Antônio Levino

Distribution of dengue vectors in neighborhoods with different urbanization types of Manaus, state of Amazonas, Brazil

Aedes aegypti and Ae. albopictus are vectors of dengue viruses, which cause endemic disease in the city of Manaus, capital of the state of Amazonas, Brazil. More than 53 thousand cases have been registered in this city since the first epidemic in 1998. We evaluated the hypothesis that different ecological conditions result in different patterns of vector infestation in Manaus, by measuring the infestation level in four neighborhoods with different urbanization patterns, during the rainy (April), dry (August), and transitional (November) seasons. Ae. aegypti predominated throughout the study areas and sampling periods, representing 86% of all specimens collected in oviposition traps. High frequencies of houses positive for both species were observed in all studied sites, with Ae. aegypti present in more than 84% of the houses in all seasons. Ae. albopictus, on the other hand, showed more spatial and temporal variation in abundance. We found no association between infestation level and house traits. This study highlights the homogeneity of dengue vector distribution in Manaus.

Dimensões e potencialidades dos sistemas de informação geográfica na saúde indígena

OBJETIVO: Discutir as potencialidades do sistema de informacao geografico na analise do perfil epidemiologico, sociodemografico e da organizacao dos servicos de saude dirigidos aos povos indigenas. METODOS: Foi efetuada a analise georreferenciada das notificacoes de tuberculose, malaria e da mortalidade de 374.123 indigenas distribuidos em 36 Distritos Sanitarios Especiais Indigenas em todo o Brasil. Definiu-se um gradiente da intensidade do risco de adoecimento indigena por tuberculose, malaria e mortalidade infantil nos anos de 2000 a 2002, comparando-os com os coeficientes encontrados na populacao nao indigena no mesmo periodo. RESULTADOS: O estudo mostrou que os dados previamente disponiveis sao fragmentarios, nao possibilitando uma visao de conjunto das condicoes de vida e da situacao de saude dos grupos etnicos. A construcao de gradientes de risco evidenciou coeficientes de incidencia de tuberculose superiores em mais de 1.000 vezes aqueles encontrados para a populacao geral brasileira. O Indice Parasitario Anual medio de malaria na populacao indigena superou em ate 10 vezes os valores medios encontrados para a populacao nao-indigena e o Coeficiente de Mortalidade Infantil variou entre 74,7/1.000 nascidos vivos em 2000 e 56,5/1.000 em 2001, superando em mais de 100% a media nacional para o periodo. CONCLUSOES: O Sistema de Informacao Geografica se revela uma ferramenta util para a gestao, possibilitando analises de situacoes sanitarias, avaliacao de risco populacional, construcao de cenarios que viabilizem o planejamento de estrategias de intervencao nos diversos niveis, transitando com rapidez e eficiencia entre macro e micro realidades.

Perfil epidemiológico da hanseníase em menores de quinze anos de idade, Manaus (AM), 1998-2005

OBJETIVO: Analisar a situacao epidemiologica da hanseniase em criancas, em zona urbana. METODOS: Foram estudados 474 casos de hanseniase, em menores de 15 anos, detectados na zona urbana de Manaus (AM), de 1998 a 2005. A partir dos dados do Sistema de Informacoes de Agravos de Notificacao foram analisados o perfil da endemia e a qualidade do atendimento nos servicos de saude, utilizando os indicadores epidemiologicos e operacionais Programa Nacional de Eliminacao da Hanseniase. RESULTADOS: Os casos de hanseniase em menores de 15 anos corresponderam a 10,4% do total de casos detectados no periodo. O coeficiente de deteccao nessa faixa etaria manteve-se no nivel hiperendemico entre 1998 e 2003, reduzindo a partir do ano de 2004 mas mantendo endemicidade muito alta. A forma clinica mais frequente foi a tuberculoide, seguida da dimorfa. As formas paucibacilares corresponderam a 70,7% dos casos e no momento do diagnostico, o grau de incapacidades foi avaliado em 94,7% dos pacientes, dos quais 2,9% apresentaram incapacidades fisicas. A maioria dos casos (99,4%) foi tratada com o esquema poliquimioterapico da Organizacao Mundial da Saude. CONCLUSOES: Apesar de seu decrescimo, o coeficiente de deteccao da hanseniase nas criancas em Manaus mantem nivel de endemicidade muito alto.OBJECTIVE To describe the epidemiological status of leprosy in children living in a metropolitan area. METHODS There were studied 474 leprosy cases detected in children under 15 living in the metropolitan area of the city of Manaus, Northern Brazil, between 1998 and 2005. The endemic profile and quality of care services were assessed based on data from the Notifiable Diseases Information System using epidemiological and operational indicators of the National Leprosy Elimination Program. RESULTS Of all leprosy cases detected in the period studied, 10.4% were found in children under 15. The detection rates in this age group remained at hyperendemic levels between 1998 and 2003, and decreased from 2004 onwards but keeping on very high endemic levels. The most common clinical form was tuberculoid followed by dimorphous. Paucibacillary forms were seen in 70.7% of the cases. The level of disability at the time of diagnosis was assessed in 94.7% of patients and 2.9% of them had physical disabilities. Most children (99.4%) were treated with the multiple drug regimen recommended by the World Health Organization. CONCLUSIONS Despite its decrease, detection rate of leprosy in children in the city of Manaus remains at a very high endemic level.

Epidemiological profile of leprosy in children under 15 in Manaus (Northern Brazil), 1998-2005

OBJETIVO: Analisar a situacao epidemiologica da hanseniase em criancas, em zona urbana. METODOS: Foram estudados 474 casos de hanseniase, em menores de 15 anos, detectados na zona urbana de Manaus (AM), de 1998 a 2005. A partir dos dados do Sistema de Informacoes de Agravos de Notificacao foram analisados o perfil da endemia e a qualidade do atendimento nos servicos de saude, utilizando os indicadores epidemiologicos e operacionais Programa Nacional de Eliminacao da Hanseniase. RESULTADOS: Os casos de hanseniase em menores de 15 anos corresponderam a 10,4% do total de casos detectados no periodo. O coeficiente de deteccao nessa faixa etaria manteve-se no nivel hiperendemico entre 1998 e 2003, reduzindo a partir do ano de 2004 mas mantendo endemicidade muito alta. A forma clinica mais frequente foi a tuberculoide, seguida da dimorfa. As formas paucibacilares corresponderam a 70,7% dos casos e no momento do diagnostico, o grau de incapacidades foi avaliado em 94,7% dos pacientes, dos quais 2,9% apresentaram incapacidades fisicas. A maioria dos casos (99,4%) foi tratada com o esquema poliquimioterapico da Organizacao Mundial da Saude. CONCLUSOES: Apesar de seu decrescimo, o coeficiente de deteccao da hanseniase nas criancas em Manaus mantem nivel de endemicidade muito alto.OBJECTIVE To describe the epidemiological status of leprosy in children living in a metropolitan area. METHODS There were studied 474 leprosy cases detected in children under 15 living in the metropolitan area of the city of Manaus, Northern Brazil, between 1998 and 2005. The endemic profile and quality of care services were assessed based on data from the Notifiable Diseases Information System using epidemiological and operational indicators of the National Leprosy Elimination Program. RESULTS Of all leprosy cases detected in the period studied, 10.4% were found in children under 15. The detection rates in this age group remained at hyperendemic levels between 1998 and 2003, and decreased from 2004 onwards but keeping on very high endemic levels. The most common clinical form was tuberculoid followed by dimorphous. Paucibacillary forms were seen in 70.7% of the cases. The level of disability at the time of diagnosis was assessed in 94.7% of patients and 2.9% of them had physical disabilities. Most children (99.4%) were treated with the multiple drug regimen recommended by the World Health Organization. CONCLUSIONS Despite its decrease, detection rate of leprosy in children in the city of Manaus remains at a very high endemic level.

Tuberculose na população indígena de São Gabriel da Cachoeira, Amazonas, Brasil

O estudo descreve a situacao da tuberculose no Municipio de Sao Gabriel da Cachoeira, Estado do Amazonas, Brasil, no periodo de 1997 a 2002. Este municipio de populacao predominantemente indigena constitui uma importante noso-area da Amazonia para o problema da tuberculose, cuja magnitude se expressa por intermedio do coeficiente 2,4 vezes mais elevado que a media estadual e ate quatro vezes mais que a media nacional. Analises estatisticas utilizadas para avaliar a tendencia em relacao a associacao com a idade, o sexo e a forma clinica revelaram diferencas no comportamento da endemia, quando comparados os coeficientes de incidencia entre os casos de procedencia urbana e rural. As taxas padronizadas mostraram a populacao masculina com uma incidencia mais elevada que a feminina nas duas areas de residencia. A faixa etaria mais atingida foi acima de 50 anos, porem a proporcao de menores de 15 anos se mostrou acima dos valores esperados na populacao geral do pais, alem de apresentar diferentes niveis de gravidade nas subareas rurais estudadas. Os achados indicam que esta situacao pode ser explicada pelas desigualdades, sobretudo, relativas a acessibilidade aos servicos de saude que, contraditoriamente, parecem menos resolutivos na area urbana.This study describes the tuberculosis situation in São Gabriel da Cachoeira, Amazonas State, Brazil, from 1997 to 2002. The county, which has a predominantly Indian population, is a relevant tuberculosis area in Amazonas, since the infection rate is 2.4 to 4 times that of the overall State and national rates. The statistical analyses used to assess its association with age, gender, and clinical form showed differences in the endemic behavior, comparing the urban and rural incidence rates. Males had higher standardized incidence rates than females in both the urban and rural areas. The most heavily affected age group was greater than 50 years, but the rate among individuals under 15 years was above the overall national rate, in addition to presenting different severity levels in the rural sub-areas that were studied. The situation can be explained mainly by inequalities in access to health services, which paradoxically appear to show lower case-resolving capacity in urban areas of the county.

Análise comparativa dos sistemas de saúde da tríplice fronteira: Brasil/Colômbia/Peru

The objectives of this article are to describe the health sector reform process in Latin American countries and its impact on the health systems of Brazil, Colombia, and Peru; analyze the structure of the national health systems of these bordering nations; and assess the constraints and potential for integrating the local health systems along the triple Amazon border. Using official documents and databases, we analyzed health system development and the structure of the services network in this segment of the border located in the heart of the Amazon region. Comparison of the three countries confirmed that Brazils model has the characteristics of a national public health system, while the Colombian and Peruvian models emphasize insurance systems, with the adoption of compulsory health care plans, the segmentation of users, and limitations on coverage. The three countries are similar in their adoption of a public-private mix in service delivery, but they differ in the degree of access and type of State regulation. We concluded that the characteristics of the health systems in the three countries make the challenge of building a unified health system capable of guaranteeing universal access, equity in care, and comprehensive care a complex undertaking. However, despite the differences identified, we can state that the weight of the public sector in the basic care network makes it possible to foresee integration of the local health systems to provide an organized supply of programmatic health actions at the primary and secondary level of care.

Leprosy in indigenous populations of Amazonas State, Brazil: an epidemiological study in the counties of Autazes, Eirunepé and São Gabriel da Cachoeira (2000 to 2005)

In 2005, Amazonas State, Brazil, showed hyperendemic leprosy detection coefficients and prevalence with medium endemicity. Although this State has the largest indigenous population in Brazil, there are no data on the leprosy profile in these groups. This study aimed to describe and analyze the epidemiological characteristics of leprosy case reporting in the municipalities (counties) of Autazes, Eirunepé, and São Gabriel da Cachoeira, comparing indigenous and non-indigenous findings according to target variables. A total of 386 cases reported to SINAN from 2000 to 2005 were analyzed. Mean detection rates were 3.55, 14.94, and 2.13/10,000 (among non-indigenous) and 10.95, 1.93, and 0.78/10,000 (among indigenous peoples) in Autazes, Eirunepé, and São Gabriel da Cachoeira, respectively. Paucibacillary cases predominated among both indigenous and non-indigenous populations; however, dimorphous cases represented one-third of notifications. Despite coverage limitations and underreporting, the findings suggest that leprosy is a major public health problem for indigenous populations in Amazonas State. Classification according to race/ethnicity has been a useful tool for solving health inequalities.

Análise da coinfecção TB/HIV como fator de desenvolvimento da tuberculose multidroga resistente: uma revisão sistemática

La tuberculosis (TB) se constituye un problema de salud publica que se ha agravado las ultimas tres decadas, en funcion del numero de nuevos casos asociados a la diseminacion de la epidemia del virus de inmunodeficiencia humana (VIH), bien como del aumento de la multirresistencia a los farmacos utilizados en el tratamiento de la enfermedad. Este articulo investiga, a traves de una revision sistematica de la literatura cientifica, si la coinfeccion TB/HIV tiene relacion con el desarrollo de la tuberculosis multidrogo resistente (TBMDR), cuando comparados pacientes con y sin la coinfeccion. La pregunta de investigacion se elaboro conforme el metodo PICO, en el cual los participantes son los pacientes con TB, la intervencion es el estatus de VIH, la comparacion es entre portador y no portador de VIH y el desenlace corresponde a los casos en que fue diagnosticada la tuberculosis multidrogo resistente (TBMDR). Se recuperaron 808 estudios cientificos catalogados en las bases de datos MEDLINE/PubMed, LILACS, ISI/Thomson Reuters y SciELO.org, que utilizaron descriptores especificos para cada una de ellas. Los articulos fueron sometidos a seleccion por evaluacion de titulos, resumenes y lectura completa del texto. Del total, apenas 16 articulos cumplian con los criterios para su inclusion, siendo identificados: sexo masculino, promedio de edad de 39 anos, historico de tratamiento anterior para TB y bajo conteo de celulas CD4 como factores asociados al desarrollo de la TBMDR en pacientes coinfectados. La revision sistematica permite concluir que los pacientes coinfectados TB/HIV son mas propensos al desarrollo de la TBMDRTuberculosis (TB) is a public health problem, and it has worsened over the past three decades as a result of new cases associated with spreading of human immunodeficiency virus (HIV) epidemic, as well as the growing problem of multidrug resistance used to treat that disease. Through a systematic review of scientific literature, this paper searches if TB/HIV coinfection is related to multidrug resistant tuberculosis (MDR-TB) comparing patients with and without coinfection. The research question was elaborated using PICO strategy where patients are those with TB, intervention is HIV status, comparison is between patients with and without HIV, and outcomes are the diagnosed MDR-TB cases. It was use a total of 808 scientific studies cataloged in MEDLINE/PubMed, LILACS, ISI/Thomson Reuters and SciELO. org databases, which used specific descriptors for each of them. All the submitted papers were selected through the title, abstract, and reading the full text. Only 16 of total met the inclusion criteria, where they are identified as masculine, medium age 39, before treatment history for TB, and low rates of CD4 cells as factors associated to MDRTB development in coinfected patients. The systematic reviewing concluded that TB/HIV coinfected patients are more likely to develop MDR-TB.

Perfil epidemiológico de la hanseniasis en menores de quince años de edad, Manaus (Norte de Brasil), 1998-2005

OBJETIVO: Analisar a situacao epidemiologica da hanseniase em criancas, em zona urbana. METODOS: Foram estudados 474 casos de hanseniase, em menores de 15 anos, detectados na zona urbana de Manaus (AM), de 1998 a 2005. A partir dos dados do Sistema de Informacoes de Agravos de Notificacao foram analisados o perfil da endemia e a qualidade do atendimento nos servicos de saude, utilizando os indicadores epidemiologicos e operacionais Programa Nacional de Eliminacao da Hanseniase. RESULTADOS: Os casos de hanseniase em menores de 15 anos corresponderam a 10,4% do total de casos detectados no periodo. O coeficiente de deteccao nessa faixa etaria manteve-se no nivel hiperendemico entre 1998 e 2003, reduzindo a partir do ano de 2004 mas mantendo endemicidade muito alta. A forma clinica mais frequente foi a tuberculoide, seguida da dimorfa. As formas paucibacilares corresponderam a 70,7% dos casos e no momento do diagnostico, o grau de incapacidades foi avaliado em 94,7% dos pacientes, dos quais 2,9% apresentaram incapacidades fisicas. A maioria dos casos (99,4%) foi tratada com o esquema poliquimioterapico da Organizacao Mundial da Saude. CONCLUSOES: Apesar de seu decrescimo, o coeficiente de deteccao da hanseniase nas criancas em Manaus mantem nivel de endemicidade muito alto.OBJECTIVE To describe the epidemiological status of leprosy in children living in a metropolitan area. METHODS There were studied 474 leprosy cases detected in children under 15 living in the metropolitan area of the city of Manaus, Northern Brazil, between 1998 and 2005. The endemic profile and quality of care services were assessed based on data from the Notifiable Diseases Information System using epidemiological and operational indicators of the National Leprosy Elimination Program. RESULTS Of all leprosy cases detected in the period studied, 10.4% were found in children under 15. The detection rates in this age group remained at hyperendemic levels between 1998 and 2003, and decreased from 2004 onwards but keeping on very high endemic levels. The most common clinical form was tuberculoid followed by dimorphous. Paucibacillary forms were seen in 70.7% of the cases. The level of disability at the time of diagnosis was assessed in 94.7% of patients and 2.9% of them had physical disabilities. Most children (99.4%) were treated with the multiple drug regimen recommended by the World Health Organization. CONCLUSIONS Despite its decrease, detection rate of leprosy in children in the city of Manaus remains at a very high endemic level.