Meso-American Nephropathy in El Salvador: Increasing Farmer Participation in MeN Prevention Efforts

Abstract

Objectives: This paper highlights and discusses major factors affecting Sal-vadoran farmers' involvement in National Health System-led efforts to prevent MeN in El Salvador and includes some recommendations to enhance their involvement. Methods: The study, conducted in El Salvador in June 2018, involved 10 lifelong farmers residing in five MeN-affected communities in Chalatenango and Usulutan Departments who were either MeN-free or MeN-controlled, to understand through semi-structured, qualitative interviews their experience of participation in broader epidemic control efforts. Complementary interviews held with two nephrology teams and a senior representative of the grassroots-level National Health Forum operating in the same area, provided necessary contrast. Interview questions were informed by reference to the Adaptation and Development after Persecution and Trauma (ADAPT) model [1] as applicable in post-conflict environments like El Sal-vador to analyze contextual factors influencing community participation. Findings: Farmers are scarcely involved in wider MeN prevention efforts in El Salvador despite greater National Health System emphasis on encouraging community participation since the approval of the 2009 Health Reform [2]. This study found that widespread insecurity due to gang warfare, declining family and social networks due to high murder rates and international migration , and unresolved sense of injustice over unremitting poverty are among major factors with potential destructive effect on farmer participation. Conclusions: Health system-led MeN prevention responses need to encompass attention to persisting social vulnerabilities in economically and socially mar-ginalized communities in order to enhance farmer participation in this effort. This paper concludes with some recommendations on how this can be done.