Academic journal article Bulletin of the World Health Organization

Patients' Associations and the Control of Leishmaniasis in Peru

Academic journal article Bulletin of the World Health Organization

Patients' Associations and the Control of Leishmaniasis in Peru

Article excerpt


American mucocutaneous leishmaniasis caused by Leishmania braziliensis is a major health problem in Peru. The annual incidence of all clinical forms of American leishmaniasis increased from 7.6 per 100 000 to 24.7 per 100 000 over the period 1979-89 Ministry of Health, unpublished data, 1992). Leishmaniasis poses a particular problem in the Cuzco Region, where 25% of all new cases reported in 1989 were located; currently, around 50% of all the mucosal cases treated in Peru are reported from this region. During the past decade, following large-scale seasonal migration of the population to the neighbouring forest of Madre de Dios, where small-scale farmers are employed by gold-mining companies during the rainy season, the number of new cases has increased considerably. However, the increasing prevalence in the region has also been the result of the lack of treatment because appropriate drugs were not available. In 1983. people with leishmaniasis in the town of Sicuani decided to form a patients' association to try to obtain anti-leishmanial drugs. Eight similar patients' associations were established between 1983 and 1993. In 1990, these associations joined together with health authorities and other institutions in the region to form a committee to coordinate their activities.

This article describes how these patients' associations were formed and discusses the importance they have had in the control of mucocutaneous leishmaniasis. As far as we know, in tropical diseases, there is no evidence of other community initiatives in which sick individuals have been able to organize spontaneously and succeed in obtaining the drugs needed to treat their disease. In view of the increasing prevalence of mucocutaneous leishmaniasis caused by L. braziliensis (1), its public health importance and the difficulties of control (2), our findings may have relevance for other countries where this form of the disease is endemic.

Materials and methods

Population movement to Madre de Dios

Although there have been gold-mining activities in the Cuzco Region since the beginning of this century, increasing migration to Madre de Dios started in 1975, after the discovery of new gold deposits, and the marked deterioration of the economic situation in Peru. Between 1972 and 1977, the production of gold increased from 122kg per year to 85 kg per month (3). People left their communities in the altiplano highlands, where the socioeconomic situation had been worsening, and travelled to Madre de Dios to seek work in the gold industry. Migration increased as the demand for workers grew, following an upsurge in the international demand for gold. A survey carried out in 1992 (J. Calmet, unpublished data) estimated that roughly 35000 people, mainly young males, migrate to Madre de Dios every year from different regions of Peru. In certain areas, half of the male population aged 15-35 years migrate every year. Most of these migrants come from the mountainous parts of the Cuzco Region.

Madre de Dios, an immense plain of tropical forest, is an endemic zone for leishmaniasis caused by L. brazilcensis (4). The disease is mainly transmitted during the destruction and burning of the forest before mining commences, but also during the extraction activities, when people are exposed to sandfly bites. Cutaneous lesions generally require several months for spontaneous healing, and are not as serious as the mucosal lesions that appear in most cases several months to many years subsequently (5). The increase in the number of patients with mucosal lesions was observed not in Madre de Dios, where the infection is acquired. but in the mountainous areas of Cuzco when the workers returned home. The absence of sandflies in the mountains explains the lack of transmission of the disease in these areas. In the mountains, the prevalence of leishmaniasis increased and the mucosal disease became a serious problem. …

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