ResumoA esquistossomose continua a ser um problema de saúde pública no Nordeste do Brasil embora o emprego, em larga escala, da quimioterapia venha sendo apontado como um dos fatores responsáveis pela redução das formas graves. O Estado de Pernambuco vem apresentando taxas crescentes de infecção humana para esquistossomose com perfil epidemiológico de prevalências crônicas (até 80%) na região rural e casos recentes de infecção aguda no litoral. Discute-se a reprodução e expansão da esquistossomose a partir de uma concepção estrutural e histórica de causas, onde se inserem fatores não só de ordem biológica mas também sociais, políticos e culturais que vêm contribuindo para a formação dos quadros endêmicos: a forma de ocupação e do uso da terra, desemprego, desnutrição, migração e outros. Questionam-se as crescentes dificuldades para o controle da doença e o papel da investigação epidemiológica na compreensão da essência social do processo saúde/doença.
This paper describes the ecology of two species of Biomphalaria: B. glabrata and B. straminea. These species have been intensively studied in Brazil and in other countries since the 1950s. The literature in this area can be broadly subdivided into three categories, linked to three distinct historical periods: 1) an accumulated store of early studies carried out in the laboratory and in the field; 2) the development of quantitative ecological models; and 3) the development of an alternative methodology for breeding snails under seminatural conditions.
The subject of this conference reflects the scientific community's interest in seeking to understand the complex causal web whose various social, economic, and biological components interact in the production and reproduction of schistosomiasis and its control in relation to community participation. From the onset, the author stresses the impossibility of dealing separately with community participation, as if social components were just one more "weapon" in the arsenal for schistosomiasis control. This study begins with a brief historical review of the 71 years of control activities with this endemic disease, stressing the enormous efforts and huge expenditures in this field vis-à-vis the limited results, despite the extraordinary technological development of specific, classical control inputs such as new treatment drugs and molluscicides. The article then discusses the various strategies used in control programs, emphasizing ideological consistencies and contradictions. Interactions at the macro and micro levels are discussed, as are the determinants and risk factors involved in producing the disease's endemicity. Unequal occupation of space leaves the segregated portion of the population exposed to extremely favorable conditions for transmission of the disease. This raises the issue of how to control an endemic disease which is so closely linked to the way of life imposed on the population. The study challenges the classical control model and suggests an alternative model now undergoing medium-term investigation in the States of Espirito Santo, and Pernambuco, Brazil. The author concludes that we do not need new strategies, but a new control model, contrary to the prevailing classical model in both concept and practice. From the conceptual point of view, the new model mentioned above is different from others in that schistosomiasis control is seen from a social perspective stressing the population's accumulated knowledge in addition to the building of shared knowledge.(ABSTRACT TRUNCATED AT 250 WORDS)
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