Simulation-based training in Leprosy: development and validation of a scenario for community health workers.

OBJECTIVES: To build and validate a clinical simulation scenario designed to instruct community health workers (CHWs) in active leprosy case detection. METHODS: Methodological study involving the development of a simulated clinical scenario and content validation by experts. The Content Validity Index (CVI) was used to determine the level of agreement among the judging commitee, and a descriptive analysis of their recommendations was performed. RESULTS: A simulated scenario with a simulated participant was developed - a simulation characterized by low complexity, moderate physical/environmental fidelity, moderate to high psychological fidelity, and high conceptual fidelity, lasting 50 minutes and capable of training up to 10 CHWs simultaneously. The scenario was validated by 14 experts, with a CVI exceeding 80% for all components. CONCLUSIONS: The validated clinical simulation possesses attributes that make it highly reproducible in various national health contexts, thereby contributing to the global "Towards Zero Leprosy" strategy.

Culture circle with community health workers about (lack of) knowledge and stigma of leprosy.

OBJECTIVE: To describe the construction aboutthe (lack of) knowledge and stigma of leprosy by Community Health Workers participating in the Culture Circle. METHOD: Qualitative, action-research type study supported by the Paulo Freire Culture Circle framework, carried out with 21 Community Health Workers. Data collected in November 2021, in the municipality of São Luís, Maranhão. The following categories were evidenced: knowledge about leprosy, signs and symptoms, stigma. RESULTS: The participants had knowledge about the disease, but they verbalized people's disinformation about leprosy, disbelief in relation to the cure, and situations of prejudice and stigma that are still present today. FINAL CONSIDERATIONS: The culture circle enabled the intertwining of scientific and empirical knowledge in the construction of a critical and reflective knowledge committed to welcoming and comprehensive care for people and families affected by leprosy.

Estigma da hanseníase por agentes comunitários de saúde: fatores associados / Stigma of leprosy by community health workers: associated factors

Objetivo: identificar os fatores associados ao estigma da hanseníase, manifestado na orientação quanto à separação de objetos no convívio familiar pelos agentes comunitários de saúde de Palmas, Tocantins, Brasil. Métodos: estudo transversal do tipo quantitativo realizado nas Unidades Básicas de Saúde de Palmas em uma população de 301 agentes comunitários de saúde, por meio de um questionário autoaplicável. Resultados: dos 301 agentes comunitários de saúde, 22,92% orientaram as pessoas no domicílio quanto à separação de objetos de uso pessoal, tais como talheres, copos, pratos, toalhas, roupa de cama, vestimentas e isolamento de dormitório. A orientação para separar objetos de uso pessoal foi significativamente maior para os agentes comunitários de saúde do sexo masculino (RP: 1,89; IC: 1,25-2,87), mais jovens (RP: 1,90; IC: 1,14-3,17), com menor tempo de moradia em Palmas (RP: 2,06; IC: 1,253,40), com localização da Unidade Básica de Saúde fora do plano diretor (RP: 1,75; IC: 1,11-2,76), que não fizeram curso em hanseníase (RP: 3,03; IC: 2,01-4,58), que nunca fizeram acompanhamento de casos (RP: 3,82; IC: 2,02-7,22) e que não teve um familiar acometido por hanseníase (RP: 1,96; IC: 1,10-3,47). Conclusão: a elevada prevalência de agentes comunitários de saúde que apresentam estigma da hanseníase representa uma barreira nas ações de controle da doença. Observou-se que as chances de ocorrência de estigma foram maiores nos agentes comunitários de saúde jovens, do sexo masculino, sem capacitação sobre hanseníase e com local de trabalho nas regiões periféricas do município. Fatores a serem considerados pelo programa de controle local com a adoção de Educação Permanente em Saúde. Investimentos em cursos direcionados à hanseníase podem contribuir para a redução do desconhecimento acerca da doença, pois os aspectos culturais e de crenças geracionais influenciam na manutenção de conceitos e do estigma social.

Objective: to identify the factors associated with the stigma of leprosy, manifested in guidance regarding the separation of objects in family life, by community health workers in Palmas, Tocantins, Brazil. Methods: quantitative cross-sectional study carried out in Basic Health Units in Palmas in a population of 301 community health workers, using a self-administered questionnaire. Results: of the 301 CHWs, 22.92% guided people at home regarding the separation of personal objects, such as cutlery, glasses, plates, towels, bed linen, clothing and bedroom isolation. Guidance to separate objects for personal use was significantly higher for male community health workers (PR: 1.89; CI:1.25-2.87), younger (PR:1.90; CI:1.14- 3.17), with less time living in Palmas (RP: 2.06; CI: 1.253.40), with the location of the Basic Health Units outside the master plan (PR: 1.75; CI: 1.11-2.76 ), who had not taken a leprosy course (PR:3.03; CI: 2.01-4.58), who had never followed up cases (PR:3.82; CI: 2.02-7.22) and who did not have a family member affected by leprosy (PR:1.96; CI: 1.10-3.47). Conclusion: the high prevalence of community health workers who have leprosy stigma represents a barrier in disease control actions. It was observed that the chances of stigma occurrence were higher in young, male community health agents, without training on leprosy and with a workplace in the peripheral regions of the city. Factors to be considered by the local control program with the adoption of Permanent Health Education. Investments in courses aimed at leprosy can contribute to reducing ignorance about the disease, as cultural aspects and generational beliefs influence the maintenance of concepts and social stigma.

Hanseníase: crenças e tabus de agentes comunitários de saúde / Hansen's disease: beliefs and taboos of the community health agents / Enfermedad de Hansen: creencias y tabúes de los agentes comunitarios de salud

Resumo Por meio da análise crítica do discurso, este artigo busca compreender na prática de agentes comunitários de saúde os discursos sobre a hanseníase/lepra, doença estigmatizada e envolta em saberes e práticas, tendo como premissa que esses profissionais incorporam representações preconcebidas ao trabalho. A pesquisa está estruturada de modo a familiarizar o leitor com os aspectos teóricos dessa análise e o percurso histórico dos profissionais na formação do discurso. Do corpus empírico emergiram as categorias: "comida reimosa: crenças e tabus alimentares"; "crenças e tabus relacionados ao álcool"; e "hanseníase, a doença que cai os pedaços". Foi revelado que os agentes acreditam na existência de alimentos reimosos e na culpabilização do álcool para o prolongamento do tratamento e que ainda circula a concepção de que a doença faz cair pedaços do corpo da pessoa acometida. Os conhecimentos técnicos equivocados dos agentes podem estar relacionados à forma como se dá a educação permanente.

Abstract Using critical discourse analysis, this article seeks to understand the discourses on Hansen's disease/leprosy, a stigmatized disease surrounded by knowledge and practices, in the practice of community health agents, based on the premise that these professionals incorporate preconceived representations into their work. The research is structured so as to familiarize the reader with the theoretical aspects of this analysis and the historical path of the professionals in the formation of the discourse. The empirical corpus led to the following categories: "reimoso [harmful] food: food beliefs and taboos"; "alcohol-related beliefs and taboos"; and "leprosy, the disease that makes the body fall apart." We found that the agents believe in the existence of reimoso [harmful] foods and in alcohol as the cause for prolonged treatment, and that the notion that the disease makes the body of affected people fall apart is still circulating. The agents' mistaken technical knowledge may be related to how continuing education occurs.

Resumen A través del análisis crítico del discurso, este artículo busca comprender los discursos sobre la enfermedad de Hansen/lepra, enfermedad estigmatizada e involucrada en conocimientos y prácticas, en la práctica de los agentes comunitarios de salud, con la premisa de que estos profesionales incorporen representaciones preconcebidas en su trabajo. La investigación se estructura con el objetivo de familiarizar al lector con los aspectos teóricos de este análisis y el recorrido histórico de los profesionales en la formación del discurso. Del corpus empírico surgieron las siguientes categorías: "alimentos remosos: creencias y tabúes alimentarios"; "creencias y tabúes relacionados con el alcohol" y "enfermedad de Hansen, la enfermedad que se desmorona". Se reveló que los agentes creen en la existencia de alimentos remosos y que el alcohol es el culpable de prolongar el tratamiento, y que sigue circulando la idea de que la enfermedad provoca la caída de pedazos del cuerpo de la persona afectada. El conocimiento técnico erróneo de los agentes puede estar relacionado con la forma en que se desarrolla la educación permanente.

Active search strategies, clinicoimmunobiological determinants and training for implementation research confirm hidden endemic leprosy in inner São Paulo, Brazil.

BACKGROUND: This study evaluates implementation strategies for leprosy diagnosis based on responses to a Leprosy Suspicion Questionnaire (LSQ), and analyzes immunoepidemiological aspects and follow-up of individuals living in a presumptively nonendemic area in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: Quasi-experimental study based on LSQ throughout Jardinópolis town by community health agents, theoretical-practical trainings for primary care teams, dermatoneurological examination, anti-PGL-I serology, RLEP-PCR, and spatial epidemiology. A Leprosy Group (LG, n = 64) and Non-Leprosy Group (NLG, n = 415) were established. Overall, 3,241 LSQs were distributed; 1,054 (32.5%) LSQ were positive for signs/symptoms (LSQ+). Among LSQ+ respondents, Q2-Tingling (pricking)? (11.8%); Q4-Spots on the skin? (11.7%); Q7-Pain in the nerves? (11.6%); Q1-Numbness in your hands and/or feet? (10.7%) and Q8-Swelling of hands and feet? (8.5%) were most frequently reported symptoms. We evaluated 479 (14.8%) individuals and diagnosed 64 new cases, a general new case detection rate (NCDR) of 13.4%; 60 were among 300 LSQ+ (NCDR-20%), while 4 were among 179 LSQ negative (NCDR-2.23%). In LG, Q7(65%), Q2(60%), Q1(45%), Q4(40%) and Q8(25%) were most frequent. All 2x2 crossings of these 5 questions showed a relative risk for leprosy ranging from 3 to 5.8 compared with NLG. All patients were multibacillary and presented hypochromatic macules with loss of sensation. LG anti-PGL-I titers were higher than NLG, while 8.9% were positive for RLEP-PCR. The leprosy cases and anti-PGL-I spatial mappings demonstrated the disease spread across the town. CONCLUSIONS/SIGNIFICANCE: Implementation actions, primarily LSQ administration focused on neurological symptoms, indicate hidden endemic leprosy in a nonendemic Brazilian state.

Optimizing Myanmar's community-delivered malaria volunteer model: a qualitative study of stakeholders' perspectives.

BACKGROUND: In parallel with the change of malaria policy from control to elimination and declines in the malaria burden in Greater Mekong Sub-region, the motivation and social role of malaria volunteers has declined. To address this public health problem, in Myanmar, the role and responsibilities of malaria volunteers have been transformed into integrated community malaria volunteers (ICMV), that includes the integration of activities for five additional diseases (dengue, lymphatic filariasis, tuberculosis, HIV/AIDS and leprosy) into their current activities. However, this transformation was not evidence-based and did not consider inputs of different stakeholders. Therefore, qualitative stakeholder consultations were performed to optimize future malaria volunteer models in Myanmar. METHODS: Semi-structured interviews were conducted with key health stakeholders from the Myanmar Ministry of Health and Sports (MoHS) and malaria implementing partners to obtain their perspectives on community-delivered malaria models. A qualitative descriptive approach was used to explore the experiences of the stakeholders in policymaking and programme implementation. Interview topic guides were used during the interviews and inductive thematic data analysis was performed. RESULTS: While ICMVs successfully provided malaria services in the community, the stakeholders considered the ICMV model as not optimal and suggested that many aspects needed to be improved including better training, supervision, support, and basic health staff's recognition for ICMVs. Stakeholders believe that the upgraded ICMV model could contribute significantly to achieving malaria elimination and universal health care in Myanmar. DISCUSSION AND CONCLUSION: In the context of high community demand for non-malaria treatment services from volunteers, the integrated volunteer service package must be developed carefully in order to make it effective in malaria elimination programme and to contribute in Myanmar's pathway to universal health coverage (UHC), but without harming the community. An evidenced-based, community-delivered and preferred model, that is also accepted by the MoHS, is yet to be developed to effectively contribute to achieving malaria elimination and UHC goals in Myanmar by 2030.

Fatores associados à hanseníase em agentes comunitários de saúde da região amazônica / Factores asociados a la lepra en agentes comunitarios de salud de la región amazónica / Factors associated with leprosy in community health agents in the amazon region

RESUMO Objetivo: investigar os fatores associados àocorrência/incidência de hanseníase em Agentes Comunitários de Saúde (ACS), em Palmas, Tocantins. Métodos: estudo transversal, realizado mediante a aplicação de questionário para 301 ACS entre os anos de 2017 e 2018, em Palmas, Tocantins. Realizou-se análise bivariada com a aplicação do teste de qui-quadrado de Pearson e o cálculo das razões de prevalência (RP) com intervalos de 95% de confiança (IC 95%). Resultados: a idade média dos ACS foi de 47 anos, com mínima de 20 e máxima de 67 anos. As razões de chance significativamente associadas foram idade ≥ 36 anos (RC:3,65 IC:1,58-8,44), mulheres (RC:2,58 IC:1,16-5,75), UBS localizada fora do plano diretor (RC:2,22 IC:1,37-3,59), renda familiar inferior a 2 salários mínimos (RC:3,50 IC:2,14-5,74), entre 10 e 18 anos de tempo de serviço como ACS (RC:3,04 IC:1,46-6,32), ter capacitação para hanseníase (RC:2,41 IC:1,24-4,69), maior número de casos de hanseníase acompanhados no território (RC:2,59 IC:1,36-4,94) e naturalidade de outro estado(RC:1,67 IC:1,05-2,67). Ter história familiar foi o único fator associado independente (OR:1,83 IC:1,10-3,02). Conclusão: a hanseníase em ACS foi associada a desfavoráveis condições sociodemográficas, maior experiência com o assunto, tendo como fator isolado ter um familiar doente, de menor renda e que acompanhou mais casos.

RESUMEN Objetivo: investigar los factores asociados a la incidencia de lepra en Agentes Comunitarios de Salud (ACS), en Palmas, Tocantins-Brasil. Métodos: estudio transversal, realizado mediante la aplicación de cuestionario para 301 ACS entre los años 2017 y 2018, en Palmas, Tocantins-Brasil. Se realizó análisis bivariado con la aplicación delaprueba de chi-cuadrado de Pearson y el cálculo de la razón de prevalencia (RP) con intervalos de 95% de confianza (IC 95%). Resultados: el promedio de edad de los ACS fue de 47 años, con mínima de 20 y máxima de 67 años. Las razones de probabilidad significativamente asociadas fueron edad ≥36 años (RC:3,65 IC:1,58-8,44), mujeres (RC:2,58 IC:1,16-5,75), UBS ubicada fuera del plan director (RC:2,22 IC:1,37-3,59), ingresos familiares por debajo de 2 sueldos mínimos (RC:3,50 IC:2,14-5,74), entre 10 y 18 años de servicio como ACS (RC:3,04 IC:1,46-6,32), tener capacitación para lepra (RC:2,41 IC:1,24-4,69), mayor número de casos de lepra acompañados en el territorio (RC:2,59 IC:1,36-4,94) y naturalidad de otro estado (RC:1,67 IC:1,05-2,67). Tener historia familiar fue el único factor asociado independiente (OR:1,83 IC:1,10-3,02). Conclusión: la lepra en ACS fue asociada a condiciones adversas sociodemográficas, mayor experiencia con el asunto, teniendo como factor aislado tener un familiar enfermo, de menor renta y que acompañó más casos.

ABSTRACT Objective: to investigate the factors associated with the occurrence/incidence of leprosy in Community Health Agents (CHA) in Palmas, Tocantins. Methods: a cross-sectional study was conducted by applying a questionnaire to 301 CHAs between 2017 and 2018, in Palmas, Tocantins. Bivariate analysis was performed using Pearson's chi-square test and calculation of prevalence ratios (PR) with 95% confidence intervals (95% CI). Results: the average age of the CHAs was 47 years old, with a minimum of 20 and a maximum of 67 years old. Odds ratios significantly associated were age ≥ 36 years old (OR: 3.65 CI: 1.58-8.44), women (OR: 2.58 CI: 1.16-5.75), UBS located outside the hospital. master plan (OR: 2.22 CI: 1.37-3.59), family income less than 2 minimum wages (OR: 3.50 CI: 2.14-5.74), between 10 and 18 years of time served as CHA (OR: 3.04 CI: 1.46-6.32), have training for leprosy (OR: 2.41 CI: 1.24-4.69), a higher number of leprosy cases followed up in the territory (OR:2.59 CI:1.36-4.94) and from another state (OR:1.67 CI:1.05-2.67). Having a family history was the only independent associated factor (OR:1.83 CI:1.10-3.02). Conclusion: leprosy in CHA was associated with unfavorable sociodemographic conditions, greater experience with the topic, with the isolated factor having a sick family member, with lower income and who followed more cases.

Community health care workers in pursuit of TB: Discourses and dilemmas.

Community-led tuberculosis (TB) active case finding is widely promoted, heavily funded, but many efforts fail to meet expectations. The underlying reasons why TB symptom screening programs underperform are poorly understood. This study examines Nigerian stakeholders' insights to characterize the mechanisms, enabling structures and influences that lead programs to succeed or fail. Eight focus group discussions were held with Community Health Workers (CWs) from four models of community-based TB screening and referral. In-depth interviews were conducted with 2 State TB program managers, 8 Community based organizations (CBOs), and 6 state TB and Leprosy Local Government supervisors. Transcripts were coded using Framework Analysis to assess how divergent understandings of CWs' roles, expectations, as well as design, political and structural factors contributed to the observed underperformance. Altruism, religious faith, passion, and commitment to the health and well-being of their communities were reasons CWs gave for starting TB symptom screening and referral. Yet politicized or donor-driven CWs' selection processes at times yielded implementers without a firm grounding in TB or the social, cultural, and physical terrain. CWs encountered suspicion, stigma, and hostility in both health facilities and communities. As the interface between the TB program and communities, CWs often bore the brunt of frustrations with inadequate TB services and CBO/iNGO collaboration. Some CWs expended their own social and financial capital to cover gaps in the active case finding (ACF) programs and public health services or curtailed their screening activities. Effective community-led TB active case finding is challenging to design, implement and sustain. Contrary to conventional wisdom, CWs did not experience it as inherently empowering. Sustainable, supportive models that combine meaningful engagement for communities with effective program stewardship and governance are needed. Crucially effective and successful implementation of community-based TB screening and referral requires a functional public health system to which to refer.

[Orientation of primary care in actions to control leprosy: factors relating to professionals]. / Orientación de la atención primaria en las acciones contra la lepra: factores relacionados con los profesionales.

OBJECTIVE: To identify factors of professionals that relate to the degree of primary health care orientation in the control of leprosy. METHOD: Study carried out in 70 units of Family Health Strategy of a capital of Brazil, between July and September 2014. An evaluation instrument applied to 408 health professionals was used. The multiple linear regression-bootstrap model was applied to analyze the association of the general, essential and derived score with the explanatory factors of the professionals (work time in the unit and in primary care services, control actions, case care and leprosy training). RESULTS: In the descriptive analysis most of the professionals did not attend cases and did not receive training to perform leprosy actions. A strong orientation was observed in the essential and general score of primary care and the association with leprosy education. In the derived score, weak orientation and association were observed with training in the disease for doctors and community health agents. CONCLUSION: Professional experience in the Family Health Strategy and leprosy care is crucial for the service to be a provider of control actions oriented according to the essential and derived attributes of primary health care. Brazil has made progress in reducing the incidence of leprosy; however, it is necessary to increase the effectiveness of health surveillance, as a means of early detection and training of professionals.

Implementation of Active Case Detection of Visceral Leishmaniasis along with Leprosy through Female Community Health Volunteers in Sarlahi District, Nepal.

Background Visceral leishmaniasis (VL) and leprosy are important public health problem in Nepal. Female Community Health Volunteers (FCHVs) play pivotal role to promote community based health services. Therefore, we designed an implementation research to assess the effectiveness of active case detection (ACD) and information education and communication (IEC) campaign of Visceral leishmaniasis cases along with leprosy cases through Female Community Health Volunteers in Visceral leishmaniasis endemic 10 Village Development Committees of both Visceral leishmaniasis and leprosy prevalent Sarlahi district of Nepal. Objective To determine the effectiveness of active case search strategy of visceral leishmaniasis along with leprosy through Female Community Health Volunteers in Sarlahi district. Method One hundred fifty one Female Community Health Volunteers of twelve Village Development Committees were oriented on detection, identification and referral of Visceral leishmaniasis and leprosy patients. They were oriented on referring the patients to district hospital for confirmatory diagnosis and treatment. The intervention was continued up to ten months after training of Female Community Health Volunteers. Data on number of Visceral leishmaniasis and leprosy patients detected and referred by Female Community Health Volunteers and detected through passively at district hospital were collected and indicators was calculated. Result Altogether 151 Female Community Health Volunteers were trained from 12 (Village Development Committees) VDCs of Sarlahi district. Their knowledge on leprosy and Visceral leishmaniasis related information subsequently increased after training. None of the Visceral leishmaniasis or leprosy cases were detected actively through Female Community Health Volunteers. However, two leprosy cases were detected through household screening. Conclusion Female Community Health Volunteers should be provided sufficient knowledge to use them in community based active case detection of Visceral leishmaniasis and leprosy.

Integrating Case Detection of Visceral Leishmaniasis and Other Febrile Illness with Vector Control in the Post-Elimination Phase in Nepal.

Nepal has completed the attack phase of visceral leishmaniasis (VL) elimination and now needs active case detection (ACD) and vector control methods that are suitable to the consolidation and maintenance phases. We evaluated different ACD approaches and vector control methods in Saptari district. We assessed 1) mobile teams deployed in villages with VL cases in 2015 to conduct combined camps for fever and skin lesions to detect VL/PKDL (post-kala-azar dermal leishmaniasis) and other infections; 2) an incentive approach by trained female community health volunteers (FCHVs) in villages with no VL cases in 2015. Both were followed by house-to-house visits. For vector control, four villages were randomly allocated to insecticide impregnation of bednets, insecticide wall painting, indoor residual spraying (IRS), and control. Sandfly density (by CDC light traps, The John W. Hock Company, USA) and mortality (World Health Organization cone bioassay) were assessed in randomly selected households. One VL, three tuberculosis, one leprosy, and one malaria cases were identified among 395 febrile cases attending the camps. Post-camp house-to-house screening involving 7,211 households identified 679 chronic fever and 461 skin lesion cases but no additional VL/PKDL. No VL/PKDL case was found by FCHVs. The point prevalence of chronic fever in camp and FCHV villages was 242 and 2 per 10,000 populations, respectively. Indoor residual spraying and bednet impregnation were effective for 1 month versus 12 months with insecticidal wall paint. Twelve-month sandfly mortality was 23%, 26%, and 80%, respectively, on IRS, bednet impregnation, and insecticide wall painting. In Nepal, fever camps and insecticidal wall paint prove to be alternative, sustainable strategies in the VL post-elimination program.

Impact of community-based adherence support on treatment outcomes for tuberculosis, leprosy and HIV/AIDS-infected individuals in post-Ebola Liberia.

BACKGROUND: Partners In Health (PIH) committed to improving health care delivery in Maryland County, Liberia following the Ebola epidemic by employing 71 community health workers (CHWs) to provide treatment support to tuberculosis (TB), HIV and leprosy patients. PIH simultaneously deployed a socioeconomic assistance program with three core components: transportation reimbursement to clinics; food support; and additional social assistance in select cases. OBJECTIVE: This study aimed to evaluate how a CHW program for community treatment support and addressing socioeconomic barriers to care can impact patient outcomes in a post-conflict and post-epidemic context. METHODS: Retrospective observational study utilizing registry data from 513 TB, 447 HIV and 75 leprosy patients at three health facilities in Maryland County, Liberia. Treatment coverage and clinical outcomes for patient cohorts enrolled in the pre-intervention period (January 2015 to June 2015) and the post-intervention period (July 2015 to July 2017) are compared using logistic regression analyses. RESULTS: TB treatment coverage increased from 7.7% pre-intervention to 43.2% (p < 0.001) post-intervention and lost to follow-up (LTFU) rates decreased from 9.5% to 2.1% (p = 0.003). ART treatment coverage increased 3.8 percentage points (p = 0.03), with patient retention improving 63.9% to 86.1% (p < 0.001); a 6.0 percentage point decrease in HIV LTFU was also observed (p = 0.21). Despite an 84.3% treatment success rate observed for leprosy patients, pre-intervention data was largely unavailable and statistical significance could not be reached for any treatment outcomes pre-post intervention. CONCLUSIONS: The PIH approach to CHW community treatment support in Liberia demonstrates how, with the right inputs, excellent clinical outcomes are possible even in post-conflict and post-epidemic contexts. Care should be taken to position and support CHWs so that they have the opportunity to succeed, including full integration and recognition within the system, and the addition of clinical system improvements and social supports that are too often dismissed as unsustainable.

Sensibilização dos agentes comunitários de saúde para a atuação nas ações prevenção e controle da hanseníase: relato de experiência / Sensitization of community health agents in leprosy control actions: an experience report

Introdução: A integração das Ações de Controle da Hanseníase (ACH) na Atenção Primária à saúde é considerada atualmente a melhor estratégia para diminuição da carga da doença. são realizadas ações que visam à promoção, prevenção, recuperação e reabilitação comprometida com a integralidade da assistência à saúde, focado na família, considerando o contexto socioeconômico, cultural e epidemiológico da comunidade em que está inserido. Objetivo:descrever a experiência de sensibilização dos Agentes Comunitários de saúde (ACs) de um município do Centro-oeste Mineiro para desenvolverem ações de prevenção e controle de hanseníase a fim de reduzir o estigma e realizar o diagnóstico oportuno de casos. Relato da experiência: Trata-se de um projeto de extensão universitária financiado pela Pró-reitoria de extensão e Assuntos Comunitários da universidade Federal de são João del rei. Foi desenvolvido no município de Carmo do Cajuru no período de março 2015 a março 2016, com 26 ACs. Para desenvolvimento das atividades foi usado o método interacionista, que é a perspectiva na qual o sujeito age diretamente sobre o objeto do conhecimento, problematizando sua ação. Como estratégica metodológica foram realizadas dinâmicas, exposição dialogada, apresentação de um vídeo seguido de roda de conversa e avaliação com exposição de frases em que o participante as julgariam como verdadeiras ou falsas. Resultados: A equipe do projeto estimulou a elaboração de um plano de mobilização da comunidade sobre a hanseníase que foi executado durante o ano de 2016. A partir da sensibilização da comunidade na igreja, houve a demanda espontânea ao serviço de saúde de uma pessoa com sinais dermatológicos, sendo que o diagnóstico de hanseníase foi confirmado em março de 2016. Conclusão: A realização de educação permanente dos ACS permitiu a qualificação para a realização das ACH na comunidade.

Introduction: The integration of leprosy control actions (LCA) in primary health care is currently considered the best strategy to reduce the burden of disease. Actions aimed by promotion, prevention, recovery and rehabilitation committed to integrality of health care, focused on the family, considering the socioeconomic, cultural and epidemiological context of the community in which it is inserted. Objective: to describe the experience of sensitization of the Community Health Agents (CHA) of a Brazilian municipality to develop leprosy control actions in order to reduce the stigma and to make a timely diagnosis of cases. Experience report: This is a university extension project funded by the Pro-rectory of Extension and Community Affairs of the Federal University of São João del Rei. It was developed in the municipality of Carmo do Cajuru from march 2015 to march 2016, with 26 CHA. For the development of activities, the interactionist method was used, which is the perspective in which the subject acts directly on the object of knowledge, problematizing its action. As a methodological strategy, dynamics were carried out, a dialogical presentation, a video followed by a round of conversation and evaluation with an exposition of sentences in which the participant would judge them as true or false. Results: The project team encouraged the development of a community mobilization plan on leprosy that was implemented during the year 2016. From the sensitization of the community in the church that there was spontaneous demand to the health service of a person with signs and the diagnosis of leprosy was confirmed in March 2016. Conclusion: The achievement of permanent education of the CHA allowed the qualification for the accomplishment of the LCA in the community.

Validação do instrumento de avaliação do desempenho da atenção primária nas ações de controle da hanseníase (PCAT ­ hanseníase): versão profissionais / Validation of assessment tool to performance leprosy control actions in primary care (PCAT ­ leprosy): professional version

Introdução: A hanseníase ainda é um problema de saúde pública no Brasil e os serviços de atenção primária possuem papel primordial na realização das ações de prevenção e controle para redução da carga de doença. Objetivo: construir e validar um instrumento de avaliação do desempenho da atenção primária nas ações de controle da hanseníase na perspectiva dos profissionais médicos e enfermeiros. Material e Métodos: Trata-se de um estudo metodológico de construção e validação de instrumento. Foram realizadas a validação de face e conteúdo com 15 especialistas, pré-teste do instrumento com 37 profissionais do município de Betim e validação de construto e de confiabilidade, cuja amostra foi composta por 124 enfermeiros e médicos de Almenara, Teófilo Otoni e Governador Valadares. Os dados foram coletados no período de junho a dezembro de 2012. Para a validação de construto, foi utilizada a análise fatorial exploratória. Para a validade, a análise da consistência interna foi realizada utilizando o coeficiente alfa de Cronbach e considerou-se um valor de, no mínimo, 0,70. O estudo de confiabilidade teste/reteste foi realizado por meio da reaplicação do instrumento em 10% da amostra, 30 dias após o término da coleta de dados em cada município. Utilizou-se o Teste de Wilcoxon, adotando o valor de p≥0,05. Resultados: A primeira fase do estudo permitiu a exclusão de 86 itens do questionário e não foi possível realizar a validação de construto devido à inadequação da amostra. Optou-se em realizar a análise fatorial para explorar o comportamento dos itens dos atributos e efetuar a exclusão dos itens em espelho à versão do instrumento destinada aos Agentes Comunitários de Saúde que foi validada. O instrumento mostrou medidas de fidedignidade aceitáveis. Conclusão: A utilização do instrumento proposto poderá identificar as fragilidades da atenção primária na atenção à hanseníase segundo a experiência dos profissionais.

Introduction: Leprosy is still a public health problem in Brazil, and primary health care services play a major role in the prevention and control actions to reduce the burden of disease. Objective: The study aimed to construct and validate an instrument to assess the performance of primary care in leprosy actions control in primary care from the perspective of doctors and nurses. Material and Methods: This study constructed and validated an instrument. The face and content validity was performed with 15 experts, pretesting with 37 professionals in the municipality of Betim and construct and reliability validation were performed with 124 nurses and doctors from Almenara, Governador Valadares and Teófilo Otoni. Data were collected from June to December 2012. For the construct validation, the exploratory factorial analysis was used. For validity, internal consistency analysis was performed using the Cronbach's alpha coefficient and a value of at least 0.70 was considered. The test / retest reliability study was performed by means of the reapplication of the instrument in 10% of the sample, 30 days after the end of the data collection in each municipality. The Wilcoxon test was used, adopting the value of p≥0.05. Results: The first phase of the study allowed the exclusion of 86 items of the questionnaire and it was not possible to construct validation because of inadequate sample. It was decided to perform the factorial analysis to explore the behavior of the items of the attributes and to exclude the items in mirror to the version of the instrument for the Community Health Agents that was validated. The instrument proved to be acceptable measures of reliability. Conclusion: The use of the proposed instrument can identify the weaknesses of primary care in leprosy care according to the professionals experience.

Avaliação do nível de informação sobre hanseníase dos agentes comunitários de saúde / Assessment of the level of information on leprosy by community health workers / Evaluación del nivel de información de los agentes comunitários de salud sobre la lepra

Objetivo: Avaliar o nível de informação dos Agentes Comunitários de Saúde (ACS) sobre a hanseníase e os aspectos como diagnóstico, cura, tratamento e transmissão. Métodos: Tratase de uma pesquisa quantitativa, descritiva e transversal. Para a coleta de dados utilizou-se um questionário com perguntas objetivas divididas em tópicos sobre a doença: aspectos gerais (bloco 1), diagnóstico (bloco 2), transmissão (bloco 3) e tratamento (bloco 4) da hanseníase, aplicado a 43 ACS de Cocal, Piauí, entre janeiro e março de 2016. Os participantes tinham como opções de respostas: sim, não e não sei responder. Resultados: Foi observado um nível de conhecimento "bom" para o bloco 3, "regular" para os blocos 1 e 4 e "ruim" para o bloco 2. Quando analisado o panorama geral, o conhecimento dos ACS foi considerado regular. Conclusão: Os resultados obtidos nesta pesquisa evidenciaram um nível de informação aquém do esperado para os ACS sobre os principais aspectos da hanseníase, fazendo-se necessário que maior atenção seja dada na educação permanente em saúde desse profissional.

Objective: To assess the level of information of Community Health Workers (CHW) regarding leprosy and aspects such as diagnosis, cure, treatment and transmission. Methods: This is a quantitative descriptive cross-sectional study. Data were collected using a questionnaire with closed-ended questions divided into topics about the disease - general aspects (block 1), diagnosis (block 2), transmission (block 3) and treatment (block 4) of leprosy - applied to 43 CHWs from Cocal, Piauí from January to March 2016. Participants had to choose between the response options: yeas, no or do not know. Results: the level of knowledge was "good" in block 3, "regular" in blocks 1 and 4 and "poor" in block 2. Considering the general overview, CHWs knowledge was considered fair. Conclusion: The results obtained in this study showed a performance below expectations for CHWs regarding the main aspects of leprosy, pointing out that more attention should be given to the continuing health education of this professional.

Objetivo: Evaluar el nivel de información de los Agentes Comunitarios de Salud (ACS) sobre la lepra y sus aspectos como el diagnóstico, la cura, el tratamiento y la transmisión. Métodos: Se trata de una investigación cuantitativa, descriptiva y transversal. Para la recogida de datos se utilizó una encuesta con preguntas tipo test divididas en tópicos sobre la enfermedad: los aspectos generales (bloque 1), el diagnóstico (bloque 2), la transmisión (bloque 3) y el tratamiento (bloque 4) de la lepra que fue aplicada a 43 ACS de Cocal, Piauí, entre enero y marzo de 2016. Los participantes tenían como opciones de respuestas: sí, no y no sé contestar. Resultados: Se observó un nivel de conocimiento "bueno" para el bloque 3, "regular" para los bloques 1 y 4 y "malo" para el bloque 2. El conocimiento de los ACS fue considerado regular tras analizar el panorama general. Conclusión: Los resultados de esta investigación evidenciaron un nivel de información mayor de lo que se esperaba de los ACS sobre los principales aspectos de la lepra, señalando la necesidad de más atención para la educación permanente en salud de ese profesional.

Saberes e práticas de agentes comunitários de saúde acerca da Hanseníase / Knowledge and practices of community health agents about Hansen's disease

Objetivo: avaliar o conhecimento de Agentes Comunitários de Saúde (ACS) acerca da hanseníase. Método: estudo descritivo, de abordagem qualitativa, com 37 ACS de Petrolina-PE escolhidos aleatoriamente. Os dados foram coletados por meio de formulário contendo questões abertas, analisados e categorizados pela Análise de Conteúdo. Resultados: a maioria dos agentes tinha pacientes hansênicos em sua área, porém alguns não realizavam tratamento; também a maioria sabia identificar a sintomatologia e medidas a serem tomadas após diagnóstico. No entanto, referiram pouco conhecimento sobre a doença. Nenhum dos participantes mencionou a importância da vacinação BCG para contatos do paciente. O preconceito ainda é algo preocupante, visto que alguns afirmaram evitar tocar ou aproximar-se dos acometidos. Conclusão: urge intensificar ações de educação em saúde, dado o contato permanente destes profissionais com a população, evitando marginalização de pacientes hansênicos e familiares. Descritores: Agentes Comunitários de Saúde; Hanseníase; Conhecimentos, Atitudes e Práticas em Saúde.(AU)

Perspectivas de sujeitos envolvidos em movimentos sociais sobre a hanseníase e seu controle em uma área endêmica / Perpectives of thoseinvolved in social movements about the leprosy and its control in an endemic area

A hanseníase, apesar dos investimentos no desenvolvimento de novas tecnologias de tratamento, diagnóstico e da adoção de novas estratégias de controle da doença no Brasil, permanece como um problema de saúde pública no país. O município de Almenara, localizado no Vale do Jequitinhonha – MG é prioritário para o controle da hanseníase por apresentar um coeficiente de detecção considerado alto pelo Ministério da Saúde. O serviço de saúde do município tem apresentado dificuldades para a realização das ações propostas pelo Programa Nacional de Controle da Hanseníase, uma vez que estudo na região demonstrou que a população, mesmo convivendo com a doença ao longo de anos, tem dificuldade para compreender aspectos importantes da doença que podem influenciar na detecção precoce de novos casos. Os conselheiros de saúde e os líderes comunitários são sujeitos sociais importantes do município que podem contribuir com o serviço de saúde no controle da hanseníase, por possuírem uma grande representatividade dentro das comunidades e/ou grupos em que atuam. A fim de envolver os sujeitos sociais do município de Almenara no controle da hanseníase, este estudo teve como objetivo analisar a hanseníase como um problema de saúde pública na perspectiva dos conselheiros de saúde e dos líderes comunitários do município de Almenara. Trata-se de pesquisa de abordagem qualitativa. Foi realizada com dez conselheiros de saúde e sete líderes comunitários do município de Almenara. A coleta de dados utilizou a técnica de entrevista com roteiro semiestruturado. O tratamento dos dados foi realizado a partir da analise qualitativa de conteúdo proposta por Laville e Dione (1999), que permitiu a construção de duas categorias de análise. A análise dos dados foi realizada à luz dos recortes analíticos deste estudo. Os resultados apontam que os sujeitos sociais identificam as manchas com perda de sensibilidade como as características da doença, mas confundem as reações e as...

Despite investments in developing new technologies for the treatment, diagnosis and the adoption of new strategies for disease control in Brazil, Leprosy remains a public health problem in the country. Almenara, a municipal district located in the Jequitinhonha Valley - MG is a priority for leprosy control for presenting a detection rate considered high by the Ministry of Health. The county’s healthservices have presented difficulties for carrying out the actions proposed by the National Leprosy Control Programme, since a study has shown that the population, even living with the disease for years, has difficulty to understand important disease aspects that can influence the early detection of new cases. Health counsellors and community leaders are important social agents of the county who can contribute to the health service in leprosy control, for possessing a large representativeness within communities and/or groups they serve. In order to involve Almenara’s social agents in leprosy control, the study aimed to assess leprosy as a public health problem from the health advisors and community leaders’ perspective. This paper uses a qualitative research methodology conducted with ten health counsellors and seven community leaders from Almenaracounty where data collection has been done under a semi-structured interview technique. Data analysis has been carried out based on a qualitative content analysis as proposed by Laville and Dione (1999), which allowed the data to be analysed into two different categories. Data analysis has been performed according to the analytical approaches in this study. The results have pointed out that social agents identify the spots with sensitivityloss as the disease characteristics, but they mistake reactions and physical disabilities with the disease signs. The health service has had difficulty to perform early diagnosis of the disease, which has contributed to a scenario where leprosy is seen as a disease that has...

The contribution of community health workers to the control of Buruli ulcer in the Ngoantet area, Cameroon.

INTRODUCTION: Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans. It is the third most common mycobacterial infection after tuberculosis and leprosy. Community Health Workers (CHWs) hold the potential to support patients and their families at the community level. METHODS: We conducted a cross-sectional descriptive study to assess the participation of CHWs in the early diagnosis and treatment of BU in Ngoantet, Cameroon. The CHWs performance was measured using: the number of cases referred to the Ngoantet Health Centre, the percentage of accomplished referrals, the percentage of cases referred by CHWs confirmed by the staff of Ngoantet Health Centre. Data was analyzed using Epi-info version 3.4.1. and Microsoft Office Excel 2003. The study focused on 51 CHWs in the Ngoantet health area. RESULTS: The referral rate was 95.0%. Most of the suspicious cases (91.5%) referred were confirmed by health workers. Most CHWs (78.4%) declared that they had identified at least one presumptive case of BU infection. CONCLUSION: We conclude that the CHWs can play a key role in scaling up BU control activities using a referral system. This study confirms the role of home visits and inspections in the early detection and treatment of BU.

[Buruli ulcer and the National Health Insurance Scheme in Ghana].

The objectives of this paper are to grasp the current status of an endemic disease in the Republic of Ghana known as Buruli ulcer(BU) and to clarify relationships between the National Health Insurance Scheme(NHIS) and the health care system. As for the method of the study, I have adopted field investigations conducted in Ghana in March, 2009 and August, 2011. All the counter-measurements on BU taken either by the very government or international NGOs have been administered and controlled the disease in accordance with the National Buruli ulcer Control Programme(NBUCP) under the guidance of Global Buruli ulcer Initiative which was established in Geneva, Switzerland in 1998 as an advisory committee of the World Health Organization. BU patients can receive treatments free. The government sponsored NBUCP and direct and indirect donations from various NGOs provide the cost of medical treatments. The Ghanian NHIS of 2003 aimed to ease and improve the health situations of the people. Some of serious endemic diseases like BU, however, are excluded from the schemes. While the NHIS remains ineffective to the diseases like BU, the burden of treatment costs puts the strain on NBUCP. The field researches indicate that the budgets provided by the NBUCP often faile to cover the fundamental medical supplies like bandages. This causes to give an extra burden on the already constrained hospital budgets. Only reliefs the hospitals can rely on are the international aids which often determine the fate of the national disease control. The research reveals that the region's health system remains unsound. Ghana represents such realities of West Africa as a whole.