title: Door-to-door screening as a strategy for the detection of congenital Chagas disease in rural Bolivia.
abstract: OBJECTIVE
  To demonstrate the feasibility of a house-to-house screening system used for congenital Chagas disease in rural areas based on an active search for pregnant women and newborns in their homes in addition to passive case detection in health facilities.
  
  
  METHODS
  Exploratory phase conducted by the research team followed by an operational period coordinated by municipal health service. A blood sample was taken for serological and parasitological tests of Trypanosoma cruzi from pregnant women who were searching antenatal care or visited at home by field investigators. Infants born to T. cruzi-infected women were examined for infection at birth and again at 1 and 7 months of age.
  
  
  RESULTS
  64.5% of the pregnant women were infected. Congenital infection was diagnosed at birth in 4.0% (12/299) of the children born to seroreactive mothers. Twelve additional cases of infection (4%) were diagnosed in children between 1 and 7 months of age. Finally, 37% of the children were lost to follow-up in the exploratory phase and 53% during the operational phase (P=0.002), significantly fewer than in most passive case detection studies.
  
  
  CONCLUSIONS
  Despite poorer outcomes after door-to-door screening activities have been transferred to the health system, a combined strategy based on active and passive case detection appeared to be efficient for identifying rural cases of congenital Chagas disease.
authors.affiliation: IRD UMR216, Mother and child facing tropical infections, La Paz, Bolivia.
authors.forename: Mario
authors.initials: M
authors.lastname: Romero
authors.forename: Jorge
authors.initials: J
authors.lastname: Postigo
authors.forename: Dominique
authors.initials: D
authors.lastname: Schneider
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Chippaux
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Santalla
authors.forename: Laurent
authors.initials: L
authors.lastname: Brutus
mesh_terms: D000293:Adolescent; D000328:Adult; D001838:Bolivia / Q000453:epidemiology; D014355:Chagas Disease / Q000151:congenital / Q000175:diagnosis* / Q000453:epidemiology / Q000635:transmission; D005240:Feasibility Studies; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008403:Mass Screening / Q000379:methods / Q000458:organization & administration; D008875:Middle Aged; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000175:diagnosis / Q000453:epidemiology; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*; D055815:Young Adult