Barbosa C S, da Silva C B, Barbosa F S
Departamento de Parasitologia do Centro de Pesquisas Aggeu Magalhães da Fundação Oswaldo Cruz, Recife, PE-Brasil.
Rev Saude Publica. 1996 Dec;30(6):609-16. doi: 10.1590/s0034-89101996000600016.
Schistosomiasis mansoni can be considered an important public health problem in Northeastern Brazil, in spite of the reduction in the prevalence of the hepatosplenic clinical forms which have been attributed to the large scale use of chemotherapy in this country. However, the rise in the prevalence rates and the spread of this endemic disease to new areas show that schistosomiasis is assuming its must cruel expression: less lethal but more greatly incapacitating in terms of irreversible physical and moral damage to human beings. The state of Pernambuco presents growing rates for schistosomiasis infection in humans. The epidemiological profile of this disease displays high and consistent prevalence rates (up to 80%) in rural areas, and new cases of acute infection on the coast, where schistosomiasis has recently been introduced. The reproduction and expansion of this endemic disease can be better understood on the basic of a conception of structural and historical causation. The disease construction process should be reconstructed in the light of biological as well as the social, political and cultural factors which are jointly responsible for the present endemic situation. Within that frame work, the historical and socioeconomic features that interact with the parasite and give rise to the present proportions of the schistosomiasis epidemic in Pernambuco are discussed. The mode of occupation and use of the land, unemployment, under-nutrition, migration, etc., raise the question of the growing difficulties confronting the control of the disease, both in rural areas where populations are extremely mobile as well as in the poorly organized urban population. Epidemiological investigation is fulfilling its role in its attempts to understand the complex relationships of an intrinsecally social nature of the health/disease process between health problems and the quality of life for the purpose of producing consistent disease control models.
尽管巴西东北部因大规模使用化疗药物，肝脾型血吸虫病的临床发病率有所下降，但曼氏血吸虫病仍被视为该地区一个重要的公共卫生问题。然而，该病发病率的上升以及在新地区的蔓延表明，血吸虫病正呈现出其最为残酷的一面：致死率降低，但对人类造成的不可逆转的身心伤害却更大，使人丧失劳动能力。伯南布哥州的人体血吸虫病感染率呈上升趋势。该疾病的流行病学特征显示，农村地区的患病率一直居高不下（高达80%），而在血吸虫病最近才传入的沿海地区，出现了急性感染的新病例。基于结构和历史因果关系的概念，能更好地理解这种地方病的传播和扩散。应根据生物因素以及共同导致当前地方病状况的社会、政治和文化因素，重新构建疾病的形成过程。在此框架内，讨论了与寄生虫相互作用并导致伯南布哥州目前血吸虫病流行比例的历史和社会经济特征。土地的占用和使用方式、失业、营养不良、移民等问题，凸显了在农村人口流动性极大以及城市人口组织不善的情况下，疾病防控面临的日益增加的困难。流行病学调查在试图理解健康/疾病过程中本质上具有社会性的复杂关系方面发挥着作用，这些关系存在于健康问题和生活质量之间，目的是建立一致的疾病控制模型。
