Primary health care in municipalities at high risk for malaria / Atenção primária à saúde em municípios de alto risco para malária / Atención primaria a la salud en municipios de alto riesgo para malaria

This study aims to characterize aspects of Primary Health Care in the Amazon Region of Brazil, considered as the main endemic area for malaria in the country. The Ministry of Health recommends the expansion of Primary Health Care in endemic areas for malaria. A survey focusing on patients infected with malaria was conducted in 6 municipalities, in January and February 2007, to investigate specific aspects of Primary Health Care. Data was analyzed quantitatively and field records helped to give support to context and policy issues in the visited sites. Quality of access to health services and medicines, continuity of health care, system coordination and community orientation are still incipient in the visited areas. The study showed that there is little integration between Primary Health Care and malaria control in the region, which calls for development of joint strategies and for the strengthening of Primary Health Care per se, as a benefit to the population of this endemic area.

Neste estudo pretendeu-se caracterizar aspectos da Atenção Básica, na região da Amazônia Legal, principal área endêmica para malária, no Brasil. O Ministério da Saúde recomenda a expansão da Atenção Básica nas áreas malarígenas. Foi realizado inquérito transversal, aplicado aos portadores de malária, em 6 municípios, durante os meses de janeiro e fevereiro de 2007. Os dados coletados foram tabulados e analisados, utilizando-se técnicas quantitativas. Registros de campo auxiliaram na composição das impressões do contexto dessas políticas nos locais pesquisados. A qualidade do acesso a consultas e medicamentos, o vínculo com os profissionais e com as Unidades Básicas de Saúde, o sistema de referência e contrarreferência, e a abordagem familiar e comunitária da saúde pelos profissionais, nos municípios do estudo, ainda são deficientes nesse nível de atenção. Há baixa integração entre o Programa Nacional de Controle de Malária e a Atenção Básica, de modo geral.

Este estudio pretende caracterizar aspectos de la Atención Básica en la región de la Amazonia Legal, principal área endémica para malaria en Brasil. El Ministerio de la Salud recomienda la expansión de la Atención Básica en las áreas afectada por la malaria. Fue realizado una encuesta transversal aplicada a los portadores de malaria en 6 municipios, durante los meses de enero y febrero de 2007. Los datos recolectados fueron tabulados y analizados utilizando técnicas cuantitativas. Registros de campo auxiliaron en la composición de las impresiones del contexto de estas políticas en los locales investigados. La calidad del acceso a consultas y medicamentos, el vínculo con los profesionales y con las Unidades Básicas de Salud, el sistema de referencia y contra-referencia y el abordaje familiar y comunitario de la salud por los profesionales en los municipios del estudio también son deficientes en este nivel de atención. Existe una baja integración entre el Programa Nacional de Control de Malaria y la Atención Básica de un modo general.

[Uncomplicated malaria treatment in the Brazilian Amazon: knowledge, practices and perceptions of health workers in high-incidence municipalities]. / Conhecimentos, práticas e percepções de profissionais de saúde sobre o tratamento de malária não complicada em municípios de alto risco da Amazônia Legal.

Malaria control in Brazil is based on early diagnosis and adequate and timely treatment as strategies for a rapid and long-lasting cure. Clinical consequences and resistance to antimalarials may arise from problems in prescribing, dispensing and in acceptance of therapeutic regimens by healthcare workers. We studied knowledge and practices, perceptions and attitudes of health workers participating in pharmaceutical services for malaria, regarding the official protocol and the possible flaws in therapy. Health workers from six municipalities in the Brazilian Amazon were interviewed. Speech analysis was employed as a technique to determine analytical categories and to organize data. There was only 1 physician among the 63 interviewees, the others were health technicians carrying out diagnosis, therapy indication and dispensing of antimalarial treatment. Training time and period since course completion varied. Flaws in the adherence to the national protocol included therapy indication, dispensing and counseling. Health workers need knowledge to face disease and treatment specificities. Holding accountable health workers that are unprepared and unfit for the job may indicate the need for adequacy in policies regarding adequate training and hiring of human resources.

Primary health care in municipalities at high risk for malaria.

This study aims to characterize aspects of Primary Health Care in the Amazon Region of Brazil, considered as the main endemic area for malaria in the country. The Ministry of Health recommends the expansion of Primary Health Care in endemic areas for malaria. A survey focusing on patients infected with malaria was conducted in 6 municipalities, in January and February 2007, to investigate specific aspects of Primary Health Care. Data was analyzed quantitatively and field records helped to give support to context and policy issues in the visited sites. Quality of access to health services and medicines, continuity of health care, system coordination and community orientation are still incipient in the visited areas. The study showed that there is little integration between Primary Health Care and malaria control in the region, which calls for development of joint strategies and for the strengthening of Primary Health Care per se, as a benefit to the population of this endemic area.

Conhecimentos, práticas e percepções de profissionais de saúde sobre o tratamento de malária não complicada em municípios de alto risco da Amazônia Legal / Uncomplicated malaria treatment in the Brazilian Amazon: knowledge, practices and perceptions of health workers in high-incidence municipalities

O controle da malária no Brasil conta com diagnóstico precoce e tratamento adequado e oportuno como estratégia para cura rápida e duradoura. Consequências clínicas e resistência aos antimaláricos podem resultar de falhas na prescrição, dispensação e aceitação dos profissionais aos esquemas terapêuticos propostos. Objetivou-se avaliar conhecimentos, práticas, percepções e atitudes de profissionais envolvidos na assistência farmacêutica à malária, frente ao protocolo oficial e a possíveis falhas na terapêutica. Entrevistaram-se profissionais em seis municípios na Amazônia Legal. Utilizou-se técnica de análise do discurso para determinação de categorias analíticas e sistematização. Dos 63 entrevistados, houve apenas um médico. Os demais, de nível médio, atuavam no diagnóstico, indicação e dispensação do tratamento antimalárico. O tempo de formação e de treinamento foi variável. Houve falhas na adesão ao protocolo nacional, perpassando indicação, dispensação e orientação aos pacientes. Os profissionais carecem de conhecimento para lidar com as especificidades da doença e do tratamento. A responsabilização de profissionais que não possuem o preparo necessário para a atenção sugere necessidade de políticas para a adequada capacitação e incorporação de recursos humanos.

Malaria control in Brazil is based on early diagnosis and adequate and timely treatment as strategies for a rapid and long-lasting cure. Clinical consequences and resistance to antimalarials may arise from problems in prescribing, dispensing and in acceptance of therapeutic regimens by healthcare workers. We studied knowledge and practices, perceptions and attitudes of health workers participating in pharmaceutical services for malaria, regarding the official protocol and the possible flaws in therapy. Health workers from six municipalities in the Brazilian Amazon were interviewed. Speech analysis was employed as a technique to determine analytical categories and to organize data. There was only 1 physician among the 63 interviewees, the others were health technicians carrying out diagnosis, therapy indication and dispensing of antimalarial treatment. Training time and period since course completion varied. Flaws in the adherence to the national protocol included therapy indication, dispensing and counseling. Health workers need knowledge to face disease and treatment specificities. Holding accountable health workers that are unprepared and unfit for the job may indicate the need for adequacy in policies regarding adequate training and hiring of human resources.

A Atenção Básica em Saúde em Municípios da Área Endêmica de Malária na Amazônia Legal - Brasil.

Verifica características da Atenção Básica em municípios de regiões endêmicas para a malária na perspectiva dos usuários do sistema. O arquivo está disponível para leitura e/ou download por meio do ícone ao lado.