Characteristics of basic health units and detection of tuberculosis cases

Abstract INTRODUCTION Tuberculosis (TB) is an infectious and contagious disease caused by Mycobacterium tuberculosis. TB emerged in the 21st century as an unsolved public health problem. This study aimed to analyze the relationship between the characteristics of basic health units (BHUs) and the number of TB cases detected in Maranhão, Brazil. METHODS An ecological, analytical study was conducted using the municipalities in the state of Maranhão as the unit of analysis. Data regarding the number of detected TB cases was obtained from the Sistema de Informação de Agravos de Notificação database, and the characteristics of the BHUs were obtained from the first cycle of data collection for the Program to Improve Access and Quality of Basic Care. The BHU structure was classified as adequate (80%-100%), partially adequate (60%-79%), poorly adequate (40%-59%), or inadequate (<40%) according to the presence of specified items. The number of BHUs per municipality in each adequacy category was estimated. Inflated Poisson regression analysis was performed to estimate the incidence density ratios (IDRs) and the 95% confidence intervals (95% CIs). RESULTS Municipalities with a higher level of BHU adequacy had a higher number of detected TB cases (IDR = 1.61, 95% CI: 1.01-2.60). CONCLUSIONS Better structured health services in primary care may be associated with better detection and/or notification of TB cases.

Spatial-temporal analysis of dengue deaths: identifying social vulnerabilities

Abstract: INTRODUCTION Currently, dengue fever, chikungunya fever, and zika virus represent serious public health issues in Brazil, despite efforts to control the vector, the Aedes aegypti mosquito. METHODS: This was a descriptive and ecological study of dengue deaths occurring from 2002 to 2013 in São Luis, Maranhão, Brazil. Geoprocessing software was used to draw maps, linking the geo-referenced deaths with urban/social data at census tract level. RESULTS: There were 74 deaths, concentrated in areas of social vulnerability. CONCLUSIONS: The use of geo-technology tools pointed to a concentration of dengue deaths in specific intra-urban areas.

Risk factors associated with death in Brazilian children with severe dengue: a case-control study

Objective: The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue. Methods: The clinical condition of hospitalized patients with severe dengue who died (cases, n = 18) was compared with that of hospitalized patients with severe dengue who survived (controls, n = 77). The inclusion criteria for this study were age under 13 years; hospital admission in São Luis, northeastern Brazil; and laboratory-confirmed diagnosis of dengue. Results: Severe bleeding (hemoptysis), a defining criterion for dengue severity, was the factor most strongly associated with death in our study. We also found that epistaxis and persistent vomiting, both included as warning signs in the World Health Organization (WHO) classification of dengue, were strongly associated with death. No significant association was observed between any of the laboratory findings and death. Conclusions: The finding that epistaxis and persistent vomiting were also associated with death in children with severe dengue was unexpected and deserves to be explored in future studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with a higher risk to progress to death may be crucial. .

Situação epidemiológica da leishmaniose visceral, na Ilha de São Luís, Estado do Maranhão / Epidemiological situation of visceral leishmaniasis on the Island of São Luis, State of Maranhão

Apresenta-se o resultado de um estudo de campo sobre a leishmaniose visceral autóctone da Ilha de São Luís. Com início em 2004 e término em 2006, a pesquisa visou conhecer aspectos epidemiológicos e clínicos determinantes da endemia. Foram analisados 299 casos autóctones, sendo 83,6 por cento em menores de 9 anos e 54,1 por cento do sexo masculino. O agravo ocorreu em todos os meses do ano com pico em junho. O coeficiente de incidência foi reduzido de 46,1 para 35,2 casos por 100.000 habitantes nos anos estudados. O diagnóstico teve confirmação laboratorial em 93,3 por cento dos casos. O tratamento de escolha foi à base de N-metilglucamina com percentual de cura de 96,1 por cento. A letalidade média foi de 3,7 por cento. Em função da inexistência de ações mais sistemáticas de controle, propõe-se a criação de um programa a ser desenvolvido pelos municípios sob a coordenação da Secretaria de Estado da Saúde.

The results from a field study on autochthonous visceral leishmaniasis on the island of São Luís are presented. This study started in 2004 and finished in 2006 and had the aim of ascertaining the determinant epidemiological and clinical characteristics of this endemic disease. Two hundred ninety nine autochthonous cases were analyzed, of which 83.6 percent were children younger than 9 years old and 54.1 percent were male. The disease occurred in all months of the year, with a peak in June. The coefficient of incidence decreased from 46.1 to 35.2 cases per 100,000 inhabitants over the years studied. The diagnosis was confirmed by laboratory tests in 93.3 percent of the cases. The treatment of choice was based on N-methylglucamine, with a cure rate of 96.1 percent. The mean lethality rate was 3.7 percent. Because of the absence of systematic control actions, the authors propose the creation of a specific program to be developed by the municipalities under the coordination of the State Department of Health.

A participação popular no controle da dengue em São Luís, MA: uma experiência em construçao / Popular engagement for dengue control in São Luís city, Maranhão state: an ongoing experience

Relato de experiência sobre o desenvolvimento do projeto de comunicaçåo para mudança de comportamento (combi) como estratégia de controle de dengue no bairro da Cohab Anil I, em Sao Luís-MA, entre outubro de 2004 e fevereiro de 2005. O objetivo principal do projeto foi a mobilizaçao e a participaçåo da comunidade, visando à construçao de atitudes positivas no enfrentamento dessa endemia. A estratégia metodológica compreendeu, inicialmente, a realizaçao de uma pesquisa formativa identificando problemas relativos ao armazenamento da água e conhecimentos sobre dengue. A partir de um processo de discussao coletiva dos dados, foram implementadas propostas participativas, elaboradas por gestores e populaçao, e estabelecidos indicadores de monitoramento. A melhoria desses indicadores demonstra que o projeto Combi é uma estratégia eficiente no controle da dengue, por incluir a populaçao como sujeito do processo