An entomological surveillance system based on open spatial information for participative dengue control

Aedes aegypti is a very efficient disseminator of human pathogens. This condition is the result of evolutionary adaptations to frequent haematophagy, as well as to the colonization of countless types of habitats associated with environmental and cultural factors that favor the proliferation of this mosquito in urban ecosystems. Studies using sensitive methods of monitoring demonstrate that the methods of surveillance used in the Brazilian program do not show the high degrees of the infestation of cities by this vector. To increase the capacity of the health sector, new tools are needed to the practice of surveillance, which incorporate aspects of the vector, place and human population. We describe here the SMCP-Aedes - Monitoring System and Population Control of Aedes aegypti, aiming to provide an entomological surveillance framework as a basis for epidemiological surveillance of dengue. The SMCP-Aedes is uphold in the space technology information, supported by the intensive use of the web and free software to collect, store, analyze and disseminate information on the spatial-temporal distribution of the estimated density for the population of Aedes, based on data systematically collected with the use of ovitraps. Planned control interventions, intensified where and when indicated by the entomological surveillance, are agreed with the communities, relying on the permanent social mobilization.

Associadas a fatores bióticos, climáticos e culturais que favorecem a proliferação do Aedes aegypti em ecossistemas urbanos, adaptações evolutivas à hematofagia freqüente e quase exclusiva em humanos e à colonização de tipos infinitos de habitats, fazem deste mosquito um disseminador extremamente eficiente de patógenos ao homem. Estudos utilizando métodos sensíveis de monitoramento demonstram que os métodos de vigilância usados no programa brasileiro não revelam as elevadas intensidades da infestação das cidades por este vetor. Para ampliar a capacidade do setor de saúde novos instrumentos são necessários à prática da vigilância, incorporando aspectos do vetor, do lugar e das pessoas do lugar. Apresentamos aqui o SMCP-Aedes - Sistema de Monitoramento e Controle Populacional do Ae. aegypti, cuja meta é a instrumentalização da vigilância entomológica como base para a vigilância epidemiológica da dengue. Para isso ele se apóia em tecnologias da informação espacial baseadas no uso intensivo da web e de software livre para coletar, armazenar, analisar e disseminar informações relativas à distribuição espaço-temporal da densidade estimada para a população do Aedes, com base em amostras obtidas continuamente com ovitrampas. Intervenções de controle planejadas e intensificadas onde e quando indicado pela vigilância entomológica, são pactuadas com os habitantes, apoiando-se na mobilização social permanente.

A nationwide population screening program for diabetes in Brazil / Programa nacional para el tamizaje poblacional de la diabetes en el Brasil

OBJETIVOS: En 2001, se invitó a los habitantes del Brasil de 40 años de edad o mayores a participar en un programa para el tamizaje de la diabetes sacarina como parte del Plan de Reorganización de la Atención de la Hipertensión Arterial y la Diabetes Mellitus, del Ministerio de Salud del Brasil. En este informe se describen los porcentajes totales de participación y de resultados positivos obtenidos en la campaña de tamizaje, así como los factores asociados con el grado de participación en las distintas municipalidades del Brasil. MÉTODOS: Se definió como resultado positivo una glucemia en ayunas = 100 mg/dL o una glucemia casual = 140 mg/dL. Los resultados del tamizaje se obtuvieron del Ministerio de Salud y se analizaron por municipalidad. RESULTADOS: De las 5 561 municipalidades del Brasil, 5 301 (95,3%) participaron y notificaron los resultados. De los 30,2 millones de personas que integraban la población destinataria, 22,1 millones (73,0%) recibieron la prueba, y de estas últimas, 3,5 millones (15,7%) tuvieron resultados positivos. Las probabilidades de un buen porcentaje de participación (> 80%) fueron mayores en las municipalidades pequeñas (razón de riesgos (RR) = 5,0, al compararse los valores extremos), en las situadas en la parte norte del país (RR = 1,8), en las ubicadas a las afueras de una zona metropolitana (RR = 1,4) y en aquellas donde era mayor el porcentaje de la población que había completado la escuela primaria (RR = 1,2) (P < 0,05). En todo el país aumentó el uso de la prueba de glucosa inmediatamente después de la campaña, quizá debido en parte a la necesidad de confirmar el diagnóstico de los casos identificados mediante el tamizaje. CONCLUSIONES: La respuesta entusiasta a la campaña ilustra que este tipo de programa puede servir para crear mayor conciencia en torno al problema de la diabetes y para sentar las bases del fortalecimiento de la capacidad en el contexto de la atención primaria de salud

Objectives. In 2001, persons throughout Brazil who were 40 years old or older were invited to participate in community screening for diabetes as part of the Brazilian Ministry of Health's Plan for the Reorganization of Care for Arterial Hypertension and Diabetes Mellitus. This report describes the overall participation rate and positivity rate of the screening campaign, as well as factors associated with the level of participation among the municipalities in Brazil. Methods. Screening test positivity was defined as a fasting glucose of ≥ 100mg/dL or a casual glucose of ≥ 140mg/dL. Screening data were obtained from the Ministry of Health and were analyzed for each municipality. Results. Out of the 5 561 municipalities in Brazil, 5 301 of them (95.3%) participated and reported results. Of the 30.2 million persons in the target population, 22.1 million of them (73.0%) were tested, and 3.5 million of the persons tested (15.7%) were positive. Higher odds of a high population participation rate (≥ 80%) were seen in municipalities that were of small size (risk ratio (RR) = 5.0, comparing extremes), were located in the North region of the country (RR = 1.8), were located outside of a metropolitan region (RR = 1.4), and had a higher proportion of their population who had completed elementary school (RR = 1.2) (P < 0.05). There was a parallel increase in glucose testing nationwide during and immediately after the campaign, presumably in part for diagnostic confirmation of cases identified during screening. Conclusions. The massive response to the campaign attests to the potential that this type of program has to raise diabetes awareness and to set the stage for capacity-building at the primary care level