title: Controlling congenital and paediatric chagas disease through a community health approach with active surveillance and promotion of paediatric awareness.
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.
authors.affiliation: Unitat de Salut Internacional, PROSICS, Programa Especial de Malalties Infeccioses Vall d'Hebron-Drassanes, Barcelona, Spain. tsorianoarandes@gmail.com.
authors.forename: Antoni
authors.initials: A
authors.lastname: Soriano-Arandes
authors.forename: Luca
authors.initials: L
authors.lastname: Basile
authors.forename: Hakima
authors.initials: H
authors.lastname: Ouaarab
authors.forename: Isabel
authors.initials: I
authors.lastname: Clavería
authors.forename: Jordi
authors.initials: J
authors.lastname: Gómez i Prat
authors.forename: Juan
authors.initials: J
authors.lastname: Cabezos
authors.forename: Pilar
authors.initials: P
authors.lastname: Ciruela
authors.forename: Pedro
authors.initials: P
authors.lastname: Albajar-Viñas
authors.forename: Mireia
authors.initials: M
authors.lastname: Jané
mesh_terms: D001838:Bolivia / Q000208:ethnology; D014355:Chagas Disease / Q000453:epidemiology / Q000517:prevention & control*; D003153:Community Health Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007843:Latin America / Q000453:epidemiology; D011159:Population Surveillance; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology / Q000517:prevention & control*; D013030:Spain / Q000453:epidemiology; D055815:Young Adult