Agentes comunitários de saúde: percepção sobre os serviços de saúde relacionados à doença de Chagas

Abstract

Resumo Introdução A doença de Chagas ainda é um importante problema de saúde pública na América Latina, apresentando alta prevalência, ampla distribuição geográfica e grande impacto social. Vários serviços relacionados à doença de Chagas são solucionados na Atenção Primária à Saúde (APS). Na Estratégia Saúde da Família (ESF), destaca-se o agente comunitário de saúde (ACS), profissional responsável pela mediação entre a comunidade e as unidades básicas de saúde (UBS). Objetivo Apreender a percepção dos coordenadores da ESF e dos ACSs sobre o conhecimento a respeito da doença de Chagas e dos serviços de saúde relacionados nos municípios da microrregional de saúde de Itaúna, em Minas Gerais, Brasil. Método Foram aplicados questionários semiestruturados aos ACSs e realizados grupos focais com os coordenadores da ESF. Resultados Foi observado que, entre os profissionais, há ausência de informações básicas relacionadas à doença de Chagas; inexiste um protocolo/fluxograma de serviço; há uma ineficiência dos serviços de referência e contrarreferência; ocorre precariedade nas condições de trabalho; há ausência de capacitação dos profissionais e de ações de promoção à saúde nos municípios. Conclusão Este é o primeiro estudo abordando esta temática: percepção dos ACSs sobre a doença de Chagas e seus serviços. Sugere-se a extensão deste estudo a outras regiões do Brasil.

Chagas Disease and Primary Health Care in Brazil

“…According to the clinical protocol and therapeutic guidelines for Chagas disease [7], the follow-up of non-serious clinical conditions of Chagas disease, and etiological treatment with benznidazole, when indicated for acute or non-severe chronic cases of Chagas disease, should be carried out within PHC. However, in a recently published study carried out in some of the municipalities of the state of Minas Gerais, Brazil, the low number of patients aff ected by Chagas disease in the municipal basic health units (Unidades Básicas de Saúde, UBSs) was pointed out during focus groups by the coordinators of the "Estratégias de Saúde da Família" (ESF, Strategies of Family Health) of the PHC [8]. In another study, also conducted in the same municipalities and by the same research group, but this time involving interviews of nursing teams, most participants claimed to have never provided care to patients aff ected by the disease [9].…”

“…Therefore, a great number of people with chronic disease were expected to be using the PHC services in these municipalities. Yet, according to the authors [8,9], one of the possible explanations for the low number of records of people aff ected with the infection in endemic areas could be related to the absence of a more redundant approach by health professionals during interviews and screening of patients, contrary to the recommendations for clinical follow-up of these patients in PHC [7].…”

“…From these pioneering studies on the relationship between Chagas disease and PHC, it was evident that there was a failure in the identifi cation of those aff ected with Chagas disease, be it acute, chronic symptomatic, or in the indeterminate phase, when the users entered the health care system, that is, PHC, the service which supplies the majority of care for neglected diseases, and that, therefore, should be the fi rst detection site for those aff ected. This failure is found throughout the health care system, from the moment when the health professional should focus attention on the individual, and stresses the importance of a better approach and interpersonal relationship, as the patient, when looking for the health facility, is found to be most fragile and often has diffi culties in reporting their complaints/symptoms clearly [8,9]. Furthermore, this failure to identify diseased individuals may also be related to the lack of knowledge of health professionals about the epidemiology of the disease, which makes more detailed interviews diffi cult, and involves not only the "diseased individual", but also encompasses the environment which that individual inhabits (i.e., whether they live in an endemic area).…”

“…Furthermore, this failure to identify diseased individuals may also be related to the lack of knowledge of health professionals about the epidemiology of the disease, which makes more detailed interviews diffi cult, and involves not only the "diseased individual", but also encompasses the environment which that individual inhabits (i.e., whether they live in an endemic area). In fact, in the work of Rodrigues, et al (2020ab) [8,9] there are also reports of a lack of training of health professionals in PHC in relation to Chagas disease, with the repercussion that the symptoms and signs of the disease are not recognized, or and that there is ignorance of eco-epidemiological aspects related to the vectors of it, such that these professionals are not prepared to detect it.…”

“…Another serious gap that became evident from the studies of Rodrigues, et al (2020ab) [8,9] was the disarticulation between PHC and the public health surveillance sector with regard to the resolution of actions and services aimed at Chagas disease in the municipalities of Minas Gerais studied.…”