Pharmaceutical services for endemic situations in the Brazilian Amazon: organization of services and prescribing practices for Plasmodium vivax and Plasmodium falciparum non-complicated malaria in high-risk municipalities

<p>Abstract</p> <p>Background</p> <p>In spite of the fact that pharmaceutical services are an essential component of all malaria programmes, quality of these services has been little explored in the literature. This study presents the first results of the application of an evaluation model of pharmaceutical services in high-risk municipalities of the Amazon region, focusing on indicators regarding organization of services and prescribing according to national guidelines.</p> <p>Methods</p> <p>A theoretical framework of pharmaceutical services for non-complicated malaria was built based on the Rapid Evaluation Method (WHO). The framework included organization of services and prescribing, among other activities. The study was carried out in 15 primary health facilities in six high-risk municipalities of the Brazilian Amazon. Malaria individuals ≥ 15 years old were approached and data was collected using specific instruments. Data was checked by independent reviewers and fed to a data bank through double-entry. Descriptive variables were analyzed.</p> <p>Results</p> <p>A copy of the official treatment guideline was found in 80% of the facilities; 67% presented an environment for receiving and prescribing patients. Re-supply of stocks followed a different timeline; no facilities adhered to forecasting methods for stock management. No shortages or expired anti-malarials were observed, but overstock was a common finding. On 86.7% of facilities, the average of good storage practices was 48%. Time between diagnosis and treatment was zero days. Of 601 patients interviewed, 453 were diagnosed for <it>Plasmodium vivax</it>; of these, 99.3% received indications for the first-line scheme. Different therapeutic schemes were given to <it>Plasmodium falciparum </it>patients. Twenty-eight (4.6%) out of 601 were prescribed regimens not listed in the national guideline. Only 5.7% individuals received a prescription or a written instruction of any kind.</p> <p>Conclusions</p> <p>The results show that while diagnostic procedure is well established and functioning in the Brazilian malaria programme, prescribing is still an activity that is actually not performed. The absence of physicians and poor integration between malaria services and primary health services make for the lack of a prescription or written instruction for malaria patients throughout the Brazilian Amazon. This fact may lead to a great number of problems in rational use and in adherence to medication.</p

Spatial analysis for stratification of priority malaria control areas, Mato Grosso State, Brazil Análise espacial na estratificação de áreas prioritárias para o controle da malária no Estado de Mato Grosso, Brasil

The goal of this study was to stratify priority areas for malaria control in the State of Mato Grosso, Brazil, based on spatial analysis. The variables used were: Annual Parasite Index (API), Plasmodium falciparum/Plasmodium vivax ratio, population variation, number of families settled, and percent of deforested area. The Moran's I and Local Moran Test were applied, visualized with the Box Map and Moran Map, for 1986- 1991, 1992-1997, and 1998-2003. Box Map identified areas with high, low, and intermediate priority for control, and Moran Map identified municipalities with significant autocorrelation. In the high priority area, located in the North of Mato Grosso, malaria incidence decreased drastically despite the increase in the number of municipalities from the first to the last period. Other municipalities were added to the lower priority area, from the Southeast, Southwest, and Central-South of the State. The intermediate priority area was located along the border with neighboring States and municipalities classified as high and low priority. Spatial analysis showed the importance of the neighboring phenomenon between municipalities in defining priority areas, thus highlighting the technique's advantages for use in malaria control and surveillance.<br>Pautado em técnicas de análise espacial, analisou-se a estratificação de áreas prioritárias para controle da malária no Estado de Mato Grosso, Brasil. Trabalhou-se Incidência Parasitária Anual, relação Plasmodium falciparum/Plasmodium vivax, variação populacional, número de famílias assentadas e percentuais da área desmatada. Foram utilizados os testes de I de Moran e Moran Local, visualizadas pelo Box Map e Moran Map, nos períodos de: 1986 a 1991, 1992 a 1997 e 1998 a 2003. Pelo Box Map identificaram-se áreas de prioridade maior, menor e intermediária, e pelo Moran Map localizaram-se municípios com autocorrelação estatisticamente significante. Na área de maior prioridade, localizada na região norte mato-grossense, a incidência reduziu drasticamente apesar do aumento do número de municípios de primeiro a último período. A área de menor prioridade agregou municípios da região sudeste, sudoeste e centro-sul. A área de prioridade intermediária localizou-se na fronteira com estados vizinhos e entre os municípios de maior e menor prioridade. A análise espacial apontou a importância da vizinhança na determinação de áreas de prioridade, constituindo em importante ferramenta para a vigilância e controle de malária