A Rationale for Schistosomiasis Control in Elementary Schools of the Rainforest Zone of Pernambuco, Brazil

In 2001, a World Health Assembly resolution urged member states to ensure treatment against schistosomiasis and soil-transmitted helminthiasis in endemic areas with the goal of attaining a minimum target of at least 75% of all school-aged children by 2010. In the highly endemic Rainforest Zone of Pernambuco (ZMP), northeast Brazil, the Schistosomiasis Control Program has registered a cumulative coverage of only 20% of the population at risk, which jeopardizes the accomplishment of the minimum target for that area. Demographic and parasitological data from a representative municipality of the ZMP provide evidence that the current, community-based approach to control can be complemented with school-based actions. In the most troubled municipalities, individual diagnosis and treatment could be focused on school-aged children rather than whole populations without compromising the principles of the primary health care system. Local health and education teams should be encouraged to include school-based interventions to scale up coverage and achieve a rapid impact on infection

Schistosomiasis Control Program.

<p>Flowchart of the activities of the Schistosomiasis Control Program within the Unified Health System (PCE-SUS) at the municipal level.</p

Historical prevalence of schistosomiasis and demographic and socio-economic indicators estimated for 2006 in the Rainforest Zone of Pernambuco (ZMP) and the municipility of Chã de Alegria.

<p>Historical prevalence of schistosomiasis and demographic and socio-economic indicators estimated for 2006 in the Rainforest Zone of Pernambuco (ZMP) and the municipility of Chã de Alegria.</p

Status of infection by <i>S. mansoni</i> among school-children (7–14 yrs) examined both at the population survey carried by the Municipal Coordination of Endemic Diseases Diseases (CME) of Chã de Alegria in 2003–2004 and in the school survey by the Schistosomiasis Reference Service of Oswaldo Cruz Foundation (SRE/Fiocruz) one year later.

<p>Neg: negatives; Pos: positives.</p

Parasitological results from the population survey carried out by the Municipal Coordination of Endemic Diseases Diseases (CME) of Chã de Alegria in 2003–2004 and from the school survey by the Schistosomiasis Reference Service of the Oswaldo Cruz Foundation (SRE/Fiocruz) one year later.

<p>Exa: number of examined persons; Pos: number of positives for <i>S. mansoni</i>. *: Estimates not reliable to detect 10% of prevalence with 95% of confidence and ±5 percentage points in finite populations <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000395#pntd.0000395-Naing1" target="_blank">[18]</a>.</p

Spatial distribution of Schistosoma mansoni infection before and after chemotherapy with two praziquantel doses in a community of Pernambuco, Brazil

Praziquantel chemotherapy has been the focus of the Schistosomiasis Control Program in Brazil for the past two decades. Nevertheless, information on the impact of selective chemotherapy against Schistosoma mansoni infection under the conditions confronted by the health teams in endemic municipalities remains scarce. This paper compares the spatial pattern of infection before and after treatment with either a 40 mg/kg or 60 mg/kg dose of praziquantel by determining the intensity of spatial cluster among patients at 180 and 360 days after treatment. The spatial-temporal distribution of egg-positive patients was analysed in a Geographic Information System using the kernel smoothing technique. While all patients became egg-negative after 21 days, 17.9% and 30.9% reverted to an egg-positive condition after 180 and 360 days, respectively. Both the prevalence and intensity of infection after treatment were significantly lower in the 60 mg/kg than in the 40 mg/kg treatment group. The higher intensity of the kernel in the 40 mg/kg group compared to the 60 mg/kg group, at both 180 and 360 days, ref lects the higher number of reverted cases in the lower dose group. Auxiliary, preventive measures to control transmission should be integrated with chemotherapy to achieve a more enduring impact