Aké-Chan Mariela, Sanmartino Mariana, Castillo-Burguete María Teresa, González-Martínez Adriana, Ibarra-Cerdeña Carlos N
Departamento de Ecología Humana, Cinvestav, Mérida, México.
Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Física de Líquidos y Sistemas Biológicos, Grupo de Didáctica de las Ciencias, La Plata, Buenos Aires, Argentina.
PLoS Negl Trop Dis. 2025 May 7;19(5):e0013052. doi: 10.1371/journal.pntd.0013052. eCollection 2025 May.
Chagas disease, caused by the parasite Trypanosoma cruzi, remains a significant public health challenge in México, symbolizing systemic neglect in healthcare. Despite longstanding efforts to control its transmission, there are critical gaps in the alignment of public health policies with the lived experiences of affected individuals. This study examines these dissonances by analyzing qualitative interviews with 61 individuals diagnosed with T. cruzi and reviewing relevant Mexican public health regulations, including national standards and action programs. Findings reveal that most diagnoses occur incidentally, such as during blood donation or vector control campaigns, with minimal active case detection at the primary healthcare level. Affected individuals often encounter insufficient follow-up care, significant barriers to treatment, and misinformation that exacerbates psychological distress. Among the 14 participants who received etiological treatment, access was frequently due to individual persistence rather than systemic support, highlighting inequities in healthcare delivery. Additionally, structural barriers, including economic constraints and insufficient local healthcare infrastructure, further limit access to timely diagnosis and treatment, particularly in rural areas. Policy gaps include the absence of universal T. cruzi testing for pregnant individuals, lack of vertical transmission prevention strategies, and inadequate communication between healthcare providers and patients. Current public health initiatives disproportionately prioritize vector control and blood bank screening, neglecting the broader social and economic challenges faced by those already diagnosed. The study underscores the urgent need for a transdisciplinary approach to Chagas disease management in México, integrating biomedical, sociocultural, and policy perspectives. Recommendations include implementing universal prenatal screening for T. cruzi, enhancing health communication strategies, reframing Chagas as a manageable condition to reduce stigma, and improving follow-up care protocols. Addressing these challenges requires intersectoral collaboration and an inclusive approach that values the lived experiences of affected communities. By bridging the gap between policy and practice, this research contributes to the development of holistic strategies that not only control Chagas disease transmission but also improve the quality of life for those already impacted. These insights are essential for informing public health reforms in México and other endemic regions, advancing equity and effectiveness in neglected tropical disease management.
恰加斯病由克氏锥虫寄生虫引起，在墨西哥仍然是一项重大的公共卫生挑战，象征着医疗保健方面的系统性忽视。尽管长期以来一直在努力控制其传播，但公共卫生政策与受影响个体的实际生活经历之间仍存在关键差距。本研究通过分析对61名被诊断为克氏锥虫感染的个体进行的定性访谈，并审查相关的墨西哥公共卫生法规，包括国家标准和行动计划，来审视这些不一致之处。研究结果显示，大多数诊断是偶然发生的，比如在献血或病媒控制活动期间，基层医疗保健层面的主动病例检测极少。受影响的个体经常遭遇后续护理不足、治疗的重大障碍以及加剧心理困扰的错误信息。在接受病原治疗的14名参与者中，获得治疗往往是由于个人的坚持而非系统性支持，这凸显了医疗保健服务提供方面的不公平。此外，包括经济限制和当地医疗基础设施不足在内的结构性障碍，进一步限制了及时诊断和治疗的可及性，尤其是在农村地区。政策差距包括缺乏针对孕妇的普遍克氏锥虫检测、缺乏垂直传播预防策略以及医疗保健提供者与患者之间沟通不足。当前的公共卫生举措过度优先考虑病媒控制和血库筛查，而忽视了已确诊患者面临的更广泛的社会和经济挑战。该研究强调，墨西哥迫切需要一种跨学科方法来管理恰加斯病，整合生物医学、社会文化和政策视角。建议包括实施针对克氏锥虫的普遍产前筛查、加强健康传播策略、将恰加斯病重新定义为可控制的疾病以减少污名化，以及改进后续护理方案。应对这些挑战需要跨部门合作以及一种重视受影响社区实际生活经历的包容性方法。通过弥合政策与实践之间的差距，本研究有助于制定全面战略，不仅能控制恰加斯病的传播，还能改善已受影响者的生活质量。这些见解对于为墨西哥和其他流行地区的公共卫生改革提供信息、推进被忽视热带病管理的公平性和有效性至关重要。
