A Multidisciplinary, Collaborative, Inter-agency and Comprehensive Approach for the Control of Chagas Disease as a Public Health Problem in Guatemala.

Abstract Background : Central America is considered a hotspot for Chagas disease transmission and the most important vector in the northern region is Triatoma dimidiata; a native vector adapted to multiple environments, including intra domestic and peri-domestic habitats. Chagas Disease is the leading cause of death associated with heart disease in Latin America, affecting mostly low-resources populations and the presence of the vector is associated to poor house constructions. Methods: A multi-institutional project named “Alliances for the elimination of Chagas in Central America” was created to help reduce the incidence of the disease in the region. Each institution performing specific role including aspects of vector control, quality of housing, surveillance implementation, diagnosis and treatment of individuals, health promotion, and training of human resources. Results: Eleven villages were entomologically evaluated; five villages were found to have high infestation rates (>20%), three had average infestation rates (10-20%) and three had low-infestation rates (<10%), coinciding with the type of risk-dwelling found in each of one. Additionally, all the villages had colonization rates greater than 50%, and several showed important levels of triatomine overcrowding. This high colonization dynamic represents a high risk of vector transmission of Chagas disease; it was necessary to improve the household so as to make them refractory to infestation, reducing those characteristics that are appropriate for colonization. Serological tests carried out in two of the 11 villages showed that children under five years of age were not infected and the prevalence of infection was higher in women than men, showing the importance of women in the disease transmission dynamics, making education and empowerment directed towards women critical for transmission control. Conclusion: Several institutions working together with specific roles promotes the community partition in several activities as vector control and patience attendance. Some epidemiological factor of the native vector was described. Trial registration: The study received clearance from San Carlos University bioethics committee, Guatemala City, Guatemala (AC-010-2018).