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IJE Advance Access published online on August 14, 2007
International Journal of Epidemiology, doi:10.1093/ije/dym065
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2007; all rights reserved.
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and Oxford University Press are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

House-level risk factors for triatomine infestation in Colombia

DH Campbell-Lendrum1,*, VM Angulo2, L Esteban2, Z Tarazona2, GJ Parra3, M Restrepo3, BN Restrepo3, F Guhl4, N Pinto4, G Aguilera4, P Wilkinson1 and CR Davies1

1London School of Hygiene and Tropical Medicine, Keppel St., London, UK.
2Centro de Investigaciones en Enfermedades Tropicales (CINTROP), Universidad Industrial de Santander, Bucaramanga, Colombia.
3Instituto Colombiano De Medicina Tropical - CES, Medellin, Colombia.
4Centro de Investigaciones en Microbiologia y Parasitologia Tropical, Universidad de Los Andes, Bogotá, Colombia.

*Corresponding author. London School of Hygiene and Tropical Medicine, Keppel St., London, UK. E-mail: campbelllendrumd{at}who.int


  Abstract

Background Chagas disease, transmitted domestically by triatomine bugs, is the most important vector-borne disease in Latin America. The association between triatomine infestation and housing characteristics was investigated based on a standardized survey in 41 971 houses in 15 Departments in Colombia.

Methods Multivariate logistic regression was used to test for associations of two highly correlated infestation measures of infestation (householders reporting having seen triatomines inside the house, and sending triatomines to the survey team), with 15 household-level risk factors. Risks were measured relative to a reference category of houses with up to three inhabitants, area up to 50 m2, unplastered adobe walls, thatch roof and no outbuildings or domestic animals.

Results The probability of seeing triatomines was highest for households with over seven inhabitants (OR = 1.24, 95% CI 1.11–1.39), overhead storage space (OR = 1.16, 95% CI 1.03–1.32), grain shed (OR = 1.25, 95% CI 1.02–1.52), cats (OR = 1.27, 95% CI 1.14–1.42) and pigs (OR = 1.16, 95% CI 1.03–1.30). Lowest risks were in houses with wooden walls (OR = 0.46, 95% CI 0.34–0.61), fully plastered walls (OR = 0.78, 95% CI 0.68–0.88), roofs made of tiles (OR = 0.51, 95% CI 0.33–0.78) and flagstone floors (OR = 0.57, 95% CI 0.42–0.76). Results for householders returning triatomines support this set of risk factors, but with wider confidence intervals.

Conclusions Surveillance of a few easily assessed household characteristics provides an accurate, rapid assessment of house-level variation in risk. Measured effect sizes for specific structural characteristics could be used to maximize the cost-effectiveness of programmes to reduce vector infestation and interrupt Chagas disease transmission by improving house quality.

Keywords Triatominae, risk factors, housing, Chagas disease, Colombia

Accepted 9 March 2007


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