Fernando Mitano - Academia.edu (original) (raw)
Papers by Fernando Mitano
Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis 1 Objective: to ... more Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis 1 Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of tuberculosis. Method: a qualitative study conducted using interviews and a semi-structured guide, administered to five subjects who were among the coordinators and managers of the tuberculosis control programs, and the secretary of health of a municipality in the south of Brazil. Situational Strategic Planning and Discourse Analysis of the French matrix were the theoretical and analytical references used, respectively. Results: three reflexive axes were identified: weaknesses in the process of planning the Directly Observed Treatment transfer, antagonism between planning and daily requirements and formulation of planning and execution. Lack of systematization regarding the planning and execution for transfer the Directly Observed Treatment policy, demonstrates the fragility and incipience of this activity, and the possibility of its non-existence. Conclusion: the urgent need for managers and coordinators to better appropriate the theoretical framework for changing public policies, and the related planning mechanisms, includes a proposal for reorganization and qualification of the diffusion process, both practical-operative and political-organization.
Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis 1 Objective: to ... more Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis 1 Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of tuberculosis. Method: a qualitative study conducted using interviews and a semi-structured guide, administered to five subjects who were among the coordinators and managers of the tuberculosis control programs, and the secretary of health of a municipality in the south of Brazil. Situational Strategic Planning and Discourse Analysis of the French matrix were the theoretical and analytical references used, respectively. Results: three reflexive axes were identified: weaknesses in the process of planning the Directly Observed Treatment transfer, antagonism between planning and daily requirements and formulation of planning and execution. Lack of systematization regarding the planning and execution for transfer the Directly Observed Treatment policy, demonstrates the fragility and incipience of this activity, and the possibility of its non-existence. Conclusion: the urgent need for managers and coordinators to better appropriate the theoretical framework for changing public policies, and the related planning mechanisms, includes a proposal for reorganization and qualification of the diffusion process, both practical-operative and political-organization.
www.ee.usp.br/reeusp Experience of health professionals in care of the homeless population with t... more www.ee.usp.br/reeusp Experience of health professionals in care of the homeless population with tuberculosis *Extracted from the dissertation: "A rua que acolhe, a rua que cura: equipe de consultório na rua como estratégia para atenção à pessoa com tuberculose",
Revista Latino-americana De Enfermagem, 2016
Objective: to discuss the right to health, incorporation into the legal instruments and the deplo... more Objective: to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. Method: this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country.Results: Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. Conclusions: the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage.
Revista Científica da UEM: Série Ciências da Educação, Nov 20, 2020
Compreender as experiencias e percepcoes sobre a gravidez na adolescencia, sobretudo as relaciona... more Compreender as experiencias e percepcoes sobre a gravidez na adolescencia, sobretudo as relacionadas com a decisao de levar a gravidez ao termo, e os problemas socio-economicos e de saude vivenciados pelas adolescentes ao longo da gravidez. Trata-se duma pesquisa que parte das experiencias e percepcoes das adolescentes sobre a gravidez, usando o metodo qualitativo baseado numa abordagem fenomenologica. Participaram 25 maes adolescentes com idades ≤19 anos que tiveram uma gravidez de termo. Estas maes foram recrutadas nas consultas de peso de criancas no Hospital Geral de Chamanculo e que aceitaram participar voluntariamente no estudo, apos o convite. A saturacao teorica foi tida em conta no recrutamento das adolescentes. Os resultados revelaram que as experiencias e as percepcoes sobre a gravidez na adolescencia variam de mae para mae, e que durante a gravidez vivencia-se o medo, incerteza, abandono escolar e ate alegria pela esperanca de que o filho podera trazer-lhe felicidade. Ma...
Zenodo (CERN European Organization for Nuclear Research), Nov 8, 2022
Leprosy Review
Objectives Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The PEP4LEP pr... more Objectives Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The PEP4LEP project will compare two integrated skin-screening interventions combined with the distribution of a single dose of rifampicin as post exposure prophylaxis (SDR-PEP) for contacts of leprosy patients. To implement the study in Mozambique, it was necessary to assess recent epidemiological indicators of leprosy and to estimate case detection delay as a main outcome indicator at baseline. Methods This was a descriptive study to establish the trend of epidemiological indicators of leprosy in the Nampula province districts Murrupula, Meconta and Mogovolas in Mozambique, between 2015 and 2019; and to calculate the average delay to diagnose leprosy cases in these districts. The National Leprosy Control Programme was also described. For the estimation of the case detection delay, 81 recently diagnosed patients were interviewed. Results There were 939 new leprosy cases detected in the three districts from 2015 to 2019, with a high proportion of disability (17.0%). The mean diagnosis delay was 26.6 months (95% CI: 18.4-34.7), while the median was 17.0 months. Multibacillary cases had an average delay of 27.9 months (95% CI: 18.6-37.1), while those with grade 2 disability had an average delay of 47.8 months (95% CI: 15.4-80.2). Conclusion The long case detection delay and high grade 2 disability rates indicate that there is a need for active case finding and chemoprophylaxis with SDR-PEP
Revista Latino-americana De Enfermagem, 2016
Objective: to discuss the right to health, incorporation into the legal instruments and the deplo... more Objective: to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. Method: this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country.Results: Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. Conclusions: the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage.
Revista da Escola de Enfermagem da USP, 2016
OBJECTIVE Analyzing statements of health professionals from a Street Clinic regarding care of a h... more OBJECTIVE Analyzing statements of health professionals from a Street Clinic regarding care of a homeless population with tuberculosis. METHOD This is a qualitative research, conducted in the central region of São Paulo at three basic health units in the period of November to December 2014. A semi-structured interview guideline was implemented for data collection and all interviews were recorded using a digital recorder. RESULTS Six health professionals were interviewed. According to the Discourse Analysis perspective, three discursive segments emerged: experiences on care in the streets; weaknesses inherent to the treatment process; and incentives as a means of maintaining sick people in treatment. CONCLUSION Caring for a the homeless population with tuberculosis constitutes a new and challenging experience. It involves difficulties in dealing with the reality of a miserable social context, a lack and inadequacy of services, as well as care limitations for treatment and treatment dr...
Objective: To analyze the effects of meaning on the political commitment of the Mozambican Govern... more Objective: To analyze the effects of meaning on the political commitment of the Mozambican Government in the transfer of the policy for the control of tuberculosis from the perspective of health professionals. Method: This is a qualitative study that uses the theoretical methodological framework of Discourse Analysis. Fifteen health professional subjects with more than one year of experience in the tuberculosis control program were interviewed. This study is approved by the National Bioethics for Health Committee and authorized by the Minister of Health of Mozambique. Results: Three discursive blocks emerged: 1) the political commitment of the Government of Mozambique to adhere to the tuberculosis control policy; 2) evidence of lack of commitment in the transfer of policy for tuberculosis control; and 3) the subjects’ imaginary and the challenges in relation to political commitment and the implementation of the policy for tuberculosis control. Conclusion: Political commitment to pol...
Procurou-se compreender o modo como a populacao do Distrito do Lago (Provincia de Niassa, Mocambi... more Procurou-se compreender o modo como a populacao do Distrito do Lago (Provincia de Niassa, Mocambique) percebe, previne e trata a malaria. Trata-se de um estudo de cunho qualitativo, centrado na abordagem de modelos explicativos da doenca, que contou com a participacao de membros de agregados familiares, profissionais de saude e medicos tradicionais. A coleta de dados aconteceu por meio de entrevistas, orientadas por um roteiro semiestruturado, realizadas nos meses de Setembro e Novembro de 2019 em 8 povoados do Distrito do Lago. Os resultados revelaram um entendimento de que a malaria e uma doenca causada pela picada de mosquito, perigosa e que mata quando nao evitada (pelo uso da rede mosquiteira e a limpeza do patio) e tratada atraves do Coartem® (artemeter + lumefantrina). Nao obstante, a adesao as medidas convencionais prevencao e tratamento e determinada por factores socioeconomicos e estruturais, o que faz com que a populacao recorra a outras alternativas de prevencao e de tra...
Revista panamericana de salud publica = Pan American journal of public health, 2015
OBJECTIVE To design and semantically validate an instrument to evaluate the transfer of directly ... more OBJECTIVE To design and semantically validate an instrument to evaluate the transfer of directly observed therapy (DOT) as a policy for tuberculosis control taking into consideration the experience of mid- and higher level health care workers. METHODS This methodological investigation was developed in two stages: literature review to design the first draft of the instrument; and semantic validation of the first draft using questionnaires adapted from the DISABKIDS® project. The information obtained was analyzed using quantitative (descriptive statistics) or qualitative (content theme analysis) methods. RESULTS Twenty-four mid- and higher level health care workers engaged in tuberculosis control participated in the study. The instrument was considered important for the work of study participants. The answers provided by participants led to changes in both the structure and content of the instrument. The process resulted in a final, semantically validated questionnaire. CONCLUSIONS Se...
BMJ Open
IntroductionLeprosy, or Hansen’s disease, remains a cause of preventable disability. Early detect... more IntroductionLeprosy, or Hansen’s disease, remains a cause of preventable disability. Early detection, treatment and prevention are key to reducing transmission. Post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) reduces the risk of developing leprosy when administered to screened contacts of patients. This has been adopted in the WHO leprosy guidelines. The PEP4LEP study aims to determine the most effective and feasible method of screening people at risk of developing leprosy and administering chemoprophylaxis to contribute to interrupting transmission.Methods and analysisPEP4LEP is a cluster-randomised implementation trial comparing two interventions of integrated skin screening combined with SDR-PEP distribution to contacts of patients with leprosy in Ethiopia, Mozambique and Tanzania. One intervention is community-based, using skin camps to screen approximately 100 community contacts per leprosy patient, and to administer SDR-PEP when eligible. The other intervention...
Revista Brasileira de Enfermagem
Objective: to investigate the possibilities of positive and negative association of improvisation... more Objective: to investigate the possibilities of positive and negative association of improvisation and the understanding of what will be the planning by managers and coordinators of tuberculosis control programs, in a context of transference of the Directly Observed Treatment policy. Method: this is a qualitative study, developed through semi-structured interviews analyzed in the light of French Discourse Analysis. Results: there was a weakening of the constructive and operational planning process, which is at the mercy of political will and the need of putting out fires. This, in turn, along with achômetro (Brazilian popular expression used on unsubstantiated point of view or opinion that is based solely and exclusively on the intuition of the person who says it), composed the metaphor of improvisation in its negative perspective, understood by automatism and unsystematization process. Improvisation, however, emerged as a representation of innovation, creativity, and contextual chan...
Revista Latino-Americana de Enfermagem
Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of... more Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of tuberculosis. Method: a qualitative study conducted using interviews and a semi-structured guide, administered to five subjects who were among the coordinators and managers of the tuberculosis control programs, and the secretary of health of a municipality in the south of Brazil. Situational Strategic Planning and Discourse Analysis of the French matrix were the theoretical and analytical references used, respectively. Results: three reflexive axes were identified: weaknesses in the process of planning the Directly Observed Treatment transfer, antagonism between planning and daily requirements and formulation of planning and execution. Lack of systematization regarding the planning and execution for transfer the Directly Observed Treatment policy, demonstrates the fragility and incipience of this activity, and the possibility of its non-existence. Conclusion: the urgent need for manager...
Revista Brasileira de Enfermagem
Objective: To analyze whether user-centered nursing practices in TB DOT are being carried out and... more Objective: To analyze whether user-centered nursing practices in TB DOT are being carried out and are contributing to democracy. Method: A cross-sectional, exploratory, descriptive study with 123 nurses in three capital cities with high incidence of TB (Manaus-AM, João Pessoa-PB, Porto Alegre-RS) in Brazil. Data were collected from January to June 2014. Descriptive and multiple correspondence analyzes were used. Results: It was identified that the most user-centered care actions had scores below 50%, considered unfavorable to the exercise of democracy. In the analysis of the general user-centered practice score per municipality, Manaus and João Pessoa presented unfavorable results, and the municipality of Porto Alegre was partially favorable. Conclusion: The three municipalities need to advance in the implementation of user-centered practices in DOT, because their health system still has difficulties and challenges to overcome.
Revista Panamericana de Salud Pública
Objetivo. Identificar estratégias de controle da tuberculose multidrogarresistente (TBMDR) e de a... more Objetivo. Identificar estratégias de controle da tuberculose multidrogarresistente (TBMDR) e de atenção aos pacientes acometidos. Métodos. Foi realizada uma revisão integrativa da literatura mediante pesquisa em três bases de dados da área da saúde (LILACS PubMed e CINAHL) e uma multidisciplinar (Scopus). Foram selecionados artigos originais que apresentassem estratégias utilizadas para operacionalização da atenção ao doente de TBMDR, publicados em inglês, espanhol ou português de 2006 a 2016. As informações coletadas foram organizadas segundo as estratégias para operacionalização da TBDMR identificadas pelos pesquisadores, que foram agrupadas em categorias temáticas. Resultados. Com base em uma amostra de 13 artigos, foram identificadas quatro categorias: a) DOTS-plus: reorganização dos serviços de saúde, aprimoramento das estruturas locais, padronização de fluxos e condutas profissionais, oferta de tratamento diretamente observado; b) descentralização do serviço: aproximação entre...
Revista brasileira de enfermagem, 2018
To analyze the discourses of health professionals about the obstacles in the process of detection... more To analyze the discourses of health professionals about the obstacles in the process of detection and reporting of tuberculosis cases in Mozambique. Qualitative exploratory study with a theoretical-methodological approach of Discourse Analysis of French matrix. The study was conducted in Mozambique in 2014 at three levels: central, provincial and district. The study included 15 health professionals, 4 physicians, 6 technicians and 5 nursing professionals, who worked in the National Tuberculosis Control Program, with more than 1 year of experience. The following discursive blocks emerged: Detection of tuberculosis cases in laboratories; Underreporting of tuberculosis cases; Obstacles to detect cases of tuberculosis: long distances and lack of transport; and Reporting of cases for decision making. The discourses analyzed point to the ideological affiliation that includes the lack of investment policies in the health sector and the political commitment as basic obstacles in the detecti...
MITANO, F. Speeches and production of meanings: experience in policy transfer of directly observe... more MITANO, F. Speeches and production of meanings: experience in policy transfer of directly observed treatment short-course to control tuberculosis in Mozambique-Africa. 2016, 296p. Thesis (Doctorate)-School of Nursing at Ribeirão Preto-University of São Paulo. The Directly Observed Treatment Short-Course (DOTS) strategy has been used in many countries, mainly in the 22 most affected by tuberculosis, which contributes about 80% of cases. However, despites the strategy shows the decline of cases and the increase of adherence to treatment, and it has been implemented in Mozambique since 1980's decade, the disease remains as a serious public health problem. This study aimed to: analyzing the policy transfer of DOTS strategy from the point of view of central, provincial and district managers, and health professionals from the province of Nampula. It is a qualitative study, which uses the Discourse Analysis of french matrix as theoretical and methodological framework, which seeks to understand the meanings from the production conditions. Fifteen health professionals that occupied managers, physician, nurses and/or technicians positions during, at least, one year of experience in the National Program of Tuberculosis Control in Mozambique, between may to august, 2014, in the central, provincial (Nampula) and district (in 8 districts at the province of Nampula), participated. For data collection, it was used a semi-structures interview's script, that allowed to explore the produced meanings. The corpus under analysis was produced from transcript inteviews. To support the data organization, it was used the software Atlas.Ti, version 6. This study had the approval of the National Committee of Bioethics and the authorization of the Ministry of Health of Mozambique. In the analysis, it was identified four discursive blocks: adopted experiences in implementation and maintenance of DOTS; strengths, weaknesses of DOTS in tuberculosis control and; unfetched speech by the script: possible solutions. The produced meanings emphasizes sayings written in discursive formations that disregard the subjectivity of ill; the weaknesses of health system, the lack of human resources and transportation, low wages, the insufficient number of laboratories, long distances between the patient housing and the health unity. Respondents still understood as strengths the involvement of community workers and family on treatment. It is concluded that for tuberculosis control using DOTS strategy, government commitment is pragmatic, translating up in concrete actions with the increase of financing for tuberculosis control, including research, training of human resources and, above all, act on the social determinants of health.
Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis 1 Objective: to ... more Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis 1 Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of tuberculosis. Method: a qualitative study conducted using interviews and a semi-structured guide, administered to five subjects who were among the coordinators and managers of the tuberculosis control programs, and the secretary of health of a municipality in the south of Brazil. Situational Strategic Planning and Discourse Analysis of the French matrix were the theoretical and analytical references used, respectively. Results: three reflexive axes were identified: weaknesses in the process of planning the Directly Observed Treatment transfer, antagonism between planning and daily requirements and formulation of planning and execution. Lack of systematization regarding the planning and execution for transfer the Directly Observed Treatment policy, demonstrates the fragility and incipience of this activity, and the possibility of its non-existence. Conclusion: the urgent need for managers and coordinators to better appropriate the theoretical framework for changing public policies, and the related planning mechanisms, includes a proposal for reorganization and qualification of the diffusion process, both practical-operative and political-organization.
Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis 1 Objective: to ... more Planning pathways in the transfer of Directly Observed Treatment of Tuberculosis 1 Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of tuberculosis. Method: a qualitative study conducted using interviews and a semi-structured guide, administered to five subjects who were among the coordinators and managers of the tuberculosis control programs, and the secretary of health of a municipality in the south of Brazil. Situational Strategic Planning and Discourse Analysis of the French matrix were the theoretical and analytical references used, respectively. Results: three reflexive axes were identified: weaknesses in the process of planning the Directly Observed Treatment transfer, antagonism between planning and daily requirements and formulation of planning and execution. Lack of systematization regarding the planning and execution for transfer the Directly Observed Treatment policy, demonstrates the fragility and incipience of this activity, and the possibility of its non-existence. Conclusion: the urgent need for managers and coordinators to better appropriate the theoretical framework for changing public policies, and the related planning mechanisms, includes a proposal for reorganization and qualification of the diffusion process, both practical-operative and political-organization.
www.ee.usp.br/reeusp Experience of health professionals in care of the homeless population with t... more www.ee.usp.br/reeusp Experience of health professionals in care of the homeless population with tuberculosis *Extracted from the dissertation: "A rua que acolhe, a rua que cura: equipe de consultório na rua como estratégia para atenção à pessoa com tuberculose",
Revista Latino-americana De Enfermagem, 2016
Objective: to discuss the right to health, incorporation into the legal instruments and the deplo... more Objective: to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. Method: this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country.Results: Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. Conclusions: the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage.
Revista Científica da UEM: Série Ciências da Educação, Nov 20, 2020
Compreender as experiencias e percepcoes sobre a gravidez na adolescencia, sobretudo as relaciona... more Compreender as experiencias e percepcoes sobre a gravidez na adolescencia, sobretudo as relacionadas com a decisao de levar a gravidez ao termo, e os problemas socio-economicos e de saude vivenciados pelas adolescentes ao longo da gravidez. Trata-se duma pesquisa que parte das experiencias e percepcoes das adolescentes sobre a gravidez, usando o metodo qualitativo baseado numa abordagem fenomenologica. Participaram 25 maes adolescentes com idades ≤19 anos que tiveram uma gravidez de termo. Estas maes foram recrutadas nas consultas de peso de criancas no Hospital Geral de Chamanculo e que aceitaram participar voluntariamente no estudo, apos o convite. A saturacao teorica foi tida em conta no recrutamento das adolescentes. Os resultados revelaram que as experiencias e as percepcoes sobre a gravidez na adolescencia variam de mae para mae, e que durante a gravidez vivencia-se o medo, incerteza, abandono escolar e ate alegria pela esperanca de que o filho podera trazer-lhe felicidade. Ma...
Zenodo (CERN European Organization for Nuclear Research), Nov 8, 2022
Leprosy Review
Objectives Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The PEP4LEP pr... more Objectives Leprosy is a chronic infectious disease caused by Mycobacterium leprae. The PEP4LEP project will compare two integrated skin-screening interventions combined with the distribution of a single dose of rifampicin as post exposure prophylaxis (SDR-PEP) for contacts of leprosy patients. To implement the study in Mozambique, it was necessary to assess recent epidemiological indicators of leprosy and to estimate case detection delay as a main outcome indicator at baseline. Methods This was a descriptive study to establish the trend of epidemiological indicators of leprosy in the Nampula province districts Murrupula, Meconta and Mogovolas in Mozambique, between 2015 and 2019; and to calculate the average delay to diagnose leprosy cases in these districts. The National Leprosy Control Programme was also described. For the estimation of the case detection delay, 81 recently diagnosed patients were interviewed. Results There were 939 new leprosy cases detected in the three districts from 2015 to 2019, with a high proportion of disability (17.0%). The mean diagnosis delay was 26.6 months (95% CI: 18.4-34.7), while the median was 17.0 months. Multibacillary cases had an average delay of 27.9 months (95% CI: 18.6-37.1), while those with grade 2 disability had an average delay of 47.8 months (95% CI: 15.4-80.2). Conclusion The long case detection delay and high grade 2 disability rates indicate that there is a need for active case finding and chemoprophylaxis with SDR-PEP
Revista Latino-americana De Enfermagem, 2016
Objective: to discuss the right to health, incorporation into the legal instruments and the deplo... more Objective: to discuss the right to health, incorporation into the legal instruments and the deployment in practice in the National Health System in Mozambique. Method: this is a documentary analysis of a qualitative nature, which after thorough and interpretative reading of the legal instruments and articles that deal with the right to health, access and universal coverage, resulted in the construction of three empirical categories: instruments of humans rights and their interrelationship with the development of the right to health; the national health system in Mozambique; gaps between theory and practice in the consolidation of the right to health in the country.Results: Mozambique ratified several international and regional legal instruments (of Africa) that deal with the right to health and which are ensured in its Constitution. However, their incorporation into the National Health Service have been limited because it can not provide access and universal coverage to health services in an equitable manner throughout its territorial extension and in the different levels of care. Conclusions: the implementation of the right to health is complex and will require mobilization of the state and political financial, educational, technological, housing, sanitation and management actions, as well as ensuring access to health, and universal coverage.
Revista da Escola de Enfermagem da USP, 2016
OBJECTIVE Analyzing statements of health professionals from a Street Clinic regarding care of a h... more OBJECTIVE Analyzing statements of health professionals from a Street Clinic regarding care of a homeless population with tuberculosis. METHOD This is a qualitative research, conducted in the central region of São Paulo at three basic health units in the period of November to December 2014. A semi-structured interview guideline was implemented for data collection and all interviews were recorded using a digital recorder. RESULTS Six health professionals were interviewed. According to the Discourse Analysis perspective, three discursive segments emerged: experiences on care in the streets; weaknesses inherent to the treatment process; and incentives as a means of maintaining sick people in treatment. CONCLUSION Caring for a the homeless population with tuberculosis constitutes a new and challenging experience. It involves difficulties in dealing with the reality of a miserable social context, a lack and inadequacy of services, as well as care limitations for treatment and treatment dr...
Objective: To analyze the effects of meaning on the political commitment of the Mozambican Govern... more Objective: To analyze the effects of meaning on the political commitment of the Mozambican Government in the transfer of the policy for the control of tuberculosis from the perspective of health professionals. Method: This is a qualitative study that uses the theoretical methodological framework of Discourse Analysis. Fifteen health professional subjects with more than one year of experience in the tuberculosis control program were interviewed. This study is approved by the National Bioethics for Health Committee and authorized by the Minister of Health of Mozambique. Results: Three discursive blocks emerged: 1) the political commitment of the Government of Mozambique to adhere to the tuberculosis control policy; 2) evidence of lack of commitment in the transfer of policy for tuberculosis control; and 3) the subjects’ imaginary and the challenges in relation to political commitment and the implementation of the policy for tuberculosis control. Conclusion: Political commitment to pol...
Procurou-se compreender o modo como a populacao do Distrito do Lago (Provincia de Niassa, Mocambi... more Procurou-se compreender o modo como a populacao do Distrito do Lago (Provincia de Niassa, Mocambique) percebe, previne e trata a malaria. Trata-se de um estudo de cunho qualitativo, centrado na abordagem de modelos explicativos da doenca, que contou com a participacao de membros de agregados familiares, profissionais de saude e medicos tradicionais. A coleta de dados aconteceu por meio de entrevistas, orientadas por um roteiro semiestruturado, realizadas nos meses de Setembro e Novembro de 2019 em 8 povoados do Distrito do Lago. Os resultados revelaram um entendimento de que a malaria e uma doenca causada pela picada de mosquito, perigosa e que mata quando nao evitada (pelo uso da rede mosquiteira e a limpeza do patio) e tratada atraves do Coartem® (artemeter + lumefantrina). Nao obstante, a adesao as medidas convencionais prevencao e tratamento e determinada por factores socioeconomicos e estruturais, o que faz com que a populacao recorra a outras alternativas de prevencao e de tra...
Revista panamericana de salud publica = Pan American journal of public health, 2015
OBJECTIVE To design and semantically validate an instrument to evaluate the transfer of directly ... more OBJECTIVE To design and semantically validate an instrument to evaluate the transfer of directly observed therapy (DOT) as a policy for tuberculosis control taking into consideration the experience of mid- and higher level health care workers. METHODS This methodological investigation was developed in two stages: literature review to design the first draft of the instrument; and semantic validation of the first draft using questionnaires adapted from the DISABKIDS® project. The information obtained was analyzed using quantitative (descriptive statistics) or qualitative (content theme analysis) methods. RESULTS Twenty-four mid- and higher level health care workers engaged in tuberculosis control participated in the study. The instrument was considered important for the work of study participants. The answers provided by participants led to changes in both the structure and content of the instrument. The process resulted in a final, semantically validated questionnaire. CONCLUSIONS Se...
BMJ Open
IntroductionLeprosy, or Hansen’s disease, remains a cause of preventable disability. Early detect... more IntroductionLeprosy, or Hansen’s disease, remains a cause of preventable disability. Early detection, treatment and prevention are key to reducing transmission. Post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) reduces the risk of developing leprosy when administered to screened contacts of patients. This has been adopted in the WHO leprosy guidelines. The PEP4LEP study aims to determine the most effective and feasible method of screening people at risk of developing leprosy and administering chemoprophylaxis to contribute to interrupting transmission.Methods and analysisPEP4LEP is a cluster-randomised implementation trial comparing two interventions of integrated skin screening combined with SDR-PEP distribution to contacts of patients with leprosy in Ethiopia, Mozambique and Tanzania. One intervention is community-based, using skin camps to screen approximately 100 community contacts per leprosy patient, and to administer SDR-PEP when eligible. The other intervention...
Revista Brasileira de Enfermagem
Objective: to investigate the possibilities of positive and negative association of improvisation... more Objective: to investigate the possibilities of positive and negative association of improvisation and the understanding of what will be the planning by managers and coordinators of tuberculosis control programs, in a context of transference of the Directly Observed Treatment policy. Method: this is a qualitative study, developed through semi-structured interviews analyzed in the light of French Discourse Analysis. Results: there was a weakening of the constructive and operational planning process, which is at the mercy of political will and the need of putting out fires. This, in turn, along with achômetro (Brazilian popular expression used on unsubstantiated point of view or opinion that is based solely and exclusively on the intuition of the person who says it), composed the metaphor of improvisation in its negative perspective, understood by automatism and unsystematization process. Improvisation, however, emerged as a representation of innovation, creativity, and contextual chan...
Revista Latino-Americana de Enfermagem
Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of... more Objective: to investigate the planning pathways in the transfer of Directly Observed Treatment of tuberculosis. Method: a qualitative study conducted using interviews and a semi-structured guide, administered to five subjects who were among the coordinators and managers of the tuberculosis control programs, and the secretary of health of a municipality in the south of Brazil. Situational Strategic Planning and Discourse Analysis of the French matrix were the theoretical and analytical references used, respectively. Results: three reflexive axes were identified: weaknesses in the process of planning the Directly Observed Treatment transfer, antagonism between planning and daily requirements and formulation of planning and execution. Lack of systematization regarding the planning and execution for transfer the Directly Observed Treatment policy, demonstrates the fragility and incipience of this activity, and the possibility of its non-existence. Conclusion: the urgent need for manager...
Revista Brasileira de Enfermagem
Objective: To analyze whether user-centered nursing practices in TB DOT are being carried out and... more Objective: To analyze whether user-centered nursing practices in TB DOT are being carried out and are contributing to democracy. Method: A cross-sectional, exploratory, descriptive study with 123 nurses in three capital cities with high incidence of TB (Manaus-AM, João Pessoa-PB, Porto Alegre-RS) in Brazil. Data were collected from January to June 2014. Descriptive and multiple correspondence analyzes were used. Results: It was identified that the most user-centered care actions had scores below 50%, considered unfavorable to the exercise of democracy. In the analysis of the general user-centered practice score per municipality, Manaus and João Pessoa presented unfavorable results, and the municipality of Porto Alegre was partially favorable. Conclusion: The three municipalities need to advance in the implementation of user-centered practices in DOT, because their health system still has difficulties and challenges to overcome.
Revista Panamericana de Salud Pública
Objetivo. Identificar estratégias de controle da tuberculose multidrogarresistente (TBMDR) e de a... more Objetivo. Identificar estratégias de controle da tuberculose multidrogarresistente (TBMDR) e de atenção aos pacientes acometidos. Métodos. Foi realizada uma revisão integrativa da literatura mediante pesquisa em três bases de dados da área da saúde (LILACS PubMed e CINAHL) e uma multidisciplinar (Scopus). Foram selecionados artigos originais que apresentassem estratégias utilizadas para operacionalização da atenção ao doente de TBMDR, publicados em inglês, espanhol ou português de 2006 a 2016. As informações coletadas foram organizadas segundo as estratégias para operacionalização da TBDMR identificadas pelos pesquisadores, que foram agrupadas em categorias temáticas. Resultados. Com base em uma amostra de 13 artigos, foram identificadas quatro categorias: a) DOTS-plus: reorganização dos serviços de saúde, aprimoramento das estruturas locais, padronização de fluxos e condutas profissionais, oferta de tratamento diretamente observado; b) descentralização do serviço: aproximação entre...
Revista brasileira de enfermagem, 2018
To analyze the discourses of health professionals about the obstacles in the process of detection... more To analyze the discourses of health professionals about the obstacles in the process of detection and reporting of tuberculosis cases in Mozambique. Qualitative exploratory study with a theoretical-methodological approach of Discourse Analysis of French matrix. The study was conducted in Mozambique in 2014 at three levels: central, provincial and district. The study included 15 health professionals, 4 physicians, 6 technicians and 5 nursing professionals, who worked in the National Tuberculosis Control Program, with more than 1 year of experience. The following discursive blocks emerged: Detection of tuberculosis cases in laboratories; Underreporting of tuberculosis cases; Obstacles to detect cases of tuberculosis: long distances and lack of transport; and Reporting of cases for decision making. The discourses analyzed point to the ideological affiliation that includes the lack of investment policies in the health sector and the political commitment as basic obstacles in the detecti...
MITANO, F. Speeches and production of meanings: experience in policy transfer of directly observe... more MITANO, F. Speeches and production of meanings: experience in policy transfer of directly observed treatment short-course to control tuberculosis in Mozambique-Africa. 2016, 296p. Thesis (Doctorate)-School of Nursing at Ribeirão Preto-University of São Paulo. The Directly Observed Treatment Short-Course (DOTS) strategy has been used in many countries, mainly in the 22 most affected by tuberculosis, which contributes about 80% of cases. However, despites the strategy shows the decline of cases and the increase of adherence to treatment, and it has been implemented in Mozambique since 1980's decade, the disease remains as a serious public health problem. This study aimed to: analyzing the policy transfer of DOTS strategy from the point of view of central, provincial and district managers, and health professionals from the province of Nampula. It is a qualitative study, which uses the Discourse Analysis of french matrix as theoretical and methodological framework, which seeks to understand the meanings from the production conditions. Fifteen health professionals that occupied managers, physician, nurses and/or technicians positions during, at least, one year of experience in the National Program of Tuberculosis Control in Mozambique, between may to august, 2014, in the central, provincial (Nampula) and district (in 8 districts at the province of Nampula), participated. For data collection, it was used a semi-structures interview's script, that allowed to explore the produced meanings. The corpus under analysis was produced from transcript inteviews. To support the data organization, it was used the software Atlas.Ti, version 6. This study had the approval of the National Committee of Bioethics and the authorization of the Ministry of Health of Mozambique. In the analysis, it was identified four discursive blocks: adopted experiences in implementation and maintenance of DOTS; strengths, weaknesses of DOTS in tuberculosis control and; unfetched speech by the script: possible solutions. The produced meanings emphasizes sayings written in discursive formations that disregard the subjectivity of ill; the weaknesses of health system, the lack of human resources and transportation, low wages, the insufficient number of laboratories, long distances between the patient housing and the health unity. Respondents still understood as strengths the involvement of community workers and family on treatment. It is concluded that for tuberculosis control using DOTS strategy, government commitment is pragmatic, translating up in concrete actions with the increase of financing for tuberculosis control, including research, training of human resources and, above all, act on the social determinants of health.