Peru Status Report

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  • Rio Armanayacu – Rio huallaga – Rio Marañon – Rio Ucayali
  • Cayetano Heredia Fundation will be the administrative leading in this projectIndigenous Health unit will be create to give a better support Global Health unit / Epidemiology department of Public Health will be associatedDra. Patricia GarciaDr. Cesar CarcamoDr. Magaly BlassSoc. Angela BayerTropical Medicine Institute of UPCHDr. Eduardo Gotuzzo
  • Connie – trained at UPCH in a master program in control infectious diseases
  • SICNA: The Information System on Native Communities in the Peruvian Amazon (Sistema de Información sobre Comunidades Nativas de la Amazonía Peruana, SICNA) is a georeferenced database that contains geographic and tabular information on native communities. The use and dissemination of the SICNA promotes territorial ordering and the defense of the rights of indigenous peoples, allowing for community territories to be titled and protecting indigenous peoples living in voluntary
  • Primary objective: To estimate the incidence of water/airborne diseases, vector-borne diseases, sexual transmitted infections (STI) and food security-related diseases in indigenous communities of the peruvian amazon region.Secondary objective:To identify individual, behavioural, and environmental risk factors associated to these problems
  • To implement a community based prospective cohort: Aproximately 1000.Three years: a baseline and three additional measures at the end of year 1 , 2 and 3. In the case of water-airborne diseases, participants will be followe very 3 months, in order to determine seasonal variations
  • Standardized questionnaire:Sociodemographic characteristics, health-related knowledge and behaviors, perceived health status, recent illnesses, and health care.Clinical evaluation: To assess nutritional status, general health status (including hypertension) and skin lesions (scare of leshmania)
  • There is not a program of control of Syphilis in those communities, and there some reports f STDs in native communitiesand because globalization this can be an indicator important to study
  • Local Minister of health has experience doing evaluation of the water quality of the river: microbiological, heavy metals and parasitological messuares
  • Iterative: We have already gotten permission from leaders of communities, however this could be asked again, It could means some modifications finall in methodologies An indigenous local coordinator will be nominated by each community to “canalizar” el proceso antes , durante y despues del desarrollo de cada protocolo
  • Treatment for malaria and leshmania will be provided for MoH as part of National ProgramsTreatment for anemia, parasites and syphilis will be provided by IHACC
  • Dr. Llanos, Dra. Patty Garcia, Dr. Isaac Alva y Dra. Carol Zavaleta, tiene experiencia trabajando con estos y con otros grupos indigenas
  • Peru Status Report

    1. INDIGENOUS HEALTHAND ADAPTATION TO CLIMATE CHANGE<br />Peruvian Amazon<br />Status Report<br />By:<br />César Cárcamo<br />IreneHofmeijer<br />Alejandro Llanos<br />Carol Zavaleta<br />
    2. STUDY SITES<br />
    3. Peruvian Amazon<br />www.lib.utexas.edu/maps/americas/peru_veg_1970.jpg<br />
    4. Peruvian Amazon<br />
    5. Ethnic Groups<br />Loreto: <br />Shawi<br />Ucayali: <br />Shipibo-Konibo<br />
    6. Shawi<br />Region: Loreto<br />Province: Alto Amazonas<br />District: Balsapuerto<br />Communities: <br />1. Nuevo Progreso<br />2. Puerto Porvenir<br />
    7. Shipibo-Konibo<br />Region: Ucayali Province: Coronel Portillo Districts: Calleria; Iparia<br />Communities: 1. Panaillo 2. Puerto Consuelo<br />Source: EsderasSilvano<br />Source: Google Maps<br />
    8. Community Characteristics<br />
    9. ORGANIZATION<br />
    10. Project Management<br />Administrative lead: <br />Cayetano Heredia Foundation (CHF)<br />Dr. Alejandro Llanos<br />Dr. Cesar Carcamo<br />Management:<br />Indigenous Health unit (CHF)<br />Dra. Carol Zavaleta<br />Dr. Isaac Alva<br />Connie Fernandez (Biologist)<br />Associates: <br />Global Health Unit (CHF)<br />Dra. Patricia Garcia<br />Faculty of Public Health – Epidemiology department (UPCH)<br />Dra. Magaly Blas<br />Angela Bayer (Sociologist)<br />Tropical Medicine Institute (UPCH)<br />Dr. Eduardo Gotuzzo<br />
    11. Partner Organizations<br />Indigenous Groups: <br />
    12. Partner Organizations<br />Ministries of Health:<br />Loreto<br />DIRESA Loreto<br />Red de Salud Alto Amazonas<br />Connie Fernandez<br />Ucayali<br />DIRESA Ucayali<br />Epidemiology department<br />Dr. Cayo<br />Environmental health unit<br />Ing. Saenz<br />
    13. Partner Organizations<br />Others:<br />Peruvian Amazon Research Institute (IIAP)<br />Virginia Montoya (Anthropologist)<br />Elsa Rengifo (Biologist)<br />Manuel Saudre (Agronomist)<br />Jose Choy (Agronomist)<br />National Meteorology and Hydrology Services (SENAMHI) – Loreto Branch<br />Marco Paredes (Engineer)<br />
    14. Collaborators<br />International Labour Office<br />PRO 169 <br />LiliamLandeo (regional coordinator)<br />www.pro169.org <br />Instituto del Bien Comun<br />Ucayali<br />Carlos Arana (regional coordinator)<br />Mario Osorio (in charge of SICNA)<br />www.ibcperu.org <br />
    15. Proposed Methodologies<br />
    16. Objectives<br />Primary Objective: <br />Estimate incidence in indigenous communities of: <br />Water / airborne disease:<br />common diarrheal infection; intestinal parasitic diseases; cyclosporidium; leptospirosis<br />respiratory infections ( flu, bronchitis, etc.); neumonia<br />Vector-borne disease: <br />malaria; dengue; leishmaniasis; yellow fever; arbovirus<br />Skin diseases: <br />Scabies; miasis; bacterial and fungal diseases<br />Sexually transmitted infections<br />Food-quality<br />Secondary Objective: <br />Identify individual / behavioural / environmental risk factors associated to problems above. <br />
    17. Cohort Study<br />Implement community based prospective cohort study: <br />Size: 1,000 approx<br />Length: 3 years<br />Frequency: <br />Baseline study start of year 1<br />Additional study end of year1, 2, and 3<br />Every three months for water/airborne diseases<br />Will allow to determine seasonal variations<br />
    18. Methods<br />Standardized questionnaire: <br />Socio-demographic characteristics<br />Health-related knowledge and behaviours<br />Perceived health status<br />Recent Illness<br />Use of health care<br />
    19. Methods<br />Clinical evaluation: <br />Assess nutritional status<br />General health status<br />Including hypertension<br />Skin lesions<br />Traces of leishmaniasis<br />Febriles<br />
    20. Methods<br />Anthropometrics:<br />Height and weight <br />Laboratory tests: <br />Malaria thick smears<br />Leishmaniasis skin test <br />Yellow fever and Dengue IgG,<br />Glucose test<br />Syphilis treponemic test and hematocrit.<br />Ova and parasites stool analysis<br />
    21. Methods<br />Entomological surveillance: <br />To be carried out by MoH at study sites <br />Water quality:<br />With support from MoH<br />Experience and tools to locally test for: <br />Fecal coliforms<br />Turbidity / conductivity<br />pH<br />parasitology<br />Heavy metal testing must be done in Lima<br />
    22. Ethical Considerations<br />Community approval: <br />Already obtained from community leaders<br />Approval must be reconfirmed<br />Could result in modification to methodologies<br />Local indigenous coordinator: <br />To help communicate the process before, during, and after the development of each research protocol<br />
    23. Ethical Considerations<br />Treatments: <br />Provided by MoH national programs: <br />Malaria<br />Leishmaniasis<br />Provided by IHACC:<br />Antibiotics<br />Anemia<br />Parasites<br />Syphilis<br />
    24. Ethical Considerations<br />Team members with experience working with indigenous groups: <br />Dr. Alejandro Llanos<br />Dr. Patty Garcia<br />Dr. César Cárcamo<br />Dr. Isaac Alva<br />Dr. Carol Zavaleta<br />
    25. Results Dissemination<br />Annual coordination meetings with: <br />Community representatives: <br />Chief and project coordinator<br />Indigenous leaders: <br />National, regional, and local indigenous organizations<br />National authorities: <br />Regional government and local municipality<br />Ministry of health representative<br />Other local collaborators<br />
    26. Thank you <br />

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