Chagas Disease Burden Rising in Migrant Populations – European Medical Journal

Global Progress on Chagas Disease in the Context of Sustainable Development Goal 3

An analysis of Chagas disease based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 indicates significant progress towards Sustainable Development Goal (SDG) 3, particularly Target 3.3, which aims to end the epidemics of neglected tropical diseases (NTDs) by 2030. However, the data also highlights persistent challenges and evolving epidemiological patterns that require targeted policy responses to ensure universal health coverage and well-being for all ages.

Progress Towards SDG Target 3.3: A Global Overview

Prevalence and Incidence Trends

Global efforts to combat Chagas disease have yielded positive results, aligning with the objectives of SDG 3. Key indicators from 1990 to 2023 demonstrate a substantial reduction in the disease burden.

• Global Prevalence: An estimated 10.5 million people were living with Chagas disease in 2023, representing a 16% decrease since 1990.
• Age-Standardised Prevalence Rate: A significant 55% reduction was observed in the global age-standardised prevalence rate, reflecting long-term success in control measures.
• Global Incidence: New cases decreased to 352,000 in 2023, with the age-standardised incidence rate falling by 55% since 1990.

Mortality Reduction

The decline in mortality underscores advancements in healthcare access and treatment, a core component of SDG 3.

• Global Deaths: Fatalities attributed to Chagas disease fell to 8,420 worldwide in 2023.
• Age-Standardised Mortality Rate: This represents a 72.5% decline in the age-standardised mortality rate since 1990.

These improvements are attributed to enhanced socioeconomic conditions (SDG 1, SDG 10), better housing (SDG 11), effective vector-control policies, and increased access to healthcare (SDG 3).

Geographical Disparities and Challenges to Health Equity

High-Burden Endemic Regions

Despite global progress, significant geographical disparities persist, posing a challenge to the SDG principle of “leaving no one behind.” The highest burden remains concentrated in Latin America.

1. Southern and Andean Latin America: Prevalence rates in these regions exceed 2,400 per 100,000 people.
2. Tropical Latin America and the Andean Region: These areas report the highest mortality rates, at 2.2 and 0.92 per 100,000, respectively.

Emerging Burden in Non-Endemic Regions

Migration patterns have shifted the disease landscape, creating new public health challenges in high-income countries and underscoring the global nature of NTDs.

• Rising prevalence is noted in North America and Europe due to migration from endemic areas.
• This trend necessitates targeted screening and care strategies to ensure equitable health access for migrant populations, in line with SDG 3.

Evolving Demographics and Implications for Health Systems

Shifting Age Distribution

The demographic profile of Chagas disease patients has aged, requiring health systems to adapt to manage chronic conditions effectively.

• The peak age of patients increased from 30–45 years in 1990 to 45–65 years in 2023.
• This ageing patient population requires a focus on long-term management of chronic complications such as heart failure, arrhythmias, and digestive disorders, reinforcing the need for robust health systems as envisioned in SDG 3.

Policy Imperatives for Accelerating Progress Towards SDG 3.3

Strategic Recommendations

To sustain momentum and address remaining gaps, the GBD 2023 findings underscore the need for integrated policy actions.

1. Enhance Surveillance: Continuous monitoring is crucial in both endemic and non-endemic regions to track epidemiological shifts.
2. Promote Early Diagnosis and Treatment: Expanding access to diagnostics and care is fundamental to reducing morbidity and mortality.
3. Strengthen Health Systems: Healthcare infrastructure must be adapted to provide specialised, long-term care for an ageing patient population with chronic Chagas-related complications.
4. Improve Data Quality: Accurate coding and reporting are essential for refining global estimates and informing evidence-based policies to achieve the final elimination goals of SDG Target 3.3.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The primary Sustainable Development Goal (SDG) addressed in the article is:

• SDG 3: Good Health and Well-being

  The entire article is dedicated to Chagas disease, a “neglected tropical condition.” It discusses the global burden, prevalence, incidence, and mortality rates associated with the disease. The focus on reducing the impact of a specific communicable disease, tracking its epidemiological trends, and highlighting the need for healthcare system responses (screening, care, treatment) directly aligns with the objective of ensuring healthy lives and promoting well-being for all at all ages.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s focus on Chagas disease, the following specific targets under SDG 3 can be identified:

• Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.

  The article directly addresses this target by focusing on Chagas disease, which it explicitly identifies as a “neglected tropical condition.” The content tracks progress towards ending its epidemic by reporting on the significant decreases in global prevalence (16% decrease since 1990), incidence (55% reduction in age-standardised rate), and mortality (72.5% decline in age-standardised mortality). This data is a direct measure of efforts to combat a neglected tropical disease.

• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

  This target is implied through the article’s discussion of policy and healthcare implications. The text highlights the “need for targeted screening and care strategies,” especially in non-endemic regions with rising prevalence due to migration. It also emphasizes the importance of “early diagnosis, and access to specialised care” and notes that improvements are linked to “increased access to healthcare and treatment.” These points underscore the necessity of strengthening health systems to provide comprehensive care for Chagas patients, which is a core component of universal health coverage.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article is rich with quantitative and qualitative indicators from the Global Burden of Disease Study 2023 that can be used to measure progress.

• Prevalence of Chagas disease

  The article provides specific data points to measure the prevalence, including the total number of people living with the disease (“an estimated 10.5 million people… in 2023”), the percentage decrease over time (“a 16% decrease compared with 1990”), and regional rates (“rates exceeding 2,400 per 100,000 people” in Latin America).

• Incidence of Chagas disease

  Progress is measured by the number of new cases (“352,000 new cases in 2023”) and the reduction in the age-standardised incidence rate (“a 55% reduction… since 1990”). This directly tracks the spread of the disease.

• Mortality rate due to Chagas disease

  The article uses mortality data as a key indicator of the disease’s impact, citing the total number of deaths (“fell to 8,420 worldwide”), the decline in the age-standardised mortality rate (“a 72.5% decline”), and specific regional mortality rates (“2.2 and 0.92 per 100,000” in Tropical and Andean Latin America, respectively).

• Access to and provision of healthcare services

  This is an implied indicator. The article suggests that progress is linked to “increased access to healthcare and treatment” and calls for “targeted screening,” “early diagnosis,” and “specialised care.” The implementation and reach of these services can serve as an indicator of progress towards universal health coverage for Chagas patients.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators’ to present the findings from analyzing the article.

Source: emjreviews.com