Eduardo Maia Freese de Carvalho

Discursos e práticas referentes ao processo de participação comunitária nas ações de educação em saúde: as ações de mobilização comunitária do PCDEN/PE

Neste artigo analisam-se alguns conceitos de participacao comunitaria nos processos de educacao em saude, contextualizando-os com as experiencias praticas em relacao as acoes dirigidas para a esquistossomose dentro do Programa de Controle das Doencas Endemicas do Nordeste (Ministerio da Saude do Brasil (MS)/Banco Mundial, 1987). Partindo-se de uma metodologia qualitativa, houve tanto a analise de discursos institucionais (Sucam, FNS e Ministerio da Saude), quanto um trabalho de campo (entrevistas com agentes de saude e populacao) realizado na Zona da Mata de Pernambuco (historicamente endemica) e, principalmente, no Municipio de Amaraji. Comparando-se discursos e praticas educativas, foram encontrados fatores responsaveis pelas respectivas convergencias e divergencias, assim como elementos vinculados ao processo social e historico das populacoes envolvidas que limitam a eficacia das acoes educativas, inclusive de uma maneira mais sistematica.

Organização do espaço urbano e expansão do calazar

OBJECTIVES: the aim of this study was to verify certain processes that are related to the occupation of urban areas and which contribute to the occurrence and expansion of kala-azar in a medium-sized town undergoing economic growth with a high influx of migrants. METHODS: the study is an epidemiological cross-section, in which house-to-house investigation was conducted concerning cases registered in 8 districts and their respective census areas, all in the municipality of Petrolina, Pernambuco state, Brazil, from 1992 to 1997. The study was backed up by laboratory research, taking into consideration both the transmitter and animal reservoir. An explanatory social determination model for the health-illness process of this endemic-epidemic situation was used. RESULTS: a concentration of kala-azar cases was observed in the urban periphery of the town of Petrolina, in areas of squatter settlement and growth, where basic sanitation was precarious, in which animals and the vector were present around the household and the population had a low level of schooling. Males and the 0-4 age group were the most affected. CONCLUSIONS: the findings suggest the establishment of a new epidemiological pattern for kala-azar in Petrolina, where this endemic occurs in areas that have been highly modified by the population. Such a situation characterises the ruralisation process of the urban peripheries endemic in large cities.

Avaliação da Vigilância Epidemiológica em âmbito municipal

ABSTRACT OBJECTIVES: to evaluate epidemiological surveil-lance (ES) and its specifics management at municipal level. METHODS: eleven municipalities were selected in the State of Pernambuco, Brazil, based on the geographical, demographic and management criteria. The level of implementation was estimated by way of interviews with key-players at three levels of ES: the headquarters, family health units (FHUs) and traditional health units (THUs), laying emphasis on features relating to infrastructure and the work process. Points were assigned for the selected variables, which, taken as a whole, allowed for classification of ES as: fully introduced, partially introduced, or not introduced. In order to evaluate management, the eleven municipal health secretaries were interviewed. RESULTS: ES was found to have been fully introduced in only 27% of municipalities and partially introduced in 45%, having a better structure in larger-scale municipalities where there is full management of the municipal system. In these, of the three levels studied, it was found that the central level showed the greatest weaknesses, and that the FHUs performed better than the THUs. So far as management is concerned, although all the municipalities were certified to carry out ES activities, it was found that there are significant obstacles to its effective introduction. CONCLUSIONS: ES still has shortcomings that hamper its full introduction at municipal level.