ABSTRACT
BACKGROUND: Chagas disease, transmitted domestically by triatomine bugs, is the most important vector-borne disease in Latin America. The association between triatomine infestation and housing characteristics was investigated based on a standardized survey in 41 971 houses in 15 Departments in Colombia. METHODS: Multivariate logistic regression was used to test for associations of two highly correlated infestation measures of infestation (householders reporting having seen triatomines inside the house, and sending triatomines to the survey team), with 15 household-level risk factors. Risks were measured relative to a reference category of houses with up to three inhabitants, area up to 50 m(2), unplastered adobe walls, thatch roof and no outbuildings or domestic animals. RESULTS: The probability of seeing triatomines was highest for households with over seven inhabitants (OR = 1.24, 95% CI 1.11-1.39), overhead storage space (OR = 1.16, 95% CI 1.03-1.32), grain shed (OR = 1.25, 95% CI 1.02-1.52), cats (OR = 1.27, 95% CI 1.14-1.42) and pigs (OR = 1.16, 95% CI 1.03-1.30). Lowest risks were in houses with wooden walls (OR = 0.46, 95% CI 0.34-0.61), fully plastered walls (OR = 0.78, 95% CI 0.68-0.88), roofs made of tiles (OR = 0.51, 95% CI 0.33-0.78) and flagstone floors (OR = 0.57, 95% CI 0.42-0.76). Results for householders returning triatomines support this set of risk factors, but with wider confidence intervals. CONCLUSIONS: Surveillance of a few easily assessed household characteristics provides an accurate, rapid assessment of house-level variation in risk. Measured effect sizes for specific structural characteristics could be used to maximize the cost-effectiveness of programmes to reduce vector infestation and interrupt Chagas disease transmission by improving house quality.
Subject(s)
Chagas Disease/transmission , Housing , Insect Vectors , Rhodnius , Animals , Animals, Domestic , Chagas Disease/prevention & control , Colombia , Ectoparasitic Infestations , Health Surveys , Housing, Animal , Humans , Multivariate Analysis , Odds Ratio , Probability , Risk Assessment/methods , Risk FactorsABSTRACT
In 1997 a descriptive study with a qualitative emphasis was carried out in order to document, by gender, the knowledge and practices related to cutaneous leishmaniasis among inhabitants 14 years and older in seven communities of Colombia's Pacific coastal department of Chocó. Since the control activities carried out by the Chocó Sectional Health Services had not had the desired results, the residents of the region were at high risk of contracting leishmaniasis, which they called bejuco (liana) and yateví. Qualitative data were collected by directly involving each community in discussion workshops and by interviewing knowledgeable informants. Using these materials as a foundation, the researchers prepared a survey with 10 closed-ended questions, which they administered to all persons over 14 years of age in each randomly chosen home visited. The results indicate that 94% of the population knew that leishmaniasis appeared as a skin disease; those not knowing that were more often women than men. With respect to the mode of transmission, 35% of the respondents connected the disease to the bite of an insect, but they did not what the etiologic agent was and thought that the bite was inflicted by a worm that lives in the mountains. In the communities studied, the residents used a great variety of treatments to cure the disease. The treatments were based on plants, chemical substances, burning the lesions with a piece of heated metal, and, to a lesser degree, drugs. Despite being responsible for taking care of sick persons in the household, women were not acquainted with the traditional treatments used in the community. This gender difference in treatment knowledge was statistically significant, the only such statistically significant gender difference found in the research. Of the people surveyed, 45% did not know how to prevent the disease. This was more often true for women; 102 of the 155 respondents saying they did not know how to prevent the disease were women. This research emphasizes the importance of studying the knowledge and practices of local inhabitants before designing and organizing educational programs to control leishmaniasis.
