Cultural perception of triatomine bugs and Chagas disease in Bolivia: a cross-sectional field study

Abstract

Background Chagas disease remains a major public health risk in Bolivia, particularly among rural indigenous communities. Here we studied the cultural perception of the triatomine vectors and Chagas disease among selected rural and urban ethnic groups from different socio-economic and geographical milieus. We focused on the indigenous communities in the Bolivian Chaco where the disease is hyperendemic. Methods A cross-sectional study using field observations and structured interviews was carried out among 480 informants in five different regions of Bolivia. Additional semi-structured interviews were conducted. Statistical analyses were performed to determine the correlation of socio-economic variables and indigenous Chagas disease knowledge systems. A total of 170 domestic Triatoma infestans vectors were collected and infection with Trypanosoma cruzi was analyzed by real-time PCR. Results Triatomine bugs were associated with Chagas disease in 70.2% ( n = 480) of the responses (48.0% Ayoreo, 87.5% Chiquitano, 83.9% Guaraní, 72.2% Quechua, 46.1% La Paz citizens and 67.7% Santa Cruz citizens). Generally, indigenous informants have been educated on the association between triatomine bugs and Chagas disease by institutional anti-Chagas disease campaigns. While communities were largely aware of the vectors as a principal mode of disease transmission, rather unexpectedly, health campaigns had little influence on their prevention practices, apparently due to cultural constraints. Overall, 71.9% of the collected domestic vectors in the Chaco region were infected with T. cruzi , matching the high infection rates in the indigenous communities. Conclusions Among the Guaraní, Ayoreo and Quechua communities, the groups living in traditional houses have not integrated the scientific knowledge about Chagas disease transmission into their daily hygiene and continue to cohabit with T. infestans vectors hyperinfected with T. cruzi . An effective translation of Western disease concepts into traditional preventive measures is missing because asymptomatic infections are not generally perceived as threat by the communities. New participatory approaches involving existing ethnomedical knowledge systems could be a successful strategy in the control of T. cruzi infection.

Phylobioactive hotspots identified through multidimensional profiling of botanical drugs used to treat Chagas disease in Bolivia and Dioscorides’ De Materia Medica

“…In fact, most of the botanical drugs applied for CD related symptoms were also used for other therapeutic purposes involving inflammatory conditions ( Table 2). We thus conclude that tangible ethnomedical concepts about CD were absent until recently and developed only during the last decades, which is in agreement with the cultural perception of T. cruzi vectors (41). This clearly hampers the application and selection of botanical drugs targeting T. cruzi parasitemia and its symptoms, and probably explains in part why the majority (> 80%) of the extracts derived from botanical drugs with reported use against CD and its symptoms were not active.…”

“…The main economic activity was subsistence farming. Traditional dwellings were predominantly constructed of adobe walls, earthen floors and thatched roofs, and constitute an ideal habitat for the CD vector T. infestans (41). T. cruzi transmission was hyperendemic showing the highest infection rates in the Chaco region and Inter-Andean valleys (42)(43)(44)(45)(46).…”

“…Biomedical health care was mainly provided by primary health centers located in the bigger villages Charagua, La Brecha and Iyovi (Chaco), San José de Chiquitos, Roboré and Concepción (Chiquitanía), Mizque and Laguna Grande (Inter-Andean valleys). However, most of them were insufficiently equipped, and CD treatment was marginally successful (41). Additionally, a survey was conducted in the herbal markets of the cities of La Paz and Santa Cruz de la Sierra.…”

“…Generally, they had no or little knowledge about traditional medicinal agents. Although Quechua informants have been educated on the association between triatomine bugs and CD by institutional anti-CD campaigns (41), they had a very limited understanding about the transmission mechanisms and symptoms of the illness. There was poor consensus among Quechua informants and we obtained only one or two use-reports for each plant taxon, with the exception of Minthostachys ovata aerial parts (3 use-reports, Table 2).…”

“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

“…For the implementation of sustainable interventions, the setting needs to be thoroughly understood and the community actively involved. However, there is a lack of up-to-date data on knowledge, perceptions, practices and experiences concerning CD from the study area [ 16 ], as well as factors for adoption of preventative measures such as early diagnosis and treatment [ 17 ]. Through assessing the local situation in the municipality of Monteagudo two years after the interventions of MSF, additional factors relevant for sustained control as well as protective behaviours within communities should be identified, and valuable lessons learned for future projects.…”