[Show abstract][Hide abstract] ABSTRACT: Visceral leishmaniasis (VL) is a vector-borne disease whose factors involved in transmission are poorly understood, especially in more urban and densely populated counties. In Brazil, the VL urbanization is a challenge for the control program. The goals were to identify the greater risk areas for human VL and the risk factors involved in transmission.
This is an ecological study on the relative risk of human VL. Spatial units of analysis were the coverage areas of the Basic Health Units (146 small-areas) of Belo Horizonte, Minas Gerais State, Brazil. Human VL cases, from 2007 to 2009 (n = 412), were obtained in the Brazilian Reportable Disease Information System. Bayesian approach was used to model the relative risk of VL including potential risk factors involved in transmission (canine infection, socioeconomic and environmental features) and to identify the small-areas of greater risk to human VL.
The relative risk of VL was shown to be correlated with income, education, and the number of infected dogs per inhabitants. The estimates of relative risk of VL were higher than 1.0 in 54% of the areas (79/146). The spatial modeling highlighted 14 areas with the highest relative risk of VL and 12 of them are concentrated in the northern region of the city.
The spatial analysis used in this study is useful for the identification of small-areas according to risk of human VL and presents operational applicability in control and surveillance program in an urban environment with an unequal spatial distribution of the disease. Thus the frequent monitoring of relative risk of human VL in small-areas is important to direct and prioritize the actions of the control program in urban environment, especially in big cities.
[Show abstract][Hide abstract] ABSTRACT: to analyze the social inequalities in the distribution of perinatal mortality in Belo Horizonte.
the perinatal deaths of residents in Belo Horizonte in the period 2003 to 2007 were studied on the basis of the Information Systems on Mortality and Newborns. The space analysis and the Health Vulnerability Index were used to identify existing inequalities in the sanitary districts regarding coverage and risk, determined by the Odds Ratio and a value p<0.05. The multivariate analysis was used to describe a model for perinatal mortality.
there was a proved variation in the numbers of perinatal mortality per one thousand total births in the sanitary districts (12.5 to 19.4), coverage areas (5.3 to 49.4) and areas of risk (13.2 to 20.7). The mortality rate diminished as the maternal schooling increased. The death rates deriving from asphyxia/hypoxia and non-specified fetal death grew with the increase of risk in the area.
it was verified that the perinatal deaths are distributed in a differentiated form in relation to the space and the social vulnerabilities. The confrontation of this complex problem requires the establishment of intersecting partnerships.
Revista Latino-Americana de Enfermagem 10/2013; 21(5):1062-1070. DOI:10.1590/S0104-11692013000500008 · 0.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to analyze factors associated with access to kidney transplants from living and cadaver donors in Belo Horizonte, Minas Gerais State, Brazil. The authors conducted a non-concurrent cohort study of patients on the waiting list for kidney transplants from 2000 to 2004 and followed until transplantation, death, exclusion, or continued presence on the line at the end of the study on December 31, 2005. The Cox model was used for competing risks. Of the 835 patients, 22.7% were transplanted. Lower risk of transplantation from living donors and cadavers was observed in patients with more time on dialysis and blood type O. Lower risk of transplantation from living donors was observed in residents in a high health risk area and in recipients with diabetes. The greatest disparity in access was observed in transplants from living donors, since there were no significant socio-demographic differences in transplants from cadaver donors. One can infer that the organ allocation system contributed to mitigating socio-demographic inequalities, and that clinical issues were more relevant in access to transplants from cadaver donors.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 12/2012; 28(12):2315-26. DOI:10.1590/S0102-311X2012001400010 · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study considers the dengue occurrence in the city of Belo Horizonte over the last fifteen years. Approximately 186,000 cases registered from 1996 to 2011 were analyzed. The home address of individuals whose dengue case was notified was used as a proxy for exposure location. For determining possible outbreaks of disease and the specific patterns of dengue cases, spatial statistics used included Kernel's estimation. The occurrence of waves of dengue outbreaks was correlated with climatic and vector presence data. Outbreaks had different durations and intensities: case clustering, thinned out both spatially and temporally. These findings may be useful for public health professionals responsible for fighting the disease providing some tools for improving evaluation of interventions such as vector control and patient care, minimizing the collective and individual burden of the disease.
Journal of Tropical Medicine 03/2012; 2012(5):760951. DOI:10.1155/2012/760951
[Show abstract][Hide abstract] ABSTRACT: The main goal of this study was to describe the spatial and temporal distribution of candidates for blood donation in Belo Horizonte, Minas Gerais State, Brazil, who appeared at the Hemominas Foundation in 1994 and 2004. The study also compared the candidates for age, gender, and clinical approval for blood donation in space and space-time. Data were obtained from a cross-sectional study for 1994 and were randomly selected from all donor candidates for 2004. The samples were georeferenced using the residential address. The spatial analysis techniques employed were: Kernel maps, thematic maps of Bayesian empirical rates and crude rates, and Moran Global. According to the findings, spatial distribution of candidates was non-random. The Kernel maps helped detect points with higher or lower concentration of candidates. Thematic maps described the concentration of candidates in relation to the population for the various categories. The results could help detect areas for actions targeting donor recruitment and areas with specific blood donation public campaign needs.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 02/2010; 26(2):229-39. · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aimed to describe the temporal-spatial patterns of dengue epidemics in Belo Horizonte, Minas Gerais State, Brazil, from 1996 to 2002 and to analyze residential address as a proxy for exposure. Reported dengue cases were analyzed according to week of onset of symptoms and residential census tract. Local Moran's index was used to assess spatial autocorrelation of incidence coefficients, and recurrent census areas over different epidemic waves were also verified. Ripley's K-function was used to compare spatial distribution patterns between the two population groups, assuming that they were distributed differently around the city. A total of 99,559 dengue cases were analyzed, resulting in seven epidemic waves with different durations and intensities, with cases clustering in a small fraction of areas, thinning out both spatially and temporally. Distinct case distribution patterns were observed according to the two exposed groups, suggesting the need to improve the reporting of possible place of infection. The observed endemic pattern of the disease also requires specific strategies and poses a major challenge for health surveillance services.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 11/2008; 24(10):2385-95. DOI:10.1590/S0102-311X2008001000019 · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study considers the vulnerability of the urban area of the City of Belo Horizonte to dengue. A total number of 89,607 cases registered in the surveillance system from 1996 to 2002 were analyzed. Seven epidemic waves were identified during this period. Cases were grouped into 2,563 census areas, and three risk categories were proposed based on how many times each area reached a threshold established for each epidemic wave. The association between the risk categories and the socioeconomic, demographic and urban-infrastructure characteristics was evaluated. Analysis included Kruskal-Wallis test variance comparisons and multivariate regression using multinomial models. Incidence rates differed significantly among the three risk categories in most of the epidemic waves. The factors that best characterized the areas were low educational level (< or =4 years of schooling), low income of the head of the family (< or =2 minimum wages per household), household density, and proportion of children and elderly women. Information related to basic sanitation was not enough to discriminate levels of susceptibility to dengue, and study of population density and concentration of establishments considered vulnerable to vector infestation yielded questionable results. It is important to consider different levels of exposure of the population to explain the heterogeneous pattern of distribution of dengue cases in an urban setting. Understanding the dynamics of dengue fever is essential for surveillance purposes, to improve control measures and to avoid epidemics of this disease.
Journal of Urban Health 06/2007; 84(3):334-45. DOI:10.1007/s11524-006-9154-2 · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Spatial analysis of health indicators is as an important methodology for detection of intra-urban differences. This study aimed to examine the spatial distribution of all live births in Belo Horizonte, analyzing the presence of spatial clusters of health indicators for newborns and their mothers, using data from the Information System on Live Births. For each area covered by a Primary Health Care Unit, we calculated the indicators using empirical Bayesian methods. For spatial analysis, the indicators obtained from the global Moran (I) index and Local Indicators of Spatial Association (LISA) were used. Analysis using LISA showed the presence of relevant spatial clusters for adolescent mothers and those with low schooling, stillbirths in previous pregnancies, cesarean sections, and low attendance at prenatal care, especially in areas with low socio-demographic characteristics. The methodology adopted was configured as a key instrument for detecting risk areas where clustering occurs. The method can easily be incorporated into health surveillance systems as a mechanism for controlling events related to births in a given area.
Cadernos de Saúde Pública 10/2006; 22(9):1955-65. · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aims to determine spatial patterns of mortality and morbidity for five health problems in an urban environment: homicides, adolescent pregnancy, asthma hospitalization, and two vector-borne diseases, dengue and visceral leishmaniasis. All events were obtained through the city health database and geoprocessed using residential addresses and 80 planning units consisting of census tracts. We used thematic maps, proportionate mortality/morbidity ratios by planning unit, and the overlapped rank of the 20th worse planning unit rates for each event. A spatial pattern of high rates of homicides, proportion of young mothers, and hospitalization due to asthma overlapped in socially and economically disadvantaged areas. For the two vector-borne diseases, high rates with great dispersion were found in underprivileged areas, in contrast with very low rates among higher income areas. The results indicated the coexistence of heavier disease burden for residents of urban areas where poverty and lack of effective public health policies may be modulating social health problems. For the two vector-borne diseases, an environmental intervention in one mosquito-borne disease might be playing a role in the other's incidence.