Seasonality, disease and behavior: Using multiple methods to explore socio-environmental health risks in the Mekong Delta

Any analysis of how changing environmental hazards impact on public health is fundamentally constrained unless it recognizes the centrality of the social and behavioral dimensions of risk. This paper reports on a research project conducted among low-income peri-urban households in the Mekong Delta of Vietnam. The research was based on cross-disciplinary inputs to develop a multi-layered understanding of the implications of a dynamic seasonal environment for diarrheal disease risk. It is a widely held assumption that the major changes in the abundance of surface water between the flood and dry seasons in the Mekong Delta are likely to be reflected in the changing patterns of disease risk, especially for poorer households that tend to rely heavily on river water for domestic water use. Therefore, this study investigated seasonal patterns in the contamination of environmental water, incidences of diarrheal illnesses, water use and hygiene behavior, together with perceptions of health risks and seasonality. During the period of October 2007 to October 2008, the UK and Vietnamese research team worked with a total of 120 households in four low-income sites around the city of Long Xuyen to conduct water testing; administer questionnaires on self-reported health, risk perceptions and behavior; and conduct semi-structured interviews. The research team found no overall evidence of a systematic seasonal risk pattern. At the population level, marginal temporal variations in water quality in the environment failed to translate into health outcomes. A complex risk narrative emerged from the interweaving data elements, demonstrating major inter- and intra-household variations in risk perceptions, hygiene behavior, seasonal behavior and other risk factors. It is suggested that these complexities of human behavior and transmission routes challenge simplistic assumptions about change in health outcomes as a result of seasonal environmental changes. These findings demonstrate the key role social science can play in a holistic and critical analysis of environment and health interactions.