Fundación Mundo Sano, Buenos Aires, Argentina.
Fundación Mundo Sano, Añatuya, Santiago del Estero, Argentina.
PLoS Negl Trop Dis. 2023 Jun 14;17(6):e0011410. doi: 10.1371/journal.pntd.0011410. eCollection 2023 Jun.
Chagas Disease (ChD) is a Neglected Tropical Disease (NTD) affecting 6 to 7 million people worldwide, mostly from Latin America. In Argentina, a national control program has been implemented since 1962, yet there are still an estimated 1.6 million infected individuals. Control programs were based almost exclusively on entomological surveillance and chemical control of households and were not continuous given a lack of coordination and resources. Argentina´s ChD program was originally vertical and centralized; later, it was partially and, in general, unsuccessfully transferred to the provinces. Herein, we describe the implementation of a control program for ChD with an ecohealth approach in rural settlements around the city of Añatuya, Santiago del Estero.
The program included yearly household visits for entomological surveillance and control, health promotion workshops, and structural house improvements. Improved structures included internal and external walls and roofs, as well as the construction of water wells and latrines, and the organization and improvement of peri-domestic structures. Activities were carried out by specifically trained personnel except for house improvements, which were performed by the community, under technical guidance and provision of materials. Data was collected using standardized questionnaires for household characterization, entomological infestation status and chemical control activities.
This program was continuously implemented since 2005 with high community participation and adherence, incorporating 13 settlements and 502 households. During the surveillance phase, 4,193 domiciliary inspections were performed, and both the intra- and peri-domestic infestation rate were reduced from 17.9% to 0.2% (P < 0.01) and from 20.4% to 3%, respectively. Additionally, 399 households were structurally improved.
The program is still ongoing and, after 14 years of implementation, has built social networks and collaboration between implementers and beneficiaries with a reduction of T. infestans infestation in the intra- and peri-domicile. This reduction, especially inside the household, has enabled access to diagnosis and treatment of the population, with minimal risk of re-infection.
恰加斯病（Chagas Disease，ChD）是一种被忽视的热带病（Neglected Tropical Disease，NTD），全球约有 600 至 700 万人受其影响，其中大部分来自拉丁美洲。在阿根廷，自 1962 年以来一直实施国家控制计划，但估计仍有 160 万感染个体。控制计划几乎完全基于家庭的昆虫学监测和化学控制，由于缺乏协调和资源，该计划并非连续实施。阿根廷的恰加斯病计划最初是垂直和集中的；后来，它部分地、总体上但不成功地转移到了各省。在此，我们描述了在圣地亚哥德尔埃斯特罗省阿纳图亚市周边农村定居点实施恰加斯病控制计划的情况，该计划采用生态健康方法。
该计划包括每年对家庭进行昆虫学监测和控制、健康促进研讨会以及结构房屋改善。改进的结构包括内部和外部墙壁和屋顶，以及水井和厕所的建造，以及周边结构的组织和改善。活动由专门培训的人员开展，除了房屋改善外，房屋改善由社区在技术指导和材料提供的情况下进行。使用标准化问卷收集家庭特征、昆虫学感染状况和化学控制活动的数据。
自 2005 年以来，该计划一直在持续实施，社区参与度和依从性很高，涵盖了 13 个定居点和 502 户家庭。在监测阶段，共进行了 4193 次家庭检查，家庭内和家庭周边的感染率分别从 17.9%降至 0.2%（P<0.01）和从 20.4%降至 3%。此外，有 399 户家庭进行了结构性改善。
该计划仍在继续进行，实施 14 年后，已经建立了实施者和受益者之间的社会网络和合作关系，减少了家庭内和家庭周边的克氏锥虫感染。这种减少，特别是在家庭内部，使得人们能够获得诊断和治疗，同时最小化了再次感染的风险。
