Spatial distribution of endemic diseases in Ribeirão Preto, São Paulo State

The perception that some diseases happen in certain places is old. The concern in studying the relation between the human being and the environment resulted in several studies of medical geography, directed to the analysis of diseases spatial distribution. This sectional study was carried out in Ribeir?o Preto, S?o Paulo State, and aimed to illustrate, through health problems (dengue, leprosy and tuberculosis), how a Geographic Information System tool allows the identification of heterogeneous areas, providing support for the choice of strategies and specific interventions according to the need of residents, as well as, priority of resources to more vulnerable groups. The population comprised cases of dengue, leprosy and tuberculosis notified in Ribeir?o Preto in 2000. Data were collected in the Health Secretary Epidemiological Surveillance of the city. In order to obtain the thematic maps, data were geo-codified with the software MapInfo 7.8 e Spring 4.3. The thematic maps showed the density distribution of dengue, leprosy and tuberculosis cases in the city as a way to complement the analysis of health information, pointing priority areas for the control of these diseases.     

Inequality of workers' survival in Botucatu, São Paulo State, Brazil

The aim of this observational study was to estimate the survival function and risk of death in Botucatu, Southeast Brazil, by occupation. The occupational history of inhabitants of Botucatu who died after their 10th birthday from January 1, 1997, to March 31, 1998, was analyzed, as were the occupational histories of workers' spouses. A total of 992 subjects were studied. Data were analyzed by fitting a proportional hazards model where the time variable was age at death or at time of interview and the main co-variable was occupation. Results showed that risk of death increased consistently as the level of occupational specialization decreased, displaying a 12-year increase in life expectancy for professional as compared to unskilled workers.     

Spotted fever in Campinas region,State of São Paulo,Brazil

Brazilian spotted fever was detected for the first time in the State of S o Paulo in 1929. However, there is no systematic reporting of the disease in the State. In 1985, three cases of the disease occurred in the municipality of Pedreira, located in the Campinas Region, belonging to the 5th Administrative Region, in the Northeast part of the State, including 88 municipalities. An investigation was conducted at the time, but the lack of case registry limited its scope. The present study was undertaken with the aim of recovering the history of the disease in the Region. Data recovered from several public health services for 1985-2000 were used to analyze incidence patterns. It was observed that the transmission area expanded and the number of suspected cases increased, especially after 1996, when mandatory reporting was established. Deaths due to spotted fever were observed in most of the years under study. The study concluded that spotted fever incidence is increasing in the Campinas Region. Complementary bio-ecological studies are currently under way to better understand the epidemiology of this disease, recognized worldwide as an emerging public health problem.     

Basic sanitary conditions in Iporanga, São Paulo State, Brazil

OBJECTIVE: To assess the pollution of water bodies by domestic sewage and to evaluate the basic sanitation conditions of residences and the knowledge of the local population concerning intestinal parasitic diseases and the hazards they present to public health. METHODS: Thirteen water samples were collected from each of four sites in different water bodies of the Bairro da Serra region, in Iporanga, S?o Paulo State. Rates of total and fecal coliforms were measured and median values were presented so as to show domestic sewage contamination in the area. Questionnaires were administered to 50% of local households in order to obtain information on water supply and disposal of domestic sewage and solid waste, and to evaluate knowledge of the transmission, health hazards, and prevention of intestinal parasitic diseases among the local population. RESULTS: The Betari river showed microbiological indexes indicative of pollution by domestic sewage. Higher levels were verified both upstream and downstream from the Bairro da Serra. Median values were even higher in two of the river's tributary streams, indicating strong pollution by domestic sewage and lack of conformity with current legislation. In 91% of the households investigated, sewage disposal was done by means of septic tanks, most of which were rudimentary and contributed to the contamination of the environment. The knowledge of 62% of interviewed subjects concerning the transmission of helminthic diseases was considered as poor. CONCLUSIONS: Our results indicate a risk of proliferation of intestinal parasitoses and of other water-transmitted diseases, an issue which is aggravated by increases in population caused by the region's vocation for ecotourism.     

Aedes albopictus in bromeliads of anthropic environment in São Paulo State, Brazil

OBJECTIVE: Aedes albopictus populations can breed in several kinds of containers, and its presence has also been reported in Bromeliaceae. The purpose of this study was to evaluate the epidemiological importance of the Bromeliaceae plants as potential breeding sites of Aedes albopictus and to document the associated Culicidae entomofauna found in this micro-habitat. METHODS: Collections of Culicidae larvae were carried out fortnightly in aquatic content of bromeliads during 1998 and 1999. Collections took place in urban and periurban areas of Ilhabela island and periurban area of Ilha Comprida island, Brazil. RESULTS: A total of 26,647 Culicidae larvae were collected at both study sites, 14,575 in the urban area and 10,987 in the periurban area of Ilhabela and the remaining 1,085 in the periurban area of Ilha Comprida. There was no statistical difference between the amount of larvae collected in urban and periurban areas of Ilhabela. Regarding the Ae. albopictus, there was found a higher frequency and amount of larvae in the urban area of Ilhabela, followed by the periurban area in the same site, whereas in the periurban area of Ilha Comprida, its presence was considered accidental, since it was reported only in the first three months. CONCLUSIONS: The results show that bromeliads, largely used in landscaping, may contribute to the spread of Ae. albopictus. The presence of this species in domesticated and domiciled bromeliads allows us to suggest that the Culicidae larva is part of the regional fauna and facilitate the contact between humans and etiological agents of the natural ecosystem.     

Analysis of seniors vaccination programme in Campinas, São Paulo State, Brazil

This study examines the planning, operations and assessment of a Seniors Vaccination Program in Campinas, S?o Paulo State, from the standpoint of practices adopted by central, district and local authorities and intended to ensure influenza vaccination coverage. The case study method was used, with work-health process benchmarks. The primary data source was semi-structured interviews, with institutional documents and records serving as secondary sources. The field of study was the municipal coordination of this Program in two Health Districts and one Basic Healthcare Unit. The choice of these Districts was based on differing vaccination coverage, while the Unit choice was guided by its outstanding campaign organization. At the district and local levels, the program was coordinated by nurses who assigned high priority to following routines and rules instead of pursuing the purpose of the campaign. Insufficient analysis capacities were identified, with poorly networked actions, incipient communications methods and ineffective use of information for planning purposes. The results underscore the importance of adopting management practices tailored to the purposes of healthcare efforts, ushering in responsible autonomy among workers and fostering ongoing reflection on these practices.     

Municipalization of vaccination in Ribeirão Preto, São Paulo, Brazil

The object of this study is the organization of activities in the vaccination program in Ribeir?o Preto, S?o Paulo, during the process of municipalization of health services, analyzing changes and estimating results. The methodology included a survey performed during supervisory visits and questionnaires with 20 nurses and 39 vaccination workers in all the vaccination rooms at the municipal primary health care unit in this city, a survey of storage conditions for immunobiological products at the municipal level and a questionnaire for the section head, and interviews with five health professionals responsible for vaccination at the State, regional, and municipal levels. It followed that since implementation of the so-called Integrated Health Actions proposal there has been an expansion of primary health care services, including vaccination services; there has also been a technical and administrative centralization of decisions involving vaccination activities, including training of human resources by the Municipal Epidemiological Surveillance division. The study points out that although this activity is dealt with carefully by those responsible for the State, municipal, and district levels, the same is not true at the local level.     

Geostatistical analysis of leprosy cases in the State of São Paulo, 1991-2002

OBJECTIVE: To analyze the spatial pattern of leprosy case occurrences in order to identify areas with a probability of disease transmission risks. METHODS: This was an ecological study in which the analysis units were municipalities in the State of S?o Paulo that were georeferenced at their centroids. The data source was the electronic database of notified leprosy cases at the Epidemiological Surveillance Center of the State of S?o Paulo, from 1991 to 2001. Geostatistical techniques were used for detecting areas with a probability of leprosy risk, and for quantifying the spatial dependency of cases. RESULTS: The spatial dependence detected extended outwards to 0.55 degrees from the georeferenced coordinates, which corresponded to approximately 60 km. The main areas identified as presenting a probability of risk were the northeastern, northern and northwestern regions of the State. CONCLUSIONS: Verification of areas with the probability of leprosy risk using spatial dependence analysis may be a useful tool for assessing health conditions and planning budget allocations.     

Apgar score associated with mode of delivery in São Paulo State, Brazil

This paper analyzes Apgar score associated with mode of delivery for live births in S?o Paulo State, Brazil, 2003. Based on data from the State Data Analysis System Foundation (SEADE), logistic regression was analyzed for live births with low Apgar score (0 to 6) at the fifth minute of life per mode of delivery, adjusted for obstetric, demographic, and social factors. Birth weight, gestational age at delivery, number of prenatal visits, maternal age, marital status, and years of schooling were statistically significant, and (as expected) all exposure categories were associated with low Apgar score. In the unadjusted model, the odds ratio (OR) for low Apgar was 0.890 (95%CI: 0.836-0.948) for cesarean section compared to vaginal delivery. Nevertheless, in the adjusted model the OR was 1.045 (95%CI: 0.977-1.117) for cesarean section compared to vaginal delivery. Adjusted for obstetric, demographic, and social factors, mode of delivery was not statistically significant for low Apgar.     

Climatic aspects in hantavirus transmission areas in São Paulo State, Brazil

The objective of this study was to investigate the spatial distribution of reported hantavirus cases in S?o Paulo State, Brazil (n = 80), from 1993 to 2005 and identify local climatic patterns during this period. Kernel point estimation of density was used to show the highest concentrations in Ribeir?o Preto, S?o Carlos, Franca, Tupi Paulista, and Greater S?o Paulo. Increase in the number of cases during this period suggests disease dissemination even when considering increased diagnostic capacity and higher sensitivity of the health services. There was a marked seasonal variation in hantavirus in the cerrado (savannah) areas; the common pattern is a higher incidence in drier months as compared to mean levels in the last 40 years. These coincide with periods of high rodent food source levels in grains, sugarcane, and other crops. Harvesting and storing grains increases human exposure to rodents. Climatic indicators together with ecological variables can be local transmission risk markers and should receive more attention in epidemiological monitoring and control of the disease.     

Impact of rotavirus vaccination on diarrhea-related hospitalizations in São Paulo State,Brazil

IntroductionFollowing introduction of routine infant rotavirus vaccination, severe diarrhea hospitalization rates declined among children aged <5 years throughout Brazil. Ensuring equity of rotavirus vaccine impact is important in countries that self-finance immunization programs. The objective of this study was to examine rotavirus vaccine impact on diarrhea admission rates among children aged <5 years in Brazil's public health system, according to area-based measures of human development in the state of São Paulo, Brazil.MethodsEcological analysis of public health system hospitalization rates for acute gastroenteritis among children aged <5 years in the state of São Paulo, Brazil, according to five categories of municipal development based on a modified Human Development Index for municipalities. Acute gastroenteritis hospitalization rates among children aged <5 years after national rotavirus vaccine introduction (2008–2011) were compared to rates in pre-vaccine years (2000–2005) to calculate percent decline in rates (1 − rate ratio) and 95% confidence intervals (CI) for each municipal development category. Direct hospitalization costs during the two periods were compared.ResultsAnnual rates declined by 40% (95% CI, 39–42%) from 631 diarrhea hospitalizations per 100,000 person years pre-rotavirus vaccination to 377 per 100,000 post-vaccination among children aged <5 years and 50% (95% CI, 48–52%) from 1009 to 505 per 100,000 among infants. Highest rates were observed in least developed municipalities. Significant declines of 26–52% among children <5 years and 41–63% among infants were observed in all categories of municipal development. Lower diarrhea hospitalization rates resulted in annual savings of approximately 2 million USD for the state of São Paulo. Savings in direct hospitalization costs benefitted municipalities in all five categories.ConclusionThe introduction of rotavirus vaccination was associated with substantial reductions of diarrhea-related admissions at all levels of municipal development in São Paulo State, Brazil.     

Prevalence of malnutrition among children in Embu,São Paulo State,Brazil, 1996-1997

This paper focused on the nutritional profile of children in the municipality of Embu, S?o Paulo State, Brazil, in 1996-1997, to identify vulnerable population segments that require specific action by health services. The sample consisted of 320 children < or = 5 years of age distributed into four socioeconomic strata. The indices were expressed as z-scores: weight/age (W/A), height/age (H/A), and weight/height (W/H) to analyze the nutritional status, and the reference for normality was the NCHS curve. In all population strata and age groups, the height/age index was the most frequently affected, while the weight/height index had the fewest deficits. No statistically significant differences were observed in children's nutritional status between the four population strata or between the different age groups. Children with low birth weight showed the highest prevalence of deficits in all indices. In the municipality, the frequency of deficits were: H/A< 2z: 7.1%, W/H< 2z: 0.2%, and W/A< 2z: 2.9%. Height deficit can be used as an early warning, considering that loss observed over the course of years has future consequences.     

Rabies virus in naturally infected bats in the State of São Paulo, Southeastern Brazil

OBJECTIVE: To identify the species of bats involved in maintaining the rabies cycle; to investigate the distribution of the rabies virus in the tissues and organs of bats and the time taken for mortality among inoculated mice. METHODS: From April 2002 to November 2003, bats from municipalities in the State of S?o Paulo were screened for the presence of the rabies virus, by means of direct immunofluorescence. The virus distribution in the bats was evaluated by inoculating mice and N2A cells with 20% suspensions prepared from fragments of different organs and tissues, plus the brain and salivary glands. The time taken for mortality among the mice was monitored daily, following intracerebral inoculation. RESULTS: Out of the 4,395 bats received, 1.9% were found positive for the rabies virus. They belonged to ten genera, with predominance of insectivores. The maximum mean times taken for mortality among the mice following inoculation with brain and salivary gland material were 15.33+/-2.08 days and 11.33+/-2.30 days for vampire bats, 16.45+/-4.48 days and 18.91+/-6.12 days for insectivorous bats, and 12.60+/-2.13 days and 15.67+/-4.82 days for frugivorous bats, respectively. CONCLUSIONS: The species infected with the rabies virus were: Artibeus lituratus, Artibeus sp., Myotis nigricans, Myotis sp., Eptesicus sp., Lasiurus ega, Lasiurus cinereus, Nyctinomops laticaudatus, Tadarida brasiliensis, Histiotus velatus, Molossus rufus, Eumops sp. and Desmodus rotundus. Virus investigation in the different tissues and organs showed that the brain and salivary glands were the most suitable sites for virus isolation.