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Controlling congenital and paediatric chagas disease through a community health approach with active surveillance and promotion of paediatric awareness.

Soriano-Arandes A, Basile L, Ouaarab H, Clavería I, Gómez i Prat J, Cabezos J, Ciruela P, Albajar-Viñas P, Jané M - BMC Public Health (2014)

Bottom Line: Finally, two (6.9%) of the 29 newborns tested with serology were positive.It is essential to implement active surveillance, education and information activities at paediatric primary care and community levels to avoid the loss of CD-infected mothers and their newborns.Training sessions addressed to paediatricians and other involved health professionals would consolidate surveillance and care reference circuits, improving the control of congenital CD.

View Article: PubMed Central - PubMed

Affiliation: Unitat de Salut Internacional, PROSICS, Programa Especial de Malalties Infeccioses Vall d'Hebron-Drassanes, Barcelona, Spain. tsorianoarandes@gmail.com.

ABSTRACT

Background: Chagas disease (CD) is endemic in countries of continental Latin America. Congenital transmission is a major concern worldwide. In 2010, the Public Health Agency of Catalonia (ASPCAT) launched a screening protocol for Trypanosoma cruzi infection in pregnant women and their newborns. In 2012, ASPCAT detected appropriate follow-up of pregnant women but incomplete information about their offspring.

Methods: The PROSICS community health team carried out active surveillance and community health action in target populations. These activities included active case searches, group awareness workshops and visualization campaigns as well as investigation of all lost children born from pregnant women with CD and their families.

Results: Overall, 42/179 (23.5%) cases were included in the study: 35/42 (83.3%) children were born in Hospitalet de Llobregat (Catalonia, Spain); 4/42 (16.7%) were born in Latin America; two were miscarried and one was stillborn. The mean age of pregnant women was 31.3 years (SD 5.52; range: 21-44): 90.5% were Bolivian, of whom 74% were diagnosed with CD during pregnancy. Of the 35 newborns, 31 were recovered by community health action; 12/31 were correctly controlled at Hospitalet de Llobregat and 19/31 were controlled at a primary health centre. Of these 19 (73.7%) cases, 14 were not tested for CD by family paediatricians and were recovered by the PROSICS community health team. Finally, two (6.9%) of the 29 newborns tested with serology were positive.

Conclusions: It is essential to implement active surveillance, education and information activities at paediatric primary care and community levels to avoid the loss of CD-infected mothers and their newborns. Training sessions addressed to paediatricians and other involved health professionals would consolidate surveillance and care reference circuits, improving the control of congenital CD.

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Related in: MedlinePlus

Pathway for screening and diagnosis in pregnant women and newborns. (Source: Protocol for screening and diagnosing Chagas disease in pregnant Latin American and their newborns.pdf; accessed 6 May 2014).
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Fig1: Pathway for screening and diagnosis in pregnant women and newborns. (Source: Protocol for screening and diagnosing Chagas disease in pregnant Latin American and their newborns.pdf; accessed 6 May 2014).

Mentions: Given the potential risk of congenital CD in Catalonia, the Public Health Agency of Catalonia (ASPCAT) launched the “Protocol for screening and diagnosing Chagas disease in pregnant Latin American and their newborns” in 2010 [13], targeting Latin American pregnant women attending antenatal consultations in Catalonia (Figure 1). The aim of the Protocol is to detect T. cruzi-positive pregnant women and follow up their offspring until 9 months of age in order to elucidate their definitive CD status. The implementation of information, education and communication activities was planned, including training of health professionals working with CD detection and treatment, and specific sessions for those working in health centres with prenatal activities. Midwives, nurses, obstetricians, primary health care physicians and paediatricians attending these sessions were trained on T. cruzi infection, diagnosis and its care, with focus on congenital CD. According to the 2012 report of the Statistical Institute of Catalonia (IDESCAT), 333,703 Latin American immigrants were living in Catalonia (15.7% from Bolivia), 6,795 newborns (15.4% from Bolivia) were delivered by pregnant women at risk of CD and an estimated 203–387 pregnant women (90% from Bolivia) were infected with T. cruzi. The expected number of T. cruzi-infected newborns was therefore 7–16 per year [14].Figure 1


Controlling congenital and paediatric chagas disease through a community health approach with active surveillance and promotion of paediatric awareness.

Soriano-Arandes A, Basile L, Ouaarab H, Clavería I, Gómez i Prat J, Cabezos J, Ciruela P, Albajar-Viñas P, Jané M - BMC Public Health (2014)

Pathway for screening and diagnosis in pregnant women and newborns. (Source: Protocol for screening and diagnosing Chagas disease in pregnant Latin American and their newborns.pdf; accessed 6 May 2014).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4289304&req=5

Fig1: Pathway for screening and diagnosis in pregnant women and newborns. (Source: Protocol for screening and diagnosing Chagas disease in pregnant Latin American and their newborns.pdf; accessed 6 May 2014).
Mentions: Given the potential risk of congenital CD in Catalonia, the Public Health Agency of Catalonia (ASPCAT) launched the “Protocol for screening and diagnosing Chagas disease in pregnant Latin American and their newborns” in 2010 [13], targeting Latin American pregnant women attending antenatal consultations in Catalonia (Figure 1). The aim of the Protocol is to detect T. cruzi-positive pregnant women and follow up their offspring until 9 months of age in order to elucidate their definitive CD status. The implementation of information, education and communication activities was planned, including training of health professionals working with CD detection and treatment, and specific sessions for those working in health centres with prenatal activities. Midwives, nurses, obstetricians, primary health care physicians and paediatricians attending these sessions were trained on T. cruzi infection, diagnosis and its care, with focus on congenital CD. According to the 2012 report of the Statistical Institute of Catalonia (IDESCAT), 333,703 Latin American immigrants were living in Catalonia (15.7% from Bolivia), 6,795 newborns (15.4% from Bolivia) were delivered by pregnant women at risk of CD and an estimated 203–387 pregnant women (90% from Bolivia) were infected with T. cruzi. The expected number of T. cruzi-infected newborns was therefore 7–16 per year [14].Figure 1

Bottom Line: Finally, two (6.9%) of the 29 newborns tested with serology were positive.It is essential to implement active surveillance, education and information activities at paediatric primary care and community levels to avoid the loss of CD-infected mothers and their newborns.Training sessions addressed to paediatricians and other involved health professionals would consolidate surveillance and care reference circuits, improving the control of congenital CD.

View Article: PubMed Central - PubMed

Affiliation: Unitat de Salut Internacional, PROSICS, Programa Especial de Malalties Infeccioses Vall d'Hebron-Drassanes, Barcelona, Spain. tsorianoarandes@gmail.com.

ABSTRACT

Background: Chagas disease (CD) is endemic in countries of continental Latin America. Congenital transmission is a major concern worldwide. In 2010, the Public Health Agency of Catalonia (ASPCAT) launched a screening protocol for Trypanosoma cruzi infection in pregnant women and their newborns. In 2012, ASPCAT detected appropriate follow-up of pregnant women but incomplete information about their offspring.

Methods: The PROSICS community health team carried out active surveillance and community health action in target populations. These activities included active case searches, group awareness workshops and visualization campaigns as well as investigation of all lost children born from pregnant women with CD and their families.

Results: Overall, 42/179 (23.5%) cases were included in the study: 35/42 (83.3%) children were born in Hospitalet de Llobregat (Catalonia, Spain); 4/42 (16.7%) were born in Latin America; two were miscarried and one was stillborn. The mean age of pregnant women was 31.3 years (SD 5.52; range: 21-44): 90.5% were Bolivian, of whom 74% were diagnosed with CD during pregnancy. Of the 35 newborns, 31 were recovered by community health action; 12/31 were correctly controlled at Hospitalet de Llobregat and 19/31 were controlled at a primary health centre. Of these 19 (73.7%) cases, 14 were not tested for CD by family paediatricians and were recovered by the PROSICS community health team. Finally, two (6.9%) of the 29 newborns tested with serology were positive.

Conclusions: It is essential to implement active surveillance, education and information activities at paediatric primary care and community levels to avoid the loss of CD-infected mothers and their newborns. Training sessions addressed to paediatricians and other involved health professionals would consolidate surveillance and care reference circuits, improving the control of congenital CD.

Show MeSH
Related in: MedlinePlus