Disease Prevention and Control / Communicable Diseases / Chagas Disease
National Strategic Plan for Chagas Disease, 2003–2007(JICA, Secretary of Health Honduras, PAHO/WHO, & CIDA-Canada) | ||
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Full text (in Spanish, 42 pp, PDF, 3276 Kb; chapter heading translated below for user orientation) Other Subregional Initiatives |
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In Honduras, the National Strategic Plan on Chagas Disease (PENCHAGAS) was developed within the framework of the Initiative of Central American Countries to Interrupt Vectoral and Trasfusional Transmission of Chagas Disease (IPCA) in collaboration with the Japan International Collaboration Agency (JICA), the Secretary of Health Honduras, and the Canadian International Development Agency (CIDA-Canada). Chagas Disease or American Trypanosomiasis was discovered in 1909 by Dr. Carlos Chagas in Brazil. It is endemic in the majority of Latin American countries, where it constitutes a serious public-health problem. It is estimated that some 20–25 million people are infected with the parasite, of which some 6–8 million have or will have some clinical manifestation of the chronic form of the disease. Vector-borne transmission by the blood-sucking insects of the subfamily Triatominae, both in traditionally endemic areas and in new ones, continues to represent the majority of the 200,000 new infections annually occurring in Latin America, according to estimates on incidence from the year 2000 (Control of Chagas Disease: WHO Report of the Expert Comittee. WHO Technical Report Series 905, 2002) .Various factors intervene the the vectoral transmission of Chagas disease—social, economic, ecological and cultural—determined by the type of housing and ecological relationship favoring household colonization by the vector and the vulnerability of communities at risk of infection. The first human case of Chagas Disease in Honduras was reported in 1960, but it was not until the 1970s and 1980s that the first seroepidemiological and entomological studies were carried out in the country. These showed the distribution of the two main vectors (Rhodnius prolixus and Triatoma dimidiata), and their association with the type of housing, as well as the seroprevalence by Trypanosoma cruzi in different areas of Honduras (Ponce and Zeledón, 1973; Ponce 1974). During the XIIIth Meeting of the Central American Health Sector (Reunión del Sector Salud de Centro América / RESSCA) in 1997, the Central American countries established in Resolution No. 13 that "control of Chagas' disease was a priority activity in the countries of Central America" (Report XIII RESSCA, Belize City, Belize. 1997). In order to implement this resolution, the countries agreed to form a Multinational Program to Interrupt Vector-Borne Transmission of Chagas' Disease and to Eliminate Transfusional Transmission of T. cruzi, or the Initiative of Central American Countries (IPCA). This Initiative, launched in Tegucigalpa in October 1997, seeks to prepare action plans and budgets for them, with the objective of guaranteeing the necessary funding to carry out the necessary activities. At the same time, the delegates adopted the following recommendations:
To date, six annual meetings have been held of IPCA's Intergovernmental Commission. However, the development of activities in the countries of the Central American subregion has not been homogeneous; in some of them, Chagas Disease still is not even considered a priority public-health problem. The 51st World Health Assembly, held on 16 May 1998, declared its involvement in eliminating the transmission of Chagas Disease by the end of 2010. It asked all Member States with populations still affected by this disease to precisely determine the extent of the disease, particularly the distribution and behavior of the vectors involved in its transmission. Furthermore, it asked them to conduct testing on the sensitivity of these vectors to the insecticides being used; to prepare action plans; to form multinational technical commissions to initiate the certification of elimination; and to coordinate the contributions of the international community, including multilateral and bilateral agencies and NGOs (WHA Resolution 51.14, 16 May 1998). At RESSCA 14 held in Guatemala City in August 1998, the Ministers of Health ratified that Chagas Disease control is a priority activity for the subregion. They approved developing a subregional project to eliminate transmission and holding the first follow-up meeting in Guatemala City in October 1998 (Report of the XIVth RESSCA. Guatemala City, Guatemala 1998). At RESSCA 15 held in San Salvador in October 1999, the Ministers of Health recognized the importance and severity of Chagas Disease in the subregion and urged countries to redouble their control and elimination efforts. They agreed to hold the second follow-up IPCA meeting in Managua (Nicaragua) in October 1999 (Report of the XVth RESSCA, San Salvador, El Salvador, 1999). In response to this important health problem, the Ministry of Health of Honduras has proposed among its policies and priorities the control of vector-borne diseases, among them Chagas Disease (source: Government Plan for Health Policy, 2002-2006). In accordance with these policies, this National Strategic Plan has been prepared for the prevention and control of Chagas Disease, through a sustained process of participatory planning during various workshops and technical workshops. This activity has been coordinated by the Ministry of Health with technical support from PAHO/WHO and broad multisectoral involvement, e.g. the Secretariat of Public Works, Transportation, and Housing (Secretaría de Obras Públicas, Transporte y Vivienda / SOPTRAVI), the Our Roots (Nuestras Raíces) Program, Honduran Social Investment fund (Fondo Hondureño de Inversiones Sociales / FHIS), and various international technical-cooperation agencies from Japan, Canada, Taiwan, and Sweden. International and national NGOs participating in the plan include World Vision Honduras, Doctors without Borders - Spain, Workers' Samaritan Federation Germany, Technical Council for Integrated Development in Honduras (ASB/COTEDIH). Present as well were representatives from the Lencas ethnic group. In structural terms, PENCHAGASS has been organized into four chapters:
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