1. Diminution of the intradomestic reinfestation by Triatoma dimidiata in Guatemala through an integrated control based on an ecosystem approach María Carlota Monroy Escobar Dulce María Bustamante Zamora Laboratory of Applied Entomology and Parasitology, Department of Biology, San Carlos University, Guatemala & Cols.

2. Chagas Disease or American Trypanosomiasis Trypanosoma cruzi Invertebrate Host (Hemiptera: Reduviidae: Triatominae) Vertebrate Host (Mammals)

3. Phases of Chagas Disease

4. Chagas in Guatemala

5. Chagas vectors in Guatemala Rhodnius prolixus* Triatoma dimidiata Other triatomines: Triatoma nitida, Triatoma ryckmani.

6. Triatoma dimidiata 3.5 cm 2.4 cm

7. Triatoma dimidiata It is a versatile species, with high capacity of adaptation (sylvatic, domestic, peridomestic). Various subpopulations geographically (genetically?) isolated. It is present in different scenarios: –sylvatic, –domestic-peridomestic, –domestic-peridomestic-sylvatic.

8. T. dimidiata intradomestic density is higher in red areas (low forest coverage, mud wall houses). Is there a higher risk in highly deforested areas (south-west)? 1:250,000

9. T. dimidiata Control Native species non eradicable: reinfestation (from sylvatic foci?). Is then necessary to learn how to coexist with this bug, preventing the contact with it (inside the house). Long term control must be based on physical and ecological methods. Active participation of the community is a priority. (Zeledón 2002)

10. Chagas Control in C.A. Central America Initiative (1998) Vectorial transmission (95%): –Massive attack with insecticides (pirethroid) –Epidemiological and entomological surveillance* –Home improvement and community surveillance* Transfusional transmission: –Blood screening in blood banks (mandatory by law)

11. Challenges for Control in C.A. House reinfestation: T. dimidiata –Residual or real immigrants? –From peridomestic or sylvatic environments? Communitary participation –Home improvement –Surveillance Epidemiological/Entomological permanent surveillance The loss of T. dimidiata natural ecotopes

12. An Ecosystem Approach for Chagas Disease Control in Guatemala

13. Why an ecosystem approach? Triatominae long term control demands: –appropriate management of the domestic and peridomestic environments to avoid colonization; and of the sylvatic environments to avoid lost of natural ecotopes  better management of the ecosystem. Transdisciplinarity to confront the variety of constraints of the problem. The research must be oriented with the vision of developing a policy (involvement of the Ministry of Health).

14. The Proposal

15. General Objective Test in a pilot project, an improved T. dimidiata control strategy, integrating a) chemical control; b) community participation in house improvement (domicile and peridomicile), entomological surveillance, and environmental management; to reduce the risks of Chagas disease transmission, for the better management of the ecosystem and to improve human health.

16. Specific Objectives To gather key information from the ecosystem, necessary to comprehend the factors who difficult the elimination of T. dimidiata from the domicile and peridomicile. To integrate a work team (researchers, Public Health workers and community), to propose, analyze, discuss and conclude, which is the best strategy for integrated control against T. dimidiata, according to everyone's expectative and real possibilities.

17. Specific Objectives To execute an integrated control intervention, considering managements in the domestic, peridomestic and sylvatic environments. To evaluate and disseminate the results of the integrated control.

18. Study Site Jutiapa (eastern Guatemala) –T. dimidiata situation: 50% dispersion, 35% infestation, >20% population in risk –Reinfestation: could be three months after sprayings; the infestation increases with time and can reach its original levels ->15% population positive to T. cruzi infection -Agriculture and cattle, Spanish speakers, houses built of mud walls (adobe), communitarian forests and beekeeping -4 villages (150 houses each, 3000 people)

19. 2 villages with integrated control (ecosystem approach) 2 villages with chemical control (traditional approach) Experimental Design 36 months

20. Traditional Approach Entomological surveillance Insecticide application in the positive houses Information to the community (school teachers) Entomological monitoring for reinfestation –selected houses- Second insecticide application

21. Ecosystem Approach Transdisciplinary Research Team –Biological Component (Ecology, Entomology) –Social Component –Engineering Component –Ministry of Public Health (ETV) IV Phases of Intervention –Characterization –Analysis, Consensus and Design –Execution of Interventions –Evaluation and Dissemination

22. Domestic and peridomestic environments (suitable places for T. dimidiata – infestation, colonization) Humans Chemical control Disease discomfort shame T.d. Reinfestation

23. Domestic and peridomestic environments (suitable places for T. dimidiata – infestation, colonization) Humans (socioeconomic situation, social organization, behavior, constructive systems.) Natural environment Agriculture, deforestation Chemical control Disease discomfort shame T.d. Loss of T. dimidiata natural ecotopes Reinfestation Environmental Management Reforestation Home Improvement

24. Phase I: Characterization Presentation of the project to the community –Establishment of the project possibilities Social diagnostics –Understand the populations perspective on the problem: people’s knowledge, attitudes, culture, expectations –Identify leaders and channels for communication

25. Ecological and Biological diagnostics –Entomological evaluation (dom-peridom) –Vectors’ sylvatic ecotopes; mobility –Vegetation and land use; diagnostic of the communitarian forests Engineering diagnostics –Constructive systems Insecticide application

26. Phase II: Analysis, Consensus and Design Analysis of the diagnostics Design of the strategy for: –Management in the domestic, peridomestic, sylvatic environments –Communitarian system for reinfestation monitoring Presentation of the proposed actions to the community. Consensus. –Who? When? How?

27. Phase III: Execution of interventions Motivational activities for an improved ecosystem management –Workshops of techniques for house improvement, meliponiculture, forestry seedbeds, medicinal plants (others). Execution of house improvements (domestic and peridomestic) by the community Establishment of the communitarian system for reinfestation monitoring

28. Promotion of an ecological restoration: sylvatic environment management (seedbeds and reforestation, meliferous plants gardens, medicinal plants gardens) Intermediate evaluation: social, entomological, housing

29. Phase IV: Evaluation and Dissemination Entomological monitoring for reinfestation. Evaluation of: –Number of houses improved (domestic, peridomestic) –Number of trees planted, reforested area –Number of hives in good conditions for production –Number of houses with gardens (medicinal or meliferous plants) –Number of bugs reported by the community

30. Analysis of the communitarian organization for the sustainability of the entomological monitoring and reforestation. Comparison of results with the control villages. Presentation of results. Recommendations for the National Control Program of the Ministry of Health.

31. Expected Results with the Ecosystem Approach Reduce and maintain the infestation index of T. dimidiata lower than 5%, the colonization index between 0-5%, and the density index lower than 1. Improve the structural and sanitary conditions of at least, 50% of the houses in the villages. Improve the management of the sylvatic environment surrounding the villages. Inform an recommend the National Control Program, about the advantages of the ecosystem approach for the control of T. dimidiata.