CONICET | Buscador de Institutos y Recursos Humanos

Background: The social determinants of health (SDHs) condition disease distribution and the ways they are handled.Socio-economic inequalities are closely linked to the occurrence of neglected tropical diseases, but empiricalsupport is limited in the case of Chagas disease, caused by the protozoan Trypanosoma cruzi. Herein we assessed therelationship between key structural SDHs and the risk of T. cruzi vector-borne transmission in rural communities of theArgentine Chaco occupied by creoles and an indigenous group (Qom). We used multiple correspondence analysis toquantify the household-level socio-economic position (social vulnerability and assets indices), access to health andsanitation services, and domestic host availability. We identified the most vulnerable population subgroups by comparingtheir demographic profiles, mobility patterns and distribution of these summary indices, then assessed theirspatial correlation and household-level effects on vector domiciliary indices as transmission risk surrogates.Results: Qom households had higher social vulnerability and fewer assets than creoles, as did local movers andmigrant households compared with non-movers. We found significantly positive effects of social vulnerability anddomestic host availability on infected Triatoma infestans abundance, after adjusting for ethnicity. Access to health andsanitation services had no effect on transmission risk. Only social vulnerability displayed significant global spatial autocorrelationup to 1 km. A hotspot of infected vectors overlapped with an aggregation of most vulnerable households.Conclusions: This synthetic approach to assess socio-economic related inequalities in transmission risk provideskey information to guide targeted vector control actions, case detection and treatment of Chagas disease, towardssustainability of interventions and greater reduction of health inequalities.