Sexually transmitted infections on the border between Brazil and French Guiana.

Purpose: The border between the State of Amapa, Brazil, and French Guiana is mostly primary forest. In the Oyapock basin, socioeconomic circumstances have fueled sex work, gold mining and the circulation of sexually transmitted infections. Given the lack of comprehensive data on this border area, we describe the different sexually transmitted infections along the Brazil/French Guiana border and the testing and care activity. Methods: We conducted a review of the available scientific and technical literature on sexually transmitted infections in this complex border area. Temporal trends were graphed and for Human Immunodeficiency Virus (HIV) we estimated incidence using the European Center for prevention and Disease Control modeling tool. Results: Until 2019, 26 of the 46 HIV-infected patients followed and treated in Saint Georges de l'Oyapock were residing on the Brazilian side in Oiapoque. Virological suppression was only achieved for 75% of treated patients; but dropped to 62% during the COVID-19 epidemic. In 2019, cooperation efforts allowed HIV care in Oiapoque, resulting in the transfer of Brazilian patients previously followed on the French side and a substantial increase in the number of patients followed in Oiapoque. The average yearly HIV serological testing activity at the health center in Saint Georges was 16 tests per 100 inhabitants per year; in Camopi it was 12.2 per 100 inhabitants. Modeling estimated the number of persons living with HIV around 170 persons, corresponding to a prevalence of 0.54% and about 40 undiagnosed infections. The model also suggested that there were about 12 new infections per year in Saint Georges and Oiapoque, representing an HIV incidence rate of 3.8 cases per 10,000 per year. HPV prevalence in Saint Georges ranges between 25 and 30% and between 35 and 40% in Camopi. Testing activity for other sexually transmitted infections markedly increased in the past 5 years; the introduction of PCR for chlamydiasis and gonorrhea also had a substantial impact on the number of diagnoses. Conclusions: The ongoing cooperation between multiple partners on both sides of the border has led to remarkable progress in primary prevention, in testing efforts, in treatment and retention on both sides of the border. In a region with intense health professional turnover, nurturing cooperation and providing accurate assessments of the burden of sexually transmitted infections is essential to tackle a problem that is shared on both sides of the border.

Planejamento e gestão do processo de trabalho em saúde: avanços e limites no Subsistema de Atenção à Saúde Indígena do SUS / Planning and management of the health work process: advances and limits in the SUS-Indigenous Health Care Subsystem

Resumo O Subsistema de Atenção à Saúde Indígena (SasiSUS), como parte do Sistema Único de Saúde (SUS), é responsável pela atenção à saúde dos povos indígenas do Brasil. Em âmbito local, são os Distritos Sanitários Especiais Indígenas (DSEI) os responsáveis pela gestão, planejamento e organização do processo de trabalho das equipes multidisciplinares de saúde indígena (EMSI), que realizam a atenção primária à saúde para essa população. O objetivo do estudo foi analisar como ocorrem o planejamento e a gestão do processo de trabalho das EMSI. Foi realizado um estudo de casos múltiplos holístico, considerando sete DSEI como unidades de análise. A principal fonte de dados utilizada foi a entrevista e, de forma complementar, a observação direta. Os resultados indicaram que, de forma geral, o planejamento está presente na organização do processo de trabalho das equipes, com variações entre os DSEI. A efetivação das ações planejadas foi relacionada à disponibilidade de diferentes recursos: funcionamento adequado do sistema de informação e a articulação intra e intersetorial do SasiSUS. Como conclusão, apontou-se a necessidade de radicalização da participação no planejamento e na gestão, necessária a uma ação coordenada para garantia da atenção diferenciada e dos princípios do SUS.

Abstract The Indigenous Health Care Subsystem (SasiSUS), as part of the Brazilian National Health System (SUS), is responsible for health care for indigenous peoples in Brazil. At the local level, the Special Indigenous Health Districts (DSEI) are responsible for managing, planning, and organizing the work process of the multidisciplinary indigenous health teams (EMSI), which provide primary health care for this population. The objective of the study was to analyze how the planning and the management of the EMSI work process occurs. A holistic multiple-case study was carried out, considering seven DSEI as units of analysis. The main source of data used were interviews and, in a complementary way, direct observation. The results indicated that, in general, planning is present in the organization of the teams' work process, with variations between the DSEI. Carrying out the planned actions was related to the availability of different resources: adequate functioning of the information system and the intra and intersectoral articulation of SasiSUS. As a conclusion, the need to radicalize participation in planning and management, necessary for a coordinated action to guarantee differentiated care and the principles of SUS, was pointed out.

Time, space and health: using the life history calendar methodology applied to mobility in a medical-humanitarian organisation.

In the medical humanitarian context, the challenging task of collecting health information from people on the move constitutes a key element to identifying critical health care needs and gaps. Médecins Sans Frontières (MSF), during its long history of working with migrants, refugees and mobile populations in different contexts, has acknowledged how crucial it is to generate detailed context-related data on migrant and refugee populations in order to adapt the response interventions to their needs and circumstances. In 2019, the Brazilian Medical Unit/MSF developed the Migration History Tool (MHT), an application based on the life history method which was created in close dialogue with field teams in order to respond to information needs emerging from medical operations in mobile populations. The tool was piloted in two different contexts: firstly, among mobile populations transiting and living in Beitbridge and Musina, at the Zimbabwe-South Africa border; and, secondly, among Venezuelan migrants and refugees in Colombia. This article describes the implementation of this innovative method for collecting quantitative retrospective data on mobility and health in the context of two humanitarian interventions. The results have proven the flexibility of the methodology, which generated detailed information on mobility trajectories and on the temporalities of migration in two different contexts. It also revealed how health outcomes are not only associated with the spatial dimensions of movement, but also with the temporalities of mobility trajectories.

[Study of the evaluability of the Information System on Indigenous Health: potentialities and challenges for supporting local health administration]. / Estudo de avaliabilidade do Sistema de Informação da Atenção à Saúde Indígena: potencialidades e desafios para apoiar a gestão em saúde no nível local.

The article's objective is to present the results of the study on the evaluability of the Information System on Indigenous Health (SIASI) and its implications for local health administration. The study was performed with the following stages: description of the intervention, description of potential users, and context analysis (internal and external). The following data collection techniques were adopted: document analysis, interviews with key informants, and a workshop. Modeling of the SIASI in the Special Indigenous Health District Upper Solimões River (Amazonas State) and Special Indigenous Health District Eastern Roraima (Roraima State) allowed a schematic view of the system's mode of functioning, considering the peculiarities of the decentralized and centralized information flow. Context analysis pointed to acknowledgment of the SIASI as a tool for organization of the work process in the multidisciplinary indigenous health team (EMSI) and for follow-up of the health situation, despite low utilization of the information in the territories. Persistent challenges include infrastructure problems and fragmentation of information, causing an increase in rework in feeding the data. One key feature is the creation of the Local SIASI Panel, generating dynamic and interactive reports on the health situation. In conclusion, the capacity for use of the SIASI as a tool to support local management can be enhanced by expanding the decentralization of the information flow.

O objetivo do artigo é apresentar os resultados do estudo de avaliabilidade do Sistema de Informação da Atenção à Saúde Indígena (SIASI) e suas implicações para a gestão em saúde no nível local. O estudo foi desenvolvido com base nas seguintes etapas: descrição da intervenção, descrição dos usuários potenciais e análise de contexto (interno e externo). Para tanto, adotaram-se as seguintes técnicas de coleta de dados: análise documental, entrevistas com informantes-chave e oficina de trabalho. A modelização do SIASI no Distrito Sanitário Especial Indígena (DSEI) Alto Rio Solimões (Amazonas) e no DSEI Leste Roraima (Roraima) possibilitou a visualização esquemática do modo de funcionamento do sistema, considerando-se as peculiaridades do fluxo de informação descentralizado e centralizado. A análise de contexto aponta para o reconhecimento do SIASI como ferramenta para a organização do processo de trabalho das equipes multidisciplinares de saúde indígena (EMSI) e o acompanhamento da situação de saúde, ainda que ocorra baixa utilização das informações nos territórios. Entre os desafios, persistem os problemas de infraestrutura e a fragmentação das informações, provocando aumento do retrabalho na alimentação dos dados. Como potencialidade, destaca-se a criação do Painel SIASI Local, que gera relatórios dinâmicos e interativos sobre a situação de saúde. Conclui-se que a capacidade de utilização do SIASI como ferramenta de apoio à gestão pelo nível local pode ser potencializada com a ampliação do processo de descentralização do fluxo de informações.

El objetivo del artículo es presentar los resultados del estudio de evaluabilidad del Sistema de Información de Atención en Salud al Indígena (SIASI) y sus implicaciones para la gestión sanitaria en el nivel local. El estudio se desarrolló en base a las siguientes etapas: descripción de la intervención, descripción de los usuarios potenciales y análisis de contexto (interno y externo). Para tal fin se adoptaron las siguientes técnicas de recogida de datos: análisis documental, entrevistas con informantes-clave y taller de trabajo. La modelización del SIASI en el Distrito Sanitário Especial Indígena (DSEI) Alto Rio Solimões (Amazonas) y en el DSEI Leste Roraima (Roraima) posibilitó la visualización esquemática del modo de funcionamiento del sistema, considerándose las peculiaridades del flujo de información descentralizado y centralizado. El análisis de contexto apunta al reconocimiento del SIASI como herramienta para la organización del proceso de trabajo de los equipos multidisciplinares de salud indígena (EMSI) y el seguimiento de la situación de salud, aunque exista una baja utilización de la información en los territorios. Entre los desafíos persisten los problemas de infraestructura y fragmentación de la información, provocando un aumento del retrabajo en la alimentación de datos. Como potencialidad se destaca la creación del Panel SIASI Local que genera informes dinámicos e interactivos sobre la situación de salud. Se concluye que la capacidad de utilización del SIASI como herramienta de apoyo a la gestión por parte del nivel local puede potenciarse con la ampliación del proceso de descentralización del flujo de información.

Vulnerability of the HIV cascade of care in an Amazonian town: A qualitative study.

The HIV care cascade spans from diagnosis to patient linkage and retention in health services for treatment. Brazil has made substantial efforts to optimize the cascade of care. However, despite these advances, there are striking regional differences and difficulties from testing to treatment, particularly in the north and northeast regions, often reflecting social inequalities. Oiapoque, a highly affected city in the state of Amapá, shares its borders with an overseas European territory-French Guiana. The objective of this study was to get a clearer picture of the different components of the HIV care cascade in the municipality of Oiapoque. The study was exploratory and qualitative, involving the mapping of health structures in the research area and interviews with the responsible healthcare professionals working in the municipality. Patients are vulnerable at several levels, including mobility limitations, mismatched information that affects the linkage and retention of treatment, an absence of infectious disease doctors, an absence of user autonomy, missed appointments, dropouts, and abandonment of care. We found that the five recommended steps in the continuum of care for people living with HIV all had weak points or were non-existent or unavailable. These results will be fundamental to rethink the municipality's actions and the strategies of the Unified Health System SUS for the HIV epidemic in these border regions of the Amazon.

Human Mobility and Health: Exploring the Health Conditions of Venezuelan Migrants and Refugees in Colombia.

Médecins sans Frontières (MSF) conducted a study to identify health needs and access barriers of Venezuelan migrants and refugees at La Guajira and Norte de Santander Colombian border states. The Migration History tool was used to gather information that included various health-related issues such as referred morbidity, exposure to violence, mental health, and access to health care services. A group migration profile with long-term permanence plans was identified. Was evidenced an important share of young population (50% under 20), indigenous people (20%), and returnees (11%). The respondents referred to a mixed pattern of chronic and acute diseases, for which the main difficulty was accessing diagnosis and continuous treatment. Health-seeking behavior was identified as the main barrier to access health care services. The article compiles main findings on the Venezuelan migrants and refugees' health conditions, contributing important evidence for the humanitarian responses in migration contexts.

Estudo de avaliabilidade do Sistema de Informação da Atenção à Saúde Indígena: potencialidades e desafios para apoiar a gestão em saúde no nível local / Study of the evaluability of the Information System on Indigenous Health: potentialities and challenges for supporting local health administration / Estudio de evaluabilidad del Sistema de Información de Atención en Salud al Indígena: potencialidades y desafíos para apoyar la gestión en salud en el nivel local

O objetivo do artigo é apresentar os resultados do estudo de avaliabilidade do Sistema de Informação da Atenção à Saúde Indígena (SIASI) e suas implicações para a gestão em saúde no nível local. O estudo foi desenvolvido com base nas seguintes etapas: descrição da intervenção, descrição dos usuários potenciais e análise de contexto (interno e externo). Para tanto, adotaram-se as seguintes técnicas de coleta de dados: análise documental, entrevistas com informantes-chave e oficina de trabalho. A modelização do SIASI no Distrito Sanitário Especial Indígena (DSEI) Alto Rio Solimões (Amazonas) e no DSEI Leste Roraima (Roraima) possibilitou a visualização esquemática do modo de funcionamento do sistema, considerando-se as peculiaridades do fluxo de informação descentralizado e centralizado. A análise de contexto aponta para o reconhecimento do SIASI como ferramenta para a organização do processo de trabalho das equipes multidisciplinares de saúde indígena (EMSI) e o acompanhamento da situação de saúde, ainda que ocorra baixa utilização das informações nos territórios. Entre os desafios, persistem os problemas de infraestrutura e a fragmentação das informações, provocando aumento do retrabalho na alimentação dos dados. Como potencialidade, destaca-se a criação do Painel SIASI Local, que gera relatórios dinâmicos e interativos sobre a situação de saúde. Conclui-se que a capacidade de utilização do SIASI como ferramenta de apoio à gestão pelo nível local pode ser potencializada com a ampliação do processo de descentralização do fluxo de informações.

The article's objective is to present the results of the study on the evaluability of the Information System on Indigenous Health (SIASI) and its implications for local health administration. The study was performed with the following stages: description of the intervention, description of potential users, and context analysis (internal and external). The following data collection techniques were adopted: document analysis, interviews with key informants, and a workshop. Modeling of the SIASI in the Special Indigenous Health District Upper Solimões River (Amazonas State) and Special Indigenous Health District Eastern Roraima (Roraima State) allowed a schematic view of the system's mode of functioning, considering the peculiarities of the decentralized and centralized information flow. Context analysis pointed to acknowledgment of the SIASI as a tool for organization of the work process in the multidisciplinary indigenous health team (EMSI) and for follow-up of the health situation, despite low utilization of the information in the territories. Persistent challenges include infrastructure problems and fragmentation of information, causing an increase in rework in feeding the data. One key feature is the creation of the Local SIASI Panel, generating dynamic and interactive reports on the health situation. In conclusion, the capacity for use of the SIASI as a tool to support local management can be enhanced by expanding the decentralization of the information flow.

El objetivo del artículo es presentar los resultados del estudio de evaluabilidad del Sistema de Información de Atención en Salud al Indígena (SIASI) y sus implicaciones para la gestión sanitaria en el nivel local. El estudio se desarrolló en base a las siguientes etapas: descripción de la intervención, descripción de los usuarios potenciales y análisis de contexto (interno y externo). Para tal fin se adoptaron las siguientes técnicas de recogida de datos: análisis documental, entrevistas con informantes-clave y taller de trabajo. La modelización del SIASI en el Distrito Sanitário Especial Indígena (DSEI) Alto Rio Solimões (Amazonas) y en el DSEI Leste Roraima (Roraima) posibilitó la visualización esquemática del modo de funcionamiento del sistema, considerándose las peculiaridades del flujo de información descentralizado y centralizado. El análisis de contexto apunta al reconocimiento del SIASI como herramienta para la organización del proceso de trabajo de los equipos multidisciplinares de salud indígena (EMSI) y el seguimiento de la situación de salud, aunque exista una baja utilización de la información en los territorios. Entre los desafíos persisten los problemas de infraestructura y fragmentación de la información, provocando un aumento del retrabajo en la alimentación de datos. Como potencialidad se destaca la creación del Panel SIASI Local que genera informes dinámicos e interactivos sobre la situación de salud. Se concluye que la capacidad de utilización del SIASI como herramienta de apoyo a la gestión por parte del nivel local puede potenciarse con la ampliación del proceso de descentralización del flujo de información.

Desigualdade social e vulnerabilidade dos povos indígenas no enfrentamento da Covid-19: um olhar dos atores nas lives / Social inequality and vulnerability of Indigenous peoples facing COVID-19: a perspective by stakeholders in the lives

RESUMO A pandemia da Covid-19 tem evidenciado as profundas desigualdades da sociedade brasileira para o enfrentamento adequado dessa catástrofe sanitária. Este estudo buscou compreender as repercussões da Covid-19 nos povos indígenas brasileiros e a sua forma de organização no contexto de desigualdade social e vulnerabilidade. Realizou-se uma pesquisa qualitativa a partir da análise de lives. A busca foi feita via plataforma YouTube usando como descritores "coronavírus e indígena" e "covid e população indígena", totalizando 56 lives - que permitiram analisar diversos olhares para o enfrentamento da pandemia, sendo evidente que o ponto de partida para prevenção, vigilância, atenção em saúde e comunicação da Covid-19 entre os povos indígenas é totalmente diferente do resto da população. O protagonismo da sociedade civil indígena está sendo extremamente relevante para o enfrentamento da pandemia. A profunda desigualdade social e as múltiplas vulnerabilidades dos povos indígenas são realidades que devem ser entendidas para superar os enormes desafios produzidos, não somente pela Covid-19, mas fundamentalmente pelo atual contexto de invisibilização, desconhecimento e ataque às sociedades indígenas brasileiras. O controle social ficou muito fragilizado, e urge seu fortalecimento para criar um modelo de saúde diferenciado que realmente contemple os interesses e modos de vida desses povos.

ABSTRACT The COVID-19 pandemic has highlighted the deep inequalities of Brazilian society to address this health-related catastrophe. This study aimed to understand the repercussions of COVID-19 on Brazilian Indigenous peoples and how they organize in the context of social inequalities and vulnerabilities. Qualitative research was conducted based on the analysis of 'lives'. The search was performed on YouTube using descriptors "coronavirus and Indigenous" and "COVID and Indigenous population", totaling 56 live events, which allowed us to analyze different perspectives on the fight against the pandemic showing that the starting point for COVID-19 prevention, surveillance, health care, and communication among Indigenous peoples is different from the rest of the population. The leading role of the Indigenous civil society is highly relevant to the fight against the pandemic. The profound inequality and the multiple vulnerabilities of Indigenous peoples are realities that must be understood to overcome the enormous challenges produced not only by COVID-19 and, fundamentally, the current context of invisibility, ignorance, and attack on Brazilian Indigenous societies. Social control has been weakened, and its strengthening is urgent to create a differentiated health model that considers these people's interests and ways of life.

Analysis of climate factors and dengue incidence in the metropolitan region of Rio de Janeiro, Brazil.

Dengue is a re-emerging disease, currently considered the most important mosquito-borne arbovirus infection affecting humankind, taking into account both its morbidity and mortality. Brazil is considered an endemic country for dengue, such that more than 1,544,987 confirmed cases were notified in 2019, which means an incidence rate of 735 for every 100 thousand inhabitants. Climate is an important factor in the temporal and spatial distribution of vector-borne diseases, such as dengue. Thus, rainfall and temperature are considered macro-factors determinants for dengue, since they directly influence the population density of Aedes aegypti, which is subject to seasonal fluctuations, mainly due to these variables. This study examined the incidence of dengue fever related to the climate influence by using temperature and rainfall variables data obtained from remote sensing via artificial satellites in the metropolitan region of Rio de Janeiro, Brazil. The mathematical model that best fits the data is based on an auto-regressive moving average with exogenous inputs (ARMAX). It reproduced the values of incidence rates in the study period and managed to predict with good precision in a one-year horizon. The approach described in present work may be replicated in cities around the world by the public health managers, to build auxiliary operational tools for control and prevention tasks of dengue, as well of other arbovirus diseases.

Zika epidemic and microcephaly in Brazil: Challenges for access to health care and promotion in three epidemic areas.

Since 2015 Brazil has experienced the social repercussions of the Zika virus epidemic, thus raising a debate about: difficulties of diagnosis; healthcare access for children with Zika Congenital Syndrome (ZCS); the search for benefits by affected families; social and gender inequalities; and a discussion on reproductive rights, among others. The objective of this article is to analyse access to specialized health services for the care of children born with ZCS in three North-eastern states of Brazil. This is an exploratory cross-sectional study which analyses recorded cases of microcephaly at the municipal level between 2015 and 2017. Most of the cases of ZCS were concentrated on the Northeast coast. Rio Grande do Norte and Paraiba had the highest incidence of microcephaly in the study period. The states of Bahia, Paraiba and Rio Grande do Norte were selected for their high incidence of microcephaly due to the Zika Virus. Socio-territorial vulnerability was stratified using access to microcephaly diagnosis and treatment indicators. The specialized care network was mapped according to State Health Secretaries Protocols. A threshold radius of 100 km was stablished as the maximum distance from municipalities centroids to specialised health care for children with microcephaly. Prenatal coverage was satisfactory in most of the study area, although availability of ultrasound equipment was uneven within states and health regions. Western Bahia had the lowest coverage of ultrasound equipment and lacked health rehabilitation services. ZCS's specialized health services were spread out over large areas, some of which were outside the affected patients' home municipalities, so displacements were expensive and very time consuming, representing an extra burden for the affected families. This study is the first to address accessibility of children with microcephaly to specialised health care services and points to the urgent need to expand coverage of these services in Brazil, especially in the northeastern states, which are most affected by the epidemic.

Contributing to Elimination of Cross-Border Malaria Through a Standardized Solution for Case Surveillance, Data Sharing, and Data Interpretation: Development of a Cross-Border Monitoring System.

BACKGROUND: Cross-border malaria is a significant obstacle to achieving malaria control and elimination worldwide. OBJECTIVE: This study aimed to build a cross-border surveillance system that can make comparable and qualified data available to all parties involved in malaria control between French Guiana and Brazil. METHODS: Data reconciliation rules based on expert knowledge were defined and applied to the heterogeneous data provided by the existing malaria surveillance systems of both countries. Visualization dashboards were designed to facilitate progressive data exploration, analysis, and interpretation. Dedicated advanced open source and robust software solutions were chosen to facilitate solution sharing and reuse. RESULTS: A database gathering the harmonized data on cross-border malaria epidemiology is updated monthly with new individual malaria cases from both countries. Online dashboards permit a progressive and user-friendly visualization of raw data and epidemiological indicators, in the form of time series, maps, and data quality indexes. The monitoring system was shown to be able to identify changes in time series that are related to control actions, as well as differentiated changes according to space and to population subgroups. CONCLUSIONS: This cross-border monitoring tool could help produce new scientific evidence on cross-border malaria dynamics, implementing cross-border cooperation for malaria control and elimination, and can be quickly adapted to other cross-border contexts.

Análise de dimensões do acesso à saúde das crianças com Síndrome Congênita de Zika (SCZ) na Região Metropolitana do Rio de Janeiro / Dimensional analysis of access to health of children with Congenital Zika Syndrome (CZS) in the Metropolitan Region of Rio de Janeiro

Resumo Desde 2015 a população brasileira vive com as repercussões da epidemia de Zika, levantando o debate sobre as dificuldades de diagnóstico e acesso aos cuidados para crianças com Síndrome Congênita do Zika. As regiões Nordeste e Sudeste foram as mais atingidas, desafiando-nos a caracterizar o acesso à saúde das crianças portadoras da Síndrome Congênita do Zika nessas regiões. O objetivo deste artigo é analisar a disponibilidade e a acessibilidade dos serviços de saúde para a reabilitação das crianças com Síndrome Congênita do Zika na Região Metropolitana do Rio de Janeiro. A metodologia consistiu no mapeamento dos casos de Síndrome Congênita do Zika entre 2015 e 2017 na Região Metropolitana do Rio de Janeiro por bairros de residência e relacionados com a localização das unidades de reabilitação indicadas no Protocolo da Secretaria de Estado de Saúde do Rio de Janeiro. Como resultado foram identificados 202 casos de Síndrome Congênita do Zika na Região Metropolitana do Rio de Janeiro no período de 2015 a 2017. A região teve 85% de todos os casos do estado do Rio de Janeiro, o município do Rio de Janeiro concentrou 63% dos casos. A acessibilidade nesse município é a melhor se comparada com os demais da região metropolitana, dado que é a capital do estado e concentra grande parte dos serviços especializados em saúde materno-infantil.

Abstract Since 2015, the Brazilian population has lived with the repercussions of the Zika epidemic, raising the debate on the difficulties of diagnosis and access to care for children with Congenital Zika Syndrome (CZS). The Northeast and Southeast regions were the hardest hit, challenging us to characterize the access to health of children with ZCS in these regions. The aim of this paper is to analyse the availability and accessibility of health services for the rehabilitation of children with CZS in the Rio de Janeiro Metropolitan Region (RMRJ). The methodology consisted of mapping the cases of CZS between 2015 and 2017 in RJRM by neighbourhoods of residence and related to the location of rehabilitation units indicated in the Protocol of the Rio de Janeiro State Secretariat of Health (SES/RJ). As a result, 202 cases of CZS were identified in the RMRJ from 2015 to 2017. The RMRJ had 85% of all cases in the state of Rio de Janeiro, the municipality of Rio de Janeiro concentrated 63% of the cases. Accessibility in this municipality is better compared to the others in the RMRJ, as it is the state capital and concentrates most of the specialized services in maternal and child health.

Malária na fronteira do Brasil com a Guiana Francesa: a influência dos determinantes sociais e ambientais da saúde na permanência da doença / Malaria in the borders between Brazil and French Guiana: social and environmental health determinants and their influence on the permanence of the disease

Resumo O objetivo deste artigo é analisar a influência dos determinantes socioambientais da saúde na incidência de malária por Plasmodium vivax na fronteira franco-brasileira. O estudo foi realizado entre 2011 e 2015, no município de Oiapoque (AP), na Amazônia brasileira. Foram incluídos na amostra 253 indivíduos de ambos os sexos, de 10 a 60 anos de idade. Houve predominância de 63,64% (161/253) de casos de malária em adultos do sexo masculino. A faixa etária mais acometida foi de 20 a 29 anos, com 30% (76/253); 84,6% (214/253) dos pacientes não concluíram o ensino médio, e 29,6% (75/253) não concluíram o ensino primário. No aspecto ambiental, houve correlação negativa entre as precipitações pluviométricas e a incidência da malária por P. vivax (p=0,0026). Em termos de mobilidade, constatou-se considerável proporção de migrantes provenientes dos estados do Pará e do Maranhão (55,73%; 141/253). Por fim, os dados apontaram que 31,23% (79/253) dos casos de malária foram importados da Guiana Francesa. Em síntese, a transmissão da malária na fronteira franco-brasileira envolve fatores ecológico-ambientais, biológicos e sociais que se expressam na elevada vulnerabilidade social da população que vive e circula na zona fronteiriça, favorecendo a ocorrência de surtos e a permanência da enfermidade.

Abstract This study analyzes the influence of socio-environmental health determinants on the maintenance of Plasmodium vivax malaria at the borders between French Guiana and Brazil. This study was carried out between 2011 and 2015 in the city of Oiapoque, Amapá, situated in the Brazilian Amazon region. The sample included 253 individuals of both sexes aged between 10 and 60 years. The disease was predominant in 63.64% (161/253) adult males. The most affected age group was 20 to 29 years old, with 30% (76/253). About 84.6% did not complete high school, while 29.6% (75/253) of the cases had not finished the first degree. Concerning the environmental aspect, negative correlation was observed between rainfall and the incidence of P. vivax malaria (p=0.0026). In terms of mobility, there was a considerable influx of migrants from the states of Pará and Maranhão, with 55.73% (141/253). Lastly, the data indicated that 31.23% (79/253) of malaria cases were imported from French Guiana. In summary, the transmission of malaria in these particular borders involved ecological, environmental, biological and social factors, which are expressed in the high social vulnerability of the population living and circulating in the border zone, favoring the occurrence of outbreaks and the maintenance of the disease.

Malaria and fish farming in the Brazilian Amazon Region: a strengths, weaknesses, opportunities, and threats analysis.

INTRODUCTION: The fish farming program in Acre is as an alternative program to generate income and employment and has promising regional, national, and international markets. While the economic importance of fish farming in the Jurua Region is clear, one must address its contribution to increase malaria transmission. METHODS: This was a qualitative study. The answers of the 16 key informants were organized into the following: (1) the healthcare services structure; (2) conscience, perception, and behaviors; and (3) socioeconomic and political issues. Each answer was classified as weaknesses, strengths, opportunities, and threats. RESULTS: Regarding healthcare services, the frequency of household visits was reduced, and subjects presenting with malaria symptoms were required to visit a healthcare unit to be diagnosed and treated. Regarding individual's conscience, perception, and behavior, malaria was considered an insignificant disease, and a large proportion of the population were engaged in health practices that put them at risk in contacting with malaria vectors. Regarding political and economic issues, there were economic and infrastructure barriers for the development of a productive activity, and the insufficient credit or formalization of their properties prevented their access to governmental incentives and the financial market. CONCLUSIONS: Support to fish farmers for low-cost inputs was not observed, and appropriate knowledge regarding the impact of the absence of maintenance and abandonment of fish tanks was insufficient. Moreover, insufficient healthcare services prevented not only the treatment of individuals with malaria but also the control of this disease.

Spatial spread of malaria and economic frontier expansion in the Brazilian Amazon.

The temporal and spatial evolution of malaria was described for the postfrontier phase of the Brazilian Amazon in 2003-2013. The current ecological study aimed to understand the relationship between spatial population mobility and the distribution of malaria cases. The study identified epidemiologically relevant areas using regional statistical modeling and spatial analyses that considered differential infections and types of work activities. Annual parasite incidence (API) in the region was highest in hotspots along the Amazon River and in the south and west settlement zone of Hiléia, with concentrations in environmental protection areas and açaí and Brazil nut extraction areas. The dispersal force decreased in the Central Amazon due to rapid urbanization and improved socioeconomic conditions for workers in consolidated settlement areas. The study characterized the spatial patterns of disease transmission according to the economic activity and regionalization of geographic areas, confirming that the incidence of infection by work activity and labor flow is linked to extractive activities and agricultural settlements.

Imported malaria in Rio de Janeiro state between 2007 and 2015: an epidemiologic approach.

Imported malaria is a malaria infection diagnosed outside the area where it was acquired and is induced by human migration and mobility. This retrospective study was performed based on secondary data from 2007 to 2015. In total, 736 cases of imported malaria (79.7% of 923 cases) were recorded in Rio de Janeiro state. Of the imported cases, 55.3% came from abroad, while 44.7% came from other regions of Brazil. Most cases of imported malaria in Brazil (85.5%) originated in Amazônia Legal, and Burundi (Africa) accounted for 59% of the cases from abroad. Analyses of the determinants of imported malaria in Rio de Janeiro state must be continued to understand the relationship between the origin and destination of cases.

Complex malaria epidemiology in an international border area between Brazil and French Guiana: challenges for elimination.

BACKGROUND: The epidemiological surveillance of malaria is a necessary intervention for eliminating the disease from the planet. The international border zones of the Amazon continue to be highly vulnerable to malaria since population mobility impedes elimination. Although in the past few years, cases of malaria have had an essential reduction in Brazil, this trend was not confirmed in municipalities along the border. This study aimed to establish the epidemiology of the disease during the last 13 years in Oiapoque, a Brazilian municipality at the international border with French Guiana, an overseas department, to develop strategies for the control/elimination of malaria in these areas. RESULTS: Data collected from 2003 to 2015 from the Malaria Epidemiological Surveillance System was used. It was found that, despite the important reduction in cases (68.1%), the annual parasite index remained a high epidemiological risk. The disease is seasonal in that the period of highest transmission occurs between September and December. Between 2003 and 2015, eight outbreaks were identified, with one of these lasting 15 months between August 2006 and October 2007. There were changes in the epidemiological profile, with imported cases representing 67.7% of cases from 2003 to 2007 and representing 32.9% of cases from 2008 to 2015 (p < 0.01). The greatest number of cases was among Brazilians coming from the artisanal gold mines of French Guiana. There were also changes in the profile of autochthonous malaria with an increase in urban cases from 14.3% in 2003 to 32.3% in 2015 (p < 0 .01). The burden of malaria in indigenous areas was also very high (67.3% in rural areas) in 2015. There were changes in the parasite species profile with a significant decrease of cases of Plasmodium falciparum (p = 0.01). Children under 15 years old, representing 9.7% of cases at the onset of the study, accounted for 34.2% of case notifications (p < 0.01) in 2015. Also, 74% of cases in 2003 and 55.9% in 2015 (p < 0.01) were among men. CONCLUSIONS: The fragility of local health services in cross-border areas continues to be an obstacle for malaria elimination.

Homeless crack cocaine users: Territories and territorialities in the constitution of social support networks for health.

Homeless crack users are an important segment of the population living in extreme vulnerability in Brazil. In 2011, the Consultório na Rua - CnaR (Street Clinic) was created, to improve access to health care for this population. Considering building up social support networks as a strategy to face life's difficulties, this study aims to analyse how crack users, in Rio de Janeiro, relate to territory and build social support networks to deal with their everyday life challenges and health needs. We carried out in-depth interviews with 10 homeless crack users assisted by CnaR and 11 health professionals; one Focus Group with 6 users, and Participant Observation of CnaR's work during 2014-2016. Methodology was based on the use of an analytical matrix with theoretical and empirical categories of "Territory", "Territoriality", "Social Support Networks" and "Gift". Results revealed crack users' territorialities, alternating moments of concentration and disaggregation with high geographical mobility, except in periods of strong consumption of crack. Territorialities are unstable, marked by violent Police repression. In spite of the stories of losses and ruptures, forms of sociability among users and CnaR professionals were identified, as well as with different actors in the territory. All this favoured the formation of supportive networks providing friendship, health care, and other material and symbolic goods. The systematization of the users' informal networks, usually invisible to workers and administrators, is relevant because of its potential to expand the production of care and strengthen the associations in the territory. To understand users' territorialities and the social support networks formed in their everyday life is not only innovative, but also contributes to the formulation of public policies that aim to guarantee civil rights to people in a situation of vulnerability, suffering and social exclusion.