Maternal mortality in Northeast Brazil 2009-2019: spatial distribution, trend and associated factors

OBJECTIVE

To analyze the spatio-temporal pattern of maternal mortality and associated factors in Northeast Brazil, from 2009 to 2019.

METHODS

This was an ecological study using the joinpoint method for temporal analysis and spatial autocorrelation and scan tests to identify clusters; regression models using the ordinary least squares and geographically weighted regression methods were used to identify factors associated with mortality, considering p-value < 0.05.

RESULTS

Maternal mortality decreased by 1.5% (95%CI; -2.5;-0.5) per year (p-value = 0.009); clusters, of deaths were found, mainly in Piauí and Maranhão, the variables associated with the maternal mortality ratio were Gini Index (β = 105.72; p-value < 0.001), municipal human development index (β = 190.91; p-value = 0.001), per capita income (β = -0.08; p-value = 0.001), Firjan Municipal Development Index-Health (β = -51.28; p-value < 0.001), life expectancy at birth (β = -3.50; p-value < 0.001).

CONCLUSION

There was a reduction in mortality in the period studied, with a concentration of deaths, primarily in Piauí and Maranhão; socioeconomic indicators were associated with higher mortality in the region.

MAIN RESULTS

There was a decrease in maternal mortality in Northeast Brazil, from 2009 to 2019. Deaths were mainly concentrated in the states of Piauí and Maranhão. Five socioeconomic indicators were associated with higher mortality in the region.

IMPLICATIONS FOR SERVICES

In order to maintain the trend of falling maternal mortality in Northeast Brazil, the need exists to reduce social inequalities and expand access to health services, especially within the scope of Primary Care.

PERSPECTIVES

Public policies are needed to expand health services in general as well as comprehensive women's health care in the Brazilian National Health System, especially for women living in contexts of greater social vulnerability.

Spatial and temporal analysis of tuberculosis incidence in Guinea-Bissau, 2018 to 2020

OBJECTIVE

to analyze the epidemiological profile, spatial and temporal distribution of tuberculosis in Guinea-Bissau from 2018 to 2020.

METHODS

an ecological study, carried out in Guinea-Bissau, considering new cases of tuberculosis. Spatial analysis of areas was used to verify tuberculosis distribution in the country, and time series were used to identify incidence evolution over the years of study.

RESULTS

a total of 6,840 new cases of tuberculosis were reported. Tuberculosis incidence rate in the country ranged from 36.8 to 267.7 cases/100,000 inhabitants, with emphasis on the regions of Bissau and Biombo (over 90 cases/100,000). By using time series, it was possible to observe an increase in case incidence over the years of study.

CONCLUSIONS

the study made it possible to identify the epidemiological profile of tuberculosis in Guinea-Bissau, spatial distribution heterogeneity, in addition to identifying the disease evolution over the years of investigation.

Vaccination coverage in children under one year of age and associated socioeconomic factors: maps of spatial heterogeneity

OBJECTIVE

to analyze vaccination coverage spatial distribution in children under one year old and the socioeconomic factors associated with meeting the recommended goals in Minas Gerais.

METHODS

an ecological study, carried out in 853 municipalities in the state. Pentavalent, poliomyelitis, meningococcal conjugate, yellow fever, rotavirus, and 10-valent pneumococcal conjugate vaccination coverage were analyzed. Scan statistics and multiple logistic regression were performed to identify spatial clusters and factors associated with meeting coverage goals.

RESULTS

spatial analysis revealed clusters with risk of low coverage for all vaccines. Number of families with per capita income of up to 1/2 wage, Minas Gerais Social Responsibility Index and percentage of the poor or extremely poor population were associated with meeting the established goals.

CONCLUSIONS

the results are useful for designing interventions regarding the structuring of vaccination services and the implementation of actions to increase vaccination coverage in clusters with less propensity to vaccinate.

Leprosy prevalence spatial distribution and trend in a health region in Northeast Brazil, 2008-2017: an ecological study

MAIN RESULTS

A total of 4,029 leprosy cases were notified. Mean prevalence varied between 2.0 and 11.5 cases/10,000 inhab. Spatial distribution of the cases was heterogeneous and there was a falling prevalence trend over the years studied.

IMPLICATIONS FOR SERVICES

These findings point to the need to strengthen active tracing strategies and expand health actions and services targeting leprosy, with the aim of increasing detection and early treatment of cases.

PERSPECTIVES

It is important to carry out epidemiological investigations on the spatial distribution and prevalence of leprosy in other health regions in the state, in order to identify other areas with greater vulnerability to leprosy.

OBJECTIVE

to analyse the spatial distribution and trend of leprosy in municipalities of a health region in a Northeast Brazilian state.

METHODS

this was an ecological time-series study based on compulsory notification of leprosy cases by the municipalities covered by the Imperatriz-MA Regional Health Management Unit, between 2008 and 2017; prevalence and mean prevalence for the period were calculated; spatial analysis of the area was carried out and maps were generated using ArcGis 10.5. Prais-Winsten regression was used for trend analysis.

RESULT

4,029 cases of the disease were identified, and average prevalence ranged from 2.0 to 11.5 cases/10,000 inhabitants-year. The overall trend was downward. Governador Edson Lobão had the highest prevalence, 11.5 cases/10,000 inhabitants, and Lajeado Novo had the lowest prevalence, 2.0 cases/10,000 inhabitants.

CONCLUSION

spatial distribution of leprosy cases was heterogeneous in the municipalities studied and prevalence had a falling trend.

Relationship between social development indicators and mortality due to Diabetes Mellitus in Brazil: a space-time analysis

OBJECTIVE

to identify the space-time pattern of mortality due to Diabetes Mellitus in Brazil, as well as its relationship with social development indicators.

METHOD

an ecological and time series nationwide study based on secondary data from the Unified Health System Informatics Department, with space-time analysis and inclusion of indicators in non-spatial and spatial regression models. The following was performed: overall mortality rate calculation; characterization of the sociodemographic and regional profiles of the death cases by means of descriptive and time analysis; and elaboration of thematic maps.

RESULTS

a total of 601,521 deaths related to Diabetes Mellitus were recorded in Brazil, representing a mean mortality rate of 29.5/100,000 inhabitants. The states of Rio Grande do Norte, Paraíba, Pernambuco, Alagoas and Sergipe, Rio de Janeiro, Paraná and Rio Grande do Sul presented high-high clusters. By using regression models, it was verified that the Gini index (β=11.7) and the Family Health Strategy coverage (β=3.9) were the indicators that most influenced mortality due to Diabetes Mellitus in Brazil.

CONCLUSION

in Brazil, mortality due to Diabetes presents an overall increasing trend, revealing itself as strongly associated with places that have worse social indicators.

HIGHLIGHTS

(1) The time-space pattern of mortality due to Diabetes presents an increasing trend. (2) The Northeast and South regions present high rates of mortality due to Diabetes. (3) Mortality due to Diabetes is associated with worse sociodemographic indicators. (4) A relationship is observed between income, access to health and mortality due to Diabetes.

Distribution and spatial autocorrelation of viral hepatitis B and C in Paraná, Brazil: an ecological study, 2011-2019

OBJECTIVE

to analyze the distribution and spatial autocorrelation of hepatitis B and C detection rates in the state of Paraná, Brazil.

METHODS

this was an ecological study of hepatitis B and C notifications held on the Notifiable Health Conditions Information System, between 2011 and 2019. Percentage change in detection rates between the first and last three-year periods was estimated. Spatial autocorrelation was analyzed using Moran's index.

RESULTS

there were 16,699 notifications of hepatitis B, with a greater reduction in detection in the North (-30.0%) and Northwest (-25.9%) macro-regions. There were clusters of high occurrence in the Foz do Iguaçu, Francisco Beltrão and Cascavel regions between 2011 and 2019. There were 10,920 notifications of hepatitis C, with a greater reduction in detection in the Northwest macro-region (-18.9%) and an increase in the West (51.1%). The Paranaguá region recorded a high detection cluster between 2011 and 2016.

CONCLUSION

hepatitis B and C showed heterogeneous distribution between health regions.

Spatial modeling of homicide mortality in the Northeast region of Brazil

OBJECTIVE

To analyze the spatiotemporal distribution of homicide mortality and association with social determinants of health in the Northeast Region of Brazil.

METHODS

Ecological study with spatiotemporal modeling of homicide deaths between 2000 and 2019. Temporal trends were analyzed by segmented linear regression. Crude mortality was calculated and adjusted by smoothing the local empirical Bayesian method and analyzed by the Global/Local Moran Index and spatiotemporal scan statistics. The association between social determinants of health and homicide mortality was performed using multiple linear regression and autoregressive spatial models.

RESULTS

353,089 deaths were recorded. Mortality increased from 2000 to 2019, with an annual increase of 4.37 in males and 3.57 in females. High risk spatial and spatiotemporal clusters were identified in the coastal region of the states. The spatial regression model showed an association with socioeconomic inequalities.

CONCLUSIONS

High risk areas for homicides associated with socioeconomic inequality, which should be considered as a priority for designing and investing in public health policies were investigated.

The COVID-19 pandemic and vaccination abandonment in children: spatial heterogeneity maps

OBJECTIVE

to identify spatial clusters corresponding to abandonment of routine vaccines in children.

METHOD

an ecological study, according to data from the 853 municipalities of a Brazilian state. The records analyzed were those of the multidose pentavalent, pneumococcal 10-valent, inactivated poliomyelitis and oral human rotavirus vaccines of 781,489 children aged less than one year old. The spatial scan statistics was used to identify spatial clusters and assess the relative risk based on the vaccination abandonment indicator.

RESULTS

the spatial scan statistics detected the presence of statistically significant clusters for abandonment regarding the four vaccines in all the years analyzed. However, the highest number of clusters with high relative risk estimates was identified in 2020. The Vale do Aço and West, North and West, and Southwest regions stand out for the pentavalent, poliomyelitis and rotavirus vaccines, respectively.

CONCLUSION

in an attempt to mitigate the devastating impact of the COVID-19 pandemic, the immunization program experienced setbacks. The presence of clusters points to the need to implement integrated strategies that may involve different sectors for an active search for children and prevent outbreaks of vaccine-preventable diseases in the near future.

Descriptive study of the Specialized Care of the Spanish Health System

OBJECTIVE

The objective of this study is to analyze the trend of the Key Indicators of the National Health System of Spain and its autonomous communities, related to Specialized Care, from the publication of the Law of Cohesion and Quality.

METHODS

This is an ecological study of temporary series of Spain and its autonomous communities from 2003 to 2014. We have analyzed 10 indicators related to Specialized Care (percentage of expenditure, professionals, waiting lists, surgical activity, average duration, infections, and mortality) using the Prais-Winsten regression method. We have obtained data from the health information system of the Spanish Ministry of Health, Social Services, and Equality.

RESULTS

Specialized care expenditure (APC = 0.059, 95%CI 0.041-0.074), number of medical professionals (APC = 0.0006, 95%CI 0.0003-0.0009) and nursing professionals (APC = 0.001, 95%CI 0.0005-0.0016), hospital infections (APC = 0.0003, 95%CI 0.0002-0.0004), and in-hospital mortality (APC = 0.0008, 95%CI 0.0006-0.001) had an increasing trend in Spain. Average duration presented a decreasing trend (APC = -0.0017, 95%CI -0.002- -0.0014). The trend of waiting lists (specialized appointment and non-urgent surgical interventions) was static. The trend of these indicators varied in the Autonomous Communities.

CONCLUSIONS

We have observed a non-compliance with the principles of equity and quality of the services offered. Increased aging, technological development, and inadequate strategies taken to reduce health costs may be the main causes.

Leprosy in Brazil and its association with characteristics of municipalities: ecological study, 2009-2011

OBJECTIVE

To analyse the ecological association between the demographic and socio-economic characteristics of the Brazilian municipalities and average leprosy incidence rate in the period 2009-2011.

METHODS

An ecological study taking the Brazilian municipalities as its units of analysis. The local empirical Bayes estimation method was used to obtain smoothed incidence rates (SIR) for leprosy. The mean, median, first quartile (Q1) and third quartile (Q3) of the SIR were calculated per 100 000 inhabitants. Hierarchical log-linear negative binomial regression models were used to estimate the incidence rate ratios (IRR).

RESULTS

In the period 2009-2011, the average SIR of leprosy in Brazil was 20.2 per 100 000 inhabitants, and the median incidence rate among municipalities was 9.1 per 100 000 inhabitants. Significantly higher adjusted IRR were identified for large municipalities (IRR = 1.67) compared to small municipalities, as well as in municipalities with higher illiteracy rates (IRR = 2.15), more urbanised municipalities (IRR = 1.53), those with greater social inequality as per the Gini index (IRR = 1.26), high percentage of households with inadequate sanitation (IRR = 1.63), higher average number of people per room (IRR = 1.41), high proportions of Family Health Programme coverage (IRR = 1.29), high percentage of household contacts investigated (IRR = 2.30) and those with percentage of cases with grade 2 disability considered to be the medium (IRR = 1.26).

CONCLUSIONS

In this study, SIR was significantly associated with municipalities with low socio-economic status. Disease control activities need to be focused on these municipalities, and investments need to be made in improving the population's living conditions.