The organization of health services and visceral leishmaniasis: an integrated intervention to improve diagnosis and treatment

Abstract

The objective of this study, carried out in municipalities located in a metropolitan region of Brazil, was to promote the early diagnosis and prompt treatment of visceral leishmaniasis. In the intervention model a health professional underwent training that covered all procedures involved in assisting patients with suspected visceral leishmaniasis. The professionals then returned to their municipalities where they implemented a workplan with the following aims: (a) at least one physician able to diagnose and treat patients; (b) training of professionals for the laboratorial diagnosis of visceral leishmaniasis; (c) delivery of information on visceral leishmaniasis to the health workers. The implementation process was evaluated by follow-up meetings. Attendance of health professionals at the meetings, implementation of the workplan, and the visceral leishmaniasis case fatality rate before (1998-1999) and after (2001-2002) implementation of the model were used in the analysis. Among the 36 municipalities in the region, 22 were enrolled. Eight (36.3%) guaranteed at least 50% attendance in the meetings, and 14 (63.6%) had less than 50% attendance with no activities implemented. The fatality rate decreased in the municipalities that implemented the activities.

Occurrence of Lutzomyia longipalpis andhuman and canine cases of visceral leishmaniasis and evaluation of their expansion in the Northwest region of the State of São Paulo, Brazil

“…In the cities considered most at risk, education and environmental management activities should be developed; professionals in veterinary clinics should be prepared to deal properly with CVL; and there should be investments in the care, diagnosis, and treatment infrastructure so that HVL can be diagnosed early and appropriate treatment can be given to prevent deaths (26) (27) .…”

“…Luz et al (26) and Barbosa et al (27) identifi ed diffi culties faced by health professionals in detecting and treating people with HVL, particularly when there are no confi rmed cases and in locations where the vector's presence and/or canine cases have not been confi rmed, which may have an effect on the disease's expansion speed and interfere with incidence, mortality, and lethality. The high lethality rates among HVL cases in the region, particularly among the elderly, may be explained by this scenario, because the observed values for this group were much higher than the national average (approximately 7%) (32) .…”

Late diagnosis: a factor associated with death from visceral leishmaniasis in elderly patients

“…Reducing mortality rates requires early diagnosis, which in turn depends on early suspicion followed by prompt intervention. 41 Anaemia, neutropaenia and thrombocytopaenia are frequently seen in VL cases, 30,[32][33][34]42 reflecting the occurrence of bone marrow suppression, aemolysis and splenic sequestration, 43 conditions that predispose to infection and haemorrage, increasing the risk of death. A study conducted in Sã o Paulo found that lethality was associated with haemoglobin levels v5 g/dl, but not with leucocyte or platelet counts.…”

Tegumentary Leishmaniasis: A Diagnostic Approach Considering Aspects of the Cytological Examination

“…Implementing and maintaining such programs is a difficult task, considering the diversity found in Brazilian endemic areas, but these programs are urgently required [26]. The morphological characteristics of parasites that present on direct examination preparations are essential for case completion.…”