Tracoma: Prevalência e fatores associados em escolares no Vale do Jequitinhonha (MG) e Desenvolvimento, Validade e Confiabilidade de um instrumento para avaliar conhecimento de médicos e enfermeiros da atenção primária

Abstract

Trachoma is an infectious disease of neglected populations that is greatly influenced by socioeconomic conditions. It is the world's leading cause of preventable infectious blindness, especially in developing countries. In Brazil, it was mistakenly considered eradicated, and this misperception made health professionals unaware of the topic. This study aimed to estimate the prevalence and to know the factors associated with trachoma among students of Jequitinhonha Valley, Minas Gerais, Brazil, and to elaborate and evaluate the validity and reliability of an instrument to assess the knowledge of primary care physicians and nurses about trachoma. Two separate studies were performed. The first, a cross-sectional and analytical study, with clinical evaluation and socioeconomic questionnaire applied to a random and representative sample of elementary school students from Jequitinhonha Valley, Minas Gerais, Brazil. Students were assessed at the school after institutional and family consent. Bivariate analyzes were performed, followed by binary logistic regression analysis to define the associated variables. 478 students were evaluated. The prevalence of trachoma observed among the students evaluated was 6.3%. Among the researched variables, after multiple regression, it was verified a greater involvement of students who lived in houses without finishing (OR = 2.27; 95% CI = 1.12-6.48), without sewerage (OR = 9, 49; 95% CI = 3.52-25.60) and studying in rural schools (OR = 3.37; 95% CI = 1.53-7.35). The second study was a methodological study, developed from the following steps: 1) identification of updated source literature on the subject; 2) elaboration of the questionnaire items by the researchers; 3) content validation by experts; 4) construct validation with instrument application and hypothesis test analysis; 5) internal consistency analysis and; 6) temporal stability analysis (test-retest). This study included 205 primary care physicians and nurses and 10 specialists in ophthalmology and infectology. The instrument, initially with 52 items, was left with 34 items after all stages. The instrument was able to adequately discriminate professionals with greater and lesser knowledge, according to the hypothesis test (p <0.001). Cronbach's alpha was 0.86 and the test-retest recorded an agreement greater than 60% for most items. In conclusion, the prevalence of trachoma among the students evaluated is not negligible and is especially associated with inadequate housing conditions of their families. The elaborated instrument presented satisfactory validity and reliability and may be useful to assess knowledge of primary care professionals about trachoma, helping in the elaboration of educational strategies for these professionals.