Community-based screening of Chagas disease among Latin American migrants in a non-endemic country: an observational study
Authors: Ramos-Sesma Violeta , Navarro Miriam , Llenas-García Jara , Gil-Anguita Concepción , Torrus-Tendero Diego , Wikman-Jorgensen Philip , García-López María , Amador-Prous Concepción , Ventero-Martín María-Paz , Guevara-Hernández Pedro , Garijo-Saiz Ana , Sanchez-Sanchez Ares , Bernal-Alcaraz Cristina , Pujades-Tarraga Ana-Isabel , Muñoz-Perez Roser , Flores-Chávez María , Ramos-Rincón José-Manuel ,   the #CorazonesSinChagas Platform, García-López María , Bernal-Alcaraz Cristina , Guevara-Hernández Pedro B. , Llenas-García Jara , Gregori-Colome Joan , Lucas-Dato Ana , Martínez-Birlanga Esther , García-Rodríguez Estefanía , Ramos-Rincón José-Manuel , Torrús-Tendero Diego , Ventero-Martín M. Paz , Gimeno-Gascón Adelin , Sánchez-Sánchez Ares , Muñoz-Pérez Roser , Almoedo-Albero Carmen , Gil-Anguita Concepción , Prous Concepción Amador , Pujades-Tárraga Ana-Isabel , Santonja Antonio , Sánchez-Valera María , Sánchez-García Rosa , Navarro-Beltrá Miriam 
Published: September 2021

Abstract
Background
Chagas disease is a parasitic disease endemic to Latin America, but it has become a disease of global concern due to migration flows. Asymptomatic carriers may host the parasite for years, without knowing they are infected. The aim of this study is to assess prevalence of Chagas disease and evaluate the participants’ level of knowledge between Latin American migrants attending a community-based screening campaign.

Methods
Three community-based campaigns were performed in Alicante (Spain) in 2016, 2017 and 2018, including educational chats and blood tests for Trypanosoma cruzi serology. Participants completed a questionnaire assessing knowledge about the mechanisms of transmission, disease presentation, diagnosis, and treatment. People seropositive for T. cruzi underwent diagnostic confirmation by two different tests. Results were analyzed by multivariable logistic regression and expressed as adjusted odds ratios (aORs), adjusting for age, sex, and time in Spain.

Results
A total of 596 participants were included in the study; 17% were aged under 18 years. Prevalence in adults was 11% [54/496; 95% confidence interval (CI): 8.3–14.5%] versus 0% among children. All but one case were in Bolivians. Diagnosis was independently associated with having been born in Bolivia (aOR: 102, 95% CI: 13–781) and a primary school-level education (aOR: 2.40, 95% CI: 1.14–5.06). Of 54 people diagnosed with Chagas disease (most of whom were asymptomatic), 42 (77.7%) returned to the clinic at least once, and 24 (44.4%) received treatment. Multivariable analysis showed that coming from Argentina (aOR: 13, 95% CI: 1.61–1188) or Bolivia (aOR: 1.90, 95% CI: 1.19–3.39) and having received information about Chagas disease in Spain (aOR: 4.63, 95% CI: 2.54–8.97) were associated with a good level of knowledge on the disease. Having primary level studies (aOR: 0.59, 95% CI: 0.34–0.98) and coming from Ecuador (aOR: 4.63, 95% CI: 2.52–847) were independently associated with a lower level of knowledge.

Conclusions
Community-based interventions are a good strategy for diagnosing neglected diseases such as Chagas disease in non-endemic countries and for identifying and treating infected, asymptomatic individuals.

Graphic abstract