Also called American trypanosomiasis, Chagas disease was first discovered by the clinician and scientist Carlos Justiniano Ribeiro Chagas in 1909 in Brazil, who identified a new species of flagella...

In the Americas, the Pan American Health Organization (PAHO) has promoted initiatives that aim at the elimination of mother-to-child transmitted diseases for over two decades. Although Guatemala has assumed the commitment to improve access and coverage of reproductive and perinatal services, the goals have not yet been reached. Often, the implementation of these efforts is hampered by complexities rooted in social, cultural, and environmental intersections. The objective of this work is to share our experience applying gender intersectionality as a methodological and analytical tool in a participatory research project that aims to improve access to maternal and child health screening services. The study shows the novel strategy that incorporates intersectionality contributing to evidence on how it can be applied to strengthen public health efforts around the implementation of the EMTCT Plus (Elimination of mother-to-child transmission of HIV, Syphilis, Hepatitis B, and Chagas disease) framework, in the mostly rural municipality of Comapa, in Guatemala. We applied a participatory methodology, integrating theoretical and methodological frameworks to have an intersectional understanding of health services delivered by both, midwives, and the public health institution, for the prevention, diagnosis, treatment, and follow-up of HIV, Syphilis, Hepatitis B, and Chagas. The data was collected by conducting interviews, focus groups, workshops, and reviewing laboratory databases, guided by five strategies from a cultural appropriateness framework. The intersectional analysis shed light on the synergies and gaps of the current efforts and protocols implemented by both the midwives and the Ministry of Health. The services offered for the four diseases were often delivered independently from each other, and a comprehensive educational and communication material strategy was absent. However, our findings will be used to inform consistent, locally relevant, and culturally appropriate educational content for the local population, also following the national policy guidelines. Using intersectionality as a method and as an analytical tool allowed us to understand the (1) interrelation of diverse social, cultural, and environmental determinants which influence the delivery of health services, as well as (2) the dynamics between the traditional and institutional health systems. (3) Community engagement and the participation of different stakeholders in a consultative process have been fundamental for the conceptual and methodological tenets of this research. (4) Finally, giving a more prominent role to midwives can strengthen sustainability and cultural appropriateness, which is complementary to the delivery of institutional health services.

This qualitative study of the situation of Latin American migrants with Chagas Disease in Geneva analyses how precarious migration-related socioeconomic conditions determine health priorities and disease perception. The study was conducted between 2016 and 2019 and is based on survey data collected in three Chagas-related community events, as well as on open-ended interviews with Bolivian migrants. This research contributes to more appropriate development of public health policies for migrants, as well as to a more nuanced and culturally sensitive understanding of how precarity affects the delivery of, and access to, healthcare in Western Europe. The significance of this research is to highlight how perceptions of Chagas Disease provide a lens to better understand the links between precarity and health among Bolivian migrants.

Congenital transmission is a key route of Trypanosoma cruzi infection in Latin America and globally, contributing significantly to the burden of Chagas disease. The interruption of transmission from mother to child has recently become a focus issue. However, the research landscape on congenital Chagas disease remains largely unexplored. The purpose of this scoping review is to assess the production of knowledge on congenital Chagas disease (CCD), aiming to identify research trends and potential gaps. Our initial hypothesis was that the CCD literature overly represents the medical sciences and that there is a need for socio-cultural research on the subject. We conducted a systematic search of publications focusing on congenital Chagas disease in six languages (English, Spanish, Portuguese, French, German and Italian). This comprehensive literature search identified 876 studies that met the inclusion criteria, out of a total of 8893 sources. The relevant literature was analyzed by language, year of publication, discipline, source type and research location. The main outcome of this study has been to prove our hypothesis that there is a scarcity of knowledge produced within the non-biomedical sciences on CCD. This underscores the need for further exploration into the social and structural issues surrounding this disease. Visually clear data concerning congenital Chagas disease produced by this study can contribute to hone in future research efforts and support funding applications. Additionally, this article provides a reference list that other researchers can consult for their own studies.

Chagas is a zoonotic disease conditioned by the need to eliminate or control the vector in human settlements before targeting infected individuals. Simultaneously it is necessary to raise awareness of health problems generated by chronic Chagas disease (ChD), for people to participate actively in vector control programs that will then enable the implementation of screening, treatment and follow-up strategies. Therefore, it is essential to engage the participation of the community in holistically designed integral programs to address ChD in all its complexity. This Perspective presents the case of Chagas management programs in the Department of General Taboada, Province of Santiago del Estero, Argentina, to showcase a possible strategy in vector control, diagnosis and treatment programs that integrate ChD into the local public health system and engage community participation. Through this Perspective we argue for the importance of the contribution of social science methodologies and epistemologies in the process of integrating ChD into the public (and primary) health care system.

Resumen: El Chagas es una enfermedad endémica en la región de las Américas. En la República Argentina hay aproximadamente 750.000 personas infectadas. Con una prevalencia de 1,59 cada 100 habitantes, se considera un problema de la salud pública. Este trabajo presenta la elaboración de un mapa de recorrido del paciente en personas con sospecha de Chagas. Se analizaron los registros de 205 consultantes en un programa de acompañamiento a personas con inquietudes sobre la enfermedad de Chagas en Argentina. La sistematización de experiencias personales mediante análisis cualitativo permite visibilizar los puntos de contacto críticos del paciente con el sistema de salud en el proceso de diagnóstico y tratamiento, identificando barreras de acceso al sistema de salud. La contribución principal del análisis es la demostración de la preponderancia de las barreras sistémicas sobre las personales como obstáculos para acceder al diagnóstico y sobre todo al tratamiento. La barrera más significativa resultó ser información incorrecta o insuficiente brindada por parte de los profesionales de salud, lo cual apunta a medidas concretas de capacitación a equipos de salud como estrategia de mejora de acceso al tratamiento.