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
Problem Soil transmitted helminth (STH) infections
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
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 2011. WHO. Helminth control in school age children: a guide for managers of control programmes - 2nd ed.
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
Geographical context Iquitos Peruvian Amazon Region Photo of belen
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
Timeline 2002-2012. 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
Dr. Martin Casapía Dr. Hugo Rodriguez Dr. Theresa W. Gyorkos 2011. One million tablets of mebendazole donated to DIRESA Loreto by FBO 2011. Regional Government (with technical advice from McGill) decides to implement full scale regional deworming program 2011-2012 Funding application to CIHR to implement baseline and monitoring program July 2012 Intervention and monitoring starts
School deworming program
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 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 <0.05 Hookworm 4.2 3.8 3.5 5.9 4.9 2.9 0.154 Any STH 82.4 61.7 58.4 58.5 56.0 57.5 <0.05 *chi 2 (between baseline and March 2014)
Prevalence (%) of moderate and severe infections in SAC Loreto Peru School Deworming Program Chau Cuica 100 90 80 70 60 50 40 30 Ascaris Trichuris Unicinarias Hookworm 20 10 0 Jul-12 Nov-12 Mar-13 Jul-13 Nov-13 Mar-14
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.
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
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
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
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.
Acknowledgements RI MUHC Brittany Blouin DIRESA LORETO Hugo Rodriguez Yuri Cabello Adelina Cieza Asociación Civil Selva Amazónica Madeleinne Montoya
Thank you - Merci - Gracias