35 Years Later, Schistosomiasis Still Lurks in the Brazilian Forests

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Schistosomiasis remains a problem in the rural forested areas in the state of Pernambuco, Brazil.

Although relatively easy to treat once diagnosed, schistosomiasis (also known as bilharzia, blood fluke, or “snail fever”) remains a public health problem in several tropical locales, including northeastern Brazil. A special program for schistosomiasis control was launched in Brazil in 1975; and it was administered centrally by the Brazilian Ministry of Health. The initial goal of the Schistosomiasis Control Program was the elimination of schistosomiasis in Brazil; however, this has proven to be difficult in the poor areas of Brazil’s Northeast Region, including the state of Pernambuco (see figure). 

The decentralization of the Schistosomiasis Control Program in 1993 from the Ministry of Health to the primary health care providers of individual states and municipalities reduced the impetus for the program in rural areas. A renewed worldwide interest in schistosomiasis was addressed by the World Health Organization in 2001; and its position was iterated in the World Health Assembly Resolution 54.19: “a minimum target of regular administration of chemotherapy to at least 75%, and up to 100%, of all school-age children at risk of morbidity by 2010.” The most recent analysis of the community-based program in Pernambuco is found in an article in PLoS Neglected Tropical Diseases, which states that the current version of the program in rural areas will not meet the goals of WHA 54.19 unless a school-based program is developed; therefore, local primary health care provider outlets should focus on schools to reach the most vulnerable yet still accessible population.

Further, the Bazilian Ministry of the Environment (IBAMA) has appeared to lose its policy “teeth” regarding the construction of dams, regardless of their construction potentially increasing the sustainability of the schistosoma intermediate snail host. Integration of the Ministry of Health mission with the Ministry of Education accessibility to school children at the local level in Pernambuco, as well as policy invigoration of the Ministry of Environment toward the public health risk associated with dam construction, could help Pernambuco and the nation of Brazil continue toward its original goal of schistosomiasis eradication.

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One Response to “35 Years Later, Schistosomiasis Still Lurks in the Brazilian Forests”

  1. annepalumbo Says:

    Thanks for a well written, interesting blog. I found the issue of the dams particularly intriguing — yet another reason why those in public health cannot ignore the complicated interplay between social, environmental, political and financial influences. It also reminds us of the vulnerable position that indigenous people often find themselves in.

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