Bolivia: Breaking the Silence
Dr Tom Ellman, Head of mission, Médecins Sans Frontières (MSF) in Bolivia
Médecins Sans Frontières (MSF) has been treating people with Chagas disease in Bolivia since 2002. Despite considerable challenges and difficulties in the field, the four projects MSF has been involved in since then have demonstrated the importance and the feasibility of providing diagnosis and treatment even in the remotest areas. These experiences have been instrumental in helping to change attitudes toward the disease and promoting access to treatment. Of the many countries where Chagas disease is endemic, Bolivia is hit the hardest. Over 1 million of the country’s 9 million inhabitants are infected with the disease, and 4 million are at risk. The disease is most frequent among those who live in poverty or in rural areas, but, through migration, urban populations are heavily affected too.
Treating is compelling
Overcoming treatment fears
MSF proves: Treatment implementation in rural areas is possible
The outcome of MSF's field experience in two Chagas programmes in Bolivia demonstrates the feasibility of implementing Chagas disease diagnosis and treatment programmes in poor, remote, rural areas, as well as in the urban environment. While side effects were frequent, only three children required hospital stays to manage these, and there were no deaths due to side effects.
Entre Rios, Bolivia, 2002-2006. The MSF programme aimed to treat all children younger than 15 years of age in a rural area of Southern Bolivia. A total of 7,613 children were screened, of whom 1,475 were confirmed with T. Cruzi infection, giving a seroprevalence rate of 19.4%. Seroprevalence by age group was 5.0% in younger than 5 years old; 14.8% in the 5-9 year-old-age group; 31.0% in the 10-14 year-old-age group; and 51.7% for 15-16 year olds. Of these, 1,409 patients began treatment – 1,363 completed at least 30 days of treatment and 1,276 completed at least 55 days (defined as a complete standard course of treatment). A total of 28 (2%) children stopped treatment due to adverse events.
Treatment is a priority
Faustino Torrico, Professor of Parasitology and Infectiology, Universidad Mayor de San Simon, Cochabamba, Bolivia and member of the Scientific Advisory Committee of DNDi:
"In Bolivia, where one million (12%) of the total population is infected with T. Cruzi, the need for an effective treatment is now a priority. Until the year 2000, more than 60% of the country was virtually infested with vinchucas (Kissing bugs). In several places, we found that up to 100% of the adult population was infected. Since 2000, the national Chagas control programme has carried out systematic and comprehensive vector control programmes in the six Chagas-endemic departments. Today the risk of infection is low in 50% of the municipalities, but there are still areas of resistance, where infestation is higher than 20%. Many challenges lie ahead, but the results are promising. The actions were made possible by grants received from the Inter-American Development Bank (IADB). Unfortunately, the funding finished in 2007 and currently there is a transfer of roles and responsibilities from the central level of the Ministry of Health to local municipalities, whose contributions differ depending on their circumstances – which explains, in part, the difference in our response activities to the disease at the municipal level."
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