Analysis of the seroprevalence of and factors associated with Chagas disease in an endemic area in Northeastern Brazil

Freitas, Erlane Chaves; Oliveira, Maria de Fátima; Vasconcelos, Arduina Sofia Ortet de Barros; Silva, José Damião da; Viana, Carlos Eduardo Menezes; Gomes, Kátia Cristina Morais Soares; Cavalcanti, Luciano Pamplona de Góes

doi:10.1590/0037-8682-0242-2016

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Major Article • Rev. Soc. Bras. Med. Trop. 50 (01) • Jan-Feb 2017 • https://doi.org/10.1590/0037-8682-0242-2016 copy

Analysis of the seroprevalence of and factors associated with Chagas disease in an endemic area in Northeastern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

INTRODUCTION:

Chagas disease (CD) is currently considered a neglected disease; hence, identifying the factors associated with its high prevalence is essential. This study aimed to identify the seroprevalence of and the possible factors associated with CD in inhabitants of the City of Limoeiro do Norte, Northeastern Brazil.

METHODS:

Between April and November 2013, blood collection was conducted and a semi-structured questionnaire was administered. Blood samples that showed positive or possible serology for anti-Trypanosoma cruzi antibodies based on indirect immunofluorescence, hemagglutination indirect, and an enzyme-linked immunosorbent assay were analyzed. Associations between CD positivity and the study variables were analyzed using prevalence ratios (PR) with 95% confidence intervals (CI).

RESULTS:

A total of 812 individuals were analyzed, of which T. cruzi seropositivity was determined in 4.2% (34 individuals). Sociodemographic variables showing a significant association with T. cruzi positivity included age >50 years (PR = 27.6; 95% CI = 6.66-114.4), elementary level education (PR = 5.15; 95% CI = 1.83-14.47), and retirement (PR = 7.25; 95% CI = 3.72-14.14). Positivity for T. cruzi was 6.17 times higher in those who had a history of living in rammed earth houses compared with those who did not (95% CI = 2.19-17.37). There was no evidence of vertical transmission in the individuals studied. Among the individuals infected with T. cruzi, the majority reported having a comorbidity (p < 0.01).

CONCLUSIONS:

This study demonstrated the seroprevalence of CD and identified factors associated with a high prevalence of CD.

Keywords:
Chagas disease; Seroepidemiological investigation; Trypanosoma cruzi; Cross-sectional study

	Participants
Health unit	number	percentage
Santa Luzia	65	8.0
Antônio Holanda de Oliveira	67	8.2
João XXIII	116	14.3
Cabeça Preta	124	15.3
Luís Alves de Freitas	135	16.6
Center	151	18.6
Arraial	154	19.0
Total	812	100.0

Serological confirmation	Sociodemographic data			Epidemiological aspects
Id	ELISA	IIF	HAI	Sex	Age	School	Income	Fam hist CD	Resided REH	Presence of insects
1	RS	RS	NRS	F	57	CHS	Up to 2 MW	No	NI	Yes
2	RS	RS	RS	F	78	I	Up to 2 MW	No	Yes	Yes
3	RS	RS	RS	F	58	IES	Up to 2 MW	No	Yes	No
4	RS	IND	RS	F	45	IES	< 1 MW	Yes	Yes	Yes
5	RS	RS	NRS	F	63	IES	Up to 2 MW	NI	Yes	No
6	RS	RS	RS	F	54	IES	Up to 2 MW	Yes	Yes	Yes
7	RS	RS	RS	M	53	IES	Up to 2 MW	Yes	Yes	Yes
8	RS	RS	---	F	55	IES	Up to 2 MW	No	Yes	Yes
9	RS	---	RS	M	71	IES	Up to 2 MW	No	Yes	No
10	RS	RS	---	F	55	I	Up to 2 MW	Yes	Yes	Yes
11	RS	---	RS	F	63	IES	Up to 2 MW	Yes	No	Yes
12	RS	---	RS	F	66	I	Up to 2 MW	No	Yes	Yes
13	RS	RS	RS	M	68	IES	Up to 2 MW	Yes	No	Yes
14	RS	RS	---	F	66	IES	Up to 2 MW	Yes	Yes	Yes
15	RS	RS	---	M	54	IES	Up to 2 MW	No	Yes	Yes
16	RS	RS	---	M	59	IES	Up to 2 MW	No	Yes	Yes
17	RS	---	RS	M	58	I	Up to 2 MW	No	Yes	Yes
18	RS	RS	---	M	68	I	Up to 2 MW	Yes	Yes	Yes
19	RS	RS	---	F	60	I	Up to 2 MW	Yes	Yes	Yes
20	RS	RS	---	F	60	IES	Up to 2 MW	No	Yes	No
21	RS	RS	---	F	50	IES	Up to 2 MW	No	Yes	Yes
22	RS	RS	---	F	69	IES	Up to 2 MW	No	Yes	Yes
23	RS	---	RS	F	58	IES	Up to 2 MW	No	Yes	No
24	RS	---	RS	F	52	IES	Up to 2 MW	Yes	Yes	No
25	RS	---	RS	F	61	IES	Up to 2 MW	No	Yes	Yes
26	RS	RS	RS	F	68	IES	Up to 2 MW	No	Yes	No
27	RS	RS	---	F	61	IES	Up to 2 MW	No	No	No
28	RS	RS	---	M	53	CES	Up to 2 MW	No	Yes	Yes
29	RS	RS	---	F	64	IES	Up to 2 MW	Yes	Yes	Yes
30	RS	RS	---	M	60	IES	Up to 2 MW	No	Yes	No
31	IND	IND	IND	F	61	CHS	Up to 2 MW	Yes	Yes	Yes
32	RS	RS	---	F	62	IES	Up to 2 MW	No	No	Yes
33	RS	RS	---	F	61	IES	Up to 2 MW	No	Yes	Yes
34	RS	RS	---	F	47	IHS	Up to 2 MW	No	Yes	Yes

	Positive		Negative
Variable	n	%	n	%	PR	P-value	95% CI
Sex
female	25	4.5	532	95.5	1.27	0.53	0.60−2.68
male	9	3.5	246	96.5
Age (years)
≥ 50	32	10.7	266	89.3	27.6	< 0.01	6.66−114.40
< 50	2	0.4	512	99.6
Income
< 1 minimum wage	1	0.9	104	99.1	0.20	0.11	0.03−1.46
≥ 1 minimum wage	33	4.7	45	95.3
Schooling
until IES	30	6.2	451	93.8	5.15	< 0.01	1.83−14.47
from CES	4	1.2	326	98.8
Place of birth
Limoeiro do Norte	23	4.4	504	95.6	1.13	0.73	0.56−2.29
other cities	11	3.9	274	96.1
Occupation
farmer	7	3.4	197	96.6	0.74	0.46	0.33−1.67
other	27	4.6	554	95.4
retired	21	14.7	122	85.3	7.25	< 0.01	3.72−14.14
other	13	2.0	629	98.0
housewife	3	5.4	539	94.6	0.13	< 0.01	0.04−0.42
other	31	4.3	698	95.7

	Positive		Negative
Variable	n	%	n	%	PR	P-value	95% CI
Family history of CD
yes	12	4.9	231	95.1	1.33	0.42	0.67−2.67
no	21	3.7	546	96.3
Resided in rammed earth houses previously
yes	29	7.2	373	92.8	6.17	< 0.01	2.19 −17.37
no	4	1.2	338	98.8
Knowledge of the triatomine
yes	28	5.1	519	94.9	2.23	0.06	0.93−5.31
no	6	2.3	255	97.7
Presence of insects and/or rodents at home
yes	25	3.9	616	96.1	1.13	0.10	0.53−2.40
no	9	3.4	252	96.6
Donated blood previously
yes	4	3.3	119	96.7	0.75	0.81	0.27−2.08
no	30	4.4	659	95.6
Received a blood donation previously
yes	2	3.4	57	96.6	0.80	1.00	0.19−3.24
no	32	4.3	720	95.7
Has pets in intradomicile and/or peridomicile habitats
yes	23	3.8	576	96.2	0.74	0.41	0.37−1.50
no	11	5.2	202	94.8
Nurtures dogs
yes	13	3.7	343	96.3	0.79	0.50	0.40−1.56
no	21	4.6	435	95.4

	Positive		Negative
Variable	n	%	n	%	PR	P-value	95% CI
Visits to the physician per year
> 2 times	26	6.9	352	93.1	4.61	< 0.01	1.79−11.87
≤ 2 times	5	1.5	330	98.5
Undergoes medical examinations frequently
yes	21	6.5	302	93.5	2.16	0.03	1.08−4.33
no	12	3.0	387	97.0
Reports a health problem
yes	27	7.4	339	92.6	4.70	< 0.01	2.07−10.67
no	7	1.6	439	98.4
Reports hypertension
yes	18 9.9	163	90.1	3.92	< 0.01	2.04−7.53
no	16	2.5	615	97.5
Reports gastrointestinal problems
yes	2	3.4	57	6.6	0.80	1.00	0.19−3.25
no	32	4.2	721	5.8
Reports diabetes
yes	1	1.9	52	98.1	0.43	0.72	0.06−3.11
no	33	4.3	726	95.7

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[1] Corresponding author: Dr. Luciano Pamplona de Góes Cavalcanti. e-mail: pamplona.luciano@gmail.com