Case Study: Environmental Global Health in Morocco and South America

This case study assignment analyzes two global health challenges: trachoma in Morocco and Chagas disease in the Southern Cone of South America. The assignment examines the health needs, financial and cultural costs, and outcomes of interventions for each disease. For trachoma, the focus is on the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, and Environmental change) and the use of azithromycin. For Chagas disease, the analysis centers on the Southern Cone Chagas Control/Elimination Initiative (INCOSUR) and the elimination of the insect vector through insecticide spraying. The assignment requires a comparative analysis of the interventions, considering their effectiveness, cost-effectiveness, and impact on public health, culminating in a conclusion that provides a summary overview and a supported opinion on which effort was most effective, backed by research and facts.

Unit 4 - Case Study Assignment – Environmental Global Health
Instructions:
Read the case studies for this assignment and complete the provided template. You will need to use the case study, concepts
learned in class, and other credible resources to assist you in completing your analysis and presentation of findings.
Note: Each box must have 5 - 7 content related sentences. Please include any in-text citations in each box, and references at the
bottom.
For the CONCLUSION – You must provide TWO 5-7 sentence paragraphs. The first paragraph will be a summary overview. The
second paragraph will present your SUPPORTED opinion on which effort was (or will be) most effective.
Be sure to support your perspective with facts and research on why you feel it is the most effective effort.
Case # 10: Controlling Trachoma in Morocco Case # 12: Controlling Chagas Disease in the Southern Cone of
South America

Geographic Area Involved
Morocco
Geographic Area Involved
Argentina, Brazil, Chile, Bolivia, Paraguay, Uruguay and Peru
Health Needs
The standard treatment for all individuals with effective
trachoma is a single dose of an antibiotic (azithromycin). This
antibiotic is prescribed also for the individual being treated
contacts. A touch is anyone who stays and/or sleeps in the same
room as a trachoma sufferer. If the indiividual lives or sleeps in
numerous households then all household members are
considered contacts. If a group has a high trachoma incidence
then all Aboriginal community members should be treated with
this antibiotic.
Aboriginal adults over 40 years of age should be tested for
trichiasis regularly in populations where trachoma is normally
Health Needs
The antiparasitary drugs benznidazole and nifurtimox may be
used. Both medications are nearly 100% efficient in infected
newborn children and are extremely effective in treating patients
during the acute phase of the illness. The effectiveness of both
drugs, however, reduces the longer an individual is infected.
Chronic illness patients may also need heart or gastrointestinal
care. Infected individuals, particularly those without symptoms,
should be given aetiologic care. The economic benefits are also
significant, in addition to the social and health benefits of
managing the Chagas disease.

present (endemic).
Financial/Cultural Costs (socioeconomic)
The Moroccan administration, with external assistance from the
United Nations Children's Financing and a public-private
partnership called the International Trachoma Project, has
offered the bulk of the program funding. The pharmaceutical
company Pfizer has donated more than $72 million value of its
antimicrobial Zithromax through such a collaboration.
In the mid-80s, the Edna McConnell Clark Hospital
reinvigorated trachoma through the funding of comprehensive
epidemiological studies and feasible management options. The
research also helped to develop a new, systematic trachoma
treatment and prevention approach. The technique was dubbed
"SAFE," and reflects the four key strategies–Surgery,
antibiotics, facial cleanliness, and environmental change.
Financial/Cultural Costs (socioeconomic)
Eliminating the insect vector in infested homes was a critical
first step, and the technological and operating processes to
achieve this goal are now proven successful and cost-effective.
Medical management of houses with long-lasting pyrethroid
insecticides has removed or greatly reduced the population of
insect vectors in the entire southern cone. Spray teams operated
through the health ministries treat every house in local
governments where the existence of the vector has been verified.
Around 1992 and 2001, they sprayed over 2.5 million houses.
Canisters which emit insecticidal fumes have also been
distributed to households when lit.
Outcome of Intervention Outcome of Intervention

Government officials at the Health Ministry worked swiftly to
decentralize surgery and ensure the eyesight treatment in small
towns and villages was readily available. Villagers and outreach
staff have been trained before surgical teams arrive in the
countryside so that the treatment can be made public and its
benefits clarified. The Ministry has used mobile ophthex systems
staffed by physicians and specialist nurses, equipped for vision-
saving operations, in collaboration with the Hassan II
Foundation of Ophthalmology. In the mid-1990s, 10,000
patients were successfully treated, Azithromycin was first
research area by Morocco. In the five southeast provinces of
1999 the expanded care with the donated medicinal substance
began, and to date about 4.2 million doses (IS figures until
December 2005) have been delivered. There was soon a
successful strategy based on recognition of the fact that
trachoma is a community disease and that re-infection occurs
very probably only when treatment isolated cases. Depending on
A new management program called the Southern Cone Chagas
Control / Elimination Initiative (INCOSUR) in 1991 tackled
these issues and intensified the involvement of countries in the
region with an infectious threat from the southern cone. The
program was a joint arrangement between the governments of
Argentina, Bolivia, Brazil, Chile, Paraguay, Uruguay and later
Peru to fight Chagas by eliminating the primary insect vector.
Led to a global commitment, and a cross-border avoidance of
reinfestation, by the Pan American Health Organizing (PAHO).
The INCOSUR is a regional project, funded and managed by
every government. Regional collaboration, however, was
important to the implementation of the initiative, and was
organized by the PAHO. At an annual meeting of the South
Cone Intergovernmental Commission, funded by the PAHO, the
leaders of the collaborating nations exchange organizational

the prevalence, various approaches have been developed.
Everyone in the household was diagnosed if more than one
quarter of the children older than ten showed signs of advanced
trachoma.
priorities, strategies and milestones each year.
Conclusion
Hence, it can be concluded, the elimination of insect vectors was an important first step in the development of infested homes
and technical and operational procedures have now proved to be successful and cost-effective. In the Southern cone, skilled care
of houses with long-lasting pyrethroid insecticides has removed or reduced significantly the insect vector population. On the other
hand, SAFE has been implemented in Morocco to take care and measure proper intervention for the trachoma disease.

References
cgdev.org. (2020). Controlling Trachoma in Morocco [Ebook] (1st ed.). Retrieved from
https://www.cgdev.org/sites/default/files/archive/doc/millions/MS_case_10.pdf
cgdev.org. (2020). Controlling Chagas Disease in the Southern Cone of South America [Ebook] (1st ed.). Retrieved from
https://www.cgdev.org/sites/default/files/archive/doc/millions/MS_case_12.pdf
sahealth.sa.gov.au. (2020). Trachoma - including symptoms, treatment and prevention :: SA Health. Retrieved 20 January 2020, from
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/
health+conditions+prevention+and+treatment/infectious+diseases/trachoma/trachoma+-+including+symptoms
%2C+treatment+and+prevention