Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.
Programa de Pós-Graduação em Enfermagem, Universidade Federal de Pelotas, Rua Gomes Carneiro, 1, Campus ANGLO, Centro, Pelotas, RS, CEP: 96010-610, Brazil.
BMC Public Health. 2018 Oct 25;18(1):1200. doi: 10.1186/s12889-018-6102-5.
Brazil is an endemic country for schistosomiasis in the Latin American and Caribbean countries. Pernambuco is a higher-endemic Brazilian state among the 19 states reporting the disease in the country; schistosomiasis affects 102 (55%) of its 185 municipalities. Our objective was to evaluate the effectiveness of the treatment cycles of the SANAR Program (Plan to Reduce and Eliminate Neglected Diseases) in Pernambuco State in Northeast Brazil.
A cross-sectional population-based study was conducted in 2014 via a household survey in 117 hyperendemic locations in the state of Pernambuco. We compared the schistosomiasis prevalence rates in hyperendemic locations, aggregated by geographical region, before and after the intervention. The dependent variable was a positive stool test result by the Kato-Katz method, and the main exposure variable was the number of treatment cycles (one/two). The covariables were the regions of the state and socioenvironmental, socioeconomic, demographic and behavioral characteristics.
In all, 12,969 individuals were interviewed, 8932 of whom had stool tests. Of these, 4969 (55.6%) underwent two cycles of collective treatment. Changes in the environmental conditions since 2011 were minimal. Comparison before (2011) and after (2014) treatment showed an average schistosomiasis prevalence of 18.6%, decreasing to 4.1% and 2.0% in locations with one and two treatment cycles, respectively. In 2014, the highest schistosomiasis prevalence was found in the forest area (2.8%), while the lowest was found in the northern region (1.2%) of the state. The adjusted analysis showed a lower occurrence of schistosomiasis in individuals living in areas with two treatment cycles than in individuals from areas with just one cycle (PR 0.65, 95% CI: 0.47-0.89).
The political decision made in Pernambuco to implement the SANAR Program in 2011 greatly impacted the burden of schistosomiasis. This program was effective in reducing the occurrence of schistosomiasis in hyperendemic areas in Pernambuco, with a stronger response in areas with two cycles of collective treatment.
巴西是拉丁美洲和加勒比地区血吸虫病的流行国家之一。伯南布哥州是该国报告该疾病的 19 个州中一个较高流行程度的州，该州有 185 个市，其中 102 个（55%）受到血吸虫病的影响。我们的目的是评估巴西东北部伯南布哥州 SANAR 计划（减少和消除被忽视疾病计划）治疗周期的有效性。
2014 年，我们在该州 117 个高度流行地区进行了一项基于人群的横断面研究，通过家庭调查进行。我们比较了干预前后按地理区域聚集的高度流行地区的血吸虫病患病率。因变量是加藤法粪便检查阳性，主要暴露变量是治疗周期数（一次/两次）。协变量是州的区域以及社会环境、社会经济、人口和行为特征。
共访谈了 12969 人，其中 8932 人进行了粪便检查。其中，4969 人（55.6%）接受了两次集体治疗。自 2011 年以来，环境条件的变化很小。与治疗前（2011 年）相比，治疗后（2014 年）的平均血吸虫病患病率为 18.6%，分别降至 1 次和 2 次治疗周期的 4.1%和 2.0%。2014 年，森林地区的血吸虫病患病率最高（2.8%），而该州北部地区（1.2%）最低。调整分析显示，接受两次治疗周期的个体发生血吸虫病的几率低于仅接受一次治疗周期的个体（PR 0.65，95%CI：0.47-0.89）。
伯南布哥州 2011 年实施 SANAR 计划的政治决策对血吸虫病的负担产生了重大影响。该计划在减少伯南布哥州高度流行地区的血吸虫病方面非常有效，在接受两次集体治疗的地区效果更强。
