In Latin America, many women go through their pregnancies with infections that can be transmitted to their children without being detected in time. Diseases such as HIV, syphilis, hepatitis B and C, or Chagas can remain undiagnosed during pregnancy and generate avoidable consequences in newborns, especially in contexts where access to health is unequal.
Among these diseases, Chagas continues to be one of the most invisible. It is a chronic parasitic disease that has a great impact on maternal and child health and, every April 14, on World Chagas Day, this problem that still faces important access barriers is put on the agenda. According to the World Health Organization, it is estimated that there are between 6 and 7 million people in the world with the infection, the majority in Latin America, many of them without diagnosis. It can be transmitted from mother to child during pregnancy or childbirth and, without timely detection, remain silent for years, maintaining the risk of transmission to the newborn.
Within this framework, nine Ibero-American countries carry out the Ibero-American Initiative ‘No Baby with Chagas’, a cooperation program to eliminate mother-to-child transmission of the disease by 2030. The Initiative, promoted by the Ibero-American General Secretariat (Segib), has the support of the World Health Organization, the Pan American Health Organization and the Mundo Sano Foundation*, in charge of accompanying its implementation, generating evidence and facilitating coordination between countries.
After five years of planning and regional construction, Guatemala became the first country to implement a concrete action in the territory. The implementation is led by the Ministry of Public Health and Social Assistance, with the support of the Pan American Health Organization, the Community of Castilla-La Mancha (Spain) and the technical support of Mundo Sano.
In eastern Guatemala, this challenge takes on a concrete dimension. In rural areas, where distances are long, some roads are difficult to access, and transportation is scarce, many women depend on care networks that exist within their own communities. There the midwives appear.
Their work begins in homes. They accompany pregnancies, listen, observe and detect warning signs. They are community leaders that support links of care where the health system simply does not reach. This proximity makes them a key bridge between communities and health services.
The experience in Guatemala provides concrete learning on how to strengthen the first level of care from the territory.
In large regions of the Americas, the prevention of mother-to-child transmission of Chagas does not depend solely on having diagnosis and treatment. The main challenges remain that pregnant women access these services in time.
This support is especially relevant in diseases such as Chagas, where diagnosis during pregnancy allows women with infection to be identified in time, ensure follow-up of the newborn and guarantee its timely testing and treatment if necessary.
One of the central axes of the project is to integrate Chagas into prenatal controls, along with other vertically transmitted infections, moving towards more comprehensive care. For this to work, it is important that the offer is unique and universal for all pregnant women. Chagas has to be within that care package.
From training to everyday practice
For this role to be sustained in practice, the project incorporates practical training to strengthen capacities in real care situations. The materials were developed from a co-creation process with midwives and local health teams, integrating community knowledge, concrete experiences and forms of communication specific to the territory.
From this work, resources with cultural relevance emerged, such as visual guides, which facilitate the communication of key content in contexts where oral and visual languages predominate. Because, beyond the specific intervention, the experience in Guatemala provides concrete learning on how to strengthen the first level of care from the territory.
In the end, the challenge is not only to have diagnostic tools and effective treatments, but to ensure that they reach those who need them most in time. Improving effective access depends not only on expanding the offering of services, but also on recognizing and strengthening the links that allow people to use them.
* Marina Gold is Executive Director, Mundo Sano Foundation, Technical Unit of the Ibero-American Initiative No Baby with Chagas
