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Honduras stands out in fight against chagas disease

January 25, 2011

Authorities in San Francisco de Opalaca are growing accustomed to visitors. Several Latin American neighbours have toured this rural county in the mountains of Honduras to see how it is controlling the spread of Chagas disease. A major health problem in many Latin American countries, Chagas is transmitted from animals to humans by a common blood-sucking insect.

To date, officials from Ecuador and El Salvador have toured the area. Bolivia is expected to shortly, while Mexico has expressed interest in the project. Nicaragua, through information exchange, is already developing a program based on San Francisco de Opalaca’s experience.

In Tegucigalpa, the Honduran capital, the Health Ministry was impressed by the county’s results and adopted the model for application in six other departments, says sociologist Lombardo Ardón, who coordinated the project. The model is based on community involvement to both treat and prevent Chagas.

 
Lombardo Ardón
 
Strong community tradition

The research to develop the model began in 2004 as part of Honduras’ National Chagas Disease Control Program, a wholesale push to intervene in communities with a high incidence of Chagas. It was imperative first to identify the factors that contributed to the spread of the disease and their relationship with community culture and practices.

World Vision Honduras carried out the research as part of the IDRC-managed 2003-2007 Honduras Program, supported by the Canadian International Development Agency (CIDA).

José Antonio Velasquez, a county advisor, explains that San Francisco de Opalaca is predominantly populated by the Lenca Indigenous group.

“We are the only Indigenous county government in the country,” he notes. “Everything passes through the county government and then to the population for discussion and a vote at town hall meetings.”

This tradition of community participation assisted efforts to treat children with Chagas and educate the population on how to control insects that transmit the disease.
 
Lombardo Ardón
 
Education first

Previous research showed that Chagas primarily affects the rural poor. In San Franciso de Opalaca, poverty is widespread: 92% of its 9 000 residents live in extreme poverty and have limited access to potable water or electricity. Among children under five years old, malnourishment is a major concern.

The study found that close to 10% of 3 993 children over six months and under 15 years of age tested positive for Chagas infection. Children and women were most vulnerable to the disease because they spent more time indoors. The study also found that the traditional Lenca homes made of mud walls and thatched roofs—and which were often in a state of disrepair—were ideal shelters for the Chagas insect vector. Keeping animals within the homes also contributed to the spread of the disease.

To tackle the problem, authorities first had to convince the Lenca that Chagas was real. A chronic parasitic disease, it gradually damages the cardiovascular system and other parts of the body over a period of several decades. Untreated, it is often fatal. The years that elapse between the initial insect bite and the appearance of the disease’s symptoms make it difficult for people to appreciate severity of the disease.

World Vision Honduras joined a national wholesale spraying program, as well as a housing improvement and construction program to eliminate the Chagas-carrying insects in San Francisco de Opalaca. Residents reported that other insects, such as cockroaches, fleas, and scorpions, also disappeared. A strictly monitored treatment program for the tested children who had the disease followed.
 
Jon Warren
 
No longer out of reach

The treatment program posed particular challenges for health authorities. County residents are scattered across 292 square kilometres. Many people live in isolated communities and walk for up to six hours just to get to the health clinic in Monteverde.

The researchers’ solution was to identify community leaders, such as teachers, who became a means to ensure the proper administration of the treatment.

It was the leaders’ job to educate the community on the characteristics of both the Chagas-carrying insect and the children’s treatment. Once treatment started, leaders regularly visited homes to ensure that children were taking their medicine, to monitor the children’s health, and to note any signs of adverse reactions. The leaders recorded their findings and reported to the health authorities, who acted on the information.

The treatment regime brought added benefits to the population. Many of the children to be treated for Chagas showed signs of malnourishment and other illnesses. Those conditions had to be treated before the medication for Chagas could be given. The overall health of the participating children improved significantly as a result of the project.

Constant vigilance

The World Vision project team trained students and teachers in the county’s 22 communities to identify and remove the insects, with the understanding that this information would be passed on to adults.

In addition, local action groups—involving the Church, women, parents, children, and community leaders—monitored homes and surrounding areas for signs of re-infestation.

World Vision Honduras’ effort to build new houses, in partnership with the national foundation for housing, was an important step in fighting Chagas transmission. To date, 45% of the county’s residents have new homes made of materials—adobe brick walls, cement floors and zinc sheet roofs—that do not attract insects, Velasquez reports. Additional efforts are underway to ensure that new homes and building materials are appropriate to the Lenca culture.

“The key to all of this was community participation,” says Dr Yovani Cardona, who runs the local clinic and actively participated in the program. Home construction, spraying, home monitoring, and education relied heavily on community engagement.

An evaluation showed that in 2007, 87% of the 390 treated children had been cured. Of the 960 children born after the program began in 2004, none were infected, Ardón says. It is this success that is drawing Honduras’ Latin American neighbours to San Francisco de Opalaca.