Peru

Ecohealth research on infectious gastrointestinal illness in Peruvian communities

Acute infectious gastrointestinal illnesses are very common human diseases worldwide due to various bacterial, viral and parasitic agents (eg: Campylobacter, Salmonella, Escherichia coli, norovirus, rotavirus, cryptosporidium). The majority of such cases are undetected by the health system, but their actual burden nevertheless is very high in terms of health cost, societal cost, and quality of life. The World Health Organization has initiated a worldwide program to precisely quantify those burdens as a first step to better reduce the occurrence and burden. For the Americas the mean number of new cases by 100 persons is 51, 62, and 40 among the 5-14 yr, 15-54, and over 55 yr groups of people, respectively1. These rates may be even higher in Peru as it is in developing countries. Those illnesses generally have a complex epidemiology that includes more than one reservoir of the causal agent (humans, food animals, wildlife, companion animals) and several transmission routes between the human or animal reservoir and the individual (i.e. foodborne, waterborne, animal-to-person).

Vehicles for the agent transmission are numerous and opportunities for human to get infected are endless. As a result, the prevention of those diseases is a responsibility shared by many parties: the animal keepers, those processing and preparing food, the patient excreting the agent, and those responsible of the water safety in particular. In summary the issue seats truly at the interface between the humans, the animals and the environment and is rooted in their common biological and social ecosystem. The eco-health approach has been proposed and successfully used to tackle such health issues. Its principles are a systemic thinking, the implication of many fields of expertise and knowledge including community’s knowledge, attitudes and practices (transdisciplinarity), the actual participation of all stakeholders including the people in the community, gender and social equity, and sustainability. In addition, ecohealth research is geared towards by action for solving the issue.

Considering the great importance of acute infectious gastrointestinal illness, their complex epidemiology, and the value of the eco-health approach, we propose to set up a scientific collaboration between researchers from Peru and Canada in order to apply the eco-health approach to the issues related to the acute infectious gastrointestinal illness in Peruvian communities. More specifically, the project will:

1. draw a comprehensive portrait of the issue in the community. This portrait will summarize the situation in terms of prevalence of the diseases; public health infrastructure (e.g.: lab capacities, staff number and expertise), public and animal health regulations; agro-environment characteristics (animal inventory, water resources and treatment); food processing, trade, and consumption; and stakeholders and any social organizations that must be considered as essential in the community. Workshops to meet and explain the issue and the expertise of the team will be held. An interlaboratory test will be organized and undertaken for the common bacterial pathogen (e.g. Salmonella) ; and
2. to set up a collaboration to develop a scientific, fair and participatory research design that would propose and test prevention measure to reduce the burden of the targeted diseases. Our final goal is to obtain preliminary data to present a multi-center project (Canada-Peru-Pan American Health Organization) of 5 year to actually reduce the burden of gastrointestinal illness in Peruvian communities.

The overarching goals are

1. from a capacity-building standpoint: to generate knowledge and expertise in the eco-health approach to deal with such issues so that other communities in Peru and in Canada may benefit; and
2. from a human health standpoint: to decrease the number and short- and long-term outcomes of current common human illnesses through tailored individual, household, community and regional practices, programs, and regulations related to contact with animals, water safety and food safety.