Doença de Chagas em comunidades rurais e/ou tradicionais do estado de Goiás, Brasil

Abstract

Chagas disease (CD) is recognized by the World Health Organization as a Neglected Tropical Disease, related to poverty and socio-environmental vulnerability. Even though Brazil is part of the American continent where 18 countries managed to interrupt household vector transmission in part or all of its territory, it has been recording an increase in the number of cases, mainly in the Amazon region, related to oral transmission and extra-household vector transmission, resulting from work habits and activities characteristic of the rural environment. Furthermore, autochthonous species of triatomines have been discovered with high colonization potential, the existence of residual foci of T. infestans, the influence of deforestation and the proximity of habitations to the barbers' natural environments, as well as the presence of T. cruzi reservoir animals, as impactful causes in the domestic transmissibility cycle. The purpose of this research arose with the identification of chagasic individuals in rural and/or traditional communities in the state of Goiás, visited during the execution of the Rural Health and Sanitation Project (SanRural Project), in which the authors participated, developed by the Federal University of Goiás (UFG) in conjunction with the National Health Foundation (FUNASA), instigating the assessment of the housing conditions of these communities, which may promote the occurrence of CD. Thus, this research aimed to evaluate whether housing conditions in rural and/or traditional communities in the state of Goiás can influence the occurrence of Chagas disease. Through a systematic literature review (RSL), using as a basis the Periodical Portal of the Coordination for the Improvement of Higher Education Personnel (CAPES), a discussion was held about the uses and concepts of the terms housing and habitability, proposing the definition of concepts of rural housing and rural habitability to guide understanding and define the study area of this research. Then, also through RSL, using the Scopus platform, a survey of predictive variables was carried out, which may influence the occurrence and spread of Chagas disease in a rural environment. Using the predictor variables raised and the data collected in the SanRural Project, a relationship was made between the occurrence of Chagas disease in rural and/or traditional communities in the state of Goiás with predictor variables characteristic of housing and the rural population residing in these communities. During visits to 48 quilombola, riverside communities and settlements, blood collections and semi-structured interviews were carried out, as well as observations of the environment. Serological investigation was carried out using the immunoenzymatic method and statistical analyzes using the logistic GAM model. A prevalence of 9.4% of people infected with T. cruzi was identified in 32 communities, with 7.0% of the population being settlers, 11.3% quilombolas and 1.5% riverside residents, finding a significant relationship between cases and: the typology of the community, number of residents up to one year of age, number of residents with a previous diagnosis of CD, structural material of the intra-domestic wall, storage of water for washing food in a fiber cement water tank, age of the person responsible for housing and resident-room ratio. The relationships found showed DC's resignation to conditions of vulnerable housing, education and sanitation services, presenting the importance of knowledge and health education, since the smaller number of resident rooms and the habit of using mosquito nets reduced the chance of, respectively, 50.0% and 70.0% of finding at least 1 (one) seropositive individual for T. cruzi randomly selected in the household. Since entomological surveillance must rely on the active participation of the population in notifying kissing bugs, as well as teams of research and health technicians, to seek control of CD, this research aims to contribute to the National Chagas Disease Control Program from the Ministry of Health, presenting the rural reality and drawing attention to the inherent existence of housing conditions, behaviors/habits and lack of knowledge of the rural population about Chagas disease, and the risk of its spread. Furthermore, it aims to assist and encourage new research in the areas of health, sanitation and multidisciplinary areas, focused on rural reality and the various realities concerning Chagas disease.