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.