Escalas e dimensões de um surto de leishmaniose tegumentar americana entre os índios Wajãpi do Amapá
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2019-01-24Autor
http://lattes.cnpq.br/2087312799844363
MORENO, Eduardo Stramandinoli
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This work aims to discuss models for the integration of methods applied to epidemiology for
simultaneous study in several scales and dimensions of health causality. The experience here
taken as reference is an investigation of an outbreak of American Tegumentary Leishmaniasis
(ATL) occurred among Wajãpi indigenous people of Amapá. Between 2012 and 2015 a large
increase in the incidence of ATL cases in the Wajãpi Indigenous Land (WIL) was identified,
much higher than the average expected for the disease in its population and the neighboring
municipalities which WIL is inserted. As part of a multi-institutional project the following
goals were developed: i) to assess limiting factors for epidemiological surveillance of the
ATL in the WIL and to propose alternative measures for its operation; and ii) to identify the
social and ecological risk factors of different scales – from individual, to the social and
ecological niche, the villages, and the relationship between the WIL and other patterns of
environmental use in the region. Between the years of 2013 and 2016, there were 15 visits to
the WIL, as well as workshops and courses with community members and Wajãpi Indigenous
Health Agents, in the context of ATL case investigation, during which active human case
ATL, study of sand fly vectors, wild and domestic animals, and other data collection activities
were held in more than 30 villages. Spatial and climatic analyzes and the construction of
historical series of social, ecological and sanitary impacts, allowed to evaluate the
deforestation rates in and out of the WIL, as well as, to evaluate the influence of large
enterprises such as hydroelectric power plants and industrial mining in the region and its
projection to this outbreak of ATL. The comparison showed that qualitative approaches and
knowledge about the cultural patterns and specificities of the indigenous group increased the
acceptability of the health service. Integrative approaches such as community and
participatory workshops that involved community members as agents of notification and
action within the service have shown important alternatives for improving the sensitivity and
representativeness of the ATL surveillance system in indigenous areas. In total, five species of
Leishmania were identified, along with other three species of trypanosomatids. Villages with
higher population densities, as well as, more deforested areas presented greater abundance of
potential vector species and hosts of Leishmania. The results showed that outbreaks of
malaria and ATL were correlated with increased rates of deforestation caused by the
expansion of rural settlements, but mainly due to the implantation of two hydroelectric plants
and intensification of industrial gold and iron mining activities in the region. The miscellany
of methods, principles and concepts applied at the same time showed an existing complexity
according to different scales and dimensions. It is hoped that the comparative approaches used
in this study could serve as a basis for improvement of health surveillance systems, especially
for vector-borne diseases in indigenous areas.
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