Uchoa E, Barreto S M, Firmo J O, Guerra H L, Pimenta F G, Lima e Costa M F
Laboratory of Epidemiology and Medical Anthropology, René Rachou Research Center, Oswaldo Cruz Foundation, Belo Horizonte, MG, Brazil.
Soc Sci Med. 2000 Nov;51(10):1529-41. doi: 10.1016/s0277-9536(00)00052-6.
This study combined anthropological and epidemiological approaches to assess the effectiveness of community mobilization for health education, developed as part of the Brazilian program for the control of schistosomiasis. The study was carried out in two villages in the state of Minas Gerais, SE Brazil, exposed to the same established schistosomiaisis control strategies. Residents of one village were also exposed to the community mobilization for health education (study area) while those from the other community were not exposed to this program (control area). Schistosoma mansoni prevalence rates for the study and control villages were compared over time. A population-based survey was carried out in the two villages to obtain information on socio-demographic factors, water contact patterns and knowledge of S. mansoni transmission. Intensive ethnographic interviews with key informants in each locality were employed to determine the knowledge, attitudes and practices of the communities regarding schistosomiasis. Ethnographic data were analysed using the model of systems of signs, meanings and actions. Differences were observed in prevalence trends between the study and control areas but they could not be explained by the existence of the community mobilization program in the former. It was also found that educational actions carried out by the Brazilian Ministry of Health transmitted information on schistosomiasis but were ineffective in transforming the information received into preventive behaviour related to water contact. With regard to disease, the population studied tended to distinguish minor symptoms, which they associated with water contact, from major symptoms, which they attributed to lack of medical treatment. This distinction mediated perceptions of the severity of "xistose" and reduced the importance of avoiding contact with potentially infested waters. The perception of protection conferred by treatment observed in the present study might also apply to other communities where access to treatment is readily available and free. The extent to which this perception exists in endemic areas needs to be determined so that apparent contradictions of this type can be addressed in future educational programs.
本研究结合了人类学和流行病学方法，以评估作为巴西血吸虫病控制计划一部分而开展的社区动员式健康教育的效果。该研究在巴西东南部米纳斯吉拉斯州的两个村庄进行，这两个村庄都采用了相同既定的血吸虫病控制策略。其中一个村庄的居民还参与了社区动员式健康教育（研究区域），而另一个社区的居民未参与该项目（对照区域）。对研究村庄和对照村庄的曼氏血吸虫感染率随时间进行了比较。在这两个村庄开展了一项基于人群的调查，以获取社会人口学因素、与水接触模式以及曼氏血吸虫传播知识等方面的信息。对每个地区的关键信息提供者进行了深入的人种学访谈，以确定社区对血吸虫病的知识、态度和行为。人种学数据采用符号、意义和行动系统模型进行分析。研究区域和对照区域之间在感染率趋势上存在差异，但无法通过前者存在社区动员项目来解释。还发现，巴西卫生部开展的教育行动传播了有关血吸虫病的信息，但未能有效地将所接收的信息转化为与水接触相关的预防行为。关于疾病，所研究的人群倾向于将他们认为与水接触有关的轻微症状与他们归因于缺乏医疗治疗的严重症状区分开来。这种区分影响了对“xistose”严重程度的认知，并降低了避免接触可能受感染水域的重要性。本研究中观察到的对治疗所提供保护的认知可能也适用于其他易于获得免费治疗的社区。需要确定这种认知在流行地区的存在程度，以便在未来的教育项目中解决此类明显的矛盾。
