Seventh Community Based Tropical Disease Research in Ecuador
June 15th/August 15th 2008
Chagas disease in Ecuador

Directed by Mario J. Grijalva, Ph.D.

Summer  2008
June 15th – August 15th, 2008 
(flexible dates)
- up to 15 credit hours -
(approximate dates, subject to change and cancellation)
Non-credit option available

Rationale

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, 2006 and 2007 a Pilot Control Program was launched in 66 communities. The results after one year were assessed in 2006 in 10 of those and showed a remarkable reduction in triatomine infestation. The results after two years indicate continued success of this strategy in Loja. In addition, the methodology was implemented in Manabi Province. As preparations are being made for a province wide control program in Loja, 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.

In 2008, the project will assess the continuing effectiveness of the Pilot Control strategy in Loja province. The expansion of the geographical area will provide data to the Ministry of Health and the National Chagas Control Program for deployment of resources to these areas in fulfillment of the commitments made to the Andean Countries and Amazonic Countries Chagas control initiatives.

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 will become the baseline for an extensive educational campaign aimed to the villagers and personnel of local and national institutions.

Community education activities will be conducted along with the research efforts. These will include discussions with the household members, distribution of printed material and interactive meetings with the members communities at large. Emphasis will be placed in the development of videos that will be used thought-out 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

Area of study and population:

Fifteen to twenty communities with a population between 500 and 1000 inhabitants, located in the rural areas of Loja Province, Ecuador previously determined to have high triatomine infestation rates.

See 10 min. video from the 2005 Project.

Specific field activities:

Geographical Information System:

• Census of the population

• Community Mapping using Geo-positioning system (GPS)

• Census of available infrastructure (electricity, health care, water, school, etc)

• Database management

• Geo-Spatial Analysis

Epidemiological and sociological study:

• Knowledge, Aptitudes and Practices (KAP)

• Housing survey

Entomological survey (mosquitoes and triatomines):

• Intra-domiciliary, peri-domiciliary and sylvatic triatomine search

• Parasite isolation from triatomine feces

• PCR analysis of blood and tissue samples

Clinical studies:

• ECGs, Echocardiograms

• Various health assessment indicators

• Blood collection (finger prick and venipuncture) will be conducted in a subset of the population.

• Immuno chromatography, ELISA, agglutination and Western blot for Chagas disease will be conducted

• Determination of local capabilities at the provincial, county and local levels for detection, diagnosis and treatment of Chagas disease in Loja Province.

Community education:

• An education team will shadow each entomological team and will conduct house by 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.

• Video spots will be produced for public health service announcements to be aired by regional TV stations.