ABSTRACT
BACKGROUND: To assess the effectiveness of mass treatment of Schistosoma mansoni infection in socially vulnerable endemic areas in northeastern Brazil. METHOD: An ecological study was conducted, in which 118 localities in 30 municipalities in the state of Pernambuco were screened before 2011 and in 2014 (after mass treatment). Information on the endemic baseline index, mass treatment coverage, socio-environmental conditions and social vulnerability index were used in the multiple correspondence analysis. One hundred fourteen thousand nine hundred eighty-seven people in 118 locations were examined. RESULTS: The first two dimensions of the multiple correspondence analysis represented 55.3% of the variability between locations. The human capital component of the social vulnerability index showed an association with the baseline endemicity index. There was a significant reduction in positivity for schistosomes. For two rounds, for every extra 1% of initial endemicity index, the fixed effect of 13.62% increased by 0.0003%, achieving at most 15.94%. CONCLUSIONS: The mass treatment intervention helped to reduce transmission of schistosomiasis in areas of high endemicity. Thus, it can be recommended that application of mass treatment should be accompanied by other control actions, such as basic sanitation, monitoring of intermediate vectors and case surveillance.
ABSTRACT
OBJECTIVE: to evaluate the implementation of schistosomiasis mansoni control actions under the Program to Combat Neglected Diseases in three municipalities in Pernambuco state, Brazil. METHODS: implementation analysis was done in 2014, considering the following components - management, epidemiological surveillance, patient care, laboratorial support and health education -; direct observation and interviews were carried out with managers and technical personnel at the state, regional, and municipal levels. RESULTS: partial implementation was found in municipalities A and B 69.7%; 62.2%, while there was full implementation in municipality C 79.5%; contextual weaknesses were found in communication between management levels, insufficient technical-management autonomy of decentralized levels, and professional staff job instability; potentialities identified were - continuing education, political articulation, knowledge about the program, and performance evaluation. CONCLUSION: contextual categories related to development and implementation stood out for their positive influence on the degree of implementation in the municipalities; we recommend intervention in the weaknesses found, in order to ensure program sustainability and institutionalization.
Subject(s)
Neglected Diseases/prevention & control , Schistosomiasis mansoni/prevention & control , Brazil/epidemiology , Cities , Health Education/organization & administration , Humans , Neglected Diseases/epidemiology , Program Development , Program Evaluation , Public Health Surveillance , Schistosomiasis mansoni/epidemiologyABSTRACT
Objetivo: avaliar a implantação das ações de controle da esquistossomose mansônica do Programa de Enfrentamento às Doenças Negligenciadas em três municípios de Pernambuco, Brasil. Métodos: análise de implantação, realizada em 2014, considerando-se os componentes de gestão, vigilância epidemiológica, assistência ao paciente e apoio laboratorial, e educação em saúde; utilizaram-se observação direta e entrevistas com gestores e técnicos dos níveis estadual, regional e municipal. Resultados: verificou-se implantação parcial nos municípios A e B 69,7%; 62,2%, enquanto o município C classificou-se como implantado 79,5%; houve fragilidades de contexto relativas à comunicação entre instâncias gestoras, insuficiente autonomia técnico-gerencial dos níveis descentralizados e instabilidade profissional; como potencialidades, identificaram-se educação permanente, articulação política, conhecimento sobre o programa e avaliação de desempenho. Conclusão: categorias contextuais relacionadas com o desenvolvimento e implantação destacaram-se pela influência positiva no nível de implantação dos três municípios; recomenda-se intervir nas fragilidades observadas, para garantia da sustentabilidade e institucionalização do programa.
Objetivo: evaluar la implantación de las acciones de control de la esquistosomiasis mansoni del Programa de Afrontamiento de Enfermedades Desatendidas en tres municipios de Pernambuco, Brasil. Métodos: análisis de implantación, realizado en 2014, considerando los componentes gestión, vigilancia epidemiológica, asistencia al paciente y apoyo de laboratorio, y educación en salud; se utilizó la observación directa y entrevistas con gestores/técnicos de niveles estadual, regional y municipal. Resultados: implantación parcial en los municipios A y B 69,7%; 62,2%, mientras que el C se clasificó como implantado 79,5%; el contexto demostró fragilidades de comunicación entre instancias gestoras, insuficiente autonomía técnico-gerencial de los niveles descentralizados e inestabilidad profesional; como potencialidades, se identificaron educación permanente, articulación política, conocimiento del programa y evaluación de desempeño. Conclusión: las categorías contextuales relacionadas al desarrollo e implantación se destacaron por la influencia positiva a nivel de implantación de los tres municipios; se recomienda intervenir sobre las fragilidades observadas, para garantizar la sostenibilidad e institucionalización del programa.
Objective: to evaluate the implementation of schistosomiasis mansoni control actions under the Program to Combat Neglected Diseases in three municipalities in Pernambuco state, Brazil. Methods: implementation analysis was done in 2014, considering the following components - management, epidemiological surveillance, patient care, laboratorial support and health education -; direct observation and interviews were carried out with managers and technical personnel at the state, regional, and municipal levels. Results: partial implementation was found in municipalities A and B 69.7%; 62.2%, while there was full implementation in municipality C 79.5%; contextual weaknesses were found in communication between management levels, insufficient technical-management autonomy of decentralized levels, and professional staff job instability; potentialities identified were - continuing education, political articulation, knowledge about the program, and performance evaluation. Conclusion: contextual categories related to development and implementation stood out for their positive influence on the degree of implementation in the municipalities; we recommend intervention in the weaknesses found, in order to ensure program sustainability and institutionalization.
