Is Brazil reaching malaria elimination? A time series analysis of malaria cases from 2011 to 2023.

In Brazil, 99% of malaria cases occur in the Amazon region, mainly caused by Plasmodium vivax (~83%) and Plasmodium falciparum (Pf) species. Aligned with the Sustainable Development Goals, Brazil aims to eliminate autochthonous malaria by 2035. This study aims to analyse epidemiological patterns of malaria in Brazil to discuss if Brazil is on track to meet malaria control targets. A time-series study was conducted analysing autochthonous malaria new infections notifications in the Brazilian Amazon region from 2011 until June 2023. Descriptive analyses were conducted, along with joinpoint regression and forecast models to verify trend and future behaviour. A total of 2,067,030 malaria cases were reported in the period. Trend analysis indicated a decreasing trend in all malaria infections since late 2017 (monthly reduction = 0.81%, p-value <0.05), while Pf infections have increased progressively since 2015 (monthly increase = 0.46%, p-value <0.05). Forecast models predict over 124,000 malaria cases in 2023 and over 96,000 cases in 2024. Predictions for Pf infections are around 23,900 cases in 2023 and 22,300 in 2024. Cases in indigenous population villages are predicted to reach 48,000 cases in 2023 and over 51,000 in 2024. In gold mining areas it is expected over 21,000 cases in 2023 and over 20.000 in 2024. Malaria elimination in Brazil has advanced over the last decade, but its speed has slowed. The country exhibits noteworthy advancements in the reduction of overall malaria cases. It is imperative, however, to proactively target specific issues such as the incidence raise among indigenous populations and in gold mining areas. Pf infections remain a persistent challenge to control in the country and may require novel measures for containment. Current government supporting actions towards combating illegal goldmining activities and protecting indigenous populations may help malaria control indicators for the following years.

Record Linkage for Malaria Deaths Data Recovery and Surveillance in Brazil.

OBJECTIVE: The objective is to describe the results and the methodological processes of record linkage for matching deaths and malaria cases. METHODS: A descriptive cross-sectional study was conducted with probabilistic record linkage of death and malaria cases data in Brazil from 2011 to 2020 using death records from the Mortality Information System (SIM) and epidemiological data from the Notifiable Diseases Information System (Sinan) and Epidemiological Surveillance Information Systems for malaria (Sivep-Malaria). Three matching keys were used: patient's name, date of birth, and mother's name, with an analysis of cosine and Levenshtein dissimilarity measures. RESULTS: A total of 490 malaria deaths were recorded in Brazil between 2011 and 2020. The record linkage resulted in the pairing of 216 deaths (44.0%). Pairings where all three matching keys were identical accounted for 30.1% of the total matched deaths, 39.4% of the matched deaths had two identical variables, and 30.5% had only one of the three key variables identical. The distribution of the variables of the matched deaths (216) was similar to the distribution of all recorded deaths (490). Out of the 216 matched deaths, 80 (37.0%) had poorly specified causes of death in the SIM. CONCLUSIONS: The record linkage allowed for the detailing of the data with additional information from other epidemiological systems. Record linkage enables data linkage between information systems that lack interoperability and is an extremely useful tool for refining health situation analyses and improving malaria death surveillance in Brazil.

Assessing the impact of the "malaria supporters project" intervention to malaria control in the Brazilian Amazon: an interrupted time-series analysis.

BACKGROUND: In 2021, Brazil was responsible for more than 25% of malaria cases in the Americas. Although the country has shown a reduction of cases in the last decades, in 2021 it reported over 139,000 malaria cases. One major malaria control strategy implemented in Brazil is the "Malaria Supporters Project", which has been active since 2012 and is directed to municipalities responsible for most Brazil's cases. The objective of this study is to analyse the intervention effect on the selected municipalities. METHODS: An ecological time-series analysis was conducted to assess the "Malaria Supporters Project" effect. The study used data on Annual Parasitic Incidence (API) spanning the period from 2003 to 2020 across 48 intervention municipalities and 88 control municipalities. To evaluate the intervention effect a Prais-Winsten segmented regression model was fitted to the difference in malaria Annual Parasitic Incidence (API) between control and intervention areas. RESULTS: The intervention group registered 1,104,430 cases between 2012 and 2020, a 50.6% reduction compared to total cases between 2003 and 2011. In 2020 there were 95,621 cases, 50.4% fewer than in 2011. The number of high-risk municipalities (API > 50 cases/1000) reduced from 31 to 2011 to 17 in 2020. The segmented regression showed a significant 42.0 cases/1000 residents annual decrease in API compared to control group. CONCLUSIONS: The intervention is not a silver bullet to control malaria, but it has reduced API in locations with high malaria endemicity. Furthermore, the model has the potential to be replicated in other countries with similar epidemiological scenarios.

The role of pets in SARS-CoV-2 transmission: an exploratory analysis.

PURPOSE: There is evidence that humans can transmit SARS-CoV-2 to cats and dogs. However, there is no evidence that they can transmit it back to humans or play any role in SARS-CoV-2 transmission. Here, we present an exploratory analysis on that matter. METHODS: We conducted a case-control study with participants with flu-like symptoms seeking care at a primary healthcare unit to be tested for COVID-19. They were asked if they owned pet cats and/or dogs in their residences, and this variable was evaluated as exposure. RESULTS: The odds ratio of "having dogs and/or cats in the residence" was 1.29 (95% CI 1.08-1.54) of "having only dogs and no cats" was 1.26 (1.05-1.52), and "no dogs and only cats" was 1.29 (0.95-1.75). CONCLUSION: Having a cat/dog in the house can affect the risk of infection by SARS-CoV-2.

Drinking Water Quality Surveillance Information System (SISAGUA): evaluation of data completeness on water supply coverage, Brazil, 2014-2020. / Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano (Sisagua): avaliação da completitude dos dados sobre cobertura de abastecimento, 2014-2020.

OBJECTIVE: To evaluate the completeness of dataset of the Drinking Water Quality Surveillance Information System (SISAGUA) regarding information on the coverage of water supply for human consumption in Brazil. METHODS: This was a descriptive study on data between 2014 and 2020. A relative frequency distribution of 35 variables was calculated. Completeness was categorized as excellent (≥ 95%), good (90% to 94%), regular (70% to 89%), poor (50% to 69%) and very poor (≤ 49%). RESULTS: In the period, there were 861,250 records of forms of water supply. With regard to data completeness, SISAGUA obtained an excellent classification for 25 variables, good for two, regular for three, poor for one and very poor for four variables. CONCLUSION: The system showed excellent data completeness for most of the variables. This type of study contributes to the continuous improvement of SISAGUA and enables the identification of inconsistencies and weaknesses.

Drinking Water Quality Surveillance Information System (Sisagua): evaluation of data completeness on water supply coverage, Brazil, 2014-2020 / Sistema de Información de Vigilancia de la Calidad del Agua para Consumo Humano (Sisagua): evaluación de la finalización de dos datos de cobertura de abastecimiento de agua, Brasil, 2014-2020 / Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano ­ Sisagua ­: avaliação da completitude dos dados sobre cobertura de abastecimento, Brasil, 2014-2020

Objective: to evaluate the completeness of the dataset of the Information System for the Surveillance of the Quality of Water for Human Consumption (Sisagua) regarding the information on the coverage of water supply for human consumption in Brazil. Methods: Descriptive study referring to data from 2014 to 2020. Relative frequency distribution of 35 variables were calculated. Completeness was measured as excellent (≥95%), good (90% to 94%), fair (70% to 89%), poor (50% to 69%) and very poor (≤49%). Results: In the period, there were 861,250 records of forms of supply. Sisagua, regarding the completeness of the data, obtained an excellent classification for 25 variables, good for two, bad for four and very bad for four other variables. Conclusion: The system presented in most of the variables an excellent completeness of the data. Studies of this nature contribute to the continuous improvement of Sisagua and make it possible to identify inconsistencies and weaknesses.

Objetivo: evaluar la completitud del conjunto de datos del Sistema de Información para la Vigilancia de la Calidad del Agua para Consumo Humano (Sisagua) en cuanto a la información sobre la cobertura de abastecimiento de agua para consumo humano en Brasil. Métodos: Estudio descriptivo referido a datos de 2014 a 2020. Se calcularon distribuciones de frecuencias relativas de 35 variables. La completitud se midió como excelente (≥95%), buena (90% a 94%), regular (70% a 89%), mala (50% a 69%) y muy mala (≤49%). Resultados: En el período, hubo 861.250 registros de formas de suministro. Sisagua, en cuanto a la completitud de los datos, obtuvo una clasificación excelente para 25 variables, buena para dos, mala para cuatro y muy mala para otras cuatro variables. Conclusión: El sistema presentó en la mayoría de las variables una excelente completitud de los datos. Estudios de esta naturaleza contribuyen a la mejora continua de Sisagua y permiten identificar inconsistencias y debilidades.

Objetivo: avaliar a completitude do conjunto de dados do Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano (Sisagua) referente às informações sobre a cobertura de abastecimento de água para consumo humano no Brasil. Métodos: Estudo descritivo, sobre dados de 2014 a 2020. Foi calculada distribuição de frequência relativa de 35 variáveis. A completitude foi mensurada como excelente (≥95%), boa (90 a 94%), regular (70 a 89%), ruim (50 a 69%) e muito ruim (≤49%). Resultados: No período, foram 861.250 registros de formas de abastecimento. O Sisagua, quanto à completitude dos dados, obteve uma classificação excelente para 25 variáveis, boa para duas, ruim para quatro e muito ruim para outras quatro. Conclusão: O sistema apresentou, em grande parte das variáveis, excelente completitude dos dados. Estudos dessa natureza contribuem para o aperfeiçoamento contínuo do Sisagua e possibilitam a identificação de inconsistências e fragilidades.

Malaria time series in the extra-Amazon region of Brazil: epidemiological scenario and a two-year prediction model.

BACKGROUND: In Brazil, malaria is caused mainly by the Plasmodium vivax and Plasmodium falciparum species. Its transmission occurs in endemic and non-endemic areas. Malaria geography in Brazil has retracted and is now concentrated in the North region. The Brazilian Amazon region accounts for 99% of Brazil's cases. Brazil's extra-Amazon region has a high frequency of imported cases and in 2019 presented a mortality rate 123 times higher than the Amazon region. Extra-Amazon cases present risks of reintroduction. This study aims to characterize the epidemiological scenario for malaria in the extra-Amazon region of Brazil from 2011 to 2020 with a two-year forecast. METHODS: Time-series study with description of malaria cases and deaths registered in Brazilian extra-Amazon region from 2011 to 2020. Public data from the Notifiable Diseases Information System (Sinan) and the Mortality Information System (SIM) were used. Descriptive analysis, incidence, and notification rates were calculated. Flow charts analysed the flux between Places of Probable Infection (PI) and places of notification. The prediction model utilized a multiplicative Holt-winters model for trend and seasonality components. RESULTS: A total of 6849 cases were registered. Cases were predominantly white males with 9 to 11 years of education, mostly between 30 and 39 years old. Imported cases accounted for 78.9% of cases. Most frequent occupations for imported cases are related to travelling and tourism activities. Among autochthonous cases, there is a higher frequency of agriculture and domestic economic activities. In the period there were 118 deaths due to malaria, of which 34.7% were caused by P. falciparum infections and 48.3% were not specified. The most intense flows of imported cases are from Amazonas and Rondônia to São Paulo, Rio de Janeiro, and Paraná. The prediction estimates around 611 cases for each of the following two years. CONCLUSION: The time series allows a vast epidemiological visualization with a short-term prediction analysis that supports public health planning. Government actions need to be better directed in the extra-Amazon region so the objective of eliminating malaria in Brazil is achieved. Carrying out quality assessments for information systems and qualifying personnel is advisable. Malaria outside the Amazon region is mainly due to imported cases and delay in diagnosis is associated with a higher fatality rate. Better strategies to diagnose and treat suspected cases can lead to lower risk of deaths and local outbreaks that will be important for achieving malaria elimination in Brazil.

Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano (Sisagua): avaliação da completitude dos dados sobre cobertura de abastecimento, 2014-2020 / Sistema de Información de Vigilancia de la Calidad del Agua para Consumo Humano (Sisagua): evaluación de la finalización de los datos de cobertura del abastecimiento de agua, Brasil, 2014-2020 / Drinking Water Quality Surveillance Information System (SISAGUA): evaluation of data completeness on water supply coverage, Brazil, 2014-2020

Objetivo: Avaliar a completitude do conjunto de dados do Sistema de Informação de Vigilância da Qualidade da Água para Consumo Humano (Sisagua) referente às informações sobre a cobertura de abastecimento de água para consumo humano no Brasil. Métodos: Estudo descritivo, sobre dados de 2014 a 2020. Foi calculada distribuição de frequência relativa de 35 variáveis. A completitude foi mensurada como excelente (≥ 95%), boa (90% a 94%), regular (70% a 89%), ruim (50% a 69%) e muito ruim (≤ 49%). Resultados: No período, foram identificados 861.250 registros de formas de abastecimento. O Sisagua, quanto à completitude dos dados, obteve uma classificação excelente para 25 variáveis, boa para duas, regular para três, ruim para uma e muito ruim para quatro. Conclusão: O sistema apresentou, em grande parte das variáveis, excelente completitude dos dados. Estudos dessa natureza contribuem para o aperfeiçoamento contínuo do Sisagua e possibilitam a identificação de inconsistências e fragilidades.

Objetivo: Evaluar la completitud del conjunto de datos del Sistema de Información para la Vigilancia de la Calidad del Agua para Consumo Humano (Sisagua), con relación a la información sobre la cobertura de abastecimiento de agua para consumo humano en Brasil. Métodos: Estudio descriptivo referido a datos de 2014 a 2020. Se calcularon distribuciones de frecuencias relativas de 35 variables. La completitud se midió como excelente (≥ 95%), buena (90% a 94%), regular (70% a 89%), mala (50% a 69%) y muy mala (≤ 49%). Resultados: En el período, hubo 861.250 registros de formas de suministro. Sisagua, en cuanto a la completitud de los datos, obtuvo una clasificación excelente para 25 variables, buena para dos, regular para tres, mala para una y muy mala para cuatro variables. Conclusión: El sistema presentó en la mayoría de las variables una excelente completitud de los datos. Estudios de esta naturaleza contribuyen a la mejoría continua de Sisagua y permiten identificar inconsistencias y debilidades.

Objective: To evaluate the completeness of dataset of the Drinking Water Quality Surveillance Information System (SISAGUA) regarding information on the coverage of water supply for human consumption in Brazil. Methods: This was a descriptive study on data between 2014 and 2020. A relative frequency distribution of 35 variables was calculated. Completeness was categorized as excellent (≥ 95%), good (90% to 94%), regular (70% to 89%), poor (50% to 69%) and very poor (≤ 49%). Results: In the period, there were 861,250 records of forms of water supply. With regard to data completeness, SISAGUA obtained an excellent classification for 25 variables, good for two, regular for three, poor for one and very poor for four variables. Conclusion: The system showed excellent data completeness for most of the variables. This type of study contributes to the continuous improvement of SISAGUA and enables the identification of inconsistencies and weaknesses.

Factors associated with Leishmania infection in dogs and geospatial analysis in the Sertão of Paraíba, Northeast Brazil.

Visceral leishmaniasis (VL) is a zoonosis with a worldwide distribution that has a major impact on public health. The aim of this study was to verify the prevalence of canine infection by Leishmania infantum, the factors associated with the infection and its spatial distribution in the municipality of Mãe D'Água, in the Sertão region of Paraíba State, Northeast Brazil. Blood samples were collected from 150 dogs for diagnosis by the DPP®, ELISA-S7®, ELISA-EIE® and qPCR assays. The prevalence was calculated considering the positivity in at least two tests. SaTScan® was used for spatial analysis. The prevalence of canine infection with Leishmania was 18.6% (28/150), with the rural area being identified as a risk factor (Odds Ratio (OR) = 2.93). The permanence of the dog loose during the night (OR = 0.33) and deworming (OR = 0.30) were identified as protective factors. A risk cluster was formed in the northern region of the urban area. Mãe D'Água showed a pattern of active transmission in the rural area, but VL control measures also need to be carried out in the urban area to prevent human cases and the spread of the disease in the risk zone.

Compulsorily notifiable diseases and health problems and socio-environmental conditions: an ecological study, Espírito Santo, Brazil, 2011-2015. / Doenças e agravos de notificação compulsória e condições socioambientais: estudo ecológico, Espírito Santo, 2011-2015.

OBJECTIVE: To analyze association between climatic-environmental conditions and occurrence of compulsorily notifiable diseases and health problems, in the state of Espírito Santo, Brazil, 2011-2015. METHODS: This was an ecological study of municipality clusters calculated based on cases confirmed on the Notifiable Health Conditions Information System for the period 2011-2015. RESULTS: Notifications were more frequent among females (51.1%); people of brown race/skin color (31.7%); in the 20-49 year age group (48.1%) and in the Metropolitan Health Region (60.3%). The factors associated with health problems were ambulatory care sensitive conditions (p-value<0.001); education development index (p-value<0.001); temperature (p-value=0.019) and degree of urbanization (p-value=0.004). Diseases were associated with population density (p-value<0.001); temperature (p-value<0.001), humidity (p-value<0.001) and altitude (p-value=0.005). CONCLUSION: Health problems were positively associated with ambulatory care sensitive conditions, the education development index and temperature; but negatively associated with degree of urbanization. Diseases were positively associated with the factors mentioned.

Diseases and disorders reportable and socio-environmental conditions: ecological study, Espírito Santo, Brazil, 2011-2015 / Enfermedades y trastornos notificables y condiciones socioambientales: estudio ecológico, Espírito Santo, Brasil, 2011-2015 / Doenças e agravos de notificação compulsória e condições socioambientais: estudo ecológico, Espírito Santo, 2011-2015

Objective: To analyze the association of climatic-environmental conditions and the occurrence of diseases and disorders reportable, in the state of Espírito Santo, Brazil, 2011-2015. Methods: Aggregated municipal ecological studies, calculated from confirmed cases in the Notification Information System for the period 2011-2015. Results: Notifications were more frequent among women (51.1%); race/brown color (31.7%); age group 20-49 years (48.1%) and metropolitan health region (60.3%). The factors associated with disorders were internations sensitive to primary care (p-value<0.001); education development index (p-value<0.001); temperature (p-value=0.019) and degree of urbanization (p-value=0.004). Diseases were associated with population density (p-value<0.001); temperature (p-value<0.001), humidity (p-value<0.001) and altitude (p-value=0.005). Conclusion: The disorders were negatively associated with conditions sensitive to primary care, with the education development index and positively with the temperature and the degree of urbanization. Diseases were positively associated with the factors mentioned.

Objetivo: Analisar a associação das condições climático-ambientais e a ocorrência das doenças e agravos de notificação compulsória no estado do Espírito Santo, Brasil. Métodos: Estudo ecológico dos agregados municipais calculados a partir de casos confirmados no Sistema de Informação de Agravos de Notificação para o período 2011-2015. Resultados: As notificações foram mais frequentes no sexo feminino (51,1%), raça/cor da pele parda (31,7%), faixa etária de 20-49 anos (48,1%) e região metropolitana de saúde (60,3%). Os fatores associados aos agravos foram as condições sensíveis à Atenção Básica (p-valor<0,001), o índice de desenvolvimento de educação (p-valor<0,001), a temperatura (p-valor=0,019) e o grau de urbanização (p-valor=0,004). As doenças estiveram associadas a densidade populacional (p-valor<0,001), temperatura (p-valor<0,001), umidade (p-valor<0,001) e altitude (p-valor=0,005). Conclusão: Os agravos associaram-se positivamente às condições sensíveis à Atenção Básica, índice de desenvolvimento da educação e temperatura; e negativamente ao grau de urbanização. As doenças associaram-se positivamente aos fatores citados.

Demographic and spatial study of visceral leishmaniasis in the state of Alagoas, Brazil, during 2007-2018.

INTRODUCTION: Visceral leishmaniasis has a broad worldwide distribution and constitutes a public health problem in the Northeast of Brazil. Located in this region is the state of Alagoas, where the disease is endemic in humans and where there has been a significant increase in the number of positive dogs. The objective of this study was to describe the temporal and spatial distribution of the cases of human VL in the state of Alagoas with the aim of identifying transmission risk areas in the period from 2007 to 2018. METHODS: The data available in the National Disease Notification System (SINAN-NET) were used. The Bayesian incidence rate and the Moran's global index were calculated using the Terra View 4.2.2 program, and the maps were created using QGIS2.18.0. RESULTS: From the 102 municipalities, 68.6% (n= 70) had at least one notified case of VL in the years of study. A total of 489 cases were registered, with an average of 40.7 cases per year and an incidence rate of 1.25/100,000 inhabitants. The highest number of confirmed cases (105) occurred in 2018. Male individuals and children between 1-4 years old were the most affected, and 64% of the cases were in rural areas. Spatial dependence was detected in all the intervals except for the first triennium, and clusters were formed in the west of the state. CONCLUSIONS: Alagoas presented an accentuated geographical expansion of VL, and it is necessary to prioritize areas and increase surveillance actions and epidemiological control.

Spatial analysis of canine leishmaniasis in an area of transmission of the semi-arid region of the State of Paraíba, Brazil.

Visceral leishmaniasis is a widely distributed zoonosis and canine infection is an important indicator of risk for the occurrence of the disease in humans. The goal of this analysis was to study the spatial clustering of canine leishmaniasis (CL) in the municipality of Santa Luzia, state of Paraíba. For this, 749 samples of canine plasma were tested using three serological tests. The dog was considered positive if it reacted in two serological tests. The location of the residences was performed with a Global Positioning System receiver (GPS Garmin® eTrex 30), and used to perform georeferencing and spatial analysis. The prevalence of CL was 15.49% and it was observed that most cases of the urban area were concentrated in the Frei Damião neighborhood, on the outskirts of the city, where a high-risk cluster for the occurrence of the disease was formed (p = 0.02; RR = 2.48). No statistically significant cluster was observed in rural areas. CL is widely distributed in the municipality of Santa Luzia in a heterogeneous manner and with a tendency to urbanization. The areas identified with high prevalence and highest risk should be prioritized to maximize the efficiency of the Visceral Leishmaniasis Surveillance and Control Program and minimize the chance of new canine and human cases.

Doenças e agravos de notificação compulsória e condições socioambientais: estudo ecológico, Espírito Santo, 2011-2015 / Enfermedades y trastornos de notificación obligatoria y condiciones socioambientales: estudio ecológico, Espírito Santo, Brasil, 2011-2015 / Compulsorily notifiable diseases and health problems and socio-environmental conditions: an ecological study, Espírito Santo, Brazil, 2011-2015

Objetivo: Analisar a associação das condições climático-ambientais e a ocorrência das doenças e agravos de notificação compulsória no estado do Espírito Santo, Brasil. Métodos: Estudo ecológico dos agregados municipais calculados a partir de casos confirmados no Sistema de Informação de Agravos de Notificação (Sinan) para o período 2011-2015. Resultados: As notificações foram mais frequentes no sexo feminino (51,1%), raça/cor da pele parda (31,7%), faixa etária de 20-49 anos (48,1%) e região metropolitana de saúde (60,3%). Os fatores associados aos agravos foram as condições sensíveis à Atenção Básica (p-valor<0,001), o índice de desenvolvimento de educação (p-valor<0,001), a temperatura (p-valor=0,019) e o grau de urbanização (p-valor=0,004). As doenças estiveram associadas a densidade populacional (p-valor<0,001), temperatura (p-valor<0,001), umidade (p-valor<0,001) e altitude (p-valor=0,005). Conclusão: Os agravos associaram-se positivamente às condições sensíveis à Atenção Básica, índice de desenvolvimento da educação e temperatura; e negativamente ao grau de urbanização. As doenças associaram-se positivamente aos fatores citados.

Objetivo: Analizar la asociación de las condiciones climáticas-ambientales y la ocurrencia de enfermedades y trastornos de notificación obligatoria en el estado de Espírito Santo, Brasil. Métodos: Estudio ecológico de los agregados municipales, a partir de casos confirmados en el Sistema de Información de Agravamientos de Notificación, período 2011-2015. Resultados: Las notificaciones fueron más frecuentes en el sexo femenino (51,1%); raza/ color de piel parda (31,7%); de 20-49 años (48,1%) y región metropolitana de salud (60,3%). Los factores asociados a los agravamientos fueron sensibles a la atención primaria (p<0,001); los índices de desarrollo educativo (p<0,001); la temperatura (p=0,019) y el grado de urbanización (p=0,004). Los agravamientos estuvieron asociados con la densidad de población (p<0,001); la temperatura (p<0,001), la humedad (p <0,001) y la altitud (p=0,005). Conclusión: Los agravamientos se asociaron positivamente con las condiciones sensibles a la atención primaria, con el índice de desarrollo educativo y la temperatura; y negativamente con el grado de urbanización. Las enfermedades se asociaron positivamente con los factores mencionados.

Objective: To analyze association between climatic-environmental conditions and occurrence of compulsorily notifiable diseases and health problems, in the state of Espírito Santo, Brazil, 2011-2015. Methods: This was an ecological study of municipality clusters calculated based on cases confirmed on the Notifiable Health Conditions Information System for the period 2011-2015. Results: Notifications were more frequent among females (51.1%); people of brown race/skin color (31.7%); in the 20-49 year age group (48.1%) and in the Metropolitan Health Region (60.3%). The factors associated with health problems were ambulatory care sensitive conditions (p-value<0.001); education development index (p-value<0.001); temperature (p-value=0.019) and degree of urbanization (p-value=0.004). Diseases were associated with population density (p-value<0.001); temperature (p-value<0.001), humidity (p-value<0.001) and altitude (p-value=0.005). Conclusion: Health problems were positively associated with ambulatory care sensitive conditions, the education development index and temperature; but negatively associated with degree of urbanization. Diseases were positively associated with the factors mentioned.

Factors associated with Leishmania infection in dogs and geospatial analysis in the Sertão of Paraíba, Northeast Brazil / Fatores associados à infecção por Leishmania em cães e análise espacial no Sertão da Paraíba, Nordeste do Brasil

Abstract Visceral leishmaniasis (VL) is a zoonosis with a worldwide distribution that has a major impact on public health. The aim of this study was to verify the prevalence of canine infection by Leishmania infantum, the factors associated with the infection and its spatial distribution in the municipality of Mãe D'Água, in the Sertão region of Paraíba State, Northeast Brazil. Blood samples were collected from 150 dogs for diagnosis by the DPP®, ELISA-S7®, ELISA-EIE® and qPCR assays. The prevalence was calculated considering the positivity in at least two tests. SaTScan® was used for spatial analysis. The prevalence of canine infection with Leishmania was 18.6% (28/150), with the rural area being identified as a risk factor (Odds Ratio (OR) = 2.93). The permanence of the dog loose during the night (OR = 0.33) and deworming (OR = 0.30) were identified as protective factors. A risk cluster was formed in the northern region of the urban area. Mãe D'Água showed a pattern of active transmission in the rural area, but VL control measures also need to be carried out in the urban area to prevent human cases and the spread of the disease in the risk zone.

Resumo A leishmaniose visceral (LV) é uma zoonose com distribuição mundial de grande impacto na saúde pública. O objetivo deste estudo foi verificar a prevalência da infecção canina por Leishmania infantum, os fatores associados à infecção e sua distribuição espacial no município de Mãe D'Água, na região do Sertão da Paraíba, Nordeste do Brasil. Amostras de sangue foram coletadas de 150 cães para diagnóstico pelos ensaios DPP®, ELISA-S7®, ELISA-EIE® e qPCR. A prevalência foi calculada considerando-se a positividade em pelo menos dois testes. O SaTScan® foi utilizado para a análise espacial. A prevalência da infecção canina com Leishmania foi de 18,6% (28/150), sendo a zona rural identificada como fator de risco (Odds Ratio (OR) = 2,93). A permanência do cão solto durante a noite (OR = 0,33) e a vermifugação (OR = 0,30) foram classificadas como fatores de proteção. Um cluster de risco foi formado na região Norte da área urbana. Mãe D'Água apresentou um padrão de transmissão ativa na área rural, porém medidas de controle da LVC também precisam ser realizadas na área urbana para evitar casos humanos e a dispersão da doença na zona de risco.

Spatial analysis of canine leishmaniasis in an area of transmission of the semi-arid region of the State of Paraíba, Brazil / Análise espacial da leishmaniose canina em uma área de transmissão do semiárido paraíbano, Brasil

Abstract Visceral leishmaniasis is a widely distributed zoonosis and canine infection is an important indicator of risk for the occurrence of the disease in humans. The goal of this analysis was to study the spatial clustering of canine leishmaniasis (CL) in the municipality of Santa Luzia, state of Paraíba. For this, 749 samples of canine plasma were tested using three serological tests. The dog was considered positive if it reacted in two serological tests. The location of the residences was performed with a Global Positioning System receiver (GPS Garmin® eTrex 30), and used to perform georeferencing and spatial analysis. The prevalence of CL was 15.49% and it was observed that most cases of the urban area were concentrated in the Frei Damião neighborhood, on the outskirts of the city, where a high-risk cluster for the occurrence of the disease was formed (p = 0.02; RR = 2.48). No statistically significant cluster was observed in rural areas. CL is widely distributed in the municipality of Santa Luzia in a heterogeneous manner and with a tendency to urbanization. The areas identified with high prevalence and highest risk should be prioritized to maximize the efficiency of the Visceral Leishmaniasis Surveillance and Control Program and minimize the chance of new canine and human cases.

Resumo A leishmaniose visceral é uma zoonose amplamente distribuída, e a infecção canina é um importante indicador de risco para a ocorrência da doença em humanos. O objetivo foi estudar o comportamento espacial da leishmaniose canina (LC) no município de Santa Luzia, estado da Paraíba. Para tal, 749 amostras de plasma canino foram testadas por meio de três técnicas sorológicas. O cão seria considerado positivo se apresentasse duas sorologias reagentes. A localização das residências foi realizado pelo receptor de Sistema de Posicionamento Global (GPS Garmin® eTrex 30) e usado para a realização do georreferenciamento e análise espacial. A prevalência da LC foi de 15,49% e observou-se que a maioria dos casos de LC da zona urbana estava concentrada no bairro Frei Damião, localizado na periferia da cidade, onde se formou um cluster de alto risco para ocorrência da doença (p = 0,02; RR = 2,48). Nenhum cluster estatisticamente significativo foi observado na zona rural. A LC está amplamente distribuída no município de Santa Luzia, porém de forma heterogênea e com tendência à urbanização. As áreas identificadas com intensa prevalência e maior risco devem ser priorizadas para maximizar a eficiência do Programa de Vigilância e Controle da Leishmaniose Visceral e minimizar a chance de novos casos caninos e humanos.