Selective Primary Health Care: Strategies for Control of Disease in the Developing World. XVI. Chagas' Disease

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Abstract
Despite much research, specific chemotherapy for Chagas' disease remains problematic, and prophylaxis by vaccination seems remote. A significant proportion of today's positive seroreactive patients will burden tomorrow's hospital services with persistent cardiac failure, arrhythmias requiring pacemaker implantation, and megasyndromes requiring corrective surgical procedures. Yet the control of transmission to humans in many endemic areas is feasible by programs of residual insecticide spraying and subsequent vigilance and, in some instances, house improvement, i.e., measures to combat domiciliated vector bugs. The success of such programs will vary, depending on the dominant bug vector and degree of development of the country's public health services. The fact that the Brazilian government voted a large sum of money in 1983 for bug control by the Ministry of Health enforces this view. Transmission of Trypanosoma cruzi to humans could decrease considerably in the next decade in Brazil as a result of this program. There is, however, still a need for research to define the cheapest ways of interrupting transmission in different epidemiologic situations so that the maximum number of people at risk can be reached with the funds available, for the children infected today may be hospital patients of the future for whom little can be done.

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