ResumoO espaço é uma categoria de síntese e convergência onde se expressam os diversos processos envolvidos nas condições de vida, ambiente e saúde das populações. Ao longo desses processos, os resultados obtidos pela análise de indicadores são sensíveis à seleção desses indicadores, das fontes de informação, da escala de análise, de unidades espaciais de referência e dos métodos de análise espacial. O objetivo deste trabalho é levantar o papel da análise espacial na avaliação das situações de saúde, que engloba a descrição de perfis epidemiológicos, de qualidade de vida e de condições ambientais. Conhecer a estrutura e a dinâmica espacial da população é o primeiro passo para a caracterização de situações de saúde. Além disso, permite o planejamento de ações de controle e alocação de recursos. A análise espacial propicia o restabelecimento do contexto no qual um evento de saúde ocorre, contribuindo para o entendimento dos processos socioambientais envolvidos.

The temporal and spatial evolution of malaria was described for the postfrontier phase of the Brazilian Amazon in 2003–2013. The current ecological study aimed to understand the relationship between spatial population mobility and the distribution of malaria cases. The study identified epidemiologically relevant areas using regional statistical modeling and spatial analyses that considered differential infections and types of work activities. Annual parasite incidence (API) in the region was highest in hotspots along the Amazon River and in the south and west settlement zone of Hiléia, with concentrations in environmental protection areas and açaí and Brazil nut extraction areas. The dispersal force decreased in the Central Amazon due to rapid urbanization and improved socioeconomic conditions for workers in consolidated settlement areas. The study characterized the spatial patterns of disease transmission according to the economic activity and regionalization of geographic areas, confirming that the incidence of infection by work activity and labor flow is linked to extractive activities and agricultural settlements.

Este estudio se propone identificar espacios críticos en la atención a la salud de la Franja Fronteriza de Brasil. Para ello se realizó una caracterización de la distribución de los recursos de salud por municipio y regiones fronterizas en 1999-2000, posteriormente relacionada con las condiciones de vida, situación de salud, accesibilidad geográfica y otros aspectos de la dinámica fronteriza. Se utilizaron datos secundarios de grandes bancos de datos nacionales de salud y geografía, completados con datos primarios recogidos sobre el terreno. Para el análisis de los datos y producción de mapas se utilizaron Sistemas de Información Geográfica. La Franja de Frontera se mostró heterogénea en los aspectos considerados. El segmento que comprende los municipios situados en la frontera norte presentó las condiciones más desfavorables constituyéndose en la región más crítica para la atención a la salud. El segmento central presentó una situación intermedia, con una proporción equilibrada de sub-regiones en situación crítica y no-crítica. El segmento sur presentó una situación satisfactoria en todas las sub-regiones. La heterogeneidad de la salud en la Franja Fronteriza mostró la necesidad de un enfoque específico que considere sus diferentes regiones y las particularidades de la dinámica fronteriza.

Since 2015 Brazil has experienced the social repercussions of the Zika virus epidemic, thus raising a debate about: difficulties of diagnosis; healthcare access for children with Zika Congenital Syndrome (ZCS); the search for benefits by affected families; social and gender inequalities; and a discussion on reproductive rights, among others. The objective of this article is to analyse access to specialized health services for the care of children born with ZCS in three North-eastern states of Brazil. This is an exploratory cross-sectional study which analyses recorded cases of microcephaly at the municipal level between 2015 and 2017. Most of the cases of ZCS were concentrated on the Northeast coast. Rio Grande do Norte and Paraiba had the highest incidence of microcephaly in the study period. The states of Bahia, Paraiba and Rio Grande do Norte were selected for their high incidence of microcephaly due to the Zika Virus. Socio-territorial vulnerability was stratified using access to microcephaly diagnosis and treatment indicators. The specialized care network was mapped according to State Health Secretaries Protocols. A threshold radius of 100 km was stablished as the maximum distance from municipalities centroids to specialised health care for children with microcephaly. Prenatal coverage was satisfactory in most of the study area, although availability of ultrasound equipment was uneven within states and health regions. Western Bahia had the lowest coverage of ultrasound equipment and lacked health rehabilitation services. ZCS's specialized health services were spread out over large areas, some of which were outside the affected patients' home municipalities, so displacements were expensive and very time consuming, representing an extra burden for the affected families. This study is the first to address accessibility of children with microcephaly to specialised health care services and points to the urgent need to expand coverage of these services in Brazil, especially in the northeastern states, which are most affected by the epidemic.

The lethality of malaria in the extra-Amazonian region is more than 70 times higher than in Amazonia itself. Recently, several studies have shown that autochthonous malaria is not a rare event in the Brazilian southeastern states in the Atlantic Forest biome. Information about autochthonous malaria in the state of Rio de Janeiro (RJ) is scarce. This study aims to assess malaria cases reported to the Health Surveillance System of the State of Rio de Janeiro between 2000-2010. An average of 90 cases per year had parasitological malaria confirmation by thick smear. The number of malaria notifications due to Plasmodium falciparum increased over time. Imported cases reported during the period studied were spread among 51% of the municipalities (counties) of the state. Only 35 cases (4.3%) were autochthonous, which represents an average of 3.8 new cases per year. Eleven municipalities reported autochthonous cases; within these, six could be characterised as areas of residual or new foci of malaria from the Atlantic Forest system. The other 28 municipalities could become receptive for transmission reintroduction. Cases occurred during all periods of the year, but 62.9% of cases were in the first semester of each year. Assessing vulnerability and receptivity conditions and vector ecology is imperative to establish the real risk of malaria reintroduction in RJ.