban and suburban Hanoi city. A total of 636 pig sera from 179 pig farms in 4 districts, namely, Chuong My, Dan Phuong, Ha Dong, and Bac Tu Liem, were analyzed by a competitive ELISA designed for flavivirus antibody detection. The results indicated a low level of awareness about MBDs among pig farmers, and a high seroprevalence in pigs at 88.5% (95%CI = 85.8-90.9%). Moreover, common practices of pig owners to prevent mosquitoes at home and farm did not show a significant reduction in flavivirus exposure in pigs. At animal level, significant associations between seropositive pigs and the farms with more than 60 pigs, and the district location were found. Farm-level multivariable analysis did not identify significant risk factors for flavivirus exposure. The study suggests that improving awareness of pig owners about MBDs in Hanoi city may be warranted to reduce the risk for MBD flavivirus infections in both humans and pigs.

Trichinellosis and cysticercosis remain challenges to human health and animal productivity worldwide, especially in developing countries. While information on the occurrence of both diseases is infrequent, they are endemic in parts of Vietnam and mainly related to indigenous pigs kept by ethnic minorities. This study aimed to determine the seroprevalence and risk factors of both diseases in indigenous pigs and explore the perception and awareness of both human and pig trichinellosis and cysticercosis of pig farmers. A total of 352 pig sera samples from 131 holdings were collected and analyzed using ELISA antibody tests in six communes in the Da Bac districts of Hoa Binh province, Vietnam. A survey was conducted with representatives from these households to understand the knowledge and perspective on food-borne parasitic diseases. Overall, the seroprevalence of trichinellosis and T. solium cysticercosis was 13.6% (95% CI 10.2-17.7) and 1.7% (95% CI 0.6-3.7), respectively. The seroprevalence of trichinellosis was significantly higher in female and older pigs. Risk perception and knowledge of interviewed people on both human and pig trichinellosis and cysticercosis of pig farmers was poor. Risky practices, including free roaming of pigs and eating undercooked or fermented pork, were observed. Educational and awareness campaigns aligned with further research on feasible practice changes are critical to addressing these issues.

Non-typhoidal salmonella (TS) remains a significant health burden worldwide. In Vietnam, pork accounts for 70% of the total meat consumed, and contamination with Salmonella is high. High levels of antimicrobial resistance (AMR) have emerged among porcine NTS and of particular concern is the emergence of colistin resistance, a "last defense" antibioic against multi-drug resistant (MDR) Gram-negative pathogens. This study aimed to investigate the antibiotic susceptibility of 69 NTS isolates collected from the pork retail outlets and slaughterhouses in Vietnam during 2014 a nd 2018/19. Phenotypic testing and whole genome sequencing was used to assess the serotype and AMR gene profiles of the 69 NTS isolates. Seventeen different serotypes were identified, of which S. enterica subsp enterica serotype Typhimurium was the most common followed by S . ser. Rissen, S . ser. London, S . ser. Anatum, and S . ser. Derby. Phenotype AMR was common with 41 (59.4%) isolates deemed MDR. MDR strains were most common in slaughterhouses (83%) and supermarkets (75%) and lowest in traditional markets (38%) and convenience stores (40%). Colistin resistance was identified in 18 strains (15 resistant, three intermediate) with mcr-1 identified in seven isolates ( S . ser. Meleagridis, S . Rissen, S . Derby) and mcr-3 in two isolates ( S . Typhimurium). This includes the first mcr positive S . Meleagridis to our knowledge. Surprisingly, boutique stores had high levels (60%) of MDR isolates including 5/20 isolates with mcr -1. This study demonstrates that pork from modern retail stores classed as supermarkets or boutique (with pork claiming to be high quality, traceable, environmentally friendly marketed toward higher income consumers) still contained NTS with high levels of AMR., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Holohan, Wallat, Hai Yen Luu, Clark, Truong, Xuan, Vu, Van Truong, Tran Huy, Nguyen-Viet, Unger, Thi Thanh Dang and Stabler.)

Objectives: To determine women's perception of the risk of food safety and how it relates to diet, health and decision making as part of formative research for a market-based intervention that aims to improve the safety of animal-source foods sold in informal markets., Design: Qualitative study including in-depth personal interviews with 24 caregivers were conducted and complemented with a second follow-up PhotoVoice interview, which allowed the women to photograph their meals and perceptions of food safety and nutrition. Interview data were analysed using thematic analysis in MAXQDA. Participants were purposively sampled from a larger Safe Food, Fair Food for Cambodia study, conducted from May to August 2018., Setting: Urban and periurban neighborhoods of Phnom Penh, Cambodia., Participants: 24 female caregivers (mothers and grandmothers) of children under age 5, each interviewed twice., Findings: A primary food safety concern expressed was that chemicals (pesticides and other agricultural additives) in animal-source foods, fruits and vegetables may impact the health of their families by causing diarrhoea and problems during pregnancy. This fear created a lack of trust in markets, which influenced their food purchasing behaviours and strategies for making the food safer for their families. These mitigation strategies, including food selection and cleaning, vary among the women but are perceived as important to be able to provide their families with what they define as safe meals., Conclusions: Interventions that wish to decrease rates of foodborne illness and increase animal source food consumption should also address the belief that the food system has been compromised by the addition of pesticides and agricultural additives., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To examine whether mothers' perceived neighbourhood food access is associated with their own and their young children's consumption of animal-flesh food, fruits and vegetables in peri-urban areas of Cambodia., Design: A cross-sectional survey measured food consumption frequency and perceived neighbourhood food access, the latter including six dimensions of food availability, affordability, convenience, quality, safety and desirability. Multivariate logistic regression was used to assess the association between perceived food access and food consumption., Setting: Peri-urban districts of Phnom Penh and Siem Reap, Cambodia., Participants: 198 mothers of children between 6 and 24 months old., Results: Over 25 % of the mothers and 40 % of the children had low consumption (< once a day) of either animal-flesh food or fruits and vegetables. Compared with perceived high food access, perceived low food access was associated with an adjusted 5·6-fold and 4·3-fold greater odds of low animal-flesh food consumption among mothers (95 % CI 2·54, 12·46) and children (95 % CI 2·20, 8·60), respectively. Similarly, relative to perceived high food access, perceived low food access was associated with 7·6-times and 5·1-times higher adjusted odds of low fruits and vegetables consumption among mothers (95 % CI 3·22, 18·02) and children (95 % CI 2·69, 9·83), respectively., Conclusions: Mothers' perceived neighbourhood food access was an important predictor of their own and their young children's nutrient-rich food consumption in peri-urban Cambodia. Future work is needed to confirm our findings in other urban settings and examine the role of neighbourhood food environment in the consumption of both nutrient-rich and nutrient-poor food.

Background: Street food plays a valuable role in several Asian countries including Vietnam. Improving the safety of street food is an important responsibility for many local food authorities. This study aims to characterize the business profile of fixed and mobile street food vendors, and to compare their compliance with the food safety criteria., Methods: A cross-sectional study was conducted using a questionnaire and observational checklist to assess the ten Vietnamese food safety criteria prescribed under Decision No. 3199/2000/QD-BYT for street food vendors in Can Tho city. A total of 400 street food vendors, composed of fixed and mobile vendors, in urban areas of the city were randomly selected for the survey., Results: The study showed significant differences between the two types of street food vendors in educational level (p = 0.017); business profile, including types of foods vended, area in use, number of employees, training in food safety, and business registration paperwork; and the status of compliance with the ten-food hygiene and safety criteria (p < 0.01). Poisson regression analysis found that education attainment (IRR = 1.228, p = 0.015), food safety training (IRR = 4.855, p < 0.01), total business capital (IRR = 1.004, p = 0.031) and total area in use (IRR = 1.007, p = 0.001) appeared to be significantly positively associated with food safety and hygiene compliance. In contrast, mobile vending type was negatively associated with the likelihood of adhering to the ten criteria (IRR = 0.547, p = 0.005)., Conclusions: These findings emphasize the need for training and education programs to improve food safety knowledge and practice among street food vendors. Basic infrastructure and services, especially clean water, proper sanitation, and waste disposal facilities, should be provided to help street food vendors better practice food safety and hygiene regulations., (© 2022. The Author(s).)

We investigate gender differences in the effects of unemployment and sentiment on suicide rates. Using monthly Australian data, we find a positive relationship between the unemployment rate and the suicide rate, and a negative relationship between consumer sentiment and the suicide rate. However, there is strong evidence of nonlinearity in the effects of both unemployment and sentiment on suicide rates, with substantial gender differences. For men, an increase in the unemployment rate increases the suicide rate, but an unemployment decrease has no effect; we find the opposite for women. For men, an increase in sentiment has stronger effects on the suicide rate than a decrease in sentiment. Again, we observe the opposite effect for women. Among sentiment components, forward-looking expectations are stronger predictors of suicide rates than present conditions. Sentiment has a much stronger effect on male suicide rates than on female suicide rates., (Copyright © 2021. Published by Elsevier Ltd.)

Many One Health programs are inherently complex, characterized by multiple perspectives from multiple sectors, delivery across various scales, and a focus on complex problems at the convergence of people, animals, and the environment. This complexity makes them difficult to conceptualize, requiring frameworks to organize the different program components. Evaluation frameworks that unpack the sequence of events linking program activities to outcomes (e.g., Theory of Change) and track outcomes (e.g., Outcome Mapping) show promise in supporting the development of One Health programs. While widely used in international development and health contexts, there has been little reflection on the use of Theory of Change and Outcome Mapping within One Health efforts. This paper reflects on the process of applying these frameworks to conceptualize a One Health food safety program in Vietnam. We find Theory of Change fostered the characterization of a change pathway toward safer pork, while Outcome Mapping kept us informed of where along the change pathway we were. One Health programs considering evaluation frameworks should adopt elements that make sense to them, be intentional about co-designing the evaluation, and view evaluation as a process, not a product., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Lam, Nguyen, Tuan, Nguyen, Nguyen-Viet, Toribio, Thanh, Pham-Van, Grace and Unger.)

Background: Dengue virus and Japanese encephalitis virus are two common flaviviruses that are spread widely by Aedes and Culex mosquitoes. Livestock keeping is vital for cities; however, it can pose the risk of increasing the mosquito population. Our study explored how livestock keeping in and around a large city is associated with the presence of mosquitoes and the risk of them spreading flaviviruses., Methods: An entomological study was conducted in 6 districts with 233 households with livestock, and 280 households without livestock, in Hanoi city. BG-Sentinel traps and CDC light traps were used to collect mosquitoes close to animal farms and human habitats. Adult mosquitoes were counted, identified to species level, and grouped into 385 pools, which were screened for flaviviruses using a pan-flavivirus qPCR protocol and sequencing., Results: A total of 12,861 adult mosquitoes were collected at the 513 households, with 5 different genera collected, of which the Culex genus was the most abundant. Our study found that there was a positive association between livestock keeping and the size of the mosquito population-most predominantly between pig rearing and Culex species ( p < 0.001). One pool of Cx. tritaeniorhynchus , collected in a peri-urban district, was found to be positive for Japanese encephalitis virus., Conclusions: The risk of flavivirus transmission in urban areas of Hanoi city due to the spread of Culex and Aedes mosquitoes could be facilitated by livestock keeping.

The 2019 African swine fever (ASF) outbreaks in Vietnam imposed considerable impacts on the pig sector in Vietnam, resulting in the death or culling of nearly six million pigs, or more than 20% of the country's pig population. In order to assess the magnitude of the outbreak at sector level (both on farm and at value chain level), on livelihoods, and on the broader national economy, a comprehensive impact assessment was conducted using a mixed methods approach that integrated a value chain assessment with the use of quantitative modeling tools at sector and national levels. The results showed that the outbreak caused severe direct and indirect economic losses among farmers, particularly medium- and large-farmers whose livelihoods are largely derived from pig production. The outbreaks also affected other value chain actors due to a halving in the volume of pigs traded. At sector level, the outbreaks posed adverse impacts on the domestic supply and demand for pork, especially in the traditional sector. Meanwhile, the modern sector with higher levels of biosecurity and high technology growth was less likely to be affected and even benefited from the outbreak, which was evidenced by increased supply and income throughout the simulation period in this sector. At national level, different model simulation scenarios showed a sharp reduction in total gross domestic product (GDP) and a substantial loss of jobs. Improvements in the system of ASF compensation scheme are needed, both in terms of its administration, but also in its targeting, with greater emphasis needed on developing improved risk-sharing and funding mechanisms across national and local levels., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Nguyen-Thi, Pham-Thi-Ngoc, Nguyen-Ngoc, Dang-Xuan, Lee, Nguyen-Viet, Padungtod, Nguyen-Thu, Nguyen-Thi, Tran-Cong and Rich.)

Background: Of the estimated 10 million people affected by (TB) each year, one-third are never diagnosed. Delayed case detection within the private healthcare sector has been identified as a particular problem in some settings, leading to considerable morbidity, mortality and community transmission. Using unannounced standardised patient (SP) visits to the pharmacies, we aimed to evaluate the performance of private pharmacies in the detection and treatment of TB., Methods: A cross-sectional study was undertaken at randomly selected private pharmacies within 40 districts of Vietnam. Trained actors implemented two standardised clinical scenarios of presumptive TB and presumptive multidrug-resistant TB (MDR-TB). Outcomes were the proportion of SPs referred for medical assessment and the proportion inappropriately receiving broad-spectrum antibiotics. Logistic regression evaluated predictors of SPs' referral., Results: In total, 638 SP encounters were conducted, of which only 155 (24.3%) were referred for medical assessment; 511 (80·1%) were inappropriately offered antibiotics. A higher proportion of SPs were referred without having been given antibiotics if they had presumptive MDR-TB (68/320, 21.3%) versus presumptive TB (17/318, 5.3%; adjusted OR=4.8, 95% CI 2.9 to 7.8). Pharmacies offered antibiotics without a prescription to 89.9% of SPs with presumptive TB and 70.3% with presumptive MDR-TB, with no clear follow-up plan., Conclusions: Few SPs with presumptive TB were appropriately referred for medical assessment by private pharmacies. Interventions to improve appropriate TB referral within the private pharmacy sector are urgently required to reduce the number of undiagnosed TB cases in Vietnam and similar high-prevalence settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Emerging zoonotic diseases exert a significant burden on human health and have considerable socioeconomic impact worldwide. In Asia, live animals as well as animal products are commonly sold in informal markets. The interaction of humans, live domestic animals for sale, food products, and wild and scavenging animals, creates a risk for emerging infectious diseases. Such markets have been in the spotlight as sources of zoonotic viruses, for example, avian influenza viruses and coronaviruses, Here, we bring data together on the global impact of live and wet markets on the emergence of zoonotic diseases. We discuss how benefits can be maximized and risks minimized and conclude that current regulations should be implemented or revised, to mitigate the risk of new diseases emerging in the future., Competing Interests: Declaration of Interests There are no interests to declare., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Japanese encephalitis (JE) is the major cause of viral encephalitis (VE) in most Asian-Pacific countries. In Vietnam, there is no nationwide surveillance system for JE due to lack of medical facilities and diagnoses. Culex tritaeniorhynchus, Culex vishnui, and Culex quinquefasciatus have been identified as the major JE vectors in Vietnam. The main objective of this study was to forecast a risk map of Culex mosquitoes in Hanoi, which is one of the most densely populated cities in Vietnam. A total of 10,775 female adult Culex mosquitoes were collected from 513 trapping locations. We collected temperature and precipitation information during the study period and its preceding month. In addition, the other predictor variables (e.g., normalized difference vegetation index [NDVI], land use/land cover and human population density), were collected for our analysis. The final model selected for estimating the Culex mosquito abundance included centered rainfall, quadratic term rainfall, rice cover ratio, forest cover ratio, and human population density variables. The estimated spatial distribution of Culex mosquito abundance ranged from 0 to more than 150 mosquitoes per 900m2. Our model estimated that 87% of the Hanoi area had an abundance of mosquitoes from 0 to 50, whereas approximately 1.2% of the area showed more than 100 mosquitoes, which was mostly in the rural/peri-urban districts. Our findings provide better insight into understanding the spatial distribution of Culex mosquitoes and its associated environmental risk factors. Such information can assist local clinicians and public health policymakers to identify potential areas of risk for JE virus. Risk maps can be an efficient way of raising public awareness about the virus and further preventive measures need to be considered in order to prevent outbreaks and onwards transmission of JE virus., Competing Interests: The authors have declared that no competing interests exist.

Cysticercosis and Trichinella spp. infection are parasitic zoonoses prevalent among pigs in Southeast Asia, where pork is the most important source of meat. In rural Cambodia, many pigs are raised extensively in family backyards, and information regarding the prevalence in rural small-scale pig production is very limited. This study was conducted in four provinces in north-eastern Cambodia to determine the seroprevalence of porcine cysticercosis and Trichinella spp. infection in rural villages, and to identify possible risk factors. Only households with less than 10 pigs above three months old were eligible. In total, 139 households participated, and 242 blood samples were collected. Farmers were interviewed about food and hygiene habits, disease knowledge and practices. The serum samples were analysed by ELISA to determine antigens to Taenia spp. cysticerci or antibodies to Trichinella spp. muscle larvae. Positivity among the pigs was 11.2% (95% CI 7.5-15.8) for Taenia spp. cysts and 2.5% (95% CI 0.9-5.4) for Trichinella spp. Cysticerci were more common in the province Preah Vihear ( p < 0.001) than in the other provinces. Risk factors associated with porcine cysticercosis were management systems for the pigs and access to human faeces ( p < 0.001). Trichinella spp. infection in pigs was more common in the province Ratanakiri ( p = 0.001). The main risk factor associated with Trichinella spp. transmission was feeding pigs with food waste ( p = 0.048). More men had heard about cysticercosis than women ( p = 0.002), and men also consumed undercooked pork meat to a greater extent ( p = 0.004). Although the present study is relatively small, several risk factors could be identified for porcine infection with Taenia spp. and Trichinella spp., which can be used to guide future interventions to improve both porcine and human health in these provinces.

Pork and pork products are important staple food in the diet of Vietnamese consumers. The safety of pork, including biological contamination, is a concern to several public authorities and value chain actors. This cross-sectional study aimed to identify Salmonella and total bacterial count (TBC) contamination of cut pork sold in different outlets, and determine the potential factors leading to contamination. A total of 671 pork samples were collected from different retail channels in three provinces in Northern Vietnam. Hygiene conditions and practices at pork vending premises were also observed and recorded. Data analysis used descriptive statistics and regression analysis. Overall, Salmonella prevalence in retailed pork was 58.1%. Salmonella contamination in pork from traditional retail, modern retail and food services were 60.5%, 50.9% and 80.5%, respectively. Eighty percent and 68% of fresh pork in canteen and street food was contaminated with Salmonella. Only a small proportion of a subset of the pork samples (6.2%) tested met the Vietnamese standard requirement for TBC contamination. Average concentration of TBC in fresh pork in traditional retail, modern retail and food services were 6.51 (SD: 0.64), 6.38 (0.65), and 6.96 (0.85) LogCFU/g, respectively. Transport time, use of the same tools for pork and other types of meat, storage temperature, and environment hygiene are important factors that might affect microbial contamination. The findings underline the high level of microbial contamination, which requires practical interventions to improve food safety hygiene practices and behavior of pork retailers., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Japanese encephalitis (JE) is endemic in Cambodia, but circulation of JE virus (JEV) among domestic pigs has previously only been studied in the southern part of the country. The main purpose of this study was to determine the seroprevalence of JEV antibodies in smallholder pigs held in rural areas of Kampong Thom, Preah Vihear, Ratanakiri, and Stung Treng provinces, northeastern Cambodia. Another purpose was to identify possible associations between serologic status and other factors, such as reproductive disorders, and to investigate the farmers' knowledge of mosquito-borne diseases and use of preventive measures. In October 2019, 139 households were visited throughout the study area, and 242 pigs were sampled for blood. The sera were analysed with ELISA for JEV antibodies. Household representatives were interviewed, and data were recorded for each sampled pig. The apparent seroprevalence was 89.1% in pigs between 3 and 6 months of age, and 100% in pigs over 6 months of age. In total, 93.0% of the pigs tested positive. Province appeared to be the only factor significantly associated with serologic status ( p < 0.001). Almost all (97.8%) respondents knew that mosquitos could transmit diseases, and 70.5% had heard of JE. However, only one respondent knew that JEV is transmitted to people through mosquito bites. Very few respondents knew that pigs can become infected with JEV, and no one knew that mosquitos transmit the virus. All families used some sort of mosquito protection for themselves, but only 15.1% protected their pigs from mosquito bites. The children were vaccinated against JE in 93 households, while adults only were vaccinated in eight households. The results suggest that JEV transmission is intense in northeastern Cambodia, and that people's knowledge about the transmission route of JEV and the role of pigs in the transmission cycle is low. Fortunately, people are well aware of mosquito-borne diseases in general and use mosquito protection, and many children are vaccinated against JE. Nonetheless, it is important that national vaccination is continued, and that people-especially in rural areas where pigs are commonly kept-are educated on the ecology and transmission of JEV.

Salmonella spp. and Staphylococcus aureus are two of the most common foodborne bacteria in animal-source foods (ASF) that cause illness worldwide. This study aimed to determine the prevalence of Salmonella spp. and S. aureus in chicken meat and pork in markets in Cambodia. Sampling was done in 52 traditional markets and 6 supermarkets in 25 provinces of Cambodia between October 2018 and August 2019. In total, 532 samples were obtained: chicken meat and pork (n = 408, 204 of each), chicken and pork cutting board swabs (n = 124, 62 of each). All samples were analyzed for the presence of Salmonella spp. and S. aureus ; colony-forming units per gram (CFU/g) of coagulase-positive Staphylococci (CPS) were counted, and a subset of samples was also analyzed for the most probable number (MPN, n = 136) of Salmonella . The overall prevalence of Salmonella spp. and S. aureus were 42.1% (224/532) and 29.1% (155/532), respectively, with 14.7% (78/532) of samples containing both bacteria. The prevalence of Salmonella spp. in chicken meat was 42.6%, on chicken cutting board it was 41.9%, on pork it was 45.1%, and the pork cutting board 30.6%. Chicken meat had a significantly ( p- value < 0.05) higher prevalence of S. aureus , 38.2%, compared to the chicken cutting board, 17.7%, pork 28.9%, and pork cutting board 11.3%. Mean MPN- Salmonella was 10.6 MPN/g in chicken and 11.1 MPN/g in pork samples. Average Log CFU/g of CPS in chicken and pork samples were 2.6 and 2.5, respectively. The results indicate that chicken meat and pork in Cambodia were highly contaminated with Salmonella spp. and S. aureus , posing risks to consumers' health. Urgent interventions are necessary to improve hygiene for safer meat in Cambodian markets.

Background: Dengue is a mosquito-borne flavivirus present in many metropolitan cities of tropical countries., Methods: During and after the dengue season (September 2018 to January 2019), we conducted a case-control study in order to determine the risk factors for dengue fever in Hanoi city, Vietnam. 98 dengue patients and 99 patients with other acute infections, such as Hepatitis B virus infection, were recruited at Department of Infectious Disease of Bach Mai national hospital in Hanoi. Patients were interviewed using a structured questionnaire covering demographic, housing, environmental factors and knowledge, attitude, and practice on dengue prevention and control. Univariate analysis and multivariable logistic regression were used to determine the risk factors of dengue status., Results: The mean score of knowledge items and practice items was only 7.9 out of total 19 points and 3.9 out of total 17 points, respectively. While the mean score of attitude items was 4.8 out of total 6 points. Multivariable logistic regression indicated that older patients had lesser risk of getting dengue infection as compared to younger adults aged 16-30, and patients living in peri-urban districts were less likely to suffer of dengue fever than patients living in central urban districts (OR = 0.31; 95% CI 0.13-0.75). This study could not find any association with occupation, water storage habit, knowledge, attitude, or practice on dengue prevention., Conclusions: All patients had a relatively low level of knowledge and practice on dengue prevention and control. However, the attitude of the participants was good. We found that age group and living district were the risk factors correlated with the dengue status. Communication programs on raising dengue awareness should be repeated all year round and target particular groups of adolescents, younger adults, landlords and migrants from other provinces to improve their knowledge and encourage them to implement preventive measures against dengue fever.

Diseases caused by flaviviruses, including dengue fever and Japanese encephalitis, are major health problems in Vietnam. This cross-sectional study explored the feasibility of domestic dogs as sentinels to better understand risks of mosquito-borne diseases in Hanoi city. A total of 475 dogs serum samples from 221 households in six districts of Hanoi were analyzed by a competitive enzyme-linked immunosorbent assay (cELISA) for antibodies to the pr-E protein of West Nile virus and other flaviviruses due to cross-reactivity. The overall flavivirus seroprevalence in the dog population was 70.7% (95% CI = 66.4-74.8%). At the animal level, significant associations between seropositive dogs and district location, age, breed and keeping practice were determined. At the household level, the major risk factors were rural and peri-urban locations, presence of pigs, coil burning and households without mosquito-borne disease experience ( p < 0.05). Mosquito control by using larvicides or electric traps could lower seropositivity, but other measures did not contribute to significant risk mitigation of flavivirus exposure in dogs. These results will support better control of mosquito-borne diseases in Hanoi, and they indicate that dogs can be used as sentinels for flavivirus exposure.

Sustainably intensifying agriculture to secure food for people, while minimizing the human, animal, and environmental health impacts is an unprecedented global food security challenge. Action research is needed to understand and mitigate impacts, with Ecosystem approaches to health (Ecohealth) emerging as a promising framework to support such efforts. Yet, few have critically examined the application of Ecohealth principles in an agricultural context, particularly in Southeast Asia where agricultural intensification is rapidly expanding. In this paper, we evaluate the strengths, challenges, and opportunities of agriculture-related Ecohealth projects in low-resource settings of Vietnam, Thailand, Indonesia, and China, drawing on a case study of the Field Building Leadership Initiative (FBLI). To do this, we used a developmental evaluation framework involving several iterative cycles of document reviews, interviews, focus groups, and outcome harvesting with researchers, partners, and community members involved in FBLI. Results highlight the importance of transdisciplinarity, participation, and knowledge-to-action principles in co-generating knowledge and co-developing practical solutions. Implementing such principles presents challenges in terms of coordinating regional collaborations, managing high workloads, meaningfully engaging communities, and ensuring ongoing monitoring and evaluation. To address these challenges, there is a need to strengthen capacity in integrated approaches to health, improve institutionalization of Ecohealth, foster community engagement, and systematically monitor and evaluate efforts. Ecohealth holds significant promise in improving food security, but only when considerable time is spent developing and implementing projects with communities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Nguyen-Viet, Pham, Lam, Pham-Duc, Dinh-Xuan, Jing, Kittayapong, Adisasmito, Zinsstag and Grace.)

Mosquito-borne diseases (MBDs) are causing high morbidity and mortality for humans. Urban livestock keeping is still common in cities around the world. The animals may serve as reservoirs for zoonotic MBDs, which increase the risks for humans. Here we assess the knowledge and practices related to MBDs in households with livestock and without livestock and explore the perceptions of the health care sector about MBDs and livestock keeping in Hanoi city of Vietnam in a cross-sectional study. A quantitative survey was conducted including 513 households with and without livestock-keeping in six districts and complemented with qualitative surveys with four health staff from Hanoi Center of Disease Control and three district health centers. The quantitative survey indicated that the participants possessed basic knowledge on MBDs with an average score of 18.3 out of 35, of which non-livestock-keeping households had a better knowledge than households keeping livestock (p<0.05). Both household categories had low score, 3.5 out of 11, regarding preventive practices against MBDs. The negative binomial model showed that occupation and location of living were factors associated to the knowledge on MBDs. Farmers were likely to have better preventive practices as compared to office workers (p<0.05). Those who had better knowledge also had more adequate preventive practices against MBDs (p<0.001). The qualitative survey revealed that livestock keeping was determined as increasing risks of MBDs due to the increase of mosquito population. It is recommended that community campaigns to raise the awareness and change behavior on MBDs should be organized based on collaboration between the health sector and the veterinary sector for households with and without livestock living in central urban and peri-urban areas. Further studies are needed to confirm the association between urban livestock keeping and potential increasing risks of MBDs such as dengue and Japanese encephalitis., Competing Interests: The authors have declared that no competing interests exist.

Background: Contact with livestock wastewater on farms and in communities can pose a risk to human and animal health., Methods: This cross-sectional study was conducted in 180 households and 24 pig farms (96 wastewater samples) to explore information about pig production, livestock waste management, antibiotic use, and to analyze antibiotic residues and microbial contamination, respectively., Results: Of the 120 households raising pigs, biogas systems were the most commonly used to treat animal waste (70%), followed by compositing (19%), and the remaining respondents discharged waste directly into drains or ponds (11%). The majority of respondents (78%) used antibiotics to treat and prevent disease in pigs, but 32% of them did not know of any disadvantages of antibiotic abuse. ELISA assays were performed on half of the wastewater samples (n = 48), demonstrating that residues of flouroquinolones and sulfonamides were present in 6.3% (3/48) and 22.9% (11/48) of tested samples, respectively. The average residual level of sulfamethazine was 27.8 ug/l. Further, E. coli concentrations exceeding regulatory levels in Vietnam were found in nearly all samples. Salmonella spp. was also found in 57.3% of samples, though prevalence rates varied across the different sites. Finally, G. lamblia was found in 8.4% of samples, and C. parvum was found in 5.2% of samples., Conclusions: This study suggests that livestock wastewater carried potential harmful pathogens and antibiotic residues that could come into contact with humans in the community. Thus, appropriate operation and application of livestock wastewater treatment (such as biogas or composting) and management should be a continued focused., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Background: Hepatitis E virus (HEV) is a zoonotic disease and has been reported around the world. The main objective of this study was to evaluate the sero-prevalence and phylogenetic analysis of HEV in Vietnam. Pig blood and fecal pooled samples were collected to assess the prevalence of HEV. We assessed the true prevalence (TP) of HEV from apparent prevalence (AP) by taking into account the sensitivity and specificity of diagnostic tests using a Bayesian approach. For phylogenetic analysis, the data compared with worldwide HEV reference strains including all eight genotypes (G1-G8) which were identified in previous study., Results: A total of 475 sera and 250 fecal pooled samples were collected at slaughterhouses and pig farms from five provinces, in Viet Nam. Overall, the sero-AP of HEV was 58.53% (95% confidence interval: 53.95-62.70) while the sero-TP was slightly higher (65.43, 95% credible interval: 47.19-84.70). In terms of pooled samples, overall, the RNA-AP was 6.80% (95% confidence interval: 4.01-10.66). One strain in Hanoi, two strains in Dak Lak, seven strains in An Giang, four strains in Son La and two strains in Nghe An were isolated. The phylogenetic tree demonstrated that 19 Vietnamese strains were clustered into HEV 3 and 4., Conclusions: This study provided evidence that HEV is circulating in domestic pigs in Vietnam. From a public health perspective, it is very important to raise public awareness for high-risk groups (e.g. slaughterhouse workers, pig traders, farmers and market sellers) who have more opportunities to come in contact with pig and contaminated meats.

The rapid urban growth of Hanoi city requires a livestock production system that ensures both food security and the livelihoods of dwellers. This paper reviews the existing policies for livestock production of Hanoi city and the changes in livestock population between 2014 and 2018 and identifies major challenges for livestock development of the city. While a remarkable increase of the livestock population in recent years is evident, the dominance of small-scale farms, the presence of animal diseases, the slow progress of transiting farms out of urban areas, as well as the lack of analysis of climate change and gender impacts are major challenges that could affect the livestock development of Hanoi., (Copyright © 2020 Pham-Thanh, Magnusson, Can-Xuan, Nguyen-Viet, Lundkvist and Lindahl.)

Interventions designed to reduce the burden of foodborne illness often require value chain actors to alter undesired and risky behaviours. This desired behavioural change may be supported by 'nudge theory', a sub-field of behavioural economics, which describes how individuals can be encouraged, or 'nudged', to act in ways which produce net societal benefits without restricting freedom of choice. This research aimed to investigate the use of nudges in the pork value chain in Vietnam. Key informant interviews (n = 12) were initially utilised to document the type of nudges being used within existing food safety interventions, followed by a questionnaire-based survey (n = 132) to describe the behavioural elements of pork value chain actors which could be amenable to nudging. Finally, a workshop was conducted to measure the response of stakeholders (n = 30) to various nudge elements which could be used to support future food safety interventions. Key informant interviews demonstrated that the use of behavioural nudges were a common aspect of food safety interventions in the pork value chain in Hanoi and Hung Yen Province. Survey participants reported that when considering food safety, veterinarians and actors' peers were highly trusted, and reputation was thought to be an effective incentive to illicit behavioural change. During the workshop, stakeholders appeared aware of the major slaughter and retail contamination points and cited lack of access to improved infrastructure as the limiting factor in their ability to improve hygiene. Value chain actors reported positive responses to the concept of using posters containing photographic images as nudges and stipulated that media should reflect the local context and contain language framed to suit the target audience. We suggest that the findings of this study are used to create site specific nudges for the Vietnamese pork industry targeting key value chain actors, such slaughterhouse workers and traditional retailers, which should be tested in the field to investigate their effectiveness., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Dengue is a growing problem in Hanoi, with cyclical epidemics of increasing frequency and magnitude. In June 2019, we conducted a cross-sectional survey using mixed methods to investigate how inhabitants of Hanoi perceive and respond to the risk of mosquito-borne diseases (MBD). A total of 117 participants recruited using a stratified random sampling method were interviewed in three districts of Hanoi. Knowledge and practices (KP) regarding MBDs were assessed using a pre-tested questionnaire. Inferential statistics were used to identify factors associated with KP scores and describe the relationship between variables. Additionally, a "risk-mapping" exercise was conducted in a subsample through semi-structured interviews and analyzed qualitatively and quantitatively using the System Effects platform. Factors significantly associated with knowledge scores were education and family history of MBDs. While knowledge and practice scores were found to be positively correlated in the statistical analysis, this was not corroborated by our observations on the field. The results also revealed gaps in knowledge about MBDs and vectors and highlighted a general feeling of powerlessness which prevented the adoption of protective behaviors. Therefore, educational interventions which provide concrete tools to empower communities should have a positive impact on improving vector control., Competing Interests: The authors declare no conflict of interest.

Background: The One Health concept promotes the enhancement of human, animal and ecosystem health through multi-sectorial governance support and policies to combat health security threats. In Vietnam, antimicrobial resistance (AMR) in animal and human health settings poses a significant threat, but one that could be minimised by adopting a One Health approach to AMR surveillance. To advance understanding of the willingness and abilities of the human and animal health sectors to undertake investigations of AMR with a One Health approach, we explored the perceptions and experiences of those tasked with investigating AMR in Vietnam, and the benefits a multi-sectorial approach offers., Methods: This study used qualitative methodology to provide key informants' perspectives from the animal and human health sectors. Two scenarios of food-borne AMR bacteria found within the pork value chain were used as case studies to investigate challenges and opportunities for improving collaboration across different stakeholders and to understand benefits offered by a One Health approach surveillance system. Fifteen semi-structured interviews with 11 participants from the animal and six from the human health sectors at the central level in Hanoi and the provincial level in Thai Nguyen were conducted., Results: Eight themes emerged from the transcripts of the interviews. From the participants perspectives on the benefits of a One Health approach: (1) Communication and multi-sectorial collaboration; (2) Building comprehensive knowledge; (3) Improving likelihood of success. Five themes emerged from participants views of the challenges to investigate AMR: (4) Diagnostic capacity; (5) Availability and access to antibiotics (6) Tracing ability within the Vietnamese food chain; (7) Personal benefits and (8) Managing the system., Conclusion: The findings of this study suggest that there is potential to strengthen multi-sectorial collaboration between the animal and human health sectors by building upon existing informal networks. Based on these results, we recommend an inclusive approach to multi-sectorial communication supported by government network activities to facilitate partnerships and create cross-disciplinary awareness and participation. The themes relating to diagnostic capacity show that both sectors are facing challenges to undertake investigations in AMR. Our results indicate that the need to strengthen the animal health sector is more pronounced.

Background: In Vietnam, lack of animal health information is considered a major challenge for pig production. The main objective of this study was to assess the seroprevalences of five pathogens [porcine circovirus type 2 (PCV2), porcine reproductive and respiratory syndrome virus (PRRSV), mycoplasma hyopneumoniae (M. hyo), Japanese encephalitis virus (JEV) and leptospirosis] and to better characterize the farm movements through a survey., Results: A total of 600 samples were collected from 120 farms from Bac Giang and Nghe An. Among unvaccinated herds, the highest seroprevalence was found for JE with 73.81% (95% CI: 68.39-78.74) in Bac Giang and 53.51% (95% CI 47.68-59.27) in Nghe An. Seroprevalences for PCV2 and M.hyo were 49.43% (95% CI: 45.06-53.80) and 46.06% (95% CI: 41.48-50.69) among unvaccinated animals. Accumulative co-infections for JE (86.25%) showed the highest level followed by M. hyo (66.25%) and PCV2 (62.50%). Three co-infections with JE had the highest positive rate (28.75%) followed by four co-infections (25.0%). Medium farms had relatively higher herd prevalences for all pathogens, except from leptospirosis. Overall, farmers exported/imported their pigs at the most 1-2 times every 6 months. Some respondents (5% for exportation and 20% for importation) had moved pigs more than 6 times over the last 6 months., Conclusions: Our study provided another pool of evidence that showed that PCV2, PRRS and H. hyo are endemic in pigs in Vietnam. Given the economic impacts of these pathogens elsewhere, the findings confirm the need for studies to evaluate the association between antibody response and clinical relevance as well as to assess the economic impact of co-infections at farm level. We also found that high seroprevalences of JE and leptospirosis were detected in pigs. From a pubic health point of view, it is crucial to raise public awareness especially for high risk occupations (mainly pig farm workers).

Background: Dengue fever is the most widespread infectious disease of humans transmitted by Aedes mosquitoes. It is the leading cause of hospitalization and death in children in the Southeast Asia and western Pacific regions. We analyzed surveillance records from health centers in Vietnam collected between 2001-2012 to determine seasonal trends, develop risk maps and an incidence forecasting model., Methods: The data were analyzed using a hierarchical spatial Bayesian model that approximates its posterior parameter distributions using the integrated Laplace approximation algorithm (INLA). Meteorological, altitude and land cover (LC) data were used as predictors. The data were grouped by province (n = 63) and month (n = 144) and divided into training (2001-2009) and validation (2010-2012) sets. Thirteen meteorological variables, 7 land cover data and altitude were considered as predictors. Only significant predictors were kept in the final multivariable model. Eleven dummy variables representing month were also fitted to account for seasonal effects. Spatial and temporal effects were accounted for using Besag-York-Mollie (BYM) and autoregressive (1) models. Their levels of significance were analyzed using deviance information criterion (DIC). The model was validated based on the Theil's coefficient which compared predicted and observed incidence estimated using the validation data. Dengue incidence predictions for 2010-2012 were also used to generate risk maps., Results: The mean monthly dengue incidence during the period was 6.94 cases (SD 14.49) per 100,000 people. Analyses on the temporal trends of the disease showed regular seasonal epidemics that were interrupted every 3 years (specifically in July 2004, July 2007 and September 2010) by major fluctuations in incidence. Monthly mean minimum temperature, rainfall, area under urban settlement/build-up areas and altitude were significant in the final model. Minimum temperature and rainfall had non-linear effects and lagging them by two months provided a better fitting model compared to using unlagged variables. Forecasts for the validation period closely mirrored the observed data and accurately captured the troughs and peaks of dengue incidence trajectories. A favorable Theil's coefficient of inequality of 0.22 was generated., Conclusions: The study identified temperature, rainfall, altitude and area under urban settlement as being significant predictors of dengue incidence. The statistical model fitted the data well based on Theil's coefficient of inequality, and risk maps generated from its predictions identified most of the high-risk provinces throughout the country., Competing Interests: The authors have declared that no competing interests exist.

Urban livestock provides an important source of food and income, but it may increase the risks for disease transmission. Vectors, such as mosquitoes, might increase and thereby cause an enhanced transmission of infectious diseases, such as dengue fever; considered the most important mosquito-borne viral disease globally. This cross-sectional study evaluated the awareness of dengue fever and investigated how the presence of dengue vectors is affected by the keeping of livestock in urban households in the city of Hanoi, Vietnam. From February to March 2018, during the season of lowest occurrence of dengue in Hanoi, 140 households were interviewed, of which 69 kept livestock. A general trend was observed; respondents living in the Dan Phuong district, a peri-urban district, had better knowledge and practice regarding dengue as compared to the urban Ha Dong district. In total, 3899 mosquitoes were collected and identified, of which 52 (1.33%) were Aedes species. A significant difference between the two districts was observed, with more households in Ha Dong having Aedes spp. mosquitoes (p = 0.02) and a higher incidence of dengue fever (p = 0.001). There was no significant association between livestock-rearing and the presence of Aedes spp. mosquitoes (p = 0.955), or between livestock-rearing and the incidence of dengue fever (p = 0.08). In conclusion, this study could not find any indication that households keeping livestock were at higher risk of dengue virus infections in Hanoi during the season of lowest occurrence of dengue, but clearly indicated the need of more information provided to urban inhabitants, particularly on personal protection., Competing Interests: The authors have declared that no competing interests exist.

Aquaculture systems are highly complex, dynamic and interconnected systems influenced by environmental, biological, cultural, socio-economic and human behavioural factors. Intensification of aquaculture production is likely to drive indiscriminate use of antibiotics to treat or prevent disease and increase productivity, often to compensate for management and husbandry deficiencies. Surveillance or monitoring of antibiotic usage (ABU) and antibiotic resistance (ABR) is often lacking or absent. Consequently, there are knowledge gaps for the risk of ABR emergence and human exposure to ABR in these systems and the wider environment. The aim of this study was to use a systems-thinking approach to map two aquaculture systems in Vietnam - striped catfish and white-leg shrimp - to identify hotspots for emergence and selection of resistance, and human exposure to antibiotics and antibiotic-resistant bacteria. System mapping was conducted by stakeholders at an interdisciplinary workshop in Hanoi, Vietnam during January 2018, and the maps generated were refined until consensus. Thereafter, literature was reviewed to complement and cross-reference information and to validate the final maps. The maps and component interactions with the environment revealed the grow-out phase, where juveniles are cultured to harvest size, to be a key hotspot for emergence of ABR in both systems due to direct and indirect ABU, exposure to water contaminated with antibiotics and antibiotic-resistant bacteria, and duration of this stage. The pathways for human exposure to antibiotics and ABR were characterised as: occupational (on-farm and at different handling points along the value chain), through consumption (bacterial contamination and residues) and by environmental routes. By using systems thinking and mapping by stakeholders to identify hotspots we demonstrate the applicability of an integrated, interdisciplinary approach to characterising ABU in aquaculture. This work provides a foundation to quantify risks at different points, understand interactions between components, and identify stakeholders who can lead and implement change., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Leptospirosis is an important zoonotic disease with a global distribution, affecting a wide range of mammalian animals and humans. Japanese encephalitis (JE) virus is the major vector-borne zoonotic disease in the Asia-Pacific region. The main objective of this study was to evaluate the seroprevalence of serovar-specific Leptospira and JE in swine from 10 provinces in Vietnam., Methods: Samples were initially collected for swine influenza surveillance from March to April 2017 at large-scale farms (with at least 50 sows and/or 250 fattening pigs) with pigs that tested positive for influenza in the previous surveillance period (2015-16)., Findings: A total of 2,000 sera samples were analyzed from 10 provinces. Overall, the seroprevalence of leptospirosis was 21.05% (95% CI: 19.28-22.90) using a cut-off titer of ≥ 1:100. The apparent prevalence of JE was 73.45% (95% CI: 71.46-75.37) while the true prevalence was slightly higher (74.46%, 95% credible interval: 73.73-86.41). We found a relatively high presence of leptospirosis and JE in pigs kept on large farms. Prevalence was comparable with other studies suggesting opportunistic testing of samples collected for other surveillance purposes can be a valuable tool to better understand and prevent the potential transmission of these zoonotic diseases from pigs to people in Vietnam., Conclusion: Our study provides evidence to veterinarians and animal health professionals for evidence-based practice such as diagnosis, vaccination and zoonotic control. Further investigation into the possible role of different domestic animals, wildlife species or environmental factors is needed to identify the potential risk factors and transmission routes in Vietnam., Competing Interests: The authors have declared that no competing interests exist.