Research Chris Delgado Ratto

Abstract

Malaria is one of the most important infectious disease in Peru but now there is a National Malaria Elimination plan launched by the government. This plan requires from research-based evidence to adapt the strategies 'on the road' to malaria elimination scenario. Therefore, we aim to continue and deepen our efforts to provide relevant evidence for malaria elimination in Peru by promoting and empowering the partnership of Amazonian public universities and local, regional and national public health institutions. We seek to potentiate the multidisciplinary health-related research and outreach skills in these institutions, for them to later contribute to the good health and well-being of the most affected populations (indigenous and children) by malaria in Peru. We will assess multiple multidisciplinary approaches that could be implemented in the malaria elimination plan and provide educational information about malaria to the civil society and the affected population.

Researcher(s)

• Promoter: Delgado Ratto Chris
• Co-promoter: Van geertruyden Jean-Pierre

Research team(s)

• Global Health Institute (GHI)

Project type(s)

• Research Project

Abstract

Despite adequate coverage of malaria intervention strategies in rural, remote areas, the elimination efforts vanished after some months, and residual malaria persists. Malaria importation might be playing a significant role in the maintenance of local transmission. From a fundamental perspective, this scenario reflects the metapopulation dynamics theory, where the parasite population's subdivisions are geographically dispersed but with limited interaction between the components. Events of extinction and recolonization give the maintenance of the metapopulation. For instance, after an adequate intervention, the parasite population might be diminished, but people returning to their villages carrying imported parasites may revert the effect. The present study aims to study the contribution of Plasmodium vivax metapopulation in the burden of residual malaria in villages sharing watersheds in the Amazon. We will unravel human mobility's role in the recolonization event by integrating epidemiological and travel data with the parasite population genetics. Our project is the first study to address P. vivax metapopulations as a significant challenge for elimination and seeks to develop a genomics platform that distinguishes among highly related parasites. The expected findings could provide crucial insights about a better design of intervention strategies.

Researcher(s)

• Promoter: Van geertruyden Jean-Pierre
• Co-promoter: Delgado Ratto Chris

Research team(s)

• Global Health Institute (GHI)

Project type(s)

• Research Project

Abstract

Malaria caused around 229 million infections and 409,000 deaths in 2019. Worldwide efforts to control and eliminate malaria have reduced its morbidity and mortality; however, the progress has stalled in the last four years, remaining a major problem on public health in endemic countries. Since last year, the world has been facing the emergence and spread of COVID-19, which rapidly spread and caused massive global disruption on public health systems, impacting peoples' lives and wellbeing. Therefore, considering that context, malaria epidemics, or resurgence in free-malaria settings can occur, and no reliable data from malaria-endemic areas is available, such as the Peruvian Amazon. In 2020, most malaria cases in Peru were concentrated in Amazonian regions: Loreto (91%) and Amazonas (8%). Cases were distributed across rural communities, featuring frequent asymptomatic and submicroscopic infections. Due to the pandemic, health posts and hospitals and surveillance activities were disrupted, contributing to missed case detections and under-reporting malaria cases in both regions. For instance, until mid-July 2020, no malaria cases were reported by the health authorities of Loreto and Amazonas, highly contrasting with previous years' reports from these regions. Reliable local data is urgently needed from endemic malaria areas to assess the impact of the COVID-19 pandemic and avoid malaria control gains over the past years. Therefore, we propose to measure the impact of the COVID-19 pandemic on the malaria burden and care in remote indigenous malaria-endemic communities of the Peruvian Amazon using mixed research methods, considering the following objectives: 1. To determine the prevalence of malaria (symptomatic and asymptomatic cases) through microscopy and molecular analysis of blood samples. 2. To determine the risk factors associated with malaria in the context of the COVID-19 pandemic through household surveys. 3. To explore indigenous communities' population's insights/perceptions about the pandemic impact on malaria care through semi-structured interviews. The information generated will assist local health authorities to plan opportunistic malaria contingency strategies, improve the intervention programs in indigenous communities during pandemic events, and provide better access to healthcare facilities for indigenous populations. The MALCOVA study will be performed in the Condorcanqui Province, located in the northern jungle of the Amazonas Region of Peru. Condorcanqui is divided into three districts: Nieva, El Cenepa, and Rio Santiago, and it has an extension of 17,892 km2, with an estimated population of 42,470 inhabitants (native and mestizos). Considering the Health Rectorate of Amazonas' communities' census, a simple random sampling method will be performed through door-to-door visits to enrol eligible participants. The participants will be considered in the study only if informed consent/assent is signed. This study will be performed in collaboration with two local Peruvian institutions, Universidad Nacional de Toribio Rodriguez de Mendoza de Amazonas (UNTRM) and the Regional Directorate of Health of Amazonas (DIRESA Amazonas). The local ethical committee at UNTRM has recently approved the study protocol. The study will be funded by the Global Minds Small project grant (2021-2022) awarded to Dr C. Delgado (UAntwerp) and local Peruvian funds.

Researcher(s)

• Promoter: Delgado Ratto Chris

Research team(s)

• Global Health Institute (GHI)

Project type(s)

• Research Project

Abstract

The Peruvian population is adversly affected by infectious diseases and current govermental efforts are not sufficient to reduce the burden. While bioinformatics and genomics are relatively new approaches in molecular epidemiology, they have already made important contributions to the health of patients and populations. Bioinformatics and genome sequencing capacity in Peru is still extremely limited. Public universities like UNSA in Arequipa and UNAP in Loreto could play a major role in regional and national level infectious disease control by providing further insights in the molecular epidemiology of the infectious diseases in Peru. We propose to develop sustainable capacity in bioinformatics and sequencing through the development of a academic network between 3 universities in Peru and 2 institutions in Belgium. We selected topics of local public health importance: malaria, tuberculosis and antibiotic resistance. For these diseases, next generation sequencing can significantly improve diagnostics, surveillance and control, thus contributing to better health of the population of Peru.

Researcher(s)

• Promoter: Van Rie Annelies
• Co-promoter: Delgado Ratto Chris

Research team(s)

• Global Health Institute (GHI)

Project type(s)

• Research Project