[Schistosoma mansoni in the context of the Brazilian health policy]

Schistosomiasis in the Middle Paranapanema river region, state of São Paulo, Brazil: Does it matter today for public health?

INTRODUCTION

The Middle Paranapanema watershed is known for the transmission of schistosomiasis, and there have been autochthonous cases since 1952. This study aimed to describe this disease in space and time and evaluate its current importance as a public health problem.

METHODS

Thematic maps showing the risk areas for transmission of schistosomiasis, using scan statistics, and flow maps were created in the period 1978-2016. Incidence was calculated, and the existence of spatial dependence between autochthonous and imported cases was evaluated using Ripley's K12-function. Species of snails were identified in high-risk clusters.

RESULTS

A total of 1,511 autochthonous cases were reported in eight of the 25 municipalities in the study area, of which 92.8% occurred in Ourinhos. A total of 2,189 imported cases were reported (27% in Ourinhos and 20% in Assis), mainly originating in the states of Paraná and Minas Gerais. Clusters of autochthonous and imported cases with higher risk were identified in Ourinhos, Assis and Ipaussu. However, over the years, the cases began to occur in low density in Ourinhos and no longer in other municipalities in the region. The cluster detected in the period 2007-2016 in Ourinhos still has risk for the transmission of schistosomiasis. K12-function analysis indicated positive spatial dependence between autochthonous and imported cases.

CONCLUSIONS

The study showed that, currently, schistosomiasis as a public health problem in Middle Paranapanema is restricted to Ourinhos. This fact may be related to the presence of Biomphalaria glabrata at a specific point and low coverage of basic sanitation.

Socioenvironmental factors associated with Schistosoma mansoni infection and intermediate hosts in an urban area of northeastern Brazil

Schistosomiasis, which is caused by trematodes of the genus Schistosoma and by the species Schistosoma mansoni in Brazil, is transmitted primarily by Biomphalaria glabrata mollusks. Infections occur in humans and mollusks in freshwater environments contaminated with feces from infected humans. This study aimed to evaluate potential foci of schistosomiasis based on the identification of infection sites for the snails, factors that increased the human infection probability of S. mansoni infection, and the relationship of the disease with abiotic, biotic, and sociocultural factors. The study was conducted in an urban area on the northeast coast of Brazil; this location was chosen based on the following factors: the presence of B. glabrata, nearby freshwater, and the absence of sewer treatment. A parasitological analysis was performed to evaluate infections of the mollusks and residents inside the perimeter defined by the collection points. Questionnaires were applied to obtain demographic data and to identify behaviors that led to human infection. To verify the contamination of freshwater by human feces, a microbiological analysis of the water was performed at the mollusk collection points to determine the rate of contamination with fecal coliforms. A total of 10,270 B. glabrata mollusks were collected between August 2013 and August 2014, of which 8.8% were positive for S. mansoni; the prevalence ranged from 0 to 34.5% over the study period. A total of 232 coprological samples from the residents were analyzed. The S. mansoni infection prevalence rate was 16.4%, and the S. mansoni parasitic load in the infected residents was 54.9 eggs per gram of feces on average. Males were more affected by the parasite, especially in the 8-17-year-old age range. Thermotolerant coliforms were observed at the mollusk collection sites, which indicated that freshwater and sewage were in continuous contact. This contamination indicated poor sanitary conditions, as was previously observed, which could be combined with detrimental behavior due to the residents' habits. These conditions cause a predisposition for both intermediate and definitive infections of the hosts by creating a socioenvironmental scenario that is conducive to the formation and maintenance of potential schistosomiasis foci. This and similar areas deserve special attention from the government with an aim of improving sanitation services and local resident knowledge to prevent future contamination.

Avaliação normativa das ações dos enfermeiros da saúde da família no controle da esquistossomose em Pernambuco

RESUMO Avaliação normativa das ações do enfermeiro da saúde da família no controle da esquistossomose em Pernambuco entre 2009 e 2011. Construiu-se e validou-se um modelológico a partir do aparato normativo e um questionário semiestruturado que foi aplicado a 40 enfermeiros de 40 unidades de uma amostra aleatória de 23 municípios. As ações técnicas e gestoras foram julgadas a partir da criação do indicador composto Grau de Implantação (GI). A função gestora (52,8%) esteve mais bem implantada do que a função técnica (33,3%). O GI processo foi de 47,84 pontos (incipiente). Verificou-se falha na identificação dos critérios ambientais de risco; no planejamento conjunto e na vigilância epidemiológica.

Evaluation of schistosomiasis control activities in the Family Health Strategy in municipalities in the Jequitinhonha Valley, Minas Gerais, Brazil

Observational study that examined the quality of the preventive actions for schistosomiasis control in the Brazilian Family Health Strategy (FHS) in an endemic area. Structured questionnaires were used to interview 97 health professionals of the FHS and the Secretary of Health of 25 municipalities belonging to the State Health Department of Pedra Azul, Minas Gerais, Brazil. Models of latent variables were used to define a score to evaluate the quality of the process. The results showed that 57.8% of the FHS teams' actions were unsatisfactory or critical. The professionals did not perform effective activities for the control of the infection and 8.1% did not use the diagnostic methods required by the government. Similarly, the professionals did not receive adequate training for the development of schistosomiasis prevention and control. There was a lack of educational materials to carry out health education activities, and the FHS teams conducted educational activities in only 48% of the schools of municipalities. Less than half of the professionals interviewed knew about the Schistosomiasis Control Program. We concluded that it is necessary to integrate this Program's practices to the FHS, and seek a suitable support of municipal management through pacts and social control.