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.

[Prevalence of trachoma in Brazilian schoolchildren]. / Prevalencia de tracoma entre escolares brasileiros.

OBJECTIVE: To estimate the prevalence and describe the distribution of trachoma among schoolchildren in Brazilian municipalities. METHODS: Cross-sectional study, using cluster sampling, of the schoolchildren population of the Brazilian municipalities with Human Development Index - Municipal lower than the national average. This trachoma prevalence survey was conducted by the Ministry of Health, in the period 2002-2007. There were 119,531 schoolchildren selected from 2,270 schools located in 1,156 municipalities. The selected schoolchildren underwent an external ocular examination, with a magnifying glass (2.5X), to detect clinical signs of trachoma according to the WHO criteria. The prevalence of trachoma, by state and national level, and their respective 95% confidence intervals were estimated. Chi-square and Chi-square for trends tests were used to compare categorical variables. RESULTS: There were 6,030 cases of trachoma detected, resulting in a prevalence of 5.0% (95%CI 4.5;5.4). There was no significant difference between the sexes. The prevalence of trachoma was 8.2% among children under 5 years of age, decreasing among higher age groups (p < 0.01). There was a significant difference in prevalence between urban and rural areas, 4.3% versus 6.2% respectively (p < 0.01). Cases were detected in 901 municipalities (77.7% of the sample), in all regions of the country. In 36.8% of the selected municipalities, the prevalence was higher than 5%. CONCLUSIONS: The study shows that trachoma is a significant public health problem in Brazil, contradicting the belief that the disease had been controlled in the country. The survey provides a baseline for evaluating planned interventions aimed at achieving the goal of global certification of elimination of trachoma as a cause of blindness in Brazil by 2020.

Prevalencia de tracoma entre escolares brasileiros / Prevalencia de tracoma entre escolares brasilenos / Prevalence of trachoma in Brazilian schoolchildren

OBJETIVO: Estimar a prevalência e descrever a distribuição do tracoma entre escolares em municípios brasileiros. MÉTODOS: Estudo de corte transversal, usando amostragem por conglomerados, da população escolar dos municípios brasileiros com Índice de Desenvolvimento Humano-Municipal menor que a média nacional. O inquérito de prevalência de tracoma foi realizado pelo Ministério da Saúde entre 2002 e 2007. Foram selecionados 119.531 alunos de 2.270 escolas localizadas em 1.156 municípios. Os alunos foram submetidos ao exame ocular externo, com lupa (2,5X), para detecção de sinais clínicos de tracoma segundo critérios da OMS. Estimou-se a prevalência de tracoma segundo estado e em nível nacional, e seus respectivos intervalos de 95% de confiança. Para a comparação de variáveis categóricas foram usados os testes do Qui-quadrado e do Qui-quadrado de tendência linear. RESULTADOS: Foram detectados 6.030 casos de tracoma, resultando em prevalência de 5,0% (IC95% 4,5;5,4). Não foi encontrada diferença significante entre os sexos. A prevalência de tracoma foi de 8,2% entre menores de cinco anos de idade, diminuindo nas faixas etárias mais altas (p < 0,01). Houve diferença significante entre as prevalências de tracoma na zona urbana e rural, 4,3% versus 6,2%, respectivamente (p < 0,01). Foram detectados casos em 901 municípios (77,7% da amostra), em todas as regiões do País. Em 36,8% dos municípios selecionados a prevalência foi superior a 5%. CONCLUSÕES: O estudo mostra que o tracoma é um importante problema de saúde pública no Brasil, contradizendo a crença de que a endemia estaria controlada no País. O inquérito realizado apresenta uma linha de base para avaliação das intervenções ...

OBJETIVO: Estimar la prevalencia y describir la distribución de tracoma entre escolares en municipios brasileños MÉTODOS: Estudio de corte transversal, usando muestreo por conglomerados, de la población escolar de los municipios brasileños con Índice de Desarrollo Humano-Municipal menor que el promedio nacional. La pesquisa de prevalencia de tracoma fue realizada por el Ministerio de la Salud entre 2002 y 2007. Se seleccionaron 119.531 alumnos de 2.270 escuelas localizadas en 1.156 municipios. Los alumnos fueron sometidos a examen ocular externo, con lupa (2,5X), para detección de señales clínicas de tracoma según criterios de la OMS. Se estimó la prevalencia de tracoma según estado y a nivel nacional, y sus respectivos intervalos de 95% de confianza. Para la comparación de variables categóricas se usaron las pruebas de Chi-cuadrado y de Chi-cuadrado de tendencia linear. RESULTADOS: Se detectaron 6.030 casos de tracoma, resultando en prevalencia de 5,0% (IC95% 4,5;5,4). No se encontró diferencia significativa entre los sexos. La prevalencia de tracoma fue de 8,2% entre menores de cinco años de edad, disminuyendo en los grupos etarios más altos (p0,01). Hubo diferencia significativa entre las prevalencias de tracoma en la zona urbana y rural, 4,3% vs. 6,2%, respectivamente (p0,01). Se detectaron casos en 901 municipios (77,7% de la muestra), en todas las regiones del País. En 36,8% de los municipios seleccionados la prevalencia fue superior a 5%. CONCLUSIONES: El estudio muestra que el tracoma es un importante problema de salud pública en Brasil, contradiciendo la creencia de que la endemia estaría controlada en el País. La pesquisa realizada presenta una línea de base para evaluación de las intervenciones planeadas con miras a alcanzar la meta mundial de certificación de eliminación del tracoma como ...

OBJECTIVE: To estimate the prevalence and describe the distribution of trachoma among schoolchildren in Brazilian municipalities. METHODS: Cross-sectional study, using cluster sampling, of the schoolchildren population of the Brazilian municipalities with Human Development Index - Municipal lower than the national average. This trachoma prevalence survey was conducted by the Ministry of Health, in the period 2002-2007. There were 119,531 schoolchildren selected from 2,270 schools located in 1,156 municipalities. The selected schoolchildren underwent an external ocular examination, with a magnifying glass (2.5X), to detect clinical signs of trachoma according to the WHO criteria. The prevalence of trachoma, by state and national level, and their respective 95% confidence intervals were estimated. Chi-square and Chi-square for trends tests were used to compare categorical variables. RESULTS: There were 6,030 cases of trachoma detected, resulting in a prevalence of 5.0% (95%CI 4.5;5.4). There was no significant difference between the sexes. The prevalence of trachoma was 8.2% among children under 5 years of age, decreasing among higher age groups (p < 0.01). There was a significant difference in prevalence between urban and rural areas, 4.3% versus 6.2% respectively (p < 0.01). Cases were detected in 901 municipalities (77.7% of the sample), in all regions of the country. In 36.8% of the selected municipalities, the prevalence was higher than 5%. CONCLUSIONS: The study shows that trachoma is a significant public health problem in Brazil, contradicting the belief that the disease had been controlled in the country. The survey provides a baseline for evaluating planned interventions aimed at achieving the goal of global certification of elimination of trachoma as a cause of blindness in Brazil by 2020. .

Lymphatic filariasis in Brazil: epidemiological situation and outlook for elimination.

Since the World Health Assembly's (Resolution WHA 50.29, 1997) call for the elimination of lymphatic filariasis by the year 2020, most of the endemic countries identified have established programmes to meet this objective. In 1997, a National Lymphatic Filariasis Elimination Plan was drawn up by the Ministry of Health of Brazil, creating local programs for the elimination of Bancroftian filariasis in areas with active transmission. Based on a comprehensive bibliographic search for available studies and reports of filariasis epidemiology in Brazil, current status of this parasitic infection and the outlook for its elimination in the country were analysed. From 1951 to 1958 a nationwide epidemiological study conducted in Brazil confirmed autochthonous transmission of Bancroftian filariasis in 11 cities of the country. Control measures led to a decline in parasite rates, and in the 1980s only the cities of Belém in the Amazonian region (Northern region) and Recife (Northeastern region) were considered to be endemic. In the 1990s, foci of active transmission of LF were also described in the cities of Maceió, Olinda, Jaboatão dos Guararapes, and Paulista, all in the Northeastern coast of Brazil. Data provide evidence for the absence of microfilaremic subjects and infected mosquitoes in Belém, Salvador and Maceió in the past few years, attesting to the effectiveness of the measures adopted in these cities. Currently, lymphatic filariasis is a public health problem in Brazil only in four cities of the metropolitan Recife region (Northeastern coast). Efforts are being concentrated in these areas, with a view to eliminating the disease in the country.

Survey of Trachoma within school students in the state of Roraima, Brazil.

PURPOSE: Trachoma, a blinding conjunctivitis, is the result of repeated infection with Chlamydia trachomatis. There are no recent data for the state of Roraima, Brazil, where it was thought that trachoma no longer existed. These data are derived from school children sampled in this state, with additional data collected from the contacts of children with trachoma. DESIGN: A population-based cross-sectional study with random sampling of students in grades 1 through 4 of all public schools within municipalities where the human development index was less than the national average in 2003. The sample was stratified according to population size. PARTICIPANTS: A sample size of 7200 was determined and a total of 6986 (93%) students were examined, along with an additional 2152 contacts. METHODS: All students were examined for trachoma according to World Health Organization criteria. Demographic data and contact information also was collected. The family and school contacts of students with trachoma then were located and examined. MAIN OUTCOME MEASURES: Prevalence and grade of trachoma, age, gender, race, and municipality location. RESULTS: The overall prevalence of trachoma was 4.5% (95% confidence interval [CI], 3.7%-5.3%), but there were municipalities within the state where the prevalence of inflammatory trachoma was more than 10%. The prevalence was greater in rural areas (4.9%; 95% CI, 3.7%-6.0%) compared with urban areas (3.9%; 95% CI, 2.9%-4.9%). Living in indigenous communities was associated with trachoma (odds ratio, 1.6; 95% CI, 0.9-2.6). An additional 2152 contacts were examined, and the overall trachoma prevalence was 9.3% (95% CI, 8.1-10.5). CONCLUSIONS: Trachoma continues to exist in Roraima, Brazil, where there are municipalities with a significant prevalence of disease. The indigenous population is highly mobile, crossing state and international borders, raising the possibility of trachoma in neighboring countries. Trachoma prevalence among the contacts of students with trachoma was higher than the school population, highlighting the importance of contact tracing. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Survey of trachoma within scholl students in the State of Roraima, Brazil

Purpose: Trachoma, a blinding conjunctivitis, is the result of repeated infection with Chlamydia trachomatis.There are no recent data for the state of Roraima, Brazil, where it was thought that trachoma no longer existed. These data are derived from school children sampled in this state, with additional data collected from thecontacts of children with trachoma.Design: A population-based cross-sectional study with random sampling of students in grades 1 through 4 of all public schools within municipalities where the human development index was less than the national averagein 2003. The sample was stratified according to population size. Participants: A sample size of 7200 was determined and a total of 6986 (93%) students were examined, along with an additional 2152 contacts. Methods: All students were examined for trachoma according to World Health Organization criteria. Demographic data and contact information also was collected. The family and school contacts of students with trachoma then were located and examined. Main Outcome Measures: Prevalence and grade of trachoma, age, gender, race, and municipality location. Results: The overall prevalence of trachoma was 4.5% (95% confidence interval [CI], 3.7%–5.3%), but there were municipalities within the state where the prevalence of inflammatory trachoma was more than 10%. The prevalence was greater in rural areas (4.9%; 95% CI, 3.7%–6.0%) compared with urban areas (3.9%; 95% CI, 2.9%–4.9%). Living in indigenous communities was associated with trachoma (odds ratio, 1.6; 95% CI, 0.9 –2.6). An additional 2152 contacts were examined, and the overall trachoma prevalence was 9.3% (95% CI, 8.1–10.5). Conclusions: Trachoma continues to exist in Roraima, Brazil, where there are municipalities with a significant prevalence of disease. The indigenous population is highly mobile, crossing state and international borders, raising the possibility of trachoma in neighboring countries. Trachoma prevalence...

[Impact of anti-Hib conjugate vaccine on the incidence of Haemophilus influenzae meningitis in Brazil's Federal District: results of a three-year follow-up]. / Impacto de la vacuna conjugada en la incidencia de meningitis por Haemophilus influenzae en el Distrito Federal de Brasil: resultados de tres años de seguimiento.

INTRODUCTION: Type b Haemophilus influenzae (Hib) continues to be an important causative agent of various infectious processes, and its encapsulated strains cause invasive disease. In some aboriginal populations, the incidence of Hib infections in children under five is greater than 400 per 100,000. In the seventies and eighties, vaccines against Hib were developed after antibodies against the capsular component were identified. The objective of this paper was to estimate the impact that the vaccine against Hib has had in Brazil's Federal District since it was introduced in March of 1998. METHODS: Using population-based data obtained from Brazil's Federal District's Ministry of Health's Surveillance System, rates of incidence of meningitis during the three years that preceded and that followed the introduction of the anti-Hib vaccine were compared. Comparisons were also drawn between changes in the trends observed. RESULTS: A comparison of the data from the two periods showed a decrease of approximately 90% in the incidence of Hib meningitis, but no concomitant decrease in other forms of bacterial meningitis was noted. There was also a proportional increase in the number of cases among infants 6 months of age and under due to a drop in the incidence of the disease in children older than 6 months. CONCLUSION: As a result of the introduction of the conjugated anti-Hib vaccine in Brazil's Federal District, the incidence of Hib meningitis among children 7 months to 35 months of age dropped from 168 per 100,000 to 15 per 100,000 (91.1%).

Impacto de la vacuna conjugada en la incidencia de meningitis por Haemophilus influenzae en el Distrito Federal de Brasil: resultados de tres años de seguimiento / Impact of anti-Hib conjugate vaccine on the incidence of Haemophilus influenzae meningitis in Brazil's Federal District: results of a three-year follow-up

INTRODUCCION: Haemophilus influenzae del serotipo b (Hib) es todavía un importante agente causal de procesos infecciosos. Su variante encapsulada es la causa de formas invasoras de enfermedad. En algunas poblaciones aborígenes, la incidencia de enfermedades causadas por Hib es mayor de 400 por 100 000 niños menores de 5 años. En los decenios de 1970 y 1980, tras la identificación de anticuerpos protectores contra la cápsula de Hib, se desarrollaron vacunas contra este microorganismo. OBJETIVO: Estimar el impacto que ha tenido desde su introducción, en marzo de 1998, la vacunación contra Hib en el Distrito Federal de Brasil. MÉTODO: Con los datos de base poblacional del Sistema de Vigilancia de la Secretaría de Salud del Distrito Federal de Brasil, se compararon las tasas de incidencia de meningitis correspondientes a los tres años anteriores y posteriores a la introducción de la vacuna. Se compararon también los cambios en su tendencia. RESULTADOS: Al comparar los dos períodos se advierte una reducción de aproximadamente 90 por ciento en la incidencia de meningitis por Hib, cambio que no ocurre en el caso de las meningitis ocasionadas por otros agentes bacterianos. Se registró un aumento proporcional de los casos entre los niños de 6 meses de edad y menores, debido a la reducción de la incidencia entre los mayores de esa edad. CONCLUSION: La introducción de la vacuna conjugada en el Distrito Federal de Brasil redujo de 168 por 100 000 (1995-1997) a 15 por 100 000 (1999-2001) la incidencia de meningitis por Hib entre niños de 7 a 35 meses. Esto representa una reducción de 91,1%.

Estudos sobre diretrizes e práticas de atenção à saúde mental / Studies on guidelines and practices of attention to mental health

O presente trabalho revê a organização do sistema de saúde brasileiro ao longo da história, com destaque para o desenvolvimento da assistência à saúde mental dentro deste processo. São enfocados os movimentos sociais em busca de mudanças, como o Movimento Sanitário e a Reforma Psiquiátrica no país, assim como as políticas públicas que marcaram significativamente a situação atual. Além disso, apresenta questões relativas às articulações existentes na estrutura política do país que determinaram, de acordo com o modo de produção adotado, o olhar para a doença e para o doente, resultando que a as ações no campo da saúde estivessem ligadas e voltadas principalmente à condição produtiva dos indivíduos. A seguir apresentam-se algumas considerações sobre o contexto da assistência à saúde mental contemporânea e seu processo de transformação a partir de análise de documentos e revisão bibliográfica não exaustiva, com a proposta de compreender aspectos preconizados pela Organização Mundial da Saúde e Legislação Brasileira para o cuidado em saúde mental, apontando influências internacionais. A partir desta breve compreensão, entende-se que informações sobre os pressupostos para o tratamento são subsídios importantes para a construção da luta pela saúde mental e cidadania. Considera-se neste trabalho, que a reestruturação da prática cotidiana dos serviços de saúde mental é condição essencial para a transformação proposta para o modelo assistencial em nosso país. O presente estudo questionou profissionais de equipes de serviços substitutivos de saúde mental do município de Botucatu, em relação aos sentidos atribuídos por eles aos procedimentos de avaliação inicial e planejamento terapêutico, como constituintes do tratamento oferecido nestes serviços. Para tanto, utilizou-se a perspectiva das práticas discursivas e produção de sentidos no cotidiano proposta por Spink...

Aspectos epidemiológicos da meningite pelo Haemophilus influenzae Meningitis in Distrito Federal (DF), Brazil, antes da introdução da vacina conjugada / Aspects epidemiologists of the meningite for the Haemophilus influenzae in the Federal District, Brazil, before the introduction of the conjugated vaccine

O Haemophilus influenzae(HI) foi o agente etiológico responsável pelo maior número de doenças invasivas na infância, entre elas a meningite. O objetivo deste trabalho é avaliar, qualitativamente, a vigilância epidemiológica(VE) da meningite pelo HI no Distrito Federal(DF), descrevendo os seus aspectos epidemilógicos antes da introdução da vacina conjugada. Foi realizado um estudo descritivo de base populacional, a partir de dados secundários da rotina dos serviços envolvidos na assistência e vigilância de casos. A incidência de meningite em menores de cinco anos variou de 82 a 110 casos para cada 100.000 habitantes/ano; a proporção de casos de meningite po HI é de 23 por cento entre as meningites bacterianas diagnosticadas. No DF. o HI foi responsável pelo maior percentual de casos de meningites em menores de cinco anos. O coeficiente de incidência de meningite por esse agente esteve entre 26 e 43 casos por 100.000 habitentes/ano; a proporção em menores de cinco anos, entre 1990 e 1997; a letalidade variou de 11 a 18 por cento e o sorotipo b foi o predominante. Os aspectos epidemiológicos observados são comparáveis aos referidos pela literatura. O estudo proporciona uma linha de base para futuras comparações e avaliação do impacto da introdução da imunização contra o HI-b no Distrito Federal...