Chagas Disease Vector Control Project in Guatemala: Progress Report, January–May 2001

Full Text (in Spanish, PDF, 36 pp, 2 Mb; chapter heading translated below for user orientation)
Summary
1. Chagas Disease Vector Control Project in the Republic of Guatemala
1.1. Background
1.2. Project Objetives
1.3. Expected Results
1.4. Activities
1.5. Strategy
1.6. Project Phases
1.7. Structure and Implementation
1.8. Investment in the Project
2. Project Progress
2.1. Elimination of R. prolixus and Reduction of the T. dimidiata Insect Population
2.2. Human-Resource Training
2.3. Implementation of Social Promotion
2.4. Participation in Regional Meetings
2.5. Plan
3. Progress in Other Areas of Chagas Disease Control
3.1. Updating Care Practices
3.2. Blood Banks
3.3. Diagnosis
Annexes
Annex 1: Project Design
Annex 2: Project Organizational Chart
Annex 3: Project Timeline

- Activities in Guatemala
- IPCA Subregional Initiative
- PAHO Chagas Page

Summary

Chagas disease only exists in the American hemisphere. It is produced by the parasite Trypanosoma cruzi and transmitted in our country by the vectors Rhodnius prolixus, Triatoma dimidiata, and Triatoma nítida. It can also be transmitted transfusionally via infected blood, by an infected mother to her child during pregnancy, and through organ transplants. Anybody is susceptible.

The World Health Organization (WHO) estimates that, in Guatemala, 780,000 people are at risk of contracting the disease and 30,000 are infected each year. Diagnosis is difficult and treatment is not commercially available in the country.

Prevention is the most important aspect for controlling the disease, with active involvement of various sectors and most importantly of members of the community, through improvement in the areas of Education and Social Promotion, Vector Control, and Housing Improvement.

In 1998, during the Fourth Meeting of the Health Sector of Central America and the Dominican Republic (RESSCA/98), the elimination of Chagas disease was established as a goal for the year 2010 in the region.

The year 2000 marked the implementation of the Chagas Disease Vector Control Project, whose general objective is to eliminate transmission of the disease in Guatemala by 2010 and whose specific objective is to interrupt vector-borne transmission in eight Health Districts. Activities are carried out by the Ministry of Public Health and Social Welfare (MSPAS), by means of its Vector-Borne Disease Program, and strengthened by support from the Japanese government through the Japan International Cooperation Agency (JICA), working in coordination with the University of San Carlos of Guatemala (USAC), Del Valle University of Guatemala (UVG)/CDC-MERTUG, PAHO/WHO, the European Union-APRESAL, UNICEF and local NGOs.

This coordination is a vital part of the project, specifically of its strategy of intersectoral collaboration used to generate all the available information, using it to plan two pesticide sprayings during the first phase of the project and to stratify five priority Departments in the country (Chiquimula, Zacapa, Santa Rosa, Jutiapa, and Jalapa). The spraying activities, that currently reach 39% of the 74,556 dwellings covered by the program, are accompanied by social promotion activities involving training for both institutional personnel and the community at large.

As a part of the strategy of regional collaboration, there is much exchange of information and experiences among the countries, which are then adapted and applied to our own environment.

Carried out simultaneously with project activities are health care and patient follow-up for persons infected with Chagas disease. These activities take into account existing weaknesses in the health-service network in detecting suspected cases during the acute and indeterminate phase, in conducting examinations to confirm diagnosis, and in acquiring the drugs that work against the parasite (Benzonidazole or nifurtimox`), which are produced and marketed only in South America.

The majority of suspected cases in Guatemala are detected in blood banks during tests to screen blood donors, in research conducted by USAC and UVG/CDC-MERTUG, and in public hospitals during the chronic phase where irreversible harm has already occurred. Screening tests are carried out using different methodologies, which increases the risk of imprecise results. Moreover, a high percentage of the examinations confirming diagnosis are conducted by the same universities in outreach activities, by public hospitals whenever reagents are available to carry out two tests using different methodologies, and the rest by private laboratories.