ABSTRACT

In the past decades, an epidemic of chronic kidney disease (CKD) has been associated with environmental and occupational factors (heat stress from high workloads in hot temperatures and exposure to chemicals, such as pesticides and metals), which has been termed CKD of non-traditional origin (CKDnt). This descriptive review aims to present recent evidence about heat stress, pesticides, and metals as possible causes of CKDnt and provide an overview of the related Brazilian regulation, enforcement, and health surveillance strategies. Brazilian workers are commonly exposed to extreme heat conditions and other CKDnt risk factors, including increasing exposure to pesticides and metals. Furthermore, there is a lack of adequate regulation (and enforcement), public policies, and strategies to protect the kidney health of workers, considering the main risk factors. CKDnt is likely to be a significant cause of CKD in Brazil, since CKD's etiology is unknown in many patients and several conditions for its development are present in the country. Further epidemiological studies may be conducted to explore causal associations and estimate the impact of heat, pesticides, and metals on CKDnt in Brazil. Moreover, public policies should prioritize reducing workers´ exposure and promoting their health and safety.

Subject(s)

Pesticides , Renal Insufficiency, Chronic , Humans , Brazil/epidemiology , Risk Factors , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/etiology

ABSTRACT

PURPOSE: Chagas disease (CD) a Neglected Tropical Diseases is an important public health issue in countries where is still endemic, included in the Sustainable Development Goals (SDG). Traditionally restricted to rural areas with diverse routes of transmissions from vectorial to oral with acute manifestations but being more common diagnosed in chronic stages. The aim of this investigation was to characterize the Knowledge, Attitudes and Practices (KAP) related to Chagas disease (CD) in two rural settlements of the Colombian Caribbean with previous records of the disease and/or the parasite. METHODS: A cross-sectional descriptive study was made in two rural settlements in Colombia and surveillance instrument was developed to measure Knowledge, Attitudes and Practices (KAP) related to Chagas disease (CD). RESULTS: In a population with > 60% women and access to social security around 66.5%; 81,6% were homeowners with access to water and electricity > 90% but only 9% of sewerage. The level of knowledge about CD was around 62% but lack of specificity about comprehension of transmission routes (74,6%), and symptoms (85,3%) were found; concluding that 86% of the surveyed sample had very poor level of knowledge about the disease despite preventive campaigns carried out in the two communities studied. CONCLUSIONS: Despite of a low frequency of CD in this Caribbean areas, the presence of vector, risk factors plus poor level of knowledge about the disease justify that public health intervention strategies should be implemented and monitored over time to maintain uninterrupted surveillance of Chagas Disease.

ABSTRACT

Objective: To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil. Methods: This was a population-based survey with probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation - follicular (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained. Results: The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%. Conclusions: The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.

ABSTRACT

[ABSTRACT]. Objective. To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil. Methods. This was a population-based survey with probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation – follicular (TF) in children aged 1–9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained. Results. The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%. Conclusions. The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.

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[RESUMEN]. Objetivo. Estimar la prevalencia del tracoma en poblaciones indígenas y no indígenas en determinadas zonas del estado de Maranhão, en el nordeste de Brasil. Métodos. Se trató de una encuesta de ámbito poblacional con muestreo probabilístico. Para el diagnóstico del tracoma, se realizó un examen ocular externo con una lupa frontal de 2,5X aumentos. Se estimó la prevalencia de la inflamación tracomatosa folicular (TF) en la población infantil de 1 a 9 años y la prevalencia de la triquiasis tracomatosa (TT) en la población de 15 años o más. Se obtuvieron las frecuencias relativas de las características sociodemográficas y ambientales. Resultados. En el estudio participaron 7 971 personas, 3 429 de poblaciones no indígenas y 4 542 de poblaciones indígenas. La prevalencia de la TF en las poblaciones no indígenas e indígenas fue de 0,1% y 2,9%, respectivamente, en tanto que la de la TT en las poblaciones indígenas fue de 0,1%. Conclusiones. La prevalencia de la TF y la TT en las dos unidades de evaluación del estado de Maranhão estuvo dentro de los límites recomendados para la eliminación del tracoma como problema de salud pública. Sin embargo, la prevalencia de la TF fue mayor en la unidad de evaluación indígena, lo que indica una mayor vulnerabilidad de esta población a la enfermedad. La prevalencia de la TF inferior al 5,0% implica una reducción de la transmisión, que puede haber sido consecuencia tanto de la mejora de las condiciones socioeconómicas como de la aplicación de la estrategia SAFE de la Organización Mundial de la Salud.

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[RESUMO]. Objetivo. Estimar a prevalência do tracoma em populações indígenas e não indígenas em áreas selecionadas do estado do Maranhão, na região Nordeste do Brasil. Métodos. Inquérito de base populacional com amostragem probabilística. Para o diagnóstico de tracoma, foi realizado exame ocular externo com o auxílio de lupas binoculares com ampliação de 2,5×. Foram estimadas a prevalência de inflamação tracomatosa folicular (TF) em crianças de 1 a 9 anos de idade e a prevalência de triquíase tracomatosa (TT) na população com idade ≥15 anos. Foram obtidas as frequências relativas das características sociodemográficas e ambientais. Resultados. O estudo incluiu 7 971 indivíduos (3 429 de populações não indígenas e 4 542 de populações indígenas). A prevalência de TF nas populações não indígenas e indígenas foi de 0,1% e 2,9%, respectiva- mente, e a prevalência de TT entre as populações indígenas foi de 0,1%. Conclusões. A prevalência de TF e TT nas duas unidades de avaliação no estado do Maranhão ficou dentro dos limites recomendados para a eliminação do tracoma como problema de saúde pública. No entanto, a prevalência de TF foi maior na unidade de avaliação indígena, indicando uma maior vulnerabilidade dessa população à doença. A prevalência de TF abaixo de 5,0% implica uma redução na transmissão, que pode ter sido resultado de melhores condições socioeconômicas e da implementação da estratégia SAFE da Organização Mundial da Saúde.

Subject(s)

Trachoma , Neglected Diseases , Prevalence , Health Surveys , Brazil , Trachoma , Prevalence , Neglected Diseases , Health Surveys , Brazil , Prevalence , Health Surveys

ABSTRACT

BACKGROUND: Visceral leishmaniasis results from complex interactions among humans, dogs and environment. Brazil accounts for 97% of cases in the Americas. METHODS: Twenty years (2001-2020) of the endemic disease in the state of Rio de Janeiro were studied. Incidence, lethality, sociodemographic and clinical characteristics were investigated, complemented with spatial methodologies (kernel and clusters). RESULTS: Ninety-seven human cases and 625 dogs were reported. Of the 92 cities, 22 were human endemic areas. The state had a low incidence level (0.6 per 100 000). Lethality was higher compared with the Brazilian average. More than 90% of infections occurred in urban areas. Most cases (66%) occurred in men. The predominant age groups were 0-4 y (28.7%) and 20-39 y (32.9%). Fever (89.5%), splenomegaly (83.2%) and hepatomegaly (76.8%) were the main clinical manifestations. Spatial analysis showed a displacement of the human endemic: in the first decade (2001-2010), cases were concentrated in the Metropolitan region, and in the second decade (2011-2020) in the Médio Paraíba region of the state. Most of the endemic area (56.4%) had canine infections without reported human cases. CONCLUSIONS: Disorderly urbanisation and precarious living conditions favour the transmission of the disease. Changes in the environment and migratory processes contribute to its expansion.

ABSTRACT

Introducción La neurocisticercosis (NCC), una posible causa de epilepsia con datos epidemiológicos limitados en la República Dominicana, es endémica en cuatro provincias de la región suroeste. El objetivo de este estudio fue determinar la asociación entre la NCC y la epilepsia en personas que viven en estas regiones endémicas, así como obtener datos preliminares sobre la prevalencia de NCC en estas provincias. Sujetos y métodos Se utilizó un diseño de casos y controles compuesto por 111 pacientes con epilepsia de causa desconocida y 60 controles sin epilepsia ni NCC. El diagnóstico de NCC se basó en la tomografía computarizada y la resonancia magnética del cráneo, así como en el inmunotransferencia de Western para anticuerpos séricos contra Taenia solium, siguiendo los criterios de Del Brutto et al. Resultados Se encontró NCC en el 27% de los pacientes con epilepsia (n = 30/111) y en el 5% de los controles (n = 3/60); los casos de epilepsia tenían siete veces más probabilidades de tener NCC que los controles (odds ratio = 7,04, intervalo de confianza al 95%: 2,04-24,18; p < 0,001). Las características sociodemográficas de los participantes, como la edad, el sexo, el nivel de escolaridad, la ocupación y la provincia de residencia no mostraron significación estadística en cuanto a la asociación con NCC. Conclusiones Este estudio sugiere que la NCC está fuertemente asociada con la epilepsia en la región suroeste de la República Dominicana, y destaca la necesidad de medidas de salud pública para mejorar la prevención, el diagnóstico y el tratamiento de ambas enfermedades. (AU)

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INTRODUCTION Neurocysticercosis (NCC), a possible cause of epilepsy with limited epidemiological data in the Dominican Republic, is endemic in four provinces in the country’s south-western region. This study aimed to determine the association between NCC and epilepsy among people living in these endemic regions, and to obtain preliminary data on the prevalence of NCC in these provinces. PATIENTS AND METHODS A case-control design was used, consisting of 111 patients with epilepsy with unknown causes, and 60 controls without epilepsy or NCC. The diagnosis of NCC was based on computed tomography and magnetic resonance imaging of the skull, as well as Western immunoblotting for serum antibodies using Taenia solium, following the criteria of Del Brutto et al. RESULTS NCC was found in 27% of the epileptic patients (n = 30/111) and in 5% of the controls (n = 3/60); the probability of the epileptic patients having NCC was seven times higher than the controls (odds ratio = 7.04, 95% confidence interval: 2.04-24.18; p < 0.001). The participants’ sociodemographic characteristics, including their age, sex, level of education, occupation, and province of residence presented no statistical significance in terms of their association with NCC. CONCLUSIONS This study suggests that NCC is strongly associated with epilepsy in the south-western region of the Dominican Republic, and highlights the need for public health measures to improve the prevention, diagnosis and treatment of both diseases. (AU)

Subject(s)

Humans , Male , Female , Child , Adolescent , Young Adult , Adult , Middle Aged , Aged , Epilepsy/diagnostic imaging , Epilepsy/diagnosis , Neurocysticercosis/diagnosis , Case-Control Studies , Tomography, X-Ray Computed , Magnetic Resonance Spectroscopy , Taenia solium , Dominican Republic

ABSTRACT

Old Yellow Enzymes (OYEs) are flavin-dependent redox enzymes that promote the asymmetric reduction of activated alkenes. Due to the high importance of flavoenzymes in the metabolism of organisms, the interaction between OYEs from the parasites Trypanosoma cruzi and Leishmania braziliensis and three diterpene icetexanes (brussonol and two analogs), were evaluated in the present study, and differences in the binding mechanism and inhibition capacity of these molecules were examined. Although the aforementioned compounds showed poor and negligible activities against T. cruzi and L. braziliensis cells, respectively, the experiments with the purified enzymes indicated that the interaction occurs by divergent mechanisms. Overall, the ligands' inhibitory effect depends on their accessibility to the N5 position of the flavin's isoalloxazine ring. The results also indicated that the OYEs found in both parasites share structural similarities and showed affinities for the diterpene icetexanes in the same range. Nevertheless, the interaction between OYEs and ligands is directed by enthalpy and/or entropy in distinct ways. In conclusion, the binding site of both OYEs exhibits remarkable plasticity, and a large range of different molecules, including that can be substrates and inhibitors, can bind this site. This plasticity should be considered in drug design using OYE as a target.

Subject(s)

Chagas Disease , Leishmania braziliensis , Trypanosoma cruzi , Humans , NADPH Dehydrogenase/chemistry , NADPH Dehydrogenase/pharmacology , Chagas Disease/parasitology , Flavins/pharmacology

ABSTRACT

AIMS: This study describes the spatio-temporal dynamics of new visceral leishmaniasis (VL) cases notified in Brazil between 2001 and 2020. METHODS AND RESULTS: Data on the occurrence of the disease were obtained by means of the Notifiable Diseases Information System of the Brazilian Ministry of Health. Joinpoint, temporal generalized additive models and conditional autoregressive (CAR) models were used to analyse the temporal evolution of the rates in Brazil, states and regions. Spatio-temporal generalized additive and CAR models were used to identify the distribution of annual risks of VL occurrence in the Brazilian territory in relation to variation in the spatial average. There were 63,966 VL cases in the target period (3.198 cases/year), corresponding to a mean incidence rate of 1.68 cases/100,000 inhabitants. Of these, 4451 resulted in deaths, which gives a mean mortality rate of 0.12 deaths/100,000 inhabitants and a case fatality of 6.96%. The highest incidence rate was found in the North region, followed closely by the Northeast region, which presented the second and first highest mortality rates, respectively. For all of Brazil, and in the Northeast region, there were stability in the incidence rates, while the other regions showed an increasing trend in different time segments in the period: Central-West up to 2011, North up to 2008, Southeast up to 2004, and South up to 2010. On the other hand, all regions experienced a reduction in incidence rate during the last years of the series. The Northeast region had the highest number of municipalities with statistically significant elevated relative risks. The spatio-temporal analysis showed the highest risk area predominantly in the Northeast region in the beginning of the time series. From 2002 to 2018, this area expanded to the interior of the country. CONCLUSIONS: The present study has shown that VL has expanded in Brazil. However, the North and Northeast regions continue to have the highest incidence, and the risk of infection has decreased in recent years.

Subject(s)

Leishmaniasis, Visceral , Animals , Brazil/epidemiology , Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/veterinary , Spatio-Temporal Analysis , Regression Analysis , Incidence

ABSTRACT

ABSTRACT Objective: To describe leprosy involvement and physical disability profiles in children and adolescents under 15 years old. Methods: Ecological time series study, based on data from the Brazilian Notifiable Diseases Information System, including new cases of leprosy residing in Palmas (TO), from 2001 to 2020. Results: A total of 471 notified cases in children and adolescents under 15 years of age were evaluated, resulting in a detection coefficient of 26.5 per 100,000 inhabitants. Of these, 52% (n=243) were women, 5% (n=24) corresponded to grade two disability, and 36% (n=168) were diagnosed through spontaneous demand. The temporal trend analysis showed a 0.5% reduction in the detection coefficient. There was a significant decrease in the diagnosis of the undetermined and tuberculoid clinical forms and a significant increase in the dimorphous form. Diagnosis through contact examination increased significantly by 13.1% and that through spontaneous demand decreased by 4.9%. The detection coefficient of cases with grade two disability reduced significantly by 7.4% while those with grade one increased by 16.8%. Conclusions: Despite the downward trend in the detection coefficient in children and adolescents under 15 years of age and in cases with grade two disability, other factors indicate failure in the adequate management of leprosy in Palmas.

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RESUMO Objetivo: Descrever os perfis de acometimento de hanseníase e incapacidade física em menores de 15 anos. Métodos: Estudo ecológico de série temporal, baseado em dados do Sistema Nacional de Agravos de Notificação, incluindo casos novos de hanseníase residentes em Palmas (TO), no período de 2001 a 2020. Resultados: Foram avaliados 471 casos notificados em crianças e adolescentes menores de 15 anos, resultando em um coeficiente de detecção de 26,5 por cem mil habitantes. Destes, 52% (n=243) eram do gênero feminino, 5% (n=24) correspondiam ao grau dois de incapacidade física, e 36% (n=168) foram diagnosticados por demanda espontânea. A análise de tendência temporal mostrou queda do coeficiente de detecção em 0,5%. Houve queda significativa no diagnóstico das formas clínicas indeterminada e tuberculoide e aumento significativo da dimorfa. O diagnóstico por exame de contato teve um aumento significativo de 13,1% e o por demanda espontânea, queda significativa de 4,9%. O coeficiente de detecção de casos com grau dois de incapacidade apresentou uma queda significativa de 7,4%, enquanto o de casos com grau um, apresentou um aumento de 16,8%. Conclusões: Apesar da tendência de queda do coeficiente de detecção em menores de 15 anos e do coeficiente de detecção de casos com grau dois de incapacidade, outros fatores indicam falha no manejo adequado da hanseníase em Palmas.

ABSTRACT

Cutaneous leishmaniasis (CL) is a neglected disease widely distributed in Maranhão, Brazil and presents a significant public health problem. However, its transmission dynamics and determining factors are not clearly understood. In this context, geospatial technologies help interpret the process. This study, then, characterized the space-time dynamics and the influence of social vulnerability on CL in an endemic area in Northeast Brazil. This is an ecological study about new cases of CL in Maranhão, from 2007 to 2020, obtained directly from the Notifiable Diseases Information System. The incidence rate was smoothed using a spatial empirical Bayesian method. Subsequently, global and local Moran statistics and their association with social vulnerability indicators were determined. Disease distribution was not random but grouped in space and time. All Social Vulnerability Index domains were positively correlated with the CL incidence. A likely cluster was detected in western Maranhão (P < 0.001), which encompassed 18 municipalities, from January 2007 to December 2013, with a high relative risk (5.06). The research findings suggest that planning public health actions and allocating resources should be prioritized in these areas to help effectively reduce the incidence of the disease.

Subject(s)

Leishmaniasis, Cutaneous , Social Vulnerability , Animals , Brazil/epidemiology , Bayes Theorem , Cities , Incidence , Leishmaniasis, Cutaneous/epidemiology

ABSTRACT

ABSTRACT Objective. To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil. Methods. This was a population-based survey with probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation - follicular (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained. Results. The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%. Conclusions. The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.

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RESUMEN Objetivo. Estimar la prevalencia del tracoma en poblaciones indígenas y no indígenas en determinadas zonas del estado de Maranhão, en el nordeste de Brasil. Métodos. Se trató de una encuesta de ámbito poblacional con muestreo probabilístico. Para el diagnóstico del tracoma, se realizó un examen ocular externo con una lupa frontal de 2,5X aumentos. Se estimó la prevalencia de la inflamación tracomatosa folicular (TF) en la población infantil de 1 a 9 años y la prevalencia de la triquiasis tracomatosa (TT) en la población de 15 años o más. Se obtuvieron las frecuencias relativas de las características sociodemográficas y ambientales. Resultados. En el estudio participaron 7 971 personas, 3 429 de poblaciones no indígenas y 4 542 de poblaciones indígenas. La prevalencia de la TF en las poblaciones no indígenas e indígenas fue de 0,1% y 2,9%, respectivamente, en tanto que la de la TT en las poblaciones indígenas fue de 0,1%. Conclusiones. La prevalencia de la TF y la TT en las dos unidades de evaluación del estado de Maranhão estuvo dentro de los límites recomendados para la eliminación del tracoma como problema de salud pública. Sin embargo, la prevalencia de la TF fue mayor en la unidad de evaluación indígena, lo que indica una mayor vulnerabilidad de esta población a la enfermedad. La prevalencia de la TF inferior al 5,0% implica una reducción de la transmisión, que puede haber sido consecuencia tanto de la mejora de las condiciones socioeconómicas como de la aplicación de la estrategia SAFE de la Organización Mundial de la Salud.

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RESUMO Objetivo. Estimar a prevalência do tracoma em populações indígenas e não indígenas em áreas selecionadas do estado do Maranhão, na região Nordeste do Brasil. Métodos. Inquérito de base populacional com amostragem probabilística. Para o diagnóstico de tracoma, foi realizado exame ocular externo com o auxílio de lupas binoculares com ampliação de 2,5×. Foram estimadas a prevalência de inflamação tracomatosa folicular (TF) em crianças de 1 a 9 anos de idade e a prevalência de triquíase tracomatosa (TT) na população com idade ≥15 anos. Foram obtidas as frequências relativas das características sociodemográficas e ambientais. Resultados. O estudo incluiu 7 971 indivíduos (3 429 de populações não indígenas e 4 542 de populações indígenas). A prevalência de TF nas populações não indígenas e indígenas foi de 0,1% e 2,9%, respectivamente, e a prevalência de TT entre as populações indígenas foi de 0,1%. Conclusões. A prevalência de TF e TT nas duas unidades de avaliação no estado do Maranhão ficou dentro dos limites recomendados para a eliminação do tracoma como problema de saúde pública. No entanto, a prevalência de TF foi maior na unidade de avaliação indígena, indicando uma maior vulnerabilidade dessa população à doença. A prevalência de TF abaixo de 5,0% implica uma redução na transmissão, que pode ter sido resultado de melhores condições socioeconômicas e da implementação da estratégia SAFE da Organização Mundial da Saúde.

ABSTRACT

La tungiasis es una de las enfermedades infecciosas desatendidas y es causada por la Tunga penetrans, también conocida como la pulga de arena. En la reunión celebrada en octubre del 2022, las delegaciones de los ministerios de salud de Brasil y Colombia presentaron información detallada sobre su experiencia en la reducción del efecto de esta enfermedad de la piel en las comunidades afectadas. En este informe se describen las medidas de vigilancia, prevención, atención y control, incluidas la identificación y caracterización de los grupos de población afectados, la vigilancia epidemiológica y entomológica, el diagnóstico y el tratamiento de casos en seres humanos, la identificación y tratamiento de los animales afectados, así como las acciones de control, monitoreo y evaluación. También se hace una descripción de las actividades integradas ejecutadas bajo el concepto de “Una Salud”. Con esta publicación, la Organización Panamericana de la Salud aspira a documentar la lucha contra enfermedades infecciosas desatendidas que, como la tungiasis, continúan afectando los grupos en situación de vulnerabilidad de la Región de las Américas.

Subject(s)

Tungiasis , Tunga , Tunga , Communicable Diseases , Neglected Diseases , Brazil , Colombia

ABSTRACT

Introduction: Lymphatic filariasis (LF) is a neglected parasitic disease transmitted by mosquitoes and affecting the lymphatic system. The aim of this study was to analyze the epidemiological and sociodemographic characteristics of patients with LF during the last 11 years of available data in Ecuador. Methods: A 11-year nationwide analysis of hospital admission and in-hospital mortality based on the National Institute of Statistics and Census (INEC) data was conducted in Ecuador from 2011 to 2021. The International Classification of Diseases 10th Revision (ICD-10) code for filariasis (ICD: B74) was used to retrieve information on severe LF as a proxy for incidence among 221 Ecuadorian cities. Results: A total of 26 hospital admissions and 3 deaths due to LF were registered. The highest mortality rate was found in populations over 80 years. Men accounted for 62.5% (n = 17) of total number of cases with an average incidence rate of 1.7 cases per/1,000,000, while females accounted for 34.6% (n = 9), representing 1 case per/1,000,000 woman. Cities located at lower altitude (459/1,000,000) reported higher incidence rates than those located at higher altitudes (7.4/1,000,000). Conclusion: This is the first study on LF in Ecuador. Although, Ecuador is not considered endemic for LF, we found evidence of the presence of this disease in recent years. The implementation and improvement of an adequate integrated epidemiological surveillance system will allow early identification of cases and therefore their respective treatment.

Subject(s)

Elephantiasis, Filarial , Male , Animals , Female , Humans , Elephantiasis, Filarial/epidemiology , Elephantiasis, Filarial/parasitology , Ecuador/epidemiology , Cities , Incidence

ABSTRACT

Objective: To analyze the spatial-temporal distribution and factors associated with mortality from neglected tropical diseases (NTDs) in Brazil from 2000 to 2019. Method: We performed an ecological study to analyze NTD-related deaths recorded in the Ministry of Health Mortality Information System (SIM). For the temporal analysis, the joinpoint method was used. Spatial dependence was analyzed using global Moran and local Getis-Ord Gi* indices. Four non-spatial and spatial regression models were used to identify factors associated with mortality. Results: The mean mortality rate from NTDs in Brazil during the study period was 3.32 deaths per 100 000 inhabitants, with the highest rate (8.68 deaths per 100 000 inhabitants) recorded in the Midwest. The most prevalent causes of death were Chagas disease (n = 94 781; 74.9%) and schistosomiasis (n = 10 271; 8.1%). There was a 1.24% reduction (95%CI = -1.6; -0.9; P < 0.001) in NTD-related mortality in Brazil per year. A high/high spatial distribution pattern and hotspots were observed in municipalities in the states of Goiás, Minas Gerais, Bahia, Tocantins, and Piauí. The indicators "population in households with density > 2 people per bedroom" (ß = -0.07; P = 0.00) and "municipal human development index" (ß = -3.36; P = 0.08) were negatively associated with the outcome, while the "index of social vulnerability" (ß = 2.74; P = 0.05) was positively associated with the outcome. Conclusion: Lower human development and higher social vulnerability are associated with higher mortality from NTDs, which should guide NTD prevention and control efforts.

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Objetivo: Analizar la distribución espacial y temporal de la mortalidad por enfermedades tropicales desatendidas en Brasil en el período 2000-2019 y los factores asociados a ella. Método: Estudio ecológico centrado en el análisis de las muertes por enfermedades tropicales desatendidas registradas en el Sistema de Información sobre Mortalidad. Para el análisis temporal se utilizó el método de regresión de puntos de inflexión (joinpoint). La dependencia espacial se analizó mediante los índices de Moran global y local y Gi* de Getis-Ord. Se utilizaron cuatro modelos de regresión espacial y no espacial para detectar los factores relacionados con la mortalidad. Resultados: La tasa media de mortalidad por enfermedades tropicales desatendidas en Brasil fue de 3,32 muertes por 100 000 habitantes en el periodo del estudio, y la tasa más alta observada (8,68 muertes por 100 000 habitantes) fue la del Centro Oeste. Las causas de muerte más prevalentes fueron la enfermedad de Chagas (n = 94.781; 74,9%) y la esquistosomiasis (n = 10.271; 8,1%). Se registró una disminución de 1,24% (IC del 95% = -1,6; -0,9; p < 0,001) anual de la mortalidad por enfermedades tropicales desatendidas en el país. Se observó un patrón de distribución espacial alto/alto, con puntos calientes en municipios de los estados de Bahía, Goiás, Minas Gerais, Piauí y Tocantins. Los indicadores "población en hogares con densidad > 2 habitantes por dormitorio" (ß = -0,07; P = 0,00) e "índice de desarrollo humano municipal" (ß = -3,36; P = 0,08) mostraron una asociación negativa con el resultado, mientras que el indicador "índice de vulnerabilidad social" (ß = 2,74; P = 0,05) arrojó una asociación positiva. Conclusiones: Cuanto menor es el grado de desarrollo humano y mayor la vulnerabilidad social, mayor es la mortalidad por enfermedades tropicales desatendidas, lo que debe orientar las medidas correspondientes de prevención y control.

ABSTRACT

BACKGROUND: Brazil ranks first in the number of snakebites in South America. A detailed analysis of these cases is required to improve the public health planning. In this study, we retrospectively examined the clinical and epidemiological profiles of snakebites in Maranhão between January 2009 and December 2019. METHODS: Data were obtained from the compulsory notification forms provided by the Health Department of Maranhão. RESULTS: A total of 17,658 cases were recorded during the study period. Most of the bites were from snakes belonging to the genus Bothrops. Medical care was mostly within three hours after the bite. Most cases were classified as mild and most victims recovered; however, 139 deaths were recorded. Most bites occurred among people aged 20-39 years, mainly among rural workers. The most frequent local clinical manifestations were pain, edema, and ecchymosis. The most common systemic clinical manifestations include neuroparalysis, vagal syndrome, and myolysis. Most snakebites occurred between January and March. The municipalities with the highest number of notifications were Buriticupu (936 cases), Arame (705 cases), and Grajaú (627 cases). CONCLUSIONS: The clinical profile of snakebites in Maranhão is similar to that observed in other states of Northeast Brazil. However, we found that some systemic manifestations are not compatible with the etiology of snakebites, which leads us to believe that the problem could be the lack of knowledge of the health professionals at the site of envenomation, who may not be ready for attendance, and an important lack of health centers with snake antivenom to treat snakebites.

Subject(s)

Antivenins , Bothrops , Neglected Diseases , Snake Bites , Animals , Humans , Antivenins/therapeutic use , Brazil/epidemiology , Retrospective Studies , Snake Bites/epidemiology , Snake Bites/mortality , Snake Bites/therapy , Snakes , Neglected Diseases/epidemiology , Neglected Diseases/therapy , Young Adult , Adult , Rural Population/statistics & numerical data

ABSTRACT

Introducción: La hidatidosis es una zoonosis cuyo control más eficiente y eficaz es la promoción en salud, especialmente en la población infante-juvenil. Objetivo: Medir el impacto de un programa de intervención educativa sobre hidatidosis en escolares del norte de Chile. Método: Estudio intervencional educativo con fases pre y post test en 3.145 estudiantes de educación preescolar, primaria y secundaria de tres comunas. Se definieron dimensiones, unidades educativas y sistemas de evaluación incorporados en las bases curriculares. Se calculó el puntaje de logro de respuestas correctas utilizando la prueba t. Se estimó el tamaño del efecto mediante d de Cohen y análisis de varianza mixto. Resultados: Se encontraron diferencias estadísticamente significativas en la muestra total y en las variables género, comuna, procedencia rural-urbana y nivel de educación. Los puntajes post intervención fueron mayores y con tamaños de efecto grandes a excepción de los primeros niveles de educación. Se hallaron puntajes mayores post test y efectos de interacción con diferencias significativas en rural-urbano y en comuna anteriormente intervenida. La dimensión mejor evaluada fue "medidas de autocuidado" y la más baja "tenencia responsable de perros". Conclusiones: El programa educativo fue efectivo al ser dirigido a grupos etarios, mediante métodos pedagógicos en las bases curriculares de los establecimientos educacionales.

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Background: Hydatidosis is a zoonosis whose most efficient and effective control is health promotion, especially in children and youth. Aim: To measure the impact of an educational intervention program on hydatidosis in schoolchildren in northern Chile. Method: Educational interventional study was performed with pre-post test phases in 3,145 students of preschool, primary and secondary education from three districts. Dimensions, educational units and evaluation systems were defined and incorporated into the curricular bases. The correct answer achievement score was calculated using the T-test. Effect size was estimated using Cohen's d and mixed analysis of variance. Results: Statistically significant differences were found in the total sample and in variables such as gender, district, rural-urban origin and level of education. Post-intervention scores were higher than pre-intervention and with large effect sizes, except for the first levels of education. Higher post-test scores and interaction effects were found with significant differences in rural-urban and in a previously intervened district. The best evaluated dimension was "self-care measures" and the lowest was "responsibly keeping dogs". Conclusions: The educational program was effective when directed to age groups, through pedagogical methods in the curricular bases of educational facilities.

ABSTRACT

[RESUMO]. Objetivo. Analisar a distribuição espaço-temporal e os fatores associados à mortalidade por doenças tropicais negligenciadas (DTNs) no Brasil de 2000 a 2019. Método. Estudo ecológico que analisou os óbitos por DTNs registrados no Sistema de Informação sobre Mortalidade (SIM). Para a análise temporal, utilizou-se o método joinpoint. A dependência espacial foi analisada pelos índices de Moran global e local e Getis-Ord Gi*. Quatro modelos de regressão não espacial e espacial foram usados para identificar fatores associados ao óbito. Resultados. A taxa média de mortalidade por DTNs no Brasil foi de 3,32 óbitos/100 000 habitantes no perí- odo considerado, com a maior taxa (8,68 óbitos/100 000 habitantes) observada no Centro-Oeste. As causas mais prevalentes de morte foram doença de Chagas (n = 94 781; 74,9%) e esquistossomose (n = 10 271; 8,1%). Houve redução de 1,24% (IC95% = -1,6; - 0,9; P < 0,001) ao ano da mortalidade por DTNs no Brasil. Observou-se padrão alto/alto de distribuição espacial e hotspots em municípios dos estados de Goiás, Minas Gerais, Bahia, Tocantins e Piauí. Os indicadores “população em domicílios com densidade > 2 habitantes por dormitório” (β = -0,07; P = 0,00) e “índice de desenvolvimento humano municipal” (β = -3,36; P = 0,08) associaram-se negativamente ao desfecho, enquanto o indicador “índice de vulnerabilidade social” (β = 2,74; P = 0,05) associou-se positivamente ao desfecho. Conclusão. Quanto menor o desenvolvimento humano e maior a vulnerabilidade social, maior é a mortalidade por DTNs, o que deve direcionar as ações de prevenção e controle das DTNs.

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[ABSTRACT]. Objective. To analyze the spatial-temporal distribution and factors associated with mortality from neglected tropical diseases (NTDs) in Brazil from 2000 to 2019. Method. We performed an ecological study to analyze NTD-related deaths recorded in the Ministry of Health Mortality Information System (SIM). For the temporal analysis, the joinpoint method was used. Spatial dependence was analyzed using global Moran and local Getis-Ord Gi* indices. Four non-spatial and spatial regression models were used to identify factors associated with mortality. Results. The mean mortality rate from NTDs in Brazil during the study period was 3.32 deaths per 100 000 inhabitants, with the highest rate (8.68 deaths per 100 000 inhabitants) recorded in the Midwest. The most prevalent causes of death were Chagas disease (n = 94 781; 74.9%) and schistosomiasis (n = 10 271; 8.1%). There was a 1.24% reduction (95%CI = -1.6; -0.9; P < 0.001) in NTD-related mortality in Brazil per year. A high/ high spatial distribution pattern and hotspots were observed in municipalities in the states of Goiás, Minas Gerais, Bahia, Tocantins, and Piauí. The indicators "population in households with density > 2 people per bedroom" (β = -0.07; P = 0.00) and "municipal human development index" (β = -3.36; P = 0.08) were negatively associated with the outcome, while the "index of social vulnerability" (β = 2.74; P = 0.05) was positively associated with the outcome. Conclusion. Lower human development and higher social vulnerability are associated with higher mortality from NTDs, which should guide NTD prevention and control efforts.

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[RESUMEN]. Objetivo. Analizar la distribución espacial y temporal de la mortalidad por enfermedades tropicales desatendidas en Brasil en el período 2000-2019 y los factores asociados a ella. Método. Estudio ecológico centrado en el análisis de las muertes por enfermedades tropicales desatendidas registradas en el Sistema de Información sobre Mortalidad. Para el análisis temporal se utilizó el método de regresión de puntos de inflexión (joinpoint). La dependencia espacial se analizó mediante los índices de Moran global y local y Gi* de Getis-Ord. Se utilizaron cuatro modelos de regresión espacial y no espacial para detectar los factores relacionados con la mortalidad. Resultados. La tasa media de mortalidad por enfermedades tropicales desatendidas en Brasil fue de 3,32 muertes por 100 000 habitantes en el periodo del estudio, y la tasa más alta observada (8,68 muertes por 100 000 habitantes) fue la del Centro Oeste. Las causas de muerte más prevalentes fueron la enfermedad de Chagas (n = 94.781; 74,9%) y la esquistosomiasis (n = 10.271; 8,1%). Se registró una disminución de 1,24% (IC del 95% = -1,6; -0,9; p < 0,001) anual de la mortalidad por enfermedades tropicales desatendidas en el país. Se observó un patrón de distribución espacial alto/alto, con puntos calientes en municipios de los estados de Bahía, Goiás, Minas Gerais, Piauí y Tocantins. Los indicadores "población en hogares con densidad > 2 habitantes por dormitorio" (β = -0,07; P = 0,00) e "índice de desarrollo humano municipal" (β = -3,36; P = 0,08) mostraron una asociación negativa con el resultado, mientras que el indicador "índice de vulnerabilidad social" (β = 2,74; P = 0,05) arrojó una asociación positiva. Conclusiones. Cuanto menor es el grado de desarrollo humano y mayor la vulnerabilidad social, mayor es la mortalidad por enfermedades tropicales desatendidas, lo que debe orientar las medidas correspondientes de prevención y control.

Subject(s)

Neglected Diseases , Chagas Disease , Schistosomiasis , Dengue , Spatial Analysis , Mortality , Epidemiology , Brazil , Neglected Diseases , Chagas Disease , Schistosomiasis , Spatial Analysis , Mortality , Epidemiology , Brazil , Neglected Diseases , Chagas Disease , Schistosomiasis , Spatial Analysis , Mortality , Epidemiology

ABSTRACT

Paracoccidioidomycosis (PCM) is a neglected endemic mycosis in Latin America. Most cases occur in Brazil. It is classified as PCM infection and PCM disease and is subdivided into chronic (adult type) or acute (juvenile type) disease, with the latter being less frequent and more severe. In 2016, we reported an increase in the numbers of patients diagnosed with acute PCM after a highway's construction. We conducted a study at INI-Fiocruz, a reference center for infectious diseases, including endemic mycoses, in Rio de Janeiro, Brazil, aiming to deepen the analysis of this new clinical and epidemiological profile of PCM. The authors developed a retrospective study including 170 patients diagnosed with PCM between 2010 and 2019. There was an increase in the number of atypical and severe forms, starting in 2014. In subsequent years, we detected a higher incidence of adverse outcomes with patients requiring more hospitalizations and an increased mortality rate. We estimate that PCM has become more severe throughout the Rio de Janeiro state, affecting a greater number of young individuals and leading to a greater number of and longer hospitalizations. Surveillance measures and close monitoring of future notification data in the state, with emphasis on children, adolescents, and young adults are necessary for a better understanding of the perpetuation of this public health challenge.

ABSTRACT

Objective: To describe the results of a national campaign aimed at the integrated control of neglected tropical diseases in Brazil in light of the World Health Organization (WHO) official documentation related to the integration of strategies for the prevention, control, and elimination or eradication of neglected tropical diseases. Methods: A document review that included official WHO documents published between 2007 and 2020 and campaign results extracted from the official technical report produced by the Brazilian Ministry of Health. Results: The integrated control of neglected tropical diseases was gradually incorporated in the WHO documentation over time. Preventive chemotherapy through mass drug administration, intensified case management, and integrated vector management were extensively recommended as strategies for integrated control. The Brazilian campaign was carried out in four iterations between 2013 and 2017. Children aged 5 to 14 years enrolled in municipal public schools nationwide were targeted. In summary, a total of 1 074 and 73 522 new cases of leprosy and trachoma, respectively, were detected. Nearly 18 million doses of preventive chemotherapy for soil-transmitted helminthiasis were administered. More than 700 cases of schistosomiasis were diagnosed and treated. Conclusions: The integrated strategies implemented in Brazil throughout the campaign generated results aligned with the WHO recommendations for the control of neglected tropical diseases, especially those regarding mass drug administration, active case detection, and intensified case management. Therefore, the continuity of the campaign with adequate evaluation tools must be encouraged as a constant public health policy in the Brazilian government agenda.

ABSTRACT

RESUMO A dengue representa um importante problema de saúde pública no Brasil devido às constantes epidemias causadas pela doença no País. Este estudo objetivou analisar o financiamento de pesquisas sobre dengue pelo Departamento de Ciência e Tecnologia do Ministério da Saúde e parceiros no período de 2004 a 2020. Analisou-se a tendência do financiamento por regressão linear generalizada do tipo Prais-Winster e sua distribuição entre as regiões e Unidades Federadas brasileiras, modalidades de contratação das pesquisas, instituições beneficiadas e temas estudados. Entre 2004 e 2020, financiaram-se 232 pesquisas (R$ 164,03 milhões), realizadas, em sua maioria, em instituições da região Sudeste (77,55%), abordando especialmente a temática controle vetorial (37,93%). A tendência de financiamento foi estacionária nos anos estudados. As chamadas estaduais foram a principal forma de modalidade de contratação das pesquisas (65,95%). Houve diferença estatisticamente significante na distribuição do valor financiado entre as modalidades de contratação, bem como no número de pesquisas financiadas e valor financiado entre as regiões brasileiras. Esses achados demonstram a importância de monitorar o financiamento de pesquisas sobre dengue no Brasil e de implementar estratégias de avaliação das pesquisas financiadas, para subsidiar e aprimorar a política de enfrentamento da doença e de seu vetor.

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ABSTRACT Dengue represents an important public health problem in Brazil, due to the constant epidemics caused by the disease in the country. This study aimed to analyze the funding of research on dengue by the Department of Science and Technology of the Ministry of Health of Brazil and partners between 2004 to 2020. Was analyzed the trend of the funding by generalized linear regression using Prais-Winster and its distribution between Brazilian regions and Federated Units, research contracting modalities, benefited institutions, and studied themes. Between 2004 and 2020, 232 research studies were funded (R$ 164.03 million), carried out mostly in institutions in the Southeast Region (77.55%), addressing especially the vector control theme (37.93%). The funding trend was stationary in the years studied. The state calls were the main form of contracting modality for the research (65.95%). There was a statistically significant difference in the distribution of the loan amount between the contracting modalities, and in the number of researches funded and loan amount among Brazilian regions. These findings demonstrate the importance of monitoring the research funding on dengue in Brazil and of implementing strategies to evaluate the research funded, to support and improve the policy to combat the disease and its vector.