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

Transcript

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