title: [Treatment of patients with American cutaneous leishmaniasis: health services evaluation in northwestern Paraná State, Brazil].
abstract: The current study focuses on outpatient treatment of patients (n = 229) with American cutaneous leishmaniasis from 2001 to 2004, before and after decentralization of treatment to the municipal level in northwestern Paraná State, Brazil. While the treatment was still centralized, clinical evaluation and medical records were more complete and detailed, treatment was initiated earlier, and follow-up of the outcome was evaluated in 95% of patients and 100% of cases that received two treatment cycles. Treatment also complied with the guidelines of the American Cutaneous Leishmaniasis Control Manual. After decentralization, treatment was less rigorous: 32% of patients were treated with two cycles of N-methyl glucamine antimoniate without complying with the guidelines; 72.6% of patients received inadequate treatment; 84% of cases failed to received proper clinical follow-up. Lack of information on patient clinical records posed a serious obstacle to evaluation. The current study failed to identify any benefit in decentralizing treatment of American cutaneous leishmaniasis to the local level.
authors.affiliation: Universidade Estadual de Maringá, Avenida Colombo 5790, Maringá, PR 87020, Brazil.
authors.forename: Meiri Vanderlei Nogueira
authors.initials: MV
authors.lastname: de Lima
authors.forename: Rosangela Ziggiotti de
authors.initials: RZ
authors.lastname: Oliveira
authors.forename: Airton Pereira
authors.initials: AP
authors.lastname: de Lima
authors.forename: Magda Lúcia Oliveira
authors.initials: ML
authors.lastname: Felix
authors.forename: Thais Gomes Verzignassi
authors.initials: TG
authors.lastname: Silveira
authors.forename: Robson Marcelo
authors.initials: RM
authors.lastname: Rossi
authors.forename: Ueslei
authors.initials: U
authors.lastname: Teodoro
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D001938:Brazil / Q000453:epidemiology; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D019538:Health Care Surveys; D006302:Health Services Research; D006801:Humans; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D017678:Sex Distribution
vernacular_title: Atendimento de pacientes com leishmaniose tegumentar americana: avaliação nos serviços de saúde de municípios do noroeste do Estado do Paraná, Brasil.