Territory, neglected diseases and the action of community and endemic combat agents

Abstract

Objective: To characterize knowledge, practices, and professional experience of community health agents (ACS) and endemic combat agents (ACE) on leprosy and Chagas disease (DC), during participation in an integrated training workshop in the IntegraDTNs-Bahia project.

Methods: Descriptive and exploratory case study, involving health agents and endemic combat agents participating in a training workshop on the shared role of these professionals in health care and surveillance processes. The project was developed in the municipalities of Anagé, Tremedal and Vitória da Conquista, in the southwestern State of Bahia, 2019-2020. A specific instrument was applied, with questions related to knowledge and practices of surveillance and care for leprosy and Chagas disease. Descriptive analysis of the data, in addition to consolidation of the lexical analysis, was performed.

Results: Out of a total of 135 participants (107 ACS and 28 ACE), 80.7% of them have been working for at least 12 years, without previous participation in joint training processes. Only 17.9% of endemic combat agentes reported having participated in training on leprosy and none reported developing specific actions to control the disease. For Chagas disease, 36.4% of community health agents participated in training more than a decade before, while for 60.7% of endemic combat agents the last training was carried out in the last five years. The development of educational actions for Chagas disease was more frequent for endemic combat agents (64.3%). When asked about ways of recognizing diseases, the term "skin spots" was the most reported (38 times) for leprosy and, for Chagas disease, the term "I don't know" (17 times).

Conclusion: Processes of health agents and endemic combat agents action in realities endemic for leprosy and Chagas disease in the interior of Bahia proved to be fragmented in the territories. For these diseases, the distance between surveillance and health care actions is reinforced, including in training processes. The importance of innovative permanent and integrated education actions is reiterated to actually promote changes in practices.

Figure 1. Development of surveillance and health care actions for leprosy in the territory of action of ACS and ACE, in municipalities in southwest Bahia, in 2019–2020.

Figure 2. Development of surveillance and health care actions for Chagas disease in the territory of action of ACS and ACE, in municipalities in southwest Bahia, in 2019–2020.

Figure 3. Answers of ACS and ACE to the question “How to recognize a person suspected of leprosy”, municipalities in the southwest of Bahia, 2019–2020.

Figure 4. Answers of ACS and ACE to the question “How to recognize a person suspected of having Chagas disease”, municipalities in southwest Bahia, 2019–2020.

Figura 1. Desenvolvimento de ações de vigilância e cuidado à saúde para hanseníase no território de atuação de ACS e ACE, em municípios do sudoeste da Bahia, em 2019–2020.

Figura 2. Desenvolvimento de ações de vigilância e cuidado à saúde para doença de Chagas no território de atuação de ACS e ACE, em municípios do sudoeste da Bahia, em 2019–2020.

Figura 3. Resposta direcionada por ACS e ACE à questão “Como reconhecer uma pessoa suspeita de hanseníase”, municípios do sudoeste da Bahia, 2019–2020.

Figura 4. Resposta direcionada por ACS e ACE à questão “Como reconhecer uma pessoa suspeita de doença de Chagas”, municípios do sudoeste da Bahia, 2019–2020.