Trachoma in Indigenous Settlements in Brazil, 2000-2008.

PURPOSE: Trachoma, caused by the bacterium Chlamydia trachomatis, is a chronic, recurrent inflammatory disease that affects the cornea and conjunctiva. Trachoma is the leading infectious cause of avoidable blindness worldwide. Its prevalence is higher among individuals of low socioeconomic status, and trachoma is common in indigenous communities. The present study presents aspects of the epidemiological profile of trachoma in indigenous communities in Brazil. METHODS: We analyzed data from two databases collected during trachoma screening activities among the population of indigenous settlements in Brazil between 2000 and 2008. Trachoma cases were detected by ocular examination in accordance with the World Health Organization simplified trachoma grading system. RESULTS: According to the surveillance database, a total of 9582 individuals in six different states were examined. Among children aged 1-9 years, the prevalence of follicular trachomatous inflammation (TF) was 35.2%. In individuals aged ≥15 years, the prevalence of trachomatous trichiasis (TT) was 1.2% in individuals and the sex-specific prevalence was 0.8% in males and 1.6% in females (p = 0.02). In a survey of two states, 2301 indigenous schoolchildren were examined. In the age bracket 5-9 years, the prevalence of TF was 4.9 (95% confidence interval 3.8-6.0%). CONCLUSION: In Brazil, trachoma appears to be a serious public health problem in indigenous settlements, which should therefore be given priority in programs aimed at the elimination of trachoma in the country.

Analyses of cataract surgery performed by the Unified Health System in Brazil, 2006-2007.

OBJECTIVE: Estimate cataract surgical rates (CSR) for Brazil and each federal unit in 2006 and 2007 based on the number of surgeries performed by the Unified Health System to help plan a comprehensive ophthalmology network in order to eliminate cataract blindness in compliance with the target set by the World Health Organization (WHO) of 3,000 cataract surgeries per million inhabitants per year. METHODS: This descriptive study calculates CSR by using the number of cataract surgeries carried out by the Brazilian Unified Health System for each federal unit and estimates the need for cataract surgery in Brazil for 2006-2007, with official population data provided by the Brazilian Institute of Geography and Statistics. The number of cataract surgeries was compared with the WHO target. RESULTS: To reach the WHO goal for eliminating age-related cataract blindness in Brazil, 560,312 cataract surgeries in 2006 and 568,006 surgeries in 2007 needed to be done. In 2006, 179,121 cataract surgeries were done by the Unified Health System, corresponding to a CSR of 959 per million population; in 2007, 223,317 were performed, with a CSR of 1,179. With the Brazilian Council of Ophthalmology estimation of 165,000 surgeries each year by the non-public services, the CSR for Brazil would be 1,842 for 2006 and 2,051 for 2007. The proportions needed to achieve the proposed target were 38.6% in 2006 and 31.6% in 2007. CONCLUSIONS: Human resources, technical expertise, and equipment are crucial to reach the WHO goal. Brazil has enough ophthalmologists but needs improved planning and infrastructure in order to eliminate the problem, aspects that require greater financial investment and stronger political commitment.

Analyses of cataract surgery performed by the Unified Health System in Brazil, 2006-2007 / Análisis de las intervenciones quirúrgicas de cataratas efectuadas en el Sistema Único de Salud del Brasil en el 2006 y el 2007

OBJECTIVE: Estimate cataract surgical rates (CSR) for Brazil and each federal unit in 2006 and 2007 based on the number of surgeries performed by the Unified Health System to help plan a comprehensive ophthalmology network in order to eliminate cataract blindness in compliance with the target set by the World Health Organization (WHO) of 3 000 cataract surgeries per million inhabitants per year. METHODS: This descriptive study calculates CSR by using the number of cataract surgeries carried out by the Brazilian Unified Health System for each federal unit and estimates the need for cataract surgery in Brazil for 2006-2007, with official population data provided by the Brazilian Institute of Geography and Statistics. The number of cataract surgeries was compared with the WHO target. RESULTS: To reach the WHO goal for eliminating age-related cataract blindness in Brazil, 560312 cataract surgeries in 2006 and 568 006 surgeries in 2007 needed to be done. In 2006, 179121 cataract surgeries were done by the Unified Health System, corresponding to a CSR of 959 per million population; in 2007, 223317 were performed, with a CSR of 1179. With the Brazilian Council of Ophthalmology estimation of 165 000 surgeries each year by the non-public services, the CSR for Brazil would be 1842 for 2006 and 2051 for 2007. The proportions needed to achieve the proposed target were 38.6 percent in 2006 and 31.6 percent in 2007. CONCLUSIONS: Human resources, technical expertise, and equipment are crucial to reach the WHO goal. Brazil has enough ophthalmologists but needs improved planning and infrastructure in order to eliminate the problem, aspects that require greater financial investment and stronger political commitment.

OBJETIVO: Calcular las tasas de cirugía de cataratas (TCC) correspondientes al 2006 y el 2007 en todo el Brasil y en cada estado según la cantidad de intervenciones efectuadas en el Sistema Único de Salud, con el objeto de planificar una red integral de atención oftalmológica tendiente a eliminar la ceguera por cataratas, en cumplimiento de la meta fijada por la Organización Mundial de la Salud (OMS), de 3 000 intervenciones quirúrgicas de cataratas por millón de habitantes por año. MÉTODOS: En este estudio descriptivo se calculó la TCC según la cantidad de intervenciones quirúrgicas de cataratas llevadas a cabo en el Sistema Único de Salud del Brasil en cada estado, y se calculó la necesidad de intervenciones quirúrgicas de cataratas en el Brasil en el 2006 y el 2007 según los datos oficiales de la población proporcionados por el Instituto Brasileño de Geografía y Estadística. Se comparó la cantidad de intervenciones quirúrgicas de cataratas con la meta de la OMS. RESULTADOS: Para alcanzar la meta de la OMS de eliminar la ceguera producida por cataratas seniles en el Brasil, deberían haberse efectuado 560 312 intervenciones quirúrgicas de cataratas en el 2006, y 568006 en el 2007. En el 2006, se efectuaron 179 121 intervenciones quirúrgicas de cataratas en el Sistema Único de Salud, lo que representa una TCC de 959 por millón de habitantes; en el 2007, se realizaron 223317, con una TCC de 1179. Si estos datos se consideran junto con la estimación del Consejo Brasileño de Oftalmología de 165000 intervenciones quirúrgicas efectuadas cada año en los servicios no públicos, la TCC correspondiente al Brasil sería de 1842 para el 2006 y de 2 051 para el 2007. Las proporciones faltantes para lograr la meta propuesta fueron de 38,6 por ciento en el 2006 y de 31,6 por ciento en el 2007. CONCLUSIONES: Los recursos humanos, los conocimientos técnicos especializados y el equipo son esenciales para alcanzar la meta de la OMS. Brasil tiene suficientes oftalmólogos pero, para eliminar el problema, necesita una mejor planificación y más infraestructura, aspectos que requieren una mayor inversión financiera y un compromiso político más firme.

Trachoma prevalence and risk factors among preschool children in a central area of the city of São Paulo, Brazil.

PURPOSE: To estimate the prevalence and severity of trachoma among preschool children and to identify the risk factors. METHODS: Cross-sectional study involving preschool children up to seven years of age residing in a neighborhood of the city of São Paulo, Brazil. RESULTS: A total of 1128 children were studied. Although most were of low socioeconomic status, access to good sanitary services was virtually universal. The prevalence of inflammatory trachoma was 4.7%. In the bivariate analysis, being 4-7 years of age and having classroom contact with a trachoma case were associated with the disease. Multivariate logistic regression showed that contact with trachoma in the classroom was an independent predictor of trachoma. CONCLUSIONS: Trachoma persists among children in low-income families, even in urban areas with good sanitation. To eliminate trachoma in a low endemic community, a sensitive surveillance system should be implemented to identify residual sources of infection.

[Prevalence of trachoma in preschool and schoolchildren in the city of São Paulo]. / Prevalência do tracoma em pré-escolares e escolares no Município de São Paulo.

OBJECTIVE: To assess the prevalence of trachoma among preschool and school children of public schools to give new focus to control programs. METHODS: An epidemiological survey was carried out in São Paulo City in 1999. Children between four and 14 years old were selected by a cluster sampling where school shift was the sampling unit. External eye examination was conducted to detect trachoma. RESULTS: A total of 27,091 children were examined and 597 cases of trachoma were found (2.2%; 95% CI: 1.86-2.55). The prevalence ranged from 0.4% to 4.2% in 10 city areas. The trachoma detection rate in the household contacts examined was 8.7%. Follicular trachoma was found in 99% of the cases and intense trachoma in 1.0%. It was observed that 21.8% of the cases were asymptomatic. CONCLUSIONS: Though the trachoma prevalence was low, the occurrence of severe cases points out to the likelihood of cicatricial trachoma cases in the future if they are not adequately treated and controlled. The great difference in the prevalences in different city areas indicates the need for strengthening epidemiological surveillance activities.

Prevalência do tracoma em pré-escolares e escolares no município de São Paulo / Prevalence of trachoma in preschool and schoolchildren in the city of São Paulo

OBJETIVO: Conhecer a prevalência de tracoma em pré-escolares e escolares das escolas públicas para redirecionar as atividades de seu controle. MÉTODOS: Realizou-se inquérito epidemiológico no Município de São Paulo, em 1999. A seleção das crianças com idade entre quatro e 14 anos foi feita por meio de amostragem por conglomerados, sendo o turno de estudo a unidade amostral. Foi realizado exame ocular externo para detectar a presença de sinais clínicos de tracoma. RESULTADOS: Das 27.091 crianças examinadas foram diagnosticados 597 casos de tracoma (2,2 por cento; IC 95 por cento: 1,86-2,55). A prevalência variou de 0,4 por cento a 4,2 por cento entre as 10 regiões do Município de São Paulo. A taxa de detecção entre os comunicantes foi de 8,7 por cento. Tracoma folicular foi encontrado em 99,0 por cento dos casos e tracoma intenso em 1,0 por cento dos casos. Verificou-se que 22,5 por cento dos casos eram assintomáticos. CONCLUSÕES: Embora a prevalência tenha sido baixa, a presença de formas graves aponta para a possibilidade da existência de casos cicatriciais no futuro, se não houver tratamento e controle adequado. A grande diferença entre as taxas encontradas para cada uma das regiões da cidade, indica a necessidade de intensificação das ações de vigilância epidemiológica do tracoma.

Ocorrência de tracoma em populaçäo pré-escolar no subdistrito de Paz da Bela Vista, município de Säo Paulo, 1995 / Occurence of trachoma in preschool population in Paz da Bela Vista subdistrict, Säo Paulo city, 1995

Aborda inquérito com o objetivo de conhecer a prevalência da doença entre pré-escolares de uma área do Município de Säo Paulo e elaborar subsídios para o aprimoramento da sua vigilância e controle em nosso meio. Foi desenvolvido um estudo de corte transversal entre ciranças pré-escolares, matriculadas em 9 creches do subdistrito da Bela Vista, conveniadas com a Prefeitura do Município de Säo Paulo. O trabalho de campo foi realizado entre os meses de agosto e outubro de 1995. Houve uma perda de 4,8 por cento das crianças. Foram submetidas a exame oftalmológico 1128 crianças. Estudou-se também as condiçöes habitacionais e sócio-econômicas das famílias. Para confirmaçäo do tracoma foi adotada a definiçäo de caso proposta pela Organizaçäo Mundial da Saúde. Todas as crianças que apresentaram sinais e sintomas compatíveis com a definiçäo de caso adotada, foram submetidas a exame laboratorial para confirmaçäo da infecçäo por Chlamydia trachomatis pela técnica de imunofluorescência direta. A prevalência encontrada foi de 4,7 por cento de tracoma inflamatório e nenhum caso de tracoma cicatricial foi identificado. O grupo etário mais atingido foi de 4 a 5 anos