Abstract
Chagas disease is caused by Trypanosoma cruzi, which is mainly transmitted by the faeces of triatomine insects that find favourable environments in poorly constructed houses. Previous studies have documented persistent triatomine infestation in houses in the province of Loja in southern Ecuador despite repeated insecticide and educational interventions. We aim to develop a sustainable strategy for the interruption of Chagas disease transmission by promoting living environments that are designed to prevent colonisation of rural houses by triatomines. This study used positive deviance to inform the design of an anti-triatomine prototype house by identifying knowledge, attitudes and practices used by families that have remained triatomine-free (2010-2012). Positive deviants reported practices that included maintenance of structural elements of the house, fumigation of dwellings and animal shelters, sweeping with "insect repellent" plants and relocation of domestic animals away from the house, among others. Participants favoured construction materials that do not drastically differ from those currently used (adobe walls and tile roofs). They also expressed their belief in a clear connection between a clean house and health. The family's economic dynamics affect space use and must be considered in the prototype's design. Overall, the results indicate a positive climate for the introduction of housing improvements as a protective measure against Chagas disease in this region.
Highlights
Despite biological and epidemiological differences, neglected tropical disease (NTD) share characteristics of social and political order that make them prevalent among people living in poverty (Hotez 2008)
Our previous studies have identified other biological and epidemiological facilitating factors for Chagas disease transmission in Loja (Black et al 2007, OcanaMayorga et al 2010), those related to housing environments that are predominant in this region
This research provided important information on the practices and knowledge regarded as protective against triatomine presence by the families of communities involved in this positive deviance (PD) research
Summary
Despite biological and epidemiological differences, NTDs share characteristics of social and political order that make them prevalent among people living in poverty (Hotez 2008). Our previous studies have identified other biological and epidemiological facilitating factors for Chagas disease transmission in Loja (Black et al 2007, OcanaMayorga et al 2010), those related to housing environments that are predominant in this region These dwellings are characterised by a predominance of domiciles built with adobe, clay and tile, dirt floors and small windows; there are peridomiciles where animal nests and food storage areas are attached to the walls of the domiciliary units. The lack of cohesion among walls and roofs in conjunction with the absence of natural light and deep cracks in the adobe walls, as well as accumulation of construction materials, piles of clothes and cluttered environments, facilitate triatomine presence inside domiciliary units (unpublished observations) These structures are vulnerable to earthquakes, landslides, robbery and increased risk of respiratory infections due to the lack of ventilation systems (Briceño-León et al 1990)
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