title: Determinants of Health Service Responsiveness in Community-Based Vector Surveillance for Chagas Disease in Guatemala, El Salvador, and Honduras.
abstract: BACKGROUND
  Central American countries face a major challenge in the control of Triatoma dimidiata, a widespread vector of Chagas disease that cannot be eliminated. The key to maintaining the risk of transmission of Trypanosoma cruzi at lowest levels is to sustain surveillance throughout endemic areas. Guatemala, El Salvador, and Honduras integrated community-based vector surveillance into local health systems. Community participation was effective in detection of the vector, but some health services had difficulty sustaining their response to reports of vectors from the population. To date, no research has investigated how best to maintain and reinforce health service responsiveness, especially in resource-limited settings.
  
  
  RESULTS
  We reviewed surveillance and response records of 12 health centers in Guatemala, El Salvador, and Honduras from 2008 to 2012 and analyzed the data in relation to the volume of reports of vector infestation, local geography, demography, human resources, managerial approach, and results of interviews with health workers. Health service responsiveness was defined as the percentage of households that reported vector infestation for which the local health service provided indoor residual spraying of insecticide or educational advice. Eight potential determinants of responsiveness were evaluated by linear and mixed-effects multi-linear regression. Health service responsiveness (overall 77.4%) was significantly associated with quarterly monitoring by departmental health offices. Other potential determinants of responsiveness were not found to be significant, partly because of short- and long-term strategies, such as temporary adjustments in manpower and redistribution of tasks among local participants in the effort.
  
  
  CONCLUSIONS
  Consistent monitoring within the local health system contributes to sustainability of health service responsiveness in community-based vector surveillance of Chagas disease. Even with limited resources, countries can improve health service responsiveness with thoughtful strategies and management practices in the local health systems.
authors.affiliation: Chagas Disease Control Project, Japan International Cooperation Agency, Tegucigalpa, Honduras.
authors.forename: Ken
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: National Chagas Disease Control Program, Directorate of Health Promotion, Ministry of Health, Tegucigalpa, Honduras.
authors.forename: Concepción
authors.initials: C
authors.lastname: Zúniga
authors.affiliation: National Vector-Borne Diseases Control Unit, Directorate of Environmental Health, Ministry of Health, San Salvador, El Salvador.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Romero
authors.affiliation: National Vector-Borne Disease Control Program, Department of Regulation of Healthcare Programs, Ministry of Health, Guatemala City, Guatemala.
authors.forename: Zoraida
authors.initials: Z
authors.lastname: Morales
authors.affiliation: Brigham and Women´s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: James H
authors.initials: JH
authors.lastname: Maguire
mesh_terms: D063147:Animal Distribution; D000818:Animals; D014355:Chagas Disease / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D004544:El Salvador / Q000453:epidemiology; D006166:Guatemala / Q000453:epidemiology; D006721:Honduras / Q000453:epidemiology; D007300:Insect Control; D007303:Insect Vectors / Q000469:parasitology* / Q000502:physiology; D014224:Triatoma / Q000469:parasitology* / Q000502:physiology; D014349:Trypanosoma cruzi / Q000502:physiology*