La enfermedad de Chagas, paradigma de la inequidad en salud

Chagas Disease, a Paradigm for Health Inequity

02.12.2014
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One study estimates the annual global cost of Chagas disease at over 7 billion US dollarsChagas disease , caused by infection with the Trypanosoma cruzi (T.cruzi) parasite, originated in Latin America. If left untreated, the disease becomes chronic. An estimated 10 million people are affected worldwide and about 90-100 million more are at risk of infection. The economic impact of the disease is considerable, with one study estimating the annual global cost at over 7 billion US dollars, similar to or even higher than the cost associated with other prominent diseases, such as cervical cancer and rotavirus.

A disease that is both silent and silenced. Chagas is often described as a silent disease because its transmission—through an insect vector that lives primarily in rural areas— usually goes unnoticed since most of the initial clinical symptoms are nonspecific and easily mistaken for other more minor illnesses. Similarly, in the chronic stage when cardiac, digestive or neurological complications arise, these are also confused with other diseases. Chagas disease is also silent because the rural areas where it most often found often lack adequate health care services in many countries. At the same time, Chagas disease is silenced because it is linked to poverty, and poverty tends to be concealed rather than displayed. It is silenced even within the world of science, which for many years accepted erroneous hypotheses about its origins. It is silenced because poor people are of little interest and are marginalized from society. And who allocates resources to areas outside the frontiers of our wealth?

Migratory population movements have carried it to the large cities of Latin America, Europe and North AmericaGlobalisation has changed the epidemiology of Chagas disease. Migratory population movements have carried it to the large cities of Latin America, Europe and North America. An estimated 70,000 people in Spain are affected.

The emergence of Chagas disease in Spain and Europe has meant that the topic is now more often discussed. We know that it is a public health problem. We also know that, in addition to transmission via an insect vector that does not exist in Europe, the parasite can also be transmitted through blood transfusions, organ transplants, and from a mother to her child during pregnancy or childbirth.

Historically, only scant resources have been devoted to the study of this disease or used to provide medical care to those affected. In 2012, funding allocated to R&D in Chagas disease was 31.7 million US dollars, only 1% of all the funds allocated for this purpose to neglected diseases.

In 2012, funding allocated to R&D in Chagas disease was 31.7 million US dollars, only 1% of all the funds allocated for this purpose to neglected diseasesIn the Latin American countries where the disease is endemic, campaigns to control the insect vector have been successful in many areas. However, a sustained effort is required to prevent recolonisation of houses by the bugs, a situation that has been detected repeatedly. On the other hand, only scant resources are allocated to the treatment of those affected by the disease. The proportion of patients who receive any medical care or treatment is well below 1%. Those lucky enough to be diagnosed are being treated with the drugs used 50 years ago, which offer only mediocre efficacy and tolerability. Clinical trials of new drugs have only recently begun.

In Spain, blood banks and organ transplants are highly controlled and an increased awareness of Chagas disease among medical professionals has led to opportunities for many patients. However, only a few regions have implemented official programmes to monitor the possible transmission of Chagas disease during pregnancy. In Spain and Europe, children infected with T.cruzi are born without anyone knowing; Chagas disease is still finding a way to infect more people through the cracks of inequity.