Chagas disease, migration and community settlement patterns in Arequipa, Peru.
Chagas disease, migration and community settlement patterns in Arequipa, Peru.
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DOI：
10.1371/journal.pntd.0000567
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发表时间：
2009-12-15
影响因子：
3.8
通讯作者：
Levy MZ
中科院分区：
文献类型：
--
作者：
Bayer AM;Hunter GC;Gilman RH;Cornejo Del Carpio JG;Naquira C;Bern C;Levy MZ
查加斯病是美洲最重要的被忽视的热带疾病之一。查加斯病的媒介传播在城市环境中历来罕见。然而，在秘鲁阿雷基帕市附近的边缘社区，城市传播周期已经确立。我们研究了这些社区的移民和定居模式的历史，以及它们与恰加斯病传播的联系。这是一项定性研究，采用焦点小组讨论和深入访谈。对来自秘鲁阿雷基帕附近三个棚户区和两个传统城镇的94名社区成员进行了五个重点小组和50次深入访谈。重点小组利用参与性方法，探讨社区的流动模式和锥蝽病媒的历史和目前的存在。根据事件历史日历进行了深入访谈，探讨了参与者的移徙模式以及与恰加斯病和病媒有关的经历。焦点小组的数据进行了分析，采用参与式分析方法，和访谈数据进行编码和分析，采用扎根理论的方法。昆虫学数据由正在进行的病媒控制运动提供。我们发现，阿雷基帕棚户区的移民不太可能在抵达时将锥蝽带到城市。然而，频繁的季节性迁移将棚户区居民带到了病媒流行的阿雷基帕周围的山谷。此外，棚户区的定居模式和居民饲养家畜的做法为病媒增殖和扩散创造了有利环境。最后，我们发现了一个传统城镇的人口流失和低收入移民的替代现象，在这个传统社区中创造了一个新的棚户区的人居模式。因此，人类移徙模式是阿雷基帕及其周围地区南美锥虫病风险的一个重要潜在决定因素。城市周边棚户区居民频繁的季节性迁移为病媒进入这些社区提供了途径。传统城镇不断变化的人口动态也为恰加斯病传播创造了有利条件。控制方案必须包括在假定没有病媒的社区监测虫害。美洲有800万至1000万人感染恰加斯病。虽然以前传播仅限于农村穷人，但南美锥虫病日益影响城市人口，特别是秘鲁阿雷基帕市附近的城市人口。我们采访了五个社区的居民，以了解他们迁移到城市的原因和时间，以及他们的迁移如何与查加斯病媒联系在一起，并探索棚户区和传统城镇的定居模式。我们发现，移民到棚户区不太可能介绍恰加斯病媒首次抵达城市。然而，频繁的季节性迁移将棚户区居民带到了病媒流行的阿雷基帕周围的山谷。此外，棚户区的定居模式和饲养家畜的做法为病媒生物创造了有利的环境。最后，一个传统城镇的人口流失和低收入移民的取代造成了棚户区的人类住区模式。这项研究揭示了种群动态与查加斯病媒侵扰之间的潜在联系。改进病媒控制的建议方法包括：今后病媒监测的重点放在有移动的人口的地区，为前往恰加斯病流行地区的移徙工人开展教育运动，促进阿雷基帕卫生部和住房部之间的合作，以确保将新的棚户区纳入病媒监测。
Chagas disease is one of the most important neglected tropical diseases in the Americas. Vectorborne transmission of Chagas disease has been historically rare in urban settings. However, in marginal communities near the city of Arequipa, Peru, urban transmission cycles have become established. We examined the history of migration and settlement patterns in these communities, and their connections to Chagas disease transmission. This was a qualitative study that employed focus group discussions and in-depth interviews. Five focus groups and 50 in-depth interviews were carried out with 94 community members from three shantytowns and two traditional towns near Arequipa, Peru. Focus groups utilized participatory methodologies to explore the community's mobility patterns and the historical and current presence of triatomine vectors. In-depth interviews based on event history calendars explored participants' migration patterns and experience with Chagas disease and vectors. Focus group data were analyzed using participatory analysis methodologies, and interview data were coded and analyzed using a grounded theory approach. Entomologic data were provided by an ongoing vector control campaign. We found that migrants to shantytowns in Arequipa were unlikely to have brought triatomines to the city upon arrival. Frequent seasonal moves, however, took shantytown residents to valleys surrounding Arequipa where vectors are prevalent. In addition, the pattern of settlement of shantytowns and the practice of raising domestic animals by residents creates a favorable environment for vector proliferation and dispersal. Finally, we uncovered a phenomenon of population loss and replacement by low-income migrants in one traditional town, which created the human settlement pattern of a new shantytown within this traditional community. The pattern of human migration is therefore an important underlying determinant of Chagas disease risk in and around Arequipa. Frequent seasonal migration by residents of peri-urban shantytowns provides a path of entry of vectors into these communities. Changing demographic dynamics of traditional towns are also leading to favorable conditions for Chagas disease transmission. Control programs must include surveillance for infestation in communities assumed to be free of vectors. Chagas disease affects 8–10 million people in the Americas. Although transmission was previously limited to the rural poor, Chagas increasingly affects urban populations, especially near the city of Arequipa, Peru. We interviewed residents of five communities to learn about why and when they migrated to the city and how their movements may link to Chagas vectors and to explore the settlement patterns of shantytowns and traditional towns. We found that migrants to shantytowns were unlikely to introduce Chagas vectors to the city upon first arrival. Frequent seasonal moves, however, took shantytown residents to valleys surrounding Arequipa where vectors are prevalent. In addition, the settlement pattern of shantytowns and the practice of raising domestic animals create a favorable environment for vectors. Finally, population loss and replacement by low-income migrants in one traditional town has created the human settlement pattern of a shantytown. This study exposes potential links between population dynamics and Chagas vector infestation. Suggested methods for improving vector control include focusing future vector surveillance in areas with mobile populations, creating educational campaigns for migrant workers to Chagas-endemic areas, and fomenting collaboration between the Arequipa Ministries of Health and Housing to ensure the inclusion of new shantytowns in vector surveillance.
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DOI：
10.1590/s0074-02762007005000092
发表时间：
2007-10-01
期刊：
Memórias do Instituto Oswaldo Cruz
影响因子：
--
作者：
Dias, João Carlos Pinto
通讯作者：
Dias, João Carlos Pinto
影响因子：
11.8
作者：
Levy MZ;Bowman NM;Kawai V;Waller LA;Cornejo del Carpio JG;Cordova Benzaquen E;Gilman RH;Bern C
通讯作者：
Bern C
DOI：
10.1590/s0074-02762007005000095
发表时间：
2007-10-01
期刊：
Memórias do Instituto Oswaldo Cruz
影响因子：
--
作者：
Briceño-León, Roberto;Méndez Galván, Jorge
通讯作者：
Méndez Galván, Jorge
影响因子：
2.9
作者：
Dufour, DL;Piperata, BA
通讯作者：
Piperata, BA
DOI：
10.1590/s0074-02762002000500002
发表时间：
2002-07-01
期刊：
Memórias do Instituto Oswaldo Cruz
影响因子：
--
作者：
Dias, JCP;Silveira, AC;Schofield, CJ
通讯作者：
Schofield, CJ