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Health Surveillance and Disease Prevention and Control / Communicable Diseases / Chagas

Workshop to Design a Comprehensive Strategy for Primary Health Care (PHC) for Controlling Chagas Disease in the Chaco Region: Elaboration of a Protocol and Intervention Guidelines in Three Pilot Areas

(La Paz, Bolivia, 14–16 May 2008)

Strategy to Fight Chagas in the Chaco Region
Report (in Spanish, 28 pp, PDF, 1.72 Mb, with links to chapters in Table of Contents; chapter headings translated below for user orientation)
- Prologue by the Minister of Health of Bolivia
- Prologue by PAHO/WHO-Bolivia (text translated to right)
I. Introduction (text translated to right)
II. Statement
III. Objectives
(text translated to right)
- Criteria for Including/Excluding Localities
IV. Intervention Areas
V. Vector Control Component
VI. Research & Entomological Surveillance Component

- Organizing Field Work & General Procedures
- Research
VII. Solidarity in Healthy Housing Component
- Improving Households & Surrounding Areas
- Healthy Housing Concept
VIII. Information/Education/Communication (IEC) Component
IX. Diagnostics & Treatment Component

- Areas of Agreement
- Objectives
- Conditions for Diagnostics & Treatment
- Strategies
X. Project Team & Responsibilities - National Chagas Program
- Departmental Chagas Program
- Local Team
- Consulting & Evaluating Team
XI. Conditions for Health Service Network
XII. General Project Timetable

Annex I: List of Participants
Annex 2: Information on Areas of Work in Chagas—Design of the Comprehensive Strategy for Chagas Control in the Biogeographic Region of the Bolivian Chaco (PowerPoint presentation with maps and photos)

Subregional Initiatives
- AMCHA (Amazon)
- INCOSUR (Southern Cone)
- IPCA (Central America)
- IPA (Andean Region)

- Geographical Distribution of Triatomines
- Geoepidemiological Spaces

Photo Galleries
- Victims
- At-Risk Housing
- Parasite Trypanosoma cruzi
- Vector Triatoma infestans

PAHO Links
- Chagas Page
- Regional Chagas Program
- Tropical Disease Research:

Other Documents of Interest
- Southern Cone Workshop on Chagas Disease: Conceptualization of Epidemiological Surveillance (Buenos Aires, Argentina, September 2003)
- PAHO Working Group on Advanced Vector Control (Spanish only)
- Process Evaluation Guide (Spanish only)
- Determining Insecticides for Vector Control (Spanish only)

Prologue by PAHO/WHO-Bolivia

Various epidemiological and ecobiological conditions in Bolivia have shaped situations highly endemic for Chagas disease, which both the country and especially communities havebeen facing resolutely and steadfastly. One example of this is the fact that the country has incorporated Chagas control as one of its priorities for the achievement of the Millennium Development Goals (MDGs).

Controlling Triatoma infestans and transfusional transmission as well as providing adequate care of the patients with Chagas disease have been short-term objectives and long-term goals on which Bolivia has be working intensely at different periods and stages. A great deal has already been done though a great deal remains yet to be done.

During the management and execution of the Inter-American Development Bank (IDB's) Chagas Project, the National Program for Chagas Control has shown radical improvement in indicators of infestation and household colonization by T. infestans; though these could be broader and more impressive, great changes in the profile have has invariably occurred. | Press release on IDB activities to fight Chagas in Bolivia

Among the remaining tasks, notable is the need to provide continuous solutions in the Chaco region for this endemic disease and its still-active transmission. The Chaco is a hyperendemic area for Chagas disease in the three countries that comprise this biogeographical region (Argentina, Bolivia, and Paraguay); its epidemiological, ecobiological, and socioeconomic conditions constitute a great challenge for the Chagas prevention and control.

From this perspective, the Ministry of Health and Sports of Bolivia—together with other ministries, PAHO/WHO, and the Spanish International Development Cooperation Agency (Agencia Española de Cooperación Internacional para el Desarrollo / AECID*)—formulated this Comprehensive Strategy for Primary Health Care (PHC) for Controlling Chagas Disease in the Chaco Region: Elaboration of a Protocol and Intervention Guidelines in Three Pilot Areas.

This is a proposal for comprehensive, integrated work to respond both effectively and efficiently to Chagas disease, endemic in the Chaco. It takes its strength from the Bolivian nation and its communities, in its capacity to work and its community organization.

Bolivia is thus beginning a new era with optimism, with PAHO/WHO and AECI technical cooperation putting themselves to work for the health of many, in order that it might be ensured …

Dr. Cristián Darras,
Representative PAHO/WHO-Bolivia

Formerly named the Agencia Española de Cooperación Internacional (AECI), with the logo depicted on the report.

Introduction: The biogeographical region of the Chaco-by virtue of its ecobiological, climatic, social, economic, and cultural conditions-has been one of the most propitious epidemiological scenarios for endemic Chagas disease transmitted by the vector Triatoma infestans.
Three countries in the Southern Cone subregion—Argentina, Bolivia, and Paraguay—share this problem area. There exists a very important migratory and commercial flow among these countries, especially in the Chaco region, that could favor the dispersion of the parasite Trypanosoma cruzi and its vector.
Southern Bolivia, departments of Tarija, part of Santa Cruz and Chuquisaca are part of the Chaco Boreal region, where figures for household infestation by T. infestans—despite effective control carried out by the country over the past few years with support from the Inter-American Development Bank and PAHO—remains on the threshold of risk.
There are high prevalence rates of human infection, and acute cases that have been recorded indicate that there is still vector-borne transmission activity.
It thus becomes important to generate models for comprehensive intervention for the Chagas prevention, control, surveillance, and care that are sustainable, effective, and efficient, with development at the local level and community participation integrated into national Primary Health Care (PHC) schemes with quality considerations.


General: Validate a comprehensive and sustainable intervention strategy for the prevention, control, and treatment of Chagas disease in the biogeographical region of the Bolivian Chaco, which will contribute to the development of the region and improvement of the quality of life of its inhabitants.


  • Develop for the Chaco region an integrated strategy and methodology for vector control of Triatoma infestans, which is both participatory and sustainable, and which effectively and efficiently allow for attaining the goal of interrupting the household transmission of Trypanosoma cruzi, including entomological surveillance and operations research.
  • Develop cost-effectiveness and cost-impact evaluations of actions taken to complete the pilot studies, enhancing the supervision component as a basic tool.
  • Develop for the Chaco an environmental management component to control Chagas disease, one which permits sustainable improvements in housing and environmental and microproductive management of peridomiciliary areas as tool for control vector and to support quality of life.
  • Implement an effective medical care model for Chagas disease, one which is efficient, timely, and accessible based on Primary Health Care (PHC) with local involvement and adequate capacities for referral and cross-referral among the different levels of complexity providing care.
  • Develop a component for information/education/communication (IEC) by applying the COMBI methodology, in conjunction with support for the other components of Chagas prevention, control and care.
  • Coordinate the prevention, control, and treatment of Chagas disease using a model suitable for the Chaco region, programming actions aimed at other diseases prevalent there.
  • Develop an information system for monitoring the components of comprehensive care for Chagas control, prevention, and treatment in communities from bottom up, as well as in all involved sectors.

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