Assessment of a Brazilian public policy intervention to address schistosomiasis in Pernambuco state: the SANAR program, 2011–2014
Abstract Background 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...
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doaj-9799536428484121b5d801c9362bdf712020-11-24T21:58:38ZengBMCBMC Public Health1471-24582018-10-0118111110.1186/s12889-018-6102-5Assessment of a Brazilian public policy intervention to address schistosomiasis in Pernambuco state: the SANAR program, 2011–2014Luiz Augusto Facchini0Bruno Pereira Nunes1Eronildo Felisberto2José Alexandre Menezes da Silva3Jarbas Barbosa da Silva Junior4Elaine Tomasi5Programa de Pós-Graduação em Epidemiologia, Universidade Federal de PelotasPrograma de Pós-Graduação em Enfermagem, Universidade Federal de PelotasGrupo de Estudos em Gestão e Avaliação em Saúde, Instituto de Medicina Integral Prof. Fernando FigueiraInstituto de Higiene e Medicina Tropical, Universidade NOVA de LisboaPan American Health Organization (PAHO/AMRO/WHO)Programa de Pós-Graduação em Epidemiologia, Universidade Federal de PelotasAbstract Background 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. Methods 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. Results 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). Conclusions 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.http://link.springer.com/article/10.1186/s12889-018-6102-5SchistosomiasisCollective treatmentParasitic diseasesPrevalenceHealth policyBrazil |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Luiz Augusto Facchini Bruno Pereira Nunes Eronildo Felisberto José Alexandre Menezes da Silva Jarbas Barbosa da Silva Junior Elaine Tomasi |
spellingShingle |
Luiz Augusto Facchini Bruno Pereira Nunes Eronildo Felisberto José Alexandre Menezes da Silva Jarbas Barbosa da Silva Junior Elaine Tomasi Assessment of a Brazilian public policy intervention to address schistosomiasis in Pernambuco state: the SANAR program, 2011–2014 BMC Public Health Schistosomiasis Collective treatment Parasitic diseases Prevalence Health policy Brazil |
author_facet |
Luiz Augusto Facchini Bruno Pereira Nunes Eronildo Felisberto José Alexandre Menezes da Silva Jarbas Barbosa da Silva Junior Elaine Tomasi |
author_sort |
Luiz Augusto Facchini |
title |
Assessment of a Brazilian public policy intervention to address schistosomiasis in Pernambuco state: the SANAR program, 2011–2014 |
title_short |
Assessment of a Brazilian public policy intervention to address schistosomiasis in Pernambuco state: the SANAR program, 2011–2014 |
title_full |
Assessment of a Brazilian public policy intervention to address schistosomiasis in Pernambuco state: the SANAR program, 2011–2014 |
title_fullStr |
Assessment of a Brazilian public policy intervention to address schistosomiasis in Pernambuco state: the SANAR program, 2011–2014 |
title_full_unstemmed |
Assessment of a Brazilian public policy intervention to address schistosomiasis in Pernambuco state: the SANAR program, 2011–2014 |
title_sort |
assessment of a brazilian public policy intervention to address schistosomiasis in pernambuco state: the sanar program, 2011–2014 |
publisher |
BMC |
series |
BMC Public Health |
issn |
1471-2458 |
publishDate |
2018-10-01 |
description |
Abstract Background 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. Methods 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. Results 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). Conclusions 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. |
topic |
Schistosomiasis Collective treatment Parasitic diseases Prevalence Health policy Brazil |
url |
http://link.springer.com/article/10.1186/s12889-018-6102-5 |
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