The COVID-19 pandemic impacted the activities of the Schistosomiasis Control Program in Brazil: is the goal of controlling the disease by 2030 at risk?

BACKGROUND: Schistosomiasis continues to represent a serious public health problem in Brazil. With the coronavirus disease 2019 (COVID-19) pandemic, several control strategies were suspended, probably compromising the goals of eradicating the disease in the country. We aimed to assess the impact of the COVID-19 pandemic on Schistosomiasis Control Program (PCE) actions in all endemic states of Brazil. METHODS: We performed an ecological study using spatial analysis techniques. The PCE variables assessed were the population surveyed, the number of Kato-Katz tests, positive cases of schistosomiasis and the percentage of cases treated between 2015 and 2021. The percent change was calculated to verify if there was an increase or decrease in 2020 and 2021, along with time trend analyses provided by the Joinpoint model. Spatial distribution maps were elaborated considering the percent change. RESULTS: The surveyed population decreased in 2020 (-65.38%) and 2021 (-37.94%) across Brazil. There was a proportional reduction in the number of Kato-Katz tests (2020, -67.48%; 2021, -40.52%), a decrease in the percentage of positive cases (2020, -71.16%; 2021, -40.5%) and a reduction in the percentage of treated cases (2020, -72.09%; 2021, -41.67%). Time trend analyses showed a decreasing trend in most PCE variables. CONCLUSIONS: The PCE activities were impacted by the COVID-19 pandemic in Brazil and PCE strategies must be urgently reviewed, focusing on investments in all endemic areas.

Reduced HIV/AIDS diagnosis rates and increased AIDS mortality due to late diagnosis in Brazil during the COVID-19 pandemic.

The COVID-19 pandemic has severely affected global health, leading to the suspension of numerous routine healthcare services and posing challenges in efforts to control other diseases, such as HIV/AIDS. This study aimed to assess the impact of the COVID-19 pandemic on HIV/AIDS diagnoses and mortality rates in Brazil during 2020 and 2021. The percentage change was calculated to determine whether there was an increase or decrease in HIV/AIDS diagnoses and mortality, considering the average numbers from the last 5 years. Additionally, a Joinpoint regression model and an interrupted time series analysis were applied to assess time trends before and after the onset of the pandemic. Lastly, choropleth maps were prepared. We observed a reduction of 22.4% (2020) and 9.8% (2021) in the diagnosis of HIV/AIDS in Brazil. Conversely, there was a significant increase in the percentage change of late diagnosis of AIDS deaths in 2020 (6.9%) and 2021 (13.9%), with some states showing an increase of over 87%. Decreasing time trends in the diagnosis of HIV/AIDS were identified before the pandemic in Brazil, especially in the Southeast and South regions, and then time trends stabilized after including the pandemic years. Along with the dissemination of COVID-19, there was a reduction in the diagnosis of HIV/AIDS and an increase in late diagnosis AIDS deaths, signaling a serious impact of the pandemic on HIV/AIDS control strategies in Brazil. Therefore, we highlight the need for continuous efforts to control both diseases, that is, maintaining regular health services even in crisis situations.

Spatiotemporal Pattern of COVID-19-Related Mortality during the First Year of the Pandemic in Brazil: A Population-based Study in a Region of High Social Vulnerability.

Currently, the world is facing a severe pandemic caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Although the WHO has recommended preventive measures to limit its spread, Brazil has neglected most of these recommendations, and consequently, our country has the second largest number of deaths from COVID-19 worldwide. In addition, recent studies have shown the relationship between socioeconomic inequalities and the risk of severe COVID-19 infection. Herein, we aimed to assess the spatiotemporal distribution of mortality and lethality rates of COVID-19 in a region of high social vulnerability in Brazil (Northeast region) during the first year of the pandemic. A segmented log-linear regression model was applied to assess temporal trends of mortality and case fatality rate (CFR) and according to the social vulnerability index (SVI). The Local Empirical Bayesian Estimator and Global Moran Index were used for spatial analysis. We conducted a retrospective space-time scan to map clusters at high risk of death from COVID-19. A total of 66,358 COVID-19-related deaths were reported during this period. The mortality rate was 116.2/100,000 inhabitants, and the CFR was 2.3%. Nevertheless, CFR was > 7.5% in 27 municipalities (1.5%). We observed an increasing trend of deaths in this region (AMCP = 18.2; P = 0.001). Also, increasing trends were observed in municipalities with high (N = 859) and very high SVI (N = 587). We identified two significant spatiotemporal clusters of deaths by COVID-19 in this Brazilian region (P = 0.001), and most high-risk municipalities were on the coastal strip of the region. Taken together, our analyses demonstrate that the pandemic has been responsible for several deaths in Northeast Brazil, with clusters at high risk of mortality mainly in municipalities on the coastline and those with high SVI.

Population-based, spatiotemporal modeling of social risk factors and mortality from schistosomiasis in Brazil between 1999 and 2018.

Schistosomiasis remains a significant public health concern in Brazil. To identify areas at, and social determinants of health (SDH) associated with, high-risk for schistosomiasis-related mortality from Brazil, we conducted a spatial and spatiotemporal modeling assessing all deaths confirmed in Brazil between 1999 and 2018. We used the segmented log-linear regression model to assess temporal trends, and the local empirical Bayesian estimator, the Global and Local Moran Index for spatial analysis. A total of 12,251 schistosomiasis-related deaths were reported in this period. Within the Mortality Information System (SIM) of the Brazilian Ministry of Health, the states of Alagoas (AL), Pernambuco (PE) and Sergipe (SE) recording the highest mortality rates: 2.21, 1.92 and 0.80 deaths/100,000 inhabitants, respectively. Analyses revealed an increase in the mean age of schistosomiasis-related deaths over the time assessed (APC = 0.9; p-value<0.05). Spatial analysis identified a concentration of municipalities presenting high risk of schistosomiasis-related mortality along the coastline of PE and AL. Similarly, we identified the formation of high space-time clusters in municipalities in the states of PE, AL, SE, Bahia, and Minas Gerais. Finally, mortality rates showed a significant correlation with 96.96% of SDH indices. The data reveal additional important changes in schistosomiasis-related deaths in Brazil between 1999 and 2018, such as a slow reduction among males (unlike females that displayed no change). Regardless, our analyses indicates that schistosomiasis continues to have the greatest detrimental impact in poor regions of Brazil and suggest the need for enhancement of current control measures to accelerate progress.

Análise do grau de implantação (GI) do programa de controle da esquistossomose mansônica (PCE) em um município endêmico do estado de Sergipe, Brasil / Implementation extent (IE) analysis of a schistosomiasis control program (SCP) in an endemic town in Sergipe, Brazil

Resumen:

Introducción/objetivo: la esquistosomiasis es endémica en varias regiones de Brasil, principalmente en el noreste, y tiene un fuerte impacto en la salud pública. El objetivo del estudio fue analizar el grado de implantación (GI) del Programa de Control de la Esquistosomiasis (PCE) en un municipio de la región centro-sur de Sergipe (Brasil).

Método: la investigación se dividió en dos etapas: inicialmente se realizó un estudio ecológico mediante encuestas al lado de las indicaciones PCE; y en el segundo, se hizo un estudio descriptivo, exploratorio y cuantitativo a través de cuestionarios. Se utilizó el modelo lógico validado por Quinino et al. (2010), el análisis de la dimensión de la estructura (recursos materiales, el trabajo en equipo y la cualificación profesional de los indicadores de cobertura) y proceso (definición epidemiológica, control de mariscos, saneamiento y educación para la salud, SISPCE, la vigilancia epidemiológica y los indicadores de cobertura). Resultados: la esquistosomiasis es considerada endémica en la región, con tasas de infección de 2,0 a 4,1% entre los años 2007 a 2011. La ciudad presenta un IG de 50, clasificado como no implantado, no realiza delimitación epidemiológica, ni acciones de malacología y tiene mala calificación profesional. El componente indicador de cobertura mostró un porcentaje muy bajo en comparación con el número de personas que trabajan. Conclusión: se concluye que existe una debilidad por el cumplimiento de las normas y de recomendaciones del Ministerio de Salud para el control efectivo de la esquistosomiasis en el municipio.

Abstract:

Introduction/purpose: schistosomiasis is endemic in a number of Brazilian regions, particularly in Northeastern ones, and has a major impact on public health. We aimed at analyzing implementation extent (IE) of a schistosomiasis control program (SCP) in a town in Central-Southern Sergipe, Brazil. Methods: a two-step study was conducted: Firstly, an ecological study was carried out by means of a survey on SCP indications; and secondly, a descriptive study was performed using exploratory and quantitative questionnaires. The logical model validated by Quinino et al. (2010) was used, with an analysis of structural dimension (material resources, team working and professional qualifications for coverage markers) and process (epidemiological definition, seafood control, sanitation and health education, SISPCE, epidemiological surveillance and coverage markers). Results: schistosomiasis is considered to be endemic in the region with infection rates achieving 2.0 to 4.1% in 2007-2011. The town shows a IE value 50, corresponding to a non-introduced level, does not perform epidemiological delimitation or malacology initiatives, and has poor professional qualification. The coverage metric component showed a very low rate compared to the number of dedicated workers. Conclusion: compliance with regulations and recommendations by Health Ministry regarding effective control of schistosomiasis in the town appears to be weak.

Introdução: a esquistossomose é uma doença endêmica em várias regiões do Brasil, principalmente, na região Nordeste, e possui forte impacto para a saúde pública. O estudo objetivou analisar o grau de implantação (GI) do Programa Controle da Esquistossomose (PCE) em um município da região centro-sul de Sergipe, Brasil. Método: a pesquisa envolveu dois momentos: inicialmente foi realizado um estudo ecológico através do levantamento de dados secundários do PCE; no segundo, realizou-se um estudo descritivo, exploratório e quantitativo através da aplicação de questionários. Foi utilizado o modelo lógico validado por Quinino et al. (2010), analisando a dimensão estrutura (recursos materiais, equipe de trabalho e indicadores de cobertura de habilitação profissional) e processo (delimitação epidemiológica, controle do molusco, saneamento e educação em saúde, SISPCE, vigilância epidemiológica e indicadores de cobertura). Resultados: a esquistossomose foi considerada endêmica na região, com as taxas de infecção de 2,0 a 4,1%, entre os anos de 2007 a 2011. O município apresentou um GI de 50 pontos, classificado como não implantado; não realiza delimitação epidemiológica; não realiza ações de malacologia e possui uma habilitação profissional deficiente. O componente indicador de cobertura evidenciou um percentual muito baixo em relação ao número de pessoas trabalhadas. Conclusão: conclui-se que existe uma fragilidade quanto ao cumprimento das normas e recomendações do Ministério da Saúde para um efetivo controle da esquistossomose no município.

Análise da acessibilidade masculina aos serviços de Atenção Primária à Saúde (APS) em um município do Nordeste da Bahia, Brasil / Learning assessment strategies applied to undergraduate nursing education in Brazil

Resumen:

Introducción: el objetivo del estudio fue evaluar los factores socioculturales que impiden a los hombres el acceso a los servicios de Atención Primaria de Salud (APS) en un municipio en el noreste de Bahía, Brasil. Método: se trata de un estudio exploratorio y descriptivo, con enfoque cuantitativo. La muestra, con método de muestreo aleatorio simple, fue de 102 usuarios del sexo masculino de 20 a 59 años, adscritos a la Estrategia de Salud de la Familia (ESF). El instrumento de recolección de datos fue una entrevista semiestructurada. Todos los análisis estadísticos se realizaron con el programa BioEstat (Versión 5.0). Resultados: la mayoría de los encuestados no conocen al equipo multidisciplinario de la Estrategia de Salud de la Familia (ESF) al cual pertenece. La demanda de asistencia sanitaria primaria se limita a las condiciones de enfermedad. El 97,06% de los hombres no conocen la atención o no la solicitan, alegando como principales impedimentos motivos como horario de atención (55,88%), temor a descubrir alguna enfermedad (9,81%) y los prejuicios (2,94%). Conclusión: es necesaria la divulgación y el desarrollo de actividades de promoción de la salud humana con el fin de reducir las bajas tasas de acceso masculino a las Unidades de Salud de la Familia (USF).

Abstract:

Introduction: The study was aimed at assessing sociocultural factors preventing men from accessing Primary Care (PC) services in Bahía, a North-Eastern Brazilian town.

Methods: An exploratory, descriptive study was carried out using a quantitative approach. A simple random sampling method was used to recruit 102 men aged 20 to 59 years assigned to the Family Health Strategy (FHS). Data collection was based on semi-structured interviews. All statistical analyses were performed with the statistical package BioEstat (release 5.0). Results: Most respondents did not know the multidisciplinary team they were assigned to within the Family Health Strategy (FHS). Primary care demands were limited to disease conditions. Most men (97.06%) do not know or do not request available healthcare, the most commonly alleged reasons being inappropriate opening times (55.88%), fear of a disease being found (9.81%), and prejudices (2.94%). Conclusion: Human health promotion activities should be developed and details on them should be disseminated in order to improve the current poor rates of access to Family Health Units (FHU) by men.

Introdução: o estudo objetiva conhecer os fatores socioculturais que inviabilizam a acessibilidade dos homens aos serviços de Atenção Primária à Saúde (APS) em um município do nordeste da Bahia, Brasil. Método: trata-se de um estudo exploratório e descritivo com abordagem quantitativa. A amostra, aleatória simples randomizada, correspondeu a 102 usuários do sexo masculino na faixa etária de 20 a 59 anos, adscritos na Estratégia Saúde da Família (ESF). O instrumento de coleta de dados foi a entrevista semiestruturada. Todas as análises estatísticas foram realizadas no programa BioEstat (Versão 5.0). Resultado: grande parte dos entrevistados não conhece a equipe multidisciplinar da Estratégia de Saúde da Família (ESF) a qual pertence; a procura pela atenção primária a saúde está restrita a condições de doença; 97,06% dos homens não conhecem ou não procuram a ESF alegando horário de atendimento (55,88%), medo de descobrir alguma doença (9,81%) e preconceito (2,94%) como principais fatores impeditivos. Conclusão: faz-se necessário a divulgação e o desenvolvimento de atividades voltadas para a promoção da saúde do homem a fim de reduzir os baixos índices de acesso masculino às Unidades de Saúde da Família (USF).

Conhecimento das enfermeiras atuantes em unidade de terapia intensiva frente a dor no recém-nascido pré-termo / Intensive care nurses' knowledge on pain in preterm newborns

Resumen:

Objetivo: este trabajo tiene como objetivo verificar el conocimiento que las enfermeras de la unidad de cuidados intensivos neonatales tienen sobre el dolor en el recién nacido. Metodología: enfoque cualitativo, exploratorio y descriptivo, el estudio fue realizado en un hospital de referencia en Aracaju, Sergipe. La muestra fue formada por enfermeras que participaron en la entrevista semiestructurada, aplicada después del consentimiento informado. Los datos fueron tabulados y seleccionados de acuerdo a las categorías, frecuencia y variables. Resultados: demostraron la percepción de las enfermeras sobre la interacción madre-recién nacido, la familia; el concepto y el reconocimiento del dolor por las enfermeras; los conocimientos de estas sobre las escalas de dolor; las actitudes enfermeras en el alivio del dolor; la percepción sobre la humanización de la unidad cuidados neonatales. Discusión: los profesionales deben realizar las medidas de alivio del dolor y promover la interacción con las familia, pero tienen dificultades en la aplicación de protocolos que permiten el manejo más adecuado del dolor y el estrés.

Abstract:

Purpose: We aimed at verifying the knowledge nurses in neonatal intensive care units have on pain in preterm newborns. Methods: A qualitative, exploratory, descriptive approach was used, with the study being carried out in a reference hospital in Aracaju, Sergipe. A semi-structured interview was used in a sample of nurses giving their informed consent. Data were tabulated and selected based on categories, frequency, and variables. Results: Findings revealed nurses' perception on mother-newborn and family interaction; pain concept and recognition by nurses; nurses' knowledge on pain assessment scales; nurses' attitudes on pain relief; perception on neonatal care unit humanization. Discussion: Nurses should apply pain relief measures and promote interaction with families, but barriers exist to apply protocols allowing a more appropriate management of pain and stress.

Introdução/objetivo: este trabalho objetiva verificar o conhecimento que os enfermeiros de unidade de terapia intensiva neonatal possuem sobre a dor no recém-nascido.

Metodologia: de abordagem qualitativa, exploratória e descritiva, realizada num Hospital de referencia em Aracaju, Sergipe. A amostra contou com enfermeiros que participaram da entrevista semiestruturada, aplicadas após o consentimento livre e esclarecido. Os dados foram tabulados e selecionados de acordo com as categorias, frequências e variáveis. Resultados: os resultados enfatizaram: percepção dos enfermeiros quanto à interação mãe, recém-nascido, família; conceito e reconhecimento da dor pelos enfermeiros; conhecimento dos enfermeiros sobre escalas de dor; atitudes de enfermeiros no alívio da dor; percepções dos enfermeiros sobre a humanização na unidade de terapia intensiva neonatal. Discussão: os profissionais executam medidas de alívio da dor e promovem interação com a família, porém apresentam dificuldades na implantação de protocolos que viabilizem o manejo mais adequado da dor e do estresse.