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

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

Contribution of fish farming ponds to the production of immature Anopheles spp. in a malaria-endemic Amazonian town

Submitted by sandra infurna ([email protected]) on 2016-03-10T15:46:30Z No. of bitstreams: 1 izabel_reis_etal_IOC_2015.pdf: 1921122 bytes, checksum: a9d37bb1b751e73973f59130437da246 (MD5)Approved for entry into archive by sandra infurna ([email protected]) on 2016-03-10T16:32:12Z (GMT) No. of bitstreams: 1 izabel_reis_etal_IOC_2015.pdf: 1921122 bytes, checksum: a9d37bb1b751e73973f59130437da246 (MD5)Made available in DSpace on 2016-03-10T16:32:12Z (GMT). No. of bitstreams: 1 izabel_reis_etal_IOC_2015.pdf: 1921122 bytes, checksum: a9d37bb1b751e73973f59130437da246 (MD5) Previous issue date: 2015Fundação Oswaldo Cruz. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Transmissores de Hematozoários. Rio de Janeiro, RJ, Brasil. / Fundação Oswaldo Cruz. NOSMOVE (Parceria DIRAC-IOC-VPAAPS/FIOCRUZ). Núcleo Operacional Sentinela de Mosquitos Vetores. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.Universidade Federal do Acre. Centro Multidisciplinar. Cruzeiro do Sul, AC, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Transmissores de Hematozoários. Rio de Janeiro, RJ, Brasil.Universidade Federal do Acre. Centro Multidisciplinar. Cruzeiro do Sul, AC, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Transmissores de Hematozoários. Rio de Janeiro, RJ, Brasil. / Fundação Oswaldo Cruz. NOSMOVE (Parceria DIRAC-IOC-VPAAPS/FIOCRUZ). Núcleo Operacional Sentinela de Mosquitos Vetores. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ, Brasil.Secretaria Municipal de Saúde de Cruzeiro do Sul. Cruzeiro do Sul, AC, Brasil.Secretaria Municipal de Saúde de Cruzeiro do Sul. Cruzeiro do Sul, AC, Brasil.Fundação Oswaldo Cruz. NOSMOVE (Parceria DIRAC-IOC-VPAAPS/FIOCRUZ). Núcleo Operacional Sentinela de Mosquitos Vetores. Rio de Janeiro, RJ, Brasil.Secretaria de Estado de Agropecuária de Cruzeiro do Sul. Cruzeiro do Sul, AC, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Transmissores de Hematozoários. Rio de Janeiro, RJ, Brasil. / Fundação Oswaldo Cruz. NOSMOVE (Parceria DIRAC-IOC-VPAAPS/FIOCRUZ). Núcleo Operacional Sentinela de Mosquitos Vetores. Rio de Janeiro, RJ, Brasil.Background: In the past decade fish farming has become an important economic activity in the Occidental Brazilian Amazon, where the number of new fish farms is rapidly increasing. One of the primary concerns with this phenomenon is the contribution of fishponds to the maintenance and increase of the anopheline mosquito population, and the subsequent increase in human malaria burden. This study reports the results of a 2-year anopheline abundance survey in fishponds and natural water bodies in a malaria-endemic area in northwest Brazil. The objective of this study was to investigate the contribution of natural water bodies (rivers, streams, creeks, ponds, and puddles) and artificial fishponds as breeding sites for Anopheles spp. in Mâncio Lima, Acre and to investigate the effect of limnological and environmental variables on Anopheles spp. larval abundance. Methods: Natural water bodies and fishponds were sampled at eight different times over 2 years (early, mid and late rainy season, dry season) in the Amazonian town of Mâncio Lima, Acre. Anopheline larvae were collected with an entomological dipper, and physical, chemical and ecological characteristics of each water body were measured. Management practices of fishpond owners were ascertained with a systematic questionnaire. Results: Fishponds were four times more infested with anopheline larvae than natural water bodies. Electrical conductivity and the distance to the nearest house were both significant inverse predictors of larval abundance in natural water bodies. The density of larvae in fishponds raised with increasing border vegetation. Fishponds owned by different farmers varied in the extent of anopheline larval infestation but ponds owned by the same individual had similar infestation patterns over time. Commercial fishponds were 1.7-times more infested with anopheline larvae compared to fishponds for family use. Conclusions: These results suggest that fishponds are important breeding sites for anopheline larvae, and that adequate management activities, such as removal of border vegetation could reduce the abundance of mosquito larvae, most importantly Anopheles darlingi