Hyperendemic Chagas disease and the unmet need for pacemakers in the Bolivian Chaco

Household insecticide spray programs have greatly diminished infestation by Triatoma infestans, the major domestic vector, blood bank and congenital Chagas disease screening have been implemented widely, and the estimated prevalence of Trypanosoma cruzi infection has fallen by more than 50% in the last 20 years [2]. A third non-profit program functioned in a similar manner, but stopped offering services for unspecified reasons (Niño Feliz, http://www.fnf.org.bo/index.php?option=com_content&view=article&id=60%3Amarcapasos&catid=37%3Amarcapasos&Itemid=2). [...]even when all three programs were functioning, only 170-200 low-cost pacemakers were available annually in the Santa Cruz region, representing only 10% of the 1,800 patients estimated to need pacemakers. Many patients undergo upgrades to implantable cardioverter-defibrillators, and pacemakers often outlive their recipients [15]. [...]thousands of pacemakers with significant battery life are explanted and returned to the manufacturers every year, or are buried or discarded by the funeral industry.