High incidence of diseases endemic to the Amazon region of Brazil, 2001-2006.A structured intervention to address the most prevalent diseases endemic endemic /en·dem·ic/ (en-dem´ik) present or usually prevalent in a population at all times. en·dem·ic adj. 1. to Brazil started when the Oswaldo Cruz Oswaldo Gonçalves Cruz, better know as Oswaldo Cruz (pron. IPA: [osvawdu cɾuz]), (b. August 5, 1872, São Luíz de Paraitinga, São Paulo state, Brazil; d. Institute in Rio de Janeiro Rio de Janeiro, city, Brazil Rio de Janeiro (rē`ō də zhänā`rō, Port. rē`  thĭ zhənĕē`r was created in 1900 and research began (1). Brazil has a
federative fed·er·a·tive adj. Forming, belonging to, or of the nature of a federation. fed  er·a political system composed of 3 levels of government: federal
(union), states, and municipalities. All are considered autonomous
bodies by the Federal Constitution of 1988 and none have authority over
the others. Brazil has 26 states, 27 federal districts (also known as
federative units), and 5,564 municipalities. Considerable demographic
disparities exist among the states on the basis of their resident
populations in 2007 (2). The 27 federative units are divided into 5
geographic regions: North, Northeast, Southeast, South, and
Central-West.
The 5 geographic regions in Brazil are analytical units that are included in any epidemiologic analyses of this country. Historically, the North and Northeast regions, which include most of the Amazon River Amazon River Portuguese Rio Amazonas River, northern South America. It is the largest river in the world in volume and area of drainage basin; only the Nile River of eastern and northeastern Africa exceeds it in length. Basin, have the greatest social inequalities and the highest prevalence of disease. Furthermore, the quality of epidemiologic data is lower in the North and Northeast regions than for other regions of Brazil Brazil is currently divided in five regions, by the Instituto Brasileiro de Geografia e Estatistica (IBGE). These divisions are composed by states with similar cultural, economical, historical and social aspects, and although through the scientific point of view information given by this . Despite advances in the Brazilian public health system (the Single Health System [SUS See Single UNIX Specification. ]) and the stated principles of universal and equitable healthcare contained in the Brazilian Constitution, many inequalities still exist with regard to access to healthcare services and to training and distribution of healthcare professionals (3). For example, according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. Ministry of Health data, despite having the second highest number of medical schools in the world (175, second only to India) (4) and accepting [approximately equal to]17,000 medical students each year, Brazil has a glut glut pronounced as rut, slut Vox populi An excess of a service or skilled labor in a particular area. See Physician glut. of physicians in the South and Southeast regions but nearly none in >1,300 municipalities (5). In Brazil, health inequities among different groups are even more striking and directly associated with social and economic conditions (6,7). Reinforcement of support networks for promotion and protection of individual and collective health is Brazil's greatest challenge, especially for states in the Amazon region of Brazil. Demographic density in the Amazon region of Brazil is low (4.7 persons/[km.sup.2] in 2007); many areas are nearly bereft of healthcare facilities. Paradoxically, an intense urbanization process is taking place in the region, and estimates in 2000 showed that [approximately equal to]70% of the population lived in urban areas. The urbanization trend contrasts with the rural lifestyle of traditional populations (indigenous groups, river dwellers, rubber tappers, quilombolas) in the region. Quilombolas are descendants DESCENDANTS. Those who have issued from an individual, and include his children, grandchildren, and their children to the remotest degree. Ambl. 327 2 Bro. C. C. 30; Id. 230 3 Bro. C. C. 367; 1 Rop. Leg. 115; 2 Bouv. n. 1956. 2. of former slaves who escaped from slave plantations that existed in Brazil until the abolition of slavery on May 13, 1888. Because of their isolated status, their primary occupations are mineral extraction or subsistence farming subsistence farming Form of farming in which nearly all the crops or livestock raised are used to maintain the farmer and his family, leaving little surplus for sale or trade. Preindustrial agricultural peoples throughout the world practiced subsistence farming. . Our study involved 5 reportable (compulsory notification) diseases (malaria malaria, infectious parasitic disease that can be either acute or chronic and is frequently recurrent. Malaria is common in Africa, Central and South America, the Mediterranean countries, Asia, and many of the Pacific islands. , leishmaniasis leishmaniasis (lēsh'mənī`əsĭs), any of a group of tropical diseases caused by parasitic protozoans of the genus Leishmania. [cutaneous cutaneous /cu·ta·ne·ous/ (ku-ta´ne-us) pertaining to the skin. cu·ta·ne·ous adj. Of, relating to, or affecting the skin. Cutaneous Pertaining to the skin. and visceral visceral /vis·cer·al/ (vis´er-al) pertaining to a viscus. vis·cer·al adj. Relating to, situated in, or affecting the viscera. visceral pertaining to a viscus. ]), dengue fever dengue fever (dĕng`gē, –gā), acute infectious disease caused by four closely related viruses and transmitted by the bite of the Aedes mosquito; it is also known as breakbone fever and bone-crusher disease. , and leprosy leprosy or Hansen's disease (hăn`sənz), chronic, mildly infectious malady capable of producing, when untreated, various deformities and disfigurements. ) of the 44 reportable diseases reportable diseases, n.pl contagious diseases that must be reported by the physician to public health authorities. They include but are not limited to malaria, influenza, poliomyelitis, relapsing fever, typhus, yellow fever, cholera, and bubonic plague. with national coverage and 10 diseases with sentinel sentinel /sen·ti·nel/ (sen´ti-n'l) one who gives a warning or indicates danger. sentinel a recording mechanism, such as an animal, a farm or a veterinarian, posted explicitly to record a possible occurrence or series of surveillance in Brazil. We determined the incidence and hospitalization hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun) 1. the placing of a patient in a hospital for treatment. 2. the term of confinement in a hospital. rates of patients with these 5 diseases in states in the Amazon region of Brazil during 2001-2006. Amazon Region of Brazil The Amazon region of Brazil (Amazon River Basin), as defined by Brazilian legislation, comprises 773 municipalities in 3 geographic regions and 9 states (the entire North region, a large portion of the state of Maranhao [183 of 217 municipalities] in the Northeast region, and the entire state of Mato Grosso Mato Grosso (mä`t grô`s) [Port.,=thick forest], state (1996 pop. in the Central-West region) (Figure
1) (8). This region has a population of [approximately equal to]23.6
million inhabitants
The game is based loosely on the concepts from SameGame. , an area of 4.97 million [km.sup.2] ([approximately equal to]60% of Brazil), and a demographic density 10x less than the national average. The National Notifiable Disease no·ti·fi·a·ble disease n. A disease that must be reported to public health authorities at the time it is diagnosed because it is potentially dangerous to human or animal health. Also called reportable disease. Information System (Sistema de Informacao de Agravos de Notificacao Compulsoria), created in 1993, is a national electronic surveillance system that contains a variety of diseases in 1 integrated database. This system accepts reports on cases and outbreaks. Relevant data are obtained from notifying health centers on standardized standardized pertaining to data that have been submitted to standardization procedures. standardized morbidity rate see morbidity rate. standardized mortality rate see mortality rate. forms. Data are entered into the system, in most instances, by personnel from the Municipal Health Secretariats (Secretarias Municipais de Saude). These data are transferred electronically according to a preestablished data flow: Municipal Health Secretariats . regional health coordination units (within states) . State Health Secretariat Secretariat, 1970–89, thoroughbred race horse. Trained by Lucien Laurin and ridden by Ron Turcotte, Secretariat won the Kentucky Derby, Preakness, and Belmont Stakes to capture the Triple Crown in 1973. Secretariat (foaled 1970) U.S. (Secretaria Estadual de Saude) . Federal Ministry of Health. The National Notifiable Disease Information System database, the malaria database (National Malaria Database [no longer in existence]), and Informational System of Epidemiological Surveillance Epidemiological surveillance is the discipline of continuously gathering, analysing, and interpreting data about diseases, and disseminating conclusions of the analyses to relevant organisations. As such, it is a key element in epidemiology. of Malaria are managed and monitored by the federal government in the Secretariat of Health Surveillance/Ministry of Health (9). Case definitions are established by the Secretariat of Health Surveillance/ Ministry of Health and are based on recommendations of the World Health Organization (9). Data from the SUS Hospitalization Information System Sistema de Informacoes Hospitalares do Sistema Unico de Saude (SIH-SUS) were also included. These data include [approximately equal to]80% of hospitalizations in the study region. This system records data according to the International Classification of Diseases, 10th revision (ICD-10) (10). Missing Data For the resident population >10 years of age, a detailed analysis of the proportion of cases with missing data for education level (Figure 2) showed large reductions in leishmaniasis, leprosy, and tuberculosis over the period of evaluation. However, incidence rates of 13% for dengue fever and 16% for malaria were maintained in persons for whom information on education level was not provided. [FIGURE 1 OMITTED] Calculation of Indicators Indicators (Table 1) for data analysis were calculated according to definitions of indicators and basic health data (Indicadores e Dados Basicos--Brasil--2007; http://tabnet.datasus.gov.br/cgi/idb2007/matriz.htm) of the Inter-Agency Health Information Network, which is composed of government agencies and institutions of higher education higher education Study beyond the level of secondary education. Institutions of higher education include not only colleges and universities but also professional schools in such fields as law, theology, medicine, business, music, and art. and research (11). Data were analyzed by using SAS (1) (SAS Institute Inc., Cary, NC, www.sas.com) A software company that specializes in data warehousing and decision support software based on the SAS System. Founded in 1976, SAS is one of the world's largest privately held software companies. See SAS System. statistical software (12) and stratified stratified /strat·i·fied/ (strat´i-fid) formed or arranged in layers. strat·i·fied adj. Arranged in the form of layers or strata. by age group, education level, and year during 2001-2006; an aggregation of the 773 municipalities in the Amazon region of Brazil formed the basic unit of analysis. For different education levels, missing data were redistributed re·dis·trib·ute tr.v. re·dis·trib·ut·ed, re·dis·trib·ut·ing, re·dis·trib·utes To distribute again in a different way; reallocate. Adj. 1. proportionally among all age groups >10 years of age, as per the statistical technique used. [FIGURE 2 OMITTED] For denominators of the incidence rates, populations projected by the Brazilian Institute of Geography and Statistics The Brazilian Institute of Geography and Statistics or IBGE (Portuguese: Instituto Brasileiro de Geografia e Estatística during 2001-2006 were used for classification of age groups. Demographic projections were specifically developed for these population groups by education level. These projections were made by using average geometric rates of annual population growth (13) obtained from the 1996 population count and expanded sample data from the 2000 demographic census (13,14). We also used a correction factor for a section of persons with >12 years of formal education because the Federal Ministry of Education had indicated that during 2001-2005, the average annual increase in university enrollments in the North region, which was used as a proxy indicator for the Amazon region of Brazil, was [approximately equal to]12% (15). Hospitalization rates for each disease were calculated by using total registered hospital stays and the corresponding ICD-10 code as registered in the national SIH-SUS database as the numerator numerator the upper part of a fraction. numerator relationship see additive genetic relationship. numerator Epidemiology The upper part of a fraction and the resident population as the denominator denominator the bottom line of a fraction; the base population on which population rates such as birth and death rates are calculated. denominator as per methods of Siqueira et al. (16). To facilitate comparison with other data, all indicators were adjusted to a rate/100,000 population. The total number of persons that purchased private health plans, according to data from the National Agency of Supplementary Health, was subtracted from the denominator (17). Incidence and Hospitalization Rate Malaria was the vector-borne disease vector-borne disease Infectious diseases Any infection, usually transmitted by insects–eg, ticks–eg, Lyme disease, Rocky Mountain spotted fever, ehrlichiosis, Colorado tick fever; mosquitos–eg, California-or La Crosse, St Louis, Eastern, Western with the highest incidence in the region; the number of new cases gradually increased from 1,530/100,000 in 2001 to 2,365/100,000 in 2006. However, a reduction in the hospitalization rate for this disease was also observed and, as expected, the most affected age group was young adults 15-49 years of age (Table 2). Dengue fever, which reemerged in Brazil in the 1980s, is endemic to the Amazon region of Brazil and has maintained its epidemiologic pattern of epidemics in isolated areas. In 2001, it reached its peak incidence (283.8/100,000) and became the most common vector-borne disease in the region until 2003 (Table 2). Leishmaniasis transmission has become an urban problem, particularly in outlying out·ly·ing adj. Relatively distant or remote from a center or middle: outlying regions. outlying Adjective far away from the main area Adj. 1. areas of major and mid-sized cities in the Amazon region of Brazil. This problem is apparent despite a reduction in incidence from 79.9/100,000 in 2001 to 60.7/100,000 in 2006 and constant hospitalization rates (Table 2) Tuberculosis incidence was lower in the study area than in the rest of Brazil (incidence rate 62/100,000 in 2006). The incidence of tuberculosis in the Amazon region of Brazil has remained constant ([approximately equal to]45.5 cases/100,000); concentration of cases was higher among the elderly, and the hospitalization rate was [approximately equal to]10.0 (Table 2). Leprosy showed little variation in incidence and hospitalization rates in most of the disease-endemic areas in the study region. A higher frequency was noted among adults and the elderly (Table 2). We calculated disease distribution per age group. The highest incidence rates for leishmaniasis and dengue fever were among persons 30-49 years of age, the highest incidence rate for malaria was among persons 15-29 years of age, the highest incidence rate for leprosy was among persons 50-69 years of age, and the highest incidence rate for tuberculosis was among persons >70 years of age. Malaria is the most prevalent disease in the Amazon region of Brazil, although its incidence has decreased over the study period (Figure 3). Table 3 shows incidence rates for the 5 diseases by patient education level. Resulting inequalities between various social and cultural groups are apparent. For example, the incidence of malaria is highest among groups with a lower education level. Leishmaniasis, even with an overall reduction in incidence in 2006, still showed differences in disease rates. The incidence rate for this disease was 3-fold greater for persons with 1-3 years of schooling than for persons with [greater than or equal to]12 years of formal education. Dengue fever, with its predominantly urban presence, affected persons in the highest socioeconomic so·ci·o·ec·o·nom·ic adj. Of or involving both social and economic factors. socioeconomic Adjective of or involving economic and social factors Adj. 1. classes. For each year of the study, we noted an illness pattern that affected the middle and upper classes more than other socioeconomic groups. [FIGURE 3 OMITTED] Incidence rates for leprosy and tuberculosis were highest for groups with lowest levels of education. Incidence rates were 2x greater for groups with <1 year and 1-3 years of formal education. Conclusions As is occurring in the rest of Brazil, the Amazon region of Brazil is undergoing an epidemiologic transition; infectious and parasitic diseases A parasitic disease is an infectious disease caused or transmitted by a parasite. Many parasites do not cause disease per se. Parasitic diseases can affect practically all living organisms, from plants to man. The study of parasitic diseases is called by parasitology. are decreasing and noncommunicable chronic diseases are increasing. However, vector-borne and mycobacterial diseases Mycobacterial diseases Diseases caused by mycobacteria, a diffuse group of acid-fast, rod-shaped bacteria in the genus Mycobacterium. The two most important species are M. tuberculosis (the cause of tuberculosis) and M. still constitute a public health problem in this tropical region. Despite decreases in incidence rates of malaria, leishmaniasis, tuberculosis, and leprosy, our study shows that these diseases are more common in persons with insufficient education of lower social classes than in other population groups. This reality is more stark and systematic in the Amazon region of Brazil than in other areas of this country. According to a report of the National Commission on Social Determinants in Health (6), Brazil is among countries with the most skewed skewed curve of a usually unimodal distribution with one tail drawn out more than the other and the median will lie above or below the mean. skewed Epidemiology adjective Referring to an asymmetrical distribution of a population or of data income distribution in the world, demonstrating the effects of social determinants as a main risk factor for illnesses in the region. Cases of autochthonous autochthonous /au·toch·tho·nous/ (aw-tok´thah-nus) 1. originating in the same area in which it is found. 2. denoting a tissue graft to a new site on the same individual. malaria in Brazil have decreased in 2007 and 2008. Data for December 2007 showed 455,899 cases (incidence rate 1,931.40/100,000 residents). This finding represents a reduction of 2,899 hospitalizations for this disease, a decrease of 32.9% from 2006 to 2007. This decrease was caused primarily by improved control of urban malaria (18-20). Integration of disease surveillance activities into the primary care network has been the main force behind improved control of malaria. Different forms of leishmaniasis are considered by the World Health Organization (21) to be a worldwide public health problem. In the Amazon region of Brazil, the incidence of leishmaniasis has decreased sharply from 108.6 cases/100,000 inhabitants in 2003 to 95.9 in 2004, 80.2 in 2005, and 62.0 in 2006; the degree of exposure was largely associated with disorganized dis·or·gan·ize tr.v. dis·or·gan·ized, dis·or·gan·iz·ing, dis·or·gan·iz·es To destroy the organization, systematic arrangement, or unity of. occupation of new areas. Therefore, cases tended to occur among populations in recent land settlements and former rainforest areas. Leishmania Leishmania /Leish·ma·nia/ (lesh-ma´ne-ah) a genus of parasitic protozoa, including several species pathogenic for humans. In some classifications, organisms are placed in four complexes comprising species and subspecies: L. (Viannia) guyanensis are protozoa enzootic en·zo·ot·ic adj. Prevalent among or restricted to animals of a specific geographic area. Used of a disease. n. An enzootic disease. enzootic peculiar to or present constantly in a location. See also endemic. to these areas. However, Campbell-Lendrum et al. (22) reported increasing domestication domestication Process of hereditary reorganization of wild animals and plants into forms more accommodating to the interests of people. In its strictest sense, it refers to the initial stage of human mastery of wild animals and plants. of cutaneous leishmaniasis cutaneous leishmaniasis n. An endemic disease in northern Africa and western and central Asia, caused by infection with promastigotes of Leishmania tropica and transmitted by the bite of a sandfly of the genus Phlebotomus. and its possible dissemination dissemination Medtalk The spread of a pernicious process–eg, CA, acute infection Oncology Metastasis, see there in households in large cities in the Amazon region of Brazil. Three serotypes of dengue virus dengue virus n. A virus of the genus Flavivirus that is the cause of dengue. (DEN-1, DEN-2, and DEN-3) are currently circulating cir·cu·late v. cir·cu·lat·ed, cir·cu·lat·ing, cir·cu·lates v.intr. 1. To move in or flow through a circle or circuit: blood circulating through the body. 2. in different regions of and have different regional manifestations. Brazil has the most cases of dengue fever in the Western Hemisphere Western Hemisphere Part of Earth comprising North and South America and the surrounding waters. Longitudes 20° W and 160° E are often considered its boundaries. ; [approximately equal to]70% of all cases are reported, and of this total, 17% are concentrated in the Amazon region of Brazil (23). When the risk factors for a dengue dengue or breakbone fever or dandy fever Infectious, disabling mosquito-borne fever. Other symptoms include extreme joint pain and stiffness, intense pain behind the eyes, a return of fever after brief pause, and a characteristic rash. epidemic in Goiania in the Central-West region of Brazil were analyzed, Siqueira et al. (24) noted a higher dengue prevalence among those with a lower educational level. This finding differs from our results and again highlights the specificities of disease in this region. Hospitalization rate for this disease increased for most of Brazil (16,25), but decreased in the Amazon region of Brazil during the study period from 61.6/100,000 in 2002 to 43.3 in 2006. In September 2008, data on the isolation of DEN-4 in the Amazon region were revised and now show that there is no evidence that this serotype serotype /se·ro·type/ (ser´o-tip) the type of a microorganism determined by its constituent antigens; a taxonomic subdivision based thereon. se·ro·type n. See serovar. v. circulates in the Amazon region of Brazil. Two thirds of the world's cases of tuberculosis are in Africa, the People's Republic People's Republic n. A political organization founded and controlled by a national Communist party. of China, and India (26). However, Brazil still has an elevated incidence rate for this disease; 42.9 cases/100,000 occurred in the Amazon region in 2007. Success in control of tuberculosis results from early detection of new cases and an effective treatment regimen regimen /reg·i·men/ (rej´i-men) a strictly regulated scheme of diet, exercise, or other activity designed to achieve certain ends. reg·i·men n. 1. . Tuberculosis incidence has remained constant in the Amazon region but the hospitalization rate for this disease has decreased. This decrease is the result of effective investment of resources in expanded access Expanded access refers to the inclusion of patients in a clinical trial for a new therapeutic treatment or chemical entity, where those patients would not satisfy the enrolment criteria for the scientific study in progress. to treatment in the primary care network. This investment has been made through greater focus on family health and strategies to strengthen the local autonomy and capacity to provide quality care, together with better health surveillance and monitoring activities. Incidence of leprosy in Brazil has shown an upward trend since 1980. However, in 2006, the number of new cases decreased to 61.9/100.000. Using negative binomial binomial (bī'nō`mēəl), polynomial expression (see polynomial) containing two terms, for example, x+y. The binomial theorem, or binomial formula, gives the expansion of the nth power of a binomial (x+ and Poisson distributions A statistical method developed by the 18th century French mathematician S. D. Poisson, which is used for predicting the probable distribution of a series of events. For example, when the average transaction volume in a communications system can be estimated, Poisson distribution is used to analyze trends in the incidence of leprosy, Penna pen·na n. pl. pen·nae A contour feather of a bird, as distinguished from a down feather or a plume. [Latin, feather; see pet- in Indo-European roots. and Penna (27) and Martelli et al. (28) reported that there should have been a constant incidence, not a sharp decrease, for this disease in 2006. Leprosy is a chronic disease that is not expected to show extensive epidemiologic changes in a short period. Our results suggest that fewer reports of leprosy cases were caused by reduced new-case detection during the study period. However, hospitalization rates for this disease in 2006 are similar to those of previous years. The SUS celebrated its 20th anniversary in 2008 and represents an ambitious example for confronting historic social inequalities in the national context through guaranteeing the right to universal healthcare. Integration of primary care and health surveillance programs has shown excellent results in the Amazon region of Brazil; particular success has occurred with malaria control, for which the number of blood slides prepared has increased from 150,000 to 450,000. Consequently, the numbers of persons who start treatment during the first 48 hours of onset of malaria symptoms has increased considerably. Conversely con·verse 1 intr.v. con·versed, con·vers·ing, con·vers·es 1. To engage in a spoken exchange of thoughts, ideas, or feelings; talk. See Synonyms at speak. 2. , factors that contribute to the presence of malaria, dengue fever, tuberculosis, leprosy, leishmaniasis, and other diseases in the Amazon region of Brazil are social inequality associated with poor funding of the public health system, imperfections in the integrated approach among the 3 spheres of government, and accelerated and disorderly urbanization of the metropolitan areas. Acknowledgments We thank the health professionals in the states and municipalities of Brazil, especially those working in primary healthcare and health surveillance; the technicians at the National Notifiable Disease Information System; Ana Nilce Silveira Maia Elkhoury, Ana Simplicio, Carla Magda Domingues, Draurio Barreira, Eduardo Hage Carmo, Fabiano Pimenta Jr., Giovanini Evelim Coelho, Heloiza Souza, Jose Lazaro de Brito Ladislau, Maria Leide Wan-Del-Rey de Oliveira, Rui Moreira Braz, Sonia Brito, and Stefano Codenotti; and the technicians and managers of the Health Surveillance Secretariat in the Ministry of Health for their assistance. Dr Penna is vice-minister for health surveillance at the Ministry of Health of Brazil and physician/researcher in the Tropical Medicine tropical medicine, study, diagnosis, treatment, and prevention of certain diseases prevalent in the tropics. The warmth and humidity of the tropics and the often unsanitary conditions under which so many people in those areas live contribute to the development and Department at the University of Brasilia. His research interests include infectious disease Infectious disease A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. control, mainly leprosy. References (1.) Cruz OG. Consideracoes gerais sobre as condicoes sanitarias do rio Madeira. Rio de Janeiro: Papelaria Americana; 1910. (2.) Brazilian Institute of Geography and Statistics. Population estimates for July 2007 [cited 2009 Jan 16]. Available from http://www.datasus.gov.br (3.) Ceccim RB, Pinto pinto Spotted horse, also called paint, piebald, skewbald, and other terms to describe variations in colour and markings. The American Indian ponies of the western U.S. were often pintos. Most pure-breed associations refuse to register horses with pinto colouring. LF. Education and specialization of health professionals and the political need to face social and regional inequalities [in Portuguese]. Revista Brasileira de Educacao Medica medica (māˑ·dē·k . 2007;31:266-77. DOI (Digital Object Identifier) A method of applying a persistent name to documents, publications and other resources on the Internet rather than using a URL, which can change over time. : 10.1590/S0100-55022007000300009 (4.) Brazilian Medical Association Associação Médica Brasileira (Brazilian Medical Association, in Portuguese language) is the national class association of physicians in Brazil. With more than 140,000 associates, is the second largest in the Americas, just after the American Medical Association. . Escolas Medicas do Brasil [cited 2009 Jan 17]. Available from http://www.escolasmedicas.com.br/intern2.php (5.) Brazil Ministry of Health. Cadastro Nacional de Estabelecimentos de Saude (CNES CNES Centre National d'Etudes Spatiales (French Space Agency) ). Recursos humanos--profissionais--individuos segundo a CBO CBO See: Collateralized Bond Obligation. 2002--Brasil [cited 2009 Jan 17]. Available from http://tabnet.datasus.gov.br/cgi/deftohtm.exe?cnes/cnv/prid02br.def DEF abbr. decayed, extraction indicated due to caries, or filled (used for permanent teeth) def abbr. (6.) National Commission on Social Determinants in Health. As causas sociais das iniquidades em saude no Brasil. Final Report, April 2008 [cited 2009 Jan 17]. Available from http://www.cndss.fiocruz.br/pdf/home/relatorio.pdf (7.) Confalonieri UE. Saude na Amazonia: um modelo conceitual para analise de paisagens e doencas. Estudos Avancados. 2005;19:221-36. DOI: 10.1590/S0103-40142005000100014 (8.) Brazil. Complementary law no. 124, January 3, 2007 [in Portuguese] [cited 2009 Jan 17]. 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(10.) Brazil Ministry of Health. Sistema de informacoes hospitalares do sistema unico de Saude (SIH-SUS). Informacoes de saude. Morbidade hospitalar. Ministerio da Saude [cited 2009 Jan 17]. Available from http://tabnet.datasus.gov.br/cgi/deftohtm.exe?sih/cnv/mrbr.def (11.) Pan American Health Organization The Pan American Health Organization (PAHO) is an international public health agency with 100 years of experience in working to improve health and living standards of the countries of the Americas. It serves as the specialized organization for health of the Inter-American System. . Rede interagencial de informacoes para a saude (RIPSA). Indicadores basicos de saude no Brasil: conceitos e aplicacoes. Brasilia: The Organization; 2008. (12.) Statistical analysis system software. Cary (NC): SAS Institute SAS Institute Inc., headquartered in Cary, North Carolina, USA, has been a major producer of software since it was founded in 1976 by Anthony Barr, James Goodnight, John Sall and Jane Helwig. . (13.) Santos Santos (sän`t  s), city (1996 pop. 412,288), São Paulo state, SE Brazil, on the island of São Vicente in the Atlantic just off the mainland. JL, Levy MS, Szmrecsanyi T, eds. Dinamica da
populacao-teoria, metodos a tecnicas de analise. Sao Paulo: TA Queiroz;
1980.
(14.) Brazilian Institute of Geography and Statistics. Contagem populacional de 1996. Rio de Janeiro: 1996 [cited 2009 Jan 17]. Available from http://www.sidra.ibge.gov.br/bda/tabela/listabl.asp?z=cd&o=15&i=P&c=473 (15.) Brazilian Institute of Geography and Statistics. Censo Demografico 2000 Educacao--Resultados da amostra. Arquivos EDUC EDUC Education EDUC Commission for Culture and Education (COR) MMMc_0003_XX_010200.XLS. Rio de Janeiro; 2000 [cited 2009 Jan 17]. Available from http://www.ibge.gov.br, link Estatistica/DownloaddeArquivos/Censo/CensoDemograficode2000/Educacao/ Municipios (16.) Siqueira JB Jr, Martelli CM, Coelho GE, Simplicio AC, Hatch DL. Dengue and dengue hemorrhagic fever hemorrhagic fever (hĕm'ərăj`ĭk), any of a group of viral diseases characterized by sudden onset, muscle and joint pain, fever, bleeding, and shock from loss of blood. , Brazil, 1981-2002. Emerg Infect infect /in·fect/ (in-fekt´) 1. to invade and produce infection in. 2. to transmit a pathogen or disease to. in·fect v. 1. Dis. 2005;11:48-53. (17.) Brazil Ministry of Education. Microdados do censo de educacao superior [cited 2009 Jan 17]. Available from http://www.inep.gov.br/basica/levantamentos/acessar.htm (18.) Marques Marques may refer to:
(19.) Gil LH, Tada MS, Katsuragawa TH, Ribolla PE, Silva sil·va also syl·va n. pl. sil·vas or sil·vae 1. The trees or forests of a region. 2. A written work on the trees or forests of a region. LH. Urban and suburban malaria in Rondonia (Brazilian Western Amazon). II. Perennial transmissions with high anopheline anopheline pertaining to the anopheles genus of mosquitoes. densities are associated with human environmental changes. Mem Inst Oswaldo Cruz. 2007;102:271-6. DOI: 10.1590/S0074-02762007005000013 (20.) Tada MS, Marques RP, Martha CD, Rodrigues JA, Neves Costa JD, Pepelascov RR, et al. Urban malaria in the Brazilian Western Amazon Region. I. High prevalence of asymptomatic carriers asymptomatic carrier, n an individual who serves as host for an infectious agent but who does not show any apparent signs of the illness; may serve as a source of infection for others. in an urban riverside district is associated with a high level of clinical malaria. Mem Inst Oswaldo Cruz. 2007;102:263-9. DOI: 10.1590/S0074-02762007005 000012 (21.) Control of the leishmaniases. Report of a WHO expert committee. World Health Organ Tech Rep TECH REP Technical Representative Ser. 1990;793:1-158. (22.) Campbell-Lendrum D, Dujardin JP, Martinez E, Feliciangeli MD, Perez JE, Silans LN, et al. Domestic and peridomestic transmission of American cutaneous leishmaniasis: changing epidemiological patterns present new control opportunities. Mem Inst Oswaldo Cruz. 2001;96:159-62. DOI: 10.1590/S0074-02762001000200004 (23.) Pan American Health Organization. Enfermedades infecciosas emergentes y reemergentes, EER EER - An extended entity-relationship model. Noticias, Region de 48. Las Americas-2007 [cited 2009 Jan 17]. Available from http://www.paho.org/Spanish/AD/DPC/CD/eid-eer-2007-09-26.htm#bra (24.) Siqueira JB Jr, Martelli CM, Maciel IJ, Oliveira RM, Ribeiro MG, Amorim FP, et al. Household survey of dengue infection in central Brazil: spatial point pattern analysis and risk factors assessment. Am J Trop Med Hyg. 2004;71:646-51. (25.) Maciel IJ, Siqueira Jr JB, Martelli CM. Epidemiologia e desafios no controle do dengue. Revista de Patologia Tropical. 2008;37:111-30. (26.) United Nations. The millennium development goals “MDG” redirects here. For other uses, see MDG (disambiguation). The Millennium Development Goals are eight goals that 192 United Nations member states have agreed to try to achieve by the year 2015. report. New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : United Nations Department of Economic and Social Affairs The United Nations Department of Economic and Social Affairs (UNDESA) is part of the United Nations Secretariat and is responsible for the follow-up to the major United Nations Summits and Conferences, as well as services to the Economic and Social Council and the Second and Third ; 2008. (27.) Penna ML, Penna GO. Trend of case detection and leprosy elimination in Brazil. Trop Med Int Health. 2007;12:647-50. (28.) Martelli CM, Stefani MM, Penna GO, Andrade AL. Endemias e epidemias brasileiras, desafios e perspectivas de investigacao cientifica: hanseniase. Revista Brasileira de Epidemiologia. 2002;5:273-85 DOI: 10.1590/S1415-790X2002000300006 DOI: 10.3201/eid1504.081329 Gerson Penna, Luiz Felipe Pinto, Daniel Soranz, and Ruth Glatt Glatt may refer to:
Address for correspondence: Gerson Penna, Ministry of Health of Brazil, Secretariat of Health Surveillance, Esplanada dos Ministerios, Bloco 5, Sala 105, Brasilia, Distrito Federal Distrito Federal (Spanish and Portuguese for Federal district) may refer to:
Author affiliations: University of Brasilia, Brasilia, Brazil (G. Penna); Serra dos Orgaos Education Foundation, Rio de Janeiro, Brazil (L.F. Pinto, D. Soranz); and Federal Ministry of Health, Brasilia (R. Glatt)
Table 1. Incidence indicators for 5 reportable diseases,
Brazil, 2008 *
Disease Indicator
Malaria Annual parasitic index for malaria
Leishmaniasis Incidence rate for forms
of leishmaniasis
Dengue fever Incidence rate for dengue fever
Leprosy Coefficient of leprosy detection
([dagger])
Tuberculosis Incidence rate for tuberculosis
Disease Criteria
Malaria No. positive examination results for malaria/
100,000 residents in a given geographic area in the
year under consideration (codes B50-B53; ICD-10).
Leishmaniasis No. new and confirmed cases of leishmaniasis (all
forms)/100,000 residents in the local population of
a given geographic area in the year under
consideration (code B55; ICD-10)
Dengue fever No. new dengue fever cases (classic and dengue
hemorrhagic forms)/100,000 residents in the local
population of a given geographic area in the year
under consideration (codes A90-A91; ICD-10)
Leprosy No. newly diagnosed cases/100,000 residents in the
([dagger]) local population of a given geographic area in the
year under consideration
Tuberculosis No. new and confirmed cases of tuberculosis (all
forms)/100,000 residents in the local population of
a given geographic area in the year under
consideration (codes A15-A19; ICD-10)
Disease Method of calculation
Malaria (No. positive test results for
malaria/total resident
population) x 100,000
Leishmaniasis (No. new/confirmed cases [all
forms] among residents/total
resident population) x 100,000
Dengue fever (No. new/confirmed cases [all
forms] among residents/total
resident population) x 100,000
Leprosy (No. new cases among
([dagger]) residents/total resident
population) x 100,000).
Tuberculosis (No. new/confirmed cases [all
forms] among residents/total
resident population) x 100,000
* Source: Pan American Health Organization (11). ICD-10,
International Classification of Diseases, 10th revision.
([dagger]) The technical control program of the Secretariat of Health
Surveillance/Ministry of Health began using a multiplication factor
of 100,000 population in August 2008 to make its detection rate data
for leprosy comparable with the incidence data for other diseases.
Table 2. Incidence and hospitalization rate, by age group, for 5
reportable diseases, Amazon region of Brazil *
2001 2002
Age group, y Incid. Hosp. Incid. Hosp.
Malaria
0-4 1,745.9 68.1 1,481.5 55.0
5-14 1,591.2 45.1 1,339.3 34.2
15-29 ([dagger]) 1,464.4 87.1 1,280.5 66.9
30-49 86.5 64.9
50-69 76.7 57.1
[greater than or 58.4 43.3
equal to] 70
Total 1,529.6 72.7 1,319.4 55.5
Leishmaniasis
0-4 28.6 11.4 32.6 10.0
5-14 37.0 2.6 37.0 2.2
15-29 106.1 2.1 108.3 2.2
30-49 113.7 2.5 116.4 2.4
50-69 97.2 4.0 99.9 4.0
[greater than or 68.3 58.0 66.9 43.3
equal to]70
Total 79.9 5.0 81.8 4.3
Dengue fever
0-4 86.7 8.4 48.1 13.0
5-14 152.3 21.7 96.7 30.0
15-29 347.0 55.8 199.4 72.2
30-49 423.5 64.8 259.2 85.9
50-69 358.2 82.2 251.4 109.0
[greater than or 258.7 88.6 160.2 115.7
equal to]70
Total 283.8 46.6 173.0 61.6
Leprosy
0-4 3.2 0.0 5.6 0.0
5-14 33.1 0.6 35.5 0.7
15-29 91.4 3.6 94.1 3.9
30-49 129.8 8.6 135.3 8.7
50-69 186.7 22.4 185.6 23.4
[greater than or 145.4 31.5 157.1 40.8
equal to]70
Total 84.8 5.8 87.9 6.2
Tuberculosis
0-4 10.8 2.3 10.8 3.1
5-14 8.7 1.7 8.4 1.3
15-29 58.0 9.0 56.2 7.6
30-49 77.7 15.8 77.1 14.8
50-69 109.3 27.6 107.9 21.9
[greater than or 144.4 33.4 145.2 32.2
equal to]70
Total 51.3 10.1 50.5 8.9
2003 2004
Age group, y Incid. Hosp. Incid. Hosp.
Malaria
0-4 1,545.5 54.0 1,682.3 55.6
5-14 1,714.9 28.6 1,920.3 33.3
15-29 ([dagger]) 2,227.1 63.2 2,465.4 68.6
30-49 2,118.1 59.0 2,376.7 62.3
50-69 1,558.5 48.2 1,813.2 51.8
[greater than or 689.9 41.0 788.4 47.9
equal to]70
Total 1,898.5 50.8 2,119.2 55.0
Leishmaniasis
0-4 44.2 11.5 43.8 10.8
5-14 45.9 1.7 42.2 2.1
15-29 131.1 1.6 117.9 1.8
30-49 135.1 2.6 124.0 2.1
50-69 107.3 4.3 98.3 3.4
[greater than or 76.6 40.7 68.9 47.7
equal to]70
Total 97.3 4.2 88.9 4.3
Dengue fever
0-4 57.8 15.1 29.4 10.1
5-14 112.1 32.7 52.9 21.3
15-29 235.3 74.3 123.8 50.0
30-49 298.0 81.0 165.3 55.3
50-69 275.4 109.6 154.7 71.8
[greater than or 168.6 114.9 105.0 91.1
equal to]70
Total 199.6 61.8 106.6 41.8
Leprosy
0-4 4.6 0.1 4.3 0.0
5-14 35.1 0.6 33.5 0.5
15-29 98.0 3.5 91.1 3.6
30-49 133.3 7.5 124.7 9.0
50-69 183.6 19.8 184.8 18.8
[greater than or 148.3 26.9 152.3 20.4
equal to]70
Total 88.0 5.1 83.8 5.2
Tuberculosis
0-4 10.2 3.8 9.4 5.5
5-14 7.6 1.6 7.4 1.5
15-29 55.5 11.6 55.8 12.8
30-49 78.2 16.3 75.5 16.8
50-69 105.3 25.4 108.6 26.8
[greater than or 127.5 32.8 141.6 37.6
equal to]70
Total 49.6 10.8 49.5 11.7
2005 2006
Age group, y Incid. Hosp. Incid. Hosp.
Malaria
0-4 2,185.0 58.4 2,057.8 51.4
5-14 2,610.5 33.9 2,428.9 26.8
15-29 ([dagger]) 2,967.1 70.0 2,573.0 52.9
30-49 2,869.0 60.9 2,469.6 47.0
50-69 2,326.1 57.8 2,025.7 42.7
[greater than or 1,102.7 63.5 964.5 41.0
equal to]70
Total 2,661.4 56.5 2,364.9 43.8
Leishmaniasis
0-4 39.6 16.5 33.5 16.6
5-14 34.1 2.7 29.2 3.0
15-29 97.6 2.0 75.4 2.0
30-49 106.0 2.3 84.1 2.6
50-69 92.4 3.7 75.3 3.2
[greater than or 62.6 63.3 61.2 41.0
equal to]70
Total 75.7 5.6 60.7 5.2
Dengue fever
0-4 38.4 13.3 44.4 12.0
5-14 87.7 28.6 85.7 25.7
15-29 197.8 65.7 165.4 51.8
30-49 256.9 72.4 221.5 56.0
50-69 227.7 91.1 216.3 68.4
[greater than or 157.1 113.7 151.6 78.9
equal to]70
Total 166.4 54.6 147.9 43.3
Leprosy
0-4 3.3 0.0 2.7 0.1
5-14 31.4 0.2 23.5 0.4
15-29 80.8 3.4 63.0 4.7
30-49 119.0 7.2 94.8 8.0
50-69 175.6 13.0 144.9 16.1
[greater than or 153.4 19.7 127.4 19.7
equal to]70
Total 78.0 4.2 61.9 5.1
Tuberculosis
0-4 7.9 6.4 6.9 1.1
5-14 7.4 1.4 6.5 0.6
15-29 51.5 9.4 48.2 5.8
30-49 72.7 14.5 70.0 12.5
50-69 109.7 24.0 106.4 21.2
[greater than or 136.2 35.1 134.3 26.6
equal to]70
Total 47.4 10.0 45.1 7.2
* Values were standardized by the Inter-Agency Health Information
Network (Pan American Health Organization, 2008) (11) for each
disease. Malaria: annual parasitic index/100,000 population;
leishmaniasis, dengue fever, and tuberculosis: incidence rate/100,000
population; leprosy: detection coefficient/100,000 population.
Incid., incidence; Hosp., hospitalization rate/100,000 population.
Data for malaria were obtained from the National Malaria Database
(2001 and 2002) and Information System of Epidemiological
Surveillance of Malaria (2003-2005), and data for the other diseases
were obtained from the National Notifiable Disease Information
System/Secretariat of Health Surveillance/Ministry of Health.
Incidence data were obtained from the Brazilian Institute of
Geography and Statistics, and hospitalization data were obtained from
the Hospitalization Information System/Ministry of Health.
([dagger]) For malaria in 2001 and 2002, this age group corresponds
to >15 years of age because the Ministry of Health used this age
group to tabulate the data.
Table 3. Incidence of 5 reportable diseases, by level of education,
Amazon region of Brazil *
Education level, y 2001 ([dagger]) 2002 ([dagger])
Malaria
<1 -- --
1-3 -- --
4-7 -- --
8-11 -- --
[greater than or -- --
equal to]12
Total -- --
Leishmaniasis
<1 146.0 121.3
1-3 19.9 101.0
4-7 181.0 120.0
8-11 31.2 45.1
[greater than or 24.8 65.0
equal to]12
Total 95.4 95.0
Dengue fever
<1 150.2 121.8
1-3 37.0 114.5
4-7 405.5 250.5
8-11 269.5 178.0
[greater than or 456.8 326.1
equal to]12
Total 251.0 187.3
Leprosy
<1 182.8 166.9
1-3 33.1 110.5
4-7 175.0 121.0
8-11 43.6 57.1
[greater than or 44.8 83.2
equal to]12
Total 107.2 108.2
Tuberculosis
<1 107.3 99.4
1-3 19.2 59.1
4-7 95.5 64.0
8-11 38.9 38.4
[greater than or 43.5 71.4
equal to]12
Total 63.8 61.1
Education level, y 2003 2004
Malaria
<1 3,501.2 2,141.0
1-3 3,934.6 4,199.2
4-7 1,674.0 1,883.4
8-11 582.1 682.9
[greater than or 1,405.5 1,197.3
equal to]12
Total 2,360.1 2,025.1
Leishmaniasis
<1 115.9 100.0
1-3 144.8 142.6
4-7 125.1 109.1
8-11 55.3 47.8
[greater than or 64.4 43.6
equal to]12
Total 108.6 95.9
Dengue fever
<1 101.4 53.4
1-3 180.8 118.5
4-7 209.1 112.2
8-11 228.9 120.1
[greater than or 405.0 204.2
equal to]12
Total 205.4 114.3
Leprosy
<1 147.9 138.7
1-3 137.2 135.7
4-7 102.6 94.5
8-11 63.9 58.5
[greater than or 88.5 69.7
equal to]12
Total 105.9 97.7
Tuberculosis
<1 87.5 82.3
1-3 76.1 70.4
4-7 49.8 49.4
8-11 39.2 44.5
[greater than or 55.8 54.6
equal to]12
Total 58.6 57.3
Education level, y 2005 2006
Malaria
<1 2,619.9 2,578.4
1-3 5,393.4 4,420.6
4-7 2,313.3 2,041.8
8-11 815.3 763.0
[greater than or 1,502.4 1,125.9
equal to]12
Total 2,473.7 2,094.3
Leishmaniasis
<1 90.7 66.6
1-3 122.3 96.0
4-7 95.2 74.2
8-11 42.0 33.9
[greater than or 33.3 26.2
equal to]12
Total 80.8 62.0
Dengue fever
<1 79.7 78.4
1-3 171.8 129.9
4-7 185.9 161.6
8-11 185.1 156.7
[greater than or 271.4 226.9
equal to]12
Total 177.6 151.4
Leprosy
<1 128.5 100.7
1-3 126.7 101.0
4-7 88.4 70.2
8-11 56.9 42.4
[greater than or 58.9 45.4
equal to]12
Total 90.0 69.3
Tuberculosis
<1 78.4 69.5
1-3 71.3 65.5
4-7 47.2 46.0
8-11 40.9 39.5
[greater than or 49.5 42.2
equal to]12
Total 54.3 50.2
* Values were standardized in the Inter-Agency Health Information
Network database (Pan American Health Organization, 2008) (11) for
each disease.
Malaria: annual parasitic index/100,000 population; leishmaniasis,
dengue fever, and tuberculosis: incidence rate/100,000 population;
leprosy: detection coefficient/100,000 population. Data for malaria
were obtained from the National Malaria Database (2001 and 2002) and
Information System of Epidemiological Surveillance of Malaria
(2003-2005), and data for the other diseases were obtained from the
National Notifiable Disease Information System/Secretariat of Health
Surveillance/Ministry of Health.
([dagger]) This information was not systematized for malaria in the
National Malaria Database in 2001 and 2002.
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