Chronic Care for Neglected Infectious Disease (Chagas included) for Primary Level. (PAHO)

03 March 2021

This new PAHO  manual  provides a framework for morbidity management and disability prevention of patients affected by Neglected Infectious Diseases (NID) and gives specific guidance for the proper care of patients suffering from chronic conditions caused by lymphatic filariasis, leprosy, trachoma, and Chagas disease. It is intended to be used mainly by health care workers at the primary health care level, but health workers at more complex and specialized levels may also find it useful. The manual provides detailed information about the management of most common cardiac and digestive complications.   Here below 12 important considerations and 17 key points to remember about Chagas disease as it is described in the document. You can download the full document through the link below. 
12 Considerations for Chagas Disease at Primary Health Level: 
1. Chagas disease is a chronic and neglected infectious condition, with a high burden of morbidity and mortality. 
2. Epidemiological risk includes vector transmission (contact with triatomines), blood and tissue transmission (transfusion, transplantation, congenital, and intravenous injecting drug use), oral transmission (contaminated food), work accident (laboratory, surgical practices), and existence of infected relatives (mother, siblings). 
3. Chagas disease can be suspected by clinical manifestations and epidemiological risk, but can only be confirmed by routine laboratory testing; many with the disease go unnoticed and undetected. 
4. Timely diagnosis and access to trypanocidal treatment with benznidazole or nifurtimox (at any stage of illness) are important to prevent disease progression and the occurrence of impairments, functional limitations, and participation restrictions (disability), as well as prevention and control in the locality of occurrence. 
5. There is a consensus that most people affected should be treated in primary health care by trained health workers who have adequate technology and a referral and counter-referral system available. 
6. Functional capacity, effectiveness of nonsurgical conservative treatment, and cardiac involvement are important factors for health-related quality of life in people affected by Chagas disease. 
7. Clear and comprehensive communication about the diagnosis and its therapeutic interventions between health care workers and the active participation of people and families affected by Chagas disease are crucial. 
8. The intervention of support professionals (social worker, psychologist, etc.) to optimize quality of care and feelings of control is desirable. 
9. Self-care and participation in self-help groups are important strategies for enabling independence; improving self-esteem; addressing depression, anxiety, and fear of death; and overcoming stigma. 
10.Any donor of blood or organs, or persons identified in population studies with positive serological screening, must be informed and advised of their probable diagnosis and referred for serological confirmation/exclusion of disease. 
11. Emphasis is placed on eliminating Chagas disease in children and young people, generating new possible donors of blood or organs, and freeing pregnant women of infection, thereby preventing transmission. 
12.Chagas disease should not limit the professional work and social life of affected persons. Routine follow-up by the health team is fundamental to ensure safety and improve quality of life.  
17 key points to remember: 
1. Carry out the etiological diagnosis through clinical-epidemiological data and parasitological or serological tests. 
2. Stage clinical forms of Chagas disease impairment to help determine the frequency of follow-up. 
3. Establish the therapeutic plan and the prognosis according to the degree of cardiac and digestive involvement. 
4. Systematically monitor persons with Chagas disease to evaluate progression. 
5. Identify associated digestive compromise and, when present, guide or refer to gastroenterology. 
6. Treat identified comorbidities or refer the person to a specialist. 
7. Stimulate adherence to pharmacological and nonpharmacological treatment, optimizing the cost/effectiveness ratio. 
8. Provide educational actions to affected people, family, and caregivers about the disease, self-management, and early identification of signs and symptoms of cardiac or digestive involvement. 
9. Clarify that there should be no donating of blood, organs, or tissues. 
10. Provide nutritional guidance. 
11. Provide psychosocial support to the person affected, his or her family, and community with a view to reducing stigma, self-prejudice, taboos, and misconceptions related to Chagas disease. 
12. Provide guidance on medical aspects, work, social security, gestation, family planning, physical exercise, and sexual activity. 
13. Clarify with the affected person, family, and caregiver when there is a need for pacemaker implantation or ICD, as well as cardiac computed tomography (CT). 14. Stress the importance of prevention of aggravating environmental and behavior factors that affect function (alcohol, smoking, licit and illicit drugs). 
15. Promote care support in special situations (people with pacemaker and ICD). 
16. Identify T. cruzi infection in other family members or people in the social network promoting integrated approaches. 
17. Stimulate and support the creation of associations of persons affected by Chagas disease, aiming to improve care, reduce stigma, advocate for social benefits, and support as needed.  
Full document Here: