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Surveillance and response to zoonotic diseases in Maya communities of Guatemala: A case for One Health

One health Guatemala project picture
 

Zoonotic diseases continue to threaten the economies of countries worldwide due to their outbreak potential. This project aims to promote a One Health approach to develop a surveillance and response proof-of-concept in the Peten region of Guatemala that can test novel methodological mechanisms for further replication in the country.

About the project

Background

World-wide ongoing research on zoonotic disease shows the perceived importance it has for its impacts on health and the economy, a topic important in the development agenda for the burden it places on many low and medium income countries. There are many neglected tropical pathogens in Central America of which most are zoonoses that may take severe tolls in already empoverished populations. In Guatemala it is estimated that outbreaks from zoonotic origin may account for up to 60% of morbidity in urban populations that have access to official health centers, yet little is known of the burden in rural areas where the majority of the population is of Maya origin with extremely low human development indexes. Some preliminary studies have identified an important presence of leptospirosis, salmonellosis, tuberculosis, cysticercosis, and leishmaniasis circulating in human and animal populations, as well as emerging pathogens like Borrelia, Bartonella and Rickettsia. Other pathogens like Hanta virus, Pox virus and Yersinia have been identified in adjacent countries, yet no data exists for Guatemala.

Objectives

The overall project aims to promote a transdisciplinary One Health approach for developing a novel and culturally appropriate surveillance and response program for zoonotic diseases in Guatemala. The strategic objectives of the project are: 

  • Record Maya health perceptions and practices of priority infectious diseases at the human-animal interface in selected communities of the Peten region, providing emic explanatory models for key zoonotic diseases.
  • Design and implement an active, participatory, community-based syndromic surveillance system for rapid detection and response of key diseases, involving traditional Maya healers, community leaders, public health and veterinary authorities, and scientists; the design, validation, and implementation of a culturally-appropriate mobile technology application allows for timely collection of samples in affected humans and animals.
  • Estimate the burden of selected infectious and emerging zoonotic disease for the region under study through the analysis of biomedical tests from human and animal samples (domestic and wild animals as well as rodents), to determine aetiology of previously recorded syndromes.
  • Implement a transdisciplinary process integrating representatives from Science (Swiss TPH, Universidad del Valle de Guatemala, CDC, Institute of Tropical Medicine, Houston), Government (Ministry of Health, Ministry of Agriculture and Livestock), local Communities (Maya Council of Elders, elected Mayors and other community leaders), and Industry (Tigo Telecommunications Company), to install national capacity on the One-Health approach and to identify appropriate responses on policy and practice levels through joint-analysis workshops that allow for the correlation of anthropological, biomedical, and epidemiological data to propose culturally-appropriate interventions.

Relevance

This project attempts to fill the gap of unknown zoonotic diseases affecting rural populations in areas with low access to official health care services, and to understand the local emic Maya explanatory models for these diseases to support correlation to biomedical models. In recent years the collaboration of human and animal health, coined One Health, has gained momentum. In Central America, however, the One Health approach is mostly unknown and official health sectors continue to work in a disconnected fashion. This project is the first one in Guatemala to employ this approach by fostering a collaboration between the Ministries of Human Health and of Animal Production/Health, and is expected to show the benefits for improving human and animal health, enhancing coverage, and reducing costs. This project also attempts to create a validated methodology for community-based syndromic surveillance in Maya-speaking rural populations, with a culturally-appropriate mobile technology interface application. This will allow us to collect samples and identify health threats in real time. In order to translate research results into appropriate policies and programs, the project is organized as a Transdisciplinary process, involving multiple stakeholders from Science, Government, Communities, and the Private Sector. This collaborative process started from joint problem definition, continuing all the way through co-production of new knowledge aimed at finding solutions to Public Health threats in the region.

Highlights and most important results

The project is approaching its first year, with its most important results being:

  • A Transdisciplinary (TD) platform has been successfully organized. A Steering board representing the Ministry of Health (MSPAS), Ministry of Agriculture (MAGA), Swiss TPH, Universidad del Valle de Guatemala, AGERS Council of Maya Elders, three Community Councils (COCODES), TIGO telecommunications company, and the Swiss Embassy, has been organized and is successfully coordinating project activities. The first TD workshop was held in September 2016 in Poptun, Guatemala, discussing the work plan and timeline, workload distribution, area of focused research, methodological approach, etc., to effectively begin activities.
  • Medical Anthropology research initiated, The first ethnographic fieldwork season was completed, which covered research on Maya knowledge systems around the animal-human relationship, traditional medicine at the human-animal interface, conception of diseases originating in animals potentially transmitted to humans and vice versa (explanatory models related to zoonoses), cultural and health practices of the local population at one of the focus sites, health seeking behavior, among others. The research also included interviews to traditional healers, biomedical specialists, personnel from the Ministry of Health in the first level and second level of patient attention, in order to deduct explanatory models (or the lack of) of zoonotic diseases.
  • Transversal epidemiological study initiated. Having obtained the approval of the Swiss and Guatemalan ethics committees, the design and validation of a transversal epidemiological study has been concluded. Currently, a staff of medical doctors, nurses, veterinary doctors, veterinary technicians, epidemiologists and anthropologists, is conducting research on a representative sample of communities from the Poptun region. The study includes conducting interviews at the household level, collecting blood samples from two adults in the family, collecting samples from one animal of each species present in the household, setting rodent tramps inside the households, and later processing the captured rodents for biological samples. The laboratory tests focus on the presence of Leptospira and Brucella immune traces, and it includes the identification of serovars to establish probable origin of contagion.
  • Design of community-based syndromic surveillance platform initiated. In preparation for the second transdisciplinary workshop, the first phases of the design for the syndromic surveillance phase of the project are taking place. These include technical approaches with TIGO Telecommunications Foundation to design a mobile technology platform, demographic and socioeconomic data gathering of three pilot communities, validation protocols for identification of acute respiratory illness (ARI) and acute febrile illness (AFI), initial designs of education/communication campaign for enrolled households.

Geographic scope

  • Guatemala, Central America

Research consortium

Grantees

  • Prof. Dr. Jakob Zinsstag, Swiss TPH, Switzerland
  • Prof. Dr. Brigit Obrist, Basel University, Switzerland
  • Prof. Celia Cordón, Universidad del Valle de Guatemala, Guatemala

Coordinator

  • Prof. Dr. Jakob Zinsstag, Deputy Head, Department of Epidemiology and Public health, Head of the Human and Animal Health Unit, Swiss TPH

Partnerships

  • Ministry of Health Guatemala (MSPAS), central and regional Peten area (Dr. Salvador Mendez)
  • Ministry of Animal Production and Health Guatemala (MAGA), central and regional Peten area
  • Maya Qéqchi’Council of Elders “Releb’aal Saq’e” (Pablo Ax, head of council)
  • TIGO Telecommunications Foundation (Melissa Martinez)
  • COCODE (Community development councils) of Sabaneta, Romana and San Marcos Poptun

Project link to P3

  • Link to project on SNSF research database P3.

 

 

 

Further information on this content

 Contact

Prof. Dr. Jakob Zinsstag Swiss Tropical and Public Health Institute Socinstrasse 57 CH-4056 Basel jakob.zinsstag@unibas.ch