The control of schistosomiasis in Brazil: an ethno-epidemiological study of the effectiveness of a community mobilization program for health education

This study combined anthropological and epidemiological approaches to asses s the effectiveness of community mobilization for health education, develop ed as part of the Brazilian program for the control of schistosomiasis. The study was carried out in two villages in the state of Minas Gerais, SE Bra zil, exposed to the same established schistosomiaisis control strategies. R esidents of one village were also exposed to the community mobilization for health education (study area) while those from the other community were no t exposed to this program (control area). Schistosoma mansoni prevalence ra tes for the study and control villages were compared over time. A populatio n-based survey was carried out in the two villages to obtain information on socio-demographic factors, water contact patterns and knowledge of S, mans oni transmission. Intensive ethnographic interviews with key informants in each locality were employed to determine the knowledge, attitudes and pract ices of the communities regarding schistosomiasis. Ethnographic data were a nalysed using the model of systems of signs, meanings and actions. Differen ces were observed in prevalence trends between the study and control areas but they could not be explained by the existence of the community mobilizat ion program in the former. It was also found that educational actions carri ed out by the Brazilian Ministry of Health transmitted information on schis tosomiasis but were ineffective in transforming the information received in to preventive behaviour related to water contact. With regard to disease, t he population studied tended to distinguish minor symptoms, which they asso ciated with water contact, from major symptoms, which they attributed to la ck of medical treatment. This distinction mediated perceptions of the sever ity of "xistose" and reduced the importance of avoiding contact with potent ially infested waters. The perception of protection conferred by treatment observed in the present study might also apply to other communities where a ccess to treatment is readily available and free. The extent to which this perception exists in endemic areas needs to be determined so that apparent contradictions of this type can be addressed in future educational programs . (C) 2000 Elsevier Science Ltd. All rights reserved.