The organization of health services and visceral leishmaniasis: an integrated intervention to improve diagnosis and treatment Contribuição à organização de serviços de saúde com atenção à leishmaniose visceral: um trabalho

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 (20012002) 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. Visceral Leishmaniasis; Health Services; Lethality Introduction Visceral leishmaniasis is particularly prevalent in Bangladesh, India, Nepal, Sudan and Brazil, with these five countries together accounting for 90% of the global visceral leishmaniasis burden 1. The disease is closely associated with poverty and usually affects the poorest people in the poorest countries. It is estimated that in India, 88% of leishmaniasis patients have a daily income of less than US$ 2.00 a day 2. Control of this disease is not easy on account of: (1) the diversity of its epidemiological profile, since it occurs in different ecological regions; (2) the limitation of diagnostic methods, which are invasive, expensive, and require a complex infrastructure that demands different and complex approaches in different settings; (3) the drawback of the therapeutic intervention, as long parenteral courses of pentavalent antimonial agents remain the treatment of choice in the vast majority of endemic countries, with an unacceptable frequency and intensity of adverse effects. In Brazil, leishmaniasis is a notifiable disease, and the Brazilian control program that started more than 40 years ago is based on the free delivery of specific drug therapy and on vector and domestic reservoir control 3. Vector control, essentially for the Lutzomyia longipalpis species, is performed by the spraying of insecticides, and reservoir control is performed by serological testing of domestic dogs (the main reservoir in urban ARTIGO ARTICLE