Waterborne toxoplasmosis, northeastern Brazil.

Two waterborne outbreaks of toxoplasmosis have been described recently in southern Brazil. We present data from a community-based study of pregnant women in northeastern Brazil. Consumption of homemade ice was the only variable associated with seropositivity (adjusted odds ratio, 3.1, 95% confidence interval, 1.53-6.24). Our results suggest that water is a source of infection with Toxoplasma gondii.

Grandes represas e seu impacto em saúde pública: ii. Efeitos a jusante / Impact of large dams on public health: ii. Dowstream effects

Represas vêm sendo construídas há milhares de anos, e, atualmente, quase metade dos rios do mundo possui pelo menos uma grande represa. Os efeitos das grandes represas na saúde de populações a montante são comuns na literatura. Entretanto, o papel das represas na saúde pública de comunidades a jusante continua sendo negligenciado. Para contribuir nessa discussão, apresenta-se uma revisão da literatura a respeito dos efeitos das grandes represas na saúde pública de populações a jusante. Foram pesquisados os bancos de dados Medline, Lilacs, Repidisca, ISI Web of Science, WHOLIS, Banco de Teses da CAPES, Scielo, PAHO database, DESASTRES, World Commission on Dams database, Google, Science Direct, Wiley Interscience, MEDCARIB, além de páginas específicas na internet. São apresentados e discutidos a redução da biodiversidade aquática, a diminuição das áreas de desova de peixes e o declínio dos serviços ambientais prestados pelas planícies aluviais, brejos, ecossistemas fluviais, estuarinos e marinhos adjacentes. Conclui-se que a construção de represas está diretamente relacionada com o status nutricional das populações ribeirinhas a jusante, como conseqüência de mudanças na pesca e na agricultura. As condições precárias de saúde dessas comunidades, vulneráveis ou suscetíveis, por diversos motivos contextuais e históricos, terão grandes chances de se ampliar. É inquestionável que represas possam trazer inúmeros benefícios, entretanto, o risco para a saúde das populações vivendo a jusante também precisa ser identificado e prevenido.

Parasitic skin diseases: health care-seeking in a slum in north-east Brazil.

Ectoparasitic diseases are endemic in many poor communities in north-east Brazil, and heavy infestation is frequent. We conducted two studies to assess disease perception and health care seeking behaviour in relation to parasitic skin diseases and to determine their public health importance. The first study comprised a representative cross-sectional survey of the population of a slum in north-east Brazil. Inhabitants were examined for the presence of scabies, tungiasis, pediculosis and cutaneous larva migrans (CLM). The second study assessed health care seeking behaviour related to these ectoparasitic diseases of patients attending a Primary Health Care Centre (PHCC) adjacent to the slum. Point prevalence rates in the community were: head lice 43.3% (95% CI: 40.5-46.3), tungiasis 33.6% (95% CI: 30.9-36.4), scabies 8.8% (95% CI: 7.3-10.6) and CLM 3.1% (95% CI: 2.2-4.3). Point prevalence rates of patients attending the PHCC were: head lice 38.2% (95% CI: 32.6-44.1), tungiasis 19.1% (95% CI: 14.7-24.1), scabies 18.8% (95% CI: 14.4-23.7) and CLM 2.1% (95% CI: 0.8-4.5). Only 28 of 54 patients with scabies, three of 55 patients with tungiasis, four of six patients with CLM and zero of 110 patients with head lice sought medical assistance. The physicians of the PHCC only diagnosed a parasitic skin disease when it was pointed out by the patient himself. In all cases patients were correctly informed about the ectoparasites they carried. The results show that tungiasis and pediculosis, and to a lesser extent scabies and CLM, are hyperendemic but neglected by both population and physicians, and that prevalence rates of tungiasis and scabies at the PHCC do not reflect the true prevalence of these diseases in the community.