Chagas disease in a non endemic country: a study in the district of Bologna (Italy).

Serological screening and multidisciplinary analysis of the disease in the Latin American migrant population

Background

Chagas disease is a tropical parasitic illness endemic in the American continent, commonly transmitted by a vector, affecting over 15 million people. Chagas disease is included in the World Health Organization (WHO) list of “Neglected Diseases”, considered a symptom of poverty and social disadvantage and with a low profile and status in public health priorities.

Due to the rapid increase of migration flows from Latin America to Europe, Chagas disease can be considered as an emerging public health issue in non endemic countries, where the highest risk is linked to non vectorial transmission routes (congenital, by blood transfusion and by organ transplantation). While in Europe countries like Spain and France are tackling the problem, in Italy the debate is still young and specific health policies have not yet been planned.

In order to close this gap, starting from the local level, the Centre for International Health based in the Public Health Department of the University of Bologna is carrying out the project “Chagas disease in a non endemic country: a study in the district of Bologna”. The project is a collaboration with the Infectious Disease and the Pediatric Department of the S.Orsola-Malpighi University Teaching Hospital, and with the Department of Anthropology of the University of Bologna. The project adopts a multidisciplinary, multi-method and partecipative research-action approach, aimed to quantify the problem and its impact in the Bologna district. We presently completed the first phase of the project ( September-December 2009), aimed to define the demographic and epidemiological profile of the Latin American migrant population living in our territory, assessing the number of migrants as well as the prevalence of pathological conditions that can be related to Chagas disease. In the mean time, a preliminary ethnographic research was conducted among Latin American migrants coming from endemic areas, to start unveiling the key socio-anthropological characteristics of this population.

Materials and methods

A retrospective analysis was performed to collect the information concerning the demographic and epidemiological profile of Latin American migrants coming from endemic countries, from 2005 to 2008, both in the Bologna district and in the Emilia Romagna region. Several databases and reports have been searched and analised: ISTAT (National Institute of Statistics), Caritas Migrantes, Observatory on Immigration of the Bologna district, regional register of hospital discharge sheets, registers of patients attended in clinics for undocumented migrants, regional register of deliveries, registers from blood and organs donors' associations. On the anthropological side, several interviews were carried out with local key informants, and an initial network was established with Latin American migrants' associations.

Preliminary results

According to most recent statistics, 16.495 migrants from endemic countries live in the Emilia Romagna region, and 3.557 live in the Bologna district. From 2005 to 2009, the number of Latin American migrants has been constantly increasing. Women have always been more than men (almost 2:1 rate).

336 patients with signs and symptoms that can be related to Chagas disease were hospitalized in that period, and 2 of them were discharged with a specific diagnosis of American Tripanosomiasis.

2.465 women from endemic countries delivered in the regional hospitals, and a significative presence of migrants was registered in the register of donors' associations.

The socio-anthropological analysis conducted among the Latin American population living in our territory showed a very diverse situation, with a generally good integration in the local context. On the other hand, most of the interviewee were not aware of Chagas disease characteristics but were, at the same time, really interested in the project. However many of them expressed the need to extend the action through the promotion of a broader right to health.

Conclusion

Chagas disease is certainly present in our region despite the lower prevalence we found compared to the international data for non endemic countries (misdiagnosis by unskilled health professionals? access barriers to health care services for migrants?). Since migration flows from Latin America are steadily increasing, it is time to act for research and policy development in this field.