Date Published: March 8, 2019
Publisher: Public Library of Science
Author(s): María Romay-Barja, Teresa Boquete, Obdulia Martinez, Marlene González, Débora Álvarez-Del Arco, Agustín Benito, Teresa Blasco-Hernández, Abdallah M. Samy.
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.
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.
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.
Chagas disease is endemic in 21 continental Latin American countries, where almost 6 million people are infected with Trypanosoma cruzi,. Considered one of the main neglected tropical diseases in Latin America, Chagas disease has crossed borders to North America and Europe, due to population mobility, where an estimated 120,000 people currently live with [2–4]. Endemically transmitted by triatomine insects, the main routes of transmission in non-endemic countries are congenital transmission, blood transfusion and solid organ transplants .
Of the 376 Bolivians interviewed about their Chagas-related health-seeking behaviour, 159 (42.4%) were men and 217 (57.6%) women. Table 1 summarizes the socioeconomic and demographic characteristics of the surveyed population. The participants had a mean age of 38 years (IQ: 33–45, minimum 18, maximum 77). Most of them (66.0%) were married or lived with a partner, but women were widowed or divorced more frequently than men (13.4% vs. 3.8%). Most of the Bolivians reported having completed secondary school or beyond (74.2%). Significantly more women (86.6%) than men (77.95) reported having children. The mean year of arrival in Spain was 2005 (IQ: 2003–2006, minimum 1982, maximum 2017) but a not-irrelevant number arrived later, especially among the men (49.7%).
This study offers new aspects of Bolivians’ health-seeking behaviour in Madrid, their Chagas screening, treatment practices and related attitudes. Despite the homogeneity of the sample, men and women had important differences in their behaviours that should be considered in the design of strategies to improve access of the endemic population to the diagnosis and treatment of Chagas.
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. Also, the number of children tested from positive mothers is low. Being diagnosed with and treated for Chagas is still a personal decision instead of a public health policy. An official protocol is needed to establish guidelines for the control and treatment of Chagas disease in Madrid. The fact that most Bolivians’ access to the health system is through the primary healthcare services should be considered when it comes to improving follow-up of treatment adherence.