Microcephaly epidemic related to the Zika virus and living conditions in Recife, Northeast Brazil.

BACKGROUND: Starting in August 2015, there was an increase in the number of cases of neonatal microcephaly in Northeast Brazil. These findings were identified as being an epidemic of microcephaly related to Zika virus (ZIKV) infection. The present study aims to analyse the spatial distribution of microcephaly cases in Recife (2015-2016), which is in Northeast Brazil, and its association with the living conditions in this city. METHODS: This was an ecological study that used data from reported cases of microcephaly from the State Health Department of Pernambuco (August 2015 to July 2016). The basic spatial unit of analysis was the 94 districts of Recife. The case definition of microcephaly was: neonates with a head circumference of less than the cut-off point of -2 standard deviations below the mean value from the established Fenton growth curve. As an indicator of the living conditions of the 94 districts, the percentage of heads of households with an income of less than twice the minimum wage was calculated. The districts were classified into four homogeneous strata using the K-means clustering algorithm. We plotted the locations of each microcephaly case over a layer of living conditions. RESULTS: During the study period, 347 microcephaly cases were reported, of which 142 (40.9%) fulfilled the definition of a microcephaly case. Stratification of the 94 districts resulted in the identification of four strata. The highest stratum in relation to the living conditions presented the lowest prevalence rate of microcephaly, and the overall difference between this rate and the rates of the other strata was statistically significant. The results of the Kruskal-Wallis test demonstrated that there was a strong association between a higher prevalence of microcephaly and poor living conditions. After the first 6 months of the study period, there were no microcephaly cases recorded within the population living in the richest socio-economic strata. CONCLUSION: This study showed that those residing in areas with precarious living conditions had a higher prevalence of microcephaly compared with populations with better living conditions.

Spatiotemporal transmission of SARS-CoV-2 lineages during 2020-2021 in Pernambuco-Brazil.

SARS-CoV-2 virus emerged as a new threat to humans and spread around the world, leaving a large death toll. As of January 2023, Brazil is among the countries with the highest number of registered deaths. Nonpharmacological and pharmacological interventions have been heterogeneously implemented in the country, which, associated with large socioeconomic differences between the country regions, has led to distinct virus spread dynamics. Here, we investigate the spatiotemporal dispersion of SARS-CoV-2 lineages in the Pernambuco state (Northeast Brazil) throughout the distinct epidemiological scenarios that unfolded in the first 2 years of the pandemic. We generated a total of 1,389 new SARS-CoV-2 genomes from June 2020 to August 2021. This sampling captured the arrival, communitary transmission, and the circulation of the B1.1, B.1.1.28, and B.1.1.33 lineages; the emergence of the former variant of interest P.2; and the emergence and fast replacement of all previous variants by the more transmissible variant of concern P.1 (Gamma). Based on the incidence and lineage spread pattern, we observed an East-to-West to inner state pattern of transmission, which is in agreement with the transmission of more populous metropolitan areas to medium- and small-size country-side cities in the state. Such transmission patterns may be partially explained by the main routes of traffic across municipalities in the state. Our results highlight that the fine-grained intrastate analysis of lineages and incidence spread can provide actionable insights for planning future nonpharmacological intervention for air-borne transmissible human pathogens.IMPORTANCEDuring the COVID-19 pandemic, Brazil was one of the most affected countries, mainly due its continental-size, socioeconomic differences among regions, and heterogeneous implementation of intervention methods. In order to investigate SARS-CoV-2 dynamics in the state of Pernambuco, we conducted a spatiotemporal dispersion study, covering the period from June 2020 to August 2021, to comprehend the dynamics of viral transmission during the first 2 years of the pandemic. Throughout this study, we were able to track three significant epidemiological waves of transmission caused by B1.1, B.1.1.28, B.1.1.33, P.2, and P.1 lineages. These analyses provided valuable insights into the evolution of the epidemiological landscape, contributing to a deeper understanding of the dynamics of virus transmission during the early years of the pandemic in the state of Pernambuco.

Evaluation of completeness, consistency and non-duplication of leprosy notification data on the Notifiable Health Conditions Information System, João Pessoa, Paraíba, Brazil: a descriptive study, 2001-2019.

OBJECTIVE: to analyze the completeness, consistency and non-duplication of leprosy notification data in João Pessoa, Paraíba, Brazil, 2001-2019. METHODS: this was a descriptive study, conducted with data from the Notifiable Health Conditions Information System, which checked for "duplication" (acceptable: < 5%), "completeness" (excellent = incompleteness ≤ 5%) and "consistency" (excellent: ≥ 90.0%), based on the proportion of complete and consistent fields. RESULTS: the sample consisted of 2,410 notifications. Duplication was acceptable (0.3%). The completeness of the "bacilloscopy", "affected nerves", "examined contacts" and "reactive episode" fields was very poor (more than 50% incomplete). Consistency between the "operational classification" and "initial treatment regimen" fields was excellent (99.6%), while consistency between "operational classification" and "clinical form" was low (50.7%). CONCLUSION: although duplication was acceptable, poor completeness of diagnosis and follow-up fields hinders epidemiological analysis, recognition of the status of the disease and adoption of measures to control it.

Detection of Wuchereria bancrofti in the city of São Luís, state of Maranhão, Brazil: New incursion or persisting problem?

BACKGROUND: The elimination of lymphatic filariasis (LF) from Brazil by 2020 was not accomplished; however, this goal can be achieved in the upcoming years with the assistance of specific strategies. The surveillance of LF can be performed using molecular xenomonitoring (MX), a noninvasive method used to infer the presence of the parasite in the human population. Herein, São Luís (state of Maranhão) was the first city to be investigated to identify whether LF transmission in Brazil has been interrupted and if there were any new incursions. METHODOLOGY/PRINCIPAL FINDINGS: Mosquitoes were collected by aspiration at 901 points distributed among 11 neighborhoods in São Luís with records of patients with microfilaremia. Pools of engorged or gravid Culex quinquefasciatus females were evaluated by WbCx duplex PCR with endogenous control for mosquitoes and target for W. bancrofti for determining the vector infection rate. Among the 10,428 collected mosquitoes, the most abundant species were C. quinquefasciatus (85%) and Aedes aegypti (12%). Significantly larger numbers of mosquitoes were collected from the neighborhoods of Areinha and Coreia (p<0.05). MX performed using PCR validated 705 pools of engorged or gravid females, fifteen of which were positive for Wuchereria bancrofti in two neighborhoods. CONCLUSIONS: The high density of engorged C. quinquefasciatus females per home, inadequate sanitation, and detection of W. bancrofti-infected mosquitoes in the city of São Luís represent a warning of the possible upsurge of LF, a disease that is still neglected; this underscores the need for the ostensive monitoring of LF in Brazil.

Spatial analysis of the natural infection index for Triatomines and the risk of Chagas disease transmission in Northeastern Brazil.

This study aimed to analyze the spatial pattern of natural infection index (NII) for triatomines and the risk of Chagas disease transmission in an endemic area of Northeastern Brazil. An ecological study was conducted, based on 184 municipalities in five mesoregions. The NII for triatomines was evaluated in the Pernambuco State, Brazil, from 2016 to 2018. Spatial autocorrelations were evaluated using Global Moran Index (I) and Local Moran Index (II) and were considered positive when I > 0 and p < 0.05, respectively. In total, 7,302 triatomines belonging to seven different species were detected. Triatoma brasiliensis had the highest frequency (53%; n = 3,844), followed by Triatoma pseudomaculata (25%; n = 1,828) and Panstrongylus lutzi (18.5%; n=1,366). The overall NII was 12%, and the higher NII values were P. lutzi (21%) and Panstrongylus megistus (18%). In the mesoregions of Zona da Mata, Agreste, Sertao, and Sertao do Sao Francisco, 93% of triatomines were detected indoors. The global spatial autocorrelation of I to NII was positive (0.2; p = 0.01), and II values calculated using BoxMap, MoranMap, Lisa Cluster Map were statistically significant for natural infections. With regard to the risk areas for the presence of triatomines, Zone 2 (the Agreste and Sertao regions) presented a relative risk of 3.65 compared to other areas in the state. Our study shows the potential areas of vector transmission of Chagas disease. In this study, the application of different methods of spatial analysis made it possible to locate these areas, which would not have been identified by only applying epidemiological indicators.

Mental health of community health workers in the COVID-19 context. / Saúde mental de agentes comunitários de saúde no contexto da COVID-19.

This study aimed to analyze the factors related to the mental health of Community Health Workers (ACS) in the COVID-19 context. A total of 1,935 ACS from four Northeastern capitals and four cities in the inland region of Ceará participated. The following data were collected: sociodemographic; professional; SRQ-20; WHOQOL-Bref, exposure to violence, General Self-Efficacy Scale (EAEG), Multidimensional Scale of Perceived Social Support (MSPSS), COVID-19-related information, and the coronavirus anxiety scale (EAC). Approximately 40.5% had SRQ > 7, signaling high levels of Common Mental Disorders (CMD)/mental health issues. We adopted the Multiple linear (backward) regression. We observed that the increased risk of CMD was influenced by exposure to violence, EAC, not knowing they had COVID-19, not knowing the variables that reduced the risk, the physical and psychological domains of the WHOQOL-Bref, not having increased working hours, and not having had COVID-19. The data reveal the multidimensional dynamics of mental health and help understand the relationship between community violence, COVID-19, quality of life, age, and ESF working time with the mental health of ACS.

O objetivo deste estudo foi analisar os fatores relacionados à saúde mental dos agentes comunitários de saúde (ACS) no contexto da COVID-19. Participaram 1.935 ACS de quatro capitais nordestinas e de quatro cidades do interior do Ceará. Foram coletados dados sociodemográficos e profissiográficos; SRQ-20; WHOQOL-Bref; exposição à violência; Escala de Autoeficácia Geral (EAEG); Escala Multidimensional de Suporte Social Percebido (MSPSS); informações relacionadas à COVID-19 e Escala de Ansiedade para Coronavírus (EAC). 40,5% exibiram SRQ > 7, sinalizando altos níveis de transtornos mentais comuns (TMC)/problemas de saúde mental. Utilizou-se a regressão linear múltiplas (backward). Observou-se que o aumento de risco de TCM foi influenciado pelos seguintes fatores: exposição à violência; EAC; não saber se teve COVID-19; desconhecer as variáveis que diminuíam o risco; os domínios físico e psicológico do WHOQOL-Bref; não ter aumento da jornada de trabalho; e não ter tido COVID-19. Os dados revelam a dinâmica multidimensional da saúde mental e ajudam a compreender a relação entre violência comunitária, COVID-19, qualidade de vida, idade e tempo de atuação na ESF com a saúde mental dos ACS.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil.

This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil.

Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.

Spatial analysis of tuberculosis in children under 15 years of age and socioeconomic risk: an ecological study in Paraíba, Brazil, 2007-2016. / Análise espacial da tuberculose em menores de 15 anos de idade e risco socioeconômico: um estudo ecológico na Paraíba, 2007-2016.

OBJECTIVE: To analyze spatial distribution of tuberculosis in individuals under 15 years old and socioeconomic factors in Paraíba, Brazil, 2007-2016. METHODS: This was an ecological study based on data from the Notifiable Health Conditions Information System (SINAN), taking each municipality to be a unit of analysis. Spatial distribution of incidence was performed, the local empirical Bayesian method and Moran's I were applied. Socioeconomic data were crossed-checked to identify areas of social prosperity. RESULTS: 426 cases were notified, with average incidence of 4.5/100,000 inhabitants. Moran's I was 0.59 (p=0.010). The Moran Map revealed concentration of cases in children under 15 in 38 high priority municipalities, in clusters with high-high and low-low patterns, in the east and northwest of the state, coinciding with areas of low social prosperity. CONCLUSION: There were clusters with greater tuberculosis transmission, indicating priority areas for addressing tuberculosis.

[Homicides in Brazil in the last decade: an integrative review]. / Homicídios do Brasil na última década: uma revisão integrativa.

Homicide is the most serious form of violence with a negative impact on the population. It is broadly studied in the scientific field and disseminated in print and in the virtual media. The scope of this article is to locate papers in national and international journals, seeking the synthesis of knowledge and the incorporation of the applicability of the results of significant studies. It involved an integrative review of the SciELO, PubMed and LILACS databases of articles published between 2006 and 2016. The following key words were researched: Homicide and Brazil. The publications were selected by the title, abstract and methodology. For homicide and health studies in Brazil, 427 papers were found, of which 98 were selected. There were publications with emphasis on the national scenario, followed by the state of São Paulo and Pernambuco. The quantitative study was the most used, with collection of secondary data. The papers dealt with homicides in the population in general (48%), Femicide (14.3%) and Social Determinants (7.1%). The Brazilian scientific production on homicide and health is on the increase. It is important that researchers, analysts and editors turn their attention to the development of papers in this area, aiming to improve the quality of published articles.

Evaluation of the quality of oral health care in Primary Health Care in Pernambuco, Brazil, 2014. / Avaliação da qualidade da assistência em saúde bucal na Atenção Primária à Saúde em Pernambuco, 2014.

OBJECTIVE: to evaluate the quality of oral health care in Primary Health Care services in Pernambuco state, Brazil, 2014. METHODS: this was an ecological health evaluation study based on the Donabedian model, involving secondary data from the 2nd cycle of the National Program for Improving Access and Quality of Primary Health Care (PMAQ-AB); comparison between the structure, process and outcome variables was done using the Kruskal-Wallis test (p<0.050); variables showing statistical significance (p<0.05) were portrayed through thematic and spatial dependence maps. Results: the standard of quality in the municipalities for the 'Structure' dimension gained better scores than the 'Work process' dimension; correlations were identified between the indicators for dental urgency, supervised tooth brushing coverage and treatments completed, in quality strata related to the work process of the Oral Health teams. CONCLUSION: organization of the work process was seen to be a determining factor in the impact on some indicators of service use.

Spatial analysis of intentional homicides in João Pessoa, Paraíba, Brazil, 2011-2016. / Análise espacial dos homicídios intencionais em João Pessoa, Paraíba, 2011-2016.

OBJECTIVE: to describe spatial patterns of intentional homicides in João Pessoa, Paraíba, Brazil, 2011-2016. METHODS: this was an ecological study using census tracts as units of analysis; the study used data on intentional homicides of victims living in João Pessoa obtained by cross-checking Mortality Information System SIM information with Public Security information; mortality coefficients were calculated for the whole period and its triennia and were later smoothed using the local empirical Bayesian method; spatial autocorrelation techniques were applied to the smoothed coefficients which were using Moran's spatial statistics. RESULTS: significant spatial autocorrelation was detected for the period as a whole I=0.679, p=0.01, the 1st triennium I=0.508, p=0.01, and the 2nd triennium I=0.572, p=0.01; areas of greater risk were identified distributed among the western, northwestern, southeastern, and far south zones of the city, mainly in regions with low socioeconomic conditions; census tracts with low coefficients were located in areas of medium/high socioeconomic status. CONCLUSION: homicides in João Pessoa were high in poor districts and these are priority areas for intervention.

Prevalence of malnutrition in children under five years old in Beira city, Mozambique, 2019 / Prevalência da má nutrição em crianças menores de cinco anos na cidade da Beira, Moçambique, 2019

Abstract Objectives: to describe the prevalence of malnutrition (underweight, low height, and overweight) in children aged six to 59 months and its spatial distribution in the city of Beira, Mozambique. Methods: an exploratory cross-sectional study was conducted between October and November 2019, involving 407 children aged six to 59 months. The sample size calculation was based on the prevalence of height-for-age deficit. Anthropometric data were analyzed using Anthro version and the prevalence of malnutrition was presented through thematic maps generated in Quantum Geographic Information System (QGIS). Results: the main findings revealed a prevalence of 27.0% for low height/age, 7.9% for underweight/height, and 4.7% for overweight. Conclusions: the spatial distribution highlighted that both urban and peri-urban areas of the city showed similar prevalence rates for the three forms of malnutrition. The prevalence of malnutrition in Beira is high, with deficit height/age being the most significant expression, while overweight is diffusely distributed.

Resumo Objetivos: descrever a prevalência da má nutrição (baixo peso, baixa estatura e excesso de peso) em crianças de seis a 59 meses e sua distribuição espacial na cidade de Beira, Moçambique. Métodos: estudo transversal exploratório, realizado entre outubro e novembro de 2019, incluindo 407 crianças de seis a 59 meses. O cálculo da amostra foi baseado na prevalência do déficit estatura/idade. Os dados antropométricos foram analisados no Anthro e a prevalência de má nutrição apresentada por meio de mapas temáticos no Quantum Geographic Information System (QGIS). Resultados: os principais resultados mostram uma prevalência de 27,0% de baixa estatura/idade, 7,9% de baixo peso/estatura e 4,7% de excesso de peso. Conclusões: a distribuição espacial evidenciou que as áreas urbanas e periurbanas da cidade apresentavam prevalências similares das três formas de má nutrição. A prevalência da má nutrição em Beira é alta, embora o déficit estatura/idade seja a sua maior expressão, estando o excesso de peso difusamente distribuído.

Household Survey of Trachoma among Children Living in Pernambuco, Brazil.

This study analyzed the association between individual and household factors and the incidence of trachoma among a population aged between 1 and 9 years in the state of Pernambuco. This was a population-based household study conducted using a population-based sample of residents from 96 census sectors of the 1778 sectors considered to be at social risk in the state. The estimated odds ratio of the univariate analysis presented a confidence interval of 95%. Weights and clusters were adjusted through the Generalized Linear and Latent Mixed Model (GLLAM) method. Trachoma cases were the dependent variable in the multivariate analysis. The independent variables were selected through the stepwise forward method, with an input criterion of 20% (p < 0.20) and an output criterion of 10% (p < 0.10). The prevalence was 6.65%. Trachoma was associated with a female sex, age of 5-9 years, either the absence of use or infrequent use of soap to wash the hands and face, the presence of nasal secretion, a lack of piped water from a public supply system, a greater number of rooms used for sleeping, a greater number of people living in the same household, and a family income of up to one minimum monthly wage. The prevalence of follicular trachoma in Pernambuco was higher than what is recommended by the World Health Organization (WHO).

Avaliação da completitude, consistência e não duplicidade dos dados de notificação da hanseníase no Sistema de Informação de Agravos de Notificação, João Pessoa, Paraíba: estudo descritivo, 2001-2019 / Evaluation of completeness, consistency and non-duplication of leprosy notification data on the Notifiable Health Conditions Information System, João Pessoa, Paraíba, Brazil: a descriptive study, 2001-2019 / Evaluación de la completitud, consistencia y no duplicidad de notificación de lepra en el Sistema de Información e Enfermidades de Declaración Obligatoria, en João Pessoa, Paraíba: estudio descriptivo, 2001-2019

Objetivo: analisar a completitude, consistência e não duplicidade dos dados da notificação da hanseníase em João Pessoa, Paraíba, Brasil, 2001-2019. Métodos: estudo descritivo, com dados do Sistema de Informação de Agravos de Notificação; verificou-se a duplicidade (aceitável quando < 5%), completitude (grau excelente = incompletitude ≤ 5%) e consistência (excelente quando ≥ 90,0%) dos dados, utilizando-se a proporção de campos preenchidos e coerentes. Resultados: a amostra de 2.410 notificações apresentou duplicidade aceitável (0,3%); a completitude dos campos "baciloscopia", "no de nervos afetados", "contatos examinados" e "episódio reacional" foi muito ruim (mais de 50% incompletos); e a consistência entre os campos "classificação operacional" e "esquema terapêutico inicial", excelente (99,6%), enquanto entre "classificação operacional" e "forma clínica" foi baixa (50,7%). Conclusão: embora a duplicidade observada fosse aceitável, a completitude de campos sobre diagnóstico e acompanhamento foi ruim, dificultando a análise epidemiológica, o reconhecimento da situação do agravo e a adoção de medidas de controle da doença.

Objective: to analyze the completeness, consistency and non-duplication of leprosy notification data in João Pessoa, Paraíba, Brazil, 2001-2019. Methods: this was a descriptive study, conducted with data from the Notifiable Health Conditions Information System, which checked for "duplication" (acceptable: ≤5%), "completeness" (excellent = incompleteness ≤ 5%) and "consistency" (excellent: ≤ 90.0%), based on the proportion of complete and consistent fields. Results: the sample consisted of 2,410 notifications. Duplication was acceptable (0.3%). The completeness of the "bacilloscopy", "affected nerves", "examined contacts" and "reactive episode" fields was very poor (more than 50% incomplete). Consistency between the "operational classification" and "initial treatment regimen" fields was excellent (99.6%), while consistency between "operational classification" and "clinical form" was low (50.7%). Conclusion: although duplication was acceptable, poor completeness of diagnosis and follow-up fields hinders epidemiological analysis, recognition of the status of the disease and adoption of measures to control it.

Objetivo: analizar la completitud, consistencia y no duplicidad de los datos de notificación de lepra en João Pessoa, Paraíba, 2001 - 2019. Métodos: estudio descriptivo, realizado con datos del Sistema de Información de Enfermedades de Declaración Obligatoria, que verificó "duplicidad" (aceptable: < 5%). "completitud" (grado excelente: incompletitud ≤ 5%) y "consistencia" (excelente: ≥ 90,0%), utilizando la proporción de campos completos y coherentes. Resultados: se obtuvo una muestra de 2.410 notificaciones. La duplicidad se consideró aceptable (0,3%). La completitud de los campos "baciloscopía", "nervios afectados", "contactos examinados" y "episodio reaccional" fue muy pobre (más del 50% incompleta). La consistencia entre los campos "clasificación operativa" y "régimen terapéutico inicial" fue excelente (99,6%), mientras que "clasificación operativa" y "forma clínica" fue baja (50,7%). Conclusión: aunque la duplicidad es aceptable, la completitud de los campos de diagnóstico y seguimiento fue deficiente, lo que dificulta el análisis epidemiológico, el reconocimiento de la situación de la enfermedad y la adopción de medidas de control de la enfermedad.

Spatial analysis of the natural infection index for Triatomines and the risk of Chagas disease transmission in Northeastern Brazil

ABSTRACT This study aimed to analyze the spatial pattern of natural infection index (NII) for triatomines and the risk of Chagas disease transmission in an endemic area of Northeastern Brazil. An ecological study was conducted, based on 184 municipalities in five mesoregions. The NII for triatomines was evaluated in the Pernambuco State, Brazil, from 2016 to 2018. Spatial autocorrelations were evaluated using Global Moran Index (I) and Local Moran Index (II) and were considered positive when I > 0 and p < 0.05, respectively. In total, 7,302 triatomines belonging to seven different species were detected. Triatoma brasiliensis had the highest frequency (53%; n = 3,844), followed by Triatoma pseudomaculata (25%; n = 1,828) and Panstrongylus lutzi (18.5%; n=1,366). The overall NII was 12%, and the higher NII values were P. lutzi (21%) and Panstrongylus megistus (18%). In the mesoregions of Zona da Mata, Agreste, Sertao, and Sertao do Sao Francisco, 93% of triatomines were detected indoors. The global spatial autocorrelation of I to NII was positive (0.2; p = 0.01), and II values calculated using BoxMap, MoranMap, Lisa Cluster Map were statistically significant for natural infections. With regard to the risk areas for the presence of triatomines, Zone 2 (the Agreste and Sertao regions) presented a relative risk of 3.65 compared to other areas in the state. Our study shows the potential areas of vector transmission of Chagas disease. In this study, the application of different methods of spatial analysis made it possible to locate these areas, which would not have been identified by only applying epidemiological indicators.

Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil / Perspectiva dos agentes comunitários de saúde sobre o impacto da COVID-19 na atenção primária à saúde no Nordeste do Brasil / Perspectiva de los agentes comunitarios de la salud sobre el impacto de pandemia de COVID-19 en la atención primaria a la salud en el Nordeste de Brasil

Abstract: This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceará State, João Pessoa - Paraíba State, Recife - Pernambuco State, Teresina - Piauí State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceará State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25±8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.

Resumo: Este artigo avalia as repercussões da pandemia da COVID-19 no cotidiano de trabalho da equipe da Estratégia Saúde da Família (ESF) em diversos municípios do Nordeste brasileiro, na perspectiva dos agentes comunitários de saúde (ACS). Um questionário estruturado foi utilizado para coletar informações sobre a COVID-19, atividades dos ACS e equipes da ESF em 2021. Participaram 1.935 ACS de quatro capitais (Fortaleza - Ceará, João Pessoa - Paraíba, Recife - Pernambuco e Teresina - Piauí) e quatro cidades do interior (Crato, Juazeiro do Norte, Barbalha e Sobral, Ceará). A idade média dos ACS era de 46,25±8,54 anos, sendo a maioria mulheres (82,42%). Muitos (39,92%) estavam infectados com COVID-19, dos quais 70,78% acreditavam ter sido infectados no ambiente de trabalho. Ao todo, 77,82% definiam seu papel como linha de frente no combate à COVID-19, 16,07% relataram receber treinamento para a COVID-19 e 13,74% tinham acesso a equipamentos de proteção suficientes contra a COVID-19. A maioria (90,27%) acredita que suas rotinas de trabalho foram modificadas pela pandemia, fortalecendo o espírito de equipe (41,46%) ou enfraquecendo-o (44,41%). Houve uma redução na promoção da saúde nas escolas (75,66%) e na frequência de visitas domiciliares (60,55%), de grupos específicos na comunidade (93,96%) e outros serviços comunitários locais (66,01%). Nos municípios avaliados, observou-se uma heterogeneidade significativa em relação à resposta à pandemia de COVID-19, possivelmente associada à falta de coordenação do Governo Federal. A pandemia levou a uma reconfiguração dos sistemas locais de saúde, fluxos de trabalho e protocolos de atenção primária para as equipes da ESF. A importância do Sistema Único de Saúde (SUS) e seu potencial de reorganização durante as crises devem ser reconhecidos, preservando-se os avanços alcançados até o momento.

Resumen: Este artículo evalúa las repercusiones de la pandemia de COVID-19 en el trabajo cotidiano del equipo de la Estrategia Salud de la Familia (ESF) en diversos municipios del Nordeste brasileño, desde la perspectiva de los agentes comunitarios de salud (ACS). Se utilizó un cuestionario estructurado para recopilar información sobre COVID-19, actividades de los ACS y equipos de la ESF en el 2021. Participaron 1.935 ACS de cuatro capitales (Fortaleza - Ceará, João Pessoa - Paraíba, Recife - Pernambuco y Teresina - Piauí) y cuatro ciudades del interior (Crato, Juazeiro do Norte, Barbalha y Sobral - Ceará). La edad media de los ACS era de 46,25±8,54 años, y la mayoría eran mujeres (82,42%). Muchos (39,92%) estaban infectados con COVID-19, de los cuales el 70,78% creía haberse contagiado en el entorno laboral. En total, el 77,82% definió su papel como línea de frente en el combate a la COVID-19, el 16,07% informó haber recibido capacitación para la COVID-19 y el 13,74% tuvo acceso a equipos de protección suficiente contra la COVID-19. La mayoría (90,27%) cree que sus rutinas de trabajo se vieron modificadas por la pandemia, fortaleciendo el espíritu de equipo (41,46%) o debilitándolo (44,41%). Hubo una reducción en la promoción de la salud en las escuelas (75,66%) y en la frecuencia de las visitas domiciliarias (60,55%), de grupos específicos en la comunidad (93,96%) y otros servicios comunitarios locales (66,01%). En los municipios analizados, se observó una heterogeneidad significativa con relación a la respuesta a la pandemia de COVID-19, posiblemente asociada a la falta de coordinación del Gobierno Federal. La pandemia condujo a una reconfiguración de los sistemas locales de salud, los flujos de trabajo y los protocolos de atención primaria para los equipos de la ESF. Se debe reconocer la importancia del Sistema Único de Salud y (SUS) su capacidad de reorganización durante las crisis, preservando los avances logrados hasta el momento.

Saúde mental de agentes comunitários de saúde no contexto da COVID-19 / Mental health of community health workers in the COVID-19 context

Resumo O objetivo deste estudo foi analisar os fatores relacionados à saúde mental dos agentes comunitários de saúde (ACS) no contexto da COVID-19. Participaram 1.935 ACS de quatro capitais nordestinas e de quatro cidades do interior do Ceará. Foram coletados dados sociodemográficos e profissiográficos; SRQ-20; WHOQOL-Bref; exposição à violência; Escala de Autoeficácia Geral (EAEG); Escala Multidimensional de Suporte Social Percebido (MSPSS); informações relacionadas à COVID-19 e Escala de Ansiedade para Coronavírus (EAC). 40,5% exibiram SRQ > 7, sinalizando altos níveis de transtornos mentais comuns (TMC)/problemas de saúde mental. Utilizou-se a regressão linear múltiplas (backward). Observou-se que o aumento de risco de TCM foi influenciado pelos seguintes fatores: exposição à violência; EAC; não saber se teve COVID-19; desconhecer as variáveis que diminuíam o risco; os domínios físico e psicológico do WHOQOL-Bref; não ter aumento da jornada de trabalho; e não ter tido COVID-19. Os dados revelam a dinâmica multidimensional da saúde mental e ajudam a compreender a relação entre violência comunitária, COVID-19, qualidade de vida, idade e tempo de atuação na ESF com a saúde mental dos ACS.

Abstract This study aimed to analyze the factors related to the mental health of Community Health Workers (ACS) in the COVID-19 context. A total of 1,935 ACS from four Northeastern capitals and four cities in the inland region of Ceará participated. The following data were collected: sociodemographic; professional; SRQ-20; WHOQOL-Bref, exposure to violence, General Self-Efficacy Scale (EAEG), Multidimensional Scale of Perceived Social Support (MSPSS), COVID-19-related information, and the coronavirus anxiety scale (EAC). Approximately 40.5% had SRQ > 7, signaling high levels of Common Mental Disorders (CMD)/mental health issues. We adopted the Multiple linear (backward) regression. We observed that the increased risk of CMD was influenced by exposure to violence, EAC, not knowing they had COVID-19, not knowing the variables that reduced the risk, the physical and psychological domains of the WHOQOL-Bref, not having increased working hours, and not having had COVID-19. The data reveal the multidimensional dynamics of mental health and help understand the relationship between community violence, COVID-19, quality of life, age, and ESF working time with the mental health of ACS.

A violência contra pessoas idosas no Brasil: fatores associados segundo o tipo de agressor / Violence against older people in Brazil: associated factors according to the type of aggressor

Resumo Analisou-se os fatores associados à violência contra pessoas idosas brasileiros segundo o tipo de agressor. Estudo transversal de base populacional com dados secundários, da Pesquisa Nacional de Saúde em 2013, totalizando 11.697 indivíduos com 60 anos ou mais no Brasil. A variável dependente foi ter sofrido violência por agressor conhecido ou desconhecido e as independentes foram divididas em blocos (Socioeconômico e demográfico; Autopercepção e cuidado com a saúde; Utilização do serviço de saúde; Estado de saúde/doença e Funcionalidade). O efeito das variáveis independentes sobre a variável resposta, foi expresso pela "Odds Ratio" com Intervalo de Confiança 95%. Realizou-se modelos hierarquizados de regressão logística multinomial simples e múltipla. Na análise simples foram eletivas para análise múltipla as variáveis com p-valor <0,05. Construiu-se um mapa temático segundo a distribuição espacial da violência, por estado. Cor da pele branca, <68 anos, saber ler e escrever, problemas no sono, não sentir prazer em fazer atividades e ter deficiência física associaram-se ao agressor desconhecido. Saúde ruim, fumar, discriminação no serviço de saúde e sentir-se mal consigo mesmo se associaram ao agressor conhecido. Discriminação por tipo de doença e pequena dificuldade para sair sozinho foram associados para ambos agressores. Estados com maior número de casos de violência encontrados foram Amapá, Paraná, Mato Grosso, Amazonas e Rio Grande do Norte. Desse modo, estimar a prevalência de violência contra pessoas idosas, o tipo de agressor, assim como os fatores associados, é imprescindível para identificação e prevenção do abuso individual, institucional e estrutural.

Abstract Factors associated with violence against older Brazilians were analyzed according to the type of aggressor. Population-based cross-sectional study with secondary data from the National Health Survey in 2013, totaling 11,697 individuals aged 60 years or older in Brazil. The dependent variable was having suffered violence by a known or unknown aggressor, and the independent variables were divided into blocks (Socioeconomic and demographic; Self-perception and health care; Health service use; Health status/disease and Functioning). The effect of the independent variables on the response variable was expressed by the "Odds Ratio" with a 95% Confidence Interval. Hierarchical models of simple and multiple multinomial logistic regression were performed. In the simple analysis, variables with p-value 0.05 were elective for multiple analysis. A thematic map was constructed according to the spatial distribution of violence, by state. White skin color, 68 years, knowing how to read and write, sleep problems, not feeling pleasure in doing activities and having a physical disability were associated with the unknown aggressor. Poor health, smoking, discrimination in the health service and feeling bad about oneself were associated with the known aggressor. Discrimination by type of illness and little difficulty going, out alone were associated for both aggressors. States with the highest number of cases of violence found were Amapá, Paraná, Mato Grosso, Amazonas and Rio Grande do Norte. Thus, estimating the prevalence of violence against older people, the type of aggressor, as well as associated factors, is essential for identifying and preventing individual, institutional and structural abuse.

Análise espacial da mortalidade fetal por sífilis congênita no Município do Recife-PE-Brasil entre 2007 e 2016 / Análisis espacial de la mortalidad fetal por sífilis congénita en el municipio de Recife-PE-Brasil entre 2007 y 2016 / Spatial analysis of fetal mortality from congenital syphilis in the municipality of Recife-PE-Brazil between 2007 and 2016

Resumo Objetivo analisar a distribuição espacial da mortalidade fetal por sífilis congênita entre os bairros do Município do Recife-PE. Método estudo ecológico, realizado a partir do indicador epidemiológico taxa de mortalidade fetal por sífilis congênita, agregado ao nível dos bairros, em dois quinquênios: 2007 a 2011 e 2012 a 2016. O padrão de autocorrelação espacial foi determinado pelos Índices de Moran Global e Local, com significância estatística inferior a 5% e representado em mapas BoxMap e MoranMap que apontaram as áreas com taxas altas, baixas e em transição epidemiológica e os clusters de maior interesse epidemiológico. Resultados foram notificados 208 óbitos fetais. O Índice Global de Moran evidenciou autocorrelação espacial positiva em grau razoável, no primeiro quinquênio (I = 0,351 e p-valor = 0,01) e, em grau fraco, no segundo quinquênio (I = 0,189 e p-valor = 0,02). Os Distritos Sanitários I e VII obtiveram os maiores percentuais de bairros que formaram o cluster de altas taxas do indicador com 63,3% e 38,4% no primeiro e segundo quinquênios, respectivamente. Conclusões e implicações para a Prática a análise espacial apontou as áreas críticas para ocorrência do indicador, podendo contribuir para o investimento nas áreas prioritárias de prevenção da transmissão vertical da sífilis.

Resumen Objetivo Analizar la distribución espacial de la mortalidad fetal por sífilis congénita entre los barrios de Recife-PE. Método Estudio ecológico, basado en el indicador epidemiológico tasa de mortalidad fetal por sífilis congénita, agregada a nivel de barrio, en dos quinquenios: 2007 a 2011 y 2012 a 2016. El patrón de autocorrelación espacial fue determinado por los Índices Moran Global y Local, con significancia estadística menor al 5% y representados en mapas de BoxMap y MoranMap, que indicaron áreas con tasas de transición alta, baja y epidemiológica y conglomerados de mayor interés epidemiológico. Resultados Notificadas 208 muertes fetales. El Índice Global de Moran mostró un grado razonable de autocorrelación espacial positiva en el primer quinquenio (I = 0,351 y p-valor=0,01) y un grado débil en el segundo quinquenio (I = 0,189 y p-valor=0,02). Los Distritos Sanitarios I y VII presentaron los mayores porcentajes de barrios que formaron el cluster de tasas altas del indicador con 63,3% y 38,4% en el primer y segundo quinquenio, respectivamente. Conclusión e Implicación para la Práctica El análisis espacial señaló las áreas críticas para la ocurrencia del indicador, que podrían contribuir a la inversión en áreas prioritarias para la prevención de la transmisión vertical de sífilis.

Abstract Objective To analyze the spatial distribution of fetal mortality due to congenital syphilis among the neighborhoods of the city of Recife-PE. Method Ecological study, based on the epidemiological indicator fetal mortality rate due to congenital syphilis, aggregated at the neighborhood level, in two five-year periods: 2007 to 2011 and 2012 to 2016. The pattern of spatial autocorrelation was determined by the Moran Global and Local Indexes, with statistical significance lower than 5% and represented in BoxMap and MoranMap maps that indicated areas with high, low and epidemiological transition rates and clusters of greater epidemiological interest. Results It was reported 208 fetal deaths. The Moran Global Index showed a reasonable degree of positive spatial autocorrelation in the first five-year period (I = 0.351 and p-value = 0.01) and a weak degree in the second five-year period (I = 0.189 and p-value = 0.02). Sanitary Districts I and VII had the highest percentages of neighborhoods that formed the cluster of high rates of the indicator with 63.3% and 38.4% in the first and second five-year periods, respectively. Conclusions and Implications for Practice The spatial analysis pointed out the critical areas for the occurrence of the indicator, which could contribute to investment in priority areas for the prevention of vertical transmission of syphilis.