1. Skin problems among farmers engaged in Peri-urban Aquatic Production Systems in Hanoi and Phnom Penh Hanoi: Vuong Tuan Anh 1, Wim van der Hoek 4, Nguyen Dang Tuan 1, Nguyen Van Thuong 5, Phung Dac Cam 1, Anders Dalsgaard 2 PhnomPenh: Vuong Tuan Anh 1, Wim van der Hoek 4, Chan Vichet 6, Phung Dac Cam 1, Anders Dalsgaard 2 1 Division of Enteric Infectious Diseases, National Institute of Hygiene and Epidemiology, Vietnam; 2 Department of Pathobiology, Royal Veterinary and Agricultural University, Denmark; 3 Faculty of Fisheries Royal University of Agriculture, Cambodia; 4 International Water Management Institute, Sri Lanka; 5 National Institute of Dermatology, Vietnam; 6 National Clinic for Dermatology & STD Unit, Cambodia

2. Objectives Estimate the prevalence of skin problems among people involved in agricultural and aqua-cultural work Determine whether wastewater exposure is associated with skin problems Formulate recommendations for preventing/reducing skin diseases and discuss these with stakeholders

3. Methodology I: Hanoi and Phnom Penh Survey in ww (100 households (HHs)) and non ww sites (100 HHs) Cross-sectional study: –Hanoi: May, Sept, and Dec 2005 –Phnom Penh: July 04, Jan 05, and March 05 Household questionnaire interviews: –Hanoi: adult farmers –Phnom Penh: all members > 15 yrs Information collected on current skin problems and skin problems experienced during the previous 3 months Clinical manifestations and patient information collected by dermatologist Free treatment provided

4. Methodology II Local assistants were trained for data collection Studies supervised and quality assured by NIHE/KVL Data entry and analysis: Access database and SPSS 11.5

5. Results: Phnom Penh Data from each of the three cross-sectional studies were entered into individual database files However, problems are experienced with merging these databases into one common database. Thus, data is not shown

6. Results: Hanoi SitesSexSurvey 1 (May ’05) Survey 2 (Sept ’05) Survey 3 (Dec ’05) Hoang Liet (ww) Male Female 23 96 29 98 29 101 Long Bien (non-ww) Male Female 29 94 35 95 35 94 Study population: more women involved in farm work than men

7. Results: Hanoi ww site non-ww site

8. Results: Hanoi ww site non-ww site

9. Results: Hanoi wwNon-ww Mainly nails!

10. Results: Hanoi SitesSurvey 1 (May ’05) Survey 2 (Sept ’05) Survey 3 (Dec ’05) Hoang Liet (ww) 42 (35%)27 (21%)19 (14%) Long Bien (non-ww) 6 (5%)7 (5%)3 (2%) Prevalence of skin problems registered at the time of interview

11. Results: Hoang Liet commune (ww)

12. Results: diagnosis of current skin problems made by the dermatologist Most common diagnosis was contact dermatitis Other diagnoses: Atopic dermatitis Urticaria Fungus infection Bacterial infection

13. Conclusions  High prevalence of self-reported skin problems among farmers exposed to wastewater  Contact dermatitis is the most common skin condition but case numbers are small  Better assessment of exposure (specific biologic and physical-chemical factors) is needed

14. Future works Phnom Penh database to be repaired and data cleaned Data analysis: –Descriptive analyses –Multiple logistic regression Manuscript submissions (2 x MS to be submitted to international peer-reviewed journals)

15. Acknowledgments We are grateful for the help and assistance offered by members of the field Team at the Royal University of Agriculture in Phnom Penh, local people in Hoang Liet and Long Bien communes for data collection Colleagues in the National Inst. of Hygiene and Epidemiology (NIHE) for data entries EU-INCO-DEV (PAPUSSA) and the Danish International Development Assistance (Danida) for financial support