Fatores sociais e ambientais associados ? ocorr?ncia da esquistossomose no munic?pio de Serro, Minas Gerais

A esquistossomose mansoni ? uma doen?a tropical negligenciada afetando anualmente milh?es de pessoas em todo mundo. ? provocada pelo parasito Schistosoma mansoni que, al?m do hospedeiro definitivo, depende do ambiente aqu?tico e de caramujos do g?nero Biomphalaria como hospedeiro intermedi?rio para completar seu ciclo biol?gico. De uma forma geral, sua ocorr?ncia est? associada a grupos sociais vulner?veis vivendo em ?reas deficit?rias em servi?os de saneamento ambiental e a padr?es de comportamento da popula??o. Al?m disso, altera??es promovidas no ambiente por atividades humanas em diferentes contextos, sobretudo aquelas que afetam diretamente as cole??es h?dricas podem favorecer a instala??o ou manuten??o de focos da doen?a. Desta forma, o presente estudo objetivou analisar os fatores ambientais e sociais associados ? din?mica de ocorr?ncia da esquistossomose no munic?pio de Serro, estado de Minas Gerais. Para tanto, conduziu-se estudo epidemiol?gico, de car?ter descritivo e quantitativo dos casos de esquistossomose ocorridos no per?odo 2010-2014, a partir de dados levantados junto ao Programa de Controle da Esquistossomose de Serro e de entrevistas com a popula??o. Foram identificados 352 casos diagnosticados no per?odo considerado, dentre os quais 104 participaram das entrevistas. Da popula??o total afetada, observou-se ser esta predominantemente masculina (62,78%), em idade economicamente ativa de 15-59 anos (80,1%), com ensino fundamental incompleto (52,8%) e residindo na ?rea rural (81,5%). Dentre os entrevistados, a maioria era natural do pr?prio munic?pio (84,7%), morando na atual resid?ncia h? mais de 20 anos (70%) na qual convivem de 3-6 pessoas (65,4%). A principal forma de ocupa??o s?o as atividades agropecu?rias (48,1%), com a maioria mantendo h?bito regular de fazer exames e consultas m?dicas (62,5%). A maior parte faz uso de ?gua proveniente de nascentes (56,7%) e consideram a ?gua consumida nas casas de boa qualidade (86,5%). A maioria das moradias possui banheiro com vaso sanit?rio (79,8%) destinando o esgoto para fossas secas no quintal ou rede de esgoto da rua (73,1%). ? expressivo o n?mero daqueles que declararam frequentar semanal (90,4%) ou quinzenalmente (79,7%) rios, ribeir?es e c?rregos (74,5%), cachoeiras (13,8%) e a?udes (9,6%) na regi?o, na maioria das vezes mantendo contato com as ?guas para pescar (55,3%), nadar (56,6%) e fazer travessia de caminho (41,5%). A maioria dos entrevistados declarou ter alguma informa??o sobre a doen?a antes de ser diagnosticado infectado (81,7%) e 62,5% n?o retornaram aos servi?os de sa?de para realizar o exame ap?s tratamento medicamentoso. A distribui??o da esquistossomose no munic?pio de Serro esteve significativamente agregada na por??o leste do munic?pio, em ?reas com menor varia??o na eleva??o e declividade, maiores ?ndice de vegeta??o e umidade, associada a ?reas com maior propor??o de domic?lios cujo esgotamento sanit?rio ocorria diretamente em cursos d??gua. Observou-se, ainda, que o maior n?mero de casos da doen?a ocorreu em localidades drenadas por rios da bacia hidrogr?fica do Rio Doce. Diante das particularidades apresentadas na extens?o do munic?pio, principalmente em rela??o ? espacializa??o da doen?a entre as duas grandes bacias hidrogr?ficas do munic?pio (Jequitinhonha e Rio Doce), as informa??es apresentadas podem contribuir para o direcionamento das a??es de controle na escala municipal, seja por meio de estrutura??o sanit?ria e ambiental, ou por meio de orienta??es quanto ao comportamento e exposi??o ?s cole??es h?dricas eventualmente contaminadas por parte da popula??o.Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Sa?de, Sociedade e Ambiente, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016.Schistosomiasis is an neglected tropical disease that affects annually millions of people worldwide. It is caused by Schistosoma mansoni worm that besides the definitive host, depends on the aquatic environment and on the Biomphalaria snails as an intermediate host to complete its life cycle. In general, its occurrence is associated with vulnerable groups living in areas where the environmental sanitation services are deficient and also associated to the population behavior patterns. In addition, changes introduced into the environment by human activities in different contexts, especially those that directly affect the water sources may promote the installation or maintenance of the disease outbreaks. Thus, this study aimed to analyze the environmental and social factors associated with the dynamics of Schistosomiasis occurrence in the city of Serro, Minas Gerais. For this it was conducted an epidemiological study, descriptive and quantitative of the Schistosomiasis cases occurred in the period 2010- 2014, from the data collected by the Schistosomiasis Control Program of Serro and interviews with the population. It was identified 352 diagnosed cases in the considered period, among which 104 participated in the interviews. Considering the total affected population, it was observed the predominance of men (62.78%), in work age of 15-59 years old (80.1%), with incomplete primary education (52.8%) and living in rural areas (81.5%). Among the respondents, most were natural of the municipality (84.7%), living at the current residence for more than 20 years (70%) living together with 3-6 people (65.4%). The main form of occupation is agricultural activities (48.1%), and most of them maintain regular habits of doing exams and having medical appointments (62.5%). Most of the respondents makes use of water coming from springs (56.7%) and consider the water consumed in their houses of good quality (86.5%). Most of the houses have bathroom with toilet (79.8%) intended for dry sewage tanks in the yard or street sewer network (73.1%). It is significant the number of those who reported that go to weekly (90.4%)or once every two weeks (79.7%) rivers, brooks and streams (74.5%), waterfalls (13.8%) and dams (9.6%) in the region, most of the time having contact with the water to fish (55.3%), to swimming (56.6%) and to crossing the path (41.5%). Most respondents claimed to have some information about the disease before being diagnosed infected (81.7%) and 62.5% did not return to health services for the exam after drug treatment. The distribution of Schistosomiasis in Serro municipality was significantly aggregated in the eastern portion of the city, in areas with less variation in elevation and slope, the largest index of vegetation and moisture associated with areas with the highest proportion of households where the sewage occurred directly into the watercourses. It was also noted that the highest number of cases of the disease occurred in places drained by rivers of the Rio Doce basin. Given the particularities presented at the county extension, especially in relation to the spatial distribution of the disease between two large municipal watersheds (Jequitinhonha and Rio Doce), the information presented may contribute to the guidance of the control actions on municipal level, either through health and environmental structuring, or through guidelines on the behavior and exposure to possibly contaminated water sources by the population