Avaliação das condições habitacionais e de saúde da comunidade quilombola Boqueirão, Bahia, Brasil / Evaluation of housing and health conditions of Boqueirão afro descendant community, state of Bahia, Brazil

A comunidade quilombola Boqueirão situada no município de Vitória da Conquista, Bahia, Brasil é formada por cerca de 500 indivíduos, e possui um único açude, com livre acesso de animais, utilizado para lavagem de roupa e coleta de água para utilização doméstica. O abastecimento de água é precário, assim como não há saneamento básico, visto que não existe água encanada e esgotamento sanitário, o que resulta no despejo de dejetos no açude e solos, comprometendo a qualidade da água consumida. Esses fatores associados ao acesso restrito da população aos serviços de saúde tornam esses indivíduos vulneráveis a doenças como infecções parasitárias. O objetivo deste trabalho foi realizar o levantamento das condições de habitação e saúde dos moradores do quilombo Boqueirão. A amostra foi composta por 467 indivíduos, que responderam a um questionário baseado em suas condições de moradia e saúde. Destes, 404 foram submetidos ao exame parasitológico de fezes para o diagnóstico de infecções parasitárias. A população é formada predominantemente por jovens ou adultos, lavradores, e a maioria das casas não possui água encanada e sanitário. A maioria da população utiliza exclusivamente o Sistema Único de Saúde, sendo a hipertensão arterial a doença pré-existente mais relatada. Em relação às parasitoses intestinais, as protozooses foram mais prevalentes que as helmintíases. A precariedade das moradias, do abastecimento de água e das condições de saneamento básico reflete o perfil sócioeconômico da população e a deficiência nas políticas públicas voltadas para a comunidade, justificando os dados encontrados referentes à prevalência de doenças crônicas e parasitárias.

The Boqueirão is an afro descendant community located in Vitória da Conquista, Bahia, Brazil formed by about 500 individuals. This community has an only dam, where animals have free access, used frequently for washing clothes and water collection for domestic use. The water supply is precarious, as well as the basic sanitation, since it does not exist canalized water and sanitary exhaustion. It results in the ousting of dejections in the dam and ground, compromising the quality of the consumed water. These factors associated to limited access of the population health services become these individuals vulnerable to parasitic infections. The aim of this work is register the habitation and health conditions of the Boqueirão community. The sample was composed by 467 individuals that answered a questionnaire about their housing and health conditions. Of these, 404 had been submitted to fecal exam for the diagnosis of parasitic diseases. The population is formed predominantly by young or adult, agricultural worker, and most of houses have not canalized water and bathroom. Most of population uses only the public system of health and the high blood pressure was the most reported preexisting disease. In relation to the intestinal parasitisms, the protozoan infections were more prevalent than helminthic infections. The precarious conditions of habitation, water supply and basic sanitation reflect the social and economic population profiles and the inefficiency of health public politics for the community that explains the data found regarding the prevalence of chronic and parasitic diseases.

Evaluación de la eficacia de drogas antihelmínticas para el control de Trichuris trichiura y otras helmintiasis en el estado Aragua, Venezuela / Evaluation of the efficacy of antihelmintic drugs for the control of Trichuris trichiura and other helminthic diseases in the state of Aragua, Venezuela

Un ensayo clínico de cuatro brazos fue llevado a cabo en 14 comunidades del estado Aragua para evaluar cuatro esquemas de tratamientos antihelmínticos para geohelmintos: Mebendazol y albendazol como monoterapias y cada una de estas drogas en combinación con ivermectina como terapias combinadas. Los tratamientos fueron administrados posteriormente a un examen coproparsitoscópico inicial, con reevaluaciones a los 7 y 21 días. Quedó en evidencia que las tasas de curación observadas a los 7 días posteriores al tratamiento, a favor de los esquemas combinados, particularmente la combinación albendazol + ivermectina (χ2 = 10,85; P < 0,0009), pero no se reflejaron a los 21 días después de la administración de los tratamientos y ningún esquema demostró una eficacia superior. Trichuris trichiura aún responde satisfactoriamente a los tratamientos convencionales. A pesar de la similitud en la eficacia de las monoterapias y terapias combinadas, el porcentaje de pacientes curados con T. trichiura solo o con infecciones mixtas fue elevada (> 93%). Las uncinarias fueron curadas en 100% (cero huevos en heces), seguido de A. lumbricoides (98,2%) y las infecciones mixtas de T. trichiura + A. lumbricoides + uncinarias (100%). La reducción porcentual de huevos por gramo de heces fue de 100% para las uncinarias, 89,3% para A. lumbricoides y 81,7% para T. trichiura. Las tasas de fracasos fueron bajas para los cuatro esquemas terapéuticos: mebendazol (5,14%), albendazol (6,20%), albendazol + ivermectina (2,02%) y mebendazol + ivermectina (2,22%). El grupo de edad de 0 a 9 años registró el mayor número de fracasos terapéuticos (n = 13). Quizás convendría emplear esquemas combinados en casos de fracasos terapéuticos. Pero, surge la duda si se está evidenciando la posibilidad de resistencia a estos medicamentos, dado que la mayoría de los fracasos terapéuticos se observaron en pacientes con bajas cargas parasitarias que bien podrían revertirse en el tiempo.

A four-arm clinical trial was carried out in 14 communities in the State of Aragua to evaluate four antihelminthics treatments, as monotherapy and combined treatments for soil-transmitted helminthiasis: Mebendazole, albendazole and each of these drugs in combination with ivermectin. Treatments were given after an initial stool specimens were obtained for examination, with two sequential stool reevaluations on days 7 and 21. Cure rates (zero eggs in stools) at day 7 after treatments were favourable for combined treatments, specially albendazole + ivermectin (χ2 = 10.85; P < 0.0009), which was not reflected by day 21 since no treatment showed any superior efficacy. Trichuris trichiura still responds satisfactorily to conventional treatments offered by the national Programme for the Fight against Anclyostomiasis and other Intestinal Parasites. Notwithstanding the similarities of monotherapy and combined treatments efficacy, the percentage of patients cured with T. trichiura solely or with mixed infections was high (> 93%). Hookworm infections were cured a 100% (zero eggs found in feces), followed by A. lumbricoides (98.2%) and mixed infections by T. trichiura + A. lumbricoides + hookworms (100%). However, the mean egg reduction percent was also a 100% for hookworms, 89.3% for A. lumbricoides and 81.7% for T. trichiura. The rates of treatment failure were limited, albendazole 6.20%, mebendazole 5.14%, for the combination of albendazole + ivermectin 2.02% and for mebendazole + ivermectine 2.22%. The majority of treatment failures were seen in the 0-9 age group. It is perhaps convenient to use combined schemes in cases of treatment failure. But, there is doubt as to whether there is the possibility of resistance to these drugs given that the majority of treatment failures observed in patients with low intensity infections which might be subdued in time.