Structural barriers in the prevention and control of leptospirosis in a municipality in Southern Brazil: a qualitative study

Abstract

Background

This article aimed to describe the structural barriers to the prevention and control of leptospirosis in a municipality in southern Brazil.

Methodology

A qualitative approach, specifically a case study design, was employed in this study conducted within primary care, surveillance, and management settings of a municipality. Thirty-three workers were selected through purposive sampling, and semi-structured individual interviews were conducted from August 2022 to March 2023. Data analysis followed a thematic sequential approach managed using the Etnograph program.

Results

Five categories describing the barriers emerged from the results. The first barrier refers to knowledge of leptospirosis and preventive measures, the second to the lack of training, the third to insufficient infrastructure, the fourth to inadequate human resources, and the fifth to the absence of information production and notification protocols. Through the identification of these barriers, it was possible to highlight local bottlenecks in providing access to healthcare and addressing the demand for leptospirosis cases.

Conclusions

While the results may not be representative of the entire national territory, they can serve as a starting point for further studies on leptospirosis, prompting inquiries into its impact in areas with high disease risk and fostering the development of interventions on a larger scale.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-025-13373-6.

Background

In the Americas region, Brazil stands out with the highest number of leptospirosis cases, with the southern region of the country commonly affected due to increasing climate change, environmental characteristics, and economic activities that facilitate transmission [1]. These characteristics are accentuated in the state of Rio Grande do Sul (RS), which in recent years has experienced intensified rainfall and occurrences of flooding, being a region with an economy focused on the agricultural sector, factors of leptospirosis transmission that put the state on alert [2, 3]. In RS, the most affected regions are the state capital and the Central and Southeast Rio-Grandense mesoregions, where the municipality of Santa Vitória do Palmar is located, with approximately 30,000 inhabitants [4].

The municipality has been among the most prevalent in the state, with high rates of leptospirosis cases over a period of ten years [3]. This may be related to rural characteristics and economic activities such as the presence of marshes and swamps, proximity to lakes, as well as its production model of extensive livestock farming and mechanized cultivation of rice, soybeans, and wheat, making it one of the most important producers in the country and exposing workers to risk who do not use protective equipment [5].

In addition, there are also actions that lead to an increase or decrease in the number of cases, such as the strategies used for prevention and control of the disease stemming from professionals involved in the management and assistance of individuals affected by leptospirosis, including healthcare workers and health managers [6]. However, in the municipality, there is an invisibility of the disease sustained by the discontinuity of public policies [7, 8], which are presented to society only in emergency situations, such as outbreaks, epidemics, or pandemics, such as COVID-19, and disregarded for preventable diseases like leptospirosis [9, 10].

What is perceived in the country is that this scenario of low visibility is also reinforced by the decrease in media coverage related to leptospirosis, as well as scientific studies that essentially prioritize quantitative themes, such as experimental and epidemiological studies of the disease [11, 12]. However, studies with a qualitative approach are still incipient, especially those that incorporate the voices of healthcare workers in Brazil, particularly in complex health issues such as leptospirosis control in high-risk areas [13]. Therefore, the present study aimed to describe the structural barriers to the implementation of prevention and control actions for leptospirosis in the municipality in southern Brazil.

Method

Study design and location

This is a qualitative research study, specifically a case study [14, 15], guided by the recommendations of the Consolidated Criteria for Reporting Qualitative Research (COREQ) [16]. The study was conducted in Santa Vitória do Palmar, a municipality located in the southernmost region of RS, Brazil, with an estimated population of 30,983 inhabitants [17]. Santa Vitória do Palmar, located in the Southeast mesoregion of the RS state, on the border between Brazil and Uruguay. The municipality covers an area of 5,206 km², with an estimated population of 29,298 inhabitants, of which 87.77% live in urban areas and 13.23% in rural areas (Fig. 1). It is characterized by its large territorial extension, with activities focused on livestock, and the mechanized planting of rice, soy, and wheat. According to the National Health Establishment Registry platform, Santa Vitória do Palmar has 10 Basic Health Units with the Family Health Strategy (BHU/FHS) (2 in rural areas and 8 in urban areas), and a Health Surveillance Department [18, 19]. In total, among the criteria formulated for the study, there are 98 primary healthcare professionals in the municipality, and 7 health surveillance professionals [19].

Fig. 1.

Map of Rio Grande do Sul showing the location of the Municipality of Santa Vitória do Palmar with respective Basic Health Units (BHU/FHS). *Orange Color: urban area/Yellow color: rural area

Study procedure

Between August 2022 and March 2023, a semi-structured interview guide was developed by the authors and pilot tested to ensure question clarity, support interviewer to identify potential sources of bias, and were conducted individually, allowing for open discussion of the proposed topic. The questions focused on themes such as ‘Knowledge of Leptospirosis,’ ‘Experiences in controlling the disease,’ ‘Whether there was turnover of human resources and the reasons for it,’ ‘Whether there was a lack of material resources and the reasons for it,’ ‘How case notifications were carried out and whether they were done adequately,’ among other questions that identified structural barriers to Leptospirosis control [20, 21]. These interviews had an average duration of 30 min. They were conducted at the BHU at times and days negotiated in advance with the participants. The interviews were conducted by three duly trained postgraduate researchers proficient in qualitative approaches. Intentional sampling was utilized. A total of 33 participants were involved in the study, including primary healthcare workers, physicians, nurses, and community health agents from both traditional basic health units and those with the Family Health Strategy (Group 1); in addition to public health surveillance professionals (Group 2) and municipal health managers (Group 3).

Group 1 - Primary healthcare professionals

This group included individuals with higher education qualifications (physicians and nurses) working in traditional basic health units or those following the Family Health Strategy. The participants consisted of physicians, nurses, and community health agents (without specific health-related academic qualifications), each with more than 6 months of experience in primary healthcare.

Group 2 - Public health surveillance professionals

This group included professionals working in epidemiological surveillance, environmental surveillance, occupational health surveillance, and staff from the Center for Zoonosis Control all with more than 6 months of experience in their respective roles.

Group 3 - Municipal health managers

This group consisted of directors, managers, or health administrators (without specific educational requirements) and the municipal health secretary. All participants were required to have at least 6 months of service experience, which was considered sufficient for integration into the daily work routine of the service. Inclusion criteria for participants were related to having more than 6 months of experience, holding a position in municipal management, and working in health surveillance and primary healthcare sectors. Exclusion criteria were applied to professionals who were on vacation, maternity leave, or assigned to micro-areas during the data collection period.

Data collection continued until data saturation was reached, at which point no new themes or relevant information emerged from subsequent interviews.

Management and analysis of data

The interviews were recorded in audio format and later transcribed from audio to text by the research team. The dataset obtained was managed using the Etnograph program. Sequential thematic content analysis was employed [21]. Therefore, data analysis followed the following operationalization: pre-analysis, material exploration and result treatment, inference, and interpretation. Initially, the selection of material to be analyzed was carried out, consisting of transcripts of interviews, followed by a preliminary reading to construct initial hypotheses. Simultaneously, data coding was operationalized by identifying units of record and context, which were subsequently grouped by similarity, enabling the creation of subcategories and categories [22]. Finally, the category “Barriers in the prevention and control of leptospirosis” emerged, describing them in five subcategories.

After analyzing the results, a feedback session was conducted with healthcare workers, addressing the topics discussed in the interviews, such as the lack of knowledge about leptospirosis, methods of prevention and control of the disease, and treatment measures.

Rigor and reliability of the data

The data were triangulated using methods to enhance credibility, including interviews and transcriptions. The quality of the collected and analyzed data was improved by the research team’s experts, who had experience and expertise in qualitative approaches. At each stage of the research, meetings and verification of the collected data were conducted to ensure rigor and credibility. Field notes made during previous stages ensured the transferability of the data, while confirmability and reliability were generated through direct quotes from the interview transcriptions. The transcriptions were carried out with detailed descriptions of the participants’ work context. This allowed for the expansion of the results and the determination of their comparison or the possibility of transferring them to another context. The first author, along with the co-authors, acted as coders to enhance the richness of the data. Methods were used to support data reliability and reduce researcher bias.

Ethics

This study adhered to Resolution 466 of 2012, which addresses research involving human beings, as well as Resolution 510 of 2016, which outlines guidelines for research in the Humanities and Social Sciences; in addition to Circular Letter 1 of 2021 regarding research in virtual environments. Furthermore, authorization for the development of this study was requested from the Municipal Health Department of Santa Vitória do Palmar. The research project was also submitted to the city administration, which was responsible for granting authorization for the study within the municipality. It is important to note that data collection only began after the project received approval from the Committee. Subsequently, the research project was presented to the primary healthcare teams, surveillance professionals, and managers.

An invitation was then extended through the Informed Consent Form (ICF), which was created according to the participants—one form for each group. During the interviews, the informed consent form was read and explained to the participants, and signatures were obtained in two copies: one for the participant and one for the researcher.” “As for the risks for each participant group, this study did not pose physical risks, but there could be emotional risks. In the event of such risks, the researcher provided support through active listening, and participation could be interrupted at any time. Additionally, participants had the right to refuse to answer any questions in full. Regarding the benefits for each participant group, the study facilitated an exchange of knowledge between the researcher and the interviewee, as well as a reflection on the work process and how it influenced their professional activities related to the proposed theme.

Results

The study included 23 women and 10 men. Among them, 5 were physicians, 8 were nurses, 17 were community health agents, 1 was from the Municipal Health Secretariat (MHS), and 2 were professionals from health surveillance (worker surveillance sector and epidemiological surveillance sector). The age of the research participants ranged from 20 to 65 years, with a predominance of young adults. They were predominantly residents of Santa Vitória do Palmar, with Brazilian nationality, with only 3 foreigners. The interviews were mainly conducted in person, with only two taking place via videoconference. The demographic data of the participants are reported in Table 1.

Table 1.

Demographic characteristics of the study participants

Health Service of Affiliation	Number of Participants
Family Health Strategy – Barra	4
Family Health Strategy – Donatos	2
Family Health Strategy – Hermenegildo	2
Family Health Strategy – Espinilho	4
Family Health Strategy – Curral Alto	3
Family Health Strategy – Artilina	2
Family Health Strategy – Porto	1
Family Health Strategy – Cohab	1
Family Health Strategy – Hermenegildo	1
Family Health Strategy – Jacinto	6
Family Health Strategy – Brasiliano	4
Family Health Strategy – Antonio O. Rotta	2
Municipal Health Department	1
Health Surveillance	3

From the corpus, five categories were constructed and described in Fig. 2.

Fig. 2.

Conceptual map for the organization of the emerging categories of structural barriers to Leptospirosis in the healthcare system of Santa Vitória do Palmar

(I) Lack of knowledge about prevention and control of leptospirosis; (II) Insufficient infrastructure; (III) Insufficient human resources; (IV) Absence of information production and protocols; Lack of training on leptospirosis.

• I.Lack of knowledge about prevention and control of leptospirosis

  For most participants, healthcare workers, there is insufficient knowledge and, in some situations, a complete lack of awareness about leptospirosis and the disease's prevention and control measures. This prevents them from planning and implementing specific actions targeted at the population and territory.

  “Yes, [I am aware of the actions], not deeply, but yes, it's more about waste control, I don't know if there's any other way.” [E6]

  “The preventive measures I usually use are: guidance, cleaning the yard, avoiding rodents in households, there's a lot of issue with people who live in the area but work in the countryside, about contact with water, because you usually get contaminated when you're in contact with water. We provide this guidance, there's not much else, and also, you know, with the pandemic, we focus on the pandemic and the vaccine, and the rest gets neglected.” [E10]

  “I couldn't tell you [about leptospirosis prevention actions], it would be good to inform people about this disease, leptospirosis.” [E5]

  Even though the disease is well-known among the group of physicians and nurses, it is observed that for the community health agents, workers in direct contact with families and territory, there is a significant knowledge gap, which reflects in insecurity in attending to the at-risk population. The knowledge built by community health agents about leptospirosis occurs through the initiative of the worker. They utilize resources such as the internet, participation in online courses, or conversations with their peers at work, for example, community health agents and nurses. These resources serve as sources of study and updating on the disease, control measures, and prevention:

  “We take online courses, always searching on Google to read.” [E26]

  “We search on the internet, we gather here [...] because in reality, we don't even hear about [leptospirosis]. There was even a regulation, but we don't, we don't know anything about it. So a colleague informs themselves or anyone else and then passes it on to the others” [E1]

• II.Insufficiena Infrastructure

  Regarding the transportation of professionals to serve the rural area, they describe that there are insufficient vehicles to act in prevention. To overcome the difficulties of mobility and enable the professionals to reach the families'residences and the population's access to health units, workers describe that there is a schedule, rotation, and sharing of vehicles among teams. However, considering the geographical extent of the municipality, which is predominantly rural, they cannot always rely on the schedule, making transportation to the community a limiting factor.

  "Logistics is also a barrier. Our unit doesn't have a car, right? Our car comes twice a week to meet the demands of the unit, we are the first urgent care post within 100 km of the city, so everything comes here before being sent to the city, right? Yes, that's for a nurse technician and a doctor, but all basic attention was resulting in a range of services."[E27]

• III.Insufficient human resources

  Home visits and meeting the workload demand within the UBS are compromised by the reduced number of professionals. The units most affected by the lack of professionals are the UBS in rural areas, due to their location and territorial extension, preventing active search for leptospirosis. Workers also pointed out the reduced number of professionals working in health surveillance, considering the municipality's health demands.

  "Oh, if there were more, a larger team would make it easier. Because I have over 400 households and over 800 people, and I can't visit everyone in 30 days."[E7]

  Parallel to the insufficient human resources, there is also a turnover of some professionals in the basic health units, described more frequently in the category of nurses, followed by doctors. The shortage of professionals can result in work overload. Participants pointed out dissatisfaction because the scarcity interferes with the progress of leptospirosis control and detection actions, with the Family Health Strategy's bond with the family and community, and with the working relationship within the UBS and the territory.

  "In this unit, what moves the most are the nurse and the doctor, the other professionals have been employees for 16, 17, and 18 years. So, when you change a nurse, you change the whole work methodology."[E2]

  "My team itself, in these three years, has changed nurses several times."[E17]

  "We also have turnover of outside doctors, doctors who are not accustomed to our conditions here, geography, so they end up not suspecting leptospirosis and treat it for something else. So, that could also be a reason."[E10]

  Regarding medical professionals, turnover was related to the hiring of foreign doctors, Uruguayans, and Cubans. Being a border municipality, distant from major cities where health centers are located, there is difficulty in attracting Brazilian doctors due to the distance and travel time. Therefore, it became common to have turnover/alternation of medical professionals from neighboring countries or government programs, such as Mais Médicos, who were interested in serving the population.

• IV.Absence of information production and protocols

  The unavailability of epidemiological information about leptospirosis in the municipality represents a barrier to planning and implementing disease prevention actions. For the workers, leptospirosis is not included in health actions due to the lack of indicators describing the disease in the municipality, as can be seen in the following segment:

  "The function of leptospirosis.... I don't know how we don't have numbers, no percentage or anything."[E25]

  Another barrier identified by the workers concerns the scarcity and absence of informational materials in the BHU to develop actions and guide families about leptospirosis and how to prevent it. However, professionals resort to some strategies such as printing"on their own,""making copies,"and when necessary, requesting materials from surveillance.

  "No, there isn't [material], there are no leaflets at the BHU. I have one or two in my box that I photocopy when I work, then I give it to them."[E8]

  The protocol for leptospirosis was described as necessary for the management of cases. Workers point out that due to recent changes in the referral of suspected cases and the lack of communication between surveillance and primary health care professionals, there is no feedback from the notification to the basic health unit, which hinders the follow-up of cases in the territory. They report that notification used to be carried out based on the recognition of suspected cases, but after a change in regulation, the case is only notified when confirmed by clinical laboratory criteria.

  "It could have some, I'm very much into protocols, right?! A protocol would be important, I believe. For management."[E11]

  "We have this difficulty in notification, which is what guides the actions, and also guides all the knowledge necessary to use the surveillance actions and procedures, but I believe there is a need for epidemiological surveillance to be more present within primary health care."[E31]

• V.Lack of training on leptospirosis

  Some workers had received training on leptospirosis prior to the COVID-19 pandemic, while others, considering their length of service, had not received any training or updates on the disease up to the time of the survey. Trainings and courses provided by health surveillance focused on diseases considered to be of high demand, such as dengue, monkeypox, and sexually transmitted infections (STIs), which require greater attention from workers in the municipality. Some of these diseases, such as dengue, do not have a high demand for cases in the region, unlike leptospirosis, which experiences epidemic cycles in the municipality.

  "No, [I haven't received any training]. Since I've been working here [for 4 years], we haven't received any training, courses, or capacitation on leptospirosis.” [E4]

  "I came here to meet a need, it wasn't planned, so I didn't receive any training. The third [Coordinator] at the time wasn't providing any training, so it was a search on my own, due to some situations. So we were putting out the fires, now that we managed to ease off with the pandemic's duties. So we have been seeking knowledge within the demands we have in the municipality. And leptospirosis is one that we still haven't delved into, there's no training available."[E32]

  "Yes (surveillance has provided training), usually it's like the disease that emerged at the time with the function of COVID. The girls came, did training, made manuals, made protocols now with the function of monkeypox as well."[E1]

  "I think training, as it is spoken, it has to be, it has to be given, even to avoid falling into oblivion like leptospirosis did. Because we end up focusing on one thing and forgetting the rest."[E5]

The metaphor"without scarf or document"was used by a community health agent to refer to the lack of knowledge resulting from the absence of training. This absence prevents them from guiding the population even though they understand the importance of participating in updates and training on the disease. As they consider it a priority disease in the municipality, which is part of their duties, they emphasize the need for the development of actions to prevent and control it.

"I would really like to have training on leptospirosis, they [the population] would like it too. If there was this course and I had training to learn, yes, I would like it."[E6]

"Oh, I think it would be good to have a course, you know, for me to learn more about leptospirosis because there are areas that are vulnerable [BHU Porto, BHU Postão]. So it would be good to learn about the disease."[E12]

"So I think we need training because we use it when we go there and bring the patient back, we have to know how to identify, right? Because sometimes we feel without scarf or document. Because a long time ago we had it once a week, and it was ending. It was ending. [...]. Any information is very important. Right? And I really value these trainings, right? Because they will help me get to the patient's house, right?"[E13]

Discussion

This research aimed to describe the structural barriers that health workers in primary health care (PHC), epidemiological surveillance, and municipal management identify as obstacles to the prevention and control of leptospirosis. According to the presented results, there are multiple barriers preventing health workers from implementing leptospirosis prevention and control actions in the municipality of Santa Vitória do Palmar, RS.

Our results demonstrate that workers in both primary healthcare and surveillance face considerable obstacles that extend through patient flow, professional conduct, work structure, material availability, provision of training on leptospirosis, and lack of protocols. To analyze how the professional/patient dynamics occur, it is necessary to understand that the healthcare infrastructure in Brazil is based on two types of primary healthcare units: basic health units and family health strategy units. In our study, primary healthcare workers operated in health units that followed the family health strategy, meaning that health practices were based on guiding principles such as the centrality of the individual/family, the bond with the user, comprehensiveness and coordination of care, integration with the healthcare network, social participation, and intersectoral action [23].

However, we observed a compromise in the community’s bond with the Basic Health Unit/Family Health Strategy regarding leptospirosis assistance. In our study, we noticed that the responsibilities regarding leptospirosis control measures, such as referring suspected cases to health units, providing information on signs and symptoms, specific prevention measures, identifying the main agents transmitting leptospirosis, and organizing community meetings, became complex to carry out due to barriers founded in the city’s health system. Futhermore, the disease’s lack of visibility results in workers and the population’s unawareness of prevention methods, contamination, and diagnosis [24]. The study revealed insufficient knowledge about leptospirosis and prevention and control measures in primary care, as acknowledged in participants’ statements, particularly in the discourse of Community Health Agents (CHAs).

The knowledge barriers [25] and lack of preparedness among healthcare professionals may be related to the absence of periodic training sessions, provided not only by health surveillance but also by the municipality and state, which can influence how to deal with the specificities of leptospirosis [25, 26]. The provision of training sessions constitutes a fundamental tool in the Family Health Strategy (FHS), supported by the National Primary Care Policy [27] for carrying out programmatic actions in monitoring suspected and confirmed cases of leptospirosis and promoting health [23, 27].

Understanding the health-disease process, as well as prevention measures, can influence the reduction of cases of a disease [28]. However, when there is a lack of knowledge stemming from insufficient training [25] difficulties arise in providing timely care, sometimes leading to late-stage presentation, undermining care quality, care management, and particularly causing implications generated by the late phase of the disease for the user, such as ophthalmologic and neurological complications, and death [26].

However, it was observed in the study that there is a dynamic of training sessions only for diseases considered to have high demand, such as Sexually Transmitted Infections (STIs), or those prioritized on the health agenda, such as COVID-19 [29]. Morosini [30, 31] clearly portrays the situation regarding diseases considered unfeasible and that suffered even more neglect during the pandemic. This scenario became evident not only regarding chronic diseases but also in those considered neglected, such as leptospirosis, which mostly affects vulnerable populations [32].

Despite the consequent invisibility brought about by COVID-19 [29], healthcare professionals in the study understand the need to strengthen attention to leptospirosis in the municipality, providing greater care for those who have ceased to be assisted [33]. This understanding is supported by the recognition of risk factors present in the municipality that favor leptospirosis contamination, such as rice cultivation and livestock farming [34, 35]. In the analysis conducted by Teles et al., [3] a high incidence of cases was observed between 2007 and 2019, justified by rice production, contact with production animals, and access to areas with synanthropic animals, such as those inhabiting the ecological reserve of Taim, near Santa Vitória do Palmar.

In the studied reality, beyond the barriers encountered in the field of knowledge, it was pointed out that structural barriers such as the lack of vehicles and informational materials for leptospirosis prevention are factors that restrict the access of surveillance and primary healthcare teams to more remote communities, hindering the provision of necessary leptospirosis control services. The barriers related to the lack of material and human resources were even more pronounced in rural areas of the municipality. A similar situation was observed in a study conducted in Peru, where healthcare professionals faced difficulties in diagnosing transmissible diseases due to the lack of resources in rural settings, and this was highlighted as a global health issue. In Sri Lanka, the authors emphasized the severity of leptospirosis, particularly in vulnerable areas, including rural regions primarily engaged in agriculture and livestock farming.

In this context, they stressed the need to train healthcare professionals and organize health education seminars to improve knowledge about leptospirosis, as there are still misconceptions and myths surrounding the disease among many people. In addition to this, there is an insufficient human resource capacity both in primary care and surveillance, considered a barrier that hinders the mobility and coverage of teams across the entire territory of operation [36].

On the other hand, this difficulty is not only associated with leptospirosis in Brazil. Dengue, another disease of global concern, was addressed in a qualitative study, where a weakness in policies related to the training and hiring of key actors was observed. The authors highlighted the scarcity of human resources as one of the main problems hindering the development of prevention and control actions for the disease in the territory.

Furthermore, there are issues related to the turnover of professionals, which, according to testimonies, leads to a deficit in care and work coverage failures. Similar findings were identified in the literature, as it was observed that nurses had the highest turnover rate within primary care compared to other professional categories [36, 37]. This is reinforced by the present study through community health agents who emphasize the continuous need for coordination and training of teams facing the turnover of nurses, who mostly also hold coordination positions, compromising their bond and accountability.

The absence of a complete healthcare team leads to helplessness among workers and consequently to the fragmentation of leptospirosis control actions [38, 39]. Regarding physicians, turnover is related to the lack of human resources, considering it is a border municipality. According to Hortelan et al. [36], in a municipality located in a border region, there are constant challenges regarding large-scale healthcare provision and the fluctuation of people entering the city. Considering the territorial characteristics of Santa Vitória do Palmar, the management includes foreign medical professionals in the workforce to expand access to healthcare and ensure the physician’s presence in the region, enabling them to meet the healthcare needs of the municipality’s population.

The workers reflect on recent changes in the protocol that assist in the notification of leptospirosis cases, emphasizing the impracticality of confirming suspected cases due to issues with patient follow-up in the healthcare system, as well as conducting active case finding [31, 40]. This barrier influences the false perception that the disease burden is low. According to the Leptospirosis Surveillance and Control Guide [31, 41], case notification should be carried out based on the suspicion of the disease [42, 43].

This observed disharmony in the regulation of leptospirosis surveillance and control practices, experienced by professionals in the municipality, contributes to a persistent problem within the realm of neglected diseases such as leptospirosis, which is underreporting [43]. Underreporting can occur due to barriers in three different phases: access to the healthcare system by the user, underdiagnosis, and notification to the information system, as seen in the workers’ testimonies. These workers need to be continuously sensitized to report cases [44, 45].

The findings of the present study lead to the conclusion that the identified barriers hinder the healthcare workers’ plan of action regarding leptospirosis prevention and control in the studied municipality. The analysis of the barriers to disease detection and control conducted here can be considered as indicators of the municipality’s health conditions in Rio Grande do Sul, serving as important tools for the development of actions that sensitize healthcare teams and the population regarding the prioritization of preventable and neglected diseases such as leptospirosis, based on the shared responsibility of these social actors.

The main limitations of our study include its restricted geographical focus on the municipality of Santa Vitória do Palmar, RS, which limits the generalizability of the findings, as well as logistical challenges due to the municipality’s location on the border of Rio Grande do Sul. These factors posed difficulties in accessing the study site and organizing fieldwork. Nonetheless, the results may serve as a foundation for future research on leptospirosis, enabling further exploration of the disease’s impact in high-risk areas and encouraging the development of broader prevention and control interventions.

Conclusions

This study has contributed to providing an understanding of the structural barriers that act as impediments to the development of prevention and control actions for leptospirosis in primary healthcare in a municipality in Southern Brazil, based on the experiences of workers within the Unified Health System.

Abbreviations

RS

Rio Grande do Sul

COREQ

Consolidated Criteria for Reporting Qualitative Research

BHU

Basic Health Units

CHAs

Community Health Agents

PHC

Primary Health Care

STIs

Sexually Transmitted Infections

FHS

Family Health Strategy

MHS

Municipal Health Secretariat

Authors’ contributions

SCMS, FRPB, and JGVZ conceived the study design. FRPB and JGVZ contributed to the review and guidance. BCB, SCMS, and RSH collected data and transcribed audio recordings. BCB, SCMS, RSH, JSL, ATS, and JVL transcribed the audio recordings. SCMS edited the article. All authors read and approved the final manuscript.

Funding

This research is supported by the Rio Grande do Sul Research Support Foundation (FAPERGS) (FRPB; grant number: 21/2551–0000608–0), the National Council for Scientific and Technological Development (CNPq) (FRPB; grant number: 316426/2021-0), and the Coordination for the Improvement of Higher Education Personnel (CAPES) (BCB and AJT; Scholarship number 001). The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation.

Data availability

Data is provided within the manuscript or supplementary information files.

Declarations

Ethics approval and consent to participate

The research was conducted in accordance with Resolution No. 466/2012 and 510/2016 of the National Health Council and was approved by a Research Ethics Committee of the Faculty of Medicine of the Federal University of Pelotas, under CAAE number 59761622.8.0000.5317. The Informed Consent Form was signed by the participants, and to ensure confidentiality and anonymity, codes were used, identified by letters representing them, followed by the order of participation in the study: “E” for the interviewee (E1, E2, E3, etc.)

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.