Danilo Vargas

Equinococosis/hidatidosis en la VII Región de Chile: diagnóstico e intervención educativa

This study was designed to embrace three areas: a) serologic and radiologic diagnosis and surgical treatment of hydatidosis in an asymptomatic human population, b) animal diagnosis and the treatment of dogs, and c) evaluation of extent of knowledge and performance of educational interventions among rural families and health, livestock, and education professionals and technicians, in order to help control the disease transmission cycle. Indirect hemagglutination and ELISA tests were performed on 5,556 apparently healthy people. Of these, 42 (0.8%) had positive results on both tests, for a seroprevalence of 754.6 per 100,000. These 42 subjects were scheduled for liver ultrasonography and a chest x-ray; of the 26 who complied, 16 showed images compatible with a hydatid cyst. Those 16 cases were sent to the hospital for surgery. In 9 of the cases the diagnosis was confirmed surgically, for a prevalence of 161.7 per 100,000. Arecoline hydrobromide was administered as a laxative to 2,358 dogs to detect the strobilar form of Echinococcus granulosus, and positive results were found in 11% of the dogs. Official data for slaughterhouses indicated the presence of hydatid cysts in 13% of the cattle, 4.4% of the sleep, and 4.2% of the pigs slaughtered in the region. The educational program included an evaluation of the extent of knowledge by surveying heads of household; an educational intervention among families through an informal active participatory process using educational games, in which 1,082 families participated; and an educational intervention with professionals and technicians using distance and in-person approaches. To evaluate the program, the results of knowledge tests before and after educational interventions with 200 families (cases) were compared with those from 95 families who did not participate (controls). Of the 1,423 heads of household initially surveyed about their knowledge of echinococcosis/hydatidosis, 783 of them (55%) said they knew nothing about the infection. It was found that the participatory educational games were well adapted to the lifestyle of people from rural areas and made change possible. Training was provided to 276 health professionals, 201 technical assistants, and 453 rural teachers. The program reached 100% of the staff members of the areas rural primary health care services.El presente estudio se proyecto para un trabajo simultaneo en tres ambitos: a) diagnostico serologico y radiologico y tratamiento quirurgico de la hidatidosis en la poblacion humana asintomatica; b) diagnostico animal y tratamiento de los perros, y c) evaluacion de conocimientos e intervencion educativa en familias campesinas y en profesionales y tecnicos en salud, agropecuaria y educacion, con el fin de contribuir al control del ciclo de transmision de la enfermedad. Se efectuaron pruebas de hemaglutinacion indirecta y ELISA a 5 566 personas aparentemente sanas. Los 42 (0,8%) casos con resultados positivos en ambas pruebas (seroprevalencia de 754,6 por 100 000) fueron citados para ser sometidos a una ecografia hepatica y una radiografia de torax y, de los 26 que acudieron, 16 presentaron imagenes compatibles con quiste hidatidico. Estos 16 casos fueron enviados al hospital para ser intervenidos y en los 9 que acudieron se confirmo el diagnostico quirurgicamente, lo cual representa una prevalencia de 161,7 por 100 000. En 2 358 perros se procedio a la deteccion de la forma estrobilar de Echinococcus granulosus mediante purga con bromhidrato de arecolina y se obtuvieron resultados positivos en 11%. Los datos oficiales registrados en los mataderos revelaron la presencia de quistes hidatidicos en 13% de los bovinos, 4,4% de los ovinos y 4,2% de los porcinos sacrificados en la region. El programa educativo comprendio una evaluacion de conocimientos mediante una encuesta al cabeza de familia, la intervencion educativa entre las familias por un proceso participatorio activo no formal de caracter ludico en el que participaron 1 082 familias, y la intervencion educativa entre profesionales y tecnicos mediante metodologia a distancia y presencial. Para evaluar los resultados del programa se compararon los resultados de las pruebas de conocimientos antes y despues de la intervencion educativa en 200 familias que participaron en ella (casos) y en 95 que no participaron (controles). Del analisis de los conocimientos sobre equinococosis/hidatidosis, 783 familias (55%) demostraron no saber nada sobre la infeccion. Se observo que las tecnicas participatorias ludicas se adaptan a la forma de ser del campesino y permiten obtener cambios. Se capacitaron 276 profesionales de la salud, 201 auxiliares tecnicos y 453 profesores rurales. Entre los equipos de atencion primaria rural, el programa tuvo una cobertura de 100%.