Spatial patterns and factors associated with the incidence of tuberculosis-diabetes in Brazil.

OBJECTIVES: The aim of this study was to analyse the spatial patterns and factors associated with the incidence of tuberculosis-diabetes (TB-DM) in Brazil, from 2001 to 2019. STUDY DESIGN: Ecological study. METHODS: Brazilian municipalities were used as the units of analysis. The local empirical Bayesian rate and the spatial autocorrelation test were calculated. Moran and Getis-Ord Gi∗ were used to identify spatial clusters, and spatially weighted regression was conducted. RESULTS: In total, 75,021 new cases of TB associated with DM were reported in Brazil during the study period. Most Brazilian municipalities had an average TB-DM incidence of 1.0-2.0/100,000 inhabitants. The regression showed that the Gini index (ß = 0.85) and family health strategy coverage (ß = -0.26) were the two indicators that had the most influence on TB-DM incidence in Brazil. CONCLUSIONS: This study identified spatial clusters of TB-DM in Brazil. The results also indicated that social inequalities played a key role in the incidence of TB.

Chronic Pancreatitis in a Large Developing Country: Temporal Trends of Over 64,000 Hospitalizations from 2009 to 2019.

BACKGROUND/OBJECTIVES: Chronic pancreatitis (CP) is a progressive inflammatory disorder associated with marked morbidity and mortality and frequently requires hospitalization. This study aimed to investigate the time trends and geographical distribution of hospital admissions, the lethality rate of CP across Brazil, and the potential relationship with social indicators and associated risk factors. METHODS: Data were retrospectively obtained from the Brazilian Public Health System Registry between January 2009 and December 2019. The prevalence and lethality rates of CP per 100,000 inhabitants in each municipality were estimated from hospitalizations to in-hospital deaths and classified by age, sex, and demographic features. RESULTS: During the study period, 64,609 admissions were retrieved, and most of the patients were males (63.54%). Hospitalization decreased by nearly half (-54.68%) in both sexes. CP rates in males were higher in all age groups. The greatest reduction in admissions (- 64%) was also noted in patients ≥ 70y. CP In-hospital lethality remained stable (5-6%) and similar for males and females. Patients ≥ 70y showed the highest lethality. The greatest increase in CP lethality rates (+ 10%) was observed in municipalities integrated into metropolises, which was mainly driven by small-sized municipalities (+ 124%). CONCLUSIONS: CP hospitalizations decrease in both urban and rural areas, particularly in the North, Northeast, and Central-West regions, and in those above 70 years of age, but are not correlated with lethality rates in the South. This suggests ongoing changes in the environmental and socioeconomic factors in Brazil.

Malacological, socio-environmental evaluation, and evidence of local transmission and maintenance of schistosomiasis in an urban area of Northeast Brazil.

To present the current epidemiological scenario of schistosomiasis related to urban transmission through an epidemiological risk assessment in Porto de Galinhas, a coastal area of Pernambuco, Brazil. Malacological and parasitological surveys were performed between the years 2018 and 2020. Snails were identified taxonomically and examined to confirm infection by Schistosoma mansoni, and so to identify Schistosomiasis Transmission Foci (STF) by the artificial light exposure technique. Stool samples were examined using the Kato-Katz method to identify schistosomiasis cases. Socioeconomic, environmental, behavioural and health data were collected by a questionnaire applied to participates in the survey and used to predict the schistosomiasis risk occurrence by multivariate logistic regression. In all, a total of 6466 snails of Biomphalaria glabrata were collected and 36 breeding sites were identified, of which 25 % were STF. A total of 2236 individuals took part of the survey which identified 187 cases of schistosomiasis, registering a positivity percentage of 8.36 %. The surveys identified the neighbourhoods with the highest risk for transmission while the socioenvironmental analysis identifies other risk factors for disease occurrence, such as gender, age range, level of education and absence of water drainage. We found that areas with poor sanitation, flooding during winter periods and dwellings located near mangroves should be treated by health authorities as priority areas for health interventions to minimize disease transmission. In addition, efforts to improve the population's educational level could certainly contribute to the adoption of measures to prevent and control this neglected tropical disease.

Snakebites epidemiology in Mexico: a 13-year ecological analysis.

BACKGROUND: Globally, snakebites have a significant impact on public health and represent substantial costs for health services. Their severity is particularly relevant in developing countries due to the lack of resources and accessibility to health facilities. Additionally, the number of cases may be underestimated, highlighting the urgent need for improved prevention measures. METHODS: An observational ecological study was undertaken using the records identified with X200-X209 codes registered in the Ministry of Health injuries database during 2010-2022. Variables included information related to the patient, the snakebite and the healthcare provided. Statistical analysis was carried out with STATA 16 and Microsoft Excel 2020. RESULTS: A total of 10 420 snakebites were registered. The average number of cases per year was 788 (IQR 615, 875) and 82.74% occurred during the rainy season. The median age was 35 (IQR 19, 52) y and early adulthood was the most affected age group; bites were most common on the hand and in the living place. The Eastern region of Mexico registered the highest number of cases, with 3496 (33.71%) of snakebites. The lethality rate was 18.23 per 10 000. CONCLUSIONS: Snakebites are a significant health problem in Mexico. Most injuries occur among men in early adulthood, in households and in the upper extremities.

Chronic exposure to fine particles (PM2.5) and mortality: Evidence from Chile.

Many Chilean cities suffer from high air pollution from industrial, mobile, and residential wood-burning sources. Several studies have linked PM2.5 air pollution exposure to higher mortality risk from cardiovascular, pulmonary, and lung cancer causes. In recent years, Chile has developed an extensive air pollution monitoring network to enforce air quality standards for PM2.5, allowing the study of the medium-term association between PM2.5 and mortality. Methods: A negative binomial regression model was used to study the association between 3-year average PM2.5 concentrations and age-adjusted mortality rates for 105 of the 345 municipalities in Chile. Models were fitted for all (ICD10 A to Q codes), cardiopulmonary (I and J), cardiovascular (I), pulmonary (J), cancer (C), and lung cancer (C33-C34) causes; controlling for meteorological, socioeconomic, and demographic characteristics. Results: A significant association of PM2.5 exposure with cardiopulmonary (relative risk for 10 µg/m3 PM2.5: 1.06; 95% confidence interval = 1.00, 1.13) and pulmonary (1.11; 1.02, 1.20) age-adjusted mortality rates was found. Cardiovascular (1.06; 0.99, 1.13) and all causes (1.02; 0.98, 1.07) were positive, but not significant. No significant association was found between cancer and lung cancer. The positive associations remained even when controlling for multiple confounding factors, model specifications, and when considering different methods for exposure characterization. These estimates are in line with results from cohort studies from the United States and European studies. Conclusion: Three-year average PM2.5 exposure is positively associated with the age-adjusted mortality rate for cardiopulmonary and cardiovascular causes in Chile. This provides evidence of the medium-term exposure effect of fine particles on long-term mortality rates.

Female Homicides in Brazil and Its Major Regions (1980-2019): An Analysis of Age, Period, and Cohort Effects.

The objective was to analyze the temporal effects of age, period, and cohort on mortality from all female homicides, and from female homicides and by firearms, in Brazil from 1980 to 2019. Data were accessed from Brazilian health records. There was an increase in the risk of death in the 2000s in the North and Northeast regions and a decrease in the Southeast, South, and Midwest. Younger women had a higher risk of death than women born between 1950 and 1954. The findings may be correlated with the inefficiency of the Brazilian state in protecting female victims of violence.

Sewerage as a protective factor for prevalence of hookworm infection in schoolchildren in Brazil: A multilevel ecological analysis of national prevalence surveys (1950-2018).

INTRODUCTION: The prevalence of hookworm infection in Brazil has decreased considerably in recent decades. However, there is no definitive consensus as to which changes have contributed to this reduction. A hypothesis is that improvements in environmental factors have contributed to lowering the parasite load and the level of host-parasite contact. METHODS: This is an ecological study using unbalanced panel data from two Brazilian surveys (1947-1953 and 2010-2015), with municipalities as the analysis unit. The sample comprised 1428 municipalities, in which a total of 745,983 schoolchildren aged 7 to 14 were examined. Zero-inflated Poisson regression models, with fixed and random effects were estimated to evaluate the association of potential explanatory variables with the prevalence of hookworm infection at a significance level of 5 %. RESULTS: We identified a significant decrease in the prevalence between the first and last analyzed periods (RR 0.096; CI 0.086-0.107); The following variables were found to have a protective effect: access to sanitary sewage systems (RR 0.984, CI 0.982-0.986), urbanization (RR 0.995, CI 0.993-0.997), and gross domestic product (RR 0.929, CI 0.912-0.945). CONCLUSION: The findings of this study show a decrease in the prevalence of hookworm infections over six decades in schoolchildren in the Brazilian municipalities. Environmental, demographic, and economic factors were associated with this trend. A historical analysis indicates that interventions aimed at improving sanitation contributed to reducing the disease prevalence.

Spatial analysis of measles vaccination coverage in the State of São Paulo.

BACKGROUND: Measles is a contagious viral disease that seriously affects children. The measles vaccine is widely recommended in Brazil and in the world; however, the disease remains relevant for the health authorities. The aim of the present study was to evaluate first and second dose of measles vaccine coverage (VC) in the cities of São Paulo and its spatial dynamics between 2015 and 2020. METHOD: In this mixed-type ecological study, we used secondary, public domain data from 2015 to 2020, extracted from the Digital Information System of the National Immunization Program, Mortality Information System and the National Live Birth Information System. After calculating the VC, the following four categories were created: very low, low, adequate, and high, and the spatial autocorrelation of VC was analyzed using the Global and Local Moran's statistics. RESULTS: A steady decline in adherence to the vaccination was observed, which dynamically worsened until 2020, with a high number of cities fitting the classification of ineffective coverage and being potentially harmful to the effectiveness of the immunization activities of their neighbors. CONCLUSION: A direct neighborhood pattern was observed between the units with low vaccination coverage, which implied that the reduction in measles VC was somehow related to and negatively influenced by the geographic location and social culture of these areas.

Trends in Cleft lip and/or Palate Prevalence at Birth in Mexico: A National (Ecological) Study Between 2003 and 2019.

OBJECTIVE: To describe trends in cases and prevalence at birth rates of cleft lip and/or palate (CL/P) in Mexico between 2003 and 2019. DESIGN: Ecological study. SETTING: Multiple data sources systematically collected into a national epidemiological surveillance data warehouse. PARTICIPANTS: National Live Birth Information System. MAIN OUTCOME MEASURE(S): Both cases and prevalence at birth rates of CL/P in Mexico within a 17-year period were used as dependent variables. RESULTS: At the national level there were 23 184 new cases of CL/P (average of 1364 per year) in the 32 states of Mexico, with an average prevalence at birth rate of 0.53 per 1000 live births. The states with the highest prevalence at birth rates of CL/P during the period were Hidalgo (1.59) and Jalisco (1.32), while the states with the lowest rates were Nayarit (0.22) and Durango (0.29). A slight decrease in both cases (z = -2.41, P = .016) and prevalence at birth rates (z = -2.58, P = .010) of CL/P was observed at the national level. States such as Durango, Puebla, Chiapas, Guerrero, Oaxaca, Mexico City, State of Mexico, Coahuila and Jalisco showed a clear downward trend (P < .05) in their prevalence at birth of CL/P between 2003 and 2019, while in Hidalgo its trend was upward (P = .05). Significant differences by sex and region were observed (P < .05). CONCLUSION: Some states consistently had the highest or lowest prevalence of CL/P. Decreasing trends in the overall prevalence at birth rates were observed. More detailed, epidemiological studies are necessary to adequately characterize CL/P in the Mexican population.

Influência da desigualdade socioeconômica na distribuição das internações e dos óbitos por covid-19 em municípios brasileiros, 2020: um estudo ecológico / Influencia de la desigualdad socioeconómica en la distribución de hospitalizaciones y muertes por COVID-19 en municipios brasileños, 2020: un estudio ecológico / Influence of socioeconomic inequality on the distribution of COVID-19 hospitalizations and deaths in Brazilian municipalities, 2020: an ecological study

Objetivo analisar a influência da desigualdade socioeconômica na distribuição da covid-19 nos maiores municípios brasileiros (> 100 mil habitantes), controlando, pelo efeito da infraestrutura hospitalar, comorbidades e outras variáveis. Métodos estudo ecológico sobre internações e óbitos por covid-19 em 2020; dados de desfecho obtidos do Ministério da Saúde; a razão de incidência foi estimada via modelo linear generalizado. Resultados identificados 291.073 internações e 139.953 óbitos; encontrou-se maior taxa de mortalidade nos municípios com maior população não branca (IC95% 1,01;1,16) e nos domicílios com mais de duas pessoas por cômodo (IC95% 1,01;1,13); para ambos os desfechos, esgotamento sanitário foi protetivo (internações: IC95% 0,87;0,99 - óbitos: IC95% 0,90;0,99), e população em aglomerados subnormais revelou-se fator de risco (internações: IC95% 1,01;1,16 - óbitos: IC95% 1,09;1,21) com interação, com a proporção de pessoas a receber auxílio emergencial (internações: IC95% 0,88;1,00 - óbitos: IC95% 0,89;0,98). Conclusão condições socioeconômicas afetaram o adoecimento e morte por covid-19 no Brasil.

Objetivo: analizar la influencia de la desigualdad socioeconómica en la distribución de COVID-19 en los mayores municipios brasileños (> 100 mil habitantes), controlando, por la infraestructura hospitalaria, comorbilidades y otras variables. Métodos: estudio ecológico sobre hospitalizaciones y muertes por COVID-19 en 2020; datos del resultado fueran obtenidos del Ministerio de Salud; razón de incidencia estimada a través del modelo lineal generalizado. Resultados: 291.073 hospitalizaciones y 139.953 muertes; mayor tasa de mortalidad en municipios con mayor proporción de población no blanca (IC95% 1,01;1,16) y con más hogares con más de dos personas por habitación (IC95% 1,01;1,13); el alcantarillado sanitario resultó protector (hospitalizaciones: IC95% 0,87;0,99 - muertes: IC95% 0,90;0,99) y la mayor proporción de población en aglomeraciones subnormales fue un factor de riesgo (hospitalizaciones: IC95% 1,01;1,16 - muertes: IC95% 1,09;1,21), interactuando con proporción de personas con asistencia de emergencia (hospitalizaciones IC95% 0,88;1,00, defunciones IC95% 0,89;0,98). Conclusión: las condiciones socioeconómicas afectaron la enfermedad y la muerte por COVID-19.

Objective: to analyze the influence of socioeconomic inequality on COVID-19 istribution in larger Brazilian municipalities, controlling for effect of hospital infrastructure, comorbidities and other variables. Methods: this was an ecological study of COVID-19 hospitalizations and deaths in 2020; outcome data were obtained from the Ministry of Health; incidence ratios were estimated using a generalized linear model. Results: we identified 291,073 hospitalizations and 139,953 deaths; we found higher mortality rates in municipalities with a higher proportion of non-White people (95%CI 1.01;1.16) and with more households with more than two people per room (95%CI 1.01;1.13); presence of sewerage systems was protective for both outcomes (hospitalizations: 95%CI 0.87;0.99 - deaths: 95%CI 0.90;0.99), while a higher proportion of the population in subnormal housing clusters was a risk factor (hospitalizations: 95%CI 1.01;1.16 - deaths: 95%CI 1.09;1.21), with this variable interacting with the proportion of people receiving Emergency Aid (hospitalizations: 95%CI 0.88;1.00 - deaths: 95%CI 0.89;0.98). Conclusion: socioeconomic conditions affected illness and death due to COVID-19 in Brazil.

Avaliação da incompletude dos registros de óbitos por causas externas do Sistema de Informações sobre Mortalidade no Rio Grande do Sul, 2000-2019 / Assessment of incompleteness of Mortality Information System records on deaths from external causes in the state of Rio Grande do Sul, Brazil, 2000-2019 / Evaluación de la incompletitud de los registros de defunción por causas externas del Sistema de Información de Mortalidad en Rio Grande do Sul, Brasil, 2000-2019

Objetivo: avaliar a incompletude dos dados do Sistema de Informações sobre Mortalidade (SIM) para óbitos por causas externas (CEs) no Rio Grande do Sul, Brasil, 2000-2019. Métodos: estudo ecológico, com dados do SIM para a totalidade das CEs e, especificamente, por acidentes de transporte, homicídios, suicídios e quedas; analisou-se a tendência da incompletude via regressão de Prais-Winsten, com nível de significância de 5%. Resultados: 146.882 óbitos foram avaliados; sexo (0,1%), local de ocorrência do óbito (0,1%) e idade (0,4%) mostraram as menores incompletudes, em 2019; a proporção de incompletude apresentou tendência decrescente para local de ocorrência do óbito e escolaridade, crescente para estado civil e estável para idade e raça/cor da pele, entre todos os tipos de óbito avaliados. Conclusão: as variáveis analisadas alcançaram alto grau de preenchimento; à exceção do estado civil e da escolaridade, para as quais persistiram escores insatisfatórios para óbitos por CEs, totais e por subgrupos.

Objective: to evaluate the incompleteness of Mortality Information System (Sistema de Informações sobre Mortalidade - SIM) data on deaths from external causes (ECs) in the state of Rio Grande do Sul, Brazil, 2000-2019. Methods: This was an ecological study, using SIM data on all deaths from external causes and, specifically, from transport accident, homicides, suicides and falls; the analysis of the trend of incompleteness was performed by means of Prais-Winsten regression, with a 5% significance level. Results: A total of 146,882 deaths were evaluated; sex (0.1%), place of death (0.1%) and age (0.4%) showed the lowest incompleteness in 2019; the proportion of incompleteness showed a decreasing trend for the place of death and schooling, an increasing trend for marital status and a stable trend for age and race/skin color, among all types of death evaluated. Conclusion: the variables analyzed reached a high degree of completion; with the exception of marital status and schooling, for which unsatisfactory scores persisted for deaths from ECs, both total and by subgroups.

Objetivo: evaluar la incompletitud de los datos del Sistema de Información de Mortalidad (SIM) para las defunciones por causas externas (CEs) en Rio Grande do Sul, Brasil, 2000-2019. Métodos: estudio ecológico con datos del SIM por causas externas, totales y por accidentes de tránsito, homicidios, suicidios y caídas; se utilizó la regresión de Prais-Winsten para evaluar la tendencia de incompletitud, con un nivel de significancia del 5%. Resultados: se evaluaron 146.882 muertes; sexo (0,1%), lugar de muerte (0,1%) y edad (0,4%) mostraron menos incompletitud en 2019; la tendencia de la proporción de incompletitud disminuyó para el lugar de ocurrencia y la educación, aumentó para el estado civil y se mantuvo estable para edad y raza/color del piel para todo tipo de muertes evaluadas. Conclusión: las variables analizadas lograron alta calidad de información, con excepción del estado civil y educación, que persistieron con incompletitud insatisfactoria para las muertes por CE (total y subgrupos).

Tendência temporal e distribuição espacial da sífilis gestacional e congênita no Brasil, período de 2008-2018 / Temporal trend and spatial distribution of gestational and congenital syphilis in Brazil, period 2008-2018

Introdução: A sífilis tornou-se um problema de saúde pública em várias regiões no mundo. Objetivo: Analisar a tendência temporal e distribuição espacial da sífilis gestacional e congênita no Brasil, no período de 2008 a 2018. Método: Trata-se de um estudo de diferentes métodos. 1) Estudo de série temporal da taxa de detecção da sífilis gestacional e correlação entre variáveis socioeconômicas e de serviços de saúde. Os dados foram extraídos de bancos de dados nacionais de acesso público. Utilizou-se o software Joinpoint Regression e o coeficiente de correlação de Pearson. 2) Estudo ecológico de análise espacial da taxa de detecção da sífilis gestacional e correlação espacial entre variáveis socioeconômicas e de serviços de saúde. Extraídos dados secundários, agregados em 482 Regiões Imediatas de Articulação Urbana. Utilizou-se o software GeoDa. 3) Estudo ecológico de tendência temporal e distribuição espacial da taxa de incidência da sífilis congênita e correlação espacial entre variáveis socioeconômicas e de serviços de saúde. Extraídos dados secundários. 4) Protocolo para uma revisão de escopo com o objetivo de identificar e mapear o uso da Análise Espacial como ferramenta em pesquisas sobre sífilis na área da saúde. Baseou-se no manual do Joanna Briggs Institute e no guia PRISMA-ScR. Resultados: A região Sul apresentou a maior tendência; enquanto a Centro-Oeste, menor. Detectada correlação com o Índice de Desenvolvimento Humano Municipal, taxa de analfabetismo, percentual de cobertura da atenção primária à saúde e proporção de médicos, enfermeiros e unidades básicas de saúde por habitante. A taxa de detecção de sífilis gestacional distribuiu-se desigualmente e mostrou correlação espacial com o Índice de Desenvolvimento Humano Municipal, percentual de cobertura da atenção básica e proporção de médicos por habitantes. A taxa de incidência de sífilis congênita mostrou tendência ascendente e distribuíção desigual. Apresentou correlação espacial com o percentual de indivíduos com abastecimento de água e saneamento inadequados e percentual de nascidos vivos com 1 a 3 consultas de pré-natal. O protocolo para a revisão de escopo explicitou a questão de pesquisa, as bases de dados para buscas, critérios de inclusão e exclusão, planilha de extração de dados e o tipo de análise dos dados. Considerações finais: Investimentos em políticas de saúde e sociais são necessárias para mitigar as vulnerabilidades sociais e fortalecer a atenção primária à saúde para o controle da sífilis (AU).

Introduction: Syphilis has become a public health problem in several regions of the world. Objective: To analyze the temporal trend and spatial distribution of gestational and congenital syphilis in Brazil, from 2008 to 2018. Method: It is a study of different methods. 1) Time series study of the detection rate of gestational syphilis and correlation between socioeconomic and health service variables. Data were extracted from publicly accessible national databases. The Joinpoint Regression software and Pearson's correlation coefficient were used. 2) Ecological study of spatial analysis of the detection rate of gestational syphilis and spatial correlation between socioeconomic variables and health services. Extracted secondary data, aggregated in 482 Immediate Urban Articulation Regions. GeoDa software was used. 3) Ecological study of temporal trends and spatial distribution of the incidence rate of congenital syphilis and spatial correlation between socioeconomic variables and health services. Secondary data extracted. 4) Protocol for a scoping review with the objective of proposing a protocol to identify and map the use of Spatial Analysis as a tool in research on syphilis in the health area. It was based on the Joanna Briggs Institute manual and guided by PRISMA-ScR. Results: The South region showed the greatest trend; while the Midwest, smaller. Correlation detected with the Municipal Human Development Index, illiteracy rate, percentage of primary health care coverage and proportion of doctors, nurses and basic health units per inhabitant. The detection rate of gestational syphilis was unevenly distributed and showed a spatial correlation with the Municipal Human Development Index, percentage of primary care coverage and proportion of physicians per population. The incidence rate of congenital syphilis showed an upward trend and uneven distribution. It showed a spatial correlation with the percentage of individuals with inadequate water supply and sanitation and the percentage of live births with 1 to 3 prenatal consultations. The protocol for the scope review explained the research question, the databases for searches, inclusion and exclusion criteria, data extraction worksheet and the type of data analysis. Final considerations: Investments in health and social policies are necessary to mitigate social vulnerabilities and strengthen primary health care for syphilis control (AU).

Associação entre consolidação da Saúde da Família e menor incidência de sífilis congênita: estudo ecológico / Association between the consolidation of Family Health and lower incidence of congenital syphilis: an ecological study

Objetivos: Estimar tendências temporais na incidência de sífilis congênita (SC) em Minas Gerais e regiões de saúde e investigar a distribuição espacial da doença, identificando regiões de maior incidência e sua associação com fatores socioeconômicos e assistenciais. Métodos: Estudo ecológico que teve as regiões de saúde como unidades de análise. Foram estimadas tendências temporais de incidência de SC no período de 2001 a 2018 para o estado e suas 13 macrorregiões de saúde e, na segunda etapa, uma análise espacial para investigar a associação entre a incidência média da SC de 2011 a 2018 e fatores socioeconômicos e assistenciais em 2010 nas microrregiões de saúde. Resultados: Todas as regiões de saúde tiveram grande crescimento na incidência de SC e a taxa estadual teve aumento médio anual de 22,5% (IC95%: 17,3%; 28,0%). As taxas de incidência foram maiores nos grandes centros urbanos e menores nas regiões de maior Índice de Desenvolvimento Humano. As regiões com ESF consolidadas tiveram taxas 24,4% menores (IC95%: 0,5%; 42,8%). A maior proporção de adequação do pré-natal ao número mínimo de consultas preconizadas também teve associação com menores taxas de incidência. Conclusões: A incidência de SC teve grande crescimento no período recente, especialmente em grandes centros urbanos e regiões com menor cobertura da ESF e de pré-natal.

Objectives: To estimate temporal trends in incidence of congenital syphilis (CS) in Minas Gerais and health regions and to investigate the spatial distribution of disease, identifying regions of higher incidence and its association with socioeconomic and care factors. Methods: Ecological study that used health regions as units of analysis. Temporal trends in incidence of CS from 2001 to 2018 were estimated for the state and its 13 health macro-regions and in the second stage, a spatial analysis was performed to investigate the association between the average incidence of SC from 2011 to 2018 and socioeconomic and care factors in 2010 in health micro-regions. Results: All health regions had great growth in incidence of CS and the state rate had an average annual increase of 22.5% (95% CI:17.3%; 28.0%). Incidence rates were higher in large urban centers and lower in regions with the highest Human Development Index. The regions with consolidated ESF had rates 24.4% lower (95% CI: 0.5%; 42.8%). The higher proportion of adequacy of prenatal care to the minimum number of recommended consultations was also associated with lower incidence rates. Conclusions: The incidence of CS has grown significantly in the recent period, especially in large urban centers and regions with less FHS coverage and prenatal care.

Spatial analysis of vaccine coverage on the first year of life in the northeast of Brazil.

BACKGROUND: Over time, vaccination has been consolidated as one of the most cost effective and successful public health interventions and a right of every human being. This study aimed to assess the spatial dynamics of the vaccine coverage (VC) rate of children aged < 1 year per municipality in the Brazilian Northeast at 2016 and 2017. METHODS: This is a mixed-type ecological study that use a Public domain data Health Information. Vaccine doses were obtained from the Information System of the Brazilian National Immunization Program, and live births from the Brazilian Information System of Live Births of the Brazilian Unified Health System. Descriptive analysis of the coverage of all the vaccines for each year of the study was conducted, and Mann-Whitney U test was used to compare VC between the study years. Chi-squared test was used to evaluate the association between the years and VC, which was stratified into four ranges, very low, low, adequate, and high. Spatial distribution was analyzed according to both each study year and vaccine and presented as thematic maps. Spatial autocorrelation was analyzed using Moran's Global and Local statistics. RESULTS: Compared with 2017, 2016 showed better VC (p < 0.05), except for Bacillus Calmette-Guérin. In the spatial analysis of the studied vaccines, the Global Moran's Index did not show any spatial autocorrelation (p > 0.05), but the Local Moran's Index showed some municipalities, particularly the Sertão Paraibano region, with high VC, high similarity, and a positive influence on neighboring municipalities (p < 0.05). In contrast, most municipalities with low VC were concentrated in the Mata Paraibano region, negatively influencing their neighbors (p < 0.05). CONCLUSION: Uneven geographic regions and clusters of low VC for children aged < 1 year in the State of Paraíba were spatially visualized. Health policy makers and planners need to urgently devise and coordinate an action plan directed at each state's regions to fulfill the vaccination calendar, thereby reversing the vulnerability of this age group, which is at a higher risk of diseases preventable by vaccination.

Congenital Zika syndrome and living conditions in the largest city of northeastern Brazil.

BACKGROUND: The Zika virus (ZIKV) epidemic hit Brazil in 2015 and resulted in a generation of children at risk of congenital Zika syndrome (CZS). The social vulnerability of certain segments of the population contributed to the disproportional occurrence of CZS in the Brazilian Northeast, the poorest region in the country. Living conditions are essential factors in understanding the social determination of CZS, which is embedded in a complex interaction between biological, environmental, and social factors. Salvador, the biggest city in the region, played a central role in the context of the epidemic and was a pioneer in reporting the ZIKV infection and registering a high number of cases of CZS. The aim of the study was identifying the incidence and spatial distribution pattern of children with CZS in the municipality of Salvador, according to living conditions. METHODS: This is an ecological study that uses the reported cases of ZIKV and CZS registered in the epidemiological surveillance database of the Municipal Secretariat of Health of the city of Salvador between August of 2015 and July of 2016. The neighborhoods formed the analysis units and the thematic maps were built based on the reported cases. Associations between CZS and living conditions were assessed using the Kernel ratio and a spatial autoregressive linear regression model. RESULTS: Seven hundred twenty-six live births were reported, of which 236 (32.5%) were confirmed for CZS. Despite the reports of ZIKV infection being widely distributed, the cases of CZS were concentrated in poor areas of the city. A positive spatial association was observed between living in places with poorer living conditions and births of children with CZS. CONCLUSIONS: This study shows the role of living conditions in the occurrence of births of children with CZS and indicates the need for approaches that recognize the part played by social inequalities in determining CZS and in caring for the children affected.

Geographic Distribution and Time Trends of Colorectal Cancer in Brazil from 2005 to 2018.

BACKGROUND: Colorectal cancer (CRC) is the third most common malignancy and the second leading cause of cancer-related death in the world. The aim of this study was to investigate the geographic distribution and time trends of CRC in Brazil. METHODS: Data were retrospectively retrieved from January 2005 to December 2018 from the Brazilian Public Health System. The incidence and lethality rates of CRC per 100,000 inhabitants in each municipality were estimated from hospitalizations and in-hospital deaths and were classified by age, sex, and demographic features. RESULTS: During the study period, the mean incidence of CRC estimated from hospitalizations and adjusted to available hospital beds more than tripled from 14.6 to 51.4 per 100,000 inhabitants (352%). Increases in CRC incidence were detected in all age ranges, particularly among people aged 50-69 years (266%). Incidence rates increased in all 5 macroregions, with a clear South to North gradient. The greatest changes in incidence and lethality rates were registered in small-sized municipalities. CRC lethality estimated from in-hospital deaths decreased similarly in both sexes, from 12 to 8% for males and females, from 2005 to 2018. The decline in lethality rates was seen in all age ranges, mainly in people aged 50 to 69 years (- 38%). CONCLUSIONS: CRC incidence is increasing, predominantly above fifty years of age, and also in areas previously considered as having low incidence, but the increase is not paralleled by lethality rates. This suggests recent improvements in CRC screening programs and treatment, but also supports the spread of environmental risk factors throughout the country.

Social inequality in incidence and mortality of malignant neoplasms of lip, oral cavity and pharynx: Is Costa Rica an international paradox?

OBJECTIVES: Low socioeconomic position (SEP) has been associated with higher incidences and mortality of lip, oral cavity and pharynx (LOP) cancers in the vast majority of countries with available data. The origins of health inequalities in cancer are socioeconomic, although they vary by time and country. Evidence from Low-and Middle-income Countries (LMICs) remains scarce. This study aims to identify and describe socioeconomic inequalities in LOP cancers incidence and mortality in Costa Rica. The hypothesis tested is that people leaving in low-SEP districts in Costa Rica have greater incidence and mortality rates of lip, oral cavity and pharynx cancers. METHODS: The 10th revision of the International Classification of Diseases (ICD-10) was used to define cancer sites. Data come from a national population-based Cancer Registry with 100% completeness to study incidence. Incidence rate included all new cases of LOP cancer diagnosed from January 1, 2011, and December 31, 2015, for a total of 2 798 517 individuals, 13 832 524 years of follow-up and 601 LOP cases. Mortality rate was extracted from the National Death Index, including 2 739 733 individuals, 23 950 240 person-years of follow-up and 586 LOP cancer deaths, from January 1, 2010, to December 31, 2018. The 2011 Census (with 94% of Costa Rican inhabitants) was used to characterize the urbanicity and wealth of 477 districts. Survival models were performed for both incidence and mortality, allowing to consider existing competitive risks. Cox models were used for incidence, and parametric survival models based on a Gompertz distribution for mortality. RESULTS: The study found that people who lived in the most socioeconomically disadvantaged areas had lower probabilities of developing LOP cancers than people in the richest districts. The same pattern for mortality, however, was not significant. CONCLUSIONS: The hypothesis that incidence and mortality of LOP cancers will show a positive social gradient was not confirmed in this study, contradicting the existing literature. This could be explained by the social distribution of risky health behaviours, more frequent in socially advantaged populations.

The Immediate Effects of a Combined Mass Drug Administration and Indoor Residual Spraying Campaign to Accelerate Progress Toward Malaria Elimination in Grande-Anse, Haiti.

BACKGROUND: Haiti is planning targeted interventions to accelerate progress toward malaria elimination. In the most affected department (Grande-Anse), a combined mass drug administration (MDA) and indoor residual spraying (IRS) campaign was launched in October 2018. This study assessed the intervention's effectiveness in reducing Plasmodium falciparum prevalence. METHODS: An ecological quasi-experimental study was designed, using a pretest and posttest with a nonrandomized control group. Surveys were conducted in November 2017 in a panel of easy access groups (25 schools and 16 clinics) and were repeated 2-6 weeks after the campaign, in November 2018. Single-dose sulfadoxine-pyrimethamine and primaquine was used for MDA, and pirimiphos-methyl as insecticide for IRS. RESULTS: A total of 10 006 participants were recruited. Fifty-two percent of the population in the intervention area reported having received MDA. Prevalence diminished between 2017 and 2018 in both areas, but the reduction was significantly larger in the intervention area (ratio of adjusted risk ratios, 0.32 [95% confidence interval, .104-.998]). CONCLUSIONS: Despite a moderate coverage, the campaign was effective in reducing P. falciparum prevalence immediately after 1 round. Targeted MDA plus IRS is useful in preelimination settings to rapidly decrease the parasite reservoir, an encouraging step to accelerate progress toward malaria elimination.

Airports, highways and COVID-19: An analysis of spatial dynamics in Brazil.

INTRODUCTION: The high transmissibility and infectivity of the new coronavirus, the high proportion of asymptomatic transmitters and the rapid and continuous spatial displacement of people, by the different mechanisms of locomotion, are elements that can contribute to the dissemination of COVID-19. This study aims to describe the geographical dispersion of COVID-19 in the state of Bahia and the importance of major airports and highways in the dynamics of disease transmission. METHODS: This is an ecological study involving all cases of COVID-19 registered in the state of Bahia between March 6, date of the first registered case and May 16, 2020. After collection, an exploratory spatial analysis was performed, considering the cases accumulated on the last day of each epidemiological week. RESULTS: The first cases of COVID-19 were concentrated in areas served by three important airport complexes in the state, located in Salvador, Ilhéus and Porto Seguro. From week 16-20, there was a more intense expansion of COVID-19 to the interior of the state. A global spatial autocorrelation was observed (I Moran 0.2323; p = 0.01), with the influence of distance: positive correlation at distances less than 205.8 km (I Moran 0.040; p = 0.01) and greater than 800 km (I Moran 0.080; p = 0.01). CONCLUSIONS: Based on the spatial dispersion pattern of COVID-19 in the state of Bahia, airports and highways that cross the state were responsible for the interiorization of the disease.

Exploring for Municipality-Level Socioeconomic Variables Related to Zika Virus Incidence in Colombia.

Colombia experienced an outbreak of Zika virus infection during September 2015 until July 2016. This study aimed to identify the socioeconomic factors that at the municipality level correlate with this outbreak and therefore could have influenced its incidence. An analysis of publicly available, municipality-aggregated data related to eight potential explanatory socioeconomic variables was conducted. These variables are school dropout, low energy strata, social security system, savings capacity, tax, resources, investment, and debt. The response variable of interest in this study is the number of reported cases of Zika virus infection per people (projected) per square kilometer. Binomial regression models were performed. Results show that the best predictor variables of Zika virus occurrence, assuming an expected inverse relationship with socioeconomic status, are "school", "energy", and "savings". Contrary to expectations, proxies of socioeconomic status such as "investment", "tax", and "resources" were associated with an increase in the occurrence of Zika virus infection, while no association was detected for "social security" and "debt". Energy stratification, school dropout rate, and the percentage of the municipality's income that is saved conformed to the hypothesized inverse relationship between socioeconomic standing and Zika occurrence. As such, this study suggests these factors should be considered in Zika risk modeling.