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 Approximately
70% of the territory of Ecuador consists of tropical and
subtropical areas. The
climate and sociological-political-economic conditions of this
region predispose the population for a number of
vector-transmitted diseases, such as Chagas disease, malaria and
dengue fever. Work previously conducted in Loja province has
demonstrated high domiciliary and peridomiciliary infestation
with Triatomine insects in 5 communities. In 2005 and 2006 a
Pilot Control Program was launched in 58 communities. The
results after one year were assessed in 2006 in 10 of those and
showed a remarkable reduction in triatomine infestation. As preparations are
being made for a province wide control program, it is important
to identify the triatomine infestation in other areas and to
verify the effectiveness of the interventions proposed. In
addition, it is important to determine the acute cases and to
understand the effects of this disease in local mortality and
morbidity.
 Besides
learning about the biology of the triatomine
species present in these region, it is important to determine
the knowledge, aptitudes and practices (KAP) of the population
regarding these insects and other risk factors for Chagas
disease, and the acceptability of the intervention strategies
implemented. These data becomes the baseline for an extensive
educational campaign aimed to the villagers and personnel of
local and national institutions.
 Community education activities
are conducted along with the
research efforts. These include discussions with the
household members, distribution of printed material and
interactive meetings with the members communities at large.
Emphasis is placed in the development of videos that will
be used throughout the province for further community
education, as well as technical training of community health
workers and control program personnel. In order in increase the
effectiveness of these materials and community participation in
the long term project, local community members and personnel
from the control agencies will be invited to participate in the
video.
The logistical arrangements to conduct research in these
geographic areas are difficult to establish due the inadequate
infrastructure. Maximization of resources by the use of
multidisciplinary teams in combination with the involvement of
local governmental and non-governmental agencies, health care
institutions and community members are crucial for the acquisition
of useful data. However, the coupling of the research with
community education and development programs and basic health care
(provided by the local health care system) can have a major impact
in improving the health status of the people in
the study areas.
Project Description
(2007 activities)
Area
of study and population:
 Thirty communities with a population between 500 and 1000 inhabitants,
located in the rural areas
of Loja and Manabi Provinces, Ecuador. The sampling scheme will aim to
include all the households in each community. Informed consent will be obtained
from each participant. Research will be conducted as an unlinked
study following Ohio University and Universidad Católica
del Ecuador IRB policies and
procedures. Community volunteers and staff from
collaborating institutions will assist in all activities.
See 10 min. video from the 2005 Project.
Specific
field activities:
Geographical
Information System:
-
 Census of the population
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Community Mapping using Geo-positioning
system (GPS)
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Census of available infrastructure
(electricity, health care, water, school, etc)
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Database management
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Geo-Spatial Analysis
Epidemiological
and sociological study:
Entomological
survey (mosquitoes and triatomines):
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 Intra-domiciliary,
peri-domiciliary and sylvatic triatomine search
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Parasite
isolation from triatomine feces
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PCR analysis of blood and tissue samples
Clinical
studies:
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ECGs,
Echocardiograms
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Various
children's health assessment indicators
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Blood
collection (finger prick and venipuncture) will be conducted
in a subset of the population.
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Immuno chromatography, ELISA,
agglutination and Western blot for Chagas disease will be
conducted
Community
education:
-
house educational
activities to the household members.
-
Seminars,
discussions and round tables will be conducted with the
participation of targeted groups of community members such as
mothers,
school
children and community
leaders in each community
-
Educational
videos will be produced using footage from each community
and will be shown at town hall meetings
-
Educational
technical videos will be produced to train community
 health
workers, entomological community volunteers, ministry of
health workers, etc.
-
Educational
videos will be produced for training of health officials at
the provincial and national level.
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Video spots will
be produced for public health service announcements to be
aired by regional TV stations.
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In addition,
the research program serves as the training ground for the
newly created National Chagas Control Program.
Partners:
Ecuadorian Chagas Control Program, Ministry of Health; PLAN
Internacional Ecuador; Catholic University of Ecuador; Ohio
University; ECLAT Network
Funding:
Special Programee for
Tropical Disease Research and Training (TDR). World Health
Organization, Genveva, Switzerland; PLAN Internacional,
Quito, Ecuador; Tropical Disease Institute, RSAC, OUCOM,
Ohio University, USA;
Children’s
HeartLink, Mineapolis, USA; Ministry of Health, Ecuador;
Knights Bridge International,
CA, USA; Local Governments in Loja Province, Ecuador
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