Temporal and spatial analysis of municipal dengue cases in Paraná and social and environmental indicators, 2012 to 2021: ecological study.

OBJECTIVE: Analyze the temporal trend and spatial distribution of the incidence rate of dengue cases in Paraná and its regions between 2012 to 2021 and investigate associated sociodemographic and environmental variables. METHODS: Ecological study with temporal and spatial analysis of the dengue incidence rate reported in the Disease and Notification Information System (SINAN) in the period 2012 to 2021 and investigation of sociodemographic and environmental variables. To identify differences between municipal incidence rates the Mann-Whitney and Kruskal-Wallis test followed by Dunn's test for multiple comparisons were used. Prais-Winsten regression was used for temporal trend analysis and for spatial analysis the univariate and bivariate Local Moran analysis were applied. RESULTS: 548,683 cases of dengue were confirmed in the period, the highest state incidence rate was observed in 2020, with 15 health regions presenting more than 500 cases/100,000 inhabitants. Higher incidences were observed among women, age group of 20-59 years and white color/race. Despite annual variations, a stationary trend was observed for incidence rates according to sex, age group, color/race and macro-region. More than half of the municipalities in Paraná formed spatial clusters (Moran's I=0.679), where 73 (18.3%) municipalities with high incidence rate formed clusters. High-High clusters of dengue incidence rate with urbanization and High-Low clusters of incidence rate with vegetation cover were observed. CONCLUSION: Sociodemographic and environmental determinants were related to the high incidence rates of dengue and heterogeneous spatial distribution in the state of Paraná, indicating the need to strengthen health surveillance actions.

Temporal and spatial analysis of municipal dengue cases in Paraná and social and environmental indicators, 2012 to 2021: ecological study / Análise temporal e espacial dos casos municipais de dengue no Paraná e indicadores sociais e ambientais, 2012 a 2021: estudo ecológico

ABSTRACT Objective: Analyze the temporal trend and spatial distribution of the incidence rate of dengue cases in Paraná and its regions between 2012 to 2021 and investigate associated sociodemographic and environmental variables. Methods: Ecological study with temporal and spatial analysis of the dengue incidence rate reported in the Disease and Notification Information System (SINAN) in the period 2012 to 2021 and investigation of sociodemographic and environmental variables. To identify differences between municipal incidence rates the Mann-Whitney and Kruskal-Wallis test followed by Dunn's test for multiple comparisons were used. Prais-Winsten regression was used for temporal trend analysis and for spatial analysis the univariate and bivariate Local Moran analysis were applied. Results: 548,683 cases of dengue were confirmed in the period, the highest state incidence rate was observed in 2020, with 15 health regions presenting more than 500 cases/100,000 inhabitants. Higher incidences were observed among women, age group of 20-59 years and white color/race. Despite annual variations, a stationary trend was observed for incidence rates according to sex, age group, color/race and macro-region. More than half of the municipalities in Paraná formed spatial clusters (Moran's I=0.679), where 73 (18.3%) municipalities with high incidence rate formed clusters. High-High clusters of dengue incidence rate with urbanization and High-Low clusters of incidence rate with vegetation cover were observed. Conclusion: Sociodemographic and environmental determinants were related to the high incidence rates of dengue and heterogeneous spatial distribution in the state of Paraná, indicating the need to strengthen health surveillance actions.

RESUMO Objetivo: Analisar a tendência temporal e a distribuição espacial da taxa de incidência de casos de dengue no Paraná e suas regiões entre 2012 e 2021 e investigar variáveis sociodemográficas e ambientais associadas. Métodos: Estudo ecológico com análises temporais e espaciais da taxa de incidência da dengue registrada no Sistema de Informação de Agravos de Notificação, de 2012 e 2021, e investigação de variáveis sociodemográficas e ambientais. Para analisar as taxas de incidência municipais foram utilizados os testes de Mann-Whitney e Kruskal-Wallis, seguidos do teste de Dunn para múltiplas comparações. Utilizou-se para análise da tendência temporal a regressão de Prais-Winsten, e para a análise espacial, o índice de Moran Local univariado e bivariado. Resultados: Foram confirmados 548.683 casos de dengue no período, apresentando a maior taxa de incidência estadual em 2020, com 15 regionais de saúde registrando mais de 500 casos/100 mil habitantes. Maiores incidências ficaram entre mulheres, faixa etária de 20-59 anos e cor/raça branca. Apesar de variações anuais, observou-se tendência estacionária para incidência segundo sexo, faixa etária, cor e macrorregião. Mais da metade dos municípios paranaenses formou aglomerados espaciais (Moran's 1=0,679) — 73 (18,3%) municípios com alta taxa de incidência formaram agrupamentos. Foram identificados agrupamentos da taxa de incidência da dengue com o grau de urbanização (alto-alto) e com o percentual de cobertura vegetal natural (alto-baixa). Conclusão: Determinantes sociodemográficos e ambientais relacionaram-se com as altas taxas de incidência da dengue e com a distribuição espacial heterogênea no estado do Paraná, indicando a necessidade do fortalecimento das ações de vigilância em saúde.

Atuação do sanitarista em município brasileiro de tríplice-fronteira: Covid-19 como emergência de saúde coletiva / Hygienist's practice in a triple-border Brazilian municipality: Covid-19 as a collective health emergency

Em virtude da atual crise sociossanitária decorrente da nova manifestação do coronavírus, este relato de experiência buscou descrever a inserção do profissional sanitarista no Departamento de Vigilância Epidemiológica de Foz do Iguaçu/PR, no âmbito da prevenção e combate à Covid-19 em território brasileiro de tríplice- fronteira (Argentina-Brasil-Paraguai). O trabalho privilegiou o diálogo entre a prática profissional e a formação acadêmica na modalidade de Residência Multiprofissional em Saúde da Família, buscando destacar as potencialidades da aprendizagem no trabalho através da perspectiva do cuidado integral à saúde nos diferentes ciclos da vida familiar. O sanitarista possui um perfil de atuação que visa o fortalecimento do Sistema Único de Saúde na atual conjuntura sociossanitária, estando altamente capacitado para lidar com questões relativas à vigilância em saúde, gestão das redes de cuidado, comunicação e educação em saúde e análise e planejamento situacional. (AU)

In view of the current sociosanitarian crisis caused by the new manifestation of the coronavirus, this experience report sought to describe the insertion of hygienist in the Department of Epidemiological Surveillance in Foz do Iguaçu/PR, in the scope of the prevention and fight against Covid-19 in a Brazilian triple-border municipality. This work privileged the dialogue between professional practice and academic training in the modality of Multiprofessional Residency in Family Health, seeking to highlight the potential of learning at work through the perspective of comprehensive health care in the different cycles of family life. The hygienist has a profile of action that aims to strengthen the Unified Health System in the current socio-health situation, being highly qualified to deal with issues related to health surveillance, management of healthcare networks, health communication and education and analysis and situational planning tasks. (AU)

Intervenções não farmacológicas como medidas de enfrentamento à pandemia de Covid-19 em município de fronteira / Non-pharmaceutical interventions as measures to tackle Covid-19 pandemic in a border town

As intervenções não farmacológicas são medidas de Saúde Pública que visam reduzir a transmissão de determinada doença. Em Foz do Iguaçu, fronteira entre Brasil, Paraguai e Argentina, a medida foi implementada como barreiras sanitárias objetivando identificar cidadãos sintomáticos respiratórios suspeitos de infecção por Covid-19. Realizou-se a implementação de 17 barreiras sanitárias em pontos estratégicos do município. O processo de monitoramento transcorreu a partir da elaboração de um formulário na ferramenta gratuita Epicollect5, tendo como resultado final o Painel de Monitoramento das Barreiras Sanitárias elaborado na plataforma Google Data Studio. Os resultados foram o aprimoramento da gestão na utilização de ferramentas livres de informação, a identificação dos casos sintomáticos no ato da abordagem nas barreiras sanitárias e a observação do fluxo transfronteiriço nesta região. Conclui-se que a estratégia de implementação e monitoramento das barreiras sanitárias utilizada é qualificada para sistematização e análise das informações em ferramentas livres de análise de dados. (AU)

The non-pharmaceutical interventions are public health measures that aim to reduce disease transmission. At Foz do Iguaçu, border city between Brazil, Paraguay, and Argentina, were implemented community measures as NPIs that aim to identify people with respiratory diseases symptoms suspected of coronavirus infection. Seventeen community measures were implemented in city strategic points. The monitoring process was carried out after data collection with a form created in the free tool Epicollect5, resulting in a Community Measure Monitoring Report developed in the Google Data Studio platform. The results were the management improvement in the use of information free tools, symptomatic cases identification in the inquiry and the cross-border flow observation in this region. In conclusion, implementation and monitoring strategies used are qualified to data analysis and systematization community measures data using free tools for data analysis. (AU)