South-south cooperation for Chagas disease

Abstract

Between 1992 and 2004, the Pan American Health Organization (PAHO) and the WHO led the creation of several south-south cooperation initiatives to accelerate control and elimination of Chagas disease in South and Central America (appendix). These include the Southern Cone Initiative (Argentina, Bolivia, Brazil, Chile, Paraguay, and Uruguay) created in 1992, followed by the Central America Initiative in 1997 (Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama), the Andean Initiative in 1998 (Colombia, Ecuador, Peru, and Venezuela), and the Amazon Initiative in 2005 (Bolivia, Brazil, Colombia, Ecuador, Guyana, French Guiana, Peru, Suriname, and Venezuela).1PAHOFundación Mundo SanoLa enfermedad de Chagas, a la puerta de los 100 años del conocimiento de una endemia americana ancestral.http://www.mundosano.org/files/web.mundosano.org/documentos/unitarias/interior%20libro.pdfGoogle ScholarThese cooperation initiatives function through annual meetings of inter-governmental commissions that assess advances, set goals, and analyse issues on control, prevention, and care, and periodic field assessments by international expert missions, which have allowed the exchange of experiences at the technical level and have given the system sustainability.These inter-country initiatives contributed to the interruption of transmission of Trypanosoma cruzi by Triatoma infestans and Rhodnius prolixus, through intensive vector control efforts. In 2012, 54% of the area that was affected by vector transmission of T cruzi in 1992 had stopped the transmission, resulting in roughly 200 million people under protective measures against infection by vector transmission. Annual deaths estimates fell from more than 45 000 in the early 1990s to 12 000 in 2008. Between 1990 and 2006, the number of new cases of Chagas disease decreased from 700 000 to 56 000 per year, and the total number of infected individuals dropped from 30 million to 6–8 million.2PAHOChagas disease.http://new.paho.org/hq/index.php?option=com_content&view=article&id=2382&Itemid=3921&lang=enGoogle Scholar, 3PAHOStrategy and plan of action for Chagas disease prevention, control and care. CD50/16.http://www2.paho.org/hq/dmdocuments/2011/CD50-16-e.pdfGoogle Scholar20 years of sustained inter-country efforts with technical cooperation from PAHO, WHO, and other partners allowed countries in South and Central America to confront and reduce the burden of this neglected disease.Yet Chagas disease still affects vulnerable populations and challenges threaten the progress achieved,4Silveira CA Programa regional para el control de la enfermedad de Chagas en America Latina: Lineamientos y recomendaciones técnicas y de política pública para el abordaje de la enfermedad de Chagas.http://chagas.zoonosis.gub.uy/Documentos/DocumentosFinales/Control_de_Chagas-Lineamientos.pdfGoogle Scholar including a lack of strong political commitment, inadequate research and development, ineffective delivery of medical care for affected people, pyrethroid-resistant T infestans, and poor community engagement in some regions.These challenges must be tackled by the cooperation initiatives through creative strategies.We declare that we have no conflicts of interest. Between 1992 and 2004, the Pan American Health Organization (PAHO) and the WHO led the creation of several south-south cooperation initiatives to accelerate control and elimination of Chagas disease in South and Central America (appendix). These include the Southern Cone Initiative (Argentina, Bolivia, Brazil, Chile, Paraguay, and Uruguay) created in 1992, followed by the Central America Initiative in 1997 (Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama), the Andean Initiative in 1998 (Colombia, Ecuador, Peru, and Venezuela), and the Amazon Initiative in 2005 (Bolivia, Brazil, Colombia, Ecuador, Guyana, French Guiana, Peru, Suriname, and Venezuela).1PAHOFundación Mundo SanoLa enfermedad de Chagas, a la puerta de los 100 años del conocimiento de una endemia americana ancestral.http://www.mundosano.org/files/web.mundosano.org/documentos/unitarias/interior%20libro.pdfGoogle Scholar These cooperation initiatives function through annual meetings of inter-governmental commissions that assess advances, set goals, and analyse issues on control, prevention, and care, and periodic field assessments by international expert missions, which have allowed the exchange of experiences at the technical level and have given the system sustainability. These inter-country initiatives contributed to the interruption of transmission of Trypanosoma cruzi by Triatoma infestans and Rhodnius prolixus, through intensive vector control efforts. In 2012, 54% of the area that was affected by vector transmission of T cruzi in 1992 had stopped the transmission, resulting in roughly 200 million people under protective measures against infection by vector transmission. Annual deaths estimates fell from more than 45 000 in the early 1990s to 12 000 in 2008. Between 1990 and 2006, the number of new cases of Chagas disease decreased from 700 000 to 56 000 per year, and the total number of infected individuals dropped from 30 million to 6–8 million.2PAHOChagas disease.http://new.paho.org/hq/index.php?option=com_content&view=article&id=2382&Itemid=3921&lang=enGoogle Scholar, 3PAHOStrategy and plan of action for Chagas disease prevention, control and care. CD50/16.http://www2.paho.org/hq/dmdocuments/2011/CD50-16-e.pdfGoogle Scholar 20 years of sustained inter-country efforts with technical cooperation from PAHO, WHO, and other partners allowed countries in South and Central America to confront and reduce the burden of this neglected disease. Yet Chagas disease still affects vulnerable populations and challenges threaten the progress achieved,4Silveira CA Programa regional para el control de la enfermedad de Chagas en America Latina: Lineamientos y recomendaciones técnicas y de política pública para el abordaje de la enfermedad de Chagas.http://chagas.zoonosis.gub.uy/Documentos/DocumentosFinales/Control_de_Chagas-Lineamientos.pdfGoogle Scholar including a lack of strong political commitment, inadequate research and development, ineffective delivery of medical care for affected people, pyrethroid-resistant T infestans, and poor community engagement in some regions. These challenges must be tackled by the cooperation initiatives through creative strategies. We declare that we have no conflicts of interest. Supplementary Material Download .pdf (.41 MB) Help with pdf files Supplementary appendix Download .pdf (.41 MB) Help with pdf files Supplementary appendix