Introduction: Coronavirus disease 2019 (COVID-19) has become a global public health emergency with lethality ranging from 1% to 5%. This study aimed to identify active high-risk transmission clusters of COVID-19 in Sergipe. Methods: We performed a prospective space-time analysis using confirmed cases of COVID-19 during the first 7 weeks of the outbreak in Sergipe. Results: The prospective space-time statistic detected "active" and emerging spatio-temporal clusters comprising six municipalities in the south-central region of the state. Conclusions: The Geographic Information System (GIS) associated with spatio-temporal scan statistics can provide timely support for surveillance and assist in decision-making.

Background Despite visceral leishmaniasis (VL) being epidemic in most Brazilian regions, the Northeast region is responsible for the highest morbidity and mortality outcomes within the country. Objective To analyse the spatiotemporal dynamics of VL cases to identify the temporal trends and high-risk areas for VL transmission, as well as the association of the disease with social vulnerability in Brazilian Northeast. Methods We carried out an ecological time series study employing spatial analysis techniques using all VL confirmed cases of 1,794 municipalities of Brazilian Northeast between the years 2000 to 2017. The Social Vulnerability Index (SVI) was used to represent the social vulnerability. Incidence rates were standardized and smoothed by the Local Empirical Bayesian Method. Time trends were examined through segmented linear regression. Spatiotemporal analysis consisted of uni- and bivariate Global and Local Moran indexes and space-time scan statistics. Results Incidence rate remained stable and ranged from 4.84 to 3.52 cases/100,000 inhabitants. There was higher case prevalence between males (62.71%), children and adolescents (63.27%), non-white (69.75%) and urban residents (62.58%). Increasing trends of new cases were observed among adult male subjects (≥ 40 years old) and urban residents. Importantly, VL incidence showed a direct spatial dependence. Spatial and space-time clusters were identified in sertão and meio-norte sub-regions, overlapping with high social vulnerability areas. Conclusions VL is a persistent health issue in Brazilian Northeast and associated with social vulnerability. Space-time clustering of VL cases in socially vulnerable municipalities demands intersectoral public policies of surveillance and control, with focus on reducing inequalities and improving living conditions for regional inhabitants.

ObjectiveThis study aimed to analyse the clinical and epidemiological indicators, temporal trends and the spatial distribution of leprosy in patients under 15 years old in an endemic area of Northeast Brazil.DesignRegional surveillance study of all reported cases.SettingState of Sergipe, endemic area of Northeast Brazil.MethodsAn ecological and time series study was conducted, based on secondary data reported by the Brazilian Information System on Notifiable Diseases for leprosy cases diagnosed in Sergipe state (2002–2015). The analysis of temporal trends was performed using the Joinpoint Regression Programme through Poisson regression. We performed spatial analysis by Kernel estimator and Moran index.ResultsThe incidence rate was reduced from 6.29 to 3.78 cases per 100 000 inhabitants in 2002 and 2015, respectively. However, Sergipe was still classified as highly endemicity in 2015. The mean number of household contacts (HHC) examined was significantly lower than those registered. Clinical data indicated that 21.4% of the patients developed leprosy reactions, and 31.3% presented with some physical disability in the multibacillary groups. Patients diagnosed by examination within the HHC presented better indicators, such as lower percentage of leprosy reaction and physical disability. Spatial analysis showed the most risk areas distributed on the northeast and cities around the capital, Aracaju.ConclusionThe data indicate that there is a persistence of activeMyobacterium lepraetransmission and a delay in disease detection, following a pattern of high endemicity in many municipalities. The early detection by HHC examination is important to stop transmission and also to detect the cases in a less severe state.

This study aimed to analyse the trend and spatial–temporal clusters of risk of transmission of COVID-19 in northeastern Brazil. We conducted an ecological study using spatial and temporal trend analysis. All confirmed cases of COVID-19 in the Northeast region of Brazil were included, from 7 March to 22 May 2020. We used the segmented log-linear regression model to assess time trends, and the local empirical Bayesian estimator, the global and local Moran indexes for spatial analysis. The prospective space–time scan statistic was performed using the Poisson probability distribution model. There were 113 951 confirmed cases of COVID-19. The average incidence rate was 199.73 cases/100 000 inhabitants. We observed an increasing trend in the incidence rate in all states. Spatial autocorrelation was reported in metropolitan areas, and 178 municipalities were considered a priority, especially in the states of Ceará and Maranhão. We identified 11 spatiotemporal clusters of COVID-19 cases; the primary cluster included 70 municipalities from Ceará state. COVID-19 epidemic is increasing rapidly throughout the Northeast region of Brazil, with dispersion towards countryside. It was identified high risk clusters for COVID-19, especially in the coastal side.

RESUMOObjetivo: analisar os aspectos gerais do acesso dos homens adultos aos serviços de atenção primária à saúde. Método: trata-se de estudo quantitativo, exploratório e transversal, com 485 homens adultos, por meio de questionário, dados armazenados no software SPSS 20.0, submetidos à estatística descritiva e apresentados em tabelas com distribuição de frequências absoluta e relativa. Resultados: 32,6% visitam os serviços de atenção primária à saúde com regularidade. A demora para ser atendido (35,7%) e a ausência de doenças (33,8%) são os principais fatores impeditivos da acessibilidade masculina aos serviços de saúde; 39,4% desconhecem os dias de funcionamento da unidade; 75% consideram ser difícil agendar consultas e 21% desconhecem a política nacional dos homens. Conclusão: a maioria dos homens adultos não buscou com regularidade os serviços de Atenção Primária à Saúde. Ressaltou-se a importância do conhecimento das razões masculinas para não buscarem os serviços da atenção primária à saúde. Este estudo pode contribuir aos gestores a compreenderem essa realidade singular masculina no planejamento de ações visando à garantia da assistência à saúde mais resolutiva. Descritores: Saúde do Homem; Acesso aos Serviços de Saúde; Atenção Primária à Saúde; Saúde Pública; Assistência à Saúde; Enfermagem.ABSTRACT Objective: to analyze the general aspects of adult men's access to primary health care services. Method: this is a quantitative, exploratory and cross-sectional study with 485 adult men, using a questionnaire, data stored in SPSS 20.0 software, submitted to descriptive statistics and presented in tables with absolute and relative frequency distribution. Results: 32.6% visit regular primary health care services. The delay to be treated (35.7%) and the absence of diseases (33.8%) are the main impediments to male accessibility to health services; 39.4% are unaware of the unit's operating days; 75% consider it difficult to schedule consultations and 21% are unaware of the national men's policy. Conclusion: the majority of adult men did not seek regular Primary Health Care services. The importance of knowing the reasons for not seeking primary health care was emphasized. This study can contribute to the managers to understand this singular masculine reality in the planning of actions aiming to guarantee the health care more resolute. Descritores:  Human Health; Access to Health Services; Primary Health Care; Public Health; Health Care; Nursing.                                                                                                    RESUMEN Objetivo: analizar los aspectos generales del acceso de los hombres adultos a los servicios de atención primaria a la salud. Método: se trata de un estudio cuantitativo, exploratorio y transversal, con 485 hombres adultos, mediante cuestionario, datos almacenados en el software SPSS 20.0, sometidos a la estadística descriptiva y presentados en tablas con distribución de frecuencias absoluta y relativa. Resultados: el 32,6% visitan los servicios de atención primaria a la salud con regularidad. La demora para ser atendida (35,7%) y la ausencia de enfermedades (33,8%) son los principales factores impeditivos de la accesibilidad masculina a los servicios de salud; 39,4% desconocen los días de funcionamiento de la unidad; El 75% considera que es difícil programar consultas y el 21% desconocen la política nacional de los hombres. Conclusión: la mayoría de los hombres adultos no buscó con regularidad los servicios de Atención Primaria a la Salud. Se resaltó la importancia del conocimiento de las razones masculinas para no buscar los servicios de atención primaria a la salud. Este estudio puede contribuir a los gestores a comprender esta realidad singular masculina en la planificación de acciones para la garantía de la asistencia sanitaria más resolutiva. Descritores: Salud del Hombre; Acceso a los Servicios de Salud; Atención Primaria a la Salud; Salud Pública; Asistencia Sanitária; Enfermería.

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Introduction: Schistosomiasis is a parasitic infectious disease with a worldwide prevalence. The objective of this work is to identify risk areas for schistosomiasis mansoni transmission in the State of Sergipe, Brazil, during the period from 2005 to 2014. Methods: We conducted an epidemiological study with secondary data from the Information System Control Program of Schistosomiasis [Sistema de Informação do Programa de Controle da Esquistossomose (SISPCE)]. Temporal trends were analyzed to obtain the annual percentage change (APC) in the rates of annual prevalence. In addition to the description of general indicators of the disease, the spatial analysis was descriptive, by means of the estimator of intensity kernel, and showed spatial dependence by indicators of global Moran (I) and Local Index of Spatial Association (LISA). Thematic maps of spatial distribution were made, identifying priority intervention areas in need of healthcare. Results: There were 78,663 cases of schistosomiasis, with an average of 8.7% positivity recorded; 79.8% of the cases were treated, and Sergipe showed a decreasing positive trend (APC: -2.78). There was the presence of spatial autocorrelation and a significant global Moran index (I = 0.19; p-value = 0.03). We identified clusters of highrisk areas, mainly located in the northeast and southcentral of the state, which each had equally high infection rates. Conclusions: There was a decreasing positive trend of schistosomiasis in Sergipe. Spatial analysis identified the geographic distribution of risk and allowed the definition of priority areas for the maintenance and intensification of control interventions.

Background Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis . It is a disease known worldwide for its vulnerability factors, magnitude and mortality. The objective of the study was to analyze the spatial and temporal dynamics of TB in the area of social inequality in northeast Brazil between the years 2001 and 2016. Methods An ecological time series study with the use of spatial analysis techniques was carried out from 2001 to 2016. The units of analysis were the 75 municipalities in the state of Sergipe. Data from the Notification of Injury Information System were used. For the construction of the maps, the cartographic base of the state of Sergipe, obtained at the Instituto Brasileiro de Geografia e Estatística, was used. Georeferenced data were analysed using TerraView 4.2.2 software (Instituto Nacional de Pesquisas Espaciais) and QGis 2.18.2 (Open Source Geospatial Foundation). Spatial analyses included the empirical Bayesian model and the global and local Moran indices. The time trend analyses were performed by the software Joinpoint Regression, Version 4.5.0.1, with the variables of sex, age, cure and abandonment . Results There was an increasing trend of tuberculosis cases in patients under 20 years old and 20–39 years old, especially in males. Cured cases showed a decreasing trend, and cases of treatment withdrawal were stationary. A spatial dependence was observed in almost all analysed territories but with different concentrations. Significant spatial correlations with the formation of clusters in the southeast and northeast of the state were observed. The probability of illness among municipalities was determined not to occur in a random way. Conclusion The identification of risk areas and priority groups can help health planning by refining the focus of attention to tuberculosis control. Understanding the epidemiological, spatial and temporal dynamics of tuberculosis can allow for improved targeting of strategies for disease prevention and control.