Physician Knowledge of Chagas Disease in a Non-Endemic Country: A Nationwide Cross-Sectional Survey

Chagas disease, caused by Trypanosoma cruzi, has become increasingly relevant in non-endemic countries due to migration. Spain hosts large Latin American communities, making physicians' awareness key for timely diagnosis and treatment. We aimed to assess knowledge of Chagas disease among physicians nationwide and to identify barriers to its clinical management.

We conducted a nationwide cross-sectional online survey of practising physicians in Spain (1 June-30 September 2025). The self-administered online questionnaire was developed through expert consensus and an extensive review of relevant literature and included demographic and professional data, 31 knowledge items across five domains (transmission, clinical presentation, screening, diagnosis, and treatment), as well as questions addressing perceived barriers. Knowledge was classified into five categories from very low to very high, with difficulty indices calculated per item. Associations used χ ², Kruskal-Wallis, or Spearman tests; independent predictors were examined with multivariable ordinal logistic regression.

Of 745 respondents (65.5% female; mean age 39.0 years [SD 11.7]; mean practise duration 12.8 years [SD 11.0]), knowledge was moderate in 55.8%, high in 32.6%, very high in 2.1%, low in 8.6%, and very low in 0.8%. Highest scores occurred in Infectious Diseases, Microbiology, and Internal Medicine; lowest score in Geriatrics. Higher knowledge was associated with perceiving clinical relevance (adjusted odds ratio [aOR] 2.51, 95% CI 1.79-3.53), specific training in the past 5 years (aOR 1.96, 1.32-2.90), and speciality (Internal Medicine, aOR 3.02, 1.96-4.65); less frequent nationality inquiry was associated with lower knowledge (frequently aOR 0.41, 0.23-0.72; occasionally 0.56, 0.35-0.89). Clinically relevant gaps were identified in diagnostic and therapeutic domains: fewer than half of physicians correctly identified PCR as the preferred diagnostic method in the acute phase or in immunocompromised patients, and only 63.1% recognised benznidazole or nifurtimox as first-line therapy. In contrast, awareness of congenital screening was high (94.0%). Main perceived barriers were low population risk perception and insufficient training.

Physicians showed moderate knowledge of Chagas disease, with important gaps in diagnosis and treatment. Targeted, large-scale educational initiatives supported by institutions are urgently needed to strengthen awareness and clinical preparedness in non-endemic settings with significant Latin American migrant populations.