Márcio Natividade

Bacterial meningitis and living conditions

INTRODUCTION Bacterial meningitis has great social relevance due to its ability to produce sequelae and cause death. It is most frequently found in developing countries, especially among children. Meningococcal meningitis occurs at a high frequency in populations with poor living conditions. This study describes the temporal evolution of bacterial meningitis in Salvador, Brazil, 1995-2009, and verifies the association between its spatial variation and the living conditions of the population. METHODS This was an ecological study in which the areas of information were classified by an index of living conditions. It examined fluctuations using a trend curve, and the relationship between this index and the spatial distribution of meningitis was verified using simple linear regression. RESULTS From 1995-2009, there were 3,456 confirmed cases of bacterial meningitis in Salvador. We observed a downward trend during this period, with a yearly incidence of 9.1 cases/100,000 population and fatality of 16.7%. Children aged <5 years old and male were more affected. There was no significant spatial autocorrelation or pattern in the spatial distribution of the disease. The areas with the worst living conditions had higher fatality from meningococcal disease (β = 0.0078117, p < 0.005). CONCLUSIONS Bacterial meningitis reaches all social strata; however, areas with poor living conditions have a greater proportion of cases that progress to death. This finding reflects the difficulties for ready access and poor quality of medical care faced by these populations.

Fatores associados ao acesso geográfico aos serviços de saúde por pessoas com tuberculose em três capitais do Nordeste brasileiro

O objetivo do presente estudo foi identificar fatores associados ao acesso geografico aos servicos de saude por portadores de tuberculose em tres capitais do Nordeste do Brasil. A amostra foi composta por casos novos de tuberculose, notificados em 2007. Foram utilizados dados provenientes do Sistema de Informacao sobre Agravos de Notificacao, e do Cadastro Nacional de Estabelecimento de Saude. Os enderecos dos domicilios e das unidades de saude foram georreferenciados e, utilizando a distância entre o domicilio e a unidade de atendimento de cada caso, foi considerado acesso dificultado quando esta distância foi maior do que 800 metros. Foram estimadas as razoes de prevalencia bruta e ajustada por meio de regressao de Poisson. Verificou-se que apos ajuste com as variaveis estudadas, apenas a variavel unidade basica, em Salvador, Bahia (RP = 0,75; IC95%: 0,720-0,794) e em Recife, Pernambuco (RP = 0,402; IC95%: 0,318-0,508), manteve associacao com o acesso dificultado. O estudo concluiu que a descentralizacao do atendimento em unidade basica pode contribuir com a melhoria do acesso aos servicos de saude.The aim of this study was to identify factors associated with geographic access to health services by tuberculosis patients in three State capitals in Northeast Brazil. The sample consisted of new tuberculosis cases reported in 2007. The study used data from the Information System on Notifiable Diseases and the National Registry of Healthcare Organizations. Addresses of households and health services were geocoded, and difficult access was defined as a distance greater than 800 meters from the household to the health service. Crude prevalence ratios were estimated, as well as adjusted prevalence ratios using Poisson regression. After adjusting the study variables, the only variable that remained associated with difficult access was primary healthcare units in Salvador, Bahia State (PR = 0.75; 95%CI: 0.720-0.794) and in Recife, Pernambuco State (PR = 0.402; 95%CI: 0.318-0.508). The study concluded that decentralization of primary care can help improve access to health services.

Social inequalities in spatial distribution of hospital admissions due to respiratory diseases

Para verificar as desigualdades sociais nas hospitalizacoes por doencas do aparelho respiratorio em Salvador, Bahia, Brasil, 2001-2007, realizou-se estudo ecologico espacial, tendo como unidade de analise zonas de informacao. Estas foram estratificadas considerando um indicador de condicoes de vida e analisadas por regressao de Poisson. A distribuicao espacial das taxas de hospitalizacao por doencas do aparelho respiratorio variou de 3,3 a 80,5/10 mil habitantes. Asma, pneumonia e doenca pulmonar obstrutiva cronica (DPOC) apresentaram padrao espacial heterogeneo, no qual estratos de piores condicoes de vida apresentaram maior risco de ocorrencia dessas internacoes. A taxa de hospitalizacao por doencas do aparelho respiratorio foi 2,4 vezes maior no estrato de condicoes de vida muito baixas do que no primeiro estrato. Houve reducao das desigualdades para pneumonia e aumento para asma e DPOC. A existencia de forte gradiente social reforca a hipotese de que aspectos socioeconomicos sao determinantes das hospitalizacoes por doencas do aparelho respiratorio.To verify social inequalities in hospital admissions due to respiratory diseases in Salvador, Bahia State, Brazil, 2001-2007, an ecological study was conducted with information zones as the units of analysis. Information zones were stratified according to living conditions and analyzed by Poisson regression. Spatial distribution of hospitalization rates due to respiratory diseases ranged from 3.3 to 80.5/10,000. Asthma, pneumonia, and chronic obstructive pulmonary disease (COPD) showed heterogeneous spatial patterns, in which strata with the worst living conditions showed higher hospitalizations rates. The hospitalization rate for respiratory diseases was 2.4 times higher in zones with very low living conditions as compared to the wealthiest zone. There was a reduction in inequalities in hospital admissions for pneumonia and an increase for asthma and COPD. The sharp social gradient supports the hypothesis that socioeconomic factors are determinants of hospitalizations for respiratory diseases.

Leprosy in children and adolescents under 15 years old in an urban centre in Brazil

This original study describes the intra-urban distribution of cases of leprosy in residents under 15 years old in Salvador, Bahia, Brazil; the study also identifies the environment in which Mycobacterium leprae is being transmitted. The cases were distributed by operational classification, clinical forms, type of contact and the addresses were geo-referenced by neighborhood. Between 2007 and 2011, were reported 145 cases of leprosy in target population living in Salvador, corresponding to detection rates of 6.21, 6.14, 5.58, 5.41 and 6.88/100,000 inhabitants, respectively. The spatial distribution of the disease was focal. Of the 157 neighborhoods of Salvador, 44 (28.6%) notified cases of leprosy and in 22 (50%) of these were detected more than 10 cases per 100,000 inhabitants. The infectious forms were found in 40% of cases. Over 90% of cases had been living in Salvador for more than five years. Overall, 52.6% reported having had contact with another infected individual inside the household and 25% in their social circle. In Salvador, M. leprae transmission is established. The situation is a major concern, since transmission is intense at an early age, indicating that this endemic disease is expanding and contacts extend beyond individual households.

The spatiotemporal trajectory of a dengue epidemic in a medium-sized city

Understanding the transmission dynamics of infectious diseases is important to allow for improvements of control measures. To investigate the spatiotemporal pattern of an epidemic dengue occurred at a medium-sized city in the Northeast Region of Brazil in 2009, we conducted an ecological study of the notified dengue cases georeferenced according to epidemiological week (EW) and home address. Kernel density estimation and space-time interaction were analysed using the Knox method. The evolution of the epidemic was analysed using an animated projection technique. The dengue incidence was 6.918.7/100,000 inhabitants; the peak of the epidemic occurred from 8 February-1 March, EWs 6-9 (828.7/100,000 inhabitants). There were cases throughout the city and was identified space-time interaction. Three epicenters were responsible for spreading the disease in an expansion and relocation diffusion pattern. If the health services could detect in real time the epicenters and apply nimbly control measures, may possibly reduce the magnitude of dengue epidemics.

Desigualdades sociais na distribuição espacial das hospitalizações por doenças respiratórias

Para verificar as desigualdades sociais nas hospitalizacoes por doencas do aparelho respiratorio em Salvador, Bahia, Brasil, 2001-2007, realizou-se estudo ecologico espacial, tendo como unidade de analise zonas de informacao. Estas foram estratificadas considerando um indicador de condicoes de vida e analisadas por regressao de Poisson. A distribuicao espacial das taxas de hospitalizacao por doencas do aparelho respiratorio variou de 3,3 a 80,5/10 mil habitantes. Asma, pneumonia e doenca pulmonar obstrutiva cronica (DPOC) apresentaram padrao espacial heterogeneo, no qual estratos de piores condicoes de vida apresentaram maior risco de ocorrencia dessas internacoes. A taxa de hospitalizacao por doencas do aparelho respiratorio foi 2,4 vezes maior no estrato de condicoes de vida muito baixas do que no primeiro estrato. Houve reducao das desigualdades para pneumonia e aumento para asma e DPOC. A existencia de forte gradiente social reforca a hipotese de que aspectos socioeconomicos sao determinantes das hospitalizacoes por doencas do aparelho respiratorio.To verify social inequalities in hospital admissions due to respiratory diseases in Salvador, Bahia State, Brazil, 2001-2007, an ecological study was conducted with information zones as the units of analysis. Information zones were stratified according to living conditions and analyzed by Poisson regression. Spatial distribution of hospitalization rates due to respiratory diseases ranged from 3.3 to 80.5/10,000. Asthma, pneumonia, and chronic obstructive pulmonary disease (COPD) showed heterogeneous spatial patterns, in which strata with the worst living conditions showed higher hospitalizations rates. The hospitalization rate for respiratory diseases was 2.4 times higher in zones with very low living conditions as compared to the wealthiest zone. There was a reduction in inequalities in hospital admissions for pneumonia and an increase for asthma and COPD. The sharp social gradient supports the hypothesis that socioeconomic factors are determinants of hospitalizations for respiratory diseases.

Factors associated with geographic access to health services by TB patients in three State capitals in Northeast Brazil

O objetivo do presente estudo foi identificar fatores associados ao acesso geografico aos servicos de saude por portadores de tuberculose em tres capitais do Nordeste do Brasil. A amostra foi composta por casos novos de tuberculose, notificados em 2007. Foram utilizados dados provenientes do Sistema de Informacao sobre Agravos de Notificacao, e do Cadastro Nacional de Estabelecimento de Saude. Os enderecos dos domicilios e das unidades de saude foram georreferenciados e, utilizando a distância entre o domicilio e a unidade de atendimento de cada caso, foi considerado acesso dificultado quando esta distância foi maior do que 800 metros. Foram estimadas as razoes de prevalencia bruta e ajustada por meio de regressao de Poisson. Verificou-se que apos ajuste com as variaveis estudadas, apenas a variavel unidade basica, em Salvador, Bahia (RP = 0,75; IC95%: 0,720-0,794) e em Recife, Pernambuco (RP = 0,402; IC95%: 0,318-0,508), manteve associacao com o acesso dificultado. O estudo concluiu que a descentralizacao do atendimento em unidade basica pode contribuir com a melhoria do acesso aos servicos de saude.The aim of this study was to identify factors associated with geographic access to health services by tuberculosis patients in three State capitals in Northeast Brazil. The sample consisted of new tuberculosis cases reported in 2007. The study used data from the Information System on Notifiable Diseases and the National Registry of Healthcare Organizations. Addresses of households and health services were geocoded, and difficult access was defined as a distance greater than 800 meters from the household to the health service. Crude prevalence ratios were estimated, as well as adjusted prevalence ratios using Poisson regression. After adjusting the study variables, the only variable that remained associated with difficult access was primary healthcare units in Salvador, Bahia State (PR = 0.75; 95%CI: 0.720-0.794) and in Recife, Pernambuco State (PR = 0.402; 95%CI: 0.318-0.508). The study concluded that decentralization of primary care can help improve access to health services.

Los factores asociados al acceso geográfico a los servicios de salud para personas con tuberculosis en tres capitales del nordeste brasileño

O objetivo do presente estudo foi identificar fatores associados ao acesso geografico aos servicos de saude por portadores de tuberculose em tres capitais do Nordeste do Brasil. A amostra foi composta por casos novos de tuberculose, notificados em 2007. Foram utilizados dados provenientes do Sistema de Informacao sobre Agravos de Notificacao, e do Cadastro Nacional de Estabelecimento de Saude. Os enderecos dos domicilios e das unidades de saude foram georreferenciados e, utilizando a distância entre o domicilio e a unidade de atendimento de cada caso, foi considerado acesso dificultado quando esta distância foi maior do que 800 metros. Foram estimadas as razoes de prevalencia bruta e ajustada por meio de regressao de Poisson. Verificou-se que apos ajuste com as variaveis estudadas, apenas a variavel unidade basica, em Salvador, Bahia (RP = 0,75; IC95%: 0,720-0,794) e em Recife, Pernambuco (RP = 0,402; IC95%: 0,318-0,508), manteve associacao com o acesso dificultado. O estudo concluiu que a descentralizacao do atendimento em unidade basica pode contribuir com a melhoria do acesso aos servicos de saude.The aim of this study was to identify factors associated with geographic access to health services by tuberculosis patients in three State capitals in Northeast Brazil. The sample consisted of new tuberculosis cases reported in 2007. The study used data from the Information System on Notifiable Diseases and the National Registry of Healthcare Organizations. Addresses of households and health services were geocoded, and difficult access was defined as a distance greater than 800 meters from the household to the health service. Crude prevalence ratios were estimated, as well as adjusted prevalence ratios using Poisson regression. After adjusting the study variables, the only variable that remained associated with difficult access was primary healthcare units in Salvador, Bahia State (PR = 0.75; 95%CI: 0.720-0.794) and in Recife, Pernambuco State (PR = 0.402; 95%CI: 0.318-0.508). The study concluded that decentralization of primary care can help improve access to health services.

Desigualdades sociales en la distribución espacial de las hospitalizaciones por enfermedades respiratorias

Para verificar as desigualdades sociais nas hospitalizacoes por doencas do aparelho respiratorio em Salvador, Bahia, Brasil, 2001-2007, realizou-se estudo ecologico espacial, tendo como unidade de analise zonas de informacao. Estas foram estratificadas considerando um indicador de condicoes de vida e analisadas por regressao de Poisson. A distribuicao espacial das taxas de hospitalizacao por doencas do aparelho respiratorio variou de 3,3 a 80,5/10 mil habitantes. Asma, pneumonia e doenca pulmonar obstrutiva cronica (DPOC) apresentaram padrao espacial heterogeneo, no qual estratos de piores condicoes de vida apresentaram maior risco de ocorrencia dessas internacoes. A taxa de hospitalizacao por doencas do aparelho respiratorio foi 2,4 vezes maior no estrato de condicoes de vida muito baixas do que no primeiro estrato. Houve reducao das desigualdades para pneumonia e aumento para asma e DPOC. A existencia de forte gradiente social reforca a hipotese de que aspectos socioeconomicos sao determinantes das hospitalizacoes por doencas do aparelho respiratorio.To verify social inequalities in hospital admissions due to respiratory diseases in Salvador, Bahia State, Brazil, 2001-2007, an ecological study was conducted with information zones as the units of analysis. Information zones were stratified according to living conditions and analyzed by Poisson regression. Spatial distribution of hospitalization rates due to respiratory diseases ranged from 3.3 to 80.5/10,000. Asthma, pneumonia, and chronic obstructive pulmonary disease (COPD) showed heterogeneous spatial patterns, in which strata with the worst living conditions showed higher hospitalizations rates. The hospitalization rate for respiratory diseases was 2.4 times higher in zones with very low living conditions as compared to the wealthiest zone. There was a reduction in inequalities in hospital admissions for pneumonia and an increase for asthma and COPD. The sharp social gradient supports the hypothesis that socioeconomic factors are determinants of hospitalizations for respiratory diseases.

561 Distribution of Asthma Mortality in Various Districts of Salvador, Brazil.

Background Brazil still does not have a national program to combat asthma. Isolated initiatives have been developed in a non-standardized fashion. The Program for Control of Asthma in Bahia (ProAR) was established in Salvador, Bahia, in 2003, aiming for the control of the most severe cases. Objective To analyze time trends in mortality from asthma and its distribution in the districts of Salvador (2000–2009) and to correlate mortality rates with social indicators. Methods Observational study of deaths from asthma registered by the National Database of Mortality according to ICD-10. Mortality rates were calculated per 100,000 inhabitants and analyzed by simple linear regression. The distribution of mortality for asthma in the period was mapped into the 12 health districts of Salvador. The correlation of the number of deaths in Salvador with GDP per capita, HDI and Index Gini was evaluated. Results The average asthma mortality in Salvador between 2000 and 2009 was 1.542/100.000 inhabitants, with a declining trend (R2 = 0.539, b = –11.1, P = 0.016). Deaths occurred more frequently in women than men (66% vs 34%). Asthma mortality rates were higher in subjects > 35 years. There was a reduction at ages younger than 1 year, 5 to 14 years, 25 to 34 years, and 45 to 54 years with a sharp decline between 55 and 64 (–8.14/100,000). The mortality rate (19.68/100,000 inhabitants in 2009) was higher for individuals > 75 years. The highest mortality rates were noted in more populated and poorer areas with less infrastructure and access to health services. It was observed that 78% of the deaths occurred in hospitals or health facilities. Deaths rates for asthma correlated directly with the district Gini index (rho = 0.400, P = 0.505) and inversely with HDI (rho = –0.300, P = 0.624), though not statistically significant. Conclusions Asthma mortality in Salvador is concentrated in the poorest areas with less infrastructure and access to health services, most commonly affecting women and the elderly. There was a reduction in mortality during the study period, possibly related to interventions for asthma control in the municipality. Mortality from asthma behaves differently in each district of the city.