Engagingthepublicin supportof Area-wideIntegratedPest ... · Engagingthepublicin supportof Area-wideIntegratedPest Management Pamela Pennington,Ph.D. Universidad del Valle de Guatemala

Engaging the public in support of Area-wide Integrated Pest Management

Pamela Pennington,Ph.D.Universidad del Valle de Guatemala

[email protected]

Sandra De Urioste-Stone,Ph.D.

Area-Wide Management of Insect Pests: Integrating theSterile Insect and Related Nuclear and Other Techniques

Vienna, AustriaMay 26 2017

1

Content

1. Central American Chagas disease control initiative and sustainability challenges

2. Implementation of Area-wide IntegratedVector Management to control Chagasdisease

3. Lessons learned in Area-wide IVM

2

Chagas is a deadly disease that affects vulnerable populations in Latin America

• 9 million infected with Trypanosomacruzi

• Silent chronic disease

• Transmitted by triatomines infesting houses under extreme poverty conditions

3

Chagas disease is mainly transmitted by vectors

• Vector-borne >80%

• Blood 16%

• Congenital 2%

• Other routes <1%

• (i.e. oral, organ transplant, laboratory accident)

4

The Central American initiative focused on interruption of vectorial transmission

• October 1997

• Interrupt transmission by Rhodnius prolixusand Triatoma dimidiata

5

Chagas disease vector control was prioritized by JICA in Guatemala

(Annual meeting CA initiative, 1999)

• 4 million at risk

• Prevalence: 9.8/100 inhabitants

• Annual incidence: 28-30 thousand cases

• >1,500 new cases/year

6 Tabaru et al. 1999

Chagas disease vector control programs are based on insecticides and house

improvement

• Indoor residual pyrethroid formulations

• Surveillance

• Community participation:

1. Surveillance

2. House improvement

3. Health education

7

Vector control sustainability is a challenge to the interruption goal

1. Insecticide cost($10/house)

2. Insecticide resistance

3. Sylvatic or peridomesticvectors

4. Slow house improvement process

5. Loss of political will

8

T. dimidiata control is a challenge in Guatemala

Manne et al 2012 doi: 10.4269/ajtmh.2012.11-0052.

9

Focalized persistent T.

dimidiata infestation afterinsecticide-based control

Content

1. Chagas disease Central American control initiative and sustainability challenges

2. Implementation of Area-wide IntegratedVector Management


10

Our objectives:

1. Improve Chagas disease prevention through an improved understanding of ecological, biological and social determinants of persistent vector infestation

2. Develop and evaluate a community-basedand intersectoral intervention for peridomestic animal management to reduce vectors in human habitats

11

A multidisciplinary projectpre-proposal

1• MoH epidemiological data

2• Central area MoH administrative support

3• Local area MoH support

4• Multidisciplinary proposal

12

Our strategy is multidisciplinary

13

Chagas

ECO BIO

SOCIAL

Vector ecology

Ecology

Ecosystem &

Human health

Vector behaviour

Sero-prevalence

in humans

Household economy and practices

Climate

Health systems

Community dynamics

Public and private services

Demographic and

Social change

Transmission Agriculture

Environment

• Health • Health Services

• Health Education

• Health Promotion

• Policy, Regulation

14

Predisposing factors

Enabling factors

Reinforcing factors

Phase 4: Educational and Ecologicalassessment

Phase 3: Behavioral and EnvironmentalAssessment

Behavior and lifestyle

Environment: Vector andreservoirdistribution

Phase 2: Epidemio-logicalAssessment

Phase 1: SocialAssessment

Quality of life: reduce Chagas diseasetransmission

Phase 5: Administrative Policy Assessment

PRECEDE: SITUATIONAL ANALYSIS

PROCEED: INTERVENTION

Phase 6: Implementation

Phase 7: Process evaluation

Phase 8: Impact evaluation

Phase 8: Outcome evaluation

Our strategy is iterative

15








Phase 1: Social assessment

16

•Establish rapport withcommunities

•Presentations toauthorities, communities, municipal leaders

•Socioeconomic case study

17



Vector andreservoirdistribution






Phase 2: Situational AnalysisDiagnostic of eco-bio-social context and

risk factors

TD

CHICKEN

RODENTHUMAN

CHICKEN

DOG

18

Rats are infected and associated withpersistent T. dimidiata infestation

19










Participatory meetings

1• Food storage practices, natural resources

2

• Land ownership, animal management, productionsystems

• Chagas disease

3• Chagas history in the area, identifying key players

and roles, local challenges, expectations

20

We implemented a ParticipatoryAction Research approach

21

•Communities actively participate in proposing solutions•Iterative process of reflection and action

Bustamante et al PLOS One, 2014

22


Enabling factors

Reinforcing factors




Vector andreservoirdistribution






Phase 4: Situational analysisEthnography

Anthropologists lived forone month in selectedcommunities

• Housing constructionpractices

• Household economicactivities

• Agricultural and animal managementpractices

23





24


Enabling factors

Reinforcing factors










Phase 5: Situational analysisStakeholder map and policy analysis

25

NGOs

UniversitiessVectors

Vectors

Epidemiol

MoHMoH

Education

Health Area

Health Center

Communities

Volunteers Communityleaders

Schoolteachers

FundingFunding

Epidemiol

Our hypothesis:

• Rodent nests maintain a constant source of infestation and transmission in thehouse

• If rodent nests are reduced, transmissionshould also be reduced

26

We chose a cluster randomizedcohort study design

27

Our Intervention:Healthy environments for Chagas

disease control

28

Indoorresidual

insecticide

Education

Participa-tion

Environ-mental

Manage-ment

Chagasprevention





29


Enabling factors

Reinforcing factors















We chose a community-basedparticipatory strategy

30De Urioste-Stone and Pennington et al 2015 Trans Roy Soc Trop Med Hyg

• 9 Participatory activities• Education, reflection and discussion of risk factorsand the disease• SWOT analysis



•Combined bottom-to-top and top-to-bottom strategies•Vector personnel supervisedcommunity volunteers to sprayinsecticide



•We taught participants to use mechanical rodent traps and effectivelyreduced rodent infestations

•Participants tested different trap designsto ensure adoption



Intersectoralenvironmentalmanagement to reduce rodent infestations



Our intervention achievedsustainable vector control levels

35

Intervention Control

Significant difference, GLMM p<0.05

“ I feel happy becauseL we respect life by taking careof our health and preventing a deadly disease”

(R1, comunidad 3, sept. 2012)

Infe

sta

tio

n(%

)





36


Enabling factors

Reinforcing factors















Our strategy is iterative

What is the importance of congenitalChagas disease?

• 1% seropositivechildren in 2015

• 10% seropositivewomen of child-bearingage in 2015

• We have started a program with midwivesto refer pregnantwomen and theirnewborns for neonatal screening

37Pennington et al submitted

Content

1. Chagas disease Central American control initiative and sustainability challenges

2. Implementation of Area-wide IntegratedVector Management


38

Complex socioeconomic problemsneed multidisciplinary approaches

• Use an iterativeprocess

• Combine bottom-up and top-to-bottom strategies

• There is no single magic bullet

• Use all the tools in the toolbox!

39

(Green and Kreuter 2005, as cited by the University of Kansas 2012)

Understand the needs

• A participatory process ismore than education, itleads to empowerment

• Participants proposesolutions

• Participants are yourcollaborators and yourchampions

• Listen carefully!

40

Understand the community

• Map stakeholders

• But, be aware that the recruitment processwill affect the end product

• Ex. house-to-house processes willproduce gender bias

• Involve leaders as participants, not onlysupporters!

41

Conclusions

1. Persistent T. dimidiata infestation associatedwith peridomestic rats threatens Chagasdisease transmission interruption in Guatemala

2. Our Integrated Vector Management Programis more sustainable than vertical insecticide-based control

3. Iterative, participatory, multidisciplinaryprocesses can sustain relevant diseasecontrol

42

Future IVM studies: Sterile Insect Technique for malaria elimination

• 1970s, USDA/CDC releasedchemosterilizedmales of Anophelesalbimanus in El Salvador

Lowe et al 1980

43

Potential SIT application in malaria elimination

• Guatemala 4,000 malaria cases in 2014

• Focalized to sites withsugar cane waterreservoirs and coastaltourist areas

• SIT: “An alternativethat must be carefullyevaluated”-MoHVector Control Program Officer

www.na.unep.net 44

CollaboratorsUVG� Sandra De Urioste-Stone (Natural resource management)� Celia Cordón (Biology)� José Guillermo Juárez (Biology)� Hugo Perdomo (Microbiology)� Hugo Enríquez (Mastozoology)� Nancy Sandoval (M.D.)� Elizabeth Pellecer (International development)� Jorge Sincal (Technician)� Edgar Pereira (Social scientist)� Teresa Aguilar (Development specialist)� Andrés Álvarez (Anthropology)

Ministry of Health� Dra. Elsa Berganza (Epidemiologist)� Ranffery Trampe (Vector control)

CDC� Joe Bryan (Congenital Chagas and Zika)� Ellen Dotson (Chagas and Malaria)Communities� COCODES and communities of Comapa and

Zapotitlán

45

Thank you

46

Indoorresidual

insecticide

Education

Participa-tion

Environ-mental

Manage-ment

Chagasprevention

Pamela Pennington,Ph.D.Universidad del Valle de [email protected]

Documents

Engagingthepublicin supportof Area-wideIntegratedPest ... · Engagingthepublicin supportof Area-wideIntegratedPest Management Pamela Pennington,Ph.D. Universidad del Valle de Guatemala