Elsevier

Acta Tropica

Volume 130, February 2014, Pages 167-174
Acta Tropica

Review
Prevalence of Chagas disease in Brazil: A systematic review and meta-analysis

https://doi.org/10.1016/j.actatropica.2013.10.002Get rights and content

Highlights

  • We analyzed data from 42 population-based studies on Chagas disease prevalence.

  • National pooled prevalence ranged from 4.4% (95% CI: 2.3-8.3) in the 1980's to 2.4% (95% CI: 1.5–3.8) after 2000.

  • Pooled prevalence in >60 year-olds was 17.7% (95% CI: 11.4-26.5).

  • Systematic population-based studies are needed to provide more accurate estimates.

  • Compulsory notification of the chronic forms of Chagas disease should be implemented.

Abstract

Chagas disease is a major public health problem in Brazil and Latin America. During the last years, it has become an emerging problem in North America and Europe due to increasing international migration. Here we describe the prevalence of Chagas disease in Brazil through a systematic review. We searched national and international electronic databases, grey literature and reference lists of selected articles for population-based studies on Chagas disease prevalence in Brazil, performed from 1980 until September 2012. Forty-two articles with relevant prevalence data were identified from a total of 4985 references. Prevalence ranged from 0% to 25.1%. Most surveys were performed in the Northeast region, especially in the state of Piauí. We observed a high degree of heterogeneity in most pooled estimates (I2 > 75%; p < 0.001). The pooled estimate of Chagas disease prevalence across studies for the entire period was 4.2% (95% CI: 3.1–5.7), ranging from 4.4% (95% CI: 2.3–8.3) in the 1980s to 2.4% (95% CI: 1.5–3.8) after 2000. Females (4.2%; 95% CI: 2.6–6.8), >60 year-olds (17.7%; 95% CI: 11.4–26.5), Northeast (5.0%; 95% CI: 3.1–8.1) and Southeast (5.0%; CI: 2.4–9.9) regions and mixed (urban/rural) areas (6.4%; 95% CI: 4.2–9.4) had the highest pooled prevalence. About 4.6 million (95% CI: 2.9–7.2 million) of people are estimated to be infected with Trypanosoma cruzi. The small number of studies and small-scale samples of the general population in some areas limit interpretation, and findings of this review do not necessarily reflect the situation of the entire country. Systematic population-based studies at regional and national level are recommended to provide more accurate estimates and better define the epidemiology and risk areas of Chagas disease in Brazil.

Graphical abstract

Estimated prevalence and geographic distribution of Chagas disease in Brazil in the last three decades are described by systematic review and meta-analysis.

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Introduction

Chagas disease is a Neglected Tropical Disease (NTD) and a major public health problem in Latin America (Moncayo and Silveira, 2009). During the last years, the disease has received increasing attention as an emerging problem in North America and Europe due to international migrations from endemic areas to non-endemic areas (Gascon et al., 2010, Schmunis and Yadon, 2010). There are about of 8–10 million infected people in Latin America (Schmunis and Yadon, 2010, WHO, 2010), with an annual death toll of about 14,000 (WHO, 2010).

After significant reduction of vector and transfusional transmission of Trypanosoma cruzi in Brazil, the number of cases with the acute form of Chagas disease has been reduced dramatically (Silveira, 2011a). Reduced specific mortality and increased survival of infected individuals is a consequence of better knowledge about the natural history of the disease and improved clinical and surgical care (Martins-Melo et al., 2012e, Martins-Melo and Heukelbach, 2013, Ramos Jr. et al., 2010). Recent estimates point to 2–3 million infected people in Brazil (Akhavan, 2000, Dias, 2007, Ramos Jr. et al., 2010), with about 6000 deaths annually (Martins-Melo et al., 2012a, Martins-Melo et al., 2012b, Martins-Melo et al., 2012d).

However, systematic data about the magnitude of Chagas disease in the general population and its distribution in Brazil's regions are not available (Camargo et al., 1984, Silveira et al., 2011). Such information is needed to optimize health resources allocation towards improvement on disease detection, treatment and control. In the present study we estimate the prevalence of Chagas disease in Brazil through a systematic review and meta-analysis of available population-based studies.

Section snippets

Study area

Brazil, South America's largest country, has a total territory of 8.5 million km2 and an estimated population of 194 million (2012). The country is divided into five geographic regions (South, Southeast, Central-West, North, and Northeast), 27 Federative Units (26 States and one Federal District) and 5570 municipalities. Despite the economic improvements that have given the country new international recognition and projection, there are still tremendous social and economic inequalities,

Literature search results

Of 4895 articles identified, 42 were considered eligible for the review (Aras et al., 2002, Arruda et al., 1984, Bento et al., 1984, Bento et al., 1989, Bento et al., 1992, Bezerra et al., 1983, Boia et al., 1999, Borges-Pereira et al., 2001, Borges-Pereira et al., 2002, Borges-Pereira et al., 2006, Borges-Pereira et al., 2008, Brito et al., 2012, Carvalho et al., 2011a, Carvalho et al., 2003, Carvalho et al., 2011b, Coimbra et al., 1992, Corrêa et al., 2011, Coura et al., 1995a, Coura et al.,

Discussion

We performed the first systematic nationwide assessment of Chagas disease prevalence in the last three decades. We describe prevalence estimates in Brazil derived from available population-based data. The data evidence high prevalence in endemic regions, especially in urban areas and the elderly. Chagas disease prevalence varied over time, with lowest levels since 2000.

Currently, only acute cases of Chagas disease are of compulsory notification in Brazil, and there are no nationwide data on the

Conclusions

Despite interruption of main vector and blood-borne transmission, considerable Chagas disease prevalence is observed in Brazil's endemic areas, with declines in the last decades. The infected population is ageing and increasingly urbanized. Systematic population-based studies at regional and national level are needed to provide more accurate estimates, identify high risk areas and to plan and assess systematic control measures in Brazil.

Acknowledgements

This study received financial support from the Brazilian Swiss Joint Research Programme (BSJRP 011008). JH is a research fellow at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). We thank CNPq (Process: 238926/2012-5) for providing PhD sandwich scholarship and the Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) for granting a PhD scholarship to FRM. The authors are grateful to Penelope Vounatsou, Frédérique Chammartin and Erika Langer for

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