One Health Action against Human Fascioliasis in the Bolivian Altiplano: Food, Water, Housing, Behavioural Traditions, Social Aspects, and Livestock Management Linked to Disease Transmission and Infection Sources.

René Angles,M Adela Valero,M Dolores Bargues,Santiago Mas-Coma,Paola Buchon

doi:10.3390/ijerph19031120

Abstract

The Northern Bolivian Altiplano is the fascioliasis endemic area with the reported highest human prevalence and intensities. A multidisciplinary One Health initiative was implemented to decrease infection/reinfection rates detected by periodic monitoring between the ongoing yearly preventive chemotherapy campaigns. Within a One Health axis, the information obtained throughout 35 years of field work on transmission foci and affected rural schools and communities/villages is analysed. Aspects linked to human infection risk are quantified, including: (1) geographical extent of the endemic area, its dynamics, municipalities affected, and its high strategic importance; (2) human population at risk, community development and mortality rates, with emphasis on problems in infancy and gender; (3) characteristics of the freshwater collections inhabited by lymnaeid snail vectors and constituting transmission foci; (4) food infection sources, including population surveys with questionnaire and reference to the most risky edible plant species; (5) water infection sources; (6) household characteristics; (7) knowledge of the inhabitants on Fasciola hepatica and the disease; (8) behavioural, traditional, social, and religious aspects; (9) livestock management. This is the widest and deepest study of this kind ever performed. Results highlight prevention and control difficulties where inhabitants follow century-old behaviours, traditions, and beliefs. Intervention priorities are proposed and discussed.

Highlights

Fasciolid trematodes are helminth parasites characterized by their low specificity at the level of the definitive host
A second purpose of this study is to offer an example which may be extrapolated to other human fascioliasis endemic areas about which factors should be considered, by which way to appropriately approach them, and how to perform an analytical description useful for the design of disease control measures
Valuable information on each site was stocked in photograph slides within a large image database. This ethnographic fieldwork methodology allowed for a scientifically more accurate descriptive method by means of a quantifying analysis of the different aspects with frequency percentages. These analyses focused on numerous aspects related to fascioliasis transmission and the sources for the human infection by F. hepatica, which are here distributed in five categories for an ordered description: (i) household location, (ii) household availabilities, (iii) knowledge about the liver fluke and the disease, (iv) behavioural, traditional, social, and religious aspects, and (v) livestock management

Summary

Introduction

Fasciolid trematodes are helminth parasites characterized by their low specificity at the level of the definitive host. The infection of livestock species is of veterinary importance because of the big losses in husbandry they cause [1]. Their capacity to infect and develop in humans underlie a disease which may induce severe pathogenicity, sequelae, community underdevelopment, and even death [2,3] in rural areas of mainly low income countries, and developed countries [4,5], in which long term sequelae have been observed in treated patients [6].

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Results

Conclusion