Environmental factors as determinants of malaria risk. A descriptive study on the northern coast of Peru.

We conducted a series of studies on the northern Pacific coast of Peru to determine environmental risk factors for malaria. We report in this paper the results of both a descriptive study of incidence and a prevalence survey of malaria. Both studies showed that the area was at low risk for malaria. The malaria incidence rate was 40/1000 p.a. during the study period, and the prevalence of infection was 0.9% (95% CI: 0.4-1.7) before and 1.4% (95% CI: 0.8-2.2) after the high incidence period. However, the risk of malaria varied according to season, village and even house within a single village. Incidence rates increased from February (2.6/1000 p.a.) to May (12.9/1000 p.a.) and decreased during the second part of the year. Most of the cases were clustered in four villages that constituted only 21% of the total population of the area. Houses where multiple cases were recorded were often located near a source of water. Our observations suggested that environmental factors, and particularly the presence of water for irrigation around villages and houses, played a major role in determining the risk of malaria. These observations were extended through an entomological study and a case-control study, to be published elsewhere.

Environmental risk factors for clinical malaria: a case-control study in the Grau region of Peru.

The role of environmental risk factors in clinical malaria has been studied mainly in Africa and Asia, few investigations have been carried out in Latin America. Field observations in northern coastal Peru, where the prevalence of malaria is high during the agricultural season, suggested that the risk of disease varied according to the characteristics of the house and the house environment. Environmental determinants of the risk of clinical malaria were therefore investigated through a case-control study: 323 clinical cases of malaria, recruited through community-based active case-finding, and 969 age-, sex- and village-matched controls were recruited into the study over a period of 12 months ending June 1997. Residual spraying of houses in the previous 6 months, living more than 100 m from a canal, a level of education equal to primary school or above and working in agriculture conferred significant protection from the risk of developing clinical malaria. The presence of spaces between the wall and roof in the subject's bedroom (eaves) and a house aged > 4 years statistically significantly increased the risk of disease. Based on these results we discuss possible control measures for malaria in this area of the country.

Las asociaciones de pacientes y el control de la leishmaniasis en el Perú / Patients' associations and the control of leishmaniasis in Perú

La leishmaniasis mucocutánea americana es un grave problema de salud en el Perú, particularmente en la región montañosa de Cuzco, donde se produjeron 25 por ciento de todos los nuevos casos notificados en 1989. El número de casos ha aumentado notablemente desde principios del denenio de 1980, cuando hubo una emigración estacional en gran escala a las zonas endémicas, especialmente a la región forestal de Madre de Dios, debido al descubrimiento de nuevas minas de oro en esa zona y al deterioro económico en el Perú. Ante la falta de respuesta oficial del Gobierno peruano, centenares de enfermos de leishmaniasis en la zona de Cuzco formaron asociaciones de autoayuda con el objetivo de obtener los medicamentos necesarios para tratar su afección. El logro principal de este movimiento que surgió espontáneamente, apoyado por varias instituciones públicas y privadas, fue animar a los enfermos, particularmente a los pacientes con lesiones de las mucosas, a salir del aislamiento. Como resultado, se han reducido mucho la prevalencia e incidencia de la enfermedad en ese territorio

American mucocutaneous leishmaniasis is an important health problem in Peru, particularly in the mountainous Cuzco Region, where 25% of all new cases reported in 1989 were located. Cases have increased considerably since the beginning of the 1980s, when large-scale seasonal migration to endemic zones occurred, particularly in the forest area of Madre de Dios, following the discovery of new gold deposits there and the deterioration in the economic situation in Peru. Following the lack of official response from the Peruvian government, hundreds of people suffering from leishmaniasis in the Cuzco area formed self-help associations with the objective of obtaining the drugs needed to treat their disease. The major achievement of this spontaneous movement, which was supported by several public and private institutions, was to encourage sick people, particularly patients with mucosal lesions, to emerge from isolation. As a result, the prevalence and incidence of the disease have now considerably decreased in the region.

Patients' associations and the control of leishmaniasis in Peru.

American mucocutaneous leishmaniasis is an important health problem in Peru, particularly in the mountainous Cuzco Region, where 25% of all new cases reported in 1989 were located. Cases have increased considerably since the beginning of the 1980s, when large-scale seasonal migration to endemic zones occurred, particularly the forest area of Madre de Dios, following the discovery of new gold deposits there, and the deterioration in the economic situation in Peru. Following the lack of official response from the Peruvian government, hundreds of people suffering from leishmaniasis in the Cuzco area formed self-help associations with the objective of obtaining the drugs needed to treat their disease. The major achievement of this spontaneous movement, which was supported by several public and private institutions, was to encourage sick people, particularly patients with mucosal lesions, to emerge from isolation. As a result, the prevalence and incidence of the disease have now considerably decreased in the region.

PIP: The deterioration in Peru's economic situation and the discovery of new gold deposits in the mountainous Cuzco Region have been associated with a considerable increase in cases of American mucocutaneous leishmaniasis. Following a lack of government response to this serious health problem, people with leishmaniasis in the town of Sicuani formed a patients' association in 1983 to try to obtain appropriate drugs for treatment. In 1983-93, eight additional patients' associations were established and, in 1990, these associations (representing 1648 members) united with health authorities and other institutions in the Cuzco Region to form a committee to coordinate their activities. The role of these associations was studied in field work conducted in the region in 1993. In interviews, association activists expressed demands that the government make free drugs available, offer financial compensation to those who acquire the disease through work, improve working conditions in the mines and living conditions for migrant workers, and identify other seasonal employment opportunities in order to prevent migration to the mining areas. The leishmaniasis movement, which originated as a spontaneous initiative, has become more structured and organized over time. A control strategy based on active case finding, early diagnosis, and early treatment of disease has been defined. A major achievement of the patients' associations, especially in Sicuani and Ocongate, has been to encourage sick people to emerge from their isolation. This program provides an example of successful multisectoral coordination and community participation of potential relevance in other countries where mucocutaneous leishmaniasis is endemic.