RESUMO
Malaria in pregnancy is associated with increased risks of maternal anemia, spontaneous abortion, low birth weight, premature delivery and other adverse effects on health. In Brazil, disease transmission is highly concentrated in the multi-state region that constitutes the Brazilian Amazon (more than 99% of all cases). This study, conducted between the first bimesters of 2007 and 2008, aims to identify the local barriers to prompt and effective case management of malaria in pregnancy and was carried out in health facilities located in three endemic municipalities of the Brazilian Amazon (Manaus, Presidente Figueiredo and Porto Velho). The study design combined both qualitative and quantitative descriptive methods. The qualitative design involved semi-structured interviews with health personnel who routinely deal with malaria care. The quantitative design involved a review of medical records of pregnant women in the visited health facilities. Additionally, data were abstracted from SIVEP-Malaria Epidemiological Surveillance Information System (Brasil, 2007) and Primary Care Information System (SIAB) databases. Flaws were detected in diagnosis (only 6.8% of women tested for malaria) and treatment (for Plasmodium falciparum infections, only 44.8% of patients received recommended first-line therapy; 10.2% of prescription presented treatments were not found in national guideline and 7.3% of the prescriptions for Plasmodium vivax and 17.9% of the prescriptions for P. falciparum were not sanctioned by the official guidelines). Training (only 37.3% had had some training), knowledge and counseling were also sub-optimal. These results indicated the need to improve the health-worker performance through training. Close supervision and feedback on the health-worker performance are also needed. These findings also highlighted the need to put into practice a series of government recommendations that encourage close collaboration between the National Malaria Control Program and Primary Health Care actions in order to achieve safer pregnancies.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Malária/diagnóstico , Malária/tratamento farmacológico , Vigilância da População/métodos , Complicações Parasitárias na Gravidez/diagnóstico , Complicações Parasitárias na Gravidez/tratamento farmacológico , Adolescente , Adulto , Antimaláricos/uso terapêutico , Atitude do Pessoal de Saúde , Brasil/epidemiologia , Bases de Dados Factuais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Pessoal de Saúde/educação , Pessoal de Saúde/estatística & dados numéricos , Humanos , Malária/epidemiologia , Prontuários Médicos , Pessoa de Meia-Idade , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Prescrições/estatística & dados numéricos , Pesquisa Qualitativa , Adulto JovemRESUMO
Malaria control in Brazil is based on early diagnosis and adequate and timely treatment as strategies for a rapid and long-lasting cure. Clinical consequences and resistance to antimalarials may arise from problems in prescribing, dispensing and in acceptance of therapeutic regimens by healthcare workers. We studied knowledge and practices, perceptions and attitudes of health workers participating in pharmaceutical services for malaria, regarding the official protocol and the possible flaws in therapy. Health workers from six municipalities in the Brazilian Amazon were interviewed. Speech analysis was employed as a technique to determine analytical categories and to organize data. There was only 1 physician among the 63 interviewees, the others were health technicians carrying out diagnosis, therapy indication and dispensing of antimalarial treatment. Training time and period since course completion varied. Flaws in the adherence to the national protocol included therapy indication, dispensing and counseling. Health workers need knowledge to face disease and treatment specificities. Holding accountable health workers that are unprepared and unfit for the job may indicate the need for adequacy in policies regarding adequate training and hiring of human resources.
Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Malária/tratamento farmacológico , Malária/epidemiologia , Brasil , Humanos , IncidênciaRESUMO
O controle da malária no Brasil conta com diagnóstico precoce e tratamento adequado e oportuno como estratégia para cura rápida e duradoura. Consequências clínicas e resistência aos antimaláricos podem resultar de falhas na prescrição, dispensação e aceitação dos profissionais aos esquemas terapêuticos propostos. Objetivou-se avaliar conhecimentos, práticas, percepções e atitudes de profissionais envolvidos na assistência farmacêutica à malária, frente ao protocolo oficial e a possíveis falhas na terapêutica. Entrevistaram-se profissionais em seis municípios na Amazônia Legal. Utilizou-se técnica de análise do discurso para determinação de categorias analíticas e sistematização. Dos 63 entrevistados, houve apenas um médico. Os demais, de nível médio, atuavam no diagnóstico, indicação e dispensação do tratamento antimalárico. O tempo de formação e de treinamento foi variável. Houve falhas na adesão ao protocolo nacional, perpassando indicação, dispensação e orientação aos pacientes. Os profissionais carecem de conhecimento para lidar com as especificidades da doença e do tratamento. A responsabilização de profissionais que não possuem o preparo necessário para a atenção sugere necessidade de políticas para a adequada capacitação e incorporação de recursos humanos.
Malaria control in Brazil is based on early diagnosis and adequate and timely treatment as strategies for a rapid and long-lasting cure. Clinical consequences and resistance to antimalarials may arise from problems in prescribing, dispensing and in acceptance of therapeutic regimens by healthcare workers. We studied knowledge and practices, perceptions and attitudes of health workers participating in pharmaceutical services for malaria, regarding the official protocol and the possible flaws in therapy. Health workers from six municipalities in the Brazilian Amazon were interviewed. Speech analysis was employed as a technique to determine analytical categories and to organize data. There was only 1 physician among the 63 interviewees, the others were health technicians carrying out diagnosis, therapy indication and dispensing of antimalarial treatment. Training time and period since course completion varied. Flaws in the adherence to the national protocol included therapy indication, dispensing and counseling. Health workers need knowledge to face disease and treatment specificities. Holding accountable health workers that are unprepared and unfit for the job may indicate the need for adequacy in policies regarding adequate training and hiring of human resources.