Time series analysis: trend in late maternal mortality in Brazil, 2010-2019.

To analyze the temporal trend of the late maternal mortality ratio (LMMR) in Brazil and its geographic regions in the period from 2010 to 2019, an ecological time series study was conducted. Data related to late maternal mortality from information systems of the Brazilian Ministry of Health were used. Statistical analysis used Prais-Winsten autoregressive models. A total of 1,470 late maternal deaths were reported in Brazil, resulting in an LMMR of 5 deaths per 100,000 live births. The late maternal mortality records revealed regional disparities, with the lowest index in the North (3.5/100,000 live births) and the highest in the South (8.3/100,000 live births). The LMMR showed an increasing trend in the country, with a general increase in the LMMR in the period and a mean annual percentage variation of 9.79% (95%CI: 4.32; 15.54). The Central-West region led this increase, with a mean annual percentage change of 26.06% (95%CI: 16.36; 36.56), followed by the North and Northeast regions, with 23.5% (95%CI: 13.93; 33.88). About 83% of the reported late maternal deaths were investigated, and 65.6% were corrected by the Maternal Mortality Committees. These findings highlight the relevance of late maternal mortality as an important indicator for maternal health, which is often invisible. The increase in the LMMR result from the improvement in the quality of the registration of these deaths in recent years in Brazil, and especially from the work of investigating deaths. The fragility of reporting with regional disparities points to the need for a more comprehensive approach that promotes equity and prevention of avoidable late maternal mortality.

Factors associated with the length of breastfeeding during the COVID-19 pandemic: a survival study.

OBJECTIVE: To investigate the repercussions of COVID-19 on the length of breastfeeding and analyze the associated factors in Belo Horizonte, Minas Gerais, Brazil. METHOD: This is an epidemiological, prospective cohort study. Data were collected from medical records and through telephone interviews. Women who weaned were estimated using Kaplan-Meier survival analysis. The log-rank test was used to verify differences between groups, analyzing weaning time, according to sociodemographic and clinical characteristics. The values of hazard ratio and 95% confidence intervals were estimated using Cox regression analysis. RESULTS: A total of 1,729 women participated in the study. During the COVID-19 pandemic, brown women and women undergoing cesarean section were more likely to stop breastfeeding. CONCLUSION: The birth route and mothers' ethnic characteristics were associated with early weaning during the COVID-19 pandemic. Such findings are important to guide the assistance of the multidisciplinary team, especially nursing, during the post-pandemic period and in future epidemiological scenarios.

Spatial and trend analysis of gestational syphilis cases in Brazil from 2011 to 2020: an ecological study.

OBJECTIVES: To analyze the rate of gestational syphilis (GS) based on temporal trends over 11 years, as well as the spatial distribution of GS in Brazil, based on the identification of spatial clusters. METHODOLOGY: An ecological, using Brazil and its regions as an analysis unit, based on gestational syphilis data reported in the Notifiable Diseases Information System (SINAN), from 2011 to 2020. Thematic maps were built for spatial data analysis, and the Prais-Winsten autoregressive model was used to verify the trend. Spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of distribution of GS across Brazilian municipalities, using a 5% significance level. RESULTS: Gestational syphilis experienced a considerable increase in cases during the studied period, with a peak of 37,436 cases in 2018. The spatial distribution of the disease is heterogeneous in the country. A growing trend was observed in all states of Brazil, except for Espírito Santo, where it remained stationary, with a monthly variation of 10.32%. CONCLUSION: The spatial and temporal trend analysis point to syphilis as an important public health problem. The numbers are alarming and show the urgent need for measures to prevent and control syphilis during pregnancy.

Analysis of the impact of health interventions on vaccination coverage for children under two years of age in municipalities of Minas Gerais.

OBJECTIVE: To evaluate the impact of the state action-research project on vaccination coverage in children under two years of age in the state of Minas Gerais, according to the size of the municipalities, comparing the years 2021 and 2022. METHODS: This is a study nested within the state action-research project, a before-after community clinical trial carried out in 212 municipalities in the state of Minas Gerais. This study used secondary data on Vaccination Coverage (VC), Homogeneity of Vaccines (HVC) and Abandonment rate of multi-dose vaccines. After classifying municipalities by size and vaccination coverage rates were equitably classified, an analysis of secondary data on 12 immunobiologicals indicated for the age group in question and their abandonment rate of multi-dose vaccines was carried out. RESULTS: There was an increase in the proportion of municipalities classified as small that reached the vaccination coverage target set by the National Immunization Program (PNI) after the action-research project was carried out. There was an increase in the proportion of small municipalities classified as having a low abandonment rate for the rotavirus vaccine, in the adequate homogeneity of vaccination coverage and in the classification of risk as very low risk and low and medium risk, all with a statistically significant difference. CONCLUSION: There was an influence of municipal size on the effectiveness of the actions applied to increase vaccination coverage, explaining that proposing individualized actions for each municipality is essential to improve vaccination coverage.

[Brazilian Ministry of Health strategy to increase vaccination coverage at bordersEstrategia del Ministerio de Salud de Brasil para aumentar las tasas de cobertura de vacunación en las fronteras]. / Estratégia do Ministério da Saúde do Brasil para aumento das coberturas vacinais nas fronteiras.

Objective: Evaluate the implementation of the Ministry of Health's "Action Plan: Border Vaccination Strategy - Agenda 2022" in the Brazil's 33 twin cities and evaluate the increase in the country's vaccination coverage (VC). Methodology: Pre-post community clinical trial. Implementation of the strategy was analyzed, and pre- and post-intervention VC were compared in two stages: P1 (pre-intervention) and P2 (post-intervention). Based on statistical analyses of P1 and P2 coverage, calculations were made of municipal averages, standard deviation, and difference in VC between the two periods. Results: Integration was observed between the primary health care (PHC), surveillance, immunization, and special indigenous health district (DSEI) teams, although there were difficulties, for example, in relation to migratory flows. While immigration flows present challenges in the areas of immunization, PHC, and DSEI, the difficulties are compounded by the polarization of these services, which hinders intersectoral integration. After carrying out the workshops, a total of 50 977 doses were administered in the general population in the 33 twin cities. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, which may be relevant in terms of increasing VC in Brazil. Conclusion: There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, helping to increase VC in Brazil.

Objetivo: Evaluar la aplicación de la Estrategia de Vacunación en las Fronteras - Agenda 2022, que forma parte del Plan de Acción del Ministerio de Salud en las 33 ciudades hermanas y evaluar el aumento de las tasas de cobertura de vacunación en Brasil. Métodos: Ensayo clínico comunitario realizado antes y después de la intervención correspondiente. Se analizó la aplicación de la estrategia y se compararon las tasas de cobertura de vacunación antes y después de la intervención en dos periodos: P1 (pre-intervención) y P2 (post-intervención). En los análisis estadísticos de la tasa de cobertura de vacunación en P1 y P2 se calcularon los valores de media y desviación estándar de los municipios y la diferencia entre las tasas de cobertura de los dos periodos. Resultados: Se observó una integración entre los equipos de Atención Primaria de Salud, Vigilancia, Inmunización y el Distrito Especial de Salud Indígena (DISEI), pero con dificultades, como las inherentes al flujo migratorio. Cabe destacar que el flujo migratorio es uno de los desafíos en el contexto de la inmunización, la atención primaria de salud y el DISEI, dificultad que se ve agravada por la polarización entre los servicios (inmunización, atención primaria de salud y el DISEI), lo que supone un reto para la integración de los sectores. Por lo que respecta al análisis de las tasas de cobertura de vacunación llevado a cabo después de realizar los talleres, se administró un total de 50 977 dosis a la población general en las 33 ciudades hermanas de Brasil. Hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados después de la intervención, lo que puede ser importante para aumentar las tasas de cobertura de Brasil. Conclusión: Después de la intervención hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados, lo cual influyó en el incremento de las tasas de cobertura de Brasil.

Impact of a research-action on vaccination indicators in the state of Minas Gerais, Brazil.

OBJECTIVE: Analyze the impact of the state research-action project on immunization indicators (vaccination coverage - VC, homogeneity of vaccination coverage - HVC, dropout rate - DR, and risk rating) before and after the intervention in municipalities and priority Regional Health Administrations/Regional Health Superintendencies (RHA/RHS). METHODS: The state research-action project was a before-after community clinical trial conducted in 212 municipalities belonging to eight RHA/RHS in the state of Minas Gerais, Brazil. The study sample comprised RHA/RHS with a decreasing trend for routine vaccination coverage in children under one year from 2015 to 2020. This study used secondary VC and DR data from 10 immunobiologicals recommended for children younger than two years from January to December 2021 (pre-intervention period, prior to the state research-action project) and from January to December 2022 (post-intervention period). The categorical variables were presented in proportions, and initially, a comparison was made between those of DR, HVC, and the risk rating for the transmission of vaccine-preventable diseases, according to the two periods (2021 and 2022), using the McNemar test. RESULTS: All immunization indicators increased after conducting the research-action project. In 2021, 80.66% of the state's municipalities had a risk rating for the transmission of vaccine-preventable diseases as "high and very high." In 2022, the value reduced to 68.40%. CONCLUSIONS: Risk rating for the transmission of vaccine-preventable diseases is an important mechanism to assist managers in defining priorities. The state research-action project used a method that enabled the construction and execution of unique action plans for each municipality, directing the improvement of immunization indicators in the state.

Impact of a research-action on vaccination indicators in the state of Minas Gerais, Brazil / Impacto de uma pesquisa-ação nos indicadores vacinais em Minas Gerais

ABSTRACT OBJECTIVE Analyze the impact of the state research-action project on immunization indicators (vaccination coverage - VC, homogeneity of vaccination coverage - HVC, dropout rate - DR, and risk rating) before and after the intervention in municipalities and priority Regional Health Administrations/Regional Health Superintendencies (RHA/RHS). METHODS The state research-action project was a before-after community clinical trial conducted in 212 municipalities belonging to eight RHA/RHS in the state of Minas Gerais, Brazil. The study sample comprised RHA/RHS with a decreasing trend for routine vaccination coverage in children under one year from 2015 to 2020. This study used secondary VC and DR data from 10 immunobiologicals recommended for children younger than two years from January to December 2021 (pre-intervention period, prior to the state research-action project) and from January to December 2022 (post-intervention period). The categorical variables were presented in proportions, and initially, a comparison was made between those of DR, HVC, and the risk rating for the transmission of vaccine-preventable diseases, according to the two periods (2021 and 2022), using the McNemar test. RESULTS All immunization indicators increased after conducting the research-action project. In 2021, 80.66% of the state's municipalities had a risk rating for the transmission of vaccine-preventable diseases as "high and very high." In 2022, the value reduced to 68.40%. CONCLUSIONS Risk rating for the transmission of vaccine-preventable diseases is an important mechanism to assist managers in defining priorities. The state research-action project used a method that enabled the construction and execution of unique action plans for each municipality, directing the improvement of immunization indicators in the state.

RESUMO OBJETIVO Analisar o impacto do projeto estadual de pesquisa-ação nos indicadores de imunização (coberturas vacinais - CV, homogeneidade de cobertura vacinal - HCV, taxa de abandono - TA e classificação de risco) antes e após a intervenção em municípios e Gerências Regionais de Saúde/Superintendências Regionais de Saúde (GRS/SRS) prioritários. MÉTODOS O projeto estadual de pesquisa-ação foi um ensaio clínico comunitário, do tipo antes-depois, realizado em 212 municípios pertencentes a oito GRS/SRS do estado de Minas Gerais, Brasil. Compuseram a amostra do estudo as SRS/GRS com tendência decrescente para a cobertura vacinal de rotina em crianças menores de 1 ano, no período de 2015 a 2020. Neste estudo, foram utilizados dados secundários de CV e TA de 10 imunobiológicos recomendados para crianças menores de 2 anos, no período de janeiro a dezembro de 2021 (período pré-intervenção, anterior ao projeto estadual de pesquisa-ação) e de janeiro a dezembro de 2022 (período pós-intervenção). As variáveis categóricas foram apresentadas em proporções e, inicialmente, realizou-se a comparação entre as de TA, HCV e a classificação de risco para a transmissão de doenças imunopreveníveis, segundo os dois períodos (2021 e 2022), utilizando-se o teste McNemar. RESULTADOS Observou-se um aumento de todos os indicadores de imunização após a realização do projeto de pesquisa-ação. No ano de 2021, 80,66% dos municípios do estado tiveram a classificação de risco para transmissão de doenças imunopreveníveis como "alto e muito alto risco". Em 2022, o valor foi reduzido para 68,40%. CONCLUSÕES A classificação de risco para transmissão de doenças imunopreveníveis é um mecanismo importante para auxiliar os gestores na definição de prioridades. O projeto estadual de pesquisa-ação empregou um método que possibilitou a construção e a execução de planos de ação singulares a cada município, direcionando a melhoria dos indicadores de imunização no estado.

Time series analysis: trend in late maternal mortality in Brazil, 2010-2019 / Análisis de serie temporal: tendencia de la mortalidad materna tardía en Brasil, 2010-2019 / Análise de série temporal: tendência da mortalidade materna tardia no Brasil, 2010-2019

Abstract: To analyze the temporal trend of the late maternal mortality ratio (LMMR) in Brazil and its geographic regions in the period from 2010 to 2019, an ecological time series study was conducted. Data related to late maternal mortality from information systems of the Brazilian Ministry of Health were used. Statistical analysis used Prais-Winsten autoregressive models. A total of 1,470 late maternal deaths were reported in Brazil, resulting in an LMMR of 5 deaths per 100,000 live births. The late maternal mortality records revealed regional disparities, with the lowest index in the North (3.5/100,000 live births) and the highest in the South (8.3/100,000 live births). The LMMR showed an increasing trend in the country, with a general increase in the LMMR in the period and a mean annual percentage variation of 9.79% (95%CI: 4.32; 15.54). The Central-West region led this increase, with a mean annual percentage change of 26.06% (95%CI: 16.36; 36.56), followed by the North and Northeast regions, with 23.5% (95%CI: 13.93; 33.88). About 83% of the reported late maternal deaths were investigated, and 65.6% were corrected by the Maternal Mortality Committees. These findings highlight the relevance of late maternal mortality as an important indicator for maternal health, which is often invisible. The increase in the LMMR result from the improvement in the quality of the registration of these deaths in recent years in Brazil, and especially from the work of investigating deaths. The fragility of reporting with regional disparities points to the need for a more comprehensive approach that promotes equity and prevention of avoidable late maternal mortality.

Resumen: Con el objetivo de evaluar la tendencia temporal de la tasa de mortalidad materna tardía (TMMT) en Brasil y sus regiones geográficas para el período de 2010 a 2019, se realizó un estudio de serie temporal ecológica. Se utilizaron datos relacionados con la mortalidad materna tardía de los sistemas de información del Ministerio de la Salud de Brasil. El análisis estadístico empleó modelos de regresión de Prais-Winsten. Hubo 1.470 muertes maternas tardías en Brasil, lo que resultó en una TMMT de 5 muertes por cada 100.000 nacidos vivos. Los registros de mortalidad materna tardía revelaron disparidades regionales con la tasa más baja en la Región Norte (3,5/100.0000 nacidos vivos) y la más alta en la Región Sur (8,3/100.000 nacidos vivos). Hubo una tendencia a aumento de TMMT en el país, con un incremento general de TMMT para el período y una variación media porcentual anual de un 9,79% (IC95%: 4,32; 15,54). La Región Centro-oeste presentó las tasas más elevadas, con una variación media porcentual anual de un 26,06% (IC95%: 16,6; 36,56), seguida de las regiones Norte y Nordeste, con un 23,5% (IC95%: 13,93; 33,88). Aproximadamente el 83% de las muertes materna tardía reportadas fueron investigadas, y el 65,6% fue corregido por los Comités de Mortalidad Materna. Estos hallazgos muestran la relevancia de la mortalidad materna tardía como un indicador de importancia para la salud materna, muchas veces invisibilizada. El incremento en la TMMT encontrada puede deberse a la mejora en la calidad del registro de estas muertes en los últimos años en Brasil, especialmente de la investigación de las muertes. La debilidad de las notificaciones con disparidades regionales apunta a la necesidad de un enfoque más integral que promueva la equidad y la prevención de la mortalidad materna tardía evitable.

Resumo: Com o propósito de analisar a tendência temporal da razão de mortalidade materna tardia (RMMT) no Brasil e suas regiões geográficas no período de 2010 a 2019, conduziu-se um estudo ecológico de série temporal. Foram utilizados dados relacionados à mortalidade materna tardia, provenientes de sistemas de informação do Ministério da Saúde. A análise estatística empregou modelos autorregressivos de Prais-Winsten. Foram notificados 1.470 óbitos maternos tardios no Brasil, resultando em uma RMMT de 5 óbitos a cada 100 mil nascidos vivos. Os registros de mortalidade materna tardia revelaram disparidades regionais com o menor índice na Região Norte (3,5/100 mil nascidos vivos) e o maior na Região Sul (8,3/100 mil nascidos vivos). Houve tendência crescente da RMMT no país, com aumento geral no período e variação percentual média anual de 9,79% (IC95%: 4,32; 15,54). A Região Centro-oeste liderou esse aumento, com variação percentual média anual de 26,06% (IC95%: 16,36; 36,56), seguida pelas regiões Norte e Nordeste, com 23,5% (IC95%: 13,93; 33,88). Cerca de 83% das mortes maternas tardias declaradas foram investigadas, sendo que 65,6% foram corrigidas pelos Comitês de Mortalidade Materna. Esses achados ressaltam a relevância da mortalidade materna tardia como um indicador de importância para a saúde materna muitas vezes invisibilizado. O aumento da RMMT verificado pode ser resultado da melhoria da qualidade do registro desses óbitos nos últimos anos no Brasil, sobretudo do trabalho de investigação dos óbitos. A fragilidade das notificações com as disparidades regionais aponta a necessidade de uma abordagem abrangente que promova equidade e prevenção de mortalidade materna tardia evitáveis.

Factors associated with the length of breastfeeding during the COVID-19 pandemic: a survival study / Factores asociados a la duración de la lactancia materna durante la pandemia de COVID-19: estudio de supervivencia / Fatores associados à duração do aleitamento materno durante a pandemia da COVID-19: estudo de sobrevida

ABSTRACT Objective: To investigate the repercussions of COVID-19 on the length of breastfeeding and analyze the associated factors in Belo Horizonte, Minas Gerais, Brazil. Method: This is an epidemiological, prospective cohort study. Data were collected from medical records and through telephone interviews. Women who weaned were estimated using Kaplan-Meier survival analysis. The log-rank test was used to verify differences between groups, analyzing weaning time, according to sociodemographic and clinical characteristics. The values of hazard ratio and 95% confidence intervals were estimated using Cox regression analysis. Results: A total of 1,729 women participated in the study. During the COVID-19 pandemic, brown women and women undergoing cesarean section were more likely to stop breastfeeding. Conclusion: The birth route and mothers' ethnic characteristics were associated with early weaning during the COVID-19 pandemic. Such findings are important to guide the assistance of the multidisciplinary team, especially nursing, during the post-pandemic period and in future epidemiological scenarios.

RESUMEN Objetivo: Investigar las repercusiones de la COVID-19 en la duración de la lactancia materna y analizar los factores asociados en Belo Horizonte, Minas Gerais, Brasil. Método: Se trata de un estudio de cohorte prospectivo epidemiológico. Los datos se recogieron de historias clínicas y mediante entrevistas telefónicas. Las mujeres que destetaron se estimaron mediante el análisis de supervivencia de Kaplan-Meier. La prueba de Mantel-Cox se utilizó para verificar diferencias entre grupos, analizando el tiempo de destete, según características sociodemográficas y clínicas. Los valores de cociente de riesgo y los intervalos de confianza del 95% se estimaron mediante análisis de regresión de Cox. Resultados: Un total de 1.729 mujeres participaron en la investigación. Durante la pandemia de COVID-19, las mujeres pardas y aquellas sometidas a cesárea tenían más probabilidades de dejar de amamantar. Conclusión: La ruta de nacimiento y las características étnicas de las madres se asociaron con el destete temprano durante la pandemia de COVID-19. Tales hallazgos son importantes para orientar la asistencia del equipo multidisciplinario, especialmente de enfermería, durante el período pospandemia y en futuros escenarios epidemiológicos.

RESUMO Objetivo: Investigar as repercussões da COVID-19 na duração do aleitamento materno e analisar os fatores associados em Belo Horizonte, Minas Gerais, Brasil. Método: Trata-se de estudo epidemiológico, de coorte prospectiva. Os dados foram coletados em prontuários médicos e por meio de entrevistas telefônicas. As mulheres que apresentaram o desmame foram estimadas por meio da análise de sobrevivência de Kaplan-Meier. O teste log-rank foi utilizado para verificar diferenças entre os grupos, analisando-se o tempo de desmame, segundo as características sociodemográficas e clínicas. Os valores de hazard ratio e intervalos de confiança de 95% foram estimados utilizando-se análise de regressão de Cox. Resultados: Participaram da pesquisa 1.729 mulheres. Durante a pandemia de COVID-19, mulheres pardas e mulheres submetidas à cesariana foram mais suscetíveis a interromper a amamentação. Conclusão: A via de nascimento e as características étnicas das mães associaram-se ao desmame precoce durante a pandemia de COVID-19. Tais achados são importantes para nortear a assistência da equipe multiprofissional, sobretudo da enfermagem, durante o pós-pandemia e em cenários epidemiológicos futuros.

Estratégia do Ministério da Saúde do Brasil para aumento das coberturas vacinais nas fronteiras / Brazilian Ministry of Health strategy to increase vaccination coverage at borders / Estrategia del Ministerio de Salud de Brasil para aumentar las tasas de cobertura de vacunación en las fronteras

[RESUMO]. Objetivo. Avaliar a implementação de estratégia do “Plano de Ação: Estratégia de Vacinação nas Fronteiras – Agenda 2022” do Ministério da Saúde nas 33 cidades gêmeas e avaliar o incremento das coberturas vacinais (CV) brasileiras. Métodos. Ensaio clínico comunitário, do tipo antes e depois. Analisou-se a realização da estratégia, bem como comparadas as CV pré e pós-intervenção em dois tempos: P1 (pré-intervenção) e P2 (pós-intervenção). Análises estatísticas sobre a CV, no P1 e P2, foram calculados os valores de média entres os municípios, desvio padrão e diferença entre as coberturas dos dois períodos. Resultados. Observou-se integração entre as equipes de Atenção Primária à Saúde (APS), Vigilância, Imunização e Distrito Sanitário Especial Indígena (DSEI), porém com dificuldades, como aquelas inerentes ao fluxo migratório. Ressalta-se que o fluxo imigratório é um dos desafios no contexto da imunização, APS e DSEI, entretanto, a esta dificuldade soma-se a polarização entre os serviços (imunização, APS e DISEI), ocasionando um desafio para a integração dos setores. Em relação à análise das CV, após a realização das oficinas, foram totalizadas 50 977 doses aplicadas na população geral nas 33 cidades-gêmeas do Brasil. Houve incremento das coberturas vacinais de crianças de até um ano de idade nos locais avaliados após a intervenção, o que pode ser importante para aumentar as CV no Brasil. Conclusão. Houve incremento das coberturas vacinais das crianças até um ano de idade nos locais avalia- dos após a intervenção e isso influenciou no aumento das CV no Brasil.

[ABSTRACT]. Objective. Evaluate the implementation of the Ministry of Health’s “Action Plan: Border Vaccination Strategy – Agenda 2022” in the Brazil’s 33 twin cities and evaluate the increase in the country’s vaccination coverage (VC). Methodology. Pre-post community clinical trial. Implementation of the strategy was analyzed, and pre- and post-intervention VC were compared in two stages: P1 (pre-intervention) and P2 (post-intervention). Based on statistical analyses of P1 and P2 coverage, calculations were made of municipal averages, standard deviation, and difference in VC between the two periods. Results. Integration was observed between the primary health care (PHC), surveillance, immunization, and special indigenous health district (DSEI) teams, although there were difficulties, for example, in relation to migratory flows. While immigration flows present challenges in the areas of immunization, PHC, and DSEI, the difficulties are compounded by the polarization of these services, which hinders intersectoral integration. After carrying out the workshops, a total of 50 977 doses were administered in the general population in the 33 twin cities. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, which may be relevant in terms of increasing VC in Brazil. Conclusion. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, helping to increase VC in Brazil.

[RESUMEN]. Objetivo. Evaluar la aplicación de la Estrategia de Vacunación en las Fronteras - Agenda 2022, que forma parte del Plan de Acción del Ministerio de Salud en las 33 ciudades hermanas y evaluar el aumento de las tasas de cobertura de vacunación en Brasil. Métodos. Ensayo clínico comunitario realizado antes y después de la intervención correspondiente. Se analizó la aplicación de la estrategia y se compararon las tasas de cobertura de vacunación antes y después de la intervención en dos periodos: P1 (pre-intervención) y P2 (post-intervención). En los análisis estadísticos de la tasa de cobertura de vacunación en P1 y P2 se calcularon los valores de media y desviación estándar de los municipios y la diferencia entre las tasas de cobertura de los dos periodos. Resultados. Se observó una integración entre los equipos de Atención Primaria de Salud, Vigilancia, Inmu- nización y el Distrito Especial de Salud Indígena (DISEI), pero con dificultades, como las inherentes al flujo migratorio. Cabe destacar que el flujo migratorio es uno de los desafíos en el contexto de la inmunización, la atención primaria de salud y el DISEI, dificultad que se ve agravada por la polarización entre los servicios (inmunización, atención primaria de salud y el DISEI), lo que supone un reto para la integración de los sectores. Por lo que respecta al análisis de las tasas de cobertura de vacunación llevado a cabo después de realizar los talleres, se administró un total de 50 977 dosis a la población general en las 33 ciudades hermanas de Brasil. Hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados después de la intervención, lo que puede ser importante para aumentar las tasas de cobertura de Brasil. Conclusión. Después de la intervención hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados, lo cual influyó en el incremento de las tasas de cobertura de Brasil.

Eventos adversos pós-vacina contra o papilomavírus humano em adolescentes: revisão sistemática da literatura / Adverse events following human papillomavirus vaccine in adolescents: systematic review of the literature / Eventos adversos tras la vacuna contra el virus del papiloma humano en adolescentes: revisión sistemática de la literatura

Objetivo: O objetivo desse estudo foi investigar a ocorrência de Eventos Supostamente Atribuídos a Vacinação e/ou Imunização associados à vacina Papilomavírus Humano entre adolescentes de ambos os sexos. Métodos:Trata-se de uma revisão sistemática, realizada segundo os preceitos do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados: Inicialmente, foram identificados 11.016 artigos e, após a remoção de duplicidades, restaram 6.824. Destes, 59 foram selecionados para leitura na íntegra. Ao final, nove estudos compuseram a amostra. Os resultados indicam que a maioria dos Eventos Supostamente Atribuídos a Vacinação e/ou Imunização foram leves e moderados, prevalecendo eventos no local da injeção, como a dor e edema. Os Eventos Supostamente Atribuídos a Vacinação e/ou Imunização sistêmicos mais frequentes foram a febre, cefaleia, fadiga e tontura. Conclusão: A vacina contra o Papilomavírus Humano para os adolescentes é segura, reforçando-se sua importância como estratégia para diminuir as taxas de incidência dos cânceres associados ao Papilomavírus Humano.

Objective: The objective of this study was to investigate the occurrence of Events Supposedly Attributable to Vaccination and/or Immunization associated with the Human Papillomavirus vaccine among adolescents of both sexes. Methods: This is a systematic review carried out according to the principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Initially, 11,016 articles were identified, of which 6,824 remained after removing duplicates, and 59 of these were selected for full reading. The sample comprised nine studies. The results indicate that most Events Supposedly Attributable to Vaccination and/or Immunization were mild and moderate, and events at the injection site, such as pain and edema, prevailed. The most common systemic Events Supposedly Attributable to Vaccination and/or Immunization were fever, headache, fatigue and dizziness. Conclusion: The Human Papillomavirus vaccine for adolescents is safe, reinforcing its importance as a strategy to reduce the incidence rates of Human Papillomavirus associated cancers

Objetivo: El objetivo de este estudio fue investigar la ocurrencia de Eventos Supuestamente Atribuibles a la Vacunación o Inmunización asociados a la Vacuna contra el Virus del Papiloma Humano entre adolescentes de ambos sexos. Métodos: Se trata de una revisión sistemática realizada según la declaración Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Resultados:Se identificaron 11.016 artículos y, tras eliminar duplicados, quedaron 6.824. De ellos, 59 fueron seleccionados para lectura completa. La muestra estuvo compuesta por nueve estudios. Los resultados indican que la mayoría de los Eventos Supuestamente Atribuibles a la Vacunación o Inmunización fueron leves y moderados, prevaleciendo los eventos en el lugar de la inyección, como dolor y edema. Los Eventos Supuestamente Atribuibles a la Vacunación o Inmunización sistémicos más comunes fueron fiebre, dolor de cabeza, fatiga y mareos. Conclusión: La vacuna contra el Virus del Papiloma Humano para adolescentes es segura, lo que refuerza su importancia como estrategia para reducir las tasas de incidencia de cánceres asociados al Virus del Papiloma Humano.

Analysis of the impact of health interventions on vaccination coverage for children under two years of age in municipalities of Minas Gerais / Análise do impacto das intervenções em saúde sobre a cobertura vacinal para crianças menores de dois anos em municípios de Minas Gerais

ABSTRACT Objective: To evaluate the impact of the state action-research project on vaccination coverage in children under two years of age in the state of Minas Gerais, according to the size of the municipalities, comparing the years 2021 and 2022. Methods: This is a study nested within the state action-research project, a before-after community clinical trial carried out in 212 municipalities in the state of Minas Gerais. This study used secondary data on Vaccination Coverage (VC), Homogeneity of Vaccines (HVC) and Abandonment rate of multi-dose vaccines. After classifying municipalities by size and vaccination coverage rates were equitably classified, an analysis of secondary data on 12 immunobiologicals indicated for the age group in question and their abandonment rate of multi-dose vaccines was carried out. Results: There was an increase in the proportion of municipalities classified as small that reached the vaccination coverage target set by the National Immunization Program (PNI) after the action-research project was carried out. There was an increase in the proportion of small municipalities classified as having a low abandonment rate for the rotavirus vaccine, in the adequate homogeneity of vaccination coverage and in the classification of risk as very low risk and low and medium risk, all with a statistically significant difference. Conclusion: There was an influence of municipal size on the effectiveness of the actions applied to increase vaccination coverage, explaining that proposing individualized actions for each municipality is essential to improve vaccination coverage.

RESUMO Objetivo: Avaliar o impacto do projeto estadual de pesquisa-ação nas coberturas vacinais em crianças menores de dois anos no estado de Minas Gerais, segundo o porte dos municípios, comparando os anos de 2021 e 2022. Métodos: Estudo aninhado ao projeto estadual de pesquisa-ação, um ensaio clínico comunitário, do tipo antes-depois, realizado em 212 municípios do estado de Minas Gerais. Utilizou-se, neste estudo, dados secundários de Cobertura Vacinal (CV), Homogeneidade das Vacinas (HCV) e Proporção de Abandono (PA). Após a classificação de municípios por porte, e as taxas de cobertura vacinal serem classificadas de maneira equânime, foi realizada uma análise de dados secundários de 12 imunobiológicos indicados para a faixa etária em questão e de suas PAs. Resultados: Observou-se aumento na proporção de municípios classificados como de pequeno porte que atingiram a meta da cobertura vacinal estabelecida pelo Programa Nacional de Imunização (PNI), após a realização do projeto de pesquisa-ação. Houve aumento na proporção de municípios de pequeno porte classificados como de baixa PA para a vacina Rotavírus, na homogeneidade adequada da CV e na classificação de risco para risco muito baixo e risco baixo e médio, todos com diferença estatisticamente significativa. Conclusão: Houve influência do porte municipal na efetividade das ações aplicadas para aumento de cobertura vacinal, explicitando que a proposição de ações individualizadas para cada município é imprescindível para melhorar a cobertura vacinal.

Estratégia do Ministério da Saúde do Brasil para aumento das coberturas vacinais nas fronteiras / Brazilian Ministry of Health strategy to increase vaccination coverage at borders / Estrategia del Ministerio de Salud de Brasil para aumentar las tasas de cobertura de vacunación en las fronteras

RESUMO Objetivo. Avaliar a implementação de estratégia do "Plano de Ação: Estratégia de Vacinação nas Fronteiras - Agenda 2022" do Ministério da Saúde nas 33 cidades gêmeas e avaliar o incremento das coberturas vacinais (CV) brasileiras. Métodos. Ensaio clínico comunitário, do tipo antes e depois. Analisou-se a realização da estratégia, bem como comparadas as CV pré e pós-intervenção em dois tempos: P1 (pré-intervenção) e P2 (pós-intervenção). Análises estatísticas sobre a CV, no P1 e P2, foram calculados os valores de média entres os municípios, desvio padrão e diferença entre as coberturas dos dois períodos. Resultados. Observou-se integração entre as equipes de Atenção Primária à Saúde (APS), Vigilância, Imunização e Distrito Sanitário Especial Indígena (DSEI), porém com dificuldades, como aquelas inerentes ao fluxo migratório. Ressalta-se que o fluxo imigratório é um dos desafios no contexto da imunização, APS e DSEI, entretanto, a esta dificuldade soma-se a polarização entre os serviços (imunização, APS e DISEI), ocasionando um desafio para a integração dos setores. Em relação à análise das CV, após a realização das oficinas, foram totalizadas 50 977 doses aplicadas na população geral nas 33 cidades-gêmeas do Brasil. Houve incremento das coberturas vacinais de crianças de até um ano de idade nos locais avaliados após a intervenção, o que pode ser importante para aumentar as CV no Brasil. Conclusão. Houve incremento das coberturas vacinais das crianças até um ano de idade nos locais avaliados após a intervenção e isso influenciou no aumento das CV no Brasil.

ABSTRACT Objective. Evaluate the implementation of the Ministry of Health's "Action Plan: Border Vaccination Strategy - Agenda 2022" in the Brazil's 33 twin cities and evaluate the increase in the country's vaccination coverage (VC). Methodology. Pre-post community clinical trial. Implementation of the strategy was analyzed, and pre- and post-intervention VC were compared in two stages: P1 (pre-intervention) and P2 (post-intervention). Based on statistical analyses of P1 and P2 coverage, calculations were made of municipal averages, standard deviation, and difference in VC between the two periods. Results. Integration was observed between the primary health care (PHC), surveillance, immunization, and special indigenous health district (DSEI) teams, although there were difficulties, for example, in relation to migratory flows. While immigration flows present challenges in the areas of immunization, PHC, and DSEI, the difficulties are compounded by the polarization of these services, which hinders intersectoral integration. After carrying out the workshops, a total of 50 977 doses were administered in the general population in the 33 twin cities. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, which may be relevant in terms of increasing VC in Brazil. Conclusion. There was an increase in vaccination coverage in children up to 1 year of age in the locations evaluated after the intervention, helping to increase VC in Brazil.

RESUMEN Objetivo. Evaluar la aplicación de la Estrategia de Vacunación en las Fronteras - Agenda 2022, que forma parte del Plan de Acción del Ministerio de Salud en las 33 ciudades hermanas y evaluar el aumento de las tasas de cobertura de vacunación en Brasil. Métodos. Ensayo clínico comunitario realizado antes y después de la intervención correspondiente. Se analizó la aplicación de la estrategia y se compararon las tasas de cobertura de vacunación antes y después de la intervención en dos periodos: P1 (pre-intervención) y P2 (post-intervención). En los análisis estadísticos de la tasa de cobertura de vacunación en P1 y P2 se calcularon los valores de media y desviación estándar de los municipios y la diferencia entre las tasas de cobertura de los dos periodos. Resultados. Se observó una integración entre los equipos de Atención Primaria de Salud, Vigilancia, Inmunización y el Distrito Especial de Salud Indígena (DISEI), pero con dificultades, como las inherentes al flujo migratorio. Cabe destacar que el flujo migratorio es uno de los desafíos en el contexto de la inmunización, la atención primaria de salud y el DISEI, dificultad que se ve agravada por la polarización entre los servicios (inmunización, atención primaria de salud y el DISEI), lo que supone un reto para la integración de los sectores. Por lo que respecta al análisis de las tasas de cobertura de vacunación llevado a cabo después de realizar los talleres, se administró un total de 50 977 dosis a la población general en las 33 ciudades hermanas de Brasil. Hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados después de la intervención, lo que puede ser importante para aumentar las tasas de cobertura de Brasil. Conclusión. Después de la intervención hubo un aumento de las tasas de cobertura de vacunación de menores de hasta un año de edad en los lugares evaluados, lo cual influyó en el incremento de las tasas de cobertura de Brasil.

Adverse event following immunization or vaccination in children in Minas Gerais: 2015 to 2020.

OBJECTIVE: To describe adverse event following immunization or vaccination in children in Minas Gerais: 2015 to 2020, resulting from immunization errors in children from zero to nine years old. METHODS: An ecological, descriptive study with a quantitative approach, based on event notifications available in the National Immunization Program Information System. RESULTS: Among the 39,903,277 doses of immunobiologicals in children aged zero to nine, administered in the state of MG, 3,259 events of types of immunization errors were recorded, around 0.008% of the total and, of these, 91.86% did not result in adverse events and 56.02% were children under one year of age. The most frequent diagnosis was application outside the recommended age (29.12%). Among the manifestations, 71.91% were local and systemic, with fever being the most common (40.85%). CONCLUSION: The study demonstrated that immunization errors were rare and that most of them were not associated with adverse events, which reinforces the safety of the immunization process. This undoubtedly raises reflection on the need and relevance of continuing education for health professionals.

Prevalence of preconception health indicators among Brazilian women of reproductive age. / Prevalência dos indicadores de saúde pré-concepcional das mulheres brasileiras em idade reprodutiva.

This article aims to evaluate the performance of preconception health indicators according to sociodemographic characteristics among Brazilian women of reproductive age. We conducted a descriptive epidemiological study using data from 21,645 and 25,228 women, respectively, who responded the 2013 and 2019 national health surveys, and data for the period 2010 to 2020 derived from the national health system's Department of Informatics (DATASUS). We calculated the prevalence of indicators according to sociodemographic characteristics and statistical significance of differences was measured using Pearson's chi-squared test. Syphilis and HIV incidence rates were also calculated. There was an increase in the prevalence of access to health service indicators (medical and dental consultations and recent Pap smear). However, there was an increase in the prevalence of hypertension, alcohol use, and obesity. The prevalence of use of contraceptive methods and fertility treatment remained stable. Syphilis incidence increased sevenfold between 2010 and 2020. Black/brown women with a low level of education, higher parity, and living in the North or Northeast performed worse for preconception health indicators. Despite the increase in access to health services, performance on preconception health indicators declined and health inequities continued.

O objetivo deste artigo é avaliar o desempenho de indicadores de saúde pré-concepcional das mulheres brasileiras em idade reprodutiva segundo as características sociodemográficas. Estudo epidemiológico e descritivo com dados de 21.645 e 25.228 mulheres que responderam à Pesquisa Nacional de Saúde de 2013 e 2019 e provenientes do DATASUS de 2010 a 2020. Estimou-se a prevalência de indicadores, segundo características sociodemográficas, e as diferenças estatísticas por meio do teste qui-quadrado de Pearson. Calculou-se a taxa de incidência dos indicadores de sífilis e HIV. Houve aumento da prevalência de indicadores que se referem ao acesso aos serviços de saúde (consultas médica, odontológica e realização de Papanicolau recente). Contudo, houve aumento da hipertensão, do consumo de álcool e da obesidade. Observou-se manutenção da prevalência do uso de contraceptivo e tratamento de fertilidade. Além disso, a taxa de incidência da sífilis aumentou sete vezes entre 2010-2020. Os resultados foram ainda piores entre mulheres de baixa escolaridade, pretas/pardas, com maior paridade e do Norte/Nordeste. Apesar do aumento no acesso aos serviços de saúde, houve piora do desempenho de indicadores de saúde pré-concepcional, e manutenção das iniquidades em saúde.

Prevalência dos indicadores de saúde pré-concepcional das mulheres brasileiras em idade reprodutiva / Prevalence of preconception health indicators among Brazilian women of reproductive age

Resumo O objetivo deste artigo é avaliar o desempenho de indicadores de saúde pré-concepcional das mulheres brasileiras em idade reprodutiva segundo as características sociodemográficas. Estudo epidemiológico e descritivo com dados de 21.645 e 25.228 mulheres que responderam à Pesquisa Nacional de Saúde de 2013 e 2019 e provenientes do DATASUS de 2010 a 2020. Estimou-se a prevalência de indicadores, segundo características sociodemográficas, e as diferenças estatísticas por meio do teste qui-quadrado de Pearson. Calculou-se a taxa de incidência dos indicadores de sífilis e HIV. Houve aumento da prevalência de indicadores que se referem ao acesso aos serviços de saúde (consultas médica, odontológica e realização de Papanicolau recente). Contudo, houve aumento da hipertensão, do consumo de álcool e da obesidade. Observou-se manutenção da prevalência do uso de contraceptivo e tratamento de fertilidade. Além disso, a taxa de incidência da sífilis aumentou sete vezes entre 2010-2020. Os resultados foram ainda piores entre mulheres de baixa escolaridade, pretas/pardas, com maior paridade e do Norte/Nordeste. Apesar do aumento no acesso aos serviços de saúde, houve piora do desempenho de indicadores de saúde pré-concepcional, e manutenção das iniquidades em saúde.

Abstract This article aims to evaluate the performance of preconception health indicators according to sociodemographic characteristics among Brazilian women of reproductive age. We conducted a descriptive epidemiological study using data from 21,645 and 25,228 women, respectively, who responded the 2013 and 2019 national health surveys, and data for the period 2010 to 2020 derived from the national health system's Department of Informatics (DATASUS). We calculated the prevalence of indicators according to sociodemographic characteristics and statistical significance of differences was measured using Pearson's chi-squared test. Syphilis and HIV incidence rates were also calculated. There was an increase in the prevalence of access to health service indicators (medical and dental consultations and recent Pap smear). However, there was an increase in the prevalence of hypertension, alcohol use, and obesity. The prevalence of use of contraceptive methods and fertility treatment remained stable. Syphilis incidence increased sevenfold between 2010 and 2020. Black/brown women with a low level of education, higher parity, and living in the North or Northeast performed worse for preconception health indicators. Despite the increase in access to health services, performance on preconception health indicators declined and health inequities continued.

Epidemiology of monkeypox notifications in the state of Minas Gerais, Brazil.

OBJECTIVES: to describe the epidemiological profile of suspected, confirmed, and probable cases of monkeypox in the state of Minas Gerais, Brazil. METHODS: a descriptive, retrospective study of reported suspected, confirmed, and probable cases of monkeypox infection in the state of Minas Gerais, Brazil. The study period was from the first notification, on June 11, to September 7, 2022. RESULTS: a total of 759 suspected, confirmed, and probable cases of monkeypox infection were reported, with 35.44% suspected, 53.75% confirmed, and 10.81% probable cases, respectively. As for the coexisting diseases within confirmed cases, 38.79% were related to people living with human immunodeficiency virus, and 13.74% had some active sexually transmitted infection. Regarding the evolution of confirmed cases, 47.43% were cured. CONCLUSIONS: the results contribute to greater knowledge and control of the infection by allowing better disease management and care offered in health services.

Repercussions of SARS-CoV-2 infection and the pandemic on birth routes: a cross-sectional study.

OBJECTIVE: To assess the repercussions of SARS-CoV-2 infection (suspected or confirmed) and the context of the pandemic on the birth route and humanized assistance during childbirth. METHOD: Cross-sectional epidemiological study, nested within a cohort and comparative with the research "Birth in Belo Horizonte: Survey on Childbirth and Delivery".The medical records of three reference maternity hospitals in Belo Horizonte were assessed, with a final sample of 1,682 pregnant women, in the months of May, June and July 2020. A descriptive analysis was carried out, with absolute and relative frequency, and a comparative one, with a Pearson's chi-square test. RESULTS: It was observed that 2.02% of pregnant women were infected with SARS-CoV-2.Before the pandemic, out of a total of 390 pregnant women, 74.10% gave birth vaginally.During a pandemic, among infected women, 51.61% gave birth via cesarean section and 48,39% via vaginal delivery;among uninfected, 26.99% cesarean sections and 73.01% vaginaldeliveries. CONCLUSION: There was an increase in the percentage of cesarean sections and a possible influence of the pandemic on the rates of indication of cesarean sections at the time of admission to the maternity ward.

Association between contextual factors and coverage of the Acwy meningococcal vaccine, after three years of its overdue, in the vaccination calendar of adolescents in the state of Minas Gerais, Brazil: global space regressions.

The objective of the study was to analyze the spatial distribution of vaccination coverage of bacterial meningitis vaccine: A, C, W and Y (menacwy) and identify the association between socioeconomic and social environment factors with menacwy vaccine coverage among adolescents in the state of Minas Gerais (MG), Brazil. This is an ecological, mixed study, conducted with secondary data from the 853 municipalities of the State of MG, Brazil, from 2020 to 2022, provided by the information system of the National Immunization Program. For spatial statistical analysis, spatial dependence and the presence of spatial clusters formed by municipalities with high and low vaccination coverage of Menacwy were evaluated. In the year 2021, MG presented the largest vaccination coverage (60.58%) since the introduction of the Menacwy vaccine by the PNI. Regarding the analysis of global regressions, it is observed that for the year 2020, as the MG Index of Social Responsibility-Health increased and MG Index of Social Responsibility-Public Security increased, increased the vaccination coverage of the municipalities of the Menacwy vaccine. Finally, compared to 2021, similar association was observed in relation to the proportion of the population served by the Family Health Strategy of the municipalities of the state of MG and per capita spending on education activities: as this indicator increased, with increased coverage of the Vaccine of the Menacwy vaccine of the state municipalities. They reinforce the importance of assessing the quality-of-care management and health surveillance system, professional training, and damage reduction to populations, especially adolescents.

Temporal and spatial distribution trends of polio vaccine coverage in less than one-year old children in Brazil, 2011-2021.

BACKGROUND: Low polio vaccine coverage can result in the spread of Poliovirus to areas free from viral circulation. This study analyzed the temporal trends and spatial distribution of polio vaccine coverage in one year-old children in Brazil, between 2011 and 2021. METHODS: This was an ecological, time-series study (2011 to 2021) with annual vaccine coverages against poliomyelitis, extracted from the Information System of the National Immunization Program from the 26 States and the Distrito Federal (DF). The percentage reductions in vaccination coverage in Brazil and in the Regions were calculated. Prais-Winsten regression models were used to analyze time series for the Regions and States, and spatial analysis identified the distribution of clusters (high-high; low-low; high-low and low-high) of vaccination coverages across Brazilian municipalities, using a 5% significance level. RESULTS: From 2011 to 2021, the coverage of polio vaccines decreased by 29,9%. There was a progressive increase observed in clusters resulting in low vaccination coverages (140 low-low Brazilian municipalities in 2011 vs. 403 in 2021), mostly reported in the North and Northeast regions of the country. There was a downward trend in vaccination coverages in 24 of the 26 States and DF (p ≤ 0.05). CONCLUSIONS: The reduction in polio vaccine coverage, as observed in the North and Northeast regions of Brazil, may favor the spread of Poliovirus. Therefore, vaccination strategies should be prioritized for children residing in areas with sharp and recurrent declines in vaccination coverages, including travelers, migrants, and refugees.