Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil.

Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.

Estratégias terapêuticas utilizadas na consulta de enfermagem a pacientes com insuficiência cardíaca de etiologia chagásica / Therapeutic strategies used in the nursing appointmentofpatients with heart failure of chagasical etiology / Experiencias de profesionales de enfermería sobre el (ir)respeto a los derechos humanos en el cuidado de personas hospitalizadas

Objetivo: O objetivo desse trabalho é descrever as estratégias terapêuticas utilizadas na consulta de enfermagem a pacientes com Insuficiência Cardíaca de etiologia Chagásica. Método: Trata-se de um estudo descritivo, com olhar qualitativo, desenhado a partir de métodos descritivos e observacionais sobre estratégias terapêuticas utilizadas na consulta de enfermagem a pacientes com Insuficiência Cardíaca de etiologia chagásica em um ambulatório referência do Estado de Pernambuco, Brasil. Resultados: através da anamnese e do exame físico, são utilizadas estratégias de intervenções relacionadas ao uso correto das medicações, dieta alimentar, atividade física e vacinação. Realizam-se orientações sobre a doença e hábitos saudáveis, a fim de fortalecer o autocuidado e melhorar a adesão terapêutica. Conclusão: sabe-se que o tratamento a esses pacientes deve ser similar ao de IC de outras etiologias, porém a etiologia chagásica exige uma coleta de dados minuciosa, para que o cuidado seja mais individualizado e integral, considerando o contexto complexo e negligenciado desta doença. (AU).

Objective: This study aims to describe the therapeutic strategies used in nursing appointments given to patients with heart failure of Chagas etiology. Method: This is a descriptive study, with a qualitative perspective, designed from descriptive and observational methods on therapeutic strategies used in the nursing appointments of patients with Heart Failure of Chagas etiology in a reference clinic in the State of Pernambuco, Brazil. Results: Through anamnesis and physical examination, intervention strategies related to the correct use of medications, diet, physical activity and vaccination are used. There are given orientations about the disease and healthy habits in order to strengthen self-care and improve therapeutic adherence. Conclusion: It is known that the treatment of these patients must be similar to the ones of Heart Failure of other etiologies, but the Chagasic etiology requires detailed data collection, so that care is more individualized and comprehensive, considering the complexity and neglected context of this disease. (AU).

El objetivo de este trabajo es describir las estrategias terapéuticas utilizadas en las consultas de enfermería de pacientes con insuficiencia cardíaca de etiología chagásica. Se trata de un estudio descriptivo, con perspectiva cualitativa, diseñado a partir de métodos descriptivos y observacionales sobre las estrategias terapéuticas utilizadas en las consultas de enfermería de pacientes con Insuficiencia Cardíaca de etiología chagásica en un servicio ambulatorio de referencia en el Estado de Pernambuco, Brasil. A través de la anamnesis y la exploración física se implementan estrategias de intervención relacionadas con el correcto uso de medicamentos, dieta, actividad física y vacunación. Se dan orientaciones sobre la enfermedad y los hábitos saludables con el fin de fortalecer el autocuidado y mejorar la adherencia terapéutica. Se sabe que el tratamiento de estos pacientes debe ser similar al de la IC de otras etiologías, pero la etiología chagásica requiere que se realice una recolección de datos detallada, para que la atención sea más individual e integral, considerando el contexto complejo y lo desatendida que está dicha enfermedad. (AU).

Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil

ABSTRACT Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.