IRD UMR216, Mother and child facing tropical infections, La Paz, Bolivia.
Trop Med Int Health. 2011 May;16(5):562-9. doi: 10.1111/j.1365-3156.2011.02746.x. Epub 2011 Feb 22.
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.
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.
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.
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.
展示一种基于主动搜索孕妇和新生儿家庭的屋到屋筛查系统在农村地区用于先天性恰加斯病的可行性，该系统除了在医疗机构进行被动病例检测外，还可用于主动搜索孕妇和新生儿家庭。
研究小组进行探索性阶段，然后由市卫生服务协调开展操作性阶段。对接受产前保健或由现场调查员上门访问的孕妇采集血清学和寄生虫学检测查加斯病（Trypanosoma cruzi）的血样。对感染 T. cruzi 的孕妇所生婴儿在出生时和 1 个月及 7 个月龄时进行感染检查。
64.5%的孕妇感染。在出生时，对血清学反应阳性母亲所生的 299 名婴儿中的 4.0%（12/299）诊断为先天性感染。在 1 至 7 个月龄的儿童中又诊断出 12 例感染（4%）。最后，在探索性阶段有 37%的儿童失访，在操作性阶段有 53%的儿童失访（P=0.002），这显著少于大多数被动病例检测研究。
尽管将上门筛查活动的结果转移到卫生系统后结果较差，但基于主动和被动病例检测的综合策略似乎对识别农村地区的先天性恰加斯病病例有效。
