Ana Lúcia Escobar

Tuberculosis among indigenous populations in Rondonia, Amazonia, Brazil

Tuberculosis persists as a serious public health problem in Brazil. Prevalence rates are alarming in certain social groups, including indigenous peoples. This article presents an epidemiological analysis of records in the Rondonia State Tuberculosis Control Program, identifying the diseases profile among indigenous groups, which are socially more vulnerable and have different issues involved in controlling the disease. The study includes a descriptive statistical and multivariate multinomial analysis of cases reported in 1992 and from 1994 to 1998, attempting to identify factors associated with tuberculosis-related deaths, treatment drop-out, and missing data. Associations were identified between variables related to the disease, to the health service, and to treatment results. There is evidence that the indigenous populations in Rondonia have an increased risk of acquiring and dying from tuberculosis as compared to other residents of the State. Attention is called to the need for prevention and control measures specifically tailored to the reality of indigenous peoples.

Aspectos epidemiológicos da tuberculose na população indígena Suruí, Amazônia, Brasil

Tuberculosis persists as a serious public health problem in Brazil. Prevalence rates are alarming in certain social groups, including indigenous peoples. This article presents an epidemiological analysis of records for the Suruí Indians available at the Tuberculosis Control Program in the Municipality of Cacoal, Rondônia. The study includes a descriptive statistical analysis of cases reported from 1975 to 2002. There is evidence that the Suruí have an increased risk of acquiring and dying from tuberculosis as compared to other indigenous groups in Rondônia as well as non-Indians. The average incidence coefficient for tuberculosis in the Suruí was 2518.9 per 100,000 inhabitants in the period 1991-2002. It was observed that 45% of the cases were diagnosed in children < 15 years old. Over half of the cases (63.3%) were reported in men. Only 43.2% of the cases were confirmed by sputum microscopy. The use of PPD skin tests, histopathological exams or bacteriological culture were not reported throughout the period. Attention is called to the need for prevention and control measures specifically tailored to the reality of indigenous peoples.

Prevalence of anemia and associated factors among indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition

BackgroundAnemia is the most prevalent nutritional deficiency globally, affecting about a quarter of the world population. In Brazil, about one-fifth of children under five years of age are anemic. Previous case studies indicate prevalence rates much higher among indigenous peoples in the Country. The First National Survey of Indigenous People’s Health and Nutrition in Brazil, conducted in 2008–2009, was the first survey based on a nationwide representative sample to study the prevalence of anemia and associated factors among indigenous children in Brazil.MethodsThe survey assessed the health and nutritional status of indigenous children < 5 years of age based on a representative sample of major Brazilian geopolitical regions. A stratified probabilistic sampling was carried out for indigenous villages. Within villages, children < 5 years of age in sampled households were included in the study. Prevalence rates of anemia were calculated for independent variables and hierarchical multivariate analysis were conducted to assess associations.ResultsEvaluation of hemoglobin levels was conducted for 5,397 children (88.1% of the total sample). The overall prevalence of anemia was 51.2%. Higher risk of presenting anemia was documented for boys, lower maternal schooling, lower household socioeconomic status, poorer sanitary conditions, presence of maternal anemia, and anthropometric deficits. Regional differences were observed, with the highest rate being observed in the North.ConclusionsThe prevalence rates of anemia in indigenous children were approximately double than those reported for non-indigenous Brazilian children in the same age group. Similarly notable differences in the occurrence of anemia in indigenous and non-indigenous children have been reported for other countries. Deeper knowledge about the etiology of anemia in indigenous children in Brazil is essential to its proper treatment and prevention.

The Dynamics of Transmission and Spatial Distribution of Malaria in Riverside Areas of Porto Velho, Rondônia, in the Amazon Region of Brazil

The study area in Rondônia was the site of extensive malaria epidemic outbreaks in the 19th and 20th centuries related to environmental impacts, with large immigration flows. The present work analyzes the transmission dynamics of malaria in these areas to propose measures for avoiding epidemic outbreaks due to the construction of two Hydroelectric Power Plants. A population based baseline demographic census and a malaria prevalence follow up were performed in two river side localities in the suburbs of Porto Velho city and in its rural vicinity. The quantification and nature of malaria parasites in clinical patients and asymptomatic parasite carriers were performed using microscopic and Real Time PCR methodologies. Anopheles densities and their seasonal variation were done by monthly captures for defining HBR (hourly biting rate) values. Main results: (i) malaria among residents show the riverside profile, with population at risk represented by children and young adults; (ii) asymptomatic vivax and falciparum malaria parasite carriers correspond to around 15% of adults living in the area; (iii) vivax malaria relapses were responsible for 30% of clinical cases; (iv) malaria risk for the residents was evaluated as 20–25% for vivax and 5–7% for falciparum malaria; (v) anopheline densities shown outdoors HBR values 5 to 10 fold higher than indoors and reach 10.000 bites/person/year; (vi) very high incidence observed in one of the surveyed localities was explained by a micro epidemic outbreak affecting visitors and temporary residents. Temporary residents living in tents or shacks are accessible to outdoors transmission. Seasonal fishermen were the main group at risk in the study and were responsible for a 2.6 fold increase in the malaria incidence in the locality. This situation illustrates the danger of extensive epidemic outbreaks when thousands of workers and secondary immigrant population will arrive attracted by opportunities opened by the Hydroelectric Power Plants constructions.

Análise espacial e determinação de áreas para o controle da malária no Estado de Rondônia

This paper discusses the use of spatial analysis for mapping the risk of malaria in the State of Rondônia between 1994 and 2005. Morans overall and local indices were used for spatial pattern analysis. Based on the Annual Parasitic Index, it can be stated that the municipalities forming the area at greater risk are those in which the urbanization process is more recent. They are characterized by higher population growth, greater number of settled families and high percentages of deforested area. The Moran map showed that the aggregated areas of municipalities at high risk of malaria have undergone a process of spreading into the northwestern and northeastern regions of the State. Among the municipalities considered to be at low risk, this process has taken place towards the southeast. The techniques used in this study deserve to be compared with the current methodology used by the Health Surveillance Department for determining areas at risk and financial transfers for malaria control..

Spatial heterogeneity of malaria in Indian reserves of Southwestern Amazonia, Brazil

BackgroundMalaria constitutes a major cause of morbidity in the Brazilian Amazon where an estimated 6 million people are considered at high risk of transmission. Indigenous peoples in the Amazon are particularly vulnerable to potentially epidemic disease such as malaria; notwithstanding, very little is known about the epidemiology of malaria in Indian reservations of the region. The aim of this paper is to present a spatial analysis of malaria cases over a four-year time period (2003–2006) among indigenous peoples of the Brazilian State of Rondônia, southwestern Amazon, by using passive morbidity data (results from Giemsa-stained thick blood smears) gathered from the National Malaria Epidemiologic Surveillance System databank.ResultsA total of 4,160 cases of malaria were recorded in 14 Indian reserves in the State of Rondônia between 2003 and 2006. In six reservations no cases of malaria were reported in the period. Overall, P. vivax accounted for 76.18 of malaria cases reported in the indigenous population of Rondônia. The P. vivax/P. falciparum ratio for the period was 3.78. Two reserves accounted for over half of the cases reported for the total indigenous population in the period – Roosevelt and Pacaas Novas – with a total of 1,646 (39.57%) and 1,145 (27.52%) cases, respectively. Kernel mapping of malaria mean Annual Parasite Index – API according to indigenous reserves and environmental zones revealed a heterogeneous pattern of disease distribution, with one clear area of high risk of transmission comprising reservations of west Rondônia along the Guaporé-Madeira River basins, and another high risk area to the east, on the Roosevelt reserve.ConclusionBy means of kernel mapping, it was shown that malaria risk varies widely between Indian reserves and environmental zones defined on the basis of predominant ecologic characteristics and land use patterns observed in the southwestern Brazilian Amazon. The geographical approach in this paper helped to determine where the greatest needs lie for more intensively focused malaria control activities in Indian reserves in the region. It also provided a reference to assess the effectiveness of control measures that have been put in place by Brazilian public health authorities.

[Indigenous peoples' health in Brazil: current perspectives].

A area da saude indigena esta atravessando uma fase singular no Brasil. O momento atual caracteriza-se por alteracoes profundas, que englobam desde aceleradas transformacoes em perfis epidemiologicos, ate a reestruturacao do sistema de assistencia a saude indigena. Concomitantemente, percebe-se que a quantidade de grupos de pesquisa debrucados sobre o tema ampliou-se, algo mais que bem-vindo. Mesmo que transbordem evidencias quanto as condicoes de marginalizacao socio-economica, com amplos impactos sobre o perfil saude/doenca, muito pouco se conhece sobre a saude dos povos indigenas no Brasil, ainda mais se considerarmos a enorme diversidade socio-cultural e de experiencias historicas de interacao com a sociedade nacional. No papel de editores convidados, procuramos reunir neste fasciculo tematico de Cadernos de Saude Publica/Reports in Public Health um conjunto de trabalhos representativos das tematicas e abordagens analiticas correntes sobre a questao. Os topicos estendemse desde analises antropologicas sobre sistemas tradicionais de cura, ate estudos epidemiologicos sobre doencas infecciosas e cronicas nao transmissiveis, bem como contribuicoes versando sobre aspectos variados dos servicos de assistencia a saude indigena. Muitos dos trabalhos nao se encaixam em fronteiras disciplinares rigidas; pelo contrario, permeiam varios campos do saber, como esperado em se tratando de um tema tao multifacetado. No Brasil e em outras partes do mundo, as doencas infecciosas ocupam um locus diferenciado na historia dos povos indigenas. E desnecessario reiterar a magnitude da desestruturacao demografica e socio-cultural a elas associada, o que fez com que se tornassem elementos cruciais no processo de subjugacao frente ao expansionismo ocidental. Como apontam varios artigos deste fasciculo, ainda que as doencas infecciosas continuem a ocupar um papel proeminente no perfil epidemiologico indigena no Brasil, ha evidencias de que a expressao das morbidades cronicas nao transmissiveis, como obesidade, hipertensao e diabetes mellitus, esta se ampliando. A sobreposicao de perfis epidemiologicos tambem se verifica na populacao brasileira em geral, mas e possivel que seja mais intensa entre os povos indigenas. As consequencias dessa sobreposicao em individuos, comunidades e servicos de saude serao amplas, ainda que seja dificil caracteriza-las no contexto atual da saude indigena no Brasil. Nos ultimos tres anos, aconteceram importantes mudancas no sistema de saude voltado para os povos indigenas com a implantacao dos Distritos Sanitarios Especiais Indigenas, de norte a sul do pais. Ha de se aguardar a acumulacao de dados e experiencias, antes de ser possivel aquilatar a extensao dos impactos associados a essa reestruturacao. Como enfatizam varios autores, um dos grandes desafios na implementacao desse novo modelo de assistencia e estrutura-lo ‐ envolvendo centenas de milhares de usuarios e agencias governamentais e nao governamentais ‐ sem perder de vista a imensa sociodiversidade indigena. Tal coadunacao e o denominador comum do modelo, e tambem uma das facetas de mais dificil implementacao. Em 2000, por ocasiao das comemoracoes e sobretudo das manifestacoes relacionadas aos 500 anos de chegada dos europeus ao territorio do que hoje denominamos Brasil (que resultaram em imagens simbolicamente expressivas, como a que ilustra a capa deste fasciculo) ficou reiterada a magnitude da divida historica e social que a sociedade brasileira tem com os povos indigenas. A precariedade das condicoes de saude e dos servicos a elas oferecidos e exemplar neste sentido. As contribuicoes deste fasciculo oferecem subsidios importantes para uma melhor compreensao desta complexa realidade, relativamente bem conhecida em seus contornos mais amplos, mas cujas matizes ainda estamos longe

Aspectos de la fecundidad de mujeres indígenas Suruí, Rondônia, Brasil: una aproximación

OBJECTIVES: to analyze female fertility among Surui Indian women in the Brazilian Amazon. METHODS: a total of 88 reproductive and birth histories were collected by means of household interviews carried out in two Surui villages in 2004. RESULTS: the average age of menarche was 12 years-old; the average ages of first marriage and of the delivering the first child were, respectively, 13.8 and 15.7 years-old. For most women, delivery took place in their own village. The average time between pregnancies was 22.8 months and the average breast feeding duration was 18.4 months. Very few Surui women use contraceptives and most have attended school for only a couple of years. On average, the total fertility rate was of 6.3 children per woman. CONCLUSIONS: in comparison with other populations, Suruis demography shows a moderately high fertility rate. The authors argue that the findings of this study can be of use to better plan health services that are more culturally compatible with the reality of Surui women.

Compreendendo o apoio matricial e o resultado da certificação de qualidade nas áreas de atenção à criança, mulher, diabetes/hipertensão e saúde mental

Este artigo apresenta a distribuicao do apoio matricial (AM) no Brasil, identificando relacoes entre as atividades de AM e a certificacao do PMAQ-AB. Utilizaram-se dois modelos de regressao logistica multipla. As atividades de AM na Atencao Basica sao significativas mas desiguais, com altos graus de AM em lugares desenvolvidos. Existe associacao positiva entre o grau de apoio e o resultado obtido na certificacao. Elevados graus de AM correspondem a 89%, 80%, 89% e 63% de chances de as equipes obterem uma melhor certificacao na atencao a mulher, crianca, hipertensao e diabetes e saude mental, respectivamente. O AM tem ajudado a melhorar a qualidade da Atencao Basica no Brasil.

Prevalence of pneumonia and associated factors among indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition

BACKGROUND Based on data from a nationally representative sample of indigenous villages in Brazilian indigenous reserves, the study sought to estimate the prevalence of pneumonia and evaluate associated factors among indigenous children under 5 years of age. METHODS Sociodemographic, clinical and reported data on child respiratory health from the First National Survey of Indigenous Peoples Health and Nutrition in Brazil were collected for 6128 children. Prevalence of pneumonia was calculated for independent variables and hierarchical multivariate analyses were performed to assess associations. RESULTS The overall prevalence proportions of cough, nasal congestion, pneumonia, and pneumonia with fever were 44.4%, 31.0%, 2.63%, and 1.28%, respectively. In the multivariate model, pneumonia was more frequent among children living in the South/Southeast and North regions of Brazil. Children living in larger households or houses with wood or thatch roofing, as well those with low birthweight or stunting, presented higher risk of pneumonia. Pneumonia was less prevalent among children living in houses with wood flooring and those presenting low weight-for-age. CONCLUSIONS The study results demonstrate that pneumonia is an important cause of illness among indigenous children throughout Brazil. The association between pneumonia and household characteristics suggests that indoor home environment is closely related to the respiratory health of indigenous children.