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Full Text (16 pp, PDF, 305 Kb)
1. Summary of the Accomplishments of the Chagas Disease Vector Control Project
1.1. Introduction
2. Outcome of vector-control activities
2.1. Vector survey
2.2. Vector-control activity
2.3. Impact of vector control
2.4. Capacity-building of project personnel
2.5. Implementation of social promotion
2.6. Collaboration with other institutions
2.7. Publicity about the project
3. Financial input and cost-benefit analysis of the project
3.1. Input for the project
3.2. Cost-benefit analysis
4. Advances in regional cooperation
5. Advances in other areas
6. Recommendations
6.1. Elimination of R. prolixus
6.2. Control of T. dimidiata
6.3. Capacity-building of vector-control personnel
6.4. Health education
 
- Guatemala Chagas Page
- IPCA Subregional Initiative
- PAHO Chagas Page
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Chagas disease is one of the most serious vector-borne diseases in Guatemala. It is estimated that in Guatemala 4,000,000 people are at risk for Chagas disease, 730,000 people are currently infected, and 30,000 people are infected annually. Chagas disease is a parasitic infection that in its chronic stage produces irreversible organ damage. It is caused by a flagellate protozoan, Trypanosoma cruzi, which is transmitted to humans through the feces of blood-sucking triatomine bugs. There are two main domiciliated triatomine species in Guatemala: Rhodnius prolixus and Triatoma dimidiata. Through a national survey conducted as part of Japan International Cooperation Agency (JICA)'s technical cooperation between 1995 and 1998, it was shown that the populations in the departments in the eastern part of the country were at highest risk of Chagas disease transmission.
The Central American Initiative for the Control of Vectoral and Transfusional Transmission of T. cruzi (IPCA) was launched in 1997 through the Meeting for the Health Sector of Central America (RESSCA). The initiative set a goal for the interruption of Chagas disease transmission by the end of 2010 through the elimination of R. prolixus, reduction in the domestic infestation index of T. dimidiata, and elimination of the transmission of T. cruzi through blood transfusion.
Under this initiative, the Ministry of Health of Guatemala (MSPAS) and JICA initiated a vector control project directed at eliminating Chagas disease transmission in five departments (Zacapa, Chiquimula, Jutiapa, Santa Rosa, and Jalapa) in the eastern region of Guatemala in January 2000, in collaboration with the Pan American Health Organization (PAHO), the Medical Entomology Research and Training Unit of Guatemala, the Centers for Disease Control of the United States (CDC), the Center for Health Studies of the Universidad del Valle (UVG) in Guatemala UVG/CDC-MERTUG), and the University of San Carlos of Guatemala (USAC).
In order to achieve these objectives, activities such as vector surveys, residual spraying with insecticides, capacity-building for vector-control personnel, and health education were implemented. In 2002, the project was extended for three more years to four additional departments: Alta Verapaz, Baja Verapaz, El Progreso, and El Quiche. The project is administered under a decentralized health system (SIAS: Sistema de Integración de Área de Salud), where each Health Area (Área de Salud) is responsible for project implementation. The ETV (Enfermedades Transmitidas por Vectores) team of each Health Area carries out the project activities.
At the central level, the National Vector-Control Program is responsible for project coordination and supervision. JICA provides experts at the central level and volunteers at the health-area level, all of whom provide technical assistance in project implementation.
Recommendations
In order to free Guatemala from the vectoral transmission of Chagas disease, the following recommendations are made for continued and future goals:
- Elimination of R. prolixus
- The MSPAS should strive to be certified for interrupting vectoral transmission of T. cruzi by R. prolixus by 2005 (Zacapa, Jutiapa, Jalapa, Santa Rosa) and 2006 (Chiquimula, El Progreso, Baja Verapaz, and El Quiche).
- 100% of the houses of all infested villages should be sprayed as soon as possible. Especially in Chiquimula, the MSPAS should increase input to assure coverage.
- 100% of the previously infested villages should be evaluated annually to assure elimination.
- All the villages in Zacapa, Chiquimula, and Jalapa should be surveyed to assure the absence of the vector.
- A vector-surveillance system with community participation should be established in areas previously infested by R. prolixus.
- Control of T. dimidiata
- 100% of the villages with domestic infestation indexes higher than 5–10%, and all the houses with nymphs (signs of colonization), should be sprayed.
- Post-spraying evaluation for vector-borne diseases (VBDs) should be implemented between 6 and 12 months after spraying and should be repeated to monitor domestic infestation and colonization.
- Vector-control activities should be expanded to other infested departments such as Huehuetenango and Guatemala, where JICA does not participate in the control program.
- A vector-surveillance system involving malaria volunteers, health promoters, the Social Action Group (GAS: Grupo de Action Social), and schoolteachers should be implemented in areas with high domestic infestation rates.
- Capacity-Building of Vector-Control Personnel
- A manual on vector-borne diseases (VBDs) should be developed and distributed and should include survey methods, spraying techniques, evaluation methods, and health education.
- A geographic information system (GIS) should be introduced to some Health Areas to help in precisely identifying vector location.
- It is important to provide the Chagas Disease Program Coordinator with a training opportunity on the diagnosis and clinical aspects of the disease as soon as possible, in order to strengthen the national prevention and control program.
- Health Education
- Priority should be placed on establishing a sustainable vector-surveillance system with community participation.
- A manual developed by a Japanese volunteer (Takero Nonami) should be distributed to health promoters, teachers, and community leaders to establish a surveillance system.
- Educational materials using illustrations only should be developed to provide information about the disease to the indigenous population who are not Spanish speakers.
- Regional Cooperation
- JICA should endeavour to provide technical assistance in vector control to the state of Chiapas (Mexico), to Nicaragua, and to Panama.
- JICA should seek human resources such as Japan Overseas Volunteers (JOCVs) and JICA experts in the area of geographical information systems (GIS) in order to introduce GIS to vector-control and surveillance programs in Central and South America.
- Inter-Institutional Cooperation
- Collaboration with PAHO/WHO should be continued and strengthened through technical cooperation to the countries (TCC), the IPCA initiative, the organization of joint regional meetings, and participation in international evaluation missions for Chagas disease control. The dispatch of a former Japanese volunteer from the JICA Chagas Disease Control Project (Ken Hashimoto) to the PAHO/WHO Guatemala office as a technical advisor on Chagas disease control will be an asset in strengthening the relationship between PAHO and JICA.
- The MSPAS, JICA, USAC and UVG should collaborate in providing technical assistance for Chagas Disease vector control in El Salvador and Honduras.
- Diagnosis
- The MSPAS should implement a serological survey on children in such high-risk health areas as Alta Verapaz, Baja Verapaz, El Progreso, El Quiche, and Huehuetenango, to diagnose the situation. The National Vector-Control Program should coordinate with the National Laboratory, USAC and UVG to implement this activity.
- Regular meetings should be held to help maintain, improve and strengthen disease diagnosis and blood-screening, involving the participation of the National Vector-Control Program, the National Blood Bank Program, the National Laboratory, PAHO, Doctors without Borders (Médicos sin fronteras/MSF) and JICA.
- UVG and USAC should be invited to these meetings to make the effort nationwide.
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