Mitigating social and health inequities: Community participation and Chagas disease in rural Argentina

Abstract

Chagas disease (CD) causes 12,500 deaths annually in Latin America. As a neglected disease primarily associated with poverty, it is a major driver of health inequity. Argentina's efforts to control vector transmission have been unsuccessful. Using new survey data (n=400 households), we compare the social patterning of the burden of CD by examining socio-demographic predictors of self-reported CD and the presence of vinchucas in two areas of rural northern Argentina known to have experienced different interventions in surveillance and control. Our analyses suggest that Avellaneda, an area known for horizontal intervention strategies which nurture community participation is quite distinct from Silipica, an area which has experienced a vertical intervention strategy since 1990. Avellaneda has higher level of self-reported Chagas infection and lower level of vinchuca presence; Silipica has pronounced and statistically significant differences patterned by the head of household's level of educational attainment. A greater awareness of the disease and its transmission, along with community mobilisation and spraying, may bring about more self-reported CD and less vinchuca presence in Avellaneda than in Silipica. This suggests that strategies based on community participation may be effective in reducing the social patterning of the burden of disease, even in poor places.

Socioeconomic Inequalities in Neglected Tropical Diseases: A Systematic Review

“…Four papers on Chagas’ disease met the inclusion criteria (Brazil [GDB #1] two [ 82 , 83 ]; Argentina [GDB #3] one [ 84 ]; Colombia [GDB #5] one [ 85 ]) ( S5 Table ). Two studies represented the general population in a specific geographical area using a cross-sectional design [ 82 , 84 ], while two focussed on pregnant women (cross-sectional) [ 85 ] or women who recently gave birth (case control) [ 83 ], reflecting the importance of vertical infection transmission.…”

“…The Argentinian study compared self-reported Chagas and vector presence by SEP. In a region with horizontal control strategies, they found lower reported vector prevalence, higher self-reported Chagas prevalence, and smaller (and not statistically significant) educational inequalities in such prevalence than in a region with vertical control strategies [ 84 ]. The authors concluded that horizontal control strategies reduced vector prevalence, raised awareness of Chagas’ disease in all strata, and reduced inequalities in such awareness.…”

Human Trypanosoma cruzi infection is driven by eco-social interactions in rural communities of the Argentine Chaco

“…To this aim we elaborated a more comprehensive measure of socio-economic status since previous studies have focused on a few proxy variables: the goat-equivalent index [16], domicile’s characteristics (i.e., construction materials, size, cracks in walls, etc.) [26,29,30], and educational level [76]. The social vulnerability index summarized all of the above and also included household overcrowding, agricultural practices, at least one member with a stable source of income by employment, and the household number of welfare recipients [54].…”

Barriers to Testing and Treatment for Chagas Disease among Latino Immigrants in Georgia

“…Additionally, awareness of Chagas disease is limited among medical providers in the USA; 68.2% of American College of Obstetricians and Gynecologists surveyed described their knowledge level about Chagas disease as “very limited” [18]. Yet, in areas where the disease is endemic, such as Argentina, there have been high rates of public participation in vector control campaigns which indicate an awareness of risk of Chagas disease [19]. …”