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

Geographical information system (GIS) modeling territory receptivity to strengthen entomological surveillance: Anopheles (Nyssorhynchus) case study in Rio de Janeiro State, Brazil

Abstract Background Extra-Amazonian malaria mortality is 60 times higher than the Amazon malaria mortality. Imported cases correspond to approximately 90% of extra-Amazonian cases. Imported malaria could be a major problem if it occurs in areas with receptivity, because it can favor the occurrence of outbreaks or reintroductions of malaria in those areas. This study aimed to model territorial receptivity for malaria to serve as an entomological surveillance tool in the State of Rio de Janeiro, Brazil. Geomorphology, rainfall, temperature, and vegetation layers were used in the AHP process for the receptivity stratification of Rio de Janeiro State territory. Results The model predicted five receptivity classes: very low, low, medium, high and very high. The ‘very high’ class is the most important in the receptivity model, corresponding to areas with optimal environmental and climatological conditions to provide suitable larval habitats for Anopheles (Nyssorhynchus) vectors. This receptivity class covered 497.14 km2 or 1.18% of the state’s area. The ‘high’ class covered the largest area, 17,557.98 km2, or 41.62% of the area of Rio de Janeiro State. Conclusions We used freely available databases for modeling the distribution of receptive areas for malaria transmission in the State of Rio de Janeiro. This was a new and low-cost approach to support entomological surveillance efforts. Health workers in ‘very high’ and ‘high’ receptivity areas should be prepared to diagnose all febrile individuals and determine the cause of the fever, including malaria. Each malaria case must be treated and epidemiological studies must be conducted to prevent the reintroduction of the disease