Chagas Disease Maternal Seroprevalence and Maternal-Fetal Health Outcomes in a Parturition Cohort in Western El Salvador

Abstract

Congenital Chagas disease is a growing concern, prioritized by the World Health Organization for public health action. El Salvador is home to some of the highest Chagas disease (Trypanosoma cruzi infection) burdens in the Americas, yet pregnancy screening remains neglected. This pilot investigation performed a maternal T. cruzi surveillance study in Western El Salvador among women presenting for labor and delivery. From 198 consented and enrolled pregnant women, 6% were T. cruzi positive by serology or molecular diagnosis. Half of the infants born to T. cruzi-positive women were admitted to the NICU for neonatal complications. Geospatial statistical clustering of cases was noted in the municipality of Jujutla. Older women and those knowing an infected relative or close friend were significantly more likely to test positive for T. cruzi infection at the time of parturition. In closing, maternal T. cruzi infections were significantly higher than national HIV or syphilis maternal rates, creating an urgent need to add T. cruzi to mandatory pregnancy screening programs.

Keywords: Chagas disease; El Salvador; Trypanosoma cruzi; congenital; maternal–child health; neglected tropical disease; perinatal; vertical transmission.

Figure 1

Recruited perinatal Salvadoran women represented all 16 of the Sonsonate department (right) municipalities, while 5 municipalities from the equally underserved neighboring Ahuachapan department were also represented (left).

Figure 2

Map of T. cruzi-positive perinatal women from western El Salvador revealing that cases were mostly from Sonsonate department. The highest case count municipalities fell in Sonsonate and Caluco (Sonsonate department) and Jujutla (Ahuachapan department).

Figure 3

Cluster and outlier analysis of Chagas positive cases by municipality. High-low outliers indicate municipalities with comparatively higher T. cruzi positive prevalence from our participant population, surrounded by municipalities of lower prevalence. Low-high outliers indicate areas of lower T. cruzi positive prevalence from our study population, surrounded by municipalities with comparatively higher prevalence.