Myanmar Pig Partnership Project Expansion

Lead Research Organisation: University of Cambridge
Department Name: Veterinary Medicine

Abstract

Diarrhoea and vomiting, caused by contaminated food of animal origin, are deeply damaging but often unrecognized blights on human health and well-being, particularly for poor people in low and middle income countries. Farming households are also likely exposed to these zoonotic animal-derived infections through direct contact, as well as through consumption of contaminated foods of animal origin. Our ongoing ZELS-funded project, "An integrated management-based approach for surveillance and control of zoonoses in emerging livestock systems: Myanmar Pig Partnership (MPP)" has already pointed towards opportunities for culturally sensitive and livelihood-relevant interventions to improve animal health, farm productivity, rational use of antibiotics and awareness of occupational and food-borne zoonotic risks. These opportunities for improved livelihoods of farmers exist on farms with lesser as well as greater intensities of production.

We propose that information on the human burden of foodborne and occupational (directly acquired) zoonotic disease from pig meat, and better understanding of the pathways for medical support of affected persons, would help greatly in the design and pilot delivery of preventive health advice for consumers as well as farmers, building further on the data already acquired in MPP. We also propose that better knowledge of this human burden of pig or pig meat-acquired disease would help us in prioritising and broadeing which government departments and policy makers we should talk to in order to make best use of our newly emergent data from MPP. This data includes detailed information on existing hygiene practices at slaughter and processing, and practices relating to selection, use and recording of antibiotics in pigs.

The key objectives of this proposal are:
(1) To set up pilot diarrhoea surveillance to obtain preliminary data on the leading pathogens causing infectious diarrhoea in Myanmar, focusing on our already identified farming households but also on acute hospital admissions in Yangon City.
(2) To develop, pilot and evaluate consumer and occupational health advice for the prevention of pig and pig meat associated zoonoses in Myanmar.
(3) To convert research outputs from the originally funded Myanmar Pig Partnership into useful evidence presented in the best format for informing policy development in food safety and antibiotic resistance, for strengthening veterinary expertise in pig health management, and to enable understanding and uptake of relevant finds by the widest possible group of stakeholders.

Technical Summary

Endemic bacterial zoonoses, especially gastrointestinal infections, are a deeply damaging but often unrecognized limiter to human health and well-being, particularly of poor people in low and middle income countries. Our ongoing ZELS-funded project, "An integrated management-based approach for surveillance and control of zoonoses in emerging livestock systems: Myanmar Pig Partnership (MPP)" has pointed towards opportunities for interventions to improve animal health, farm productivity, rational use of antibiotics and awareness of occupational and food-borne zoonotic risks. Now we propose that data on the human burden of zoonotic disease especially from pig meat, and pathways for medical support of affected persons, would help in the design and pilot delivery of farmer and consumer targeted preventive health advice. We also propose that better knowledge of this human burden of pig or pig meat-acquired disease would help us in prioritising which government departments and policy makers we should talk to in order to make best use of our newly emergent data from MPP.

The key objectives of this proposal are:
(1) To set up pilot diarrhoea surveillance to obtain preliminary data on the leading pathogens causing infectious diarrhoea in Myanmar, focusing on our already identified farming households but also on acute hospital admissions in Yangon City.
(2) To develop, pilot and evaluate consumer and occupational health advice for the prevention of pig and pig meat associated zoonoses in Myanmar.
(3) To convert research outputs from the originally funded Myanmar Pig Partnership into useful evidence presented in the best format for informing policy development in food safety and antibiotic resistance, for strengthening veterinary expertise in pig health management, and to enable understanding and uptake of relevant finds by the widest possible group of stakeholders.

Planned Impact

Impact-related activities in this project will benefit from the involvement of OUCRU, which has experience facilitating engagement activities with farming communities in SE Asia around zoonoses; MOCRU, which has local research and patient engagement expertise; and IDS, which has experience with high-level convening and managing impact-related communications, including those with a One Health focus. Relationships developed during MPP, in particular with national and international (OIE and FAO especially) stakeholders will be exploited and key to ensuring impact in this new project. The involvement of the Government of Myanmar, via our LBVD partner, will present opportunities for direct influencing.
The project will benefit people in poor rural communities by reducing the incidence of foodborne infections from pigs/pig meat to people. We will do this by organising culturally relevant events (for example, a village meeting or performance) in which we will impart key messages on how best to prevent infection from zoonotic pathogens such as Salmonella and Strep. suis. Messages will be developed in consultation with LBVD and MOCRU in Myanmar to ensure they are clear and practically feasible (where relevant) in the low-resource setting of Myanmar rural households. We will develop communications products to ensure these messages remain 'live' within the communities. Such products may include posters printed domestic items (such as plates and T-shirts) and stickers, which we will distribute at the events.
We will extend the impact of these messages beyond the participating communities by producing a short video which we will promote via social media, most likely Facebook, which is popular in Myanmar. Also, by seeking opportunities with the Myanmar Farmer Channel (TV), with which LBVD has links. Further, we will use our new links with village drug shops, Township Medical Officers, and high-level officials from the Ministry of Health to encourage their take-up, leading to the fast-tracking of public health education programmes for broader uptake of food safety, as well as AMR control, messages.
We anticipate making tangible step-changes in infrastructure, capacity and training for surveillance and diagnostic investigation of bacterial endemic zoonoses in humans in Myanmar. This will be achieved via laboratory up-scaling and up-skilling. We anticipate further impact in this regard as we expect the lab we support in Yangon to obtain subsequent research funding through, for instance, links to FAO-Myanmar.
We aim to influence shifts in national food safety policy and legislation. We will do this by maintaining and building upon the relationships with policy stakeholders made at local, national and regional levels in MPP, as well as extending them into the human clinical and public health areas. We will use research updates, newsletters and policy briefs to supplement one-to-one contact to communicate with our stakeholders. Our final stakeholder meeting will allow us to influence and promote a One Health agenda in Myanmar as we bring our range of key stakeholders together.
We will achieve international impact by convening a pig specialist veterinarian conference in Naypyidaw. We will communicate our key findings at this event, which will also strengthen national, regional and international pig specialist vet links - and provide an opportunity to launch a Myanmar national specialist pig vet association which can build upon this network, providing lasting impact in terms of access to knowledge and technical support.
Learning from our project will also be taken up at the international level by non-governmental development, animal health and One Health agencies. Our strong links with the regional OIE and FAO offices will in particular strengthen dissemination of our findings.
Academic impact will be achieved chiefly via open access publication in peer-reviewed journals and presentation at our pig specialist veterinarian conference.
 
Description This project enabled active collaboration between Yangon Children's Hospital and the project partners, including training and provision of laboratory equipment to prepare for a survey of causes of childhood diarrhoea.

The project also enabled constructive engagement on pig health management, food safety and AMR between large scale pig producers (Myanmar Livestock Federation) and Myanmar Government (LBVD). Prior to our project there was was veryclimited engagement/trust between MLF and LBVD)

A no cost extension was granted in March 2020 because of delayed renewal of a previously existing Memorandum of Understanding between our key in-country partner (MOCRU) and the Myanmar Government Department of Medical Research. The MoU was finally approved by Myanmar DMR in November 2020 and the project was then submitted for ethical approval. COVID resulted in further delays to ethical approval and field work. The Coup in Feb 2021 resulted in FCDO requirement to cease all elements of the project that directly or indirectly support Myanmar Gov. This includes the diarrhoea surveillance work with Yangon Children's Hospital and the Pig Vet Conference planned with Yezin University of Vet Science for Sept 2021. Project outputs have been revised in discussion with FCDO and UKRI. All efforts will be made to conclude the deliverable outputs - now primarily focussed on field work to describe the burden of food borne zoonotic disease in the Yangon Region, and to engage with non-governmental stakeholders at a revised project dissemination meeting planned for September 2021.

Ongoing security and COVID concerns resulted in FCDO stopping us from completing our planned work. Impact associated activity with Myanmar government was also stopped art FCDO request. We have been able to develop a series of 'research briefs' for publication in 2022 to provided better penetration of our findings in the One Health and regional INGO community in addition to planned academic publications.
Exploitation Route A project dissemination meeting was scheduled for September 2021 bu this was halted because of objections from Myanmar government - who were barred from participating by FCDO. Instead we are finalising a series of research briefing documents which will be disseminated in 2022.
Sectors Agriculture

Food and Drink

Communities and Social Services/Policy

Government

Democracy and Justice

 
Description This project enabled active collaboration between Yangon Children's Hospital and the project partners, including training and provision of laboratory equipment to prepare for a survey of causes of childhood diarrhoea. The project also enabled constructive engagement on pig health management, food safety and AMR between large scale pig producers (Myanmar Livestock Federation) and Myanmar Government (LBVD). Prior to our project there was was veryclimited engagement/trust between MLF and LBVD) A no cost extension was granted in March 2020 because of delayed renewal of a previously existing Memorandum of Understanding between our key in-country partner (MOCRU) and the Myanmar Government Department of Medical Research. The MoU was finally approved by Myanmar DMR in November 2020 and the project was then submitted for ethical approval. COVID resulted in further delays to ethical approval and field work. The Coup in Feb 2021 resulted in FCDO requirement to cease all elements of the project that directly or indirectly support Myanmar Gov. This includes the diarrhoea surveillance work with Yangon Children's Hospital and the Pig Vet Conference planned with Yezin University of Vet Science for Sept 2021. Project outputs have been revised in discussion with FCDO and UKRI. All efforts will be made to conclude the deliverable outputs - now primarily focussed on field work to describe the burden of food borne zoonotic disease in the Yangon Region, and to engage with non-governmental stakeholders at a revised project dissemination meeting planned for September 2021. Ongoing security and COVID concerns resulted in FCDO stopping us from completing our planned work. Impact associated activity with Myanmar government was also stopped at FCDO request, including the stakeholder meeting meeting and vet conference planned for 2021. We have been able to develop a series of 'research briefs' for publication in 2022 to provided better penetration of our findings in the One Health and regional INGO community in addition to planned academic publications.
First Year Of Impact 2021
Sector Agriculture, Food and Drink,Healthcare,Government, Democracy and Justice
Impact Types Policy & public services

 
Description OUCRU collaboration 
Organisation University of Oxford
Department Oxford University Clinical Research Unit Vietnam (OUCRU)
Country Viet Nam 
Sector Academic/University 
PI Contribution We have shared whole genome sequence data for UK isolates of Streptococcus suis. I have contributed veterinary clinical expertise in pig health management towards the preparation of further research proposals.
Collaborator Contribution OUCRU (Hoa Ngo Thi) has shared whole genome sequence data for VN isolates of S. suis.
Impact Submitted research proposal to ZELS Initiative (Myanmar Pig Partnership), funded in 2014 to commence Jan 2015. Submitted joint manuscript for publication. Multidisciplinary collaboration: molecular bacteriology, genomics, evolutionary biology, clinical veterinary infectious disease management, human infectious diseases.
Start Year 2012
 
Description Farm management workshop series, Taikkyi, Myanmar 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact Farm Management Workshops (FMW) were designed to provide a facilitated participatory based learning experience for farmers. These were piloted in Taikkyi township. Facilitated by LBVD (Myanmar Gov Vet Dept) vet Myo Min with the support of Michael Loevinsohn, 14 bi-weekly sessions were held from May 2019 until March 2020. The curriculum focused on ensuring good nutrition, recognizing and preventing diseases (including zoonoses) and tracking profitability. Participants, who included the core 8 farmers and some 10 others, improved their knowledge and skills through experiential learning, trials, discussion, videos and farm visits. The most notable outcomes were improved individual-level prevention and initiation of collective action e.g. on vaccination and limiting traders' access to farms and village. A bulletin on the FMW is being prepared for the national broadcaster's Farmer Channel and a longer video may follow. This will be used to support learning in the other two townships and will be available to farmers throughout the country.
Year(s) Of Engagement Activity 2020
URL https://steps-centre.org/blog/project-pioneers-innovative-workshops-with-myanmar-pig-farmers/
 
Description GOING DEEPER WITH VALUE CHAIN ANALYSIS: UNDERSTANDING POWER RELATIONS FOR ANIMAL DISEASE CONTROL IN MYANMAR 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Value chain analysis is already praised as a powerful tool for animal disease control. International organisations such as the UN's Food and Agriculture Organization (FAO) routinely conduct value chain analyses to understand where animals are distributed, and who is involved in managing, moving, processing and purchasing them. In this way, policymakers and practitioners can track animal disease hotspots and identify groups of people potentially responsible for risky practices.

However, in our recently published paper from our work with the Myanmar Pig Partnership, we argue that there is a lot more we can do with value chain analysis (pdf).

Social science research has shed a light on the power relationships and governance issues that can influence value chain actors' behaviours. Understanding the power relationships and governance of livestock value chains can tell us not only who is involved in moving animals from farm to table and whose practices might pose health risks, but, importantly, also what lies behind risky practices.
Year(s) Of Engagement Activity 2019
URL https://steps-centre.org/blog/going-deeper-with-value-chain-analysis-understanding-power-relations-f...
 
Description Key note presentation on responsible antibiotic use in Myanmar: an event organised by the Netherlands Embassy in Myanmar, with Trouw Nutrition. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact The project's Myanmar government partner (LBVD) was invited to give key note presentation at this meeting organised by the NL Embassy with Trouwe Nutrition to discuss antibiotic use, regulation, and surveillance of AMR in livestock. Project methodology and data was presented to demonstrate Myanmar government pilot approaches on AMR surveillance in livestock (pigs).
Year(s) Of Engagement Activity 2019
 
Description Myanmar National Action Plan on AMR: Presentation of project data and methods for livestock surveillance 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact 1. Presentation Second Meeting of National Coordinating center for AMR and TWGs (Surveillance, IPC and Research and Innovation) by Dr. Thiri Su Wai
i. Date: 30.8.2019
ii. Venue: Summit Parkview hotel, Grand ball room
iii. Organization: Ministry of Health and Sports and LBVD, Ministry of Defense, FAO, Myanmar Medical Association, Ministry of Livestock Federation, Myanmar Pharmaceutical organization, JICA, ADB
Year(s) Of Engagement Activity 2019
 
Description Student One Health Society Lecture. October 2021 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Student One Health Society Lecture. October 2021.
A presentation and discussion to 25 international postgrad students.
Year(s) Of Engagement Activity 2021
 
Description Veterinary Advisory Visist series: a pilot preventive health program for vets and farmers in Yangon region, Myanmar. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Industry/Business
Results and Impact Veterinary Advisory Visits (VAVs) were designed to pilot the use of vet-led preventive health advisory visits to farms. The goal was partly to train vets and build a user guide for other vets to employ as a paid service, and seconf to encourage farmers to take up technical preventive health advice. VAVs were concluded in June 2020 - seven visits were delivered by LBVD vets to the 6 participating farms in each of the 3 Townships. Sessions covered the following topics: Biosecurity and disease management, Antimicrobial use, Nutrition and ASF preparedness, Reproduction, husbandry and facilities, Antimicrobial use and Husbandry, Nutrition and economics, Final assessment. VAVs were supported by in-country training of vet team by Juan Hernandez in December 2019. The final 8th visit was delivered remotely by phone in June 2020 because of COVID-restrictions. A final report describing the VAV initiative, including User Guide and User Resources, was submitted in September 2020 (to be presented at a vet conference in Myanmar in 2021).
Year(s) Of Engagement Activity 2019,2020
 
Description Webinar as part of Myanmar LBVD (gov vet Dept) Young Scientist series: 'Diagnoisis, management and prevention of zoonoses of pigs' 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Tucker led a webinar as part of LBVD Young Scientist series: 'Diagnoisis, management and prevention of zoonoses of pigs'. Attended by >100 LBVD government veterinarians.
Year(s) Of Engagement Activity 2020