86 / 105
86
História
sociated morbidity and mortality levels vary according to
region and the availability of modern biomedical technolo-
gies. Many fungal infections are endemic in tropical and
subtropical regions such as Mozambique.The evolution of
exact morbidity and mortality rates of mycoses in Mozam-
bique over time are not well known. Currently, serious
fungal infections are estimated to affect approximately 1.8
million people (about 7.6% of population), particularly
due to complications of HIV infection.The author provid-
ed an overview of longitudinal trajectories of clinical and
diagnostic capabilities in Mozambique, while discussing
the present situation and perspectives for the near future.
Given that fungal infections are not captured accurately in
routinely published data, the paper relies on scarce reports
and papers that were found through a comprehensive
search on Google, Google Scholar, PubMed platforms, as
well grey literature in different library archives in Maputo
City. Although the analysis thus has its limitations, the re-
view of retrieved materials allows for a relatively reliable
understanding of tropical mycoses diagnosis in Mozam-
bique in different periods and contexts.
The paper ‘Brazil and leishmaniases: diseases from the
tropics that become global risk’ presented by
Jaime
Benchimol (FioCruz/Casa Osvaldo Cruz) focused on the
epidemiological trajectory of leishmaniasis in Brazil during
the 20
th
century.The first cases of cutaneous and
mucocuta-
neous
leishmaniasis in the Americas were described in São
Paulo in 1909; but only in 1934, a pathologist of theYellow
Fever Service found cases of visceral leishmaniasis (kala
azar) in Brazil.The Commission for the Study of Leishma-
niasis created in 1939 by São Paulo’s Health Department
resulted in a study of American tegumentary leishmaniasis
published in 1944 by Samuel Barnsley Pessoa and Mauro
Barretto. In the meantime, the Commission for Studies on
AmericanVisceral Leishmaniasis headed by Evandro Cha-
gas (Instituto Oswaldo Cruz) had given rise to the
Instituto
de Patologia Experimental
do
Norte
(IPEN) in 1936 and the
Serviço de Estudo
de Grandes Endemias
(SEGE) in 1937.They
were absorbed into the National Department for Rural
Endemic Diseases in 1956. As a result, the study of leish-
maniases gained relevance, especially in the Northeast of
Brazil, giving rise to control measures against hosts (dogs)
and vectors (
Phlebotomine sand flies
). Development projects
undertaken in Brazil’s hinterland following the 1964 mili-
tary coup, transformed leishmaniases in a serious problem,
also in theAmazon region. By the end of the 20th century,
forms of leishmaniasis that appeared to be under control,
re-emerged in rural and urban areas owing to environ-
mental changes, human migrations, chaotic urban growth
and economic policies affecting large portions of the Bra-
zilian hinterland.
Denis Guedes Jogas Junior (FioCruz/Casa Osvaldo Cruz)
addressed the role of medical entomology and its im-
pact on research into diseases (possibly) transmitted by
hematophagous insects in ‘Leishmaniasis and its
vectors:
building and circulating knowledge on Phlebotomine sand
flies on a global scale’. The work by Patrick Manson on
the transmission of filariasis and the research conducted
by Ronald Ross and Giovanni Grassi, Amico Bignami and
Giuseppe Bastinelli on malaria, provided an explanatory
model for this new field of research. A global network of
mutual exchange of knowledge, specimens and informa-
tion was promoted by the British Museum of Natural His-
tory, with strong participation of Latin American experts.
Its aim was collect and describe all hematophagous insects
acting as vectors and intermediate hosts of diseases consid-
ered relevant to tropical medicine. Initially, the
Culicidae
gained the lead, turning this period into the “golden era
of medical entomology.” However, in a process as yet lit-
tle explored by historians of tropical medicine, other he-
matophagous insects became the targets of medical-scien-
tific investigations, such as the
simulidae
,
triatomas
,
tabanids
and
Phlebotomine sand flie
s, as new theories and speculations
associated them emerged with advancing research on the
transmission of tropical diseases.
3.6.
Global health, Epidemiology
and Public Health Policies
and Practices in Lusophone Africa
In the paper ‘Neglected Tropical Diseases (NTDs) past
and present: the case of Angola’, Filomeno Fortes (Health
Ministry,Angola),Virgílio do Rosário (former IHMT), Di-
nora Lopes (GHTM-IHMT) and Philip J. Havik (GHTM-
IHMT) provided an overview of the evolution of Ne-
glectedTropical Diseases (NTDs) and control measures in
Angola from the 19
th
century to the present. Focusing on
yellow fever, schistosomiasis, onchocerciasis and trypano-
somiasis, it concludes that the NTDs in question remain
‘old’ infectious diseases affecting vulnerable populations,
in a country that experiences protracted armed conflict,
a lack adequate and effective human resources, limited re-
search, non cost-effective measures, logistical problems,
insecticide resistance and climate
change.Weconsider that
NTDs control in any country will only be possible with
an understanding of disease distribution, investment of ad-
equate resources in parallel with understanding the social
determinants of health.Taking the 2008-2015 Global Plan
developed by theWHO - based upon tool-ready NTDs,
individual case management, cross-cutting strategic ap-
proaches in order to prevent, control, eliminate or eradi-
cate NTDs – as a reference, the paper assesses the progress
made in Angola, identifies existing constraints and makes
recommendations for improvement.
The paper by Philip J. Havik (IHMT-UNL) ‘FromTropi-
cal to Social Medicine and back again?Transformations in