During an intervention focused on community epidemiology by the Center of Community Epidemiology and Tropical Medicine (CECOMET) and the San Lorenzo Health District, done in six Awá indigenous communities in the north of the Esmeraldas province, Ecuador, several triatomines were discovered. This brought about a participative investigation that involved health promoters, community leaders, and administration from the Awá Indigenous Federation (FCAE). Through the investigation they confirmed the species, evaluated the risk of transmission of Chagas disease, identified infected people, and eventually established a treatment and control program.


A key part of the process was the ongoing Information, Education, and Communication strategy (IEC), with respect to the time needed for the internal discussion of the communities in question. This facilitated dialogue between important figures and decisions made collectively between community organizations and technicians in order to carry out necessary activities.

In order to guarantee a dialogue, several different meetings were arranged with community leaders and authorities from the Awá Federation. After an audiovisual presentation with simple educational material, they were able to recognize this health problem of which they had no previous knowledge and understand the next steps needed to confirm/deny the presence of Chagas in the Awá population.

After six months of discussion amongst members of the administration and visits to the communities, the leaders accepted the challenge of actively participating in this process. Regarding the intervention, the communities that were difficult to access consulted with their health promoters to establish an appropriate strategy for a screening event: a mobile laboratory was brought to the community for the blood tests, and those who tested positive underwent further testing at a more accessible location for the medical team, although it meant a three-hour journey through the jungle.

At the end of the event, the women shared a simple meal they had prepared. The results of the screening event have been analyzed and discussed at every level–in the communities, with FCAE leaders, and with health authorities–in order to establish a collective intervention plan that would involve training all health personnel in the district.


The two most important results from this process are:

1. The documentation of a center of transmission of T. cruzi in the Awá communities. The presence of T. cruzi was confirmed with a PCR test in 42.3% of the wild vectors collected by the PS (27 Triatoma dispar and 1 Pastrongylus rufotuberculatus). Out of the 1648 inhabitants, 718 (43%) had participated in the blood screening, although it was the very first screening event organized; 15 people tested positive in the two ELISA tests that were performed and 8 of those people have been treated with Nifurtimox. Each family received mosquito netting for individual protection according to the number of inhabitants.
2. Improvement in community organization and organization of the Awá Federation.

Conclusions: Seeing, deciding, and acting are the pillars of this methodology. The impact of IEC on a problem depends on the implementation of integral community intervention in order to guarantee improvement in health in its various aspects.




St. Lorenzo Health District (08D05)

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