Back to profile

Projects - NVS (Natalie) Vinkeles Melchers-Martinez

Onchocerciasis transmission in West-Africa

Onchocerciasis (‘river blindness’) is a devastating disease that historically occurs throughout large areas of Africa, as well as some countries in Central America and the Middle East. Infection can be transmitted to humans by the bite of an infected blackfly that breeds near fast-flowing rivers. Infection leads to stigmatizing skin disease, and with prolonged infection, the disease can cause blindness. Disease is related with high socio-economic and disease burden. Onchocerciasis is a Neglected Tropical Disease, and is targeted for elimination by 2030 by the World Health Organization. The disease can be controlled and eliminated through the use of large-scale ivermectin drug administration among at-risk populations as well as (focal) vector control. This project analysis historical trends in infection and entomological indicators since the start of control interventions in West-Africa by the Onchocerciasis Control Programme (1974-2002) and assesses more recent evaluation survey results to identify areas where elimination has almost been achieved or where further interventions are required. This project is in close collaboration with the Erasmus Medical Centre Rotterdam, the Ministries of Health in West-Africa, and the World Health Organization (WHO-ESPEN).

  • Natalie Vinkeles Melchers is involved in various project that aim to provide geospatial risk maps for the identification of vector-borne infectious disease, many of them from zoonotic origin, to assist policy-makers and research in the identification of areas at high-risk of transmission or future disease outbreaks.

  • Integrated health systems for the control of cutaneous leishmaniasis in Suriname

    Cutaneous leishmaniasis (CL) is a parasitic, neglected tropical disease (NTD) with a high burden of disease. Infection with CL requires treatment to be cured, but also to control further spread of the disease among the population in endemic areas. In remote areas of Suriname, health-seeking behaviour is not optimal due to many obstacles. In these areas, CL-infected individuals may be prone to using traditional medicines, self-treatment options, or seek health services by traditional healers. In order to improve access to treatment, and management of CL in these local settings, it may be beneficial for CL-infected individuals to receive integrated health-care through traditional and conventional health systems. In this project, we will assess what is required to optimalise integration of conventional and traditional medicine and health-care to improve access to treatment, and management of CL as well as to prevent further disease transmission. This project also assesses the acceptability of this integration by the CL patients, traditional healers, conventional health workers, policy-makers and other stakeholders through, among others, Participatory Action Research.    

  • Surveillance systems for detecting and reporting infectious diseases are present in the Caribbean, but these can be further developed and strengthened. There is currently no overview of which infectious diseases occur in the Caribbean part of the Kingdom (CdvhK), while this knowledge contributes to improved resilience against infectious diseases of pandemic potential. In co-creation and collaboration between partners, we will evaluate which infectious diseases and environmental risks occur in the CdvhK and provide advice on prevention of these risks. We organize a stakeholder meeting, develop an infographic, and a risk disc. We conduct observational research and conduct questionnaires, interviews, and focus groups. We share and disseminate knowledge at individual, community, healthcare, and policy levels. The programme will be carried out by the WUR with advice of the, the local government of Curacao, and the Caribbean Prevention Centre.

  • Chagas disease is a devastating infectious disease caused by the parasite Trypanosoma cruzi transmitted by triatomine bugs (the vectors). The disease can cause infection in humans and animals. It is prevalent throughout rural areas of Central and South America. This project aims to prevent disease, which will reduce poverty and health inequalities, and improve quality of life of humans and animals. The project will also assess the relative contribution of oral transmission in the current status-quo of Chagas disease in an endemic area of Brazil. The project will apply a transdisciplinary One Health approach to look at social systems and human vulnerability to infection, the animal reservoir and health, ecosystems, vector density, and food security issues (contaminated food products) through close collaboration with various partners and stakeholders.

A Whole-of-Society Approach to Health System Resiliency and Pandemic Preparedness in Indonesia

Zoonotic pathogens represent an ongoing threat to human and animal morbidity and mortality, with significant implications for global public health, national economies, international trade and personal livelihoods. Highly pathogenic avian influenza (HPAI), which has been identified as of high pandemic risk, can occur at the human-topoultry interface. While human-to-human transmission has to date been limited, there have been 200 cases in Indonesia, with 168 deaths (with a case fatality rate of 84%) (WHO, 2023c). HPAI can have significant social and economic costs to Indonesian livelihoods. Indonesian poultry industry mainly consists of small-scale poultry farms, which makes them the most exposed to the human and economic costs of HPAI. Addressing HPAI risk in Indonesia cannot happen by focusing on the health care sector alone. We take a Whole-of-Society (WoS) approach to address the risk of an HPAI outbreak in  Indonesia. WoS approaches move beyond public authorities or sectoral approaches alone to include other relevant stakeholders at multiple levels and diverse contexts, including families, communities, and industry (Ortenzi et al.2022). When approaching health and health policy, WoS approaches recognize that health is also affected by policies outside the health sector,
and that intersectoral action addressing the broad range of social-ecological drivers of health is needed. We implement a WoS approach to reducing the risk of poultry-to-human HPAI transmission through a set of five work packages aimed at addressing underexamined leverage points in the current system. These packages address the context of One Health governance, the development of integrated surveillance systems, the implementation of multi-level community interventions, the challenge of AMR in the face of HPAI in Indonesia, and then finally how do we apply our learnings to other settings. Together, our research offers a Whole-of-Society Approach to One Health actions.