Análise espacial da dengue e o contexto socioeconômico no município do Rio de Janeiro, RJ

Abstract

OBJECTIVE:To analyze the dengue epidemic in relation to the socioeconomic context according to geographical areas. METHODS:An ecological study was conducted in the municipality of Rio de Janeiro (Southeastern Brazil), in areas delimited as neighborhoods, based on information about notifi ed dengue cases concerning residents in the municipality. The average incidence rate of dengue was calculated between the epidemiological weeks: 48 th of 2001 and 20 th of 2002. The occurrence of dengue was correlated with socioeconomic variables through Pearsons' correlation coeffi cient. Moran's global and local indexes were used to assess the spatial auto-correlation between dengue and the variables that signifi cantly correlated with the disease. The multiple linear regression model and the conditional auto-regression spatial model were used to analyze the relationship between dengue and socioeconomic context. RESULTS:The neighborhoods located in the west zone of the municipality presented high rates of average dengue incidence. The variables presenting signifi cant correlation were: percentage of households connected with the general sanitary network, households with washing machines, and population density per urban area. Moran's spatial auto-correlation index revealed spatial dependence between dengue and the selected variables. The utilized models indicated percentage of households connected with the general sanitary network as the sole variable signifi cantly associated with the disease. The residual fi gures in both models revealed signifi cant spatial auto-correlation, with a positive Moran Index (p<0.001) for linear regression model, and a negative one (p=0.005) for the conditional auto-regression one. CONCLUSIONS:Problems related to basic sanitation contribute decisively to increase the risk of the disease.

Análise dos aspectos epidemiológicos da dengue: implicações para a gestão dos serviços de saúde

“…Alguns aspectos têm sido ressaltados para a identificação de fatores associados à dengue que possam subsidiar a elaboração de novos mecanismos para o controle da doença 7 .…”

Análise espacial de dados de contagem com excesso de zeros aplicado ao estudo da incidência de dengue em Campinas, São Paulo, Brasil

“…Ressalta-se que embora áreas periféricas apresentem menor cobertura de saneamento e intermitência de oferta de água encanada com pior situação socioeconômica, outros fatores interferem na circulação viral. A circulação prévia do sorotipo do vírus, resultando na imunidade adquirida pela população, medidas de controle específicas por parte do poder público, mudança no comportamento da população após a notificação de casos, são fatores que interferem nos caminhos da transmissão 12,14,16 .…”

“…Almeida et al 14 na cidade do Rio de Janeiro, Pessanha et al 43 em Belo Horizonte (Minas Gerais), Resendes et al 44 em Niterói (Rio de Janeiro) e Costa et al 17 46 em Nova e Iguaçu (Rio de Janeiro) e Teixeira et al 47 no Rio de Janeiro encontraram resultados semelhantes aos registrados no presente estudo.…”

“…A utilização de ferramentas de epidemiologia espacial 11 tem contribuído para estimar e representar a incidência de dengue em diferentes escalas geográficas, bem como identificar fatores de risco associados à sua distribuição no espaço geográ-fico 12,13,14,15,16,17 .…”

Diferenciais intraurbanos na distribuição de dengue em Cuiabá, 2007 e 2008

“…It is likely that the results that have been observed in different studies in Brazilian cities and that show this dissociation between living conditions, infestation rates and incidence, can be explained in the disease production process itself, for which the household microenvironment conditions may be more relevant than the context of the macro social environment 25 . Analyses based on ample and heterogeneous spaces, such as neighborhoods, may not allow relations between this micro social level and incidence to appear 26 .…”