title: The organization of health services and visceral leishmaniasis: an integrated intervention to improve diagnosis and treatment.
abstract: The objective of this study, carried out in municipalities located in a metropolitan region of Brazil, was to promote the early diagnosis and prompt treatment of visceral leishmaniasis. In the intervention model a health professional underwent training that covered all procedures involved in assisting patients with suspected visceral leishmaniasis. The professionals then returned to their municipalities where they implemented a workplan with the following aims: (a) at least one physician able to diagnose and treat patients; (b) training of professionals for the laboratorial diagnosis of visceral leishmaniasis; (c) delivery of information on visceral leishmaniasis to the health workers. The implementation process was evaluated by follow-up meetings. Attendance of health professionals at the meetings, implementation of the workplan, and the visceral leishmaniasis case fatality rate before (1998-1999) and after (2001-2002) implementation of the model were used in the analysis. Among the 36 municipalities in the region, 22 were enrolled. Eight (36.3%) guaranteed at least 50% attendance in the meetings, and 14 (63.6%) had less than 50% attendance with no activities implemented. The fatality rate decreased in the municipalities that implemented the activities.
authors.affiliation: Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil. profeta@cpqrr.fiocruz.br
authors.forename: Zélia M P
authors.initials: ZM
authors.lastname: Luz
authors.forename: Mariângela
authors.initials: M
authors.lastname: Carneiro
authors.forename: Virgínia
authors.initials: V
authors.lastname: Schall
authors.forename: Ana
authors.initials: A
authors.lastname: Rabello
mesh_terms: D001938:Brazil / Q000453:epidemiology; D003191:Comprehensive Health Care / Q000458:organization & administration; D006284:Health Plan Implementation / Q000458:organization & administration* / Q000706:statistics & numerical data; D006298:Health Services Administration; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*