Abstract
BACKGROUND: Chagas disease, caused by Trypanosoma cruzi, remains a significant public health problem in Venezuela, with evidence of re-emerging transmission and increasing concern over non-vectorial routes such as oral and congenital transmission. Effective public health strategies require a clear understanding of community-level knowledge, attitudes, and practices (KAP). This study aimed to characterize and identify predictors of KAP regarding Chagas disease in a rural, endemic community in Portuguesa state, Venezuela. METHODS: A cross-sectional survey was conducted in September 2024 in the "Virgen de Coromoto" community. Participants aged 18 and older were recruited via non-probabilistic sampling. Data were collected using a pre-validated 57-item questionnaire covering sociodemographic aspects, knowledge, attitudes, and practices. KAP levels were categorized as high/low, positive/negative, and appropriate/inappropriate using a data-driven two-step cluster analysis. Binomial logistic regression was used to identify factors associated with these KAP outcomes. RESULTS: A total of 317 individuals participated in the study. The median age was 36 years, and 57.7% (n = 183) were female. While a majority of participants demonstrated high knowledge (59.3%) and positive attitudes (57.4%), a significant proportion engaged in inappropriate preventive practices (61.8%). Knowledge deficits were identified concerning non-vectorial transmission routes, with only 24.9% correctly identifying contaminated food/juices and 40.7% identifying blood transfusions as risks. Women of reproductive age had significantly lower knowledge scores compared to the rest of the population (median score 9 vs. 11, p < 0.001). Being a woman of reproductive age (aOR = 1.75, 95% CI = 1.04-2.95, p = 0.034) and having negative attitudes (aOR = 1.82, 95% CI = 1.09-3.03, p = 0.021) were significant predictors of low knowledge. Having metallic screens on windows and doors was associated with a lower likelihood of inappropriate practices (aOR = 0.46, 95% CI = 0.22-0.97, p = 0.04). CONCLUSIONS: Despite generally high awareness, a critical disconnect exists between knowledge and protective behaviours in this endemic community. Specific vulnerabilities, including poor understanding of oral and congenital transmission routes and lower knowledge among women of reproductive age, pose significant risks. These findings underscore the need for targeted, evidence-based educational interventions that move beyond general awareness to address specific behavioural barriers and protect vulnerable groups.