Pilot Chagas Disease Control Program

Assisting Ecuador's Loja Province

Research and Community Education Make a Difference in Outcomes

Approximately 70 percent 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 five 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 at 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 on 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 -erm 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 nongovernmental 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. I nformed 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.

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 children's 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

Community education

  • House educational activities will be provided 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.

  • 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