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Parisi S, Navarro M, Du Plessis JD, Shock JP, Apodaca Michel B, Lucuy Espinoza M, Terán C, Calizaya Tapia NA, Oltmanns K, Baptista Mora A, Saveedra Irala C, Rivera Rojas AA, Rubilar G, Zoller T, Pritsch M. "We have already heard that the treatment doesn't do anything, so why should we take it?": A mixed method perspective on Chagas disease knowledge, attitudes, prevention, and treatment behaviour in the Bolivian Chaco. PLoS Negl Trop Dis 2020; 14:e0008752. [PMID: 33119632 PMCID: PMC7595318 DOI: 10.1371/journal.pntd.0008752] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chagas disease (CD) is highly endemic in the Bolivian Chaco. The municipality of Monteagudo has been targeted by national interventions as well as by Médecins Sans Frontières to reduce infection rates, and to decentralize early diagnosis and treatment. This study seeks to determine the knowledge and attitudes of a population with increased awareness and to identify remaining factors and barriers for sustained vector control, health care seeking behaviour, and access, in order to improve future interventions. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional survey was conducted among approximately 10% (n = 669) of the municipality of Monteagudo's households that were randomly selected. Additionally, a total of 14 in-depth interviews and 2 focus group discussions were conducted with patients and key informants. Several attitudes and practices were identified that could undermine effective control against (re-)infection. Knowledge of clinical symptoms and secondary prevention was limited, and revealed specific misconceptions. Although 76% of the participants had been tested for CD, only 18% of those who tested positive concluded treatment with benznidazole (BNZ). Sustained positive serologies after treatment led to perceived ineffectiveness of BNZ. Moreover, access barriers such as direct as well as indirect costs, BNZ stock-outs and a fear of adverse reactions triggered by other community members made patients opt for alternative treatments against CD such as veterinary ivermectin, used by 28% of infected participants in our study. The lack of accessible care for chronic complications as well as socioeconomic consequences, such as the exclusion from both job opportunities and bank loans contributed to the ongoing burden of CD. CONCLUSIONS/SIGNIFICANCE Large scale interventions should be accompanied by operational research in order to identify misconceptions and unintended consequences early on, to generate accessible data for future interventions, and for rigorous evaluation. An integrated, community-based approach tackling social determinants and including both traditional and animal health sectors might help to overcome current barriers and advocate for patients' rights.
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Affiliation(s)
- Sandra Parisi
- Institute of Tropical Medicine and International Health, Charité –Universitätsmedizin Berlin, Berlin, Germany
- DAHW Deutsche Lepra- und Tuberkulosehilfe e. V., Würzburg, Germany
- Department of General Practice, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Miriam Navarro
- Department of Public Health, Science History and Gynecology, Universidad Miguel Hernández, Alicante, Spain
| | | | - Jonathan Phillip Shock
- Department of Maths and Applied Maths, University of Cape Town, Rondebosch, South Africa
| | - Boris Apodaca Michel
- Hospital Dermatológico Monteagudo, Monteagudo, Bolivia
- Fundacion Intercultural NORSUD, Sucre, Bolivia
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Minerva Lucuy Espinoza
- Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Faculty of Medicine, Sucre, Bolivia
| | - Carolina Terán
- Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Faculty of Medicine, Sucre, Bolivia
| | | | - Katharina Oltmanns
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Abundio Baptista Mora
- Fundacion Intercultural NORSUD, Sucre, Bolivia
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
- Universidad Mayor, Real y Pontificia de San Francisco Xavier de Chuquisaca, Faculty of Medicine, Sucre, Bolivia
| | - Claudia Saveedra Irala
- Hospital Dermatológico Monteagudo, Monteagudo, Bolivia
- Fundacion Intercultural NORSUD, Sucre, Bolivia
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Angel Alberto Rivera Rojas
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Gonzalo Rubilar
- DAHW Asociación Alemana de Asistencia al Enfermo con Lepra y Tuberculosis, Oficinas Suramérica, Bogotá, Colombia
| | - Thomas Zoller
- Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Infectious Diseases and Respiratory Medicine, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital Munich, Munich, Germany
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