A rationale for schistosomiasis control in elementary schools of the rainforest zone of pernambuco, Brazil

• Published in: PLoS neglected tropical diseases Vol. 3; no. 3; p. e395
• Main Authors: Favre, Tereza C, Pereira, Ana P B, Galvão, Aline F, Zani, Luciana C, Barbosa, Constança S, Pieri, Otávio S
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 2009; Public Library of Science (PLoS)
• Subjects: Adolescent; Animals; Anthelmintics - therapeutic use; At risk youth; Brazil - epidemiology; Chemotherapy; Child; Children & youth; Disease prevention; Education; Government Programs; Health facilities; Health Priorities; Humans; Infection Control; Mass Screening; Population; Prevalence; Primary care; Public health; Public Health and Epidemiology/Epidemiology; Rainforests; Reference services; Rural Health - statistics & numerical data; Schistosoma mansoni; Schistosomiasis; Schistosomiasis mansoni - diagnosis; Schistosomiasis mansoni - drug therapy; Schistosomiasis mansoni - epidemiology; Schools; Tropical diseases; World Health Organization; Brazil; Schistosoma mansoni; Prevalence; World Health Organization; Humans; Infection Control; Anthelmintics; Health Priorities; Rural Health; Schistosomiasis mansoni; Animals; Mass Screening; Adolescent; Brazil; Government Programs; Child
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0000395

Since its beginning in 1999, the Schistosomiasis Control Program within the Unified Health System (PCE-SUS) has registered a cumulative coverage of just 20% of the population from the Rainforest Zone of Pernambuco (ZMP), northeast Brazil. This jeopardizes the accomplishment of the minimum goal of the Fifty-Fourth World Health Assembly, resolution WHA54.19, of providing treatment for schistosomiasis and soil-transmitted helminthiases (STH) to 75% of school-aged children at risk, which requires attending at least 166,000 residents in the 7-14 age range by year 2010 in that important endemic area. In the present study, secondary demographic and parasitological data from a representative municipality of the ZMP are analyzed to provide evidence that the current, community-based approach to control schistosomiasis and STH is unlikely to attain the WHA-54.19 minimum goal and to suggest that school-based control actions are also needed.
Data available on the PCE-SUS activities related to diagnosis and treatment of the population from the study municipality were obtained from the State Secretary of Health of Pernambuco (SES/PE) for 2002-2006, complemented by the Municipal Secretary of Health (SMS) for 2003-2004. Data from a school-based stool survey carried out by the Schistosomiasis Reference Service of the Oswaldo Cruz Foundation (SRE/Fiocruz) in 2004 were used to provide information on infection status variation among school-aged children (7-14 years). According to the SES, from 2004 to 2006, only 2,977 (19.5%) of the estimated 15,288 residents of all ages were examined, of which 396 (13.3%) were positive for Schistosoma mansoni. Among these, only 180 (45.5%) were treated. According to the SMS, of the 1,766 examined in the 2003-2004 population stool survey 570 (32.3%) were children aged 7-14 years. One year later, the SRE/Fiocruz school survey revealed that the infection status among those children remained unchanged at 14%-15% prevalence. By 2006, the school-aged population was estimated at 2,981, of which 2,007 (67.3%) were enrolled as pupils.
It is suggested that in the most troubled municipalities individual diagnosis and treatment should be concentrated in school-aged children rather than the whole population. School-based actions involving teachers and children's families may help the health teams to scale up control actions in order to attain the WHA-54.19 minimum goal. This strategy should involve health and education organs and include both enrolled and non-enrolled children.