[Cases of dengue and urban waste collection: a study in the City of Recife]

Spatial distribution of arboviruses and its association with a social development index and the waste disposal in São Luís, state of Maranhão, Brazil, 2015 to 2019

OBJECTIVE

To detect spatial and spatiotemporal clusters of urban arboviruses and to investigate whether the social development index (SDI) and irregular waste disposal are related to the coefficient of urban arboviruses detection in São Luís, state of Maranhão, Brazil.

METHODS

The confirmed cases of Dengue, Zika and Chikungunya in São Luís, from 2015 to 2019, were georeferenced to the census tract of residence. The Bayesian Conditional Autoregressive regression model was used to identify the association between SDI and irregular waste disposal sites and the coefficient of urban arboviruses detection.

RESULTS

The spatial pattern of arboviruses pointed to the predominance of a low-incidence cluster, except 2016. For the years 2015, 2016, 2017, and 2019, an increase of one unit of waste disposal site increased the coefficient of arboviruses detection in 1.25, 1.09, 1.23, and 1.13 cases of arboviruses per 100 thousand inhabitants, respectively. The SDI was not associated with the coefficient of arboviruses detection.

CONCLUSION

In São Luís, spatiotemporal risk clusters for the occurrence of arboviruses and a positive association between the coefficient of arbovirus detection and sites of irregular waste disposal were identified.

Relationship between microcephaly and indicators of social inequality in the state of Paraíba, Brazil

OBJECTIVE

• Seventy-four (33.18%) municipalities in the state of Paraíba registered live births with microcephaly. • The highest proportion of cases (23.03%) was concentrated in the capital, João Pessoa. • Number of inhabitants, number of cases of Zika virus, water supply, and average household income were associated with a higher proportion of new cases. To analyze the relationship between microcephaly and social inequality indicators in the state of Paraíba during the biennium January 2015 and December 2016.

METHODS

Ecological study with data from newborn microcephaly records and municipal socioeconomic, environmental, and demographic indicators was conducted using two health information systems from the Brazilian Ministry of Health (SINASC and SINAN) and the Brazilian Institute of Geography and Statistics. A Poisson multiple regression model was applied with a significance level of 5%.

RESULTS

Among 223 municipalities in Paraíba, 74 registered new cases of microcephaly. The number of Zika virus cases, number of inhabitants, number of households without adequate water supply, and household income were predictor variables of the number of new cases of microcephaly in Paraíba.

CONCLUSION

Microcephaly is associated with indicators of social inequality in Paraíba. Zika virus cases, water supply, and family income are the indicators that best explain the increase in microcephaly cases. Therefore, these variables must be monitored by health professionals and authorities.

Association Between Hydrological Conditions and Dengue Fever Incidence in Coastal Southeastern China From 2013 to 2019

IMPORTANCE

Dengue fever is a climate-sensitive infectious disease. However, its association with local hydrological conditions and the role of city development remain unclear.

OBJECTIVE

To quantify the association between hydrological conditions and dengue fever incidence in China and to explore the modification role of city development in this association.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study collected data between January 1, 2013, and December 31, 2019, from 54 cities in 4 coastal provinces in southeast China. The Standardized Precipitation Evapotranspiration Index (SPEI) was calculated from ambient temperature and precipitation, with SPEI thresholds of 2 for extreme wet conditions and -2 for extreme dry conditions. The SPEI-dengue fever incidence association was examined over a 6-month lag, and the modification roles of 5 city development dimensions were assessed. Data were analyzed in May 2022.

EXPOSURES

City-level monthly temperature, precipitation, SPEI, and annual city development indicators from 2013 to 2019.

MAIN OUTCOMES AND MEASURES

The primary outcome was city-level monthly dengue fever incidence. Spatiotemporal bayesian hierarchal models were used to examine the SPEI-dengue fever incidence association over a 6-month lag period. An interaction term between SPEI and each city development indicator was added into the model to assess the modification role of city development.

RESULTS

Included in the analysis were 70 006 dengue fever cases reported in 54 cities in 4 provinces in China from 2013 to 2019. Overall, a U-shaped cumulative curve was observed, with wet and dry conditions both associated with increased dengue fever risk. The relative risk [RR] peaked at a 1-month lag for extreme wet conditions (1.27; 95% credible interval [CrI], 1.05-1.53) and at a 6-month lag for extreme dry conditions (1.63; 95% CrI, 1.29-2.05). The RRs of extreme wet and dry conditions were greater in areas with limited economic development, health care resources, and income per capita. Extreme dry conditions were higher and prolonged in areas with more green space per capita (RR, 1.84; 95% CrI, 1.37-2.46). Highly urbanized areas had a higher risk of dengue fever after extreme wet conditions (RR, 1.80; 95% CrI, 1.26-2.56), while less urbanized areas had the highest risk of dengue fever in extreme dry conditions (RR, 1.70; 95% CrI, 1.11-2.60).

CONCLUSIONS AND RELEVANCE

Results of this study showed that extreme hydrological conditions were associated with increased dengue fever incidence within a 6-month lag period, with different dimensions of city development playing various modification roles in this association. These findings may help in developing climate change adaptation strategies and public health interventions against dengue fever.

Spatial dynamics of dengue fever spreading for the coexistence of two serotypes with an application to the city of São Paulo, Brazil

BACKGROUND AND OBJECTIVE

Dengue fever is a disease in which individuals' spatial distribution and Aedes aegypti mosquitoes breeding places are important factors for the disease dynamics. Typically urban, dengue is a problem for least developed countries due to the ineffectiveness in controlling the vector and disorderly urbanization processes. The result is a composition of urban sanitation problems and areas with high demographic densities and intense flows of people. This paper explores the spatial distribution of vector breeding places to evaluate introducing a new dengue serotype to a population at equilibrium for a pre-existing serotype. The paper's objective is to analyze the spatial dynamics of dengue using variations of the basic reproduction number.

METHODS

A model based on probabilistic cellular automata is proposed to permitting the necessary flexibility to consider some spatial distributions of vector breeding places. Then, ordinary differential equations are used as a mean-field approach of the model, and the basic reproduction number (R₀) is derived considering the next-generation matrix method. A spatial approach for R₀ is also proposed, and the model is tested in a neighbourhood from the city of São Paulo, Brazil, to examine the potential risks of vector breeding cells distribution.

RESULTS

The results indicated that the more spread out these places, the higher are the values of R₀. When the model is applied to a neighbourhood in São Paulo, residential areas may boost the infections and must be under public vigilance to combat vector breeding sites.

CONCLUSIONS

Considering the mean-field approximation of the cellular automata model by ordinary differential equations, the basic reproduction number derived returned an estimative of the disease dynamics in the population. However, the spatial basic reproduction number was more assertive in showing areas with a higher disease incidence. Moreover, the model could be easily adapted to be used in real maps enabling simulations closer to real problems.

Percepção da população sobre a atuação das autoridades e das comunidades no controle das arboviroses

RESUMO O controle ambiental para a prevenção das arboviroses depende tanto de ações dos poderes públicos quanto do envolvimento das comunidades. A presente pesquisa analisou a percepção de 385 pessoas em 17 municípios das 5 regiões do País sobre a atuação das autoridades e da própria comunidade em relação ao controle e à prevenção da dengue. Independentemente da região, os participantes reconheceram que ações como saneamento básico, coleta regular de lixo, fiscalização de terrenos baldios e domicílios fechados têm sido frequentemente negligenciadas pelas autoridades. A responsabilização da comunidade, na figura do vizinho que não cumpre as medidas de controle, também foi percepção dominante, chamando a atenção a ausência de qualquer reconhecimento sobre como condições sociais desfavoráveis influenciam nas dificuldades para a realização dos procedimentos preventivos. Reflete-se ainda acerca dos prejuízos que a pandemia de Covid-19 tem causado às práticas preventivas e seus possíveis impactos futuros.

Perception of the population on the role of authorities and communities in controlling arboviruses

ABSTRACT The environmental control for prevention of arboviruses depends both on the actions of public authorities and the involvement of communities. The present study analyzed the perception of 385 citizens of 17 municipalities from the 5 regions of Brazil regarding the actions of the authorities and the community itself in relation to the control and prevention of dengue. The participants acknowledged that actions such as basic sanitation, regular waste collection, inspection of vacant lots and closed homes have often been neglected by the authorities. There was a tendency to hold the community accountable, through the example of neighbors who do not carry out prevention procedures. It was also noteworthy the silencing around unfavorable social conditions that can hinder the implementation of prevention procedures. We also reflected on the damage that the COVID-19 pandemic has caused to preventive practices and its possible future impacts.

Health and Work Conditions of Garbage Collectors: A Cross-Sectional Study

Background:

Waste is considered everything that has lost utility after being use; therefore, it no longer has value to a person or a community. After objects have lost their value, they need to be removed from homes, workplaces, stores, markets, etc. Hence, waste collectors remove the garbage left on the streets and allocate it to appropriate places. From a historical perspective, waste disposal is closely related to consumption and values of cleanliness, purity, and organization of the current society.

Objective:

To analyze health and work conditions of waste collectors and the association of these parameters with the length of service.

Methods:

Cross-sectional study. The sample consisted of 112 participants. Questionnaires addressing sociodemographic, work, and health conditions were used. The analysis of the association between health conditions and length of service was performed using Fisher's exact test with a significance level of p < 0.05.

Results:

There was a statistically significant difference between the length of service (more than two years) and a higher occurrence of injuries such as sharp injuries (p <0.001), headache (p = 0.036), back pain (p = 0.008) and work leave (p = 0.021).

Conclusion:

The working health conditions of waste collectors described in this study are associated with back pain, headache, and work and sick leave.

The role of primary care pharmacists in the response to the Zika epidemic

Background:

Zika virus (ZIKV) infection emerged in Brazil in 2015, leading to the declaration of a national public health emergency, mainly due to its consequences for pregnant women and newborn babies. The Zika epidemic demanded major efforts from the public health system to address the full range of disease consequences.

Objective:

The objective of this study was to investigate the role of Primary Health Care pharmacists working in the city of Campo Grande in the State of Mato Grosso do Sul.

Methods:

A qualitative cross-sectional interview-based study with pharmacists working in municipal Primary Health Care services was carried out to investigate knowledge about the disease and involvement in the response to the health emergency. Informed consent was obtained. After coding, the corpus underwent thematic analysis.

Results:

The data show that few professionals had received specific training in public health. Knowledge largely encompassed disease transmission by the mosquito and collective and individual preventive measures. Findings highlight knowledge gaps relating to signs and symptoms, diagnosis, consequences of infection, and the role of epidemiological surveillance. Most professionals mentioned at least one of the recommendations on the use of medicines in symptom management protocols. The practical implications surrounding knowledge gaps and misconceptions were reflected in pharmacists´ role in response, restricted to counselling on preventive measures. Few respondents participated in institutional groups and committees or in multiprofessional teams involving case management.

Conclusions:

The study identified important knowledge gaps and showed that the involvement of pharmacy professionals in the response to the Zika epidemic was timid or inadequate. The results also suggest that pharmacists failed to recognize their role in interventions related to the ZIKV epidemic. Findings highlight the need to increase the involvement of primary care pharmacists in community-based actions, for communication and reduction of health risks, and emergency preparedness and response.

[Adequate solid waste management as a protection factor against dengue casesGestión adecuada de los residuos sólidos como factor de protección contra los casos de dengue]

Objetivo.

Verificar a existência de associação de indicadores de gestão de resíduos sólidos e socioeconômicos municipais com índices de incidência de dengue, Zika e Chikungunya nos municípios do estado brasileiro de Minas Gerais.

Métodos.

Este estudo de caráter exploratório, quantitativo e transversal abrangeu os 853 municípios do estado de Minas Gerais. Todos os dados utilizados foram secundários, coletados e agrupados por regionais de planejamento. Como variáveis independentes, foram consideradas a cobertura de coleta de resíduos sólidos urbanos, cobertura de coleta seletiva e massa de resíduos sólidos urbanos, além de um indicador da qualidade da destinação final de resídulos, índices de desenvolvimento humano municipal e de Gini, renda mensal per capita e porcentagem de vulneráveis à pobreza. Os fatores potencialmente associados aos desfechos – incidências municipais de dengue, Chikungunya e Zika – foram selecionados inicialmente através de análises univariadas. Posteriormente, os modelos de regressão linear para as incidências de dengue, Chikungunya ou Zika foram gerados considerando os preditores selecionados pela análise univariada.

Resultados.

Não foi observada associação entre gestão de resíduos sólidos e incidência de Chikungunya e Zika. Por sua vez, a incidência de dengue associou-se à gestão de resíduos sólidos e apresentou relação inversa significativa com o percentual de vulneráveis à pobreza. Houve também associação direta o índice de Gini, sugerindo que quanto maiores os registros de incidência de dengue de 2007 a 2016, maiores os valores de Gini dos municípios – ou seja, maior a desigualdade social. A cobertura da coleta seletiva apresentou relação inversa e significativa com os casos de dengue, sugerindo que quanto menor a cobertura da coleta de seletiva, maiores foram os casos registrados de dengue.

Conclusões.

A gestão de resíduos sólidos pode influenciar os casos de dengue e, por isso, deve ser considerada nas ações de saúde pública.

Dengue Surveillance System in Brazil: A Qualitative Study in the Federal District

Dengue's increasing trends raise concerns over global health and pose a challenge to the Brazilian health system, highlighting the necessity of a strong surveillance system to reduce morbidity, mortality, and the economic burden of this disease. Although the Brazilian surveillance system reports more dengue cases than any other country, recent studies suggest that non-reported cases are the majority. The aim of the study is to explore the strengths and weaknesses of the Brazilian surveillance system, particularly looking at the functioning of data collection and reporting. This was done through qualitative semi-structured interviews with 17 experts in dengue surveillance, supported by quantitative data from the official notification system. To select the interviewees, purposive and theoretical sampling were used. Data were analyzed through thematic analysis. The research highlighted that a lack of human and technological resources in healthcare units and surveillance departments slows down the notification process and data analysis. Due to a lack of integration in the private sector, the surveillance system fails to detect the socioeconomic profile of the patients. Investments in public healthcare, human and technological resources for surveillance and better integration in the private healthcare system, and vector surveillance may improve dengue surveillance.