Article published on April 17, 2020
In 2019, Bahia registered 1,292 cases of cutaneous leishmaniasis, an infectious, non-contagious disease that causes ulcers on the skin and mucous membranes. The numbers divulgated by the Health Secretary of Bahia State (Sesab) can be even more expressive because of underreporting, which occurs when it is not diagnosed the disease by official health agencies. Also according to the survey, Valença is at the top of the notifications: there were at least 121 cases just last year. The situation in that municipality will now be monitored by the ECLIPSE project, a global study that aims to investigate the social impact of leishmaniasis in four countries.
Led by Dr. Helen Price and Professor Lisa Dikomitis, from Keele University, in the United Kingdom, the study will be conducted in Brazil by the doctor Paulo Machado, coordinator of the Immunology Service (SIM) of the Professor Edgard Santos University Hospital (Hupes) of Federal University of Bahia (UFBA), and by Professor Leny Trad, coordinator of the Community, Family and Health Program (FA-SA) of the UFBA’s Collective Health Institute. The project is funded by the UK National Institute for Health Research (NIHR).
“Tegumentary (or cutaneous) leishmaniasis develops when a person is bitten by the Lutzomyia mosquito, which contains Leishmania-type parasites. These microorganisms reach the blood vessels and form lesions on the skin that can grow in size,” explains Dr. Helen Price.
In addition to Brazil, the study will be carried out in the United Kingdom, Ethiopia and Sri Lanka, countries with different realities in terms of understanding and coping with tegumentary leishmaniasis. “In Ethiopia, for example, there is no official report on the disease. In Sri Lanka, the disease is more recent and the local population does not have much knowledge about the subject”, explains Dr. Helen Price.
She notes that the Brazilian population has more knowledge about cutaneous leishmaniasis, but that accessibility to treatment is still a problem to be overcome. “What is happening in one country can help those who work in the other, so that we can exchange experiences and establish collaborations”, she highlights.
The project brings together researchers from different areas such as anthropology, medicine, parasitology, psychology, social sciences and the arts. For four years, the team plans to collect data, create intervention models and empower communities to deal with the effects of the social stigma caused by leishmaniasis.
“Stigma is not just about scars, it involves other aspects. The project proposal is a biopsychosocial approach to health. Therefore, in each country, it is important for the community to get involved and participate in the interventions”, explains Professor Lisa Dikomitis.
Brazilian reference center
In Brazil, in addition to Valença, the project will also operate in Presidente Tancredo Neves and Teolândia, municipalities in Bahia with a significant history of cases. The contact of the researchers will be made with the collaboration of the municipal health secretariats and the Leishmaniasis Reference Center Dr. Jackson Maurício Lopes Costa, located in the Corte de Pedra district, in Presidente Tancredo Neves, where most cases in the region are attended to.
“In the last 30 years, the Immunology Service of Hupes/UFBA has been developing important research projects at the Corte de Pedra health post, an area of high endemicity for cutaneous leishmaniasis”, highlights doctor Paulo Machado.
The Brazilian experience will now serve as the basis for the performance of the new study. “This is a disease linked to environmental factors, affecting a poor population in the rural area and bringing numerous challenges, such as the impossibility of prevention due to the absence of vaccines and other prophylactic means”, he observes.
For the coordinator, the treatment based on injectable medications that cause several toxic effects in patients is another obstacle for those living with the disease. “Unfortunately, cutaneous leishmaniasis is a neglected disease and health policies to deal with this endemic disease are far from meeting the minimum necessary,” he says.
Recognizing the territory
The group first meeting with local researchers took place at the Federal University of Bahia on March 2020. For a week, the team led by Dr. Helen Price and Professor Lisa Dikomitis got to know closely the UFBA units involved in the project.
On the occasion, they presented the main proposals to members of the Collective Health Institute, the Dean of Research and Graduate Studies and the Immunology Service of the Professor Edgard Santos University Hospital (Hupes/UFBA). “We had a particularly productive and strategic week to create the bases for the project at the university”, highlights Leny Trad, Professor at ISC/UFBA and coordinator of ECLIPSE in Brazil.
The team of researchers also visited the municipalities that are the focus of the project: Valença, Presidente Tancredo Neves and Teolândia. “We made an initial approach to the territories that will be the target of ethnography and especially rich contacts with some collaborators and key research informants”, explains the coordinator.
In addition to conversation circles with community members, the researchers also followed the activities of the Dr. Jackson Maurício Lopes Costa Reference Center for Leishmaniasis, in the municipality of Presidente Tancredo Neves, which provides specialized care for the disease for the population of that region. “The residents are very lucky to have that reference center, but we know that in other areas there is not even a supply of medications”, notes Professor Lisa Dikomitis.
For her, direct contact with communities is the main way to understand all the difficulties that the population is going through. “What we want is for all of our researchers to make the patients’ itinerary. What does it mean, for example, to travel 6 hours by bus to seek care? All researchers must take this same journey to discover how painful the treatment is”, she suggests.
Brazil was the first country visited by researchers from Keele University to formalize the cooperation and multicentric research of the project. The ECLIPSE will last for four years and the expectation is to create committees and work groups in this period that can subsidize public policies to face the disease.
At UFBA, the project is supported by the Dean of Research and Graduate Studies, Advisory on International Affairs, Institute of Collective Health and Faculty of Medicine of Bahia (Fameb).
“In addition to the impacts on the academic field, I highlight the potential for the health of the population, since ECLIPSE contemplates interventions aimed at overcoming the biopsychosocial challenges associated with leishmaniasis in local contexts, built together with key social actors”, concludes Trad.
Information about the project can be followed through the website https://www.eclipse-community.com and also through the ECLIPSE profile on Twitter: @ECLIPSE_Keele.