[Treatment of patients with American cutaneous leishmaniasis: health services evaluation in northwestern Paraná State, Brazil].

The current study focuses on outpatient treatment of patients (n = 229) with American cutaneous leishmaniasis from 2001 to 2004, before and after decentralization of treatment to the municipal level in northwestern Paraná State, Brazil. While the treatment was still centralized, clinical evaluation and medical records were more complete and detailed, treatment was initiated earlier, and follow-up of the outcome was evaluated in 95% of patients and 100% of cases that received two treatment cycles. Treatment also complied with the guidelines of the American Cutaneous Leishmaniasis Control Manual. After decentralization, treatment was less rigorous: 32% of patients were treated with two cycles of N-methyl glucamine antimoniate without complying with the guidelines; 72.6% of patients received inadequate treatment; 84% of cases failed to received proper clinical follow-up. Lack of information on patient clinical records posed a serious obstacle to evaluation. The current study failed to identify any benefit in decentralizing treatment of American cutaneous leishmaniasis to the local level.