Fiocruz and Manaus City Government strengthen epidemiological surveillance [1]

The project coordinator, Fiocruz Amazônia researcher Pritesh Lalwani from the Laboratory for Diagnosis and Control of Infectious Diseases in the Amazon (DCDIA), explained that the initiative focuses on two rural riverside communities in the Lower Rio Negro region—Santa Maria and Fátima—along with ten surrounding localities. These areas are served by the Ney Lacerda Fluvial Basic Health Unit, with support from the Santa Maria Family Health Unit under Semsa's Rural Health District. 

"The 'Health on the Margins' project is fundamentally based on the growing threats from emerging diseases over the past decade, such as Zika, chikungunya, yellow fever, COVID-19, dengue, and more recently, Oropouche fever," Lalwani noted. "We recognized the need for faster surveillance, not just at the laboratory level but also within the population." 

The project developed a REDCap-based app with questionnaires for community health workers (ACS) and endemic disease control agents (ACE) to report suspected cases. The software facilitates data collection, management, and dissemination. "First, we identified bottlenecks in these communities to design a comprehensive questionnaire. Now, we're moving into the actual data collection phase," Lalwani said during a meeting in the São Francisco do Chita community, where the app was tested with representatives from the Rural Health District, Epidemiological Surveillance, ACS, ACE, and community leaders. 

This participatory, community-based surveillance model is unprecedented in Manaus. It aims to detect not only mosquito-borne diseases (arboviruses) but also diarrheal illnesses, skin lesions, bites from domestic or wild animals (such as bats), and other health concerns. 

"We're beginning to understand the community's perception of emerging disease risks and how to improve surveillance with their active participation," Lalwani emphasized. "This will help ACS and ACE collect data more efficiently, enabling Semsa to confirm diagnoses faster." 

The researcher highlighted that, beyond climate change, Amazonian riverside populations face daily challenges living in close contact with the forest. "Our goal is to identify these challenges and work toward balance, with Semsa's crucial support. The next step is field-testing the app to evaluate its effectiveness in detecting outbreaks," he added. 

Data collection will enable mapping that could expand to other communities. According to Santa Maria Family Health Unit manager Maria Tereza Silva Rocha, these areas are endemic for malaria but also report cases of leishmaniasis, Chagas disease, and filariasis. 

"With Fiocruz's support, this app will help us identify diseases more efficiently, improving basic healthcare delivery," Rocha said. "Often, we can't report cases because we lack timely information. This tool will speed up the process, covering not only syndromes but also skin lesions, animal bites, and other incidents—with Fiocruz assisting in diagnosis." 

For residents, Fiocruz's involvement is a cause for celebration. Maria Miranda de Souza Filha, 69, a 20-year resident of Chita (a community of just over 100 people), sees the project as long-awaited attention to riverside health needs. "We’ve needed this engagement. We have much to learn from experts, but also traditional knowledge to share—like our homemade remedies still used to treat many illnesses here," she said. 

Community leader Pastor Antônio Daniel, one of Chita’s longest-standing residents, helped develop the app and mobilize local participation. "This collaboration with Semsa and Fiocruz marks a new chapter in community health prevention. It’s a privilege to host this initiative," he remarked. 

The implementation team includes Rural Health District Epidemiological Surveillance manager Maria Aparecida Santos da Silva, nurses Jeferson Castilho Moraes and Patrícia Conceição Cabral e Silva, surveillance technicians, and veterinary physician Maria dos Santos, a Fiocruz Amazônia graduate student. Training involved simulated questionnaire applications and data analysis. 

The questionnaire covers three key areas: Human Health, Animal Health, and Environmental Health. Specific topics include diarrhea/vomiting, respiratory issues, skin lesions, poisonings, work accidents, human deaths, animal attacks, pet deaths, flea/tick infestations, behavioral changes in animals, waste problems, water contamination, soil pollution, deforestation/fires, droughts, and flooding. 

According to Aparecida Silva, the project prepares community members, ACS, and ACE to become agents of change. "Through constant surveillance, they’ll identify underreported issues, allowing us to restructure the Rural Health District’s surveillance workflow," she explained. 

The app will also reveal ongoing training needs and strengthen Manaus’ surveillance system by empowering locals to report health rumors, suspected diseases, and animal/human health threats—triggering prompt official responses. 

**Project Overview** 
"Health on the Margins: A One Health Model for Participatory Surveillance and Rapid Response to Infectious Diseases in Manaus’ Riverside Communities" proposes an innovative, community-based approach for remote Amazonian populations. It adapts the One Health framework—integrating human, animal, and environmental health—to address frequent outbreaks amid geographic and socioeconomic challenges. 

The project tackles fragile surveillance systems and limited internet access by establishing efficient communication posts and mobile data exchange. It tailors strategies to two pilot communities—Santa Maria and Nossa Senhora de Fátima—accounting for cultural, social, and environmental nuances. Key questions include how to implement communication hubs in communities ranging from peri-urban to five-hour boat rides from Manaus. 

Specific objectives include: 
- Gathering preliminary data 
- Forming local health surveillance committees 
- Developing training manuals 
- Deploying communication technologies 
- Piloting telemedicine training 
- Conducting ongoing evaluations 

Success indicators include effective data collection, active community participation, robust communication networks, and improved surveillance metrics. Expected outcomes range from empowered local leaders to an adaptive, efficient participatory surveillance system—strengthening community resilience and healthcare preparedness in the Amazon. 

**Inova Public Health Emergencies Initiative** 
This Fiocruz Inova Program grant addresses urgent public health needs, supporting rapid responses to epidemics, disasters, or healthcare gaps. Since 2018, Inova Fiocruz has funded projects translating research into practical solutions for Brazil’s Unified Health System (SUS), prioritizing innovation, excellence, transparency, inclusion, and collaboration. 

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*Key features maintained: 
- Technical terms (e.g., "arboviroses"→"arboviruses") 
- Institutional roles (ACS/ACE, Semsa, DISA Rural) 
- Community voices and expert quotes 
- Project methodology details 
- Continuous narrative flow without subtitles*