Planejamento e gestão do processo de trabalho em saúde: avanços e limites no Subsistema de Atenção à Saúde Indígena do SUS

The Indigenous Health Care Subsystem (SasiSUS), as part of the Brazilian National Health System (SUS), is responsible for health care for indigenous peoples in Brazil. At the local level, the Special Indigenous Health Districts (DSEI) are responsible for managing, planning, and organizing the work process of the multidisciplinary indigenous health teams (EMSI), which provide primary health care for this population. The objective of the study was to analyze how the planning and the management of the EMSI work process occurs. A holistic multiplecase study was carried out, considering seven DSEI as units of analysis. The main source of data used were interviews and, in a complementary way, direct observation. The results indicated that, in general, planning is present in the organization of the teams’ work process, with variations between the DSEI. Carrying out the planned actions was related to the availability of different resources: adequate functioning of the information system and the intra and intersectoral articulation of SasiSUS. As a conclusion, the need to radicalize participation in planning and management, necessary for a coordinated action to guarantee differentiated care and the principles of SUS, was pointed out.O Subsistema de Atenção à Saúde Indígena (SasiSUS), como parte do Sistema Único de Saúde (SUS), é responsável pela atenção à saúde dos povos indígenas do Brasil. Em âmbito local, são os Distritos Sanitários Especiais Indígenas (DSEI) os responsáveis pela gestão, planejamento e organização do processo de trabalho das equipes multidisciplinares de saúde indígena (EMSI), que realizam a atenção primária à saúde para essa população. O objetivo do estudo foi analisar como ocorrem o planejamento e a gestão do processo de trabalho das EMSI. Foi realizado um estudo de casos múltiplos holístico, considerando sete DSEI como unidades de análise. A principal fonte de dados utilizada foi a entrevista e, de forma complementar, a observação direta. Os resultados indicaram que, de forma geral, o planejamento está presente na organização do processo de trabalho das equipes, com variações entre os DSEI. A efetivação das ações planejadas foi relacionada à disponibilidade de diferentes recursos: funcionamento adequado do sistema de informação e a articulação intra e intersetorial do SasiSUS. Como conclusão, apontouse a necessidade de radicalização da participação no planejamento e na gestão, necessária a uma ação coordenada para garantia da atenção diferenciada e dos princípios do SUS

Interacciones transfronterizas y salud en la frontera Brasil-Colombia-Perú

The border area between Brazil, Colombia, and Peru has a population of over 100,000 people; at least a quarter are indigenous (mostly Tikuna), and the rest is composed of people from the Andean region and some itinerant groups (migrants, traders, etc.). The “twin cities”, Tabatinga (Brazil) and Leticia (Colombia), receive a significant flux of people from the adjacent regions of each country, each one having a referral hospital for attending cases of moderate complexity. This region has a high incidence of  water-borne diseases, such as diarrhea and hepatitis, those transmitted by vectors, such as malaria and leishmaniasis, and other infectious diseases related to living conditions and the level of access to the health system, such as sexually transmitted infections, tuberculosis, and Hansen’s disease.. This work presents attempts to carry out a global analysis of the prevalence of some health problems introduced into the area during the last two decades, such as cholera epidemics, malaria, and HIV/AIDS infection, attempting to describe their main determinants in the region. La triple frontera Brasil-Colombia-Perú tiene una población de más de cien mil personas; al menos una cuarta parte son indígenas (mayoritariamente tikuna) y el resto está conformado por población de la zona andina y algunos grupos itinerantes (migrantes, comerciantes, etcétera). Las “ciudades-gemelas”, Tabatinga (Brasil) y Leticia (Colombia), reciben un flujo significativo de personas de las regiones adyacentes de cada país, contando cada una con un hospital de referencia para la atención de media complejidad. En esta región son elevadas las incidencias de enfermedades transmitidas por el agua como las enfermedades diarreicas y las hepatitis, las enfermedades transmitidas por vectores como la malaria y la leishmaniasis y otras enfermedades infecciosas también relacionadas con las condiciones de vida y acceso al sistema de salud como las infecciones de transmisión sexual, la tuberculosis y la enfermedad de Hansen. Este trabajo presenta un análisis global de la prevalencia de algunos problemas de salud que han sido introducidos en el área en las últimas dos décadas, como son la epidemia del cólera, la malaria y la infección por el VIH/sida, procurando describir sus principales determinantes en la región.

Interacciones transfronterizas y salud en la frontera Brasil-Colombia-Perú

The border area between Brazil, Colombia, and Peru has a population of over 100,000 people; at least a quarter are indigenous (mostly Tikuna), and the rest is composed of people from the Andean region and some itinerant groups (migrants, traders, etc.). The “twin cities”, Tabatinga (Brazil) and Leticia (Colombia), receive a significant flux of people from the adjacent regions of each country, each one having a referral hospital for attending cases of moderate complexity. This region has a high incidence of  water-borne diseases, such as diarrhea and hepatitis, those transmitted by vectors, such as malaria and leishmaniasis, and other infectious diseases related to living conditions and the level of access to the health system, such as sexually transmitted infections, tuberculosis, and Hansen’s disease.. This work presents attempts to carry out a global analysis of the prevalence of some health problems introduced into the area during the last two decades, such as cholera epidemics, malaria, and HIV/AIDS infection, attempting to describe their main determinants in the region. La triple frontera Brasil-Colombia-Perú tiene una población de más de cien mil personas; al menos una cuarta parte son indígenas (mayoritariamente tikuna) y el resto está conformado por población de la zona andina y algunos grupos itinerantes (migrantes, comerciantes, etcétera). Las “ciudades-gemelas”, Tabatinga (Brasil) y Leticia (Colombia), reciben un flujo significativo de personas de las regiones adyacentes de cada país, contando cada una con un hospital de referencia para la atención de media complejidad. En esta región son elevadas las incidencias de enfermedades transmitidas por el agua como las enfermedades diarreicas y las hepatitis, las enfermedades transmitidas por vectores como la malaria y la leishmaniasis y otras enfermedades infecciosas también relacionadas con las condiciones de vida y acceso al sistema de salud como las infecciones de transmisión sexual, la tuberculosis y la enfermedad de Hansen. Este trabajo presenta un análisis global de la prevalencia de algunos problemas de salud que han sido introducidos en el área en las últimas dos décadas, como son la epidemia del cólera, la malaria y la infección por el VIH/sida, procurando describir sus principales determinantes en la región.

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

Complex malaria epidemiology in an international border area between Brazil and French Guiana: challenges for elimination

Abstract Background The epidemiological surveillance of malaria is a necessary intervention for eliminating the disease from the planet. The international border zones of the Amazon continue to be highly vulnerable to malaria since population mobility impedes elimination. Although in the past few years, cases of malaria have had an essential reduction in Brazil, this trend was not confirmed in municipalities along the border. This study aimed to establish the epidemiology of the disease during the last 13 years in Oiapoque, a Brazilian municipality at the international border with French Guiana, an overseas department, to develop strategies for the control/elimination of malaria in these areas. Results Data collected from 2003 to 2015 from the Malaria Epidemiological Surveillance System was used. It was found that, despite the important reduction in cases (68.1%), the annual parasite index remained a high epidemiological risk. The disease is seasonal in that the period of highest transmission occurs between September and December. Between 2003 and 2015, eight outbreaks were identified, with one of these lasting 15 months between August 2006 and October 2007. There were changes in the epidemiological profile, with imported cases representing 67.7% of cases from 2003 to 2007 and representing 32.9% of cases from 2008 to 2015 (p < 0.01). The greatest number of cases was among Brazilians coming from the artisanal gold mines of French Guiana. There were also changes in the profile of autochthonous malaria with an increase in urban cases from 14.3% in 2003 to 32.3% in 2015 (p < 0 .01). The burden of malaria in indigenous areas was also very high (67.3% in rural areas) in 2015. There were changes in the parasite species profile with a significant decrease of cases of Plasmodium falciparum (p = 0.01). Children under 15 years old, representing 9.7% of cases at the onset of the study, accounted for 34.2% of case notifications (p < 0.01) in 2015. Also, 74% of cases in 2003 and 55.9% in 2015 (p < 0.01) were among men. Conclusions The fragility of local health services in cross-border areas continues to be an obstacle for malaria elimination

Imported malaria in Rio de Janeiro state between 2007 and 2015: an epidemiologic approach

Submitted by Sandra Infurna ([email protected]) on 2019-09-04T13:41:09Z No. of bitstreams: 1 HermanoG_Albuquerque_etal_IOC_2019.pdf: 932025 bytes, checksum: ebfd4ee3e500202e982b73ea555a4e67 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2019-09-04T13:49:16Z (GMT) No. of bitstreams: 1 HermanoG_Albuquerque_etal_IOC_2019.pdf: 932025 bytes, checksum: ebfd4ee3e500202e982b73ea555a4e67 (MD5)Made available in DSpace on 2019-09-04T13:49:16Z (GMT). No. of bitstreams: 1 HermanoG_Albuquerque_etal_IOC_2019.pdf: 932025 bytes, checksum: ebfd4ee3e500202e982b73ea555a4e67 (MD5) Previous issue date: 2019Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Laboratório de Monitoramento Epidemiológico de Grandes Empreendimentos. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Laboratório de Monitoramento Epidemiológico de Grandes Empreendimentos. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Laboratório de Monitoramento Epidemiológico de Grandes Empreendimentos. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Laboratório de Monitoramento Epidemiológico de Grandes Empreendimentos. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Laboratório de Monitoramento Epidemiológico de Grandes Empreendimentos. Rio de Janeiro, RJ, Brasil.Secretaria de Estado de Saúde do Rio de Janeiro. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ, Brasil.Imported malaria is a malaria infection diagnosed outside the area where it was acquired and is induced by human migration and mobility. This retrospective study was performed based on secondary data from 2007 to 2015. In total, 736 cases of imported malaria (79.7% of 923 cases) were recorded in Rio de Janeiro state. Of the imported cases, 55.3% came from abroad, while 44.7% came from other regions of Brazil. Most cases of imported malaria in Brazil (85.5%) originated in Amazônia Legal, and Burundi (Africa) accounted for 59% of the cases from abroad. Analyses of the determinants of imported malaria in Rio de Janeiro state must be continued to understand the relationship between the origin and destination of cases

Malaria in the state of Rio de Janeiro, Brazil, an Atlantic Forest area: an assessment using the health surveillance service

The lethality of malaria in the extra-Amazonian region is more than 70 times higher than in Amazonia itself. Recently, several studies have shown that autochthonous malaria is not a rare event in the Brazilian southeastern states in the Atlantic Forest biome. Information about autochthonous malaria in the state of Rio de Janeiro (RJ) is scarce. This study aims to assess malaria cases reported to the Health Surveillance System of the State of Rio de Janeiro between 2000-2010. An average of 90 cases per year had parasitological malaria confirmation by thick smear. The number of malaria notifications due to Plasmodium falciparum increased over time. Imported cases reported during the period studied were spread among 51% of the municipalities (counties) of the state. Only 35 cases (4.3%) were autochthonous, which represents an average of 3.8 new cases per year. Eleven municipalities reported autochthonous cases; within these, six could be characterised as areas of residual or new foci of malaria from the Atlantic Forest system. The other 28 municipalities could become receptive for transmission reintroduction. Cases occurred during all periods of the year, but 62.9% of cases were in the first semester of each year. Assessing vulnerability and receptivity conditions and vector ecology is imperative to establish the real risk of malaria reintroduction in RJ