A Proposal to Control Schistosomiasis in Caju

1
A Proposal to Control Schistosomiasis in Caju

• January 18, 2008

2
Outline

• Introduction
• Objectives
• Methods
• Results
• Discussion
• Recommendations

3
Caju

• Approximately 570 residents in central Caju and
  surrounding area (2005 data)
• 1 health post with one health worker
• Physician visit every 15 days

4
Caju
Travessa Ma. Gato St.
Manoel Gato St.
Stream
Nova St.
Stream
Cesario Martins St.
Rural Area
School
Joaquim M. Araujo St.
Plaza
PSF
7 de setembro St.
Church
Main Acess
5
Snapshot of Caju 2005

• 23 illiterate
• 43 lack a bathroom
• Occupations
• 22 agriculture
• 13 housewife
• 7 retired
• 32 students
• 13 under school-age

6
Earlier Study of Schisto.

• Methods
• Data from 2003-2005
• Prior to availability of treated water
• Feces exam 1 egg/g of feces ? Prevalence 61,4
  (n235)
• 1o Stool Exam nov/2003
• 1o Treatment nov/2004
• 2o Stool Exam dec/2004
• 2o Treatment feb/2005
• 3o Stool Exam mar/2005
• Analysis of database Epi-Info 6.04 d Program

7
Schisto. Cases in Caju

• Results
• Median age 17 (range 1-91)
• Gender 57 Female
• Median monthly earnings 250 reais
• Median monthly govt. support 75 reais

8
Earlier Study of Schisto.

• Results
• Feces exam 1 egg/g of feces ? n 387

Missing 17.9 No information in database
9
Descriptive Study
Comparison of in-home laundry facility between
cases and non-cases
Prevalence Ratio 0.35 (0.21 0.57) p lt 0.05
10
Descriptive Study
Comparison of in-home water container between
cases and non-cases
Prevalence Ratio 0.42 (0.25 0.68) p 0.0001
containing untreated water
11
Descriptive Study
Comparison of faucet between cases and non-cases
Prevalence Ratio 0.48 (0.30 0.76) p 0.0008
12
Descriptive Study
Comparison of stream use between cases and
non-cases
Prevalence Ratio 2.09 (1.31 3.36) p 0.001
13
Descriptive Study
Comparison of gender between cases and non-cases
Prevalence Ratio 1.82 (1.17 2.83) p 0.0045
14
Descriptive Study
Comparison of age between cases and non-cases
15
Earlier Study of Schisto.

• Results
• Warm burden (eggs/g feces) of Caju Schisto. Cases
• (first exam)

16
Descriptive Study
Comparison of median of eggs/g feces between
gender
17
Earlier Study of Schisto.

• Results
• Percentage of Distribution of Different Sources
  of Water

18
Our Project
19
Objectives

• To identify the sources and purposes of water
  used by residents in central Caju
• To evaluate residents knowledge of
  Schistosomiasis
• To propose potential solutions to control
  Schistosomiasis

20
Methods

• Attempted to interview the eldest member of every
  household (preferably female) in central Caju on
  January 15 16, 2008
• 3 teams of two administered a 10-question survey
  instrument
• Visited main sources of water for Caju residents

21
Results

• Interviewed 79 households (out of 91)
• Median Age of respondents 46 (range 13-95)
• Percentage that use treated water 100
• Percentage willing to pay for treated water
  93.7
• Percentage that own a water container 70
• 12.7 fill container with untreated water

22
Knowledge of Schisto.
23
Water Use
24
Sources of Water in Caju
25
Untreated Water
26
Uses of Stream Water
27
Discussion (1)

• High-risk populations women and children
• Lack of facilities for large loads of laundry
• No safe alternatives for water recreation

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Discussion (2)

• Quality and appearance of water
• Lack of water
• During part of the day
• During the dry season
• Lack of knowledge about Schistosomiasis
• Limited impact of health education

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Proposed Solution 1

• Community laundry facility and sprinkler using
  treated water
• Provide a safe, attractive alternative to
  untreated water

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Proposed Solution 1

• Create a community space for domestic work and
  social activities

31
Proposed Solution 1

• Free for all Caju residents
• Proposed location in plaza near school and health
  center

32
Proposed Solution 1

• Project specifications/requirements
• Routine cleaning and maintenance
• Potential to negotiate with COPASA
• Follow Oficina Municipal de Saneamento, 2006
• Improve domestic and community sanitation

33
Proposed Solution 2

• Develop partnerships with local cities/towns to
  create one shared health education team
• Provide more specific information
• Potential to use teams for education for other
  diseases

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Longer-Term Planning

• Improved water quality control
• Training of technician
• Water testing kits
• Fence off area around dam and clear vegetation

35
Longer-Term Planning

• Better sanitation and sewage treatment
• 43 lack a bathroom (2005 data)
• Itabirinha success story
• Concrete latrine and septic tank for every house

36
Limitations

• Study and recommendations are specific to Caju
• Make sure residents will use a community laundry
  facility and sprinkler
• Could ask a sample of residents if they would use
  such a facility and where they would like the
  facility to be located
• Limitations of self-reported data
• Limited amount of field work

37
Acknowledgements

• UFMG and Fiocruz
• Jequitinhonha Mayors Office
• Residents of Caju
• Caju Public Health Post
• Santa Casa
• Harvard School of Public Health
• Brazil Studies, DRCLAS, Harvard

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Obrigada!
39
Thank you!
40
?????!(Arigatou)
41
Field Work
42
Many Hardships
43
Our Fearless Leader
44
Earlier Study of Schisto.

• Results
• Feces exam 1 egg/g of feces ? n 387

Missing 17.9 No information in database