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Door‐to‐door screening as a strategy for the detection of congenital Chagas disease in rural Bolivia

Door‐to‐door screening as a strategy for the detection of congenital Chagas disease in rural Bolivia Summary Objective To demonstrate the feasibility of a house‐to‐house screening system used for congenital Chagas disease in rural areas based on an active search for pregnant women and newborns in their homes in addition to passive case detection in health facilities. Methods Exploratory phase conducted by the research team followed by an operational period coordinated by municipal health service. A blood sample was taken for serological and parasitological tests of Trypanosoma cruzi from pregnant women who were searching antenatal care or visited at home by field investigators. Infants born to T. cruzi‐infected women were examined for infection at birth and again at 1 and 7 months of age. Results 64.5% of the pregnant women were infected. Congenital infection was diagnosed at birth in 4.0% (12/299) of the children born to seroreactive mothers. Twelve additional cases of infection (4%) were diagnosed in children between 1 and 7 months of age. Finally, 37% of the children were lost to follow‐up in the exploratory phase and 53% during the operational phase (P = 0.002), significantly fewer than in most passive case detection studies. Conclusion Despite poorer outcomes after door‐to‐door screening activities have been transferred to the health system, a combined strategy based on active and passive case detection appeared to be efficient for identifying rural cases of congenital Chagas disease. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Tropical Medicine & International Health Wiley

Door‐to‐door screening as a strategy for the detection of congenital Chagas disease in rural Bolivia

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References (29)

Publisher
Wiley
Copyright
© 2011 Blackwell Publishing Ltd
ISSN
1360-2276
eISSN
1365-3156
DOI
10.1111/j.1365-3156.2011.02746.x
pmid
21342373
Publisher site
See Article on Publisher Site

Abstract

Summary Objective To demonstrate the feasibility of a house‐to‐house screening system used for congenital Chagas disease in rural areas based on an active search for pregnant women and newborns in their homes in addition to passive case detection in health facilities. Methods Exploratory phase conducted by the research team followed by an operational period coordinated by municipal health service. A blood sample was taken for serological and parasitological tests of Trypanosoma cruzi from pregnant women who were searching antenatal care or visited at home by field investigators. Infants born to T. cruzi‐infected women were examined for infection at birth and again at 1 and 7 months of age. Results 64.5% of the pregnant women were infected. Congenital infection was diagnosed at birth in 4.0% (12/299) of the children born to seroreactive mothers. Twelve additional cases of infection (4%) were diagnosed in children between 1 and 7 months of age. Finally, 37% of the children were lost to follow‐up in the exploratory phase and 53% during the operational phase (P = 0.002), significantly fewer than in most passive case detection studies. Conclusion Despite poorer outcomes after door‐to‐door screening activities have been transferred to the health system, a combined strategy based on active and passive case detection appeared to be efficient for identifying rural cases of congenital Chagas disease.

Journal

Tropical Medicine & International Health – Wiley

Published: May 1, 2011

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