A Community-Based Intervention for the Detection of Chagas Disease in Barcelona, Spain

Abstract

Chagas disease (CHD) has become a challenge in Spain due to the high prevalence of immigrants coming from endemic areas. One of the main difficulties for its control and elimination is its underdiagnosis. The identification and integral treatment of CHD are key to increasing rates of diagnosis, overcoming psycho-social barriers and avoiding CHD progression. Community interventions with in situ screening have proven to be a useful tool in detecting CHD among those with difficulties accessing health services. To determine the underdiagnosis rate of the population most susceptible to CHD among those attending two different Bolivian cultural events celebrated in Barcelona; to describe the sociodemographic characteristics of the people screened; and to analyse the results of the screening. The community interventions were carried out at two Bolivian cultural events held in Barcelona in 2017. Participants were recruited through community health agents. A questionnaire was given to determine the participants’ prior knowledge of CHD. In situ screening was offered to those who had not previously been screened. Those who did not wish to be screened were asked for the reason behind their decision. Results were gathered in a database and statistical analyses were performed using STATA v14. 635 interviews were carried out. 95% of the subjects reported prior knowledge of CHD. 271 subjects were screened: 71.2% women and 28.8% men, of whom 87.8% were of Bolivian origin. The prevalence of CHD was 8.9%. Community health interventions with in situ screening are essential to facilitating access to diagnosis.

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Fig. 1

Abbreviations

CHD:

Chagas Disease

WHO:

World Health Organization

NTD:

Neglected Tropical Diseases

USIDVH:

International Health Unit Drassanes-Vall d’Hebron

eSPiC:

Public Health and Community Team

ASAPECHA:

Asociación de Amigos de las personas afectadas por la enfermedad de Chagas - Associations of Friends of Chagas affected patients

IQR:

Interquartile range

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Acknowledgements

To the patients who participated in the community interventions, to ASAPECHA for the community work performed and to all the professionals involved in the in situ interventions and the development of the interviews. To Alexandra Craddock for the English editing of the manuscript.

Funding

This intervention was partially funded by the NGO Fundación Mundo Sano – España, financing part of the promotional material of the community intervention. The design of the study and the collection, the data analysis and its interpretation has not been funded.

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Authors

Contributions

All authors have made substantial contributions to conception and design of the intervention and acquisition of data. JGP, ICG, EC, IOS, NSD, CP, JJS and HO designed the in situ screening intervention. CP was the responsible for the intervention logistics. JGP, ICG, EC, IOS, NSD and HO interviewed the participants and collected the interview data. JGP, PPT and IOS collected the clinical data. ES and ME performed the laboratory tests. JGP, ICG, EC, IOS and HO participated in the follow-up of the patients. PPT performed the data analysis. All authors discussed the results obtained and the intervention performed. PAV and CAT contributed to the interpretation of the results. JGP and PPT wrote the first draft of the manuscript. All authors have revised critically the article for intellectual content. JGP and PPT wrote the final version of the manuscript. All authors approved the final version of the submitted manuscript. JGP and PPT are first co-authors of the manuscript.

Corresponding author

Correspondence to Jordi Gómez i Prat.

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Competing interests

The authors declare not having any potential conflict of interest to declare.

Ethics Approval

The Ethical Committee of Vall d’Hebron Hospital approved the study from an Ethical and Scientific point of view (number 339) (Supplemental Material 2).

Informed Consent

All the subjects who were interviewed gave informed verbal consent to participate in the study and also in the in situ screening. Verbal consent to participate was used rather than written consent as it was part of the conventional protocol of screening and follow-up of susceptible to Chagas Disease patients of our clinics. The procedures performed during the screening are the ones recommended by the WHO. No data containing personal or identifying information from the participants has been published.

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Gómez i Prat, J., Peremiquel-Trillas, P., Claveria Guiu, I. et al. A Community-Based Intervention for the Detection of Chagas Disease in Barcelona, Spain. J Community Health 44, 704–711 (2019). https://doi.org/10.1007/s10900-019-00684-z

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Keywords

  • Chagas
  • Community health
  • In situ screening
  • Community interventions