Chagas disease affects 8 – 10 million people in the Americas. Previously limited to the rural poor, it is spreading to the poor of urban areas. A qualitative, interview-based study (PDF file) of five per-urban communities of Arequipa shows that men who have recently migrated to the city’s “new shantytowns” from the countryside are most at risk of contracting Chagas. But the migrants tend to come from Chagas-free areas and therefore do not bring the vector with them. Instead, it appears likely that they become infected through short-term migration to the Chagas-endemic valleys west of the city for seasonal agricultural labor.
Thus migration is involved in the spread of Chagas but the causal chain involves more than simply rural to urban migration. First, poverty in the rural areas prompts people, even young children on their own, to migrate to the city to seek work. Once there, limited employment options force many migrants to take on seasonal work in Chagas-endemic areas. They return to the shantytowns bringing the vectors with them. The disease then spreads rapidly in the new shantytowns, given their suboptimal housing, population crowding and high density of animals. Suggested methods for improving vector control include: focusing vector surveillance on mobile populations, motivating the Arequipa Ministry of Health and Ministry of Housing to work together to include new shantytowns in their vector surveillance and launching education campaigns for migrant workers who go to Chagas-endemic areas.
Improving vector control is certainly important, and I hope it proves successful in keep Chagas out of Peru’s cities. But what about programs in rural areas directed at protecting livelihoods and entitlements so that fewer people are compelled to migrate to cities in the first place? And how about focusing intense poverty alleviation efforts in Chagas-endemic areas? Such endeavors would help reduce the need for surveillance. If the conditions that foster Chagas were reduced and Chagas eventually eradicated, then education campaigns could focus on other, more productive kinds of learning.
Image: “Chagas” by Flickr user Clonny, licensed through Creative Commons.
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