title: Integrating an infectious disease programme into the primary health care service: a retrospective analysis of Chagas disease community-based surveillance in Honduras.
abstract: BACKGROUND
  Integration of disease-specific programmes into the primary health care (PHC) service has been attempted mostly in clinically oriented disease control such as HIV/AIDS and tuberculosis but rarely in vector control. Chagas disease is controlled principally by interventions against the triatomine vector. In Honduras, after successful reduction of household infestation by vertical approach, the Ministry of Health implemented community-based vector surveillance at the PHC services (health centres) to prevent the resurgence of infection. This paper retrospectively analyses the effects and process of integrating a Chagas disease vector surveillance system into health centres.
  
  
  METHODS
  We evaluated the effects of integration at six pilot sites in western Honduras during 2008-2011 on; surveillance performance; knowledge, attitude and practice in schoolchildren; reports of triatomine bug infestation and institutional response; and seroprevalence among children under 15 years of age. The process of integration of the surveillance system was analysed using the PRECEDE-PROCEED model for health programme planning. The model was employed to systematically determine influential and interactive factors which facilitated the integration process at different levels of the Ministry of Health and the community.
  
  
  RESULTS
  Overall surveillance performance improved from 46 to 84 on a 100 point-scale. Schoolchildren's attitude (risk awareness) score significantly increased from 77 to 83 points. Seroprevalence declined from 3.4% to 0.4%. Health centres responded to the community bug reports by insecticide spraying. As key factors, the health centres had potential management capacity and influence over the inhabitants' behaviours and living environment directly and through community health volunteers. The National Chagas Programme played an essential role in facilitating changes with adequate distribution of responsibilities, participatory modelling, training and, evaluation and advocacy.
  
  
  CONCLUSIONS
  We found that Chagas disease vector surveillance can be integrated into the PHC service. Health centres demonstrated capacity to manage vector surveillance and improve performance, children's awareness, vector report-response and seroprevalence, once tasks were simplified to be performed by trained non-specialists and distributed among the stakeholders. Health systems integration requires health workers to perform beyond their usual responsibilities and acquire management skills. Integration of vector control is feasible and can contribute to strengthening the preventive capacity of the PHC service.
authors.affiliation: Takemi Program in International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA. hashimok@gmail.com.|Chagas Disease Control Project 2008-2011, Japan International Cooperation Agency, Tegucigalpa, Honduras. hashimok@gmail.com.
authors.forename: Ken
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Ministry of Health, Tegucigalpa, Honduras. concepcionzuniga@gmail.com.
authors.forename: Concepción
authors.initials: C
authors.lastname: Zúniga
authors.affiliation: Chagas Disease Control Project 2008-2011, Japan International Cooperation Agency, Tegucigalpa, Honduras. jironjp@yahoo.co.jp.|Project Management Direction, External Cooperation Department, Estrella Inc., Tokyo, Japan. jironjp@yahoo.co.jp.
authors.forename: Jiro
authors.initials: J
authors.lastname: Nakamura
authors.affiliation: Independent consultant, Chiba, Japan. hanada.quqmo@tbz.t-com.ne.jp.|Former Senior Advisor, Human Development Department, Japan International Cooperation Agency, Tokyo, Japan. hanada.quqmo@tbz.t-com.ne.jp.
authors.forename: Kyo
authors.initials: K
authors.lastname: Hanada
mesh_terms: D000293:Adolescent; D014355:Chagas Disease / Q000097:blood; D002648:Child; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006721:Honduras; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011159:Population Surveillance; D011320:Primary Health Care / Q000458:organization & administration; D012189:Retrospective Studies; D016036:Seroepidemiologic Studies; D012947:Social Work