Lima Mayara Maia, Costa Veruska Maia da, Palmeira Swamy Lima, Castro André Peres Barbosa de
Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brasil.
Cad Saude Publica. 2021 Jun 23;37(6):e00175920. doi: 10.1590/0102-311X00175920. eCollection 2021.
The identification of the magnitude of chronic Chagas disease in Brazil requires linking activities in health surveillance, seeking to develop a wide, hierarchically organized and geographically distributed network of services to provide care to thousands of individuals with Trypanosoma cruzi infection. The study aimed to elaborate a model for prioritization of municipalities for chronic Chagas disease, to offer comprehensive care for persons with the disease. A multicriteria analysis was thus performed using the PROMETHEÉ II algorithm, implemented in the Pradin software. The criteria for assessing the model consisted of three indices built from the following indicators: (a) epidemiological, directly related to chronic Chagas disease, (b) related to the evolution in chronic Chagas disease, and (c) related to access to health services. Saaty's Fundamental Scale was used to define the indicators' weights, with greater importance assigned to those directly related to chronic Chagas disease and to those with greater reliability and respective quality of information. Assessment of the models' consistency was based on comparison of the available data in historically endemic areas with the distribution of acute cases, besides other sensitivity analyses. The best model was defined by 1,345 municipalities with medium priority, 1,003 high priority, and 601 with very high priority for chronic Chagas disease, with the highest proportions in the Southeast and Northeast regions. Prioritization allows the administration to rationalize and channel resources, and it is essential to identify the territories where persons with chronic Chagas disease are living, to promote comprehensive care and improve quality of life.
确定巴西慢性恰加斯病的规模需要将卫生监测活动联系起来，力求建立一个广泛、层次分明且地理分布广泛的服务网络，为数千名感染克氏锥虫的个体提供护理。该研究旨在制定一个慢性恰加斯病城市优先排序模型，为该病患者提供全面护理。因此，使用Pradin软件中实现的PROMETHEÉ II算法进行了多标准分析。评估该模型的标准由根据以下指标构建的三个指数组成：(a) 与慢性恰加斯病直接相关的流行病学指标，(b) 与慢性恰加斯病演变相关的指标，以及(c) 与获得卫生服务相关的指标。使用萨蒂基本量表来确定指标权重，对与慢性恰加斯病直接相关的指标以及信息可靠性和质量更高的指标赋予更大权重。除其他敏感性分析外，模型一致性评估基于将历史流行地区的可用数据与急性病例分布进行比较。最佳模型确定了1345个中等优先级、1003个高优先级和601个非常高优先级的慢性恰加斯病城市，其中东南部和东北部地区比例最高。优先排序使管理部门能够合理分配和引导资源，识别慢性恰加斯病患者居住的地区对于促进全面护理和改善生活质量至关重要。
