Doença de Chagas em Minas Gerais: internações por AVC, manejo clínico na atenção primária a saúde e medo da COVID-19 entre portadores

Abstract

Chagas Disease (CD) is considered one of the major neglected tropical diseases that still affects many countries in Latin America, including Brazil. Minas Gerais (MG) is considered an endemic state for CD, with a particular emphasis on the Northern regions and the Jequitinhonha Valley. This dissertation presents three different studies on CD within the state of MG. Study 1: The objective was to evaluate the incidence of Stroke (CVA) in hospitalizations within the state and its macro-regions, and its relationship with CD. An analytical study of the records from the Hospital Information System of SUS (SIH-SUS) of MG, 2022. Data selection was based on the International Classification of Diseases (ICD-10), in which CVA was recorded as the primary cause and CD/sentinel as the secondary cause. Stroke hospitalization rates were estimated, and a correlation analysis was conducted with the Chagas Disease Vulnerability Index (CDVI). There were 25.823 hospitalizations for CVA as the primary cause in MG, and among these, 18 had a record of CD/sentinel as the secondary cause. A high incidence of CVA was observed in MG, mainly in the Jequitinhonha Valley and Northern regions of the state, areas with a high CDVI although without statistical significance. The data suggest underreporting of CD records. Study 2: The objective was to describe the clinical management of CD by Primary Health Care (PHC) physicians in an endemic region. This was a web survey. Descriptive and bivariate analyses were conducted, considering the time since graduation. A total of 136 physicians from 23 municipalities participated. The majority mentioned being familiar with the Clinical Protocol and Therapeutic Guidelines (CPTG) for CD, but they did not prescribe benznidazole and felt insecure in managing the patient. Only the knowledge about CD acquired during their medical education was associated with the time since graduation. Significant obstacles persist in the medical management of CD patients in the PHC of endemic regions in MG. Study 3: The objective was to determine the prevalence and factors associated with the fear of COVID-19 during the pandemic among individuals with CD. This was a cross-sectional study conducted with 460 individuals with CD. The dependent variable was derived from the COVID-19 Fear Scale (little fear vs. moderate/high fear). The independent variables included sociodemographic characteristics, lifestyle habits, clinical history, and social isolation. Multiple Binary Logistic Regression was conducted. It was observed that 45.7% had "Moderate/High fear" of COVID-19, and this fear was higher among females, those living in houses/apartments, those not engaging in physical activity, those with a negative self perception of health, those whose professions were affected by social isolation, and those who received emergency government assistance during the pandemic. Conclusion: CD remains neglected in both hospital services and PHC, continuing to pose a challenge in care, causing insecurity among doctors and patients.