Comparison of health conditions treated with traditional and biomedical health care in a Quechua community in rural Bolivia

<p>Abstract</p> <p>Background</p> <p>The objective of the present study was to reveal patterns in the treatment of health conditions in a Quechua-speaking community in the Bolivian Andes based on plant use data from traditional healers and patient data from a primary health care (PHC) service, and to demonstrate similarities and differences between the type of illnesses treated with traditional and biomedical health care, respectively.</p> <p>Methods</p> <p>A secondary analysis of plant use data from semi-structured interviews with eight healers was conducted and diagnostic data was collected from 324 patients in the community PHC service. Health conditions were ranked according to: (A) the percentage of patients in the PHC service diagnosed with these conditions; and (B) the citation frequency of plant use reports to treat these conditions by healers. Healers were also queried about the payment modalities they offer to their patients.</p> <p>Results</p> <p>Plant use reports from healers yielded 1166 responses about 181 medicinal plant species, which are used to treat 67 different health conditions, ranging from general symptoms (e.g. fever and body pain), to more specific ailments, such as arthritis, biliary colic and pneumonia. The results show that treatment offered by traditional medicine overlaps with biomedical health care in the case of respiratory infections, wounds and bruises, fever and biliary colic/cholecystitis. Furthermore, traditional health care appears to be complementary to biomedical health care for chronic illnesses, especially arthritis, and for folk illnesses that are particularly relevant within the local cultural context. Payment from patients to healers included flexible, outcome contingent and non-monetary options.</p> <p>Conclusion</p> <p>Traditional medicine in the study area is adaptive because it corresponds well with local patterns of morbidity, health care needs in relation to chronic illnesses, cultural perceptions of health conditions and socio-economic aspects of health care. The quantitative analysis of plant use reports and patient data represents a novel approach to compare the contribution of traditional and biomedical health care to treatment of particular health conditions.</p

Chagas disease in an area of recent occupation in Cochabamba, Bolivia

INTRODUCTION: A descriptive, entomological and seroepidemiological study on Chagas disease was conducted in a place of recent occupation on the outskirts of Cochabamba, Bolivia: Avaroa/Primer de Mayo (population:3,000), where the socio-economic level is low and no control measures have been made available. METHODS: The immunofluorescent antibody test (IFAT) was used for IgG and IgM anti-Trypanosoma cruzi antibodies in filter paper bloodspot eluates from 128 subjects (73 females, 55 males) selected by systematic sampling. Concerning each subject age, gender, birthplace, occupation, duration of residence and building materials used in their houses were recorded. Vectors were captured both in domestic and peridomestic environments. RESULTS: Seropositive, 12.5% (16/128): females, 15.1% (11/73); males, 9.1% (5/55). Average time of residence: 6.1 years for the whole population sample and 7.4 years for the seropositive subjects. Most houses had adobe walls (76.7% , n= 30), galvanized iron rooves (86.7%) and earthen floors (53.4%) 80% of the walls had crevices. One hundred forty seven specimens of Triatoma infestans were captured, of which 104 (70.7%) were domestic, and 1 peridomestic Triatoma sordida. Precipitin host identification: birds, 67.5%; humans, 27.8%; rodents, 11.9%; dogs, 8.7%; cats, 1.6%. House infestation and density indices were 53.3 and 493.0 respectively. We found 21 (14.3%) specimens of T. infestans infected with trypanosomes, 18 (85.7%) of which in domestic environments. DISCUSSION: The elements for the vector transmission of Chagas disease are present in Avaroa/Primer de Mayo and the ancient custom of keeping guinea pigs indoors adds to the risk of human infection. In neighboring Cochabamba, due to substandard quality control, contaminated blood transfusions are not infrequent, which further aggravates the spread of Chagas disease. Prompt action to check the transmission of this infection, involving additionally the congenital and transfusional modes of acquisition, is required

Chagas disease in an area of recent occupation in Cochabamba, Bolivia Doença de Chagas numa área de ocupação recente em Cochabamba, Bolívia

INTRODUCTION: A descriptive, entomological and seroepidemiological study on Chagas disease was conducted in a place of recent occupation on the outskirts of Cochabamba, Bolivia: Avaroa/Primer de Mayo (population:3,000), where the socio-economic level is low and no control measures have been made available. METHODS: The immunofluorescent antibody test (IFAT) was used for IgG and IgM anti-Trypanosoma cruzi antibodies in filter paper bloodspot eluates from 128 subjects (73 females, 55 males) selected by systematic sampling. Concerning each subject age, gender, birthplace, occupation, duration of residence and building materials used in their houses were recorded. Vectors were captured both in domestic and peridomestic environments. RESULTS: Seropositive, 12.5% (16/128): females, 15.1% (11/73); males, 9.1% (5/55). Average time of residence: 6.1 years for the whole population sample and 7.4 years for the seropositive subjects. Most houses had adobe walls (76.7% , n= 30), galvanized iron rooves (86.7%) and earthen floors (53.4%) 80% of the walls had crevices. One hundred forty seven specimens of Triatoma infestans were captured, of which 104 (70.7%) were domestic, and 1 peridomestic Triatoma sordida. Precipitin host identification: birds, 67.5%; humans, 27.8%; rodents, 11.9%; dogs, 8.7%; cats, 1.6%. House infestation and density indices were 53.3 and 493.0 respectively. We found 21 (14.3%) specimens of T. infestans infected with trypanosomes, 18 (85.7%) of which in domestic environments. DISCUSSION: The elements for the vector transmission of Chagas disease are present in Avaroa/Primer de Mayo and the ancient custom of keeping guinea pigs indoors adds to the risk of human infection. In neighboring Cochabamba, due to substandard quality control, contaminated blood transfusions are not infrequent, which further aggravates the spread of Chagas disease. Prompt action to check the transmission of this infection, involving additionally the congenital and transfusional modes of acquisition, is required.INTRODUÇÃO: Estudo descritivo, entomológico e soroepidemiológico da infecção chagásica em área de ocupação recente da periferia de Cochabamba, Bolívia: Avaroa/Primer de Mayo, onde o nível socioeconômico da população é baixo e não foram instituídas medidas de controle. MÉTODOS: Por meio da reação de imunofluorescência indireta (RIFI), de anticorpos IgG e IgM anti-Trypanosoma cruzi em sangue capilar absorvido em papel-filtro, foram pesquisadas 128 pessoas (73 femininas e 55 masculinas) selecionadas por amostragem sistemática dentre 3.000 habitantes. Registraram-se idade, sexo, naturalidade, ocupação, tempo de moradia e características de construção das casas. RESULTADOS: Verificou-se que 12,5% (16/128) foram sororreagentes: 15,1% (11/73) do sexo feminino e 9,1% (5/55) masculino. O tempo médio de moradia foi de 6,1 anos para toda a amostra da população e de 7,4 anos para os sororreagentes. Predominaram construções de adobe (76,7%), teto de zinco (86,7%) e piso de terra (53,4%). Observaram-se gretas nas paredes de 80,0% das casas (n=30). Capturaram-se 148 exemplares de triatomíneos: 147 de Triatoma infestans, 104 (70.7%) intradomiciliares, e 1 de T. sordida, peridomiciliar. Os índices de infestação e de densidade por casa visitada foram, respectivamente, 53,3 e 493,0. A identificação dos hospedeiros dos triatomíneos (reações de precipitina) foi: aves, 67,5%; humanos, 27,8%; roedores, 11,9%; cães, 8,7%; e gatos, 1,6%. Os adultos e ninfas de T. infestans infectados por tripanossomas foram: 21 (14,3%), dos quais 18 (85,7%) intradomiciliares. CONCLUSÕES: Na área periférica de Cochabamba estudada foram encontrados todos os elementos da cadeia de transmissão vetorial: pessoas e vetores infectados e cobaios criados no interior das casas. A proximidade de Cochabamba, onde as transfusões de sangue são freqüentes, representa um risco adicional de transmissão. É necessária a pronta instituição de medidas profiláticas e trabalho educativo sobre as vias de transmissão da doença de Chagas, inclusive transfusional e congênita

Identification of a Hyperendemic Area for Trypanosoma cruzi Infection in Central Veracruz, Mexico

The state of Veracruz, Mexico, is a well-recognized endemic region for Chagas disease, but the geographic distribution of the disease and its magnitude are still poorly documented. We evaluated the seroprevalence of Trypanosoma cruzi infection in the sanitary jurisdictions of Cordoba and Cosamaloapan in central Veracruz. A total of 654 serum samples from 19 rural localities were tested by using four tests: two enzyme-linked immunosorbent assays, an indirect immunofluorescent, and Western blotting. Overall, 110 (16.8%) of 654 samples were positive for T. cruzi by ≥ 2 tests (95% confidence interval = 14.2–19.9%). The municipality of Tezonapa in the jurisdiction of Cordoba was identified as a potential hyperendemic region with seroprevalence rates ≤ 45% in young children. No cases were detected in the jurisdiction of Cosamaloapan. Further studies should help clarify T. cruzi transmission dynamics in Tezonapa. The magnitude of T. cruzi infection rate in this region calls for the urgent implementation of extensive epidemiologic surveillance and control programs

Programa de Controle da Doença de Chagas no Estado de São Paulo: sorologia de moradores como parte de investigação de unidades domiciliares com presença de triatomíneos vetores na década de 1990 The Chagas Disease Control Program of the São Paulo State: the contribution of serology to the epidemiological investigation of triatomine-infested domiciliary units during the 1990s

O Programa de Controle da Doença de Chagas (PCDCh) no Estado de São Paulo encontra-se na fase de vigilância entomológica, submetendo a exames sorológicos os moradores de unidades domiciliares (UDs), em que triatomíneos vetores tenham sido encontrados infectados por Trypanosoma cruzi. No decênio 1990-1999 foram trabalhadas localidades que, segundo graus de infestações no intra ou no peridomicílio, desencadearam trabalhos de rotina de busca desses vetores e de atendimento a notificações por parte de moradores. Em 1.415 UDs examinadas, 5.587 amostras de sangue foram obtidas, 87 (1,56%) das quais reagentes. Dessas, sete correspondiam a pessoas com menos de 29 anos de idade. As espécies mais freqüentemente associadas, em suas formas adultas, às UDs foram: Panstrongylus megistus, Triatoma sordida e T. tibiamaculata. Não foi observada associação entre UDs com sororreagentes e presença de triatomíneos infectados por Tr. cruzi (odds ratio = 1,498; 0,875 < OR < 2,564, 95% de confiança). Propõe-se utilizar inquéritos sorológicos amostrais no PCDCh, para investigar a situação prevalente em áreas identificáveis como de risco de transmissão, complementando-os com estudos isolados de Tr. cruzi aí obtidos.<br>The Chagas Disease Control Program in São Paulo State, Brazil, now in the entomological surveillance phase, includes a serological examination of individuals residing in domiciliary units infested with vector triatomines infected with Trypanosoma cruzi. From 1990 to 1999, this action included area in which triatomine searches were conducted either as a routine procedure, according to their levels of intra- or peridomiciliary infestation, or at the request of local residents. Among residents of the 1,415 UDs inspected, we collected 5,587 blood samples for serological examination, 87 of which (1.56%) tested positive, seven of which from individuals under 29 years of age. The species most frequently captured were Panstrongylus megistus, Triatoma sordida, and Triatoma tibiamaculata in the adult stage. No association was found between presence of seropositive residents and triatomines infected with Tr. cruzi (OR = 1.498; 0.875 < OR < 2.564, 95% C.I.). Our purpose was to use serological testing to investigate the situation of areas identifiable as being at risk of Chagas disease transmission and to compare the results with extant data about Tr. cruzi infection both in humans and vector triatomines

Cavia porcellus as a Model for Experimental Infection by Trypanosoma cruzi

The guinea pig (Cavia porcellus) is a natural reservoir for Trypanosoma cruzi but has seldom been used as an experimental infection model. We developed a guinea pig infection model for acute and chronic Chagas disease. Seventy-two guinea pigs were inoculated intradermally with 104 trypomastigotes of T. cruzi strain Y (experimental group); 18 guinea pigs were used as control group. Eight animals from the experimental group and two from the control group were sacrificed 5, 15, 20, 25, 40, 55, 115, 165, and 365 days after inoculation. During the acute phase (15 to 55 days), we observed parasitemia (with a peak on day 20) and positive IgM and IgG Western blots with anti-shed acute-phase antigen bands. The cardiac tissue showed vasculitis, necrosis (on days 40 to 55), moderate to severe inflammation, and abundant amastigote nests. Smaller numbers of amastigote nests were also present in kidney, brain, and other organs. In the early chronic phase (115 to 165 days), parasitemia disappeared and anti–T. cruzi IgG antibodies were still detectable. In cardiac tissue, the number of amastigote nests and the grade of inflammation decreased. In the chronic phase (365 days), the cardiac tissue showed vasculitis and fibrosis; detectable parasite DNA was associated with higher grades of inflammation. The experimental T. cruzi infection model in guinea pigs shows kinetics and pathologic changes similar to those of the human disease