Renata Gracie

Georreferenciamento de dados de saúde na escala submunicipal: algumas experiências no Brasil

This work describes experiences in geocoding health data in Brazilian municipalities, analyzed according to the availability and update of cartographic databases and the treatment given to addresses data in health information systems (SIS). The diversity of current geocoding strategies in Brazil results of local conditions on which these projects are developed, presenting variable efficiency and accuracy for health event location. The authors suggest strategies to capture and store addresses data in SIS, compatible with the existent street registries, as well as the development of programs and scripts to search and link these two databases.

Heterogeneidade espacial da dengue em estudos locais, Niterói, RJ

OBJETIVO: Analisar a ocorrencia espacial e temporal da dengue e sua associacao com a heterogeneidade de caracteristicas do ambiente urbano. METODOS: Foram georreferenciados 1.212 casos de dengue registrados no Sistema de Informacao de Agravos de Notificacao entre 1998 e 2006, no municipio de Niteroi, RJ, segundo setores censitarios. Os setores foram classificados em areas homogeneas para a ocorrencia da doenca: favela, estaleiro e urbano. Os casos foram agrupados em cinco periodos: dois interepidemicos 1998-2000 e 2003-2005; tres epidemicos 2001, 2002 e 2006 e analisados por meio de operacoes entre camadas em ambiente sistema de informacao geografica. Para identificacao de conglomerados com maior intensidade de casos, utilizou-se o metodo de kernel. O metodo de varredura espacial de Kulldorff foi usado para confirmacao estatistica desses clusters. RESULTADOS: Do total de casos, 57% eram do sexo feminino. As faixas etarias com maior concentracao de casos foram de 20-29 anos (20,5%) e de 30-39 anos (17,7%). O setor favela morro apresentou somente 11% dos domicilios atendidos por servico de coleta de lixo, o maior percentual de nao alfabetizados (8,7%) e de chefes de familia com rendimentos menores de 1 salario minimo (29,5%). Os casos permaneceram nos setores denominados favelas. No primeiro ano epidemico e nos periodos interepidemicos o maior numero de casos estava situado nos setores favelas morro e favela plana; no segundo e terceiro ano de epidemia, situavam-se no setor favela plana. CONCLUSOES: A parcela economicamente ativa foi a mais atingida na area de estudo. Os setores censitarios mostram heterogeneidade espacial em relacao as condicoes de vida e dentro de alguns setores, ha diferenciais na distribuicao espacial e temporal do risco de ocorrencia da dengue.OBJECTIVE To analyze the spatial and temporal occurrence of dengue fever and its association with the heterogeneity of urban environment characteristics. METHODS A total of 1,212 dengue cases, recorded in the Information System for Notifiable Diseases (Sinan) between 1998 and 2006, in the city of Niterói, Southeastern Brazil, were georeferenced according to census tracts. These tracts were classified into homogeneous areas for the occurrence of the disease: slum, shipyard and urban area. Cases were grouped into five periods--two inter-epidemic periods (1998-2000 and 2003-2005) and three epidemic periods (2001, 2002 and 2006)--and analyzed using operations between layers in a geographic information system (GIS) environment. The kernel method was used to identify clusters of cases. Kulldorffs spatial scan statistic was used to confirm these clusters statistically. RESULTS Of all cases, 57% were females. Age groups with the highest number of cases were 20-29-years (20.5%) and 30-39-years (17.7%). The hill slum sector showed only 11% of households covered by garbage collection service, the highest percentage of illiterate individuals (8.7%) and head of families with income lower than one monthly minimum wage (29.5%). Cases remained in the slum sectors. In the first epidemic year and in the inter-epidemic periods, the highest number of cases was found in the hill and flatland slum sectors; in the second and third epidemic years, in the flatland slum sector. CONCLUSIONS The economically active portion of the population was that most affected in the study area. Census tracts show spatial heterogeneity in relation to life conditions. In addition, in some tracts, there are differences in spatial and temporal distribution of the risk of occurrence of dengue fever.

Hepatite A no Município do Rio de Janeiro, Brasil: padrão epidemiológico e associação das variáveis sócio-ambientais. Vinculando dados do SINAN aos do Censo Demográfico

This article discusses the linking of data from SINAN (the Reportable Diseases Database) and population census in Brazil to identify the socio-environmental context of hepatitis A, analyzing the contribution by environmental and socio-demographic variables to reported and confirmed cases of hepatitis A. Also, based on individual case data provided by SINAN, we discuss the pattern of hepatitis A endemicity in the city of Rio de Janeiro. At the aggregate level, the unit of analysis was the census tract and census data, associated with the location of 1,553 cases in the city from 1999 to 2001. The observed pattern was high to medium endemicity, indicating a less favorable situation than observed by sero-epidemiological studies. The mean rank of number of households with unfavorable conditions was higher in the census tracts with excess risk of hepatitis A (two or more cases), a statistically significant result according to the Mann-Whitney Test. Socio-demographic variables had more impact than environmental ones (poverty and children in the household less than 5 years of age showed the highest mean ranks).

Geographical Scale Effects on the Analysis of Leptospirosis Determinants

Leptospirosis displays a great diversity of routes of exposure, reservoirs, etiologic agents, and clinical symptoms. It occurs almost worldwide but its pattern of transmission varies depending where it happens. Climate change may increase the number of cases, especially in developing countries, like Brazil. Spatial analysis studies of leptospirosis have highlighted the importance of socioeconomic and environmental context. Hence, the choice of the geographical scale and unit of analysis used in the studies is pivotal, because it restricts the indicators available for the analysis and may bias the results. In this study, we evaluated which environmental and socioeconomic factors, typically used to characterize the risks of leptospirosis transmission, are more relevant at different geographical scales (i.e., regional, municipal, and local). Geographic Information Systems were used for data analysis. Correlations between leptospirosis incidence and several socioeconomic and environmental indicators were calculated at different geographical scales. At the regional scale, the strongest correlations were observed between leptospirosis incidence and the amount of people living in slums, or the percent of the area densely urbanized. At the municipal scale, there were no significant correlations. At the local level, the percent of the area prone to flooding best correlated with leptospirosis incidence.

Social geography of AIDS in Brazil: identifying patterns of regional inequalities

The trend towards decline and stabilization of the AIDS epidemic in Brazil should be analyzed carefully, since aggregate data can mask regional or local inequalities in such a large and diverse country. The current study reevaluates the epidemics spatial dissemination and the AIDS-related mortality pattern in Brazil. The study considered all AIDS cases diagnosed in individuals over 18 years of age and living in Brazil, as well as AIDS deaths recorded in 1998-2008. Three-year moving average rates were estimated, and a spatial analysis was conducted using a local empirical Bayesian method. The epidemic was only found to be expanding in the North and Northeast regions, while declining in the rest of the country, especially in the Southeast. According to the findings, the apparent stabilization of AIDS mortality tends to mask regional disparities. Social determinants of health and regional disparities should be taken into account in program development and policymaking.La disminucion y estabilizacion de la epidemia de SIDA en Brasil deben ser consideradas con prudencia, ya que, en un pais grande y diverso, los datos agregados pueden ocultar desigualdades regionales pronunciadas. El estudio reevaluo la difusion espacial de la epidemia y las muertes secundarias por SIDA. Se consideraron todos los casos diagnosticados con 18+ anos, residentes en Brasil, asi como las muertes registradas en 1998-2008. Se estimaran las tasas medias moviles desde hace tres anos y se llevo a cabo el analisis espacial a traves del metodo bayesiano empirico local. La epidemia estaba en expansion en el Norte y Noreste, mientras que se redujo en el resto del pais, en especial en el Sureste. Los analisis subrayan que la aparente estabilizacion de la mortalidad por SIDA oculta disparidades regionales. Los determinantes sociales de la salud y las disparidades regionales son claves en la formulacion de programas y politicas publicas en Brasil.The trend towards decline and stabilization of the AIDS epidemic in Brazil should be analyzed carefully, since aggregate data can mask regional or local inequalities in such a large and diverse country. The current study reevaluates the epidemic’s spatial dissemination and the AIDS-related mortality pattern in Brazil. The study considered all AIDS cases diagnosed in individuals over 18 years of age and living in Brazil, as well as AIDS deaths recorded in 1998-2008. Three-year moving average rates were estimated, and a spatial analysis was conducted using a local empirical Bayesian method. The epidemic was only found to be expanding in the North and Northeast regions, while declining in the rest of the country, especially in the Southeast. According to the findings, the apparent stabilization of AIDS mortality tends to mask regional disparities. Social determinants of health and regional disparities should be taken into account in program development and policymaking

Spatial heterogeneity of dengue fever in local studies, City of Niterói, Southeastern Brazil

OBJETIVO: Analisar a ocorrencia espacial e temporal da dengue e sua associacao com a heterogeneidade de caracteristicas do ambiente urbano. METODOS: Foram georreferenciados 1.212 casos de dengue registrados no Sistema de Informacao de Agravos de Notificacao entre 1998 e 2006, no municipio de Niteroi, RJ, segundo setores censitarios. Os setores foram classificados em areas homogeneas para a ocorrencia da doenca: favela, estaleiro e urbano. Os casos foram agrupados em cinco periodos: dois interepidemicos 1998-2000 e 2003-2005; tres epidemicos 2001, 2002 e 2006 e analisados por meio de operacoes entre camadas em ambiente sistema de informacao geografica. Para identificacao de conglomerados com maior intensidade de casos, utilizou-se o metodo de kernel. O metodo de varredura espacial de Kulldorff foi usado para confirmacao estatistica desses clusters. RESULTADOS: Do total de casos, 57% eram do sexo feminino. As faixas etarias com maior concentracao de casos foram de 20-29 anos (20,5%) e de 30-39 anos (17,7%). O setor favela morro apresentou somente 11% dos domicilios atendidos por servico de coleta de lixo, o maior percentual de nao alfabetizados (8,7%) e de chefes de familia com rendimentos menores de 1 salario minimo (29,5%). Os casos permaneceram nos setores denominados favelas. No primeiro ano epidemico e nos periodos interepidemicos o maior numero de casos estava situado nos setores favelas morro e favela plana; no segundo e terceiro ano de epidemia, situavam-se no setor favela plana. CONCLUSOES: A parcela economicamente ativa foi a mais atingida na area de estudo. Os setores censitarios mostram heterogeneidade espacial em relacao as condicoes de vida e dentro de alguns setores, ha diferenciais na distribuicao espacial e temporal do risco de ocorrencia da dengue.OBJECTIVE To analyze the spatial and temporal occurrence of dengue fever and its association with the heterogeneity of urban environment characteristics. METHODS A total of 1,212 dengue cases, recorded in the Information System for Notifiable Diseases (Sinan) between 1998 and 2006, in the city of Niterói, Southeastern Brazil, were georeferenced according to census tracts. These tracts were classified into homogeneous areas for the occurrence of the disease: slum, shipyard and urban area. Cases were grouped into five periods--two inter-epidemic periods (1998-2000 and 2003-2005) and three epidemic periods (2001, 2002 and 2006)--and analyzed using operations between layers in a geographic information system (GIS) environment. The kernel method was used to identify clusters of cases. Kulldorffs spatial scan statistic was used to confirm these clusters statistically. RESULTS Of all cases, 57% were females. Age groups with the highest number of cases were 20-29-years (20.5%) and 30-39-years (17.7%). The hill slum sector showed only 11% of households covered by garbage collection service, the highest percentage of illiterate individuals (8.7%) and head of families with income lower than one monthly minimum wage (29.5%). Cases remained in the slum sectors. In the first epidemic year and in the inter-epidemic periods, the highest number of cases was found in the hill and flatland slum sectors; in the second and third epidemic years, in the flatland slum sector. CONCLUSIONS The economically active portion of the population was that most affected in the study area. Census tracts show spatial heterogeneity in relation to life conditions. In addition, in some tracts, there are differences in spatial and temporal distribution of the risk of occurrence of dengue fever.

Traffic Crashes and Alcohol Outlets in a Brazilian State Capital

Objective: Restricting alcohol outlets is being considered as a measure for preventing alcohol-related crashes. However, in many developing countries, alcohol availability is not regulated and its influence on motor vehicle traffic crashes is unknown. This study explores the association between traffic crashes and alcohol outlets in a Brazilian city. Method: Data were geocoded and exploratory analysis was conducted using the kernel density estimator. Two generalized additive models (GAMs) were implemented to predict the factors associated with alcohol-related crashes. Results: For 78 percent of the 3840 traffic crashes where the driver was a victim, there was at least one bar located within a 300-m radius. The median distances between an outlet were 124.4 and 130.7 m for a non-alcohol- and alcohol-related crashes, respectively (P =.13). The GAMs did not make evident any significant association between the outlet locations and alcohol-related crashes: the presence of at least one outlet was associated with alcohol-related crashes with an odds ratio (OR) of 0.94 (95% confidence interval [CI] = 0.75–1.17). Alcohol crashes are more likely to be observed among males (OR = 1.58; 95% CI = 1.21–2.06), young drivers vs. those aged 50 years+ (OR = 3.4; 95% CI = 1.79–6.43), and crashes with fatalities (OR = 1.73; 95% CI = 0.98–3.04). Conclusions: Density of alcohol outlets was high all over the city and both alcohol- and non-alcohol-related crashes occurred near an outlet. The study helps to better understand the relationship between alcohol availability and traffic crashes in a middle-income country where licensing/zoning is absent and suggests that measures for restricting the physical availability of alcohol are necessary, even though further studies are still needed.

A experiência de mapeamento participativo para a construção de uma alternativa cartográfica para a ESF

Maps and mapping procedures are useful tools for systematic interpretation and evaluation and for reporting of results to management. Applied to the Family Health Strategy (FHS), these maps permit the demarcation of the territory and the establishment of links between the territory, its population and health services. In this paper the use of maps by the FHS in 17 municipalities in northern and northeastern Brazil is studied and the process of demarcation and digitization of areas with the participation of teams is described. The survey conducted using questionnaires and discussion workshops showed that difficulties still prevail in reconciling the map (drawing) produced at the local level with maps produced by other government sectors. In general, the maps used at local level employ their own references, which prevent the interplay of information with other cartographic documents and their full use as a tool for evaluation and management. The combination of participatory mapping tools, associated with Geographic Information Systems (GIS) applications proposed in this paper, represents an alternative to mapping the territory of operations of FHS teams, as well as a reflection on the concept of territory and operation by the FHS.

Situação da malária na tríplice fronteira entre Brasil, Colômbia e Peru

This article aims to analyze the malaria surveillance situation on the triple border between Brazil, Colombia, and Peru. This was a qualitative study using questionnaires in the border towns in 2011. The results were analyzed with the SWOT matrix methodology, pointing to significant differences between the malaria surveillance systems along the border. Weaknesses included lack of linkage between actors, lack of trained personnel, high turnover in teams, and lack of malaria specialists in the local hospitals. The study also showed lack of knowledge on malaria and its prevention in the local population. The strengths are the inclusion of new institutional actors, improvement of professional training, distribution of insecticide-treated bed nets, and possibilities for complementary action between surveillance systems through cooperation between health teams on the border. Malaria control can only be successful if the region is dealt with as a whole.O objetivo deste artigo e analisar a situacao da vigilância da malaria na triplice fronteira entre Brasil, Colombia e Peru. E um estudo qualitativo com aplicacao de questionarios em cidades da fronteira realizado em 2011. Os resultados foram analisados pela metodologia DOFA e apontaram diferencas significativas entre os sistemas de vigilância da malaria na fronteira. Observou-se como debilidades a desarticulacao entre atores responsaveis, a insuficiencia de pessoal treinado, a alta rotatividade das equipes e a falta de medicos especialistas em malaria nos hospitais locais. Verificou-se ainda o desconhecimento sobre a malaria e suas formas de prevencao na populacao entrevistada. As fortalezas sao a insercao de novos atores institucionais, a melhora da qualificacao profissional, a distribuicao de mosquiteiros impregnados e possibilidades de complementaridade entre os sistemas de vigilância a serem aproveitadas pela cooperacao entre as equipes de saude da fronteira, pois o controle da malaria so pode ter sucesso tomando-se esta regiao em seu conjunto.

Diarrhea outbreaks in northeastern Brazil in 2013, according to media and health information systems - Surveillance of climate risk and health emergencies.

This study has the objective of analyzing information about diarrhea outbreaks in Brazils northeast in the year 2013. Information came from electronic media and from health information systems. A total of 33 news events related to diarrhea outbreaks were identified, some of them mentioning causes and aggravating factors. The analysis of spatial and temporal distribution of the news, admissions and deaths showed that more than 100,000 persons were affected and, according to the news analyzed, the most affected states were Alagoas and Pernambuco, with a greater extent in the months from May to July. The use of alternative sources of water such as ponds, wells, water trucks and household water reservoirs were identified as the most immediate causes of these outbreaks. However, other underlying factors such as precarious water supply systems in the semi-arid region, the exceptional conditions of drought, considered the worst in the last 60 years, as well as the capacity of the health sector to respond to a large number of cases, should be considered to recover the context in which these outbreaks are produced.