RESUMO
O Programa de Controle da Esquistossomose (PCE) vem sendo desenvolvido em áreas da Bahia pela Fundação Nacional de Saúde (FNS). Em 1989, ações de Informação, Educação, Comunicação e Mobilização Comunitária (IEC/MC) foram iniciadas. Neste estudo avalia-se o impacto epidemiológico do IEC/MC, adotando-se um desenho quasi-experimental, comparando-se prevalências de infecção por S. mansoni em áreas IEC/MC com estimativas de áreas referentes. Os dados são secundários, coletados rotineiramente pela FNS. Verificou-se uma redução da prevalência da esquistossomose em todas as áreas, que alcança maior intensidade nas áreas com IEC/MC. Aparentemente, ações de controle rotineiras realizadas isoladamente são mais efetivas entre escolares e pessoas do sexo masculino, enquanto que nas áreas com IEC/MC, observou-se maior impacto entre as mulheres, refletindo, provavelmente, as distintas estratégias adotadas. Aponta-se para a necessidade de estudos de avaliação qualitativos, além de estimativas do custo-benefício e custo-efetividade de modo a aprimorar o processo de tomada de decisões.
The Program for S. mansoni Control (PCE) has been developed in some areas of the State of Bahia by the Fundação Nacional de Saúde (FNS). In 1989, activities on Information, Education, Communication and Community Mobilization (IEC/MC) were initiated. This study evaluates the epidemiological impact of the IEC/MC, using a quasi-experimental study design strategy, comparing the prevalences of infection for S. mansoni in areas of IEC/MC and estimates of other areas. The data used were routinely collected by the local staff of the FNS. A decrease on the prevalence of S. mansoni infection was found in all study areas, specially in those of IEC/MC activities. Findings indicate that PCE activities are more effective among school-age individuals and male adults, although IEC/MC allows for higher epidemiological impact among women, reflecting the differences among the strategies. These findings point out the need for qualitative evaluation research, as well as cost benefit and cost effectiveness analyses, that are more appropriate for decision making processes.
Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Comunicação , Esquistossomose mansoni/prevenção & controle , Educação em Saúde , Avaliação de Programas e Projetos de Saúde , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Brasil/epidemiologia , Contagem de Ovos de Parasitas/estatística & dados numéricos , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/parasitologia , Fezes/parasitologia , Prevalência , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Distribuição por SexoRESUMO
The Program for S. mansoni Control (PCE) has been developed in some areas of the State of Bahia by the Fundação Nacional de Saúde (FNS). In 1989, activities on Information, Education, Communication and Community Mobilization (IEC/MC) were initiated. This study evaluates the epidemiological impact of the IEC/MC, using a quasi-experimental study design strategy, comparing the prevalences of infection for S. mansoni in areas of IEC/MC and estimates of other areas. The data used were routinely collected by the local staff of the FNS. A decrease on the prevalence of S. mansoni infection was found in all study areas, specially in those of IEC/MC activities. Findings indicate that PCE activities are more effective among school-age individuals and male adults, although IEC/MC allows for higher epidemiological impact among women, reflecting the differences among the strategies. These findings point out the need for qualitative evaluation research, as well as cost benefit and cost effectiveness analyses, that are more appropriate for decision making processes.
Assuntos
Comunicação , Educação em Saúde , Avaliação de Programas e Projetos de Saúde , Esquistossomose mansoni/prevenção & controle , Adolescente , Adulto , Brasil/epidemiologia , Criança , Fezes/parasitologia , Feminino , Humanos , Masculino , Contagem de Ovos de Parasitas/estatística & dados numéricos , Prevalência , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Esquistossomose mansoni/epidemiologia , Esquistossomose mansoni/parasitologia , Distribuição por Sexo , População Urbana/estatística & dados numéricosRESUMO
This study evaluates the effectiveness of the Schistosomiasis Control Program, PCE, in Cachoeira, state of Bahia-Brazil, in Paraguaçu Basin Area. Data comes from PCE-111 cards of SUCAM/FNS, which are routinely registered in the 111 villages identified during the study follow up, 1982-1992. The S. mansoni infection was diagnosed through Katz-Kato technique for stool exams. Temporal trends of the prevalence of infection were analyzed for each village. Four trend patterns were identified, and the most common was those of recurrence of infection prevalence (67.6%). Control of the endemics was achieved in 22.5% of the villages, while expansion trends were found in only 9.9% of them. In general, there was found a decrease in the prevalence, particularly, from 1982 to 1985, followed by an increase that do not reach the initial levels. It was observed a relative reduction on the number of villages that shows prevalence below or equal to 5%, that indicates control of the infection. It was not possible to evaluate trends of infection intensity neither the occurrence of severe shistossomiasis disease or related deaths, that may allow a more complete evaluation of this program.
Assuntos
Esquistossomose/prevenção & controle , Adolescente , Brasil/epidemiologia , Criança , Humanos , Prevalência , Avaliação de Programas e Projetos de Saúde , Esquistossomose/epidemiologia , Fatores de TempoRESUMO
In this study we evaluated three immunologic methods for confirmation of clinical diagnosis of Chagas' disease, in 120 in-patients. The skin testing with the T12E antigen and the immunofluorescence were positive in 10% of cases. The hemagglutination was positive in 14.1% of these patients. The co-positivity of results of skin-testing with hemagglutination and of this latter with immunofluorescence reached 7.5% of cases. However, only 5% of co-positivity was achieved with results of skin testing, immunofluorescence and hemagglutination. Furthermore, 19.1% of the in-patients showed at least one out of these exams to be positive. The specificity of the skin testing paralleled that of the immunofluorescence. The sensitivity of these exams, however, was lower than that obtained by the indirect hemagglutination. These data show that the skin testing with T12E antigen allows the diagnosis of Chagas' disease by a simple and handy method.
Assuntos
Antígenos de Protozoários/imunologia , Doença de Chagas/diagnóstico , Hipersensibilidade Tardia , Trypanosoma cruzi/imunologia , Adulto , Idoso , Animais , Criança , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Testes Sorológicos , Testes CutâneosRESUMO
Dam construction and associated flooding along rivers can alter ecosystems and pose serious threats to the welfare and health of local populations. This article describes a severe gastroenteritis epidemic in the Paulo Afonso region of Brazil's Bahia State related to flooding of the newly constructed Itaparica Dam's reservoir in 1988. Some 2,000 gastroenteritis cases, 88 of which resulted in death, were reported over a 42-day period. Responding to the outbreak, clinical data and water sample test results were reviewed; blood and fecal specimens from gastroenteritis patients were subjected to bacteriologic, virologic, and toxicologic testing; and drinking water samples were examined for microorganisms and heavy metals. The results revealed that the source of the outbreak was water impounded by the dam and pointed to toxin produced by cyanobacteria as the responsible agent. Proliferation of these microbes, present at concentrations of 1,104 to 9,755 standard cyanobacterial units per milliliter in untreated water, appears to have been encouraged by the decomposing biomass and other conditions prevailing in the newly flooded reservoir area.