Evaluation of a pamphlet on visceral leishmaniasis as a tool for providing disease information to healthcare professionals and laypersons Avaliação de um folheto sobre leishmaniose visceral como instrumento para fornecer informações a profissionais de saúde e leigos

Although educational materials are frequently produced and used as part of control programs in Brazil, little is known about the efficacy of this type of information. This study evaluated the potential for disseminating information on visceral leishmaniasis using a pamphlet. The sample consisted of 551 healthcare workers and 379 laypeople from a metropolitan area located in southeast Brazil. Both before and after reading the pamphlet, subjects completed a multiple-choice questionnaire. Overall baseline knowledge of the disease was estimated by the proportion of correct answers before reading the pamphlet. Although specific knowledge among zoonosis control workers was higher (90.0% on average), overall baseline knowledge of the disease varied from 45.0% to 77.0%. After reading the pamphlet, the levels increased to 71.0% and 96.0%, respectively. Before reading, the lowest proportion of correct answers in all groups related to the disease symptoms. Analysis of incorrect answers showed that visceral leishmaniasis is mainly confused with leptospirosis. The increased proportion of correct answers after reading the pamphlet is evidence of its potential as an educational tool. Pamphlets; Visceral Leishmaniasis; Questionnaires; Health Personnel Introduction In Brazil, visceral leishmaniasis (VL), caused by Leishmania (Leishmania chagasi), is the most severe of the leishmaniases and can be fatal if untreated. In this country, as elsewhere in Latin America, increasing migration and urbanization have contributed greatly to the rise of VL as a major public health problem 1,2. Although the disease was historically found in rural areas, its epidemiological pattern has changed in the last 20 years. In some previously non-endemic large cities, VL incidence has been increasing 3,4,5. The Greater Metropolitan Area of Belo Horizonte in the State of Minas Gerais in Southeast Brazil has a population of 4,606,318 (http:// www.datasus.gov.br, accessed on 21/Mar/2003). Since the first reported case in 1989, VL cases have increased exponentially. Simultaneously, a geographic expansion of VL within Greater Metropolitan Belo Horizonte has been observed. As of 2002, 51.0% of the municipalities comprising this Greater Metropolitan Area reported autochthonous VL cases. Death from VL in Greater Metropolitan Belo Horizonte is common; the case-fatality rate is approximately 10.0%. The low number of qualified healthcare professionals capable of making an early diagnosis and the resulting lack of prompt treatment contribute to this elevated case-fatality rate 5. EVALUATION OF A PAMPHLET ON VISCERAL LEISHMANIASIS 607 Cad. Saúde Pública, Rio de Janeiro, 21(2):606-621, mar-abr, 2005 The leishmaniasis control program follows a limited and costly protocol focusing on treatment of human cases, intra-domiciliary application of insecticide, and sacrificing seropositive dogs. Awareness-raising strategies concerning the disease are needed at all levels of the community. Dissemination of VL information in an educational campaign using informative/educational materials such as handbooks, booklets, and pamphlets may be a valuable tool as an adjunct to healthcare service protocols and control programs. Nonetheless, in order to serve as effective teaching tools, these materials must be preceded by scientific investigation and produced within well-defined criteria. It is crucial that they provide tangible concepts which are presented with the target population’s cognitive potential in mind 6. Although educational materials are frequently produced and used as part of control programs in Brazil, very little is known about the effectiveness of this kind of information. The low quality of available leishmaniasis information in Brazil (especially in booklets and pamphlets) has been discussed by Luz et al. 7. These authors concluded that the 18 publications analyzed generally failed to provide bibliographies or properly identify the target readers or objectives. Moreover, the lack of appropriate illustrations and the presence of conceptual errors clearly undermined the information’s impact. This study presents an evaluation of knowledge among healthcare workers and laypeople both before and after reading an independently prepared informative pamphlet on VL.