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.

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.

The process of population aging is a worldwide reality becoming a global public health challenge. Although population aging is especially noticeable in more developed regions, there has also been a significant advance in the quantity of elderly people in areas with unfavourable socioeconomic indicators, and a rapid growth in countries with a low level of economic development. This article presents an analysis based on spatial autocorrelation of the relationship between life expectancy and social determinants in a north-eastern region of Brazil. An ecological study was conducted using the secondary data of social, demographic, and health indicators of elderly people collected in the Brazilian Demographic Census of the 75 municipalities of the state of Sergipe. Spatial autocorrelation was evaluated using the Moran global index and the local indicators of space association. Multiple linear regression models were used to identify the relationship between life expectancy and social determinants. The South-eastern region of the state presented clusters with all indicators pointing to acceptable lifestyles, whereas the municipalities of the north-western and far-eastern regions were characterized by values demonstrating precarious living conditions. The high dependency ratio, illiteracy rate, and unemployment rate among elderly people had a negative impact on life expectancy. The evidence confirms that there is an autocorrelation between social determinants and life expectancy, indicating that the worse the social, economic, and health indicators are, the lower the life expectancy. This finding indicates the need to redirect public policies and formulate strategies aimed at reducing social and health inequalities.

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.

RESUMO O objetivo deste estudo foi descrever a prevalência de paralisia cerebral entre crianças e adolescentes, seus subtipos, as possíveis comorbidades e as características socioeconômicas das famílias. Foi realizado um estudo epidemiológico do tipo transversal a partir de um inquérito de base populacional sobre a paralisia cerebral em crianças e adolescentes na cidade de Aracaju (SE), Brasil. O estudo obteve informações sobre 240 crianças e adolescentes com paralisia cerebral a partir das respostas a um questionário feitas por seus responsáveis. Foi encontrada a prevalência de período de 1,37 em cada mil. Alguns bairros possuem prevalência de três a quatro vezes maior, revelando que a taxa de prevalência total não é um indicador homogêneo. A maioria dos participantes foi do sexo masculino (56,25%), de raça/cor declarada como parda ou preta (67,50%), sendo que a média de idade foi de 8,56 anos. A paralisia cerebral de tipo espástica bilateral foi a mais frequente (45,42%) e a comorbidade referida na maioria dos casos foi a epilepsia (48,33%). A renda familiar mensal correspondia a $252,87 dólares. O estudo revelou que as crianças e adolescentes com paralisia cerebral são, em grande parte, pertencentes a minorias sociais, de raça/cor parda ou preta, e suas famílias vivem na linha da extrema pobreza.

This study aimed to analyse the spatial-temporal distribution of COVID-19 mortality in Sergipe, Northeast, Brazil. It was an ecological study utilising spatiotemporal analysis techniques that included all deaths confirmed by COVID-19 in Sergipe, from 2 April to 14 June 2020. Mortality rates were calculated per 100000 inhabitants and the temporal trends were analysed using a segmented log-linear model. For spatial analysis, the Kernel estimator was used and the crude mortality rates were smoothed by the empirical Bayesian method. The space-time prospective scan statistics applied the Poisson's probability distribution model. There were 391 COVID-19 registered deaths, with the majority among ≥60 years old (62%) and males (53%). The most prevalent comorbidities were hypertension (40%), diabetes (31%) and cardiovascular disease (15%). Observed was an increasing mortality trend across the state, with a higher increase in the countryside. An active spatiotemporal cluster of mortality comprising the metropolitan area and neighbouring cities was identified. The trend of COVID-19 mortality in Sergipe was increasing and the spatial distribution of deaths was heterogeneous with progression towards the countryside. Therefore, the use of spatial analysis techniques may contribute to surveillance and control of COVID-19 pandemic.

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Este artigo objetiva analisar o papel da sociedade civil na política de saúde da pessoa com deficiência no município de Aracaju-SE. Foi realizado um estudo qualitativo com entrevistas semiestruturadas com representantes do Conselho de Defesa dos Direitos da Pessoas com Deficiência. Os dados foram analisados de acordo com a análise temática de conteúdo. Os resultados demonstram que o entendimento da concepção da deficiência, por parte dos representantes da sociedade civil, é difuso, transitando entre os paradigmas existentes. Foi notável a dificuldade dos representantes em propor temas para a agenda política no âmbito local e participar na formulação e implementação da política pública de saúde, criando um distanciamento entre os órgãos de controle social e gestão.