Integrated Analyses of Human Dimensions and Policy Implications of Cross-Border Migration on Vector-Borne Neglected Tropical Diseases (NTDs) in the Andes-Amazon Region

What are the effects of cross-border migration in the southwestern Amazon on the transmission of two neglected tropical diseases (American Cutaneous Leishmaniasis and Bartonellosis)?

Project Summary

The municipality of Assis Brasil is the main border crossing point between Brazil and Peru. Increased migration in this area of the South-western Amazon has been facilitated through the recent pavement of the Pacific Highway through the region, connecting Brazilian agricultural and commercial shipments to Peruvian coastal ports.

The role of migration and temporary cross-border movements in transmission and occurrence of American Cutaneous Leishmaniasis (ACL) and Bartonellosis is unknown in the region, but thought to be important. Assis Brasil has the highest incidence of ACL of all municipalities in Brazil and Acre’s incidence is 11 times the national average, while the distribution of Bartonellosis is moving from districts in Peru towards Brazilian borders.

As non-immune migrants move into areas of endemicity for NTDs, and infected migrants return to non-endemic areas, population movement can complicate disease control efforts, and many diseases have re-emerged over the past decade. These diseases present trans-national challenges requiring multi-lateral approaches between governments.

A comparative survey involving Acre, Brazil and the districts of Madre de Diós and Cusco in Peru will provide information on social determinants associated with migration, health seeking behaviour, health care access and an observational assessment of environmental risks associated with ACL and Bartonellosis comparing migrants from Peru and Brazil, with the respective resident populations.

This project provides a focused look at the role of migration and drivers of migration and environmental risk in the distribution of disease. It thus replies to the need of an improved surveillance and disease forecasting through a multidisciplinary approach for NTD control elimination strategies. This research has the potential to target and integrate high-risk groups into current WHO elimination and control strategies for NTDs.

Academic Output

Working Paper

Migration and the ecology of American Cutaneous Leishmaniasis in Madre de Dios, Peru, and Acre, Brazil: A mixed methods approach

The Southwestern Amazon is an area of internal and cross-border population movement and transit due to the newly paved Transoceanic Highway, connecting Atlantic ports in Brazil with Pacific Ports in Peru. As the highway crosses through forested and deforested jungles endemic for vector-borne diseases (VBDs), there is increased concern about the (re)emergence and increased distribution of diseases to non-endemic areas. Environmental destruction due to increased agriculture, farming, and illegal gold mining operations has expanded deforested areas in the Southwestern Amazon in Brazil and Peru, a known risk factor for vector-borne diseases (VBDs).

American Cutaneous Leishmaniasis (ACL) is a disfiguring parasitic disease which causes ulcerative cutaneous lesions on the skin leading to secondary infections, while the mucosal form can cause complete destruction of the nasal cavity.

Madre de Dios, Peru and Acre, Brazil are highly endemic areas for ACL, with incidence rates 34 (713/100,000) and 12 times (144/100,000) the national average of ACL, respectively. Non-immunity to ACL is considered to be a risk factor for migrants arriving from non-endemic to endemic areas and length of time (>6 years) has been shown to increase immune response to the disease.

The geographic distribution of disease transmission may increase or decrease when vectors move into new areas with changed climatic conditions, or changing conditions that decrease vector reproduction and survival.

Species of the sub-genus Leishmania (Viannia) (Kinetoplastida: Trypanosomatidae) are the causative parasitic agents of ACL in the Peruvian and Brazilian tropical areas of the Eastern side of the Andean Cordillera. Hence, the questions: What are the effects of cross-border migration in the southwestern Amazon on the transmission of two neglected tropical diseases (American Cutaneous Leishmaniasis and Bartonellosis)? is raised and answered in this research project.

Working Paper

O migrante invisível da fronteira Brasil-Peru (In Portuguese)

Since the establishment of an open border policy between MERCOSUR countries, initiated in 2002 through the signing of the Agreement on Residence for Nationals of MERCOSUR States Parties, Bolivia and Chile, the flow of cross-border migration between the participating countries – Brazil, Argentina, Uruguay and Paraguay, Bolivia and Chile – has been facilitated. Since 2011, Peru has joined the MERCOSUR Agreement, which determines that all the member countries’ citizens who have no criminal record may enter the country of their interest and work regularly, having a temporary permit of 2 years. At the end of this period, if the foreigner can prove fixed residence and lawful work, he can request a permanent stay in the country of destination. We conducted an in-depth study to investigate the dynamics of migration between Acre / Brazil and Madre de Dios / Peru, with field work of qualitative approach. About 100 interviews were conducted, half of them with key informants from local governments, the immigration, health, church, employer and general community sectors, and others with migrants from Brazil and Peru, for an understanding of migration between countries. In this article is discussed the preliminary results of a qualitative study that explores the emigration of Brazilians to the Peruvian Department of Madre de Dios, and the immigration of Peruvians to the State of Acre in Brazil. Migrants and key informants provided rich ethnographic data through in-depth interviews conducted in Brazil and Peru. The patterns and determinants of migration were examined, as well as the influence of public policies on migration, support networks, labour situation and barriers to the residence of migrants in both countries. The preliminary analysis of patterns and determinants of migration between the two countries suggests two distinct groups: those who have benefited from MERCOSUR policy and those who remain outside the legislation. Migration, in general, is labour, but more than money, issues are at stake as characteristics of labour legislation in both countries. Social networks, both family and labour, also facilitate the movement between Brazil and Peru.

Working Paper

Migração peruana no Acre, Amazônia: determinantes, vulnerabilidades e oportunidades para promoção de saúde (In Portuguese)

The study presents the determinants of migration of Peruvians to Acre (Brazil),through the perception of migrants considering their integration to place of destination and nature of migration. Improved accessibility represented by the Interoceanic Highway, the implementation of the Mercosur Residency Agreement, and the expansion of Latin American integration are also discussed. The field research, in Assis Brazil and Rio Branco, consisted of semi structured interviews with 18 migrants, which were recorded and transcribed for content analysis. The respondents demonstrate partial lack of knowledge about their prerogative benefits from Mercosur Agreement, after the Peru adhesion to it. They count on friends for housing and working issues, but they have fragmented perception of their legal status. They are characterized as a vulnerable group due to language and cultural barriers, with restrictions on active search for inclusion and autonomy actions.

Executive Summary

The recently constructed Transoceanic Highway has facilitated increased cross-border migration between Brazil and Peru in the Southwestern Amazon. The objective of this research was to determine whether migrants are at greater risk for the endemic vector-borne American Cutaneous Leishmaniasis (ACL) than non-migrating populations, and to explore the emergence of Bartonellosis in Acre, Brazil and Madre de Dios, Peru. Residence and employment in forested and deforested areas, such as those often frequented with migration in the region is a known risk factor for vector-borne diseases. Social drivers, experiences and patterns of migration were explored among cross-border and internal migrants. An interdisciplinary approach was utilized that captured the migrants’ experiences and disease risks through qualitative, epidemiological and biological investigations.

Drivers for migration included employment and familial relationships. Consular services in Acre Brazil facilitated residence while Brazilians in Peru remained largely confined to ‘tourist’ status. Migrants were familiar with local term for ACL, but not with transmission risk. ACL was associated with migration and sleeping outdoors in Peru where illegal gold mining and Brazil nut harvesting are primary sources of informal work in forested and deforested areas, known risk factors for ACL. Distance, cost and cultural variations hindered access to health services. This research provided the first multidisciplinary investigation into ACL and Bartonellosis in the Southwest Amazon and provides key insights for prevention and early intervention among vulnerable and migrating populations.

Research Team

Esther Schelling
Coordinator
Swiss Tropical and Public Health Institute

Manuel Cesario
Co-Coordinator
Universidade de Franca

Eduardo Gotuzzo
Co-Coordinator
Universidad Peruana Cayetano Heredia

Christine Murto
Co-Coordinator
Swiss Tropical and Public Health Institute

Monica Andrade-Morraye
Principal Member
Universidade de Franca

Giorgio Bruno
Principal Member
Universidad Peruana Cayetano Heredia

Raquel Cesario
Principal Member
Universidade de Franca

Alejandro Llanos Cuentas
Principal Member
Universidade Peruana Cayetano Heredia

Marco Tulio Antonio Garcia-Zapata
Principal Member
Universidade Federal de Goias

 

Katarzyna Grabska
Principal Member
Swiss Tropical and Public Health Institute

Humberto Guerra
Principal Member
Universidad Peruana Cayetano Heredia

Ciro Maguiña
Principal Member
Universidad Peruana Cayetano Heredia

Dalila Martinez
Principal Member
Universidad Peruana Cayetano Heredia

Daniel Mäusezahl
Principal Member
Swiss Tropical and Public Health Institute

Dennys Samillan Ortiz
Principal Member
Universidade de Franca

Susan Thieme
Principal Member
University of Zurich

Palmira Ventosilla
Principal Member
Universidad Peruana Cayetano Heredia

Status

completed

Disciplines

Themes

Regions

Countries

Switzerland , Peru, Brazil

Host Institution

Coordinator

Year