An ecosystem approach to human health and the prevention of cutaneous leishmaniasis in Tumaco, Colombia.

Carlos A Rojas

doi:10.1590/s0102-311x2001000700029

Abstract

A study was conducted during 1996-1997 in 20 villages of Tumaco, Colombia, to evaluate the effectiveness of personal protective measures against cutaneous leishmaniasis (CL). The intervention was effective, but the high costs of the preventive measures and the lack of a more holistic approach hampered the intervention's sustainability. This paper analyzes the results using an ecosystem approach to human health. Using this approach, we found that CL has been present in the study area for a long time and affects farmers and those living closest to the forest. The forest constitutes the habitat for insect vectors (sandflies) and parasite reservoirs (wild mammals). Four spatial scales were identified in this ecosystem: residential, village, regional, and global. From the ecosystem perspective, three interventions are proposed to prevent CL in the 20 villages: improve housing construction, organize village housing in clusters, and make diagnosis and treatment of CL more accessible. The design and implementation of these interventions require active involvement by people with the disease (village inhabitants) and decision-makers (local authorities).

Highlights

Control of cutaneous leishmaniasis (CL) in the Americas has been restricted principally to case management (WHO, 1990; Desjeux, 1996)
To evaluate the effectiveness of personal protective measures in preventing CL transmission, a randomized community trial was conducted during 1996-1997 (Rojas & Becerra, 1994)
The system includes both people with CL and those without the disease but who are involved in disease treatment and prevention

Summary

Introduction

Control of cutaneous leishmaniasis (CL) in the Americas has been restricted principally to case management (WHO, 1990; Desjeux, 1996). Housing located closer to the forest or on the village periphery is more likely to be built with materials that facilitate access by sandflies Such homes are inhabited by poorer village families who work in farming, are unable to move their families to urban Tumaco, and lack the economic means to upgrade their housing. Occupational variables and the forest interact on a weekly basis because people do not work on the farms every day The system includes both people with CL (children < 5 years, farmers, and community leaders) and those without the disease but who are involved in disease treatment and prevention (field health workers, local and national health authorities, researchers, funding agencies, and the international community) (see Table 2).

Funding agencies

Findings

Conclusions