Hanseníase em populações indígenas do Amazonas, Brasil: um estudo epidemiológico nos municípios de Autazes, Eirunepé e São Gabriel da Cachoeira (2000 a 2005)

Prevalence of trachoma in indigenous and non-indigenous areas, Northeastern Brazil, 2019-2021

Objective

To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil.

Methods

This was a population-based survey with probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation - follicular (TF) in children aged 1-9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained.

Results

The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%.

Conclusions

The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.

Snakebite envenomations and access to treatment in communities of two indigenous areas of the Western Brazilian Amazon: A cross-sectional study

BACKGROUND

The indigenous populations of Brazil present poor health indicators and a disproportionate prevalence and case-fatality rate of neglected tropical diseases, including snakebite envenomations (SBEs). This study aims to estimate access to medical care for SBEs and analyze the barriers that prevent victims from accessing healthcare in indigenous communities in two health districts located in the Western Brazilian Amazon.

METHODOLOGY/PRINCIPAL FINDINGS

This cross-sectional study used semi-structured interviews to collect data from individuals who experienced SBEs in the Upper Rio Solimões and Upper Rio Negro indigenous health districts. Of the 187 participants, 164 (87.7%) reported that they had access to healthcare and received assistance in a hospital in the urban area of the municipalities. Frequency was 95.4% in the Upper Rio Solimões SIHD, and 69.6% in the Upper Rio Negro SIHD (P<0.0001). The study found that the availability of indigenous medicine as the only choice in the village was the main reason for not accessing healthcare (75%), followed by a lack of financial resources and means of transportation (28.1%). Four deaths were reported from SBEs, resulting in a case-fatality rate of 2.1%.

CONCLUSIONS/SIGNIFICANCE

In the study areas, there are records of SBE patients who did not receive medical attention. Availability of pre-hospital emergency transport using motorboats, a greater number of hospitals and better navigability of the Solimões River and its tributaries would make access easier for indigenous people living in the region of the Upper Solimões River. The implementation of cross-cultural hospital care needs to be considered in order to reduce the resistance of indigenous populations in relation to seeking treatment for SBEs.

Socioeconomic determinants of leprosy new case detection in the 100 Million Brazilian Cohort: a population-based linkage study

BACKGROUND

Although leprosy is recognised as a disease of poverty, there is little evidence on the specific socioeconomic factors associated with disease risk. To inform targeted strategies for disease elimination, we investigated socioeconomic markers of leprosy risk in Brazil.

METHODS

Socioeconomic data from the 100 Million Brazilian Cohort were linked to the Brazilian national disease registry (Sistema de Informação de Agravos de Notificação) for leprosy from Jan 1, 2007, to Dec 31, 2014. Using Poisson regression, we assessed the association of socioeconomic factors with risk of incident leprosy in the full cohort and in children (aged 0-15 years), by leprosy subtype and region of residence.

FINDINGS

In an analysis of 23 899 942 individuals including 18 518 patients with leprosy, increased levels of deprivation were associated with an increased risk of leprosy in Brazil. Directions of effect were consistent in children younger than 15 years and across disease subtypes. Individuals residing in regions with the highest poverty in the country (central-west, north, and northeast regions) had a risk of leprosy incidence five-to-eight times greater than did other individuals. Decreased levels of income and education and factors reflecting unfavourable living conditions were associated with an up to two-times increase in leprosy incidence (incidence rate ratio 1·46, 95% CI 1·32-1·62, for lowest vs highest quartile of income per capita; 2·09, 95% CI 1·62-2·72, for lowest vs highest level of education).

INTERPRETATION

Within the poorest half of the Brazilian population, the most deprived individuals have the greatest risk of leprosy. Strategies focusing on early detection and treatment in the poorest populations could contribute substantially to global disease control.

FUNDING

Medical Research Council, Wellcome Trust, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Brazil), the Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa, Economic and Social Research Council, Biotechnology and Biological Sciences Research Council, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and Fundação de Apoio à Pesquisa do Distrito Federal.

The context of leprosy in Brazil-Paraguay border

In Brazil, leprosy is endemic in three regions: the North, Northeast, and Mid-West. Counties with contiguous binational urban areas are characterized by a constant flow of people, goods, and services, which facilitates the transmission of diseases and influences the epidemiological profile of leprosy. The purpose of this study was to examine territorial differences in relation to the incidence of leprosy, focusing on border counties with contiguous binational urban areas or otherwise. Each county was taken as an information unit for leprosy cases reported during 2001-2011, based on data from original notification records of the state's Department of Health. In counties with contiguous binational urban areas detection rates showed tendency to increase, Virchowian (lepromatous) disease and disability grade II predominated when compared with Groups II and III: 0.64 and 0.54/100,000 inhabitants for Virchowian disease and 0.14 and 0.27/100,000 inhabitants for disability grade II respectively, and were associated with higher transmission rates. The findings demonstrate the role of border areas in maintaining the endemicity of leprosy.

Skin diseases in indigenous population: retrospective epidemiological study at Xingu Indigenous Park (XIP) and review of the literature

BACKGROUND

Skin diseases among indigenous populations have been poorly described in the literature. Risk factors linked to habits, cultural practices, genetics, and environmental characteristics can influence the frequency and clinical presentation of these diseases.

METHODS

This was a cross-sectional study conducted through a review of dermatological medical records. Data were obtained over three visits to Xingu Indigenous Park (XIP). Main dermatoses were compared by gender, age, ethnicity, and village. Diseases were classified into four groups: infectious, inflammatory, neoplastic, and other.

RESULTS

Of the 398 patients included in the study, 54.2% were female. The participants ranged in age from 1 to 75 years (median, 10 years). The predominant ethnic group was Caiabi (49.7%), followed by Ikpeng (14.3%) and Kamaiurá (10.0%). The primary village studied was Diauarum, followed by Moigú and Morena. Infectious dermatoses were the most frequent (43.8%), followed by inflammatory (33.7%), neoplastic (15.5%), and other skin diseases (7.0%). Infectious diseases were predominant in Caiabi and Kamaiurá Indians, whereas inflammatory skin diseases were more frequent in Ikpeng and Juruna populations. We also observed a high frequency of malignancy in the Ikpeng and Trumai ethnic groups. Infectious skin diseases, except for fungal infections, were frequent in younger age groups. This trend was not replicated for neoplastic skin diseases. Uncommon dermatoses such as Heck's disease, lichen striatus, and aquagenic urticaria were also observed. Jorge Lobo's disease was not included in this analysis.

CONCLUSION

Improved knowledge of the distribution of common dermatoses among different ethnic groups and villages in XIP will aid in the prevention of skin infections and skin cancer. This improved knowledge will also allow the development of skin disease guidelines that can help local indigenous health professionals.

[Indigenous peoples' access to health services in Cuiabá, Mato Grosso State, Brazil]

This study aimed to evaluate indigenous peoples' access to medium and high-complexity health services in the municipality of Cuiabá, Mato Grosso State, Brazil, through the Casa de Saúde Indígena or Indigenous Peoples' Clinic (CASAI Cuiabá). A single case study with a qualitative approach was conducted at CASAI Cuiabá. Data were obtained from observation of the work routines at CASAI Cuiabá, semi-structured interviews with health professionals and administrators from the Cuiabá Special Indigenous Health District (DSEI) and CASAI Cuiabá, and document analysis. Data analysis used a matrix derived from the theoretical and logical model of accessibility, validated by the Delphi method with a group of experts on indigenous peoples' health. Despite advances achieved by CASAI in improving indigenous peoples' access, there are persistent social, organizational, cultural, and geographic barriers in access to medium and high-complexity health services in Cuiabá. The study highlights the need for specific strategies to improve access to health services by indigenous peoples in Mato Grosso State.

Sociodemographic features and operating indicators of tuberculosis control between indigenous and non-indigenous people of Rondônia, Western Amazon, Brazil

With the intention of improve knowledge on the epidemiological situation of tuberculosis (TB) among vulnerable populations in Brazil, our objective was to analyze sociodemographic characteristics and operational indicators related to TB control, comparing indigenous and non-indigenous people, in Rondônia. We conducted a retrospective and descriptive epidemiological study of new TB cases reported between 1997, January 1st and 2006, December 31st. We excluded duplicate records and those for whom the results of treatment was change in diagnosis and transfer. TB cases were classified into two categories: indigenous and non-indigenous people and analysis was performed according to sex, age, origin (urban /rural), State of residence, clinical form, diagnostic tests, monitoring indicators and results of treatment. Altogether 4832 cases were reported, with 322 cases (6.7%) in indigenous people. There was a male predominance (ratios: 1.7 to 1.3 in non-indigenous and indigenous people). The majority of cases for indigenous people (82.6%) was in rural area and there was high concentration of cases (36.0%) in children < 15 years. The analysis of diagnostic tests showed a predominance of smear positive in non-indigenous (56.1%) and smear negative and smear not performed in indigenous people (31.7% and 35.4% respectively, P value=0.0001). There was difference in the monitoring in relation to smear of second month (6.1% positivity, P value = 0.0001) and exam at least one contact (69.6%, P value = 0.017) for non-indigenous. On the other hand, DOTS was more associated with indigenous people cases (23.6%, P value = 0.0001). Stands out the predominance of cure in both groups, with bigger concentration in indigenous people (90.4%, P value = 0.0001) and higher rate of noncompliance in non-indigenous (14.7%, P value = 0.0001). The approach showed useful for elucidate inequalities and has exceeded the usual analysis carried out surveillance on services that aim to delineate the epidemiological situation based only on rates or absolute values.

[The contribution of indigenous community health workers to special healthcare for Brazilian indigenous peoples]

Indigenous community health workers are part of a strategy developed by Brazil in the last two decades to promote a special healthcare model for indigenous peoples. Their role is designed to deal with various aspects of the special health policy, including the link between the heath team and the community and mediation between scientific and indigenous medical knowledge. Despite a significant increase in the number of indigenous community health workers in recent years, an evaluation of their responsibilities and contributions to the success of special care had not been conducted previously. This article, based on a literature review and original research by the authors, analyzes the role of the indigenous community health workers vis-à-vis their training and participation in health teams in different contexts in Brazil. Considering the importance assigned to the role of indigenous community health workers, this analysis reveals various ambiguities and contradictions that hinder both their performance and their potential contribution to the special health services.

Tuberculosis in indigenous children in the Brazilian Amazon

OBJECTIVE: Assess the epidemiological aspects of tuberculosis in Brazilian indigenous children and actions to control it. METHODS: An epidemiological study was performed with 356 children from 0 to 14 years of age in Rondônia State, Amazon, Brazil, during the period 1997-2006. Cases of TB reported to the Notifiable Diseases Surveillance System were divided into indigenous and non-indigenous categories and analyzed according to sex, age group, place of residence, clinical form, diagnostic tests and treatment outcome. A descriptive analysis of cases and hypothesis test (χ²) was carried out to verify if there were differences in the proportions of illness between the groups investigated. RESULTS: A total of 356 TB cases were identified (125 indigenous, 231 non-indigenous) of which 51.4% of the cases were in males. In the indigenous group, 60.8% of the cases presented in children aged 0-4 years old. The incidence mean was much higher among indigenous; in 2001, 1,047.9 cases/100,000 inhabitants were reported in children aged < 5 years. Pulmonary TB was reported in more than 80% of the cases, and in both groups over 70% of the cases were cured. Cultures and histopathological exams were performed on only 10% of the patients. There were 3 cases of TB/HIV co-infection in the non-indigenous group and none in the indigenous group. The case detection rate was classified as insufficient or fair in more than 80% of the indigenous population notifications, revealing that most of the diagnoses were performed based on chest x-ray. CONCLUSIONS: The approach used in this study proved useful in demonstrating inequalities in health between indigenous and non-indigenous populations and was superior to the conventional analyses performed by the surveillance services, drawing attention to the need to improve childhood TB diagnosis among the indigenous population.

[Spatial and temporal distribution of tuberculosis in indigenous and non-indigenous of Rondônia State, Western Amazon, Brazil]

This study analyzed the spatial and temporal distribution of crude and adjusted rates of incidence of tuberculosis (TB) between 1997 and 2006, identifying areas of greatest risk to the indigenous and non-indigenous population of Rondônia State, Brazil. An ecological study was conducted analyzing municipalities and Indian reserves, using the local empirical Bayesian method. The crude average rate of incidence of TB among the non-indigenous population was 35.6/100,000 inhabitants, while for the indigenous population it was 415.0/100,000. Rates greater than 600/100,000 were reported in the Karipuna, Sete de Setembro, Igarapé, Ribeirão and Karitiana reserves. We observed a greater number of cases in under 15 year-olds with little schooling in contrast to the situation in the non-indigenous population. After making adjustments, the rates in some Indian reserves exceeded 240/100,000 inhabitants, while in coinciding municipalities incidence was between the range of 61-120/100,000. The Bayesian method led to decreased overall heterogeneity in rates. Evidence suggests that the indigenous population is more vulnerable to contracting TB and highlighted areas that require further attention to ensure the adequate control of TB in Rondônia.

[Epidemiological profile of leprosy patients in the extreme south of Santa Catarina between 2001 and 2007]

INTRODUCTION

Leprosy is one of the oldest diseases of humanity and persists as a serious public health problem. Brazil has the highest incidence and second highest prevalence. In the Americas, it accounts for 93% of the cases, according to World Health Organization data from 2008. The objective of this study was to ascertain the profile of leprosy patients in the municipalities of the Association of Municipalities of the Carboniferous Region (AMREC), over the period from January 1, 2001, to December 31, 2007.

METHODS

This was a retrospective cross-sectional study carried out in the AMREC region in Santa Catarina, Brazil. The sample was of census type, in which all the patients notified were analyzed.

RESULTS

54 patients were analyzed, among whom 57% were female and 42.6% were male. The most prevalent age group was from 30 to 39 years old (31.5%) and 79.6% had white skin color. The occupation was unknown in 51 cases, as was bacilloscopy in 98%. The tuberculoid and Virchowian forms each presented a frequency of 27.8%. The coefficient of detection observed in the municipalities ranged from low to very high.

CONCLUSIONS

Neither multibacillary nor paucibacillary forms predominated in the analysis, nor any specific clinical form. Nevertheless, it is known that cases are being diagnosed late because of the low percentage of indeterminate cases, with predominance among females. Added to this, the information on the notification forms is sparse, which makes it impossible to show the realities of the study population.