RESUMO
ABSTRACT Background: Chagas disease (CD) is caused by Trypanosoma cruzi and transmitted by triatomines. Historical information from the 20th century demonstrates T. cruzi records in the metropolitan region of Salvador (MRS), the third largest urban agglomeration in the Brazilian Northeast and the eighth largest in Brazil, an area with intense migratory activity from CD-endemic regions. Therefore, this study aimed to evaluate CD indicators (prevalence and mortality) in the MRS. Methods: A mixed ecological and descriptive study was conducted using secondary data. We analyzed data from 2008 to 2015: deaths due to CD, self-reported cases of CD, and blood donors that were non-negative for T. cruzi infection. Results: São Francisco do Conde was one of the municipalities with the highest mortality rates due to CD. The seroprevalence rates varied by year and municipality; those with the highest values were 2008: Vera Cruz, 2009: Mata de São João, 2010: Dias D'Ávila, 2011 and 2015: São Francisco do Conde, 2012: São Sebastião do Passé, and 2013 and 2014: Pojuca. Spatial correlations between the municipalities were not detected. Conclusions: We conclude that CD is present in the MRS. The indicators analyzed in the MRS are below-state-level data. Given the importance of indicator analysis for the surveillance and control of CD at the state and national levels, it is important to strengthen the surveillance program at the municipal level, including the regions classified as low risk for T. cruzi vector transmission.
RESUMO
ABSTRACT Background: Neglected tropical diseases are a growing threat to global health, and endemic Chagas disease has emerged as one of the most important health problems in America. The main strategy to prevent Trypanosoma cruzi transmission is chemical control of vectors. This study presents a descriptive analysis of synanthropic triatomines before and after the implementation of a vector-control program in Bahia, Brazil. Methods: Descriptive analysis and geospatial statistics were performed on triatomine data, (1) the relative abundance and (2) proportional spatial distribution, from Bahia during two periods: (A) 1957 to 1971 and (B) 2006 to 2019. Results: We observed a decrease in the relative abundance of Panstrongylus megistus (A: n=22.032, 61.9%; B: n=1.842, 1.0%) and Triatoma infestans (A: n=1.310, 3.7%; B: n=763, 0.43%), as well as an increase in the relative abundance of T. sordida (A: n=8.314, 23.4%, B: n=146.901, 81.6%) and T. pseudomaculata (A: n=894, 2.5%, B: n=16.717, 9.3%). Conclusions: Our results indicate a clear reduction in the occurrence of P. megistus and T. infestans (last record in 2015) and an increase in the relative abundance and geographical distribution of T. sordida and T. pseudomaculata after 40 years of the vector-control program. The high frequency of other triatomine species in the municipalities of the state of Bahia and their abundance in recent years highlight the need to reinforce permanent entomological surveillance actions to prevent Chagas disease.
RESUMO
O alto consumo de agrotóxicos na Bahia e o impacto do uso de agrotóxicos na saúde e no ambiente exigem a aplicação de metodologias integradoras de vigilância e atenção à saúde das populações expostas. O texto relata uma experiência de educação em saúde voltada para a construção de metodologias e práticas integradas de vigilância e atenção à saúde de populações expostas a agrotóxicos, por meio da capacitação de técnicos das secretarias estadual e municipais de saúde, dos âmbitos central, regional e municipal. Nessa experiência, adotou-se a metodologia dialógica, valorizando as experiências individuais. Utilizaram-se instrumentos e mecanismos que permitiram a construção coletiva com base em uma determinada temática, potencializando a reflexão crítica da realidade. A abordagem teve como princípio a articulação intra e interinstitucional, a gestão da informação para a ação e a qualificação das equipes de saúde para atuarem em situações de rotina e em eventos inusitados. O Grupo de Trabalho de Agrotóxicos da Secretaria da Saúde do Estado da Bahia elaborou o plano de ação estadual, identificando estratégias para sua operacionalização, dentre elas o curso para técnicos de municípios definidos como prioritários, das áreas de Vigilância em Saúde e Centro de Referência Regional em Saúde do Trabalhador, bem como das respectivas Diretorias Regionais de Saúde. A experiência vivenciada pelos participantes durante o processo de concepção e realização do curso foi transformadora enquanto metodologia participativa e aprendizado coletivo, possibilitando a reflexão sobre a prática e o agir dos sujeitos.
The high consumption of pesticides in Bahia and the impact of pesticide use on human health and the environment and require the application of integrative methodologies of surveillance and attention to the health of the exposed population. This text reports on a health education experience focused on building methodologies and integrated surveillance and health care practices for populations exposed to pesticides through the capacitation of technicians from state and municipal departments of health, central, regional and municipal areas. For this experience the dialogic methodology was adopted, valuing individual experiences. Tools and mechanisms that allowed the collective construction based on a particular subject, potentiate the critical reflection on reality. The approach has had as principle the articulation intra and inter institutional, the management of information for the action and the qualification of health teams to work in routine situations and in unusual events. The Pesticide Working Group of the Department of Health of the State of Bahia elaborated the state action plan, identifying strategies for its operation, including the course for technicians of the municir municipalities defined as priority areas of Public Health Surveillance and Occupational Health´s Reference Center as well as the respective Regional Health Board. The experience experimented by the participants during the process of conception and execution of the course was exceptional as participative methodology and collective learning, allowing the reflectio on the practice and action of the subjects.
El alto consumo de plaguicidas en Bahia y el impacto del uso de plaguicidas en la salud y el medio ambiente exigen la aplicación de metodologías integradoras de vigilancia y atención a la salud de las poblaciones expuestas. El texto presenta la experiencia de educación para la salud dirigida a la construcción de metodologías y prácticas integradas de vigilancia y atención a la salud de las poblaciones expuestas a los plaguicidas, a través de la capacitación técnica de las secretarías de salud estatal y municipal, de los niveles central, regional y municipal. Por lo tanto, se ha adoptado la metodología dialógica, para valorar las experiencias individuales. Se han utilizado instrumentos y mecanismos que permitieron la construcción colectiva basada en una temática específica, potenciando la reflexión crítica de la realidad. El abordaje tuvo como principio la articulación intrainstitucional e interinstitucional, el manejo de la información para la acción y la calificación de los equipos de salud para actuar en situaciones de rutina y eventos inusuales. El Grupo de Trabajo de Plaguicidas del Departamento de Salud de Bahia ha elaborado el plan de acción estatal identificando estrategias para su operacionalización, entre ellas el curso para técnicos de municipalidades definidas como prioritarias, de las áreas de vigilancia de la salud y de los centros de referencia de salud de los trabajadores, así como de las respectivas Juntas Directivas Regionales de Salud.