The Global Leprosy Assessment Index (GLAI): A new approach for measuring the severity of disease in Brazil.

Background: In Brazil, the Ministry of Health (MH) monitors leprosy using 15 indicators, with the aim of implementing and evaluating evidence-based public policies. However, an excessive number of variables can complicate the definition of objectives and verification of epidemiological goals. Methods: In this paper, we develop the Global Leprosy Assessment Index (GLAI), a composite measure that integrates two key dimensions for the control the disease: epidemiological and operational. Using a confirmatory factor analysis model to examine 2020 state-level data, we have standardized GLAI to a range of 0 to 1. Results: Higher values within this range indicate a greater severity of the disease. The mean value of the GLAI was 0.67, with a standard deviation of 0.22. Roraima has the highest value, followed by Paraíba with 0.88 while Tocantins records the lowest value of the indicator, followed by Mato Grosso with 0.14. The epidemiological and operational indicators have a positive but statistically insignificant correlation (r = 0.25; p-value = 0.20). Conclusions: The development of evidence-based public policies depends on the availability of valid and reliable indicators. The GLAI presented in this paper is easily reproducible and can be used to monitor the disease with disaggregated information. Furthermore, the GLAI has the potential to serve as a more robust parameter for evaluating the impact of actions designed to eradicate leprosy in Brazil.

"Won't get fooled again": statistical fault detection in COVID-19 Latin American data.

BACKGROUND: Claims of inconsistency in epidemiological data have emerged for both developed and developing countries during the COVID-19 pandemic. METHODS: In this paper, we apply first-digit Newcomb-Benford Law (NBL) and Kullback-Leibler Divergence (KLD) to evaluate COVID-19 records reliability in all 20 Latin American countries. We replicate country-level aggregate information from Our World in Data. RESULTS: We find that official reports do not follow NBL's theoretical expectations (n = 978; chi-square = 78.95; KS = 4.33, MD = 2.18; mantissa = .54; MAD = .02; DF = 12.75). KLD estimates indicate high divergence among countries, including some outliers. CONCLUSIONS: This paper provides evidence that recorded COVID-19 cases in Latin America do not conform overall to NBL, which is a useful tool for detecting data manipulation. Our study suggests that further investigations should be made into surveillance systems that exhibit higher deviation from the theoretical distribution and divergence from other similar countries.

The forensics of fraud: Evidence from the 2018 Brazilian presidential election.

Objective: This paper studies the integrity of the vote counting system in Brazil. Method: We analyze data from the Superior Electoral Court (TSE) for the 2018 Brazilian presidential election to assess suspicious vote count patterns deploying five techniques commonly used to detect fraud: a) the second-digit Benford's law test; b) the last digit mean; c) frequency analysis of last digits 0 and 5; d) correlation between the percentage of votes and the turnout rate; and e) resampled Kernel density of the proportion of votes. Results: The results show that the second-digit distributions for the three most voted candidates - Jair Messias Bolsonaro (PSL), Fernando Haddad (PT), and Ciro Gomes (PDT) - conform to Benford's law. We also find that last digit means and last digit frequency are within normal parameters, indicating no irregularities. Similarly, the fingerprint plot indicates a correlation coefficient that is consistent with the theoretical expectation of a fair election. The resampled Kernel density suggests that the vote count was performed without statistically significant distortions. These results are robust at different levels of data aggregation (polling station and municipality). Conclusion: The joint application of digit-focused tests, regression-based techniques, and patterns in the distribution of vote-shares provide a more reliable method for detecting anomalous cases. Relying on this unified framework, we find no evidence of electoral fraud in the 2018 Brazilian presidential election. These results advance our current understanding of statistical forensics tools and may be easily replicated to examine electoral integrity in other countries.

O efeito das medidas de distanciamento social sobre a incidência de COVID-19 no Brasil: Uma análise multissetorial / The effect of social distancing measures on the incidence of COVID-19 in Brazil: A multisectoral analysis

Objetivo: Este artigo estima o impacto das medidas de distanciamento social sobre a incidência de COVID-19 a partir de uma perspectiva multissetorial. Métodos: O desenho de pesquisa utiliza um modelo de regressão em painel para analisar a relação entre restrições de mobilidade em diferentes setores econômicos e a dinâmica longitudinal da doença nos estados do Brasil. Resultados: Os principais resultados indicam que apenas os coeficientes das variáveis que representam os setores de restaurantes (p-valor < 0,05), compras (p-valor < 0,05) e transporte (p-valor < 0,001) obtiveram significância estatística. Em especial, o transporte (ß= -0,674) é a variável que mais influencia a variação do número de casos de COVID-19. Conclusões: As evidências reportadas nesta pesquisa podem auxiliar o processo de tomada de decisão dos gestores governamentais a respeito da eficácia de intervenções não farmacológicas como instrumento para reduzir a disseminação da COVID-19 (AU)

Objective: This article estimates the impact of social distancing measures on the incidence of COVID-19 from a multisectoral perspective. Methods: The research design uses a panel regression model to analyze the relationship between mobility restrictions in different economic sectors and the longitudinal dynamics of the infection across Brazilian states. Results: The main results indicate that only the coefficients for the restaurant (p-value < 0.05), shopping (p-value < 0.05), and transport sectors (p-value < 0.001) reached statistical significance. In particular, transport (ß = -0.674) is the variable with the strongest impact on the variation in the number of COVID-19 cases. Conclusions: The evidence reported in this research can assist the decision-making process of government managers regarding the effectiveness of non-pharmacological interventions as a tool to reduce the spread of COVID-19

Saneamento importa? Uma análise da relação entre condições sanitárias e COVID-19 nas capitais brasileiras / Does sanitation matter? An analysis of the relationship between sanitary and COVID-19 conditions in Brazilian capitals

RESUMO Este artigo analisa a relação entre o saneamento básico e a disseminação da COVID-19 nas capitais brasileiras. Para tanto, estima-se o Índice de Acesso ao Saneamento Básico pela redução das dimensões cobertura do saneamento e qualidade da gestão, obtidas por dados disponíveis no Sistema Nacional de Informação sobre Saneamento. Em seguida, aferiu-se o nível de associação entre saneamento e taxas de incidência e mortalidade da doença em todas as capitais brasileiras entre março e setembro de 2020. Os resultados sugerem que Curitiba (0,824), Campo Grande (0,808) e Goiânia (0,794) lideram o ranking de acesso ao saneamento básico. Além disso, as evidências apontam para uma correlação negativa entre saneamento e taxas de incidência e mortalidade por COVID-19. Contudo, a significância estatística das estimativas varia em função do tempo. Esses achados estão alinhados com a literatura internacional, que identifica o acesso ao saneamento como uma medida chave de profilaxia de doenças infecciosas.

ABSTRACT This article analyzes the relationship between basic sanitation and the spread of COVID-19 in Brazilian state capitals. For that, the Basic Sanitation Access Index is estimated based on the reduction in the dimensions of sanitation coverage and management quality, obtained from data available in the National Sanitation Information System. Then, the level of association between sanitation and disease incidence and mortality rates in all Brazilian capitals between March and September 2020 is measured. The results suggest that Curitiba (0.824), Campo Grande (0.808), and Goiânia (0.794) lead the ranking of access to basic sanitation. Also, evidence points to a negative correlation between sanitation and COVID-19 incidence and mortality rates. However, the statistical significance of the estimates varies with time. These findings are in line with the international literature, which identifies access to sanitation as a key measure of infectious disease prophylaxis.

Social distancing and severe acute respiratory syndrome coronavirus 2 transmission: A case study from Araraquara, São Paulo, Brazil.

INTRODUCTION: This study evaluates the impact of social distancing on the spread of coronavirus disease (COVID-19). METHODS: Using data from the Brazilian Ministry of Health, we conducted an interrupted time series analysis to estimate the impact of lockdown on the number of daily cases of COVID-19 in Araraquara, São Paulo. RESULTS: Policy changes neutralized the positive trend of the disease. To provide more reliable evidence, we added two control cases from Araçatuba and São Carlos to the regression model, and the results remained consistent. CONCLUSIONS: Social distancing interventions are effective tools for flattening epidemic curves.

Using Benford's law to assess the quality of COVID-19 register data in Brazil.

We employ Newcomb-Benford law (NBL) to evaluate the reliability of COVID-19 figures in Brazil. Using official data from February 25 to September 15, we apply a first digit test for a national aggregate dataset of total cases and cumulative deaths. We find strong evidence that Brazilian reports do not conform to the NBL theoretical expectations. These results are robust to different goodness of fit (chi-square, mean absolute deviation and distortion factor) and data sources (John Hopkins University and Our World in Data). Despite the growing appreciation for evidence-based-policymaking, which requires valid and reliable data, we show that the Brazilian epidemiological surveillance system fails to provide trustful data under the NBL assumption on the COVID-19 epidemic.

Social distancing and severe acute respiratory syndrome coronavirus 2 transmission: A case study from Araraquara, São Paulo, Brazil

Abstract INTRODUCTION: This study evaluates the impact of social distancing on the spread of coronavirus disease (COVID-19). METHODS: Using data from the Brazilian Ministry of Health, we conducted an interrupted time series analysis to estimate the impact of lockdown on the number of daily cases of COVID-19 in Araraquara, São Paulo. RESULTS: Policy changes neutralized the positive trend of the disease. To provide more reliable evidence, we added two control cases from Araçatuba and São Carlos to the regression model, and the results remained consistent. CONCLUSIONS: Social distancing interventions are effective tools for flattening epidemic curves.

The effect of lockdown on the COVID-19 epidemic in Brazil: evidence from an interrupted time series design.

In response to the COVID-19 pandemic, governments worldwide have implemented social distancing policies with different levels of both enforcement and compliance. We conducted an interrupted time series analysis to estimate the impact of lockdowns on reducing the number of cases and deaths due to COVID-19 in Brazil. Official daily data was collected for four city capitals before and after their respective policies interventions based on a 14 days observation window. We estimated a segmented linear regression to evaluate the effectiveness of lockdown measures on COVID-19 incidence and mortality. The initial number of new cases and new deaths had a positive trend prior to policy change. After lockdown, a statistically significant decrease in new confirmed cases was found in all state capitals. We also found evidence that lockdown measures were likely to reverse the trend of new daily deaths due to COVID-19. In São Luís, we observed a reduction of 37.85% while in Fortaleza the decrease was 33.4% on the average difference in daily deaths if the lockdown had not been implemented. Similarly, the intervention diminished mortality in Recife by 21.76% and Belém by 16.77%. Social distancing policies can be useful tools in flattening the epidemic curve.

The effect of lockdown on the COVID-19 epidemic in Brazil: evidence from an interrupted time series design / O efeito do lockdown sobre a epidemia da COVID-19 no Brasil: evidências a partir de uma análise de séries temporais interrompidas / El efecto del confinamiento por la epidemia de COVID-19 en Brasil: evidencia de un diseño de serie temporal interrumpida

In response to the COVID-19 pandemic, governments worldwide have implemented social distancing policies with different levels of both enforcement and compliance. We conducted an interrupted time series analysis to estimate the impact of lockdowns on reducing the number of cases and deaths due to COVID-19 in Brazil. Official daily data was collected for four city capitals before and after their respective policies interventions based on a 14 days observation window. We estimated a segmented linear regression to evaluate the effectiveness of lockdown measures on COVID-19 incidence and mortality. The initial number of new cases and new deaths had a positive trend prior to policy change. After lockdown, a statistically significant decrease in new confirmed cases was found in all state capitals. We also found evidence that lockdown measures were likely to reverse the trend of new daily deaths due to COVID-19. In São Luís, we observed a reduction of 37.85% while in Fortaleza the decrease was 33.4% on the average difference in daily deaths if the lockdown had not been implemented. Similarly, the intervention diminished mortality in Recife by 21.76% and Belém by 16.77%. Social distancing policies can be useful tools in flattening the epidemic curve.

Em resposta à pandemia da COVID-19, muitos governos no mundo adotaram políticas de distanciamento social, com diferentes níveis de implementação e adesão. Realizamos uma análise de séries temporárias interrompidas para estimar o impacto dos lockdowns na redução do número de casos e óbitos por COVID-19 no Brasil. Os dados diários oficiais foram coletados para quatro capitais estaduais, antes e depois das respectivas intervenções políticas, com base em uma janela de 14 dias de observação. Estimamos uma regressão linear segmentada para avaliar a efetividade das medidas de lockdown sobre a incidência e mortalidade de COVID-19. O número inicial de novos casos e óbitos mostrou uma tendência positiva antes da mudança política. Depois do lockdown, foi observada uma queda estatisticamente significativa em novos casos confirmados, em todas as capitais. De maneira semelhante, as evidências mostraram que medidas de distanciamento revertiam a tendência de novos óbitos diários pela COVID-19. Em São Luís, observamos uma redução de 37,85%, enquanto em Fortaleza a queda foi de 33,4% na diferença média em óbitos diários, comparado com uma eventual não implementação de lockdown. Além disso, a intervenção diminuiu a mortalidade em Recife em 21,76%, e em Belém em 16,77%. As políticas de distanciamento social podem ser ferramentas úteis no achatamento da curva epidêmica.

En respuesta a la pandemia de COVID-19, muchos gobiernos en todo el mundo han implementado las políticas de distanciamiento social con diferentes niveles, tanto en lo que se refiere a la observancia, como al cumplimiento. Realizamos un análisis de serie temporal interrumpida para estimar el impacto de los confinamientos en reducir el número de casos y muertes, debidos a la COVID-19 en Brasil. Los datos oficiales diarios fueron recogidos de cuatro capitales antes y después de sus respectivas políticas de intervención, basadas en el mantenimiento de 14 días de observación de autoconfinamiento. Estimamos una regresión lineal segmentada para evaluar la efectividad de las medidas de confinamiento en la incidencia de COVID-19 y la mortalidad. El número inicial de nuevos casos y nuevas muertes tuvo una tendencia positiva previa al cambio de política. Tras el confinamiento, se presentó una disminución estadísticamente significativa de nuevos casos confirmados, que fueron encontrados en todas las capitales de estado. De igual modo, encontramos evidencias de que las medidas de confinamiento probablemente revirtieron la tendencia de nuevas muertes diarias debidas al COVID-19. En São Luís, observamos la reducción de un 37,85%, mientras en Fortaleza la disminución fue de un 33,4% en la diferencia media en muertes diarias, si no se hubiera implementado el confinamiento. Igualmente, la intervención redujo la mortalidad en Recife en un 21,76% y Belém tuvo un 16,77%. Las políticas de distanciamiento social pueden ser herramientas útiles en el aplanamiento de la curva epidémica.

Política de residência médica e carência de especialistas em ginecologia e obstetrícia no sus em pernambuco / Medical residency policy and lack of specialists in gynecology and obstetrics in the pernambuco unified health system / Política de residencia médica y carencia de especialistas en ginecología y obstetricia en el sistema único de salud en pernambuco

Resumo A distribuição eficiente de profissionais de saúde, em especial os médicos, é um dos principais problemas enfrentados pelos gestores de políticas públicas da saúde. Na tentativa de resolver essa problemática, o estado de Pernambuco está ampliando o número de graduandos de medicina, inclusive de maneira interiorizada, e incentivando os programas de residência médica, com aumento de vagas e programas. Tais ações são estratégias para a fixação e o provimento do profissional médico. O objetivo geral do estudo que deu origem a este artigo foi apresentar a política de residência médica como estratégia de formação de recursos humanos para o Sistema Único de Saúde e demonstrar a carência de médicos especialistas em ginecologia e obstetrícia para o Sistema Único de Saúde de Pernambuco, a partir da desassistência ao parto. Os resultados encontrados demonstraram maior procura dos médicos pela especialidade de ginecologia e obstetrícia ao longo dos anos, porém existe grande concentração dessa especialidade na região próxima à capital (Recife) e de partos em determinadas localidades do estado.

Abstract The efficient distribution of health professionals, especially physicians, is one of the main issues public health policy managers face. In an attempt to solve this problem, the state of Pernambuco, Brazil, is increasing the number of medical graduates, including in the interior, and encouraging medical residency programs with more openings and programs. Such actions are strategies for the establishment and provision of medical professionals. The general objective of the study that gave rise to this article was to introduce the medical residency policy as a strategy for training human resources for the Unified Health System and to demonstrate the lack of specialists in gynecology and obstetrics for the Unified Health System of Pernambuco, based on the lack of childbirth care. The results demonstrated an increased demand among physicians for the gynecology and obstetrics specialty over the years, but there is a great concentration of this specialty in the region near the capital city (Recife) and of deliveries in certain locations of the state.

Resumen La distribución eficiente de profesionales de la salud, especialmente los médicos, es uno de los principales problemas enfrentados por los gestores de políticas públicas de la salud. En un intento por resolver esta problemática, el estado de Pernambuco, Brasil, está aumentando el número de estudiantes de pregrado de medicina, incluso en forma interiorizada, e incentivando los programas de residencia médica, aumentando vacantes y programas. Tales acciones son estratégicas para la fijación y la designación del profesional médico. El objetivo general del estudio que dio origen a este artículo fue presentar la política de residencia médica como estrategia de formación de recursos humanos para el Sistema Único de Salud y demostrar la carencia de médicos especialistas en ginecología y obstetricia para el Sistema Único de Salud de Pernambuco, a partir de la falta de asistencia en el parto. Los resultados encontrados mostraron una mayor demanda por médicos con especialidad en ginecología y obstetricia a lo largo de los años; sin embargo, hay una gran concentración de esta especialidad en la región próxima a la capital (Recife) y de partos en determinadas localidades del estado.