A little known tropical disease, Chagas was recently compared to the HIV/AIDS epidemic in its first two decades. Like AIDS, its long incubation time, the lack of good treatments, and a widespread ignorance of its existence have allowed it to spread with little resistance, primarily throughout Latin America. With prevention being the most effective approach at the moment, one solution lies in the disease’s inherent link to housing materials and conditions.
The disease is spread through vector species known as triatomine bugs. The insects ingest the parasite when taking a blood meal from infected animals or humans. The parasite is then spread through their feces, either by contact with the bite wound or by subsequent contact with the eye, nose, and mouth mucosa. Chagas can also be spread by blood transfusion, ingesting contaminated foods, and from mother to fetus.
The symptoms of the acute phase are minor and often overlooked: only 50% of infected people may show a marked swelling or rash in one eye, and some flu-like symptoms such as prolonged fever and malaise may appear within about 2 months of infection. After this initial phase, a chronic phase begins that can last years, again frequently unnoticed. This phase involves irreversible damage to the heart, intestines, and nervous system, often culminating in debilitating health complications and death. There are currently only two existing medications to treat Chagas, which lose effectiveness after the acute phase and are often in short supply, with instances of parasite resistance also being reported. An estimated 7 to 8 million people are chronically infected worldwide.
While triatomine bugs feed at night, during the daytime they require dark cracks and crevices to dwell in, specifically the gaps resulting from mud, straw, and certain brick and wood constructions. The WHO recommends eliminating these conditions as an effective way of minimizing and even eliminating triatomine populations. The improvements entailed are relatively simple and inexpensive, and can be entirely implemented at a community level. Mud construction should be plastered to fill in all cracks or gaps, and a layer of cement should be added. All flooring should also be smoothed, compacted, and covered with cement. Straw roofs should be replaced with tiles or corrugated metal. Community-based programs involving local labor and construction materials have been shown to successfully eliminate triatomine infestations in numerous Latin American countries, but greater action and awareness is needed.
As with any housing development, the use of local labor and materials engages the local economy and makes for independent, cooperative communities. However, making sure that programs are community-based is of particular importance with Chagas disease. As the insects can migrate short spaces, it is important that all structures in the community, including public spaces and animal dwellings, be improved and regularly checked for necessary maintenance. Such solutions are an important option or supplement to insecticide spraying, which is temporary, expensive, and risky, as insects can develop resistance. Moreover, these simple housing improvements have health benefits that extend beyond Chagas.
Facing an expanding disease without a reliable cure, a better understanding of the scope of prevention is necessary. Housing improvement is not only inherently linked to the Chagas problem: it is a long-term, cost-efficient, community-based solution with added health and socioeconomic benefits to individuals.
Tommaso Dalla Favera, Campaign Officer for ARCHIVE Global
Did you know the workers in developing nations have a higher chance of lung cancer than developed nations? As a matter of fact, the leading cause of lung cancer in developing nations is occupational health hazards in the agriculture industry. Pesticides that are prevalent in the incidents of lung cancer include “herbicides (MCPA), insecticides (DDT, HCH and Toxaphen), organic phosphorus compounds (Parathion), organic nitro derivatives and fungicides”[i]. In this instant, with a dwindling work force and the rapidly increasing population agriculture safety is at a crossroads. Men and women are exposed daily to long hours, harsh working conditions, and inclement weather that creates a breaking point; the rise in population has increased demand on a already shortened food supply. All of which leads us to question marks: Is the social benefit of collecting food for the masses greater or the attempt for a stable income more important than workers personal health?
In developing nations the #1 source of income and usually the nation’s top Gross Domestic Product supplied is agriculture. According to the International Labor Organization “about 70 percent of developing countries economically active population works in agriculture”[ii]. Lung cancer has contributed to more cancer related deaths than any other cancer known to man. The death toll of lung cancer is described by the World Health Organization in their fact sheet writing, “there are significant regional differences in cancer prevalence, but the biggest cancer killers worldwide are lung cancer (1.4 million deaths in 2008), stomach cancer (740,000 deaths in 2008), liver cancer (700,000 deaths in 2008)…”[iii]. Many of the people that are dying are in low income communities where clean water and food are not commodities. A study performed by the Bhaktapur Cancer Care Center, in Bhaktapur, Nepal, studied 85 cases of lung cancer with a mixed gender pool. All of the 85 patients they were selected according to their occupational history and the exposure rate to concerning carcinogenic agents. Their findings show that “incidence is slightly higher in males than in females…frequent cancer type among males in the developing countries is in the lungs…430,000 new cases in 2000 followed by stomach cancer…47.7% of which occurred in the developing countries. Lung cancer is 2.7 times less frequent among women” [iv].
Some would argue that pesticides are beneficial for the development of agriculture. Interdisciplinary Toxicology (IT) – a peer reviewed journal – reports that there are multiple advantages to pesticides, such as “killing caterpillars feeding on the crop brings the primary benefit of higher yields” and “additional revenue that could be put towards children’s education or medical care, leading to a healthier, better educated population” [v]. After fully reading the report written by IT, the detriments far exceed the benefits of using pesticides. Sadly, children are brought into the defense of using pesticides knowing that most people will have blind eye for the benefit of children. The possibility that money for education and earning yields outweighs the overall health of people is baffling.
The problem is that many cases of lung cancer in developing nations can be avoided by simply wearing the proper protective equipment. The causes of lung cancer in work related incidents have been studied and documented in developed nations. World Health Statistics states that the “developing world workers often face unregulated and unprotected exposure…workers are being exposed when widespread knowledge is available about the risks and effective preventive measures” [vi]. The risk taken daily by worker must be lowered in order to have a sustainable agricultural system.
Preventing lung cancer is easier said, than done, when a population does not have the correct equipment or knowledge to protect themselves from harmful toxins. While there are simple measures to reduce agricultural workers vulnerability in poor working conditions there must be an intersection met in order to protect against lung cancer.
Charles Burton, Research Officer for ARCHIVE Global
[i] Safi, JM. Association between chronic exposure to pesticides and recorded cases of human malignancy in Gaza Governorates (1990-1999). Sci Total Environ, 2002 Feb 4; 284(1-3): 75-84.
[ii] International Labour Organization. 2002a. Decent Work and the Informal Economy. Report VI of the International Labour Conference, 90th Session, Geneva: ILO.
[iii] World Health Organization. Cancer Factsheet. Available from: http://www.who.int/mediacentre/factsheets/fs297/en/ Last accessed January 2013.
[iv] Parkin DM, Pisani P, Lopez AD, Masuyer E: At least one in seven cases of cancer is caused by smoking. Global estimates for 1985. Int J Cancer, 1994; 59: 494-504.
[v] Webster JPG, Bowles RG, Williams NT. Estimating the Economic Benefits of Alternative Pesticide Usage Scenarios: Wheat Production in the United Kingdom. Crop Production. 1999;18:83.
[vi] Kjellstrom, T., and L. Rosenstock. 1990. “The Role of Occupational and Environmental Hazards in the Adult Health Transition.” World Health Statistics Quarterly 43: 188-96.