Fatores associados ao tratamento com Benzonidazol e manejo clínico da Doença de Chagas em região endêmica de Minas Gerais- Brasil

Abstract

Chagas disease (CD) is a consequence of human infection by the flagellate protozoan Trypanosoma cruzi. It is considered by the World Health Organization (WHO) as one of rações da versãoethe thirteen main neglected tropical diseases and is endemic in the 21 countries of Latin America. There is only one antiparasitic drug (against Trypanosoma cruzi) available in Brazil: Benzonidazole (BZN). Thus, this dissertation aimed to evaluate factors related to the use and prescription of BZN considered in two endemic regions for DC in the state of Minas Gerais. For that, two manuscripts were prepared. The first one had as objective to know the prevalence and the factors associated to the previous use of BZN among individuals with Chronic Chagas' Cardiomyopathy (CCC). Data were obtained from the baseline of a cohort study (SaMi-Trop) conducted among individuals with CCC from two endemic regions (North of Minas Gerais and Jequitinhonha Valley). SaMi-Trop was conceived in a multicentric form by four Brazilian public universities and funded by the National Institute of Health (NIH). An interview, peripheral blood collection and electrocardiogram (ECG) were performed in all participants. The dependent variable adopted was related to the previous use of BZN. The independent variables were grouped into three blocks: socioeconomic, life habits and clinical history. Binary Logistic Regression was conducted (n = 1,812). The study revealed a small proportion of 27.2% (n = 493) of prior BZN use among CCC patients. The likelihood of prior use of BZN was higher among younger individuals (OR = 2.7), individuals with a higher education (OR = 2.7), individuals with a lower monthly per capita income (OR = 1.3), individuals who practiced physical exercise (OR = 1.5), individuals who had prior knowledge of the CD diagnosis (OR = 2.5), individuals without hypertension (OR = 1.3) and individuals with a longer time to the CD diagnosis (OR = 6.1). The second study had the objective of knowing how Primary Health Care (PHC) physicians have given the management of patients with CD from the same endemic regions of Minas Gerais, Brazil. Were considered a total of 104 PHC doctors from 39 municipalities. Data were collected through a self - administered questionnaire addressing sociodemographic profile, academic background and clinical practice. Descriptive statistics were conducted. It was verified that 62.1% (n = 64) of the interviewees finished graduation in the last 4 years, and that 49% (n = 51) of them reported that graduation did not offer sufficient training for the treatment of CD. The professionals reported experience in the treatment of chronic CD (76.6%, n = 79) and acute (56.9%, n = 58). Only 8.8% (n = 9) reported feeling totally safe to perform care for patients with CD and 34% (n = 34) reported not knowing the BZN. This study showed that a little more than a quarter of the CCC patients investigated have ever used BZN. That previous use of BZN was higher among individuals with lower income and with longer diagnosis of CD, but with better clinical and demographic conditions. Negative aspects have also been observed that make it difficult to provide adequate medical care to patients with CD. There is a lack of specific training for treatment of CD, there is a lack of knowledge regarding the only available anti trypanosome, and there is uncertainty in conducting this treatment among physicians of the PHC of the endemic regions contemplated. The number of CD patients cared for in PHC remains high, requiring close attention from physicians, health managers and researchers in order to plan better care and coping with the disease. CD needs to be part of the undergraduate curricula, especially of universities located in endemic areas. There is also a need for effective implementation of actions related to continuing education for professionals of the Unified Health System (SUS) with content focused on CD, especially in the endemic regions. It is recommended that clear and objective management and treatment protocols be established for PHC professionals, as well as effective health policies targeted at those infected with CD.