Use of insect repellent as personal protection among women of childbearing age in an arbovirus endemic area in Northeastern Brazil.

OBJECTIVE: To analyze the factors associated with the individual use of insect repellent by women of childbearing age living in area endemic for arboviruses in Fortaleza, Brazil. METHODS: This is a cohort study carried out between 2018 and 2019 with women aged between 15 and 39 years in Fortaleza, state of Ceará, Brazil. A total of 1,173 women users of one of the four selected primary health care units participated in the study. The outcome was divided into: continued use, discontinued use, and nonuse of insect repellent. Crude and adjusted multinominal logistic regression analysis was carried out guided by a hierarchical model, with presentation of the respective odds ratio (OR) and 95% confidence intervals (95%CI). The independent variables include: socioeconomic and demographic data, environmental and sanitary characteristics, knowledge of the insect repellent, and behavioral and pregnancy-related aspects. RESULTS: Only 28% of the participants reported using insect repellent during the two waves of the cohort. Women with higher education (OR=2.55; 95%CI 1.44-4.51); who are employed (OR=1.51; 95%CI 1.12-2.03); who received guidance from healthcare professionals (OR=1.74; 95%CI 1.28-2.36) and the media (OR=1.43; 95%CI 1.01-2.02); who intensified precautions against mosquitoes during the epidemic (OR=3.64; 95%CI 2.29-5.78); and who were pregnant between 2016 and 2019 (OR=2.80; 95%CI 1.83-4.30) had increased odds for continued use of insect repellent. CONCLUSION: The use of insect repellent among women of childbearing age was associated with a higher level of education, employment, guidance on insect repellent provided by healthcare professionals and the media, behavioral changes to protect against mosquitoes during the Zika virus epidemic, and pregnancy when occurring as of the beginning of the epidemic period.

Usabilidade da Plataforma Zelo Saúde por cuidadores de pessoas idosas dependentes / Usability of the Zelo Saúde Platform by caregivers of dependent elderly people / Usabilidad de la Plataforma Zelo Saúde por cuidadores de personas mayores dependientes

A Plataforma Zelo Saúde (PZS) é uma tecnologia mSaúde de apoio ao cuidado de pessoas idosas. Este artigo apresenta um estudo de usabilidade que analisou a utilização da PZS por 68 cuidadores/familiares de pessoas idosas dependentes por 10 semanas. Foram preenchidos um formulário pré- e outro pós-uso do aplicativo, e foi feita uma série de perguntas visando ao monitoramento semanal. Para análise dos dados, utilizou-se o software SPSS® v.25. Os resultados indicaram que a plataforma foi simples de usar e de fácil compreensão. A PZS alcançou uma nota média, na avaliação de usabilidade, de 8,9 ± 1,6 na escala de 0 a 10 da System Usability Scale, e possibilitou não só o acesso dos cuidadores/familiares às informações clínico-funcionais, à rotina de cuidados, aos medicamentos em uso, como também a comunicação entre eles e os profissionais de saúde por meio de chat. A plataforma conta também com vídeos educativos, no contexto da atenção básica à saúde e dos serviços de atenção domiciliar, mostrando-se uma ferramenta de apoio ao cuidado de pessoas idosas em seus domicílios

The Zelo Saúde Platform (PZS) is an mHealth technology to support the care of the elderly. This article presents a usability study that analyzed the use of the PZS by 68 caregivers/relatives of dependent elderly people for 10 weeks. Pre- and post-use forms were illed by participants and a set of questions aiming weekly monitoring was answered. For data analysis, SPSS® v.25 software was used. The results indicated that the platform was simple to use and easy to understand. The PZS achieved an average usability score of 8.9 ± 1.6 on a scale of 0 to 10 of the System Usability Scale, and enabled caregivers/family members to access to functional status information, routine care, medications in use, and permitted the communication between them and health professionals through chat. The platform also includes educational videos, in the context of primary health care and home care services, proving to be a tool to support the home care of elderly people

La Plataforma Zelo Saúde (PZS) es una tecnología mHealth (salud móvil) para apoyar el cuidado de las personas mayores. Este artículo presenta un estudio de usabilidad que analizó el uso de la PZS por parte de 68 cuidadores/familiares de personas mayores dependientes durante 10 semanas. Fueron llenados un formulario previo y otro posterior a la utilización de la aplicación, y se formularon diversas preguntas con vistas al seguimiento semanal. Para el análisis de los datos se utilizó el software SPSS® v.25. Los resultados indicaron que la plataforma era sencilla de usar y fácil de entender. La PZS alcanzó una calificación media de usabilidad de 8,9 ± 1,6 en una escala de 0 a 10 de la System Usability Scale, y permitió a los cuidadores/familiares acceder a la información clínico funcional, a los cuidados de rutina, a los medicamentos en uso y permitó también la comunicación entre ellos y los profesionales de la salud a través de chat. La plataforma cuenta aun con videos educativos, en el contexto de la atención primaria de salud y de los servicios de atención domiciliaria, demostrando ser una herramienta de apoyo al cuidado en el domicilio de personas mayores

Screening for coronavirus disease 2019 in pregnant women admitted for delivery: an observational study.

OBJECTIVE: The aim of this study was to examine the impact of symptom-based screening on the prevalence and outcomes of neonatal coronavirus disease 2019 in pregnant women admitted for delivery. METHODS: A retrospective observational study was conducted from June to August 2020 at Gonzaga Mota of Messejana Hospital, Fortaleza, CE, Brazil. All pregnant women were screened for coronavirus disease 2019 based on symptoms. Reverse transcription-polymerase chain reaction or immunology assays for severe acute respiratory syndrome coronavirus 2 were performed when a patient reported a symptom. All newborns of symptomatic patients were submitted for Reverse transcription-polymerase chain reaction. Newborns were divided into groups according to the Reverse transcription-polymerase chain reaction results to identify the relationship between maternal symptoms and neonatal coronavirus disease 2019. RESULTS: A total of 55 (55/1,026, 5.4%) and 50 (50/1,026, 4.8%) pregnant women reported symptoms and had a positive confirmatory test, respectively. The most common symptom of coronavirus disease 2019 among the pregnant women with positive confirmatory test was cough (n=23, 46%). Seven newborns (7/50, 14%) of symptomatic mothers had positive Reverse transcription-polymerase chain reaction. Upon birth, no newborn had serious complications. CONCLUSION: Universal screening of pregnant women admitted for delivery can reduce the perinatal transmission of coronavirus disease 2019. Symptom-based screening can be an alternative for regions with a low prevalence of the disease where a better allocation of financial resources is necessary.

Vacinação contra poliomielite no Brasil de 2011 a 2021: sucessos, reveses e desafios futuros / Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead

Resumo A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde.

Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

Vacinação do sarampo no Brasil: onde estivemos e para onde vamos? / Measles vaccination in Brazil: where have we been and where are we headed?

Resumo A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal.

Abstract The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.

Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead. / Vacinação contra poliomielite no Brasil de 2011 a 2021: sucessos, reveses e desafios futuros.

The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde.

Measles vaccination in Brazil: where have we been and where are we headed? / Vacinação do sarampo no Brasil: onde estivemos e para onde vamos?

The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.

A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal.

Positivity of dengue, chikungunya, and Zika infections in women in Northeast Brazil post-Zika epidemic.

The state of Ceará, in the Northeast Region of Brazil, presents the simultaneous circulation of Zika (ZIKV), dengue (DENV) and chikungunya (CHIKV) viruses. In 2017 there were a high number of cases of these three arboviruses, especially CHIKV. Here, we detected the presence of arboviruses ZIKV, DENV and CHIKV and their coinfections in women in endemic regions of the city of Fortaleza, Ceará in a post-Zika epidemic year. Sociodemographic and environmental characteristics associated with arbovirus positivity were also analyzed. Women (n = 1289) between 15 and 39 years old were included. RT-qPCR was performed for virus detection and IgM antibody positivity was also analyzed. One hundred and six (8.3%) participants were positive for one or more arboviruses. Monoinfections (76; 5.9%) were distributed between 22 (1.7%) for ZIKV, 39 (3.1%) for DENV and 15 (1.2%) for CHIKV. Co-infections were detected in 30 (2.3%) of the positive participants and one case with triple infection was found. IgM positivity was found in 2.4% of ZIKV RT-qPCR, 9.6% of DENV and 16.3% of CHIKV. RT-qPCR positivity for arboviruses was associated with low socioeconomic class and presence of a water box sealing in the household. A higher positivity to the three viruses occurred in the month with the lowest wind velocity, which was also preceded by the highest peak of rain and humidity. We identified the simultaneous circulation and co-infection of ZIKV, DENV and CHIKV in Fortaleza in a post-Zika epidemic year. We also highlight the need for continuous epidemiological surveillance combined with molecular diagnostic tools.

HIV testing inside Brazilian female prisons: results of a national survey.

This study aimed to identify the prevalence of women in prisons who have already had an HIV test inside prison and the factors associated with this test. A cross-sectional study was carried out with 1327 women in 15 prisons in 9 states in Brazil. Almost 60% (95% CI: 57.8-63.7) of women have already been tested for HIV in prison. The factors associated with this HIV test were age ≥41 years (OR = 1.9; 95% CI = 1.2-2.9), highest level of education (OR = 1.9; 95% CI = 1.3-2.8), having been arrested 3 or more times (OR = 1.9; 95% CI = 1.3-2.8), having received information about HIV/STI in the lifetime (OR = 1.4; 95% CI = 1.1-1.9) and perceived themselves to be at no risk for HIV infection (OR = 1.7; 95% CI = 1.2-2.5), black or mixed race (OR = 0.7; 95% CI = 0.5-0.9) and having a male sexual partner (OR = 0.6; 95% CI = 0.5-0.9). The routine HIV testing in prisons needs to be expanded to promote HIV prevention for a population with limited access to these services outside of prison.

Screening for coronavirus disease 2019 in pregnant women admitted for delivery: an observational study

SUMMARY OBJECTIVE: The aim of this study was to examine the impact of symptom-based screening on the prevalence and outcomes of neonatal coronavirus disease 2019 in pregnant women admitted for delivery. METHODS: A retrospective observational study was conducted from June to August 2020 at Gonzaga Mota of Messejana Hospital, Fortaleza, CE, Brazil. All pregnant women were screened for coronavirus disease 2019 based on symptoms. Reverse transcription-polymerase chain reaction or immunology assays for severe acute respiratory syndrome coronavirus 2 were performed when a patient reported a symptom. All newborns of symptomatic patients were submitted for Reverse transcription-polymerase chain reaction. Newborns were divided into groups according to the Reverse transcription-polymerase chain reaction results to identify the relationship between maternal symptoms and neonatal coronavirus disease 2019. RESULTS: A total of 55 (55/1,026, 5.4%) and 50 (50/1,026, 4.8%) pregnant women reported symptoms and had a positive confirmatory test, respectively. The most common symptom of coronavirus disease 2019 among the pregnant women with positive confirmatory test was cough (n=23, 46%). Seven newborns (7/50, 14%) of symptomatic mothers had positive Reverse transcription-polymerase chain reaction. Upon birth, no newborn had serious complications. CONCLUSION: Universal screening of pregnant women admitted for delivery can reduce the perinatal transmission of coronavirus disease 2019. Symptom-based screening can be an alternative for regions with a low prevalence of the disease where a better allocation of financial resources is necessary.

Análise da tendência nas taxas de detecção de sífilis em gestantes e de incidência de sífilis congênita no Ceará no período de 2015 a 2021 / Trend analysis in syphilis detection rates in pregnant women and in the incidence rate of congenital syphilis in the state of Ceará from 2015 to 2021

RESUMO Objetivo: Analisar a tendência na taxa de detecção de sífilis em gestantes (SG) e na taxa de incidência de sífilis congênita (SC) no estado do Ceará. Métodos: Estudo ecológico que utilizou a técnica da série temporal interrompida para analisar os dados mensais de casos de SG e SC obtidos no Departamento de Informática do Sistema Único de Saúde (DATASUS) no período de janeiro de 2015 a julho de 2021. Utilizaram-se o teste de Kernel e a estimativa de Lincoln-Petersen para analisar a significância estatística. Resultados: Em 2015, estimou-se uma taxa de detecção mensal de SG de 5,4 e de incidência de SC de 8,2 por 1 mil nascidos vivos (NV). A implantação da portaria que alterou os critérios de definição de caso de SG e de SC implicou no aumento de 4,9 na taxa de detecção de SG (p<0,0001; IC95% 3,33; 6,61) e na queda de 0,1 na taxa de incidência de SC (p<0,001; IC95% -0,2; -0,1). A pandemia de COVID-19 não impactou na taxa de detecção mensal de SG (p=0,558; IC95% 5,92; 3,22), nem na sua tendência (p=0,7397; IC95% 0,28; 0,3), mas houve aumento de 0,19 na de SC (p<0,001; IC95% 0,1; -0,31). Conclusões: Entre os anos de 2015 e junho de 2021, a tendência na taxa de detecção de SG e na taxa de incidência da SC sofreu impacto das mudanças nos critérios de definição de caso desses agravos propostas pelo Ministério da Saúde e da pandemia de COVID-19.

ABSTRACT Objective: To analyze the trend in the detection rate of Syphilis in Pregnant Women (SP) and in the incidence rate of Congenital Syphilis (CS) in the state of Ceará. Methods: This is an ecological study that used the technique of interrupted time series to analyze monthly data on cases of SP and CS obtained from the Department of Informatics of the Brazilian Unified Health System (DATASUS) from January 2015 to July 2021. The Kernel test and the Lincoln-Petersen estimate were used to analyze the statistical significance. Results: In 2015, a monthly detection rate of SP was estimated at 5.4 and a CS incidence rate of 8.2 per one thousand live births (LB). The implementation of the ordinance that changed the criteria for defining cases of SP and CS resulted in an increase of 4.9 (p<0.0001; 95%CI; 3.33; 6.61) in the detection rate of SP and a decrease of 0.1 on the incidence of CS (p<0.001; 95%CI -0.2; -0.1). The COVID-19 pandemic did not impact the monthly detection rate of SP (p=0.558; 95%CI 5.92; 3.22), nor its trend (p=0.7397; 95%CI 0.28; 0.3), but there was an increase of 0.19 in CS (p<0.001; 95%CI 0.1; -0.31). Conclusion: Between 2015 and June 2021, the trend in the detection rate of SP and in the incidence rate of CS was impacted by changes in the criteria for defining cases of these diseases proposed by the Brazilian Ministry of Health and the COVID-19 pandemic.

Avaliação de estrutura da assistência pré-natal para prevenção e controle da sífilis congênita / Evaluation of the structure of prenatal care for the prevention and control of congenital syphilis / Evaluación de la estructura de la atención prenatal para la prevención y el control de la sífilis congénita

O objetivo deste estudo é avaliar a estrutura das Unidades Básicas de Saúde (UBS) para prevenção e controle da sífilis congênita durante a assistência pré-natal. Para tanto, foi feita uma pesquisa avaliativa, realizada entre agosto de 2016 e abril de 2018 em uma Coordenadoria Regional de Saúde do Ceará. A amostra foi composta por 102 UBS e, para coleta de dados, realizou-se observação direta e aplicação de checklist. A análise de dados foi feita a partir da estatística descritiva e pela correlação de Spearman, e o estudo foi aprovado pelo Comitê de Ética, sob protocolo nº 1.633.568. Verificou-se que apoio laboratorial, medicamentos, recursos materiais e sistema de referência apresentaram correlação relevante e positiva com a taxa de sífilis congênita. Estrutura física e sistema de registro indicou correlação negativa muito baixa, embora estatisticamente significante. Conclui-se que a recrudescência da sífilis continua sendo um problema de saúde pública. Avaliações de estrutura, como esta, servem como subsídio para construção de ações que visem a prevenção e o controle da sífilis congênita.

This study aims to evaluate the structure of Basic Health Units (UBS) for the prevention and control of congenital syphilis during prenatal care. To that end, an evaluative research was carried out, between August 2016 and April 2018 in a Regional Health Coordination of Ceará. The sample consisted of 102 UBS and, for data collection, direct observation and application of the check-list were carried out. Data analysis was based on descriptive statistics and Spearman's correlation, and the study was approved by the Research Ethics Committee, under protocol No. 1,633,568. Laboratory support, drugs, material resources, and reference system showed a relevant and positive correlation with the rate of congenital syphilis. The physical structure and registration system domains showed a very low negative correlation, although statistically significant. In conclusion, syphilis recrudescence continues to be a public health problem. Structural assessments, like this, serve as a basis for building actions aimed at preventing and controlling congenital syphilis.

El objetivo de este estudio fue evaluar la estructura de las Unidades Básicas de Salud (UBS) en la prevención y control de la sífilis congénita durante la atención prenatal. Para ello, se realizó una investigación evaluativa, llevada a cabo en el periodo de agosto de 2016 a abril de 2018 en una Coordinación Regional de Salud de Ceará (Brasil). La muestra consistió en 102 UBS, y se recabaron los datos mediante la observación directa y la aplicación de una lista de verificación. El análisis de datos se estableció por medio de estadística descriptiva y la correlación de Spearman, y el estudio fue aprobado por el Comité de Ética en Investigación con el número 1.633.568. Se constató que el soporte de laboratorio, los medicamentos, los recursos materiales y el sistema de referencia mostraron una correlación relevante y positiva con la tasa de sífilis congénita. La estructura física y los dominios del sistema de registro tuvieron una correlación negativa muy baja, aunque estadísticamente significativa. Se concluyó que el recrudecimiento de la sífilis sigue siendo un problema de salud pública. Las evaluaciones estructurales como esta sirven como base para construir acciones destinadas a prevenir y controlar la sífilis congénita.

Spatial distribution pattern of new leprosy cases under 15 years of age and their contacts in Sobral, Ceará, Brazil.

This study's objective was to analyze the spatial distribution pattern of new leprosy cases under 15 years and their contacts. A cross-sectional descriptive study covering sociodemographic characteristics and spatial analysis was carried out. The participants were from the city of Sobral, Ceará and the study was conducted between August 2014 and September 2015. Contacts were identified by the persons responsible for the children. Seropositivity was determined with the NDO-LID antigen, and positive cases were plotted on Voronoi polygons. Nine new cases of leprosy under 15 years of age have been found. The average number of people living with the cases was higher than the number of people living with non-household contacts. All household contacts were aware of other leprosy cases and had a higher rate of seropositive tests than non-household contacts. The index cases lived in the poorest regions of the municipality and hyper-endemic areas. Spatial analysis revealed a cluster of subclinical infection within a radius of 102 meters, suggesting that non-household transmission is related to proximity with seropositive individuals. In conclusion, the search for new leprosy cases cannot be restricted to household contacts.

Spatial distribution pattern of new leprosy cases under 15 years of age and their contacts in Sobral, Ceará, Brazil / Distribuição espacial de novos casos de hanseníase em menores de 15 anos e de seus contatos em Sobral, Ceará, Brasil

Abstract This study's objective was to analyze the spatial distribution pattern of new leprosy cases under 15 years and their contacts. A cross-sectional descriptive study covering sociodemographic characteristics and spatial analysis was carried out. The participants were from the city of Sobral, Ceará and the study was conducted between August 2014 and September 2015. Contacts were identified by the persons responsible for the children. Seropositivity was determined with the NDO-LID antigen, and positive cases were plotted on Voronoi polygons. Nine new cases of leprosy under 15 years of age have been found. The average number of people living with the cases was higher than the number of people living with non-household contacts. All household contacts were aware of other leprosy cases and had a higher rate of seropositive tests than non-household contacts. The index cases lived in the poorest regions of the municipality and hyper-endemic areas. Spatial analysis revealed a cluster of subclinical infection within a radius of 102 meters, suggesting that non-household transmission is related to proximity with seropositive individuals. In conclusion, the search for new leprosy cases cannot be restricted to household contacts.

Resumo O objetivo deste estudo foi analisar o padrão de distribuição espacial de novos casos de hanseníase em menores de 15 anos e seus contatos. Estudo transversal, descritivo, abrangendo características sociodemográficas e análise espacial. Os participantes eram de Sobral, Ceará e o estudo foi realizado entre agosto de 2014 e setembro de 2015. Os contatos foram identificados pelos responsáveis pelas crianças. A soropositividade foi determinada com o antígeno NDO-LID e os casos positivos foram plotados em polígonos de Voronoi. Nove novos casos de hanseníase em menores de 15 anos foram encontrados. O número médio de pessoas que conviviam com os casos foi superior ao número de pessoas que conviviam com contatos não domiciliares. Todos os contatos domiciliares sabiam de outros casos de hanseníase e apresentaram maior taxa de testes soropositivos do que os contatos não domiciliares. Os casos índice residiam nas regiões mais pobres do município e em áreas hiperendêmicas. A análise espacial revelou um agrupamento de infecção subclínica em um raio de 102 metros, sugerindo que a transmissão não domiciliar está relacionada à proximidade com indivíduos soropositivos. Concluindo, a busca por novos casos de hanseníase não pode se restringir aos contatos domiciliares.

Social inequalities associated with COVID-19 case fatality rate in Fortaleza, Ceará state, Brazil, 2020. / Desigualdades sociais associadas com a letalidade por COVID-19 na cidade de Fortaleza, Ceará, 2020.

OBJECTIVE: To analyze the association among social and health inequalities, socioeconomic status, spatial segregation and Case Fatality Rate (CFR) due to COVID-19 in Fortaleza, the state capital of Ceará, Brazil. METHODS: This was an ecological study of confirmed cases and deaths due to COVID-19. The 119 neighborhoods of Fortaleza were used as units of analysis. Incidence, mortality and apparent CFR indicators due to COVID-19 were calculated between January 1 and June 8, 2020. Socioeconomic indicators were obtained from the 2010 Brazilian Demographic Census. Spatial analysis was performed and local and global Moran's indexes were calculated. RESULTS: There were 22,830 confirmed cases, 2,333 deaths and the apparent CFR was 12.7% (95% CI 11.6;13.9). Significant spatial autocorrelations between apparent CFR (I=0.35) and extreme poverty (I=0.51), overlapping in several neighborhoods of the city, were found. CONCLUSION: The apparent CFR due to COVID-19 is associated with the worst socioeconomic and health status, which shows the relationship between social inequalities and health outcomes in times of pandemic.

COVID-19 in northeast Brazil: first year of the pandemic and uncertainties to come.

OBJECTIVE: To analyze the epidemic of COVID-19 in northeastern Brazil, one of the regions most affected by the virus. METHODS: The official data for COVID-19, from March 2020 to March 2021 in the states of the Northeast Region (NE), were used. The analysis of capital cities and states for accumulated weekly cases and confirmed deaths was made using the JoinPoint Trend Analysis application. RESULTS: In one year, the Northeast region reported 22.9% of the cases and 21.5% of the deaths in the country due to COVID-19. At the beginning of the pandemic, all states showed a growing number of cases, first in the capitals and then in the interior. Following this wave, decreases are observed in all states and their capitals, but with many still reporting a large number of cases. In the middle of the 2nd semester of 2020 the number of cases begins to increase again simultaneously in states and their capitals-some at explosive speed-especially in late 2020 and early 2021. A similar pattern is observed in deaths, which exceed or approach the peak seen in the first wave. In the first wave, all capitals and northeastern states adopted intense isolation measures. Fortaleza, Recife and Teresina reached the highest isolation index of all capitals, close to 0.60. This index decreases, with a slight growth trend until the end of December. With the exception of Fortaleza and Salvador, the other capitals fell to less than 0.40. CONCLUSION: The Brazilian NE and the country are in increasingly complicated health, social and economic situations. It is necessary to speed up vaccinations and maintain non-pharmacological measures: face masks, social distancing measures and hygiene care, in addition to policies to protect workers who have lost their incomes and to subsidize small business owners.

[Covid-19 in the Northeast of Brazil: from lockdown to the relaxation of social distancing measures]. / Covid-19 no nordeste do Brasil: entre o lockdown e o relaxamento das medidas de distanciamento social.

Even in the period when the Covid-19 pandemic was on the rise in the Northeast of Brazil, the relaxation of social distancing measures was introduced. The scope of the study is to assess, in the light of the epidemiological-sanitary situation in the region, the suitability of relaxation of social distancing measures. Based on the WHO guidelines for relaxation of social distancing, operational indicators were created and analyzed for each guideline in the context of the Northeast. To analyze the behavior of the epidemic, according to selected indicators, Joinpoint trend analysis techniques, heat maps, rate ratios and time trends between capitals and the state interior were compared. The weekly growth peak of the epidemic occurred in May-July 2020 (epidemiological weeks 19 to 31). In most capitals, there was no simultaneous downward trend in the number of cases and deaths in the 14 days prior to flexibilization. In all states the number of tests performed was insufficient. In epidemiological week 24, the state percentages of ICU/Covid-19 bed occupancy were close to or above 70%. The epidemiological situation of the nine Northeastern state capitals analyzed here did not meet criteria and parameters recommended by the World Health Organization for the relaxation of social distancing measures.

Mesmo no período em que a pandemia de Covid-19 encontrava-se em crescimento no Nordeste do Brasil, iniciou-se a adoção de medidas de flexibilização do distanciamento social. O objetivo do estudo é o de avaliar a pertinência das propostas de flexibilização, tomando-se em conta a situação da pandemia em cada local e o momento em que foram adotadas. Tendo como referência as diretrizes da OMS, foram construídos e analisados indicadores operacionais para cada diretriz, no contexto da região Nordeste. Para análise do comportamento da epidemia, conforme indicadores selecionados, foram usadas técnicas de Joinpoint Trend Analysis, mapas de calor, razão de taxas e comparação da tendência temporal entre capitais e interior dos estados. O pico do crescimento semanal ocorreu em maio-julho/2020 (semanas epidemiológicas 19 a 31). Na maioria das capitais não se observou tendência decrescente simultânea do número de casos e óbitos nos 14 dias prévios à flexibilização. Em todos os estados o quantitativo de testes realizados foi insuficiente. Na semana epidemiológica 24 os percentuais estaduais de ocupação de leitos de UTI/Covid-19 foram próximos ou superiores 70%. A situação epidemiológica das nove capitais dos estados do Nordeste, no momento em que a decisão de flexibilização foi tomada, mostra que nenhuma delas atendia aos critérios e parâmetros recomendados pela OMS.

Covid-19 no nordeste do Brasil: entre o lockdown e o relaxamento das medidas de distanciamento social / Covid-19 in the Northeast of Brazil: from lockdown to the relaxation of social distancing measures

Resumo Mesmo no período em que a pandemia de Covid-19 encontrava-se em crescimento no Nordeste do Brasil, iniciou-se a adoção de medidas de flexibilização do distanciamento social. O objetivo do estudo é o de avaliar a pertinência das propostas de flexibilização, tomando-se em conta a situação da pandemia em cada local e o momento em que foram adotadas. Tendo como referência as diretrizes da OMS, foram construídos e analisados indicadores operacionais para cada diretriz, no contexto da região Nordeste. Para análise do comportamento da epidemia, conforme indicadores selecionados, foram usadas técnicas de Joinpoint Trend Analysis, mapas de calor, razão de taxas e comparação da tendência temporal entre capitais e interior dos estados. O pico do crescimento semanal ocorreu em maio-julho/2020 (semanas epidemiológicas 19 a 31). Na maioria das capitais não se observou tendência decrescente simultânea do número de casos e óbitos nos 14 dias prévios à flexibilização. Em todos os estados o quantitativo de testes realizados foi insuficiente. Na semana epidemiológica 24 os percentuais estaduais de ocupação de leitos de UTI/Covid-19 foram próximos ou superiores 70%. A situação epidemiológica das nove capitais dos estados do Nordeste, no momento em que a decisão de flexibilização foi tomada, mostra que nenhuma delas atendia aos critérios e parâmetros recomendados pela OMS.

Abstract Even in the period when the Covid-19 pandemic was on the rise in the Northeast of Brazil, the relaxation of social distancing measures was introduced. The scope of the study is to assess, in the light of the epidemiological-sanitary situation in the region, the suitability of relaxation of social distancing measures. Based on the WHO guidelines for relaxation of social distancing, operational indicators were created and analyzed for each guideline in the context of the Northeast. To analyze the behavior of the epidemic, according to selected indicators, Joinpoint trend analysis techniques, heat maps, rate ratios and time trends between capitals and the state interior were compared. The weekly growth peak of the epidemic occurred in May-July 2020 (epidemiological weeks 19 to 31). In most capitals, there was no simultaneous downward trend in the number of cases and deaths in the 14 days prior to flexibilization. In all states the number of tests performed was insufficient. In epidemiological week 24, the state percentages of ICU/Covid-19 bed occupancy were close to or above 70%. The epidemiological situation of the nine Northeastern state capitals analyzed here did not meet criteria and parameters recommended by the World Health Organization for the relaxation of social distancing measures.

Hospitalization costs for congenital syphilis in the state of Ceará / Custo das internações hospitalares por sífilis congênita no Estado do Ceará

Abstract Objectives: this study aimed to describe direct medical-hospital costs of hospitalizations for Congenital Syphilis (CS) in children under one year of age, users of the public health network in the state of Ceará, Brazil, from 2012 to 2017. Methods: this is a cross-sectional study that used the DATASUS Hospital Information System database, built from the information registered in the Inpatient Hospital Authorizations (IHA), organized in a Microsoft Office Excel 2010 spreadsheet and analyzed in SPSS, version 23. Results: there were 4,085 hospitalizations registered for CS (16.6% of total hospital admissions for infectious and parasitic diseases) at a cost of US$ 927,726.84, representing an annual average of US$ 234.73 per child. A slight decrease in approved IHA for infectious and parasitic diseases (5.5%) was verified when compared with CS, which increased by 36.4%> over the evaluated years. Conclusion: high treatment costs for CS in the state of Ceará were identified, a situation that could be avoided if pregnant women with syphilis were diagnosed and treated during prenatal care.

Resumo Objetivos: descrever os custos diretos médico-hospitalares das internações hospitalares por Sífilis Congênita (SC) em crianças menores de um ano usuárias da rede pública de saúde do Estado do Ceará, no período de 2012 a 2017. Metodos: estudo transversal cuja coleta de dados aconteceu no banco de dados do Sistema de Informações Hospitalares do Datasus, a partir das informações das Autorizações de Internação Hospitalar (AIH). Os dados foram digitados em uma planilha no Microsoft Office Excel (versão 2010) e analisados no SPSS, versão 23. Resultados: foram registradas 4.085 internações hospitalares por SC (16,6% do total de internações por doenças infecciosas e parasitárias), perfazendo um custo total de $ 927. 726,84 dólares e média anual para cada criança de $234, 73dólares. Observou-se um discreto decréscimo das AIH aprovadas para doenças infecciosas e parasitárias (5,5%) quando comparadas com SC, que apresentou um acréscimo de 36,4%o ao longo dos anos avaliados. Conclusão: identificou-se custo elevado com o tratamento da SC no estado do Ceará, situação que poderia ser evitada se as gestantes com sífilis fossem diagnosticadas e tratadas durante a assistência pré-natal.

Clinical-epidemiological profile of children and adolescents with COVID-19 in Ceará / Perfil clínico-epidemiológico de crianças e adolescentes com COVID -19 no Ceará

Abstract Objectives: to describe the clinical-epidemiological profile of children and adolescents notified by COVID-19 in Ceará. Methods: descriptive epidemiological study from open data repositories of the State Government of Ceará, about cases of OVID-19 in children and adolescents, from 03/15/2020 to 07/31/2020. For data analysis the tests χ2 Pearson, Fisher's exact and Poisson's regression with robust variance were used. Results: 48,002 cases of children and adolescents suspected of COVID-19 were reported, of which 18,180 (8.9%) were confirmed. The median of confirmed cases was 12 years old, 10.5% were newborns/lactants, 10.7% were pre-school children, 21.2% were school children and 57.7% were adolescents. They evolved to death 0.3% of the cases, of which 15% had comorbidities. They needed hospitalization 1.8% of the cases. The highest probability of hospitalization was found in newborns/lactants, male and with comorbidities. Conclusions: most of the confirmed cases occurred in adolescents, however, the evolution of the disease was more severe and with greater need for hospitalization in the age group of newborns/lactants, being the male gender and the presence of comorbidities additional factors for the need for hospitalization.

Resumo Objetivos: descrever o perfil clínico-epidemiológico de crianças e adolescentes notificadas por COVID-19 no Ceará. Métodos: estudo epidemiológico descritivo a partir de repositórios de dados abertos do Governo do Estado do Ceará, sobre casos de COVID-19 em crianças e adolescentes, no período de 15/03/2020 a 31/07/2020. Para análise dos dados foram utilizados os testes χ2 Pearson, exato de Fisher e a regressão de Poisson com variância robusta. Resultados: foram notificados 48.002 casos de crianças e adolescentes suspeitos de COVID-19, dos quais 18.180 (8,9%) foram confirmados. A mediana dos casos confirmados foi de 12 anos, sendo que 10,5% eram recém-nascidos/lactentes, 10,7% eram crianças em idade pré-escolar, 21,2% escolares e 57,7% adolescentes. Evoluíram para óbito 0,3% dos casos, dos quais 15% apresentavam comorbidades. Necessitaram de internação 1,8% dos casos. A maior probabilidade de internação foi encontrada em recém-nascidos/lactentes, sexo masculino e com comorbidades. Conclusões: a maioria dos casos confirmados ocorreu em adolescentes, no entanto, a evolução da doença foi mais grave e com maior necessidade de internação no grupo etário de recém-nascidos/lactentes, sendo o sexo masculino e a presença de comorbidades fatores adicionais para a necessidade de internamento.