I am sooooooo excited to share this Postcard from Olga Andre Chichava. Her post made me laugh, cry and most importantly think! Olga is a science mom from Mozambique who studied Leprosy in Brazil. Her post encompasses the vision of the JIDC Postcard and I am proud to have her on the Blog. There is no doubt Olga has a bright future ahead of her!
A Challenge!! An Opportunity!!
My name is Olga André Chichava, and I’m a young biologist from Mozambique!
It has always been my dream to study abroad, to know how others do research and then hopefully help to improve the Health Sector back in my home country.
The opportunity arose in February 2009, when I was awarded a Brazilian Government “PEC-PG” scholarship (CNPq) and was accepted at the Public Health Master program at Ceará Federal University (Fortaleza, Brazil) under the supervision of Prof. Jörg Heukelbach.
The decision to go to Fortaleza was not easy, since I had a 3-year-old daughter and my husband was also abroad, enrolled in a PhD program in Japan. After a lot of discussions, we came to the agreement of leaving our daughter with my parents in Mozambique and took all provisions so she could have a “normal life” (expect our warm love and affection) while we both were abroad.
Upon choosing the hard way, and despite the semester starting at the end of that same month, a painful two-month waiting period followed, because the travel expenses, which were to be provided by my government, were still not available. I lost several classes and was informed that the ticket had been purchased, just a day before my departure on March 17, 2009!
In Brazil, I was welcomed by nice people but also with a long bureaucratic process regarding my student registration, which had to be done while attending classes and trying to recover the lost credits. This ended up adding further complications and delays in receiving my scholarship funds. So I had to live for several months without any funds. But Brazilians helped me a lot so that I was able to conclude all mandatory lectures and get the credit points.
I then joined the research team of the MAPATOPI project, an interdisciplinary approach to improve the leprosy control program in Brazil, coordinated by Prof. Heukelbach.
Leprosy is an infecto-contagious disease with a chronic evolution and high infectivity, though low pathogenicity, caused by the intracellular and acid-resistant bacteria Mycobacterium leprae (Fogos AR et al., 2000). The transmission occurs to people who have been in contact with a sick, non-medicated person; its immunogenic power is responsible for the high incapacitating potential of the illness.
Despite numerous efforts and advances to control leprosy in the world, the disease is still a serious public health’s problem in Brazil and several other countries (Galvao et al., 2008; Goulart IMB et al., 2002; ). Until 2007, Mozambique was the nation with the highest prevalence rate in Africa (Griffiths S & Ready N 2001; Honrado ER et al., 2008). According to the World Health Organization (WHO), the annual detection rate of leprosy in the endemic regions has considerably declined since 2002, and the number of new cases as of 2008 was about 249.000, confirming that the disease hasn’t been yet eliminated from the Asian, South American and African continents (El Hassan LA et al., 2002; Heijnders ML 2004).
So, I found it interesting to join this team of professionals and took up the challenge of researching not just about this contagious disease, but to also excel myself in epidemiology investigation, so needed to contain many other diseases back home.
The study was conducted in 78 municipalities in Tocantins State, Central Brazil, a leprosy endemic area. Tocantins is the State with the highest leprosy annual detection rate (about 88.5 new cases per 100.000 population/year) (Kerr-pontes LR et al., 2006). So this was a real exciting challenge! We visited all these 78 districts and included all leprosy patients from these districts in the study. The field work was done in four months, in which we conducted scheduled interviews with patients usually in the local Health Centers, in both periods of the day. However, on several occasions we had to go after the patients because they did not show up, either because they lived far away, were at work, or their health condition was too poor. This situation was common in the rural areas and an extra effort was put in place to reduce the non-participation bias (Chalise SC 2005). The daily number of interviews ranged from 12 to 25, and we included a total of about 1,000 individuals with leprosy in the study.
My task was to identify risk factors for defaulting multidrug therapy that usually lasts 6-12 months. I have perceived that adherence to therapy is a result of a complex interaction between different socio-cultural, service-related, drug-related and economical factors (Aagard-Hansen et al., 2010; Altice FL & Friedland G 1998; Coebergh JA & Buddingh H 2004; Fogos AR et al., 2000; Ignotti E et al., 2001; Kar S et al., 2010; Nsagha DS et al., 2009; Natal S et al., 1999; Trindade LC et al., 2009). Intermittent problems of drug supply need to be resolved and many people complained of problems swallowing the drugs; thus producers should consider oral drug formulations that may be more easily accepted by patients (Chichava OA et al., 2011; Rao PS 2008). I have seen how complex public health interventions can be, and that an integrated approach is needed to further improve adherence and other aspects of leprosy control, such as early diagnosis. Improved adherence to treatment will further improve the leprosy control programs and in addition minimize the risk of possibly upcoming drug resistance. I am happy that I could contribute to the control of such an interesting disease and I learned a lot about epidemiological studies, not only in theory, but also in practice. I defended my Master’s thesis in less than two years, and the results of my study were published in two scientific journals: “Reasons for interrupting Multidrug Therapy against Leprosy: The patient’s point of view; Lepr Rev (2011) 82, 78-79” (Chichava OA et al., 2011) and “Interruption and Defaulting of Multidrug Therapy against Leprosy: Population-Based Study in Brazil’s Savannah Region; PLoS Negl Trop Dis (2011) 5(5): 1031” (Heukelbach J et al., 2011).
I am currently living with my lovely daughter and husband in Japan for the remainder of his PhD course, while we repair our broken family links and boost ourselves for the service of our country, starting probably mid next year!
Thank you very much for allowing me to share my little story with all of you in this blog.
Olga André Chichava
Olga Andre Chichava was born in Maputo, Mozambique, and is 35 years old. She attended primary school at “Escola Primaria 7 de Setembro”, junior high-school at “Escola Secundaria Josina Machel”, high-school at “Escola Secundaria Francisco Manyanga” and college at “Universidade Eduardo Mondlane”, all in Mozambique’s capital city Maputo. After college she worked at the private clinical laboratory “LAC-Laboratorio de Analises Clinicas”, before studying in Brazil.
AAGARD-HANSEN, J. H.; NOMBELA, N. & ALVAR, J. Population movement: a key factor in the epidemiology of neglected tropical diseases. Tropical Medicine and International Health, 15(11): 1281-1288, 2010.
ALTICE, F. L. & FRIEDLAND, G. H. The era of adherence to HIV therapy. Annals of Internal Medicine, 129(6): 503-505, 1998.
CHALISE, S. C. Leprosy disease in Nepal: Knowledge and non-compliance of patients. Journal of Nepal Medical Association 44(158): 39-43, 2005.
CHICHAVA, O. A.; ARIZA, L.; OLIVEIRA, A. R.; FERREIRA, A. C.; MARQUES DA SILVA, L. F.; BARBOSA, J. C.; RAMOS JR., A. N.; HEUKELBACH, J. Reasons for interrupting multidrug therapy against leprosy: the patients’ point of view. Leprosy Review, 82, 78-79, 2011.
COEBERGH, J. A. & BUDDINGH, H. Non-adherence to leprosy treatment in Western Sudan; the people behind the numbers. Leprosy Review, 75(4): 404, 2004.
EL HASSAN, L. A.; KHALIL, E. A. & EL-HASSAN, A. M. Socio-cultural aspects of leprosy among the Masalit and Hawsa tribes in the Sudan. Leprosy Review, 73(1): 20-28, 2002.
FOGOS, A. R.; OLIVEIRA, E. R. A. & GARCIA, M. L. T. Análise dos motivos para abandono do tratamento – o caso dos pacientes hansenianos da Unidade de Saúde em Carapina/ES. Hansenologia Internationalis, 25(2): 147-156, 2000.
GALVÃO, P. R. S.; FERREIRA, A. T.; MACIEL, M. D. G. G.; ALMEIDA, R. P.; HINDERS, D.; SCHREUDER, P. A.; KERR-PONTES, L. R. An evaluation of the SINAN health information system as used by the Hansen’s disease control programme, Pernambuco State, Brazil. Leprosy Review, 79(2): 171-182, 2008.
GOULART, I. M. B.; ARBEX, M. H. C.; RODRIGUES, M. S.;GADIA, R., Efeitos adversos da poliquimioterapia em pacientes com hanseníase: um levantamento de cinco anos em um centro de saúde da Universidade Federal de Uberlândia. Revista da Sociedade Brasileira de Medicina Tropical, 35(5):453-460, 2002.
GRIFFITHS, S. & READY, N. Defaulting patterns in a provincial leprosy control programme in Northern Mozambique. Leprosy Review, 72(2): 199-205, 2001.
HONRADO, E. R.; TALLO, V.; BALIS, C. A.; CHAN, G. P.; CHO, S. N. Noncompliance with the World Health Organization multidrug therapy among leprosy patients in Cebu, Philipines: Its causes and implications on the leprosy control program. Dermatologic Clinics, 26(74): 221-229, 2008.
HEIJNDERS, M. L. An exploration of the views of people with in Nepal concerning the quality of leprosy services and their impact on adherence behavior. Leprosy Review, 75(4): 338-347 2004.
HEUKELBACH, J.; CHICHAVA, O. A.; OLIVEIRA, A. R.; HAFNER, K.; WALTER, F.; MORAIS DE ALENCAR, C. H.; RAMOS JR., A. N.; FERREIRA, A. C.; ARIZA, L. Interrupting and defaulting of multidrug therapy against leprosy: Population-Based study in Brazil’s Savannah Region. Neglected Tropical Diseases, 5(5), e 1031, 2011.
IGNOTTI, E.; ANDRADE, V. L. G.; SABROSA, P. C.; ARAÚJO, A. J. G. Estudo da adesão ao tratamento da hanseníase no município de Duque de Caxias – Rio de Janiero. Abandonos ou abandonados? Hansenologia Internationalis, 26(1): 23-30, 2001.
KAR, S.; PAL, R. & BHARATI, D. R. Understanding non-compiance with WHO-multidrug therapy among leprosy patients in Assam, India. Jornal of Neurosciences in Rural Practice, 1(1): 9-13, 2010.
KERR-PONTES, L. R.; BARRETO, M. L.; EVANGELISTA, C. M.; RODRIGUES, L.C.; HEUKELBACH, J.; FELDMEIER, H. Socioeconomic, environmental, and behavioural risk factors for leprosy in Northeast Brazil: results of a case-control study. International Journal of Epidemiology, 35(4): 994-1000, 2006.
KUMAR, R. B. C.; SINGHASIVANON, P.; MEHAISAVARIYA, P.; KAEWKUNGWAL, J.; SHERCHAND, J. B.; PEERAPAKORN, S.; MAHOTARN, K. Gender differences in epidemiological factors associated with treatment completion status of leprosy patients in the most hyperendemic district of Nepal. Southeast Asian Journal of Tropical Medicine and Public Health, 35(2): 334-339, 2004.
LOCKWOOD, D. & SUNEETHA, S. Leprosy: too complex a disease for a simple elimination paradigm. Bulletin of the World Health Organization, 83(3): 230-235, 2005.
NSAGHA, D. S.; BAMGBOYE, E. A. & OYEDIRAN, A. B. O. O. Operational barrier to the implementation of multidrug therapy and leprosy elimination in cameroon. Indian Journal Dermatol Venereol Leprol, 75 (5): 469-475, 2009.
NATAL, S.; VALENTE, J.; GERHARDIT, G.; PENNA, M.L. Modelo de predição para o abandono do tratamento da tuberculose pulmonar. Boletim de Pneumologia Sanitária, 7(1): 65-78, 1999.
RAO, P. S. A study on non adherence to MDT among leprosy patients. Indian journal leprosy, 80: 149-154, 2008.
TRINDADE, L. C.; ZAMORA, A. R. N.; MENDES, M. S.; CAMPOS, G. P.; AQUINO, J. A. P.; CANTÍDIO, M. M.; HEUKELBACH, J. Fatores associados ao abandono do tratamento da hanseníase em João Pessoa, Estado de Paraíba. Cadernos Saúde Coletiva, 17(1): 51-65, 2009.