Strategies for prevention and control of Chagas disease: a rapid review of systematic reviews, 2024ABSTRACT
Objective: To identify effective strategies for the prevention and control of Chagas disease.
Methods: This is a rapid review of systematic reviews. The search was conducted in March 2024, with no time restrictions, in the Medline (via PubMed) and Embase databases. Study selection was performed by pairs of reviewers using Rayyan, and data extraction was conducted in a standardized spreadsheet. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews tool, version 2. Data were analyzed and presented narratively.
Results: Of the 21 reviews identified, four systematic reviews were included. The first, which included 93 studies, indicated that insecticides were an effective intervention for reducing infestations. However, reinfestations were frequent, and highlighted community-based vector notification as the most cost-effective strategy compared with active surveillance or passive devices. The second addressed the monitoring of domestic and wild animals as sentinels to identify risk areas and support public policies. The third reinforced household protection with insecticides, but reported inconsistent results for insecticide-impregnated curtains and bed nets. The fourth, with only one study on Chagas disease, addressed educational actions and environmental management aimed at behavioral change and reduction of infestation. All reviews presented a critically low methodological quality.
Conclusion: Control of Chagas disease remains primarily reliant on insecticides, underscoring the need for community participation as a strategic complement to ensure sustainability. Given the limited number and low methodological quality of the studies, caution is recommended when applying these findings.
Keywords:
Chagas Disease; Vector Control of Diseases; Community Participation; Public Health; Review
Resumo
Objetivo: Identificar estratégias eficazes de prevenção e controle da doença de Chagas.
Métodos: Trata-se de revisão rápida de revisões sistemáticas. A busca foi realizada, sem restrição temporal, nas bases Medline (via PubMed) e Embase em março de 2024. A seleção foi realizada por duplas de revisores no Rayyan, com extração em planilha padronizada. A avaliação da qualidade metodológica foi feita por meio da ferramenta Assessment of Multiple Systematic Reviews, versão 2. Os dados foram analisados e apresentados de forma narrativa.
Resultados: De 21 revisões identificadas, 4 revisões sistemáticas foram incluídas. A primeira, que reuniu 93 estudos, apontou o uso de inseticidas como intervenção eficaz na redução da infestação, embora com reinfestações frequentes, e destacou a notificação comunitária de vetores como estratégia mais custo-efetiva em relação à vigilância ativa ou a dispositivos passivos. A segunda abordou o monitoramento de animais domésticos e silvestres como sentinelas para identificação de áreas de risco e apoio a políticas públicas. A terceira reforçou a proteção domiciliar com inseticidas, mas apresentou resultados inconsistentes para cortinas e mosquiteiros impregnados. A quarta, com apenas um estudo sobre doença de Chagas, tratou de ações educativas e manejo ambiental voltados à mudança comportamental e à redução da infestação. Todas apresentaram qualidade metodológica criticamente baixa.
Conclusão: O controle da doença de Chagas continua sendo baseado em inseticidas, o que ressalta a participação comunitária como complemento estratégico para garantir a sustentabilidade. Devido ao número limitado e à baixa qualidade metodológica dos estudos, recomenda-se cautela ao aplicar esses achados.
Palavras-chave:
Doença de Chagas; Controle de Vetores de Doenças; Participação da Comunidade; Saúde Pública; Revisão
Resumen
Objetivo: Identificar estrategias eficaces para la prevención y el control de la enfermedad de Chagas.
Métodos: Se trata de una revisión rápida de revisiones sistemáticas. La búsqueda se realizó sin restricción temporal en las bases de datos Medline (vía PubMed) y Embase en marzo de 2024. La selección fue realizada por pares de revisores en Rayyan, y la extracción se llevó a cabo en una hoja de cálculo estandarizada. La evaluación de la calidad metodológica se realizó mediante la herramienta Assessment of Multiple Systematic Reviews, versión 2. Los datos fueron analizados y presentados de forma narrativa.
Resultados: De 21 revisiones identificadas, se incluyeron 4 revisiones sistemáticas. La primera, que reunió 93 estudios, señaló el uso de insecticidas como una intervención eficaz para reducir la infestación, aunque con reinfestaciones frecuentes, y destacó la notificación comunitaria de vectores como la estrategia con mayor costo-efectividad en comparación con la vigilancia activa o los dispositivos pasivos. La segunda abordó el monitoreo de animales domésticos y silvestres como centinelas para identificar áreas de riesgo y apoyar políticas públicas. La tercera reforzó la protección domiciliaria con insecticidas, pero mostró resultados inconsistentes con cortinas y mosquiteros impregnados. La cuarta, con solo un estudio sobre Chagas, abordó acciones educativas y de manejo ambiental orientadas al cambio conductual y a la reducción de la infestación. Todas presentaron una calidad metodológica críticamente deficiente.
Conclusión: El control de la enfermedad de Chagas continúa basándose en insecticidas, lo que resalta la participación comunitaria como un complemento estratégico para garantizar la sostenibilidad. Debido al número limitado y a la baja calidad metodológica de los estudios, se recomienda precaución al aplicar estos hallazgos.
Palabras clave:
Enfermedad de Chagas; Control de Vectores de las Enfermedades; Participación de la Comunidad; Salud Pública; Revisión
Introduction
Chagas disease, also known as American trypanosomiasis, is a socially determined disease 1 and is caused by the protozoan Trypanosoma cruzi. Other determinants include the vector's habitat, socioeconomic conditions, climate and environment, public health control practices, and population mobility 1,5,6.
Despite being known the beginning of the 20th century Chagas disease remains a neglected disease 7. This means that it receives little attention and limited financial resources compared with other diseases, resulting in significant gaps in research, treatment development, and effective public health policies.
Available treatments are limited, are effective mainly in the acute phase of the disease, and there is no preventive vaccine. People affected by the disease experience invisibility and call for sensitive listening, given the need to recognize their demands 8,9. Control efforts focus on environmental interventions and health education; However, they still face considerable challenges, especially in rural areas and low-income communities, with persistent reinfestations by triatomine bugs (kissing bugs) posing a major challenge 10.
In Latin America, an estimated 5.3 million people were infected with Trypanosoma cruzi in 2010 7. In Brazil, the mortality burden of Chagas disease is high and represents one of the four leading causes of death from infectious and parasitic diseases. Since 2015, an average of 4 thousand deaths per year have been recorded with the disease as the underlying cause 7,10. Despite its epidemiological and social relevance, important gaps persist in the available evidence on the prevention and control of Chagas disease, hindering the definition of more effective and sustainable approaches.
This study sought to map existing systematic reviews in the literature and identify research gaps and priorities. The objective was to identify effective strategies for the prevention and control of Chagas disease.
Methods
Study design
This is a rapid review of systematic reviews, a systematic method that optimizes the review process by leveraging validated methodological shortcuts to meet policymakers' needs. Rapid reviews of systematic reviews aim to meet demand in health system management, in which strategies identified in systematic reviews are used to address health problems 11.
To ensure timely delivery to decision-makers, validated methodological shortcuts were adopted, considering that full reviews are difficult to implement in health management settings. These shortcuts enabled feasible delivery and provided valuable, reliable information through rapid responses 11.
Among the shortcuts adopted in this review, the extraction process and the assessment of the methodological quality of the systematic reviews stood out; these were conducted by one researcher and reviewed by another. No assessment of confidence in the systematic reviews was performed.
Eligibility criteria
To guide this rapid review of systematic reviews, the following research question was formulated: "Which strategies are effective for the prevention and control of Chagas disease?" This question was structured according to the PICOS acronym (detailed below), which is widely used to formulate clinical questions and define inclusion criteria in systematic reviews.
• P (population/problem): refers to individuals exposed to Chagas disease, considering its incidence and prevalence in different endemic regions.
• I (intervention): encompasses strategies for the prevention and control of the disease, whether applied individually or in combination, including epidemiological surveillance actions, vector control, health education, and housing improvements.
• C (comparator): no comparator was applied, as the objective of the review was to map and describe existing interventions, regardless of comparison groups.
• O (outcome): includes reduction of the population of triatomine vectors, decrease in disease incidence, increased population knowledge about the disease, and identification of possible adverse events resulting from the interventions.
• S (study/study type): considers systematic reviews the methodological design of choice, given their robustness in synthesizing scientific evidence.
Systematic reviews published in English, Spanish, and Portuguese, with no temporal or geographic restrictions, that addressed strategies for the prevention and control of Chagas disease were considered eligible. Publications such as conference abstracts, primary and tertiary studies, theses and dissertations, or those addressing strategies related to other vectors were excluded.
Sources of information
Searches were conducted in the scientific literature databases Medline (via PubMed) and Embase. No eligible studies were found in other indexed databases. No filters were applied in the databases regarding year of publication, publication status, or language. Systematic review filters were applied in the databases to optimize the rapid review process.
Search strategy
A search strategy was developed for the Medline database (via PubMed) and adapted for the Embase database. The search strategies were elaborated based on the combination of keywords structured according to the PICOS acronym, using MeSH terms in Medline (via PubMed) and Emtree terms in Embase, combined with appropriate Boolean operators (Supplementary Table 1). Searches in all databases were conducted on 19 March 2024, and the results were exported to the bibliographic management application Rayyan 12.
Selection process
After removing duplicate studies, four researchers (BG, FST, RLTS, and VJM) independently selected studies based on titles and abstracts and subsequently assessed the full texts using Rayyan 12. One reviewer (RCM) checked all selections, and discrepancies were resolved by consensus through an online meeting.
Data collection process
A prior alignment among the researchers was carried out using a standardized electronic spreadsheet. Four researchers (BG, FST, RLTS, and VJM) independently extracted data from the included studies. One reviewer (RCM) checked all extractions. Discrepancies were resolved by consensus through an online meeting.
Data items
Data were extracted on: authors; year of publication; countries; study settings; study type; name of the intervention; frequency of implementation; target population of the intervention; intervention setting; and observed outcomes.
Methodological assessment
The quality of the included systematic reviews was assessed by four independent reviewers (BG, FST, RLTS, and VJM) using the Assessment of Multiple Systematic Reviews tool, version 2 (AMSTAR 2) 13. Discrepancies were discussed and resolved with one author (RCM). The final classification was performed according to the presence of flaws in critical and non-critical items described by the authors 13, as follows:
• High confidence: no critical flaws and at most one non-critical flaw.
• Moderate confidence: no critical flaws and more than one non-critical flaw.
• Low confidence: one critical flaw, with or without non-critical flaws.
• Critically low confidence: more than one critical flaw, with or without non-critical flaws.
Data synthesis methods
Data synthesis was conducted narratively, grouping findings by type of intervention identified in the included reviews. Reported effects, consistency of evidence, and application contexts were described, highlighting methodological gaps and limitations. The analysis aimed to identify patterns of effectiveness, promising strategies, and contextual factors influencing the results.
Outcomes
The search for systematic reviews on the prevention and control of Chagas disease yielded 21 publications. After removing duplicates, 19 titles and abstracts were assessed, and seven eligible studies were read in full; 4 systematic reviews were included (Figure 1). The list of excluded studies is provided in the supplement (Supplementary Table 2).
The included systematic reviews 14-17 had participant samples in the primary studies ranging from 37.0 thousand households 16 to 32.7 thousand households 14 (Table 1). The strategies to address the problem consisted of insecticide spraying 14,16 or the use of curtains and bed nets 16,17; surveillance strategies with resident notification or using devices for passive vector detection 14; surveillance through domestic and wild animals as sentinels 17; and intersectoral collaboration strategies that included health education 15. Four primary studies were included in more than one systematic review (Table 2).
The included systematic reviews were classified as critically low methodological quality according to the AMSTAR 2 (Figure 2). Recurring flaws were observed in the adherence to critical domains, particularly the following aspects: lack of explicit reporting on the prior definition of review methods and justification for significant protocol deviations (item 2); lack of consideration of the risk of bias of included studies in the interpretation and discussion of results (item 13); failure to present the list of excluded studies with justification for each exclusion (item 7); and inadequate or absent techniques for assessing the risk of bias of included studies (item 9).
The primary studies included in the systematic reviews were conducted predominantly in Brazil (34.7%) and Argentina (22.2%). Other countries were less represented: Guatemala (8.3%); Chile and Venezuela (both 6.9%); the United States (4.2%); Bolivia, Mexico, Nicaragua, and Paraguay (each 2.8%); and Colombia, Honduras, Peru, and Uruguay (1.4% each).
Two systematic reviews 14,17 reported results regarding surveillance strategies. One concerned vector notification by residents, and the other concerned the use of sentinel animals.
One of the systematic reviews analyzed results from 93 articles on interventions for Chagas disease control and surveillance 14. Six studies conducted in Brazil, Argentina, Chile, and Venezuela were used to compare resident-based vector notification with active vector searches performed by professional health surveillance teams 14. The data indicated that resident-based vector notification outperformed active insect searches conducted by surveillance teams in detecting infestation foci. Surveillance systems were more effective when residents reported suspected insects to the surveillance team than when the program team conducted searches, whether manually or with vector-detection devices.
This review highlighted that resident participation in vector notification should be a strategic component of Chagas disease surveillance. Still, only professional insecticide spraying has consistently been effective in eliminating infestation foci 14. Since residents are asked to report suspected insect infestations in their homes, there is a need for rapid response by surveillance professionals to eliminate infestations when necessary 14.
Vector detection devices, such as Gómez-Núñez boxes, María sensor boxes, and other devices to capture triatomines (kissing bugs) or detect their traces, were also mentioned. Although sometimes complementary to active searches by surveillance teams, they proved inferior to resident-based notification 14.
The use of dogs, as well as other domestic and wild animals, as sentinels was reported in one of the included reviews 17. These animals can be used to track risk zones and areas with potential transmission or occurrence of Chagas disease 17. Sentinel animals are employed to detect disease circulation and provide early warning of outbreaks, allowing the implementation of preventive measures. This can be more cost-effective than other monitoring methods, such as the capture and analysis of triatomines. The main justifications for using animals for this purpose are their resistance to infection and ease of handling. However, such use requires ethical care and adherence to management and monitoring protocols to minimize animal suffering. Monitoring is performed using blood or other bodily fluids from animals, which are analyzed for antibodies against Trypanosoma cruzi or for the parasite itself.
Sentinel animals infected with Trypanosoma cruzi enabled the identification of households and groups at risk of Chagas disease transmission. These sentinels predicted the resurgence of Trypanosoma cruzi populations, as they were spatially linked to zones of Chagas disease infection and to areas with vector presence 17.
Two systematic reviews 14,16 reported results on the use of insecticides and their effects on infection rates among vectors and hosts.
Analysis of more than 90 studies conducted in several countries, particularly in Latin America, revealed important patterns across triatomine species (kissing bugs) 14. The results showed unequivocally that domestic insecticide spraying successfully reduced infestation rates throughout Latin America. The review, however, warned that reinfestation of dwellings by native vector species is common. In many cases, the elimination of introduced populations was closely followed by the occupation of vacant niches by "secondary" vector species. The review presented studies addressing both vector reduction and significant decreases in seropositivity rates in countries that adopted this strategy 14.
The most widely used and successfully applied intervention for Chagas disease was insecticide spraying, both intra- and peridomiciliary 16. This intervention successfully reduced Chagas disease transmission in the Southern Cone. Although the systematic review supported this intervention, reliance on a single intervention for protection against Chagas disease is common, often using the same insecticides. This creates an opportunity for the development of resistance and the formation of new vector habitats 16.
One systematic review 15 highlighted the importance of intersectoral collaboration in reducing vector-borne diseases, including malaria, dengue, Zika, schistosomiasis, African trypanosomiasis, leishmaniasis, Chagas disease, yellow fever, Japanese encephalitis, and onchocerciasis. Only one of the included studies addressed Chagas disease. This study emphasized the importance of educational interventions and social mobilization, supported by community leaders, along with environmental management (rodent control, composting, home gardens), to promote behavioral change and reduce infestations 15.
Discussion
This rapid review included four systematic reviews that addressed strategies for the prevention and control of Chagas disease. The interventions were interpreted into three options for addressing the problem: (i) surveillance strategies (entomological surveillance with resident-based notification and the use of domestic and wild animals as sentinels); (ii) chemical control strategies (insecticide spraying and insecticide-impregnated curtains); and (iii) intersectoral actions (education combined with environmental strategies).
The listed strategies may be implemented individually or in combination, according to the local context. The results of this review were derived mainly from studies conducted in Latin America, reflecting the epidemiological reality of endemic areas or areas with reemergence of transmission. However, it is important to consider that the data came from a small sample of systematic reviews and their included studies.
Resident-based notification is a critical component in the control of Chagas disease, as it promotes "immediate" or "near-immediate" detection, strengthens vector surveillance and control, engages the community, and enables essential feedback for health policy formulation 18. Active collaboration by residents is fundamental to an effective and sustainable response to the disease. Residents provide valuable information on local conditions that is essential to territorialization and the identification of risk areas.
In addition, residents can help identify and report triatomine (kissing bug) infestations and report suspected cases of the disease. This creates a network of support and collaboration between residents and health authorities, facilitating the implementation of control and prevention strategies 19. Such interactions are essential for adapting vector control and elimination measures in a more targeted and efficient manner and for supporting the development of health policies tailored to the specific needs of each community.
Intersectoral collaboration integrates sectors (health, education, environment, and social development) and enables the combination of knowledge and resources essential to the control of Chagas disease. Health education, for example, is fundamental for sharing knowledge and practices related to the disease and its vectors. Collective health education actions that combine information on the biology of triatomines (kissing bugs) and prevention practices can be strategic in the context of Chagas disease. This can be achieved by implementing educational programs in schools and communities, as well as through social media 19,20.
Other possibilities may include environmental control strategies, such as improving housing conditions and implementing vector control measures. Integration with the sanitation and urbanization sectors may result in the elimination of suitable habitats for insect vectors. In Brazil, housing improvements constitute a structural measure with significant impact, as evidenced by the elimination or reduction of infestations across different contexts. Still, they also entail operational difficulties that impede sustainability 21-24.
At the national level, the sustainability of intradomiciliary insecticide spraying is ensured through centralized procurement by the Ministry of Health, which distributes products to the states and coordinates logistics with municipalities 25. This process ensures a certain degree of stability. Still, it also depends on administrative processes and coordination across different levels of management, which may compromise the continuity of actions in scenarios of poor coordination.
For participatory surveillance, triatomine information points (popularly known as PIT [postos de informação de triatomíneos ]) are strategic for expanding community participation in Chagas disease surveillance, thereby favoring early vector detection. However, their effectiveness is limited by implementation and sustainability challenges, including low visibility, lack of records, frequent deactivation, and the absence of feedback to the population. These barriers highlight the need for greater coordination of health services and educational campaigns to ensure the active and continuous use of triatomine information points 26.
Although the results indicated promising interventions for the prevention and control of Chagas disease, the included systematic reviews exhibited methodological flaws and were classified as critically low. These findings point to important methodological gaps that should be considered by those conducting future systematic reviews on the topic. It was noted that systematic reviews in this area should be conducted using rigorous methods, which are essential to enhance the reliability and applicability of the evidence produced.
This study also presented limitations inherent to the design of a rapid review: although based on validated methods, it employs methodological shortcuts to provide timely responses to decision-makers in the short term. A preliminary search of several databases identified only two potentially eligible studies, which were included in the study. Methodological quality assessment was performed by one researcher and validated by another. No assessment of confidence in the systematic reviews was performed.
It should be noted that significant gaps were identified. The limited number and quality of the systematic reviews identified and analyzed highlight the need for more rigorous reviews on the prevention and control of Chagas disease. None of the analyzed systematic reviews reported actions to improve prenatal care or reduce vertical and oral transmission of the disease, underscoring the need for further systematic reviews in this area. Although studies of this nature address the vertical transmission of Chagas disease, most focus on estimating maternal prevalence, congenital transmission rates 27-30, or associated risk factors 31.
In addition to the study's search and review period, a systematic review focused on preventing vertical transmission was identified 32. This review demonstrated that trypanocidal treatment in infected women of reproductive age is an effective strategy for preventing congenital Chagas disease, with complete elimination of vertical transmission 32. None of the systematic reviews reported interventions related to housing improvement.
The findings of this study point to prevention and control strategies that involve community participation in vector notification, combined with rapid responses by decentralized surveillance teams to enable the professional application of insecticides. The use of insecticide-impregnated curtains and bed nets to reduce vector infestations and the use of sentinel animals to track Chagas disease incidence were also highlighted. Active surveillance was also mentioned, with or without vector-detection devices to support it. Finally, intersectoral actions involving the health sector, universities and research institutions, international donors, non-governmental organizations, communities, environmental sectors, and health educators should be considered in the formulation of prevention and control strategies for Chagas disease to reflect the problem as a health, environmental, and social issue.
Supplementary material
Supplementary Table 1
Supplementary Table 2
References
- 1. Alencar MMF, Santos Filho RAB, Hirschheiter CA, Carmo MCN, Santana MS, Ramos JLD, et al. Epidemiology of acute Chagas Diseases in Brazil from 2007 to 2018. R S and Development. 2020;9(10):e8449109120.
- 2. Chagas C. Nova tripanozomiaze humana. Estudos sobre a morfolojia e o ciclo evolutivo do Schizotrypanum cruzi n.gen. n. sp., ajente etiolojico de nova entidade morbida do homem. Mem Inst Oswaldo Cruz. 1909;1:159-218
- 3. Swett MC, Rayes DL, Campos SV, Kumar RN. Chagas Disease: Epidemiology, Diagnosis, and Treatment. Curr Cardiol Rep. 2024;26(10):1105-12.
- 4. Carbajal-de-la-Fuente AL, Sánchez-Casaccia P, Piccinali RV, Provecho Y, Salvá L, Meli S, et al. Urban vectors of Chagas disease in the American continent: A systematic review of epidemiological surveys. PLoS Negl Trop Dis. 2022;16(12):e0011003.
- 5. Sangenis LHC, Nielebock MAP, Santos CS, Silva MCC, Bento GMR. Transmissão da doença de Chagas por consumo de carne de caça: revisão sistemática. Rev Bras Epidemiol. 2016;19:803-11.
- 6. Dias JCP, Amato Neto V, Luna EJA. Mecanismos alternativos de transmissão do Trypanosoma cruzi no Brasil e sugestões para sua prevenção. Rev Soc Bras Med Trop. 2011;44:375-9.
- 7. Pérez-Molina JA, Molina I. Chagas disease. Lancet. 2018;391(10115):82-94.
- 8. Zaidel EJ, Liprandi AS, Liprandi AS. Neglected of the neglected: Crude reality of Chagas Disease. Med B Aires. 2021;81(4):675-6.
- 9. Pereira-Silva FS, Mello MLBC, Araújo-Jorge TC. Doença de Chagas: enfrentando a invisibilidade pela análise de histórias de vida de portadores crônicos. Cien Saude Colet. 2022;27:1939-49.
- 10. Souza CB, Grala AP, Villela MM. Óbitos por moléstias parasitárias negligenciadas no Brasil: doença de Chagas, esquistossomose, leishmaniose e dengue. Braz J Dev. 2021;7(1):7718-33.
- 11. Silva MT, Silva EN, Barreto JOM. Rapid response in health technology assessment: a Delphi study for a Brazilian guideline. BMC Med Res Methodol. 2016;18:5.
- 12. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210.
- 13. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.
- 14. Abad-Franch F, Vega MC, Rolón MS, Santos WS, Arias AR. Community Participation in Chagas Disease Vector Surveillance: Systematic Review. PLoS Negl Trop Dis. 2011;5(6):e1207.
- 15. Herdiana H, Sari JFK, Whittaker M. Intersectoral collaboration for the prevention and control of vector borne diseases to support the implementation of a global strategy: A systematic review. PLOS ONE. 2018;13(10):e0204659.
- 16. Horstick O, Runge-Ranzinger S. Protection of the house against Chagas disease, dengue, leishmaniasis, and lymphatic filariasis: a systematic review. Lancet Infect Dis. 2018;18(5):e147-58.
- 17. Kruse CS, Guerra DA, Gelillo-Smith R, Vargas A, Krishnan L, Stigler-Granados P. Leveraging technology to manage Chagas disease by tracking domestic and sylvatic animal hosts as sentinels: a systematic review. Am J Trop Med Hyg. 2019;101(5):1126-34.
- 18. Silva RA, Wanderley DMV, Domingos MF, Yasumaro S, Scandar SAS, Pauliquévis-Júnior C, et al. Doença de Chagas: notificação de triatomíneos no Estado de São Paulo na década de 1990. Rev Soc Bras Med Trop. 2006;39:488-94.
- 19. Dias JCP, Ramos Junior AN, Gontijo ED, Luquetti A, Shikanai-Yasuda MA, Coura JR, et al. II Consenso Brasileiro em Doença de Chagas, 2015. Epidemiol Serv Saude. 2016;25(esp):7-86.
- 20. Pérez-Gutiérrez E, Agrelo RS, Figueroa R. Consulta técnica em epidemiologia, prevenção e manejo da transmissão da doença de Chagas como doença transmitida por alimentos. Rev Soc Bras Med Trop. 2006;39:512-4.
- 21. Brasil. Fundação Nacional de Saúde. Elaboração e apresentação de propostas e projetos de melhorias habitacionais para controle da doença de Chagas: orientações técnicas. 2. ed. Brasília: Funasa; 2022.
- 22. Leal ARS, Ferreira ALS, Araujo-Pereira T, Sousa RLT, Campos JHF, Reis RT, et al. Eco-epidemiological aspects and risk factors associated with human Chagas disease in rural areas of the state of Piauí, Brazil. BMC Infect Dis. 2024;24(1):1335.
- 23. Santos CV, Bedin C, Wilhelms TS, Villela MM. Assessment of the Housing Improvement Program for Chagas Disease Control in the Northwestern municipalities of Rio Grande do Sul, Brazil. Rev Soc Bras Med Trop. 2016;49(5):572-8.
- 24. Lima MM, Carvalho-Costa FA, Toma HK, Borges-Pereira J, Oliveira TG, Sarquis O. Chagas disease and housing improvement in northeastern Brazil: a cross-sectional survey. Parasitol Res. 2015;114(5):1687-92.
-
25. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Saúde Ambiental, do Trabalhador e Vigilância das Emergências em Saúde Pública. Manual sobre medidas de proteção à saúde dos agentes de combate às endemias. Volume 1: arboviroses transmitidas pelo Aedes aegypti [recurso eletrônico]. Brasília: Ministério da Saúde; 2019. Available from: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/dengue/manual_protecao_agentes_endemias.pdf/view
» https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/svsa/dengue/manual_protecao_agentes_endemias.pdf/view - 26. Amaral VCF, Freitas MVS, Paulo GL, Barbosa SE, Souza JMB, Amaral BS, et al. Community-based surveillance of Chagas disease: characterization and use of Triatomine Information Posts (TIPs) in a high-risk area for triatomine reinfestation in Latin America. PLoS Negl Trop Dis. 2025;19(6):e0013153.
- 27. Tinajeros F, Rodríguez-Olguin BA, Cutshaw MK. Prevalence of maternal Chagas disease and vertical transmission rates in Bolivia: a systematic review and meta-analysis. Am J Trop Med Hyg. 2024;110(4):663-8.
- 28. Howard EJ, Xiong X, Carlier Y, Sosa-Estani S, España C, Buekens P. Frequency of the congenital transmission of Trypanosoma cruzi: a systematic review and meta-analysis. BJOG. 2014;121(1):22-33.
- 29. Martins-Melo FR, Lima MS, Ramos Junior AN, Alencar CH, Heukelbach J. Prevalence of Chagas disease in pregnant women and congenital transmission of Trypanosoma cruzi in Brazil: a systematic review and meta-analysis. Trop Med Int Health. 2014;19(7):840-50.
- 30. Santana KH, Oliveira LGR, Castro DB, Pereira M. Epidemiology of Chagas disease in pregnant women and congenital transmission of Trypanosoma cruzi in the Americas: a systematic review and meta-analysis. Trop Med Int Health. 2020;25(8):894-905.
- 31. Klein, Proaño A, Noazin S, Scaudone M, Gilman RH, Bowman. Risk factors for vertical transmission of Chagas disease: a systematic review. Int J Infect Dis. 2021;108:74-82.
- 32. Moraes FCA, Souza MEC, Moro LD, Donadon IB, Silva ER, Souza DSM, et al. Prevention of congenital Chagas disease by trypanocide treatment in women of reproductive age: a meta-analysis of observational studies. PLoS Negl Trop Dis. 2024;18(1):e0012407.
-
Data availability
The study used bibliographic and publicly accessible data. The spreadsheet containing data extraction and the Assessment of Multiple Systematic Reviews, version 2, assessment is available in a supplementary file at: https://osf.io/5vuar.
-
Protocol registration
The study protocol was previously published in the Open Science Framework repository under the title "Protocolo de síntese rápida - estratégias de prevenção e controle da doença de Chagas" for public consultation and is available at: https://doi.org/10.17605/OSF.IO/NHQGD.
-
Use of generative artificial intelligence
The use of generative artificial intelligence was limited to the occasional rewriting of certain sentences in the text.
Edited by
-
Editor-in-Chief:
Jorge Otávio Maia Barreto - https://orcid.org/0000-0002-7648-0472
-
Scientific Editor:
Maria Auxiliadora Parreiras Martins - https://orcid.org/0000-0002-5211-411X
-
Associate editor:
Carolina Muller Ferreira - https://orcid.org/0000-0002-7975-5777
-
Peer Review Administrator:
Izabela Fulone - https://orcid.org/0000-0002-3211-6951
The study used bibliographic and publicly accessible data. The spreadsheet containing data extraction and the Assessment of Multiple Systematic Reviews, version 2, assessment is available in a supplementary file at: https://osf.io/5vuar.
