Trends and spatial patterns of mortality related to neglected tropical diseases in Brazil

We analysed nationwide trends and spatial distribution of NTD-related mortality in Brazil. We included all death certificates in Brazil from 2000 to 2011, in which NTDs were recorded as any causes of death. A total of 100,814/12,491,280 (0.81%) death certificates were identified, which mentioned at least one NTD. Age-adjusted NTD-related mortality rates showed a significant decrease over time (annual percent change [APC]: − 2.1%; 95% CI: − 2.8 to − 1.3), with decreasing mortality rates in the Southeast, South, and Central-West regions, stability in the Northeast region, and increase in the North region. We identified spatial and spatiotemporal high-risk clusters for NTD-related mortality in all regions, with a major cluster covering a wide geographic range in central Brazil. Despite nationwide decrease of NTD-related mortality in the observation period, regional differences remain, with increasing mortality trends especially in the socioeconomically disadvantaged regions of the country. The existence of clearly defined high-risk areas for NTD-related deaths reinforces the need for integrated prevention and control measures in areas with highest disease burden

Pos-alta hospitalária en Lepra en Ceará: limitación de actividad funcional, conciencia de riesgo y participación social

Caracterizar a limitação funcional, de atividade, consciência de risco, e restrição à participação social em pessoas atingidas pela hanseníase no pós-alta. Estudo seccional-descritivo com 69 residentes em Sobral, Ceará, com alta entre 2003 a 2005. Foram realizados exame físico dermato-neurológico, avaliação demográfica, de limitação funcional-atividade-consciência de risco e de restrição à participação social. Vinte (28,9%) apresentaram escores SALSA 19 e 20 e escore EHF zero. O maior escore EHF foi alcançado por dois participantes, com 25 e 28 na escala SALSA. Na escala de participação 37 (53,6%) não apresentaram restrição e tinham escore EHF zero. Dois (2,9%) com escore EHF zero tinham leve restrição e 1 (1,5%), grande restrição. Reafirma-se a potencialidade destas ferramentas para a atenção integral aos portadores.To characterize the functional limitation, activity limitation, risk conscience, and the social participation in people reached by hansen's disease in the post-MDT period. Cross-sectional, descriptive study, accomplished in 2006. Sixty-nine residents in Sobral that had discharge from MDT between 2003-2005 participated. The subjects were interviewed: demographic evaluation, dermato-neurological exams, evaluation of functional limitation-activity-risk conscience and the restriction in social participation. Twenty (28.9%) presented SALSA scores 19 and 20 and EHF score zero. The largest EHF score was reached by two participants, with scores 25 and 28 in the SALSA scale. In the participation scale 37 (53.6%) didn't present restriction and had EHF scores zero. Two (2.9%) with EHF score zero had mild restriction, and 1 (1.5%) severe restriction. This study reaffirms the potentiality of these tools for integral care of people reached.Caracterizar la limitación funcional de actividad, conciencia de riesgo y restricción a la participación social en personas atingidas por la lepra en el post-alta. Estudio seccional y descriptivo con 69 sitiados en Sobral, Ceará, con alta entre 2003 y 2005. Fueron hechos examen físico dermatológico y además neurológico, evaluación demográfica, de limitación funcional, actividad y conciencia de riesgo y de restricción a la participación social. Veinte (28,9%) presentaron escores SALSA 19 y 20 escore EHF cero. La mayor EHF fue alcanzada por dos participantes, con 25 y 28 años en la escala SALSA. En la categoría participación, 37 (53,6%) no presentaron restricción y tenían escore EHF cero. Dos (2,9%) con EHF cero tenían poca restricción y 1 (1,5%), gran restricción. Delante de eso, se afirma una vez más la potencialidad de éstas herramientas para la atención integral a los portadores

Seroprevalence of Toxoplasma gondii IgG antibody in HIV/AIDS-infected individuals in Maputo, Mozambique

OBJETIVO Avaliar a prevalência de anticorpos IgG anti- Toxoplasma gondii em pessoas infectadas pelo HIV/Aids e a associação de variáveis demográficas e sociais. MÉTODOS Estudo transversal que incluiu a análise de dados sociodemográficos e laboratoriais de 200 pessoas infectadas por HIV/Aids, atendidas em unidade laboratorial em 2010 na Província de Maputo, Moçambique. Os dados foram coletados por meio de questionário autopreenchido por todos os participantes. Para a análise de anticorpos, amostras de plasma coletadas foram confirmadas para testagem de IgG anti- T. gondii por hemaglutinação. RESULTADOS A soroprevalência de IgG anti- T. gondii foi de 46,0% (IC95% 39,2;52,9), 39,3% (IC95% 29,5;50,0) em homens e de 50,9% (IC95% 41,9;59,8) em mulheres, sem diferença entre sexo (OR 1.30; IC95% 0.95;1.77; p = 0.12). A idade variou de 10 a 60 anos, com maior prevalência de infecção em grupos etários mais idosos, mas sem haver diferença significativa entre eles. Ter consumo regular de carne de gado bovino (OR 1,74; IC95% 1,04;2,89, p = 0,05), possuir criação de gatos/cães (OR 6,18; IC95% 3,60;10,62, p < 0,000) e ter contato regular com a terra (OR 3,38; IC95% 2,19;5,21, p < 0,000) estiveram significativamente associados ao risco de infecção latente. CONCLUSÕES A infecção por toxoplasmose apresenta alta prevalência na população de Moçambique, cujo risco amplia-se pelos aspectos culturais e comportamentais. A toxoplasmose pode ser responsável pela grande carga de morbimortalidade associada a lesões meningoencefálicas em pessoas com HIV/Aids no país.OBJETIVO Evaluar la prevalencia de anticuerpos IgG anti- Toxoplasma gondii en personas infectadas por VIH/SIDA y la asociación de variables demográficas y sociales. MÉTODOS Estudio transversal que incluyó el análisis de datos sociodemográficos y de laboratorio de 200 personas infectadas por VIH/SIDA, atendidas en unidad de laboratorio en 2010 en la Provincia de Maputo, Mozambique. Los datos fueron colectados por medio de cuestionario auto llenado por todos los participantes. Para el análisis de anticuerpos, las muestras de plasma colectadas fueron confirmadas para evaluación anti- T. gondii por hemaglutinación. RESULTADOS La seroprevalencia de IgG anti- T. gondii fue de 46% (IC95% 39,2;52,9), 39,3% (IC95% 29,5;50,0) en hombres y de 50,9% (41,9-59,8%) en mujeres, sin diferencia entre sexo (OR 1.30; IC95% 0.95;1.77; p = 0.12). La edad varió de 10 a 60 años, con mayor prevalencia de infección en grupos etarios más ancianos, pero sin haber diferencia significativa entre ellos. Consumir carne de ganado bovino regularmente (OR 1,74; IC95% 1,04;2,89, p = 0,05), poseer cria de gatos/perros (OR 6,18; IC95% 3,60;10,62, p < 0,000) y tener contacto regular con la tierra (OR 3,38; IC95% 2,19;5,21, p < 0,000) estuvieron significativamente asociados al riesgo de infección latente. CONCLUSIONES La infección por toxoplasmosis presenta alta prevalencia en la población de Mozambique, cuyo riesgo se amplía por los aspectos culturales y de comportamiento. La toxoplasmosis puede ser responsable por la gran carga de morbi-mortalidad asociada a lesiones meningoencefálicas en personas con VIH/SIDA en el país.OBJECTIVE To analyze the prevalence of IgG antibodies to Toxoplasma gondii in patients infected with HIV/AIDS and the association of demographic and social variables. METHODS Descriptive cross-sectional study that included the analysis of sociodemographic data and laboratory findings of 200 patients infected with HIV/AIDS treated in a laboratory unit in Maputo, Mozambique, in 2010. Individual data for all participants were collected with a self-administered questionnaire. Plasma samples were tested for IgG testing of anti- T. gondii using hemagglutination for the analysis of antibodies. RESULTS The seroprevalence of IgG anti- T. gondii was 46.0% (95%CI 39.2;52.9), 39.3% (95%CI 29.5;50.0) in men and 50.9% (95%CI 41.9;59.8) in women, with no difference between sex (OR 1.30; 95%CI 0.95;1.77; p = 0.12). Ages ranged from 10 to 60 years, with a higher prevalence of infection in older age groups, but with no significant difference between them. Regularly consuming cattle meat (OR 1.74; 95%CI 1.04;2.89, p = 0.05), breeding cats/dogs (OR 6.18; 95%CI 3.60;10.62, p < 0.000) and having regular contact with soil (OR 3.38; 95%CI 2.19;5.21; p < 0.000) were significantly associated with risk of latent infection. CONCLUSIONS Toxoplasmosis is an infection with high prevalence in Mozambique. Cultural and behavioral aspects increase the risk. Toxoplasmosis can be responsible in our environment by the great burden of morbidity and mortality associated with meningoencephalic injuries in patients with HIV/AIDS

Oral health conditions in leprosy cases in hyperendemic area of the Brazilian Amazon

Leprosy is a hyperendemic chronic condition in the Rondônia State . Despite the significant impact of oral health on the quality of life and clinical evolution of leprosy patients, systematic evaluation of oral health status has been neglected. To analyze the dental-clinical profile, self-perceived oral health and dental health service access of leprosy cases in the municipality of Cacoal in Rondônia State , North Brazil, from 2001 to 2012. A descriptive, cross-sectional study design was performed based on dental evaluation and standardized structured instruments. We investigated clinically assessed and self-perceived oral health status, as well as dental health service access. A total of 303 leprosy cases were included; 41.6% rated their oral health as good, and 42.6% reported being satisfied with their oral health. Self-reported loss of upper teeth was 45.5%. The clinical evaluation revealed that 54.5% had active caries. Most (97.7%) cases reported having been to the dentist at least once in their life and 23.1% used public health services. The poor standard of oral health in this population may increase the risk for leprosy reactions, consequently reducing quality of life. Low access to public health dental services and poor self-perceived oral health reinforce the need to achieve comprehensive health care in this population

Mortalidade por doenças tropicais negligenciadas no Piauí, Nordeste do Brasil: tendência temporal e padrões espaciais, 2001-2018

Objective: To analyze temporal trends and spatial patterns of mortality from neglected tropical diseases (NTD) in Piauí, 2001-2018. Methods: Mixed ecological study, with hazard ratio (RR) calculation,spatio- temporal trend analysis, Poisson regression with inflection points, using data from the Mortality Information System. Results: There were 2,609 deaths due to NTD in the period (4.60/100,000 inhabitants), 55.2% due to Chagas disease. There was a higher risk of death in men (RR=1.76 – 95%CI 1.25;2.46), aged ≥60 years (RR=40.71 – 95%CI 10.01;165.53), municipalities with vulnerability average social (RR=1.76 – 95%CI 1.09;2.84), smaller population size (RR=1.99 – 95%CI 1.28;3.10) and Cerrados macro-region (RR=4.51-95%CI 2.51;8.11). There was an upward trend in mortality rates from 2001-2008 and a reduction from 2009- 2018. Conclusion: Mortality due to NTD in Piauí remains high, particularly due to Chagas disease, among groups with greater vulnerability, with concentration of higher rates in the southwest of the semi-arid macro-region, northeast and south of the Cerrados.Objetivo: Analizar las tendencias temporales y patrones espaciales de mortalidad por enfermedades tropicales desatendidas (ETD) en Piauí, 2001-2018. Métodos: Estudio ecológico mixto, con cálculo de hazard ratio (RR), análisis de tendencias espacio-temporales, regresión de Poisson con puntos de inflexión, utilizando datos del Sistema de Información de Mortalidad. Resultados: Hubo 2.609 defunciones por ETD en el período (4,60/100.000 habitantes), 55,2% por enfermedad de Chagas. Hubo un mayor riesgo de muerte en hombres (RR=1,76 – IC95% 1,25;2,46), edad ≥60 años (RR=40,71 – IC95% 10,01;165,53), municipios con vulnerabilidad social media (RR=1,76 – IC95% 1,09;2,84), tamaño de población más pequeño (RR=1,99 – IC95% 1,28;3,10) y macrorregión de Cerrados (RR=4,51 – IC95% 2,51;8,11). Hubo tendencia al alza en las tasas de mortalidad de 2001-2008 y  reducción de 2009-2018. Conclusión: La mortalidad por ETD en Piauí sigue siendo alta, particularmente por la enfermedad de Chagas, entre los grupos con mayor vulnerabilidad, con concentración de tasas más altas en el suroeste de la macrorregión semiárida, noreste y sur de los Cerrados.Objetivo: Analisar tendência temporal e padrões espaciais da mortalidade por doenças tropicais negligenciadas (DTNs) no Piauí, Brasil, 2001-2018. Métodos: Estudo ecológico misto, com cálculo de razão de risco (RR), análise de tendência  espaço-temporal e regressão de Poisson com pontos de inflexão, utilizando-se dados do Sistema de Informações sobre Mortalidade. Resultados: Verificou-se 2.609 óbitos por DTNs no período (4,60/100 mil habitantes), 55,2% por doença de Chagas. Houve maior risco de morte em homens (RR=1,76 –IC95% 1,25;2,46), idade ≥60 anos (RR=40,71 –IC95% 10,01;165,53), municípios com vulnerabilidade social média (RR=1,76 – IC95% 31,09;2,84), menor porte populacional (RR=1,99 – IC95% 1,28;3,10) e macrorregião dos Cerrados (RR=4,51 – IC95% 2,51;8,11). Verificou-se tendência de aumento nas taxas de mortalidade em 2001-2008 e redução em 2009-2018. Conclusão: A mortalidade por DTNs no Piauí persiste elevada, particularmente por doença de Chagas, entre grupos de maior vulnerabilidade, concentrando-se as maiores taxas no sudoeste da macrorregião do Semiárido, nordeste e sul dos Cerrados

Ampliação da sobrevida em crianças com AIDS no Brasil: resultados do segundo estudo nacional de 1999 a 2002

The objective of this study is to characterize survival in children with AIDS diagnosed in Brazil between 1999-2002, compared with the first national study (1983-1998). This national retrospective cohort study examined a representative sample of Brazilian children exposed to HIV from mother-to-child transmission and followed through 2007. The survival probability after 60 months was analyzed by sex, year of birth and death, clinical classification, use of antiretroviral therapy (ART) and prophylaxis for opportunistic diseases. 920 children were included. The survival probability increased: comparing cases diagnosed before 1988 with those diagnosed from 2001-2002 it increased by 3.5-fold (from 25% to 86.3%). Use of ART, initial clinical classification, and final classification were significant (p < 0.001) predictors of survival. Issues regarding quality of records and care were identified. The results point to the success of the Brazilian policy of providing ART. The improvement of clinical status contributes to quality of life, while indicating challenges, particularly practices to improve long-term care.Este estudo caracteriza a sobrevida em crianças com AIDS no Brasil entre 1999-2002, contextualizando com o primeiro estudo nacional (1983-1998). Trata-se de coorte histórica, com crianças expostas ao HIV por transmissão vertical e acompanhadas até 2007. A probabilidade de sobrevivência em 60 meses foi analisada segundo sexo, ano de nascimento e de óbito, classificação clínica, uso de terapia antirretroviral (TARV) e de profilaxia para doenças oportunistas. No total, 920 crianças foram incluídas. A probabilidade de sobrevivência foi ampliada 3,5 vezes nos dois períodos avaliados, passando de 25% antes de 1988 para 86,3% no período de 2001-2002. Uso de TARV, classificação clínica inicial e atual/final foram preditores que influíram significativamente (p < 0,001) para a ampliação da sobrevida. Os resultados deste estudo indicam o sucesso da política brasileira para a abordagem das crianças infectadas com HIV. A melhora do estado clínico contribuiu para melhora da qualidade de vida, mas sinaliza-se para a necessidade de incorporação de práticas pautadas na integralidade do cuidado

High occurrence of disabilities caused by leprosy: census from a hyperendemic area in Brazil's savannah region

Objectives: To describe leprosy-related disabilities, we performed a census including people affected by leprosy in 78 municipalities of Tocantins state in northern Brazil. The study consisted of a review of patient charts, structured questionnaires, and clinical examinations for disabilities of eyes, hands, and feet (August – December 2009), according to WHO standards. Results: A total of 910 individuals diagnosed from 2006 to 2008 were included (clinical examination and application of questionnaires), but information from patient charts was not available in all cases, resulting in different denominators. The majority (783/858; 91·3%) had completed multidrug therapy. The most common clinical findings included: enlarged/painful peripheral nerves (412/910, 45·3%), namely of ulnar (207; 22·7%), posterior tibial (196; 21·6%), peroneal (186; 20·5%), and radial cutaneous nerves (166; 18·2%); reduction/loss of sensibility 201/907 (22·2%) and reduced motor function (185/906, 20·4%). At diagnosis, 142/629 (22·6%) had Grade 1 disability (G1D), and 28/629 (4·5%) had Grade 2 disability (G2D). At the time of the study, 178/910 (19·6%) presented with G1D, and 84/910 (9·2%) with G2D. Disability grading was significantly higher in males ( P , 0·01). Subjects with G2D showed claw hands (26; 2·9%), followed by plantar ulcers (23; 2·5%), abrasion/excoriation on the foot (12; 1·3%), claw foot (7; 0·7%), and drop foot (7; 0·7%). Conclusions: Leprosy- related disabilities were common in a highly endemic area. Prevention and rehabilitation measures, especially after release from treatment, should be intensified by the primary health care system. Policy makers need to be aware of an ongoing demand for leprosy control programmes, even in a world of constantly reducing leprosy detection

La Lepra en el municipio de Fortaleza, CE, Brasil: aspectos epidemiológicos y operacionales en menores de 15 años (1995-2006)

Estudo transversal que objetiva analisar a ocorrência de casos de hanseníase em menores de 15 anos de idade residentes no Município de Fortaleza e notificados no SINAN. Os indicadores epidemiológicos nesta população mostram hiperendemicidade. Operacionalmente observa-se a manutenção da concentração de atendimento em algumas unidades de referência, apesar de alguns avanços. Diagnóstico tardio, elevado grau de incapacidade no diagnóstico e baixo grau de avaliação de contatos registrados revelam a fragilidade das ações de controle. Ressalta-se a possibilidade de erro diagnóstico frente às características da infecção nesta população. A ocorrência de casos de hanseníase nesta população representa um indicador epidemiológico de grande relevância e sua análise amplia a discussão sobre problemas operacionais na rede de serviços de saúde.This is a sectional study that aims to analyze the occurrence of Hansen's disease cases in 15 year-old minors in the Municipality of Fortaleza and notified in SINAN. The epidemiological indicators in this population show hiperendemicity. In operational terms is observed the maintenance of the service concentration in some reference units, in spite of some progress. Late diagnosis, a high degree of incapacity in the diagnosis and low degree of evaluation of contacts registered reveal the fragility of the actions of control. This study emphasizes the possibility of error diagnostic front to the characteristics of the infection in this population. The occurrence of cases of leprosy in this population represents an epidemiologic indicator of great importance and its analysis extends the discussion on operational problems in the network of health services.Estudio transversal con el objetivo de analizar las ocurrencias de los casos de lepra en menores de 15 años de edad sitiados en la ciudad de Fortaleza y enterados en el SINAN. Los indicadores epidémicos en ésta población se presentaron hiperendémicos. En la operacinalización, se observa el mantenimiento de la concentración de atención en algunas unidades recomendables, a pesar de algunos avances. Diagnósticos muy tardes, gran grado de incapacidad en el diagnóstico y bajo grado de evaluación de contactos registrados, muestran la fragilidad de las acciones de control. Se resalta así la posibilidad de error de diagnóstico delante de las características de la infección en ésta población. La ocurrencia de casos de lepra en ésta población representa un indicador epidémico de gran importancia y su análisis amplia la discusión sobre los problemas operacionales en la red de servicios públicos.Edital MCT CNPq/MS SCTIE DECIT Departamento de Ciência e Tecnologia do Ministério da Saúd

HISTOPLASMIN SURVEY IN HIV-POSITIVE PATIENTS: RESULTS FROM AN ENDEMIC AREA IN NORTHEASTERN BRAZIL

SUMMARY Background. Disseminated histoplasmosis is common in AIDS patients with advanced immunosuppression in Ceará, Northeastern Brazil. The goal of this study was to determine the prevalence of Histoplasma infection in patients with HIV/AIDS living in Fortaleza, the capital of Ceará. Methods. Intradermal tests with histoplasmin (mycelial phase) were performed in 161 HIV patients with CD4 ≥ 350 cells/mm 3 . Evidence of recent illness was evaluated with immunodiffusion (ID) tests in 76 of these individuals. Results. A total of 11.8% of patients reacted to histoplasmin and 2.63% had ID test positive to Histoplasma. The presence of mango trees (Mangifera indica) in the patient neighborhood (OR = 2.870; 95% CI = 1.081-7.617; p = 0.040) and past activity involving soil (OR = 2.834; 95% CI = 1.045-7.687; p = 0.045) or visits to a farm (OR = 3.869; 95% CI = 1.189-12.591; p = 0.033) were significantly associated with Histoplasma infection. Conclusions. Patients with HIV living in Fortaleza have an expressive prevalence of infection with Histoplasma.RESUMO Introdução: Histoplasmose disseminada ocorre com grande frequência em pacientes com aids e imunossupressão avançada no Ceará, Brasil. O objetivo deste artigo é determinar a prevalência da infecção por Histoplasma em pacientes com HIV/aids residentes em Fortaleza capital. Métodos. Testes intradérmicos com histoplasmina (fase micelial), foram realizados em 161 pacientes com CD4 ≥ 350 células/mm 3 . Doença recente foi estudada por imunodifusão em 76 desses indivíduos. Resultados. Reagiram à histoplasmina, 11,8% dos pacientes e à imunodifusão para Histoplasma: 2,63%. A presença da árvore mangueira (Mangifera indica) na vizinhança (OR = 2,870; IC 95% = 1,081-7,617; p = 0,040), atividade com o solo no passado (OR = 2,834; IC 95% = 1,045-7,687, p = 0,045) e visitar sítio no passado (OR = 3,869; IC 95% = 1,189-12,591; p = 0,033); foram significativamente associados com positividade para o teste. Conclusões. Pacientes com HIV que vivem em Fortaleza apresentam uma prevalência expressiva de infecção por Histoplasma

Late-stage diagnosis of HIV infection in Brazilian children: evidence from two national cohort studies

This study analyzed data from two consecutive retrospective cohort samples (1983 to 1998 and 1999 to 2002) of Brazilian children with AIDS (N = 1,758) through mother-to-child-transmission. Late-stage diagnosis (CDC category C) was investigated in relation to the following variables: year of birth, year of HIV diagnosis, and time periods related to changes in government treatment guidelines. Late-stage diagnosis occurred in 731 (41.6%) of cases and was more prevalent in infants under 12 months of age. The rate of late-stage diagnosis decreased from 48% to 36% between the two periods studied. We also observed a reduction in the proportion of late-stage diagnoses and the time lapse between HIV diagnosis and ART initiation. A significant association was found between timely diagnosis and having been born in recent years (OR = 0.62; p = 0.009) and year of HIV diagnosis (OR = 0.72; p = 0.002/OR = 0.62; p < 0.001). Infants under the age of 12 months were more likely to be diagnosed at a late stage than older children (OR = 1.70; p = 0.004). Despite advances, there is a need to improve the effectiveness of policies and programs focused on improving early diagnosis and management of HIV/AIDS