Inequalities in the social determinants of health and Chagas disease transmission risk in indigenous and creole households in the Argentine Chaco

María Del Pilar Fernández,Ricardo E Gürtler,María Sol Gaspe

doi:10.1186/s13071-019-3444-5

Abstract

BackgroundThe social determinants of health (SDHs) condition disease distribution and the ways they are handled. Socio-economic inequalities are closely linked to the occurrence of neglected tropical diseases, but empirical support is limited in the case of Chagas disease, caused by the protozoan Trypanosoma cruzi. Herein we assessed the relationship between key structural SDHs and the risk of T. cruzi vector-borne transmission in rural communities of the Argentine Chaco occupied by creoles and an indigenous group (Qom). We used multiple correspondence analysis to quantify the household-level socio-economic position (social vulnerability and assets indices), access to health and sanitation services, and domestic host availability. We identified the most vulnerable population subgroups by comparing their demographic profiles, mobility patterns and distribution of these summary indices, then assessed their spatial correlation and household-level effects on vector domiciliary indices as transmission risk surrogates.ResultsQom households had higher social vulnerability and fewer assets than creoles, as did local movers and migrant households compared with non-movers. We found significantly positive effects of social vulnerability and domestic host availability on infected Triatoma infestans abundance, after adjusting for ethnicity. Access to health and sanitation services had no effect on transmission risk. Only social vulnerability displayed significant global spatial autocorrelation up to 1 km. A hotspot of infected vectors overlapped with an aggregation of most vulnerable households.ConclusionsThis synthetic approach to assess socio-economic related inequalities in transmission risk provides key information to guide targeted vector control actions, case detection and treatment of Chagas disease, towards sustainability of interventions and greater reduction of health inequalities.

Highlights

The social determinants of health (SDHs) condition disease distribution and the ways they are handled
This study addresses the gap in our understanding of the combined effects of structural and intermediary SDHs on key vector indices closely associated with the risk of vector-borne transmission of T. cruzi [26, 32, 33]
By summarizing multiple SDHs associated with poverty, this quantitative index corroborated the direct association between household socio-economic position and the risk of vector-borne transmission of T. cruzi

Summary

Introduction

The social determinants of health (SDHs) condition disease distribution and the ways they are handled. The social determinants of health (SDHs) are social, economic and cultural factors that condition both disease distribution and the ways they are handled [1] The links between these factors and health outcomes have been widely recognized since the 1990s and gained increasing. Based on the CSDH framework, the SDHs of NTDs include socio-economic and demographic factors such as ethnicity, gender, occupation, educational level and income (i.e. structural determinants), which affect other factors more directly associated with disease exposure and outcome (i.e. intermediary determinants), household and dwelling characteristics [3, 7,8,9]

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Conclusion