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Nogueira de Brito R, Tanner S, Runk JV, Hoyos J. Looking through the lens of social science approaches: A scoping review of leishmaniases and Chagas disease research. Acta Trop 2024; 249:107059. [PMID: 37918504 DOI: 10.1016/j.actatropica.2023.107059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/04/2023]
Abstract
Scholars have called for increased attention to sociocultural, economic, historical, and political processes shaping Neglected Tropical Diseases (NTDs) ecology. We conducted a scoping review to identify major research themes and the knowledge gaps in social science literature in leishmaniases or Chagas disease (CD). Following the scoping review protocol, we first determined the focus of the review to be centered on identifying research that approaches leishmaniases and CD from social science perspective and was indexed by large, biomedically focused databases. We then searched PubMed and Web of Science using "Leishmaniasis" and "Chagas disease" with "social science" or "anthropology" as search terms. We analyzed 199 articles (123 on leishmaniases and 76 on CD), categorizing them into three main research themes. Sociocultural dimensions of the diseases (leishmaniases=60.2 %; CD=68.4 %) primarily focused on individuals' knowledge, practices, and behaviors, barriers to accessing healthcare (especially in endemic regions), psychosocial effects, stigma, and traditional treatments. Research focused on socioeconomic dimensions of the diseases (leishmaniases=29.3 %; CD=19.7 %) included topics like household characteristics, social capital, and infrastructure access. A final theme, the historical and political contexts of the diseases (Leishmaniases=10.5 %; CD=11.9 %) was less common than other themes. Here, studies consider civil war and the (re)emergence of leishmaniasis, as well as the significance of CD discovery for scientific and public health in Brazil, which is the most common country for research on both leishmaniases and CD that draws on social science approaches. Future directions for research include focusing on how social institutions and economic factors shape diseases education, control measures, healthcare access, and quality of life of people affected by NTDs. Greater attention to social sciences can help mitigate and undo the ways that structural biases have infiltrated biomedicine.
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Affiliation(s)
- Raíssa Nogueira de Brito
- Department of Anthropology, University of Georgia, Athens, GA 30602, United States; Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA 30602, United States.
| | - Susan Tanner
- Department of Anthropology, University of Georgia, Athens, GA 30602, United States
| | - Julie Velásquez Runk
- Environment and Sustainability Studies Program, Wake Forest University, Winston Salem, NC 27109, United States; Smithsonian Tropical Research Institute, Balboa, Ciudad de Panamá 0843-03092, Republic of Panama
| | - Juliana Hoyos
- Odum School of Ecology, University of Georgia, Athens, GA 30602, United States
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Herrera C, Bernabé KJ, Dumonteil E, DeCuir J, Thompson JM, Avendano M, Tu W, Leonhardt MM, Northland BA, Frederick J, Prieto B, Paternina-Caicedo A, Ortega E, Fonseca M, Hincapie M, Echeverri M. Assessment of Community Awareness and Screening of Chagas Disease in the Latin American Community of Greater New Orleans. Trop Med Infect Dis 2023; 8:515. [PMID: 38133447 PMCID: PMC10747578 DOI: 10.3390/tropicalmed8120515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
Chagas disease is a public health problem in the Americas, from the southern United States (USA) to Argentina. In the USA, less than 1% of domestic cases have been identified and less than 0.3% of total cases have received treatment. Little is known about affected immigrant Latin American communities. A prospective study was conducted to assess knowledge about Chagas disease among the Latin American community living in the Greater New Orleans area. Participants answered a baseline questionnaire, viewed a short educational video presentation, completed a post-presentation questionnaire, and were screened with an FDA-approved blood rapid diagnostic test (RDT). A total of 154 participants from 18 Latin American countries (n = 138) and the USA (n = 16) were enrolled and screened for Trypanosoma cruzi infection. At baseline, 57% of the participants knew that Chagas disease is transmitted through an insect vector, and 26% recognized images of the vector. Following the administration of an educational intervention, the participants' knowledge regarding vector transmission increased to 91% and 35% of participants were able to successfully identify images of the vector. Five participants screened positive for T. cruzi infection, indicating a 3.24% [95%CI: 1.1-7.5%] prevalence of Trypanosoma cruzi infection within the Latin American community of the New Orleans area. Results highlight the urgent need for improving access to education and diagnostics of Chagas disease.
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Affiliation(s)
- Claudia Herrera
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Kerlly J. Bernabé
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Eric Dumonteil
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - James DeCuir
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Julie M. Thompson
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Mariana Avendano
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Weihong Tu
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Maxwell M. Leonhardt
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.M.L.); (B.A.N.)
| | - Bianka A. Northland
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.M.L.); (B.A.N.)
| | - Jynx Frederick
- Department of Tropical Medicine, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA; (K.J.B.); (E.D.); (J.D.); (J.M.T.); (M.A.); (W.T.); (J.F.)
| | - Bryn Prieto
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA;
| | - Angel Paternina-Caicedo
- Department of Epidemiology, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA;
| | - Emma Ortega
- Office of Public Health-Infectious Disease Epidemiology, Louisiana Department of Health, New Orleans, LA 70802, USA;
| | - Maria Fonseca
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA; (M.F.); (M.H.); (M.E.)
| | - Marcela Hincapie
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA; (M.F.); (M.H.); (M.E.)
| | - Margarita Echeverri
- College of Pharmacy, Xavier University of Louisiana, New Orleans, LA 70125, USA; (M.F.); (M.H.); (M.E.)
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Iglesias-Rus L, Romay-Barja M, Boquete T, Benito A, Jordan B, Blasco-Hernández T. Mapping health behaviour related to Chagas diagnosis in a non-endemic country: Application of Andersen’s Behavioural Model. PLoS One 2022; 17:e0262772. [PMID: 35051245 PMCID: PMC8775331 DOI: 10.1371/journal.pone.0262772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background Chagas disease has become a challenge for non-endemic countries since population mobility has increased in recent years and it has spread to these regions. In order to prevent vertical transmission and improve the prognosis of the disease, it is important to make an early diagnosis. And to develop strategies that improve access to diagnosis, it is important to know the factors that most influence the decision of the population to know their serological status. For this reason, this study uses Andersen’s Behavioural Model and its proposed strategies to explore the health behaviours of Bolivian population. Methods Twenty-three interviews, two focus groups, and two triangular groups were performed with Bolivian men and women, involving a total of 39 participants. In addition, four interviews were conducted with key informants in contact with Bolivian population to delve into possible strategies to improve the Chagas diagnosis. Results The most relevant facts for the decision to being diagnosed pointed out by participants were having relatives who were sick or deceased from Chagas disease or, for men, having their pregnant wife with a positive result. After living in Spain more than ten years, population at risk no longer feels identified with their former rural origin and the vector. Moreover, their knowledge and awareness about diagnosis and treatment still remains low, especially in younger people. Limitations on access to healthcare professionals and services were also mentioned, and proposed strategies focused on eliminating these barriers and educating the population in preventive behaviours. Conclusions Based on Andersen’s Behavioural Model, the results obtained regarding the factors that most influence the decision to carry out Chagas diagnosis provide information that could help to develop strategies to improve access to health services and modify health behaviours related to Chagas screening.
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Affiliation(s)
- Laura Iglesias-Rus
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
| | - María Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Teresa Boquete
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Agustín Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | | | - Teresa Blasco-Hernández
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
- * E-mail:
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The Importance of Screening for Chagas Disease Against the Backdrop of Changing Epidemiology in the USA. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:185-193. [PMID: 36105114 PMCID: PMC9463514 DOI: 10.1007/s40475-022-00264-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 01/11/2023]
Abstract
Purpose of Review This review seeks to identify factors contributing to the changing epidemiology of Chagas disease in the United States of America (US). By showcasing screening programs for Chagas disease that currently exist in endemic and non-endemic settings, we make recommendations for expanding access to Chagas disease diagnosis and care in the US. Recent Findings Several factors including but not limited to increasing migration, climate change, rapid population growth, growing urbanization, changing transportation patterns, and rising poverty are thought to contribute to changes in the epidemiology of Chagas disease in the US. Outlined are some examples of successful screening programs for Chagas disease in other countries as well as in some areas of the US, notably those which focus on screening high-risk populations and are linked to affordable and effective treatment options. Summary Given concerns that Chagas disease prevalence and even risk of transmission may be increasing in the US, there is a need for improving detection and treatment of the disease. There are many successful screening programs in place that can be replicated and/or expanded upon in the US. Specifically, we propose integrating Chagas disease into relevant clinical guidelines, particularly in cardiology and obstetrics/gynecology, and using advocacy as a tool to raise awareness of Chagas disease.
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Livingston EG, Duggal R, Dotters-Katz S. Screening for Chagas Disease during Pregnancy in the United States-A Literature Review. Trop Med Infect Dis 2021; 6:tropicalmed6040202. [PMID: 34941658 PMCID: PMC8704518 DOI: 10.3390/tropicalmed6040202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/13/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Obstetrician-gynecologists in the United States have little clinical experience with the epidemiology, pathophysiology, diagnosis, and treatment of Chagas disease. The number of US parturients born in Central and South America has continued to increase over the last 20 years, making US obstetricians more and more likely to care for Chagas-infected mothers who may never be identified until dealing with long-term consequences of the disease. A literature search demonstrates that few US obstetric care providers recognize the risk of vertical transmission for the neonate and the missed opportunity of infant treatment to decrease disease prevalence. Most women will be asymptomatic during pregnancy, as will their neonates, making routine laboratory screening a necessity for the identification of at-risk neonates. While the benefits of treating asymptomatic women identified in pregnancy are not as clear as the benefits for the infants, future health screenings for evidence of the progression of Chagas disease may be beneficial to these families. The literature suggests that screening for Chagas in pregnancy in the US can be done in a cost-effective way. When viewed through an equity lens, this condition disproportionately affects families of lower socioeconomic means. Improved education of healthcare providers and appropriate resources for diagnosis and treatment can improve this disparity in health outcomes.
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Valdez Tah AR. Making Sense of Chagas Disease among Mexican Immigrants in California. Med Anthropol 2021; 40:511-524. [PMID: 33798000 DOI: 10.1080/01459740.2021.1894560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mexican immigrants are affected by Chagas disease (CD) in California. It is through the representation of Chagas as a rare disease that participants make sense of the disease. A positive diagnosis has meant the disruption of patients' sense of normality and self-image, as well as their memories of homeland both reproducing and challenging hegemonic and stigmatized ideas of the disease associated with rurality and poverty. Access to treatment and medical care was the major coping mechanism. Health programs on CD should consider the emotional and social impact of the disease on people's self-perceptions to develop better medical care and prevention.
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Affiliation(s)
- Alba R Valdez Tah
- Peninsular Center of Humanities and Social Sciences, Autonomous University of Mexico (Centro Peninsular en Humanidades y Ciencias Sociales, UNAM), Mérida, México
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Mills RM. Chagas Disease: Epidemiology and Barriers to Treatment. Am J Med 2020; 133:1262-1265. [PMID: 32592664 DOI: 10.1016/j.amjmed.2020.05.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/24/2022]
Abstract
Chronic human infection by the protozoan parasite Trypanosoma cruzi, known as Chagas disease, results in heart failure and death in 20%-30% of affected individuals. Recognition and treatment of the infection are difficult. Disease control requires elimination of the vector, the reduviid bug, that infests housing of poor quality in endemic areas. In South America, control has largely succeeded in the Southern Cone countries-Argentina, Chile, Uruguay, southern Brazil and São Paulo, and Paraguay-but lags severely in the Northern Triangle (Central American) countries: El Salvador, Honduras, and Guatemala. Surges in poverty and violence in Central America have increased immigration of persons at risk for Chagas disease to the United States, and immigrants to the United States with Chagas disease face multiple barriers to obtaining effective care. These include issues with financing and payment for health care, limited effectiveness of screening and diagnosis, limited effectiveness of available treatment, and lack of provider awareness, public health education, and research. Each of these barriers presents a unique public health challenge.
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Affiliation(s)
- Roger M Mills
- Vice President, Clinical Development, Renova Therapeutics, Inc., Carlsbad, CA.
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Iglesias Rodríguez IM, Mizukami S, Manh DH, Thuan TM, Justiniano HA, Miura S, Ito G, Huy NT, Smith C, Hirayama K. Knowledge, behaviour and attitudes towards Chagas disease among the Bolivian migrant population living in Japan: a cross-sectional study. BMJ Open 2020; 10:e032546. [PMID: 32928842 PMCID: PMC7490920 DOI: 10.1136/bmjopen-2019-032546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the knowledge, behaviour and attitudes towards Chagas disease (CD) among Latin American migrants in Japan and to evaluate the effectiveness of an educational activity (EA) in increasing knowledge of CD. DESIGN A cross-sectional, mixed-methods study employing a preknowledge and postknowledge test and focus group discussion, conducted from March 2018 to June 2018. PARTICIPANTS Seventy-two participants were included, all born in Bolivia and residents in four Japanese cities. Fifty-nine of them participated in the EA. INTERVENTIONS The EA comprised showing three videos about CD and a group discussion covering different dimensions of CD and was evaluated with questionnaires to analyse the knowledge of the participants before and after. RESULTS Seventy-two participants were enrolled, predominantly from highly endemic CD areas of Bolivia. Though most participants were familiar with vector-borne transmission, epidemiology and symptomatology of CD, the baseline knowledge of CD was low. Less than 10% of them had been tested prior for CD. The dominant factors associated with better knowledge were living in Japan for more than 10 years (OR=8.42, 95% CI 1.56 to 48.62) and previously testing for CD (OR=11.32; 95% CI 1.52 to 105.9). The EA significantly improved the CD knowledge of the participants (p value <0.0001; 95% CI 2.32 to 3.84). The participants associated the term 'Chagas' mostly with fear and concern. The level of stigmatisation was low, in contrast to the results of other studies. The barriers encountered in care-seeking behaviour were language, the migration process and difficulties to access the healthcare system. CONCLUSION EA with an integrative approach is useful to increase the knowledge of CD within the Bolivian migrant population living in Japan. The activity brings the possibility to explore not only the level of knowledge but also to reveal experiences and to understand the needs of the people at risk. Considering them as actors towards healthcare solutions could lead to better outcomes for the success of future policies and interventions aimed to decrease the global burden.
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Affiliation(s)
| | - Shusaku Mizukami
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Dao Huy Manh
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Tieu Minh Thuan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Sachio Miura
- NPO organization. MAIKEN. Motohachiojimachi, Hachioji-shi, Tokyo, Japan
| | - George Ito
- Consulate General of Brazil in Japan, Shinagawa-ku, Tokyo, Japan
| | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Chris Smith
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Leading Graduate School Program, and Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Romay-Barja M, Boquete T, Martinez O, Benito A, Blasco-Hernández T. Factors associated with Chagas screening among immigrants from an endemic country in Madrid, Spain. PLoS One 2020; 15:e0230120. [PMID: 32168359 PMCID: PMC7069611 DOI: 10.1371/journal.pone.0230120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 02/21/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Approximately 120,000 people live with Chagas disease in Europe, 43% of whom are living in Spain. Early diagnosis and treatment are critical to improve outcomes for those living with Chagas, and also for the prevention of ongoing transmission. The decision to be tested for Chagas is affected by a range of factors. Studies have highlighted the need to consider the wider social determinants of healthcare seeking behaviour related to Chagas. In Madrid, 44% of Bolivians undergo Chagas screening, which is a higher rate than other European regions, but studies concerning the factors which determine testing have not been performed. This study aimed to assess, for a first time, the factors associated with screening for Chagas among Bolivians living in Madrid trying to help in developing strategies and health recommendations. METHODS This was a cross-sectional survey about knowledge of Chagas and practices of Bolivians living in Madrid, Spain. A structured questionnaire was administered to 376 participants regarding Chagas health-seeking behaviour. Determinants were assessed by multiple logistic regressions adjusted by sex. RESULTS After adjusting for others variables and sex, the factors shown to be associated with Chagas screening were to have between 35 and 54 years of age; coming from a department with high prevalence of Chagas (OR 2.17 95% CI 0.99-4.76); received information about Chagas in Spain (OR 2.44 95% CI 1.32-4.51); and received any advice to do the test, especially if the advice came from a professional. CONCLUSIONS Health authorities should coordinate and promote strategies addressed to diagnose and treat Chagas taking into account all factors associated with screening. Our study suggests that professional advice appears to be the cornerstone to encourage Bolivians to undergo Chagas screening in Madrid. It is time to change the burden of the decision of being screened from the patient to the doctor. Being diagnosed for Chagas needs to become an institutional strategy.
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Affiliation(s)
- María Romay-Barja
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Teresa Boquete
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Obdulia Martinez
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
| | - Agustin Benito
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
| | - Teresa Blasco-Hernández
- Centro Nacional de Medicina Tropical, Instituto de Salud Carlos III, Madrid, Spain
- Red de Investigación Colaborativa en Enfermedades Tropicales, RICET, Madrid, Spain
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Forsyth C, Meymandi S, Moss I, Cone J, Cohen R, Batista C. Proposed multidimensional framework for understanding Chagas disease healthcare barriers in the United States. PLoS Negl Trop Dis 2019; 13:e0007447. [PMID: 31557155 PMCID: PMC6762052 DOI: 10.1371/journal.pntd.0007447] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Chagas disease (CD) affects over 300,000 people in the United States, but fewer than 1% have been diagnosed and less than 0.3% have received etiological treatment. This is a significant public health concern because untreated CD can produce fatal complications. What factors prevent people with CD from accessing diagnosis and treatment in a nation with one of the world's most advanced healthcare systems? METHODOLOGY/PRINCIPAL FINDINGS This analysis of barriers to diagnosis and treatment of CD in the US reflects the opinions of the authors more than a comprehensive discussion of all the available evidence. To enrich our description of barriers, we have conducted an exploratory literature review and cited the experience of the main US clinic providing treatment for CD. We list 34 barriers, which we group into four overlapping dimensions: systemic, comprising gaps in the public health system; structural, originating from political and economic inequalities; clinical, including toxicity of medications and diagnostic challenges; and psychosocial, encompassing fears and stigma. CONCLUSIONS We propose this multidimensional framework both to explain the persistently low numbers of people with CD who are tested and treated and as a potential basis for organizing a public health response, but we encourage others to improve on our approach or develop alternative frameworks. We further argue that expanding access to diagnosis and treatment of CD in the US means asserting the rights of vulnerable populations to obtain timely, quality healthcare.
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Affiliation(s)
- Colin Forsyth
- Drugs for Neglected Diseases initiative, North America, New York, New York, United States of America
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California, United States of America
| | - Sheba Meymandi
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California, United States of America
| | - Ilan Moss
- Drugs for Neglected Diseases initiative, North America, New York, New York, United States of America
| | - Jason Cone
- Médecins sans Frontières/Doctors Without Borders USA, New York, New York, United States of America
| | - Rachel Cohen
- Drugs for Neglected Diseases initiative, North America, New York, New York, United States of America
| | - Carolina Batista
- Drugs for Neglected Diseases initiative, Latin America, Rio de Janeiro, Brazil
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Valdez Tah AR. “Enfermarse aquí es un lujo”: prácticas y perspectivas en la atención de enfermedades entre inmigrantes yucatecos en el sur de California. Glob Health Promot 2019. [DOI: 10.1177/1757975919868169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Resumen: Este estudio se enfoca en cómo un grupo de inmigrantes originarios del estado de Yucatán, en México, y quienes viven en el sur de California, atienden las enfermedades que les aquejan y cómo articulan sus prácticas de atención con sus condiciones socioeconómicas, su estatus migratorio y acceso a los servicios de salud institucionales. La metodología elegida fue de corte cualitativo, a través de entrevistas se recopilaron datos etnográficos analizados con el software MAXQDA12. Las modalidades de las trayectorias en la búsqueda de atención son complejas al ser articulaciones a través de las cuales los entrevistados enfrentan las barreras estructurales para acceder a servicios médicos, y por constituirse al mismo tiempo como una síntesis dinámica de los sistemas de conocimiento científico y del saber popular. Las limitantes estructurales son mayormente prevalentes en el acceso de servicios médicos a partir del segundo nivel y son más profundas entre los participantes indocumentados. El trabajo reflexiona sobre el impacto estructural de la política pública en salud y de la política migratoria sobre las modalidades de atención, sobre las condiciones de salud de los participantes, y sobre las implicaciones de los hallazgos en las estrategias de promoción a la salud en el contexto de migración internacional.
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A Community-Based Intervention for the Detection of Chagas Disease in Barcelona, Spain. J Community Health 2019; 44:704-711. [DOI: 10.1007/s10900-019-00684-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chagas screening and treatment among Bolivians living in Madrid, Spain: The need for an official protocol. PLoS One 2019; 14:e0213577. [PMID: 30849113 PMCID: PMC6407767 DOI: 10.1371/journal.pone.0213577] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/25/2019] [Indexed: 12/28/2022] Open
Abstract
Background It is estimated that around 52,000 people live with Chagas in Spain, but only 10% have been diagnosed. Migrants from Bolivia bear the burden of Chagas infection in Spain. However, little is known about their current management of Chagas diagnosis and treatment patterns. This study aimed to assess the Chagas related disease perception and health behaviour of Bolivians living in Madrid. Methods and principal findings For a first time, a cross-sectional survey about Chagas’ knowledges and practices was carried out in Madrid, Spain. A total of 376 Bolivians were interviewed about their Chagas health-seeking behaviour. Differences between men and women were assessed Most of Bolivians living in Madrid have access to the public health services. 44% of Bolivians included in the survey had a Chagas screening test done. However, while women did their test for Chagas mostly at hospital (59.2%), men also used the community campaigns (17.5%) and blood banks (14.3%). The prevalence reported among Bolivians tested was 27.7%. Unfortunately, more than half of those reporting a positive test for Chagas did not begin or completed treatment. Only 45.7% of positives reported having had their children tested for Chagas. Conclusions Despite the increase in the number of Chagas diagnoses done in Madrid, the number of Bolivians who tested positive and then started or completed treatment remains very low. The fact that most Bolivians’ access to the health system is through the primary healthcare services should be considered for improving management of cases and follow-up of treatment adherence. Local and national protocol establishing guidelines for the screening and treatment of Chagas disease would help improving case detection and management at all levels of the healthcare system.
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Forsyth CJ, Hernandez S, Flores CA, Roman MF, Nieto JM, Marquez G, Sequeira J, Sequeira H, Meymandi SK. "It's Like a Phantom Disease": Patient Perspectives on Access to Treatment for Chagas Disease in the United States. Am J Trop Med Hyg 2018; 98:735-741. [PMID: 29380723 PMCID: PMC5930901 DOI: 10.4269/ajtmh.17-0691] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Chagas disease (CD) affects > 6 million people globally, including > 300,000 in the United States. Although early detection and etiological treatment prevents chronic complications from CD, < 1% of U.S. cases have been diagnosed and treated. This study explores access to etiological treatment from the perspective of patients with CD. In semi-structured interviews with 50 Latin American-born patients of the Center of Excellence for Chagas Disease at the Olive View-UCLA Medical Center, we collected demographic information and asked patients about their experiences managing the disease and accessing treatment. Patients were highly marginalized, with 63.4% living below the U.S. poverty line, 60% lacking a high school education, and only 12% with private insurance coverage. The main barriers to accessing health care for CD were lack of providers, precarious insurance coverage, low provider awareness, transportation difficulties, and limited time off. Increasing access to diagnosis and treatment will not only require a dramatic increase in provider and public education, but also development of programs which are financially, linguistically, politically, and geographically accessible to patients.
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Affiliation(s)
- Colin J Forsyth
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California
| | - Salvador Hernandez
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California
| | - Carmen A Flores
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California
| | - Mario F Roman
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California
| | - J Maribel Nieto
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California
| | - Grecia Marquez
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California
| | - Juan Sequeira
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California
| | - Harry Sequeira
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California
| | - Sheba K Meymandi
- Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center, Sylmar, California
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Traina M, Meymandi S, Bradfield JS. Heart Failure Secondary to Chagas Disease: an Emerging Problem in Non-endemic Areas. Curr Heart Fail Rep 2017; 13:295-301. [PMID: 27807757 DOI: 10.1007/s11897-016-0305-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chagas disease affects millions of people worldwide. Though the majority of infected individuals remain asymptomatic, approximately 30 % of patients progress to develop cardiac manifestations and eventual heart failure. While vectorial transmission occurs predominantly in South America, Central America, and Mexico, millions of people originally from these endemic regions immigrate to non-endemic countries in North America, Europe, and Asia. Outside of rare specialized centers, health-care providers lack experience diagnosing and treating this disease. This lack of experience likely leads to far fewer Chagas disease patients being diagnosed than what actually exist in non-endemic countries, with subsequent adverse effect on patient outcomes and health-care expenses. Underdiagnosis increases the risk of developing cardiomyopathy, associated heart failure, and life-threatening ventricular arrhythmias as the disease progresses.
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Affiliation(s)
- Mahmoud Traina
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, 14445 Olive View Dr., Sylmar, CA, 91342, USA
- Cleveland Clinic Abu Dhabi, Heart and Vascular Institute, PO Box 112412, Al Maryah Island, Abu Dhabi, UAE
| | - Sheba Meymandi
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, 14445 Olive View Dr., Sylmar, CA, 91342, USA
| | - Jason S Bradfield
- Center of Excellence for Chagas Disease, Olive View-UCLA Medical Center, 14445 Olive View Dr., Sylmar, CA, 91342, USA.
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA.
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Curtis-Robles R, Zecca IB, Roman-Cruz V, Carbajal ES, Auckland LD, Flores I, Millard AV, Hamer SA. Trypanosoma cruzi (Agent of Chagas Disease) in Sympatric Human and Dog Populations in "Colonias" of the Lower Rio Grande Valley of Texas. Am J Trop Med Hyg 2017; 96:805-814. [PMID: 28167589 PMCID: PMC5392625 DOI: 10.4269/ajtmh.16-0789] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/31/2016] [Indexed: 11/12/2022] Open
Abstract
AbstractThe zoonotic, vector-borne parasite Trypanosoma cruzi causes Chagas disease throughout the Americas, but human and veterinary health burdens in the United States are unknown. We conducted a cross-sectional prevalence study in indigent, medically underserved human and cohabiting canine populations of seven south Texas border communities, known as colonias. Defining positivity as those samples that were positive on two or more independent tests, we found 1.3% seroprevalence in 233 humans, including one child born in the United States with only short-duration travel to Mexico. Additionally, a single child with no travel outside south Texas was positive on only a single test. Among 209 dogs, seroprevalence was 19.6%, but adjusted to 31.6% when including those dogs positive on only one test and extrapolating potential false negatives. Parasite DNA was detected in five dogs, indicating potential parasitemia. Seropositive dogs lived in all sampled colonias with no difference in odds of positivity across age, sex, or breed. Colonia residents collected two adult Triatoma gerstaeckeri and one nymph triatomine from around their homes; one of three bugs was infected with T. cruzi, and blood meal hosts were molecularly determined to include dog, human, and raccoon. Dogs and the infected vector all harbored T. cruzi discrete typing unit I, which has previously been implicated in human disease in the United States. Colonias harbor active T. cruzi transmission cycles and should be a priority in outreach and vector control initiatives.
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Affiliation(s)
- Rachel Curtis-Robles
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Italo B. Zecca
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Valery Roman-Cruz
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Ester S. Carbajal
- Department of Entomology, Texas A&M University, College Station, Texas
- International Valley Health Institute, Edinburg, Texas
| | - Lisa D. Auckland
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | | | - Ann V. Millard
- School of Public Health, Texas A&M Health Science Center, McAllen, Texas
| | - Sarah A. Hamer
- College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
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Navarro M, Berens-Riha N, Hohnerlein S, Seiringer P, von Saldern C, Garcia S, Blasco-Hernández T, Navaza B, Shock J, Bretzel G, Hoelscher M, Löscher T, Albajar-Viñas P, Pritsch M. Cross-sectional, descriptive study of Chagas disease among citizens of Bolivian origin living in Munich, Germany. BMJ Open 2017; 7:e013960. [PMID: 28093440 PMCID: PMC5253600 DOI: 10.1136/bmjopen-2016-013960] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Chagas disease (CD) has become a global health issue mainly due to migration. Germany lacks surveillance data and is home to a large Latin American immigrant population. Recognising that Bolivia is the country with the highest CD prevalence in Latin America, this cross-sectional, descriptive pilot study investigated CD and associated factors among citizens of Bolivian origin living in Munich, Germany. METHODS Participants completed a questionnaire in order to collect socioeconomic and health-related data. In addition, serology was performed. In case of positive serological tests, PCR diagnostic and clinical staging together with disease management was initiated. Qualitative research was conducted to identify personal and community barriers as well as strategies to increase CD awareness among the population at risk. RESULTS Between June 2013 and June 2014, 43 people from Bolivia (or descendants) were enrolled. A total of 9.3% (4/43), of whom two women were of childbearing age, tested seropositive (ELISA and IFAT), and one also by PCR. For 2/4 positive participants, clinical evaluation was performed and the indeterminate form of CD was diagnosed. Knowledge about CD symptoms and ways of transmission were completely absent among 55.8% (24/43, 2/4 with CD) and 30.2% (13/43, 1/4 with CD) of participants, respectively. A total of 27.9% (12/43, 0/4 with CD) of participants had donated blood prior to the study, whereas 62.8% (27/43, 3/4 with CD) were motivated to donate blood in the future. The qualitative research identified lack of knowledge as well as stigma and fears related to CD. CONCLUSIONS Despite the small number of participants, the prevalence of CD as well as the potential risk of non-vectorial transmission was alarming. Campaigns adapted for Latin American migrants as well as control strategies should be developed and put in place in order to prevent non-vectorial transmission and actively detect cases of CD in Germany.
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Affiliation(s)
| | - Nicole Berens-Riha
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Stefan Hohnerlein
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Peter Seiringer
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Charlotte von Saldern
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Sarah Garcia
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Teresa Blasco-Hernández
- Centro Nacional de Medicina Tropical (Instituto de Salud Carlos III), Madrid, Spain
- Red de investigación Cooperativa en Enfermedades Tropicales, Madrid, Spain
| | | | - Jonathan Shock
- The Laboratory for Quantum Gravity & Strings, Department of Mathematics and Applied Mathematics, University of Cape Town, Cape Town, South Africa
| | - Gisela Bretzel
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Michael Hoelscher
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Thomas Löscher
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
| | - Pedro Albajar-Viñas
- Department of Control of Neglected Tropical Diseases, World Health Organization (WHO), Geneva, Switzerland
| | - Michael Pritsch
- Department of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Munich, Germany
- German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
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Health Care Seeking Behavior of Persons with Acute Chagas Disease in Rural Argentina: A Qualitative View. J Trop Med 2016; 2016:4561951. [PMID: 27829843 PMCID: PMC5088329 DOI: 10.1155/2016/4561951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/28/2016] [Indexed: 02/01/2023] Open
Abstract
Chagas disease (CD) is a tropical parasitic disease largely underdiagnosed and mostly asymptomatic affecting marginalized rural populations. Argentina regularly reports acute cases of CD, mostly young individuals under 14 years old. There is a void of knowledge of health care seeking behavior in subjects experiencing a CD acute condition. Early treatment of the acute case is crucial to limit subsequent development of disease. The article explores how the health outcome of persons with acute CD may be conditioned by their health care seeking behavior. The study, with a qualitative approach, was carried out in rural areas of Santiago del Estero Province, a high risk endemic region for vector transmission of CD. Narratives of 25 in-depth interviews carried out in 2005 and 2006 are analyzed identifying patterns of health care seeking behavior followed by acute cases. Through the retrospective recall of paths for diagnoses, weaknesses of disease information, knowledge at the household level, and underperformance at the provincial health care system level are detected. The misdiagnoses were a major factor in delaying a health care response. The study results expose lost opportunities for the health care system to effectively record CD acute cases.
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Conners EE, Vinetz JM, Weeks JR, Brouwer KC. A global systematic review of Chagas disease prevalence among migrants. Acta Trop 2016; 156:68-78. [PMID: 26777312 DOI: 10.1016/j.actatropica.2016.01.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/31/2015] [Accepted: 01/02/2016] [Indexed: 12/31/2022]
Abstract
Human migration has been identified as a potential factor for increased Chagas disease risk and has transformed the disease from a Latin American problem to a global one. We conducted a systematic review of the scientific literature between 2004-2014 in order to: summarize recent seroprevalence estimates of Chagas disease among Latin American migrants, in both endemic and non-endemic settings; compare seroprevalence estimates in migrants to countrywide prevalence estimates; and identify risk factors for Chagas disease among migrants. A total of 320 studies were screened and 23 studies were included. We found evidence that the prevalence of Chagas disease is higher than expected in some migrant groups and that reliance on blood donor screening prevalence estimates underestimates the burden of disease. Overall there is a dearth of high quality epidemiologic studies on the prevalence of Chagas disease in migrants, especially among intra-regional migrants within Latin America. Given that this zoonotic disease cannot likely be eradicated, improved surveillance and reporting is vital to continuing control efforts. More accurate health surveillance of both Latin American migrants and the Chagas disease burden will help countries appropriately scale up their response to this chronic disease. Overall, improved estimates of Chagas disease among migrants would likely serve to highlight the real need for better screening, diagnostics, and treatment of individuals living with the disease.
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20
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Blasco-Hernández T, García-San Miguel L, Navaza B, Navarro M, Benito A. Knowledge and experiences of Chagas disease in Bolivian women living in Spain: a qualitative study. Glob Health Action 2016; 9:30201. [PMID: 26976265 PMCID: PMC4789531 DOI: 10.3402/gha.v9.30201] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/04/2016] [Accepted: 02/12/2016] [Indexed: 11/23/2022] Open
Abstract
Background In Europe, Spain has the highest number of people with Chagas disease (CD). Bolivian migrants account for 81% of the reported cases. One of the priorities in controlling the disease is prevention of mother-to-child transmission. Despite under-diagnosis in Spain being estimated at 90%, there are currently few studies that explore the social and cultural dimensions of this disease. Objective The aim of this study was to explore the knowledge and experiences of Bolivian women with CD, in order to generate a useful understanding for the design and implementation of public health initiatives. Design Qualitative study based on semi-structured interviews, triangular groups, and field notes. Participants Fourteen Bolivian women with CD living in Madrid. Results The participants were aware that the disease was transmitted through the vector, that it could be asymptomatic, and that it could also be associated with sudden death by heart failure. They opined that the treatment as such could not cure the disease but only slow it down. There was a sense of indifference along with a lack of understanding of the risk of contracting the disease. Participants who presented with symptoms, or those with relatives suffering from the disease, were concerned about fatalities, cardiac problems, and possible vertical transmission. There was also a fear of being rejected by others. The disease was described as something that affected a large number of people but only showed up in a few cases and that too after many years. There was a widespread assumption that it was better not to know because doing so, allows the disease to take hold.
Conclusions Disease risk perception was very low in Bolivian women living in Madrid. This factor, together with the fear of being screened, may be contributing to the current rate of under-diagnosis.
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Affiliation(s)
| | | | | | | | - Agustín Benito
- National Centre for Tropical Medicine, Health Institute Carlos III, Madrid, Spain
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Hotez PJ, Dumonteil E, Betancourt Cravioto M, Bottazzi ME, Tapia-Conyer R, Meymandi S, Karunakara U, Ribeiro I, Cohen RM, Pecoul B. An unfolding tragedy of Chagas disease in North America. PLoS Negl Trop Dis 2013; 7:e2300. [PMID: 24205411 PMCID: PMC3814410 DOI: 10.1371/journal.pntd.0002300] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Peter J. Hotez
- National School of Tropical Medicine at Baylor College of Medicine and the Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, Texas, United States of America
- James A. Baker III Institute for Public Policy, Rice University, Houston, Texas, United States of America
- * E-mail:
| | | | | | - Maria Elena Bottazzi
- National School of Tropical Medicine at Baylor College of Medicine and the Sabin Vaccine Institute and Texas Children's Hospital Center for Vaccine Development, Houston, Texas, United States of America
| | | | - Sheba Meymandi
- Olive View-UCLA Medical Center, Los Angeles, California, United States of America
| | - Unni Karunakara
- Medecins Sans Frontieres/Doctors Without Borders (MSF), Geneva, Switzerland
| | - Isabela Ribeiro
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland and New York, New York, United States of America
| | - Rachel M. Cohen
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland and New York, New York, United States of America
| | - Bernard Pecoul
- Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland and New York, New York, United States of America
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Ventura-Garcia L, Roura M, Pell C, Posada E, Gascón J, Aldasoro E, Muñoz J, Pool R. Socio-cultural aspects of Chagas disease: a systematic review of qualitative research. PLoS Negl Trop Dis 2013; 7:e2410. [PMID: 24069473 PMCID: PMC3772024 DOI: 10.1371/journal.pntd.0002410] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 07/17/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Globally, more than 10 million people are infected with Trypanosoma cruzi, which causes about 20 000 annual deaths. Although Chagas disease is endemic to certain regions of Latin America, migratory flows have enabled its expansion into areas where it was previously unknown. Economic, social and cultural factors play a significant role in its presence and perpetuation. This systematic review aims to provide a comprehensive overview of qualitative research on Chagas disease, both in endemic and non-endemic countries. METHODOLOGY/PRINCIPAL FINDINGS Searches were carried out in ten databases, and the bibliographies of retrieved studies were examined. Data from thirty-three identified studies were extracted, and findings were analyzed and synthesized along key themes. Themes identified for endemic countries included: socio-structural determinants of Chagas disease; health practices; biomedical conceptions of Chagas disease; patient's experience; and institutional strategies adopted. Concerning non-endemic countries, identified issues related to access to health services and health seeking. CONCLUSIONS The emergence and perpetuation of Chagas disease depends largely on socio-cultural aspects influencing health. As most interventions do not address the clinical, environmental, social and cultural aspects jointly, an explicitly multidimensional approach, incorporating the experiences of those affected is a potential tool for the development of long-term successful programs. Further research is needed to evaluate this approach.
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Affiliation(s)
- Laia Ventura-Garcia
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic, Universitat de Barcelona), Barcelona, Spain
| | - Maria Roura
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic, Universitat de Barcelona), Barcelona, Spain
| | - Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Elisabeth Posada
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic, Universitat de Barcelona), Barcelona, Spain
| | - Joaquim Gascón
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic, Universitat de Barcelona), Barcelona, Spain
| | - Edelweis Aldasoro
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic, Universitat de Barcelona), Barcelona, Spain
| | - Jose Muñoz
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic, Universitat de Barcelona), Barcelona, Spain
| | - Robert Pool
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic, Universitat de Barcelona), Barcelona, Spain
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
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