School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil.
Research Department, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
PLoS Negl Trop Dis. 2023 Jul 13;17(7):e0011485. doi: 10.1371/journal.pntd.0011485. eCollection 2023 Jul.
The indigenous populations of Brazil present poor health indicators and a disproportionate prevalence and case-fatality rate of neglected tropical diseases, including snakebite envenomations (SBEs). This study aims to estimate access to medical care for SBEs and analyze the barriers that prevent victims from accessing healthcare in indigenous communities in two health districts located in the Western Brazilian Amazon.
METHODOLOGY/PRINCIPAL FINDINGS: This cross-sectional study used semi-structured interviews to collect data from individuals who experienced SBEs in the Upper Rio Solimões and Upper Rio Negro indigenous health districts. Of the 187 participants, 164 (87.7%) reported that they had access to healthcare and received assistance in a hospital in the urban area of the municipalities. Frequency was 95.4% in the Upper Rio Solimões SIHD, and 69.6% in the Upper Rio Negro SIHD (P<0.0001). The study found that the availability of indigenous medicine as the only choice in the village was the main reason for not accessing healthcare (75%), followed by a lack of financial resources and means of transportation (28.1%). Four deaths were reported from SBEs, resulting in a case-fatality rate of 2.1%.
CONCLUSIONS/SIGNIFICANCE: In the study areas, there are records of SBE patients who did not receive medical attention. Availability of pre-hospital emergency transport using motorboats, a greater number of hospitals and better navigability of the Solimões River and its tributaries would make access easier for indigenous people living in the region of the Upper Solimões River. The implementation of cross-cultural hospital care needs to be considered in order to reduce the resistance of indigenous populations in relation to seeking treatment for SBEs.
巴西的土著居民健康状况不佳，患有被忽视的热带病（包括蛇伤）的流行率和病死率不成比例。本研究旨在评估巴西西部亚马逊地区两个卫生区的蛇伤患者获得医疗服务的情况，并分析阻碍土著社区患者获得医疗服务的障碍。
方法/主要发现：本横断面研究使用半结构式访谈收集了在上里奥·索利蒙斯和上里奥·内格罗土著卫生区经历过蛇伤的 187 名参与者的数据。其中，164 人（87.7%）报告说他们能够获得医疗服务，并在所在城镇的医院接受了治疗。在上里奥·索利蒙斯 SHID 中，这一比例为 95.4%，在上里奥·内格罗 SHID 中为 69.6%（P<0.0001）。研究发现，在村里只能选择土著药物作为唯一选择，这是他们不去就医的主要原因（75%），其次是缺乏经济资源和交通工具（28.1%）。报告了四起蛇伤死亡病例，病死率为 2.1%。
结论/意义：在所研究的地区，有记录显示一些蛇伤患者没有得到医疗救治。使用摩托艇提供院前急救转运、增加医院数量以及改善索利蒙斯河及其支流的通航能力，将使生活在上里奥·索利蒙斯河流域的土著居民更容易获得医疗服务。为了减少土著居民对蛇伤治疗的抵触，需要考虑实施跨文化医院护理。
