Assistência à saúde de populações com doença de Chagas em área endêmica no Brasil

Abstract

Chagas disease (CD) is a parasitic disease caused by the protozoan Trypanosoma cruzi that predominantly affects poor and vulnerable populations. Despite substantial reductions in the prevalence and incidence of CD in recent decades, this disease still imposes a great social, economic and public health burden in most Latin American countries, including Brazil. The aim of this thesis was to analyze to health care for populations with CD in an endemic area in Brazil, and for this, three studies were carried out. 1) The first study aimed to estimate the percentage of the population with CD in the state of Minas Gerais that had access to antiparasitic treatment and to describe the profile of Benznidazole (BZN) prescriptions in the state. This is a cross-sectional study that analyzed secondary data relating to medical prescription and dispensing of BZN in the state from 2009 to 2019. Descriptive analyzes were conducted and estimates, frequencies and means were calculated. The results showed that 0.28% of the estimated population with CD for the state of Minas Gerais (444,545) had access to antiparasitic treatment in the period 2009 to 2019 and 0.26% of the estimated population with CD under 50 years (321,404) had access to this treatment in the chronic phase of the disease. The profile of BZN prescriptions was characterized by the fact that they were mostly aimed at female patients (52.4%), adults under 50 years of age (65.9%), with the chronic indeterminate form (86.7%) and with a predominance of major cardiac alteration (55.3%) when cardiac alteration is present. More than a third (36%) of the prescriptions presented an unsatisfactory dose according to the therapeutic recommendations in force for the analyzed period. 2) The second article aimed to assess the prevalence and contextual and individual factors associated with non-use of health services in the last year by people with CD in an endemic area in Brazil. This is a multilevel study organized based on the Behavioral Model of Health Services Use by Andersen & Davidson. Contextual data were collected in official publicly accessible databases of the Brazilian government, at the municipal level. Individual data came from the first follow-up of the SaMi-Trop cohort. The sample consisted of 1,160 individuals with CD. The analysis was performed using Poison Regression with Robust Variance. The prevalence of non-use of health services in the last year was 23.5% (95%CI: 21.1-25.9). The contextual factor “larger population” (PR: 1.6; 95%CI = 1.2-2.0) and individual factors related to the lower severity of the disease, such as functional class without limitations (PR: 1.6; 95%CI = 1.2-2.1) and unaltered NT-proBNP levels (PR: 2.2; 95%CI = 1.3-3.6), increased the prevalence of non-use of the health service in the last year by people with DC. 3) The third article aimed to explore the challenges of family doctors to provide care to patients with CD in an endemic region in Brazil with high coverage of public Primary Health Care services. A focus group with 15 family doctors was carried out in a municipality participant of the SaMi-Trop cohort. Data were analyzed using the thematic content analysis technique. Family doctors pointed out as challenges for the care of patients with CD: unsatisfactory medical education; uncertainties regarding antiparasitic treatment in the chronic phase of the disease; difficulty in accessing specialized care; and trivialization of the disease by patients. According to these studies, it is concluded that health care for populations with CD in an endemic area in Brazil still represents an important challenge for the health system. Investments in the training and training of health professionals and in the organization of a Health Care Network for People with CD in endemic áreas may increase the access of populations with CD to diagnosis, antiparasitic treatment and longitudinal follow-up, thus reducing health inequities in affected populations by the disease.