A government, NGO and academia research partnership to implement and monitor a school-based mass deworming program in Loreto, Peru (Chau Cuica)

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1 A government, NGO and academia research partnership to implement and monitor a school-based mass deworming program in Loreto, Peru (Chau Cuica) Hugo Rázuri, Hugo Rodríguez, Martín Casapía, Brittany Blouin, Madeleinne Montoya, Theresa W. Gyorkos

in Loreto, Peru (Chau Cuica) Hugo Rázuri, Hugo Rodríguez,

2 Problem Soil transmitted helminth (STH) infections

3 Soil-transmitted Helminths (STHs) Groups at risk School-age children Preschool-age children Women of reproductive age Morbidity Malabsorption Malnutrition Anemia Stunting Lack of energy Absenteeism

of reproductive age Morbidity Malabsorption

4 School-age children are at risk because: Period of intense physical growth and rapid metabolism Period of intense learning In high exposure settings, they lack awareness of the need forgood personal hygiene PICTURE OF CHILDREN WHO. Helminth control in school age children: a guide for managers of control programmes - 2nd ed.

awareness of the need forgood personal hygiene PICTURE OF CHILDREN 2011. WHO.

5 Control Strategies for STH infections in school-age children Schools in high risk areas (STH prevalence > 50%) Treat all school-age children 2/yr Improve sanitation and water supply Provide health education

> 50%) Treat all school-age children 2/yr Improve

6 Geographical context Iquitos Peruvian Amazon Region Photo of belen

7 Epidemiological Background (Belén-Perú) (Gyorkos et al 2013 ) N=1089 Ascaris lumbricoides Prevalence (%) 52.5 Trichuris trichiura Prevalence (%) 62.1 Hookworm Prevalence (%) 12.3 Any STH Prevalence (%) 75.3

8 Timeline Partnership for STH and maternal and child health research. ( PI: Dr. Theresa Gyorkos) STH infection and maternal anemia Deworming and education interventions Deworming during pregnancy Preschool children deworming Deworming and school abseenteism

9 Dr. Martin Casapía Dr. Hugo Rodriguez Dr. Theresa W. Gyorkos One million tablets of mebendazole donated to DIRESA Loreto by FBO Regional Government (with technical advice from McGill) decides to implement full scale regional deworming program Funding application to CIHR to implement baseline and monitoring program July 2012 Intervention and monitoring starts

Regional Government (with technical advice from McGill) decides to implement full scale

10 School deworming program

11 Prevalence (%) of STH infections in school-age children Loreto - Peru. School Deworming Program Chau Cuica Jul-12 Nov-12 Mar-13 Jul-13 Nov-13 Mar-14 p-value* Ascaris <0.05 Trichuris <0.05 Hookworm Any STH <0.05 *chi 2 (between baseline and March 2014)

Ascaris 65.2 43.1 39.4 37.0 39.6 41.3 <0.05 Trichuris 64.8 40.4 38.4 36.0 34.5 34.0 <0.

12 Prevalence (%) of moderate and severe infections in SAC Loreto Peru School Deworming Program Chau Cuica Ascaris Trichuris Unicinarias Hookworm Jul-12 Nov-12 Mar-13 Jul-13 Nov-13 Mar-14

100 90 80 70 60 50 40 30 Ascaris Trichuris Unicinarias

13 What s the role of this partnership? STH infections in children are a known problem in the region for decades. MoH has the capacity to implement large scale complex programs (malaria, TB, etc). WHO has guidelines, support and now, even free treatment. This partnership made possible a wellimplemented, science-driven, well-monitored and accountable program.

MoH has the capacity to implement large scale complex programs (malaria, TB, etc).

14 Government What government has: Knows the population, the problem and its causes Knows the resources (personnel/infrastructure) to solve it Has access to political decisions (intentions ) Has resources for large program implementation What government lacks: (often in developing countries) Initiative ( for new out-of-the-box interventions ). Why? Overburdened with multiple programs Challenged politically with higher priorities Updated technical knowledge. Good (excellent) doing what they have been doing. Don t speak the language. International public health language. English or French

Initiative ( for new out-of-the-box interventions ). Why?

15 Academia (International Research Partner) What academia has: Hunger for new challenges Up-to- date technical capacity Speaks the language and has the contacts (i.e. WHO) May possess more accurate information What academia lacks: Jurisdiction Cultural/social connection Language barrier Knowledge of bureaucracy and politics

16 Local NGO What the local NGO has: Local project/research implementation experience Monitoring/training experience Local connections with government at different levels Knowledge of hiring processes, logistics

17 Conclusions This is one example of how institutions can complement their efforts for global health. A close collaboration with local institutions is crucial to identify opportunities. Empowerment of local institutions, government and academia should be a mutual goal on the path to successful global health.

A close collaboration with local institutions is crucial to identify

18 Acknowledgements RI MUHC Brittany Blouin DIRESA LORETO Hugo Rodriguez Yuri Cabello Adelina Cieza Asociación Civil Selva Amazónica Madeleinne Montoya

19 Thank you - Merci - Gracias

National deworming program

- Background Paper 22 - National deworming program Kenya's experience Stewart Kabaka 1 Christine Wanza Kisia 2 1 Ministry of Public Health and Sanitation, Kenya 2 World Health Organization, Kenya Country