Áreas vulneráveis e fatores de risco a ocorrência da esquistossomose em Sergipe

• Autor(a) principal: Silva, Marília Matos Bezerra Lemos
• Data de Publicação: 2018
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFS
• Texto Completo: http://ri.ufs.br/jspui/handle/riufs/10354
• topic: Geografia médica; Esquistossomose; Esquistossomose em Sergipe; Saúde ambiental; Indicadores de saúde; Endemias; Esquistossomose mansônica; Vulnerabilidade; Análise geoespacial; Modelo reprodutivo; Schistosomiasis mansoni; Vulnerability; Geospatial analysis; Reproductive model; CIENCIAS HUMANAS::GEOGRAFIA

Nowadays, among the parasitic diseases that affect humans, schistosomiasis is one of the most widespread in the world. In Sergipe, the magnitude of its prevalence associated with its socioeconomic importance confers the disease great relevance as a public health problem (SVS, 2017). The ability to point out the spatial distribution of this parasite, as well as to determine potential areas for the occurrence of the disease, will have important implications in the planning actions of the control programs. In this perspective, from a systemic approach, the present study aims to evaluate the vulnerability and risk factors of the occurrence of schistosomiasis in endemic areas of the State of Sergipe. The study suggested in the thesis is based on the conception of epidemiological structure defined by Loureiro et al. (1979); in Cutter's perception of vulnerability (1996); in the methodological contributions of Batelle (DEE, 1973); and the use of geoprocessing techniques (spatial distribution and analysis - IDW and Kriging). The present research is divided into three stages. Initially it proposes a model of evaluation of the vulnerability to the occurrence of schistosomiasis in endemic areas of the state. It then carries out a mixed ecological descriptive study of temporal and analytical series to evaluate the evolution and the geographical distribution of the disease, while checking the association (Mann-Whitney test) between areas of high prevalence and socio-demographic and environmental variables of the state. Finally, an observational, cross-sectional observational epidemiological study was carried out in two hyperendemic areas of the state, aiming to present the different epidemiological patterns and the risk factors (logistic regression) associated with the occurrence of the disease. In the temporal analysis performed, there was no evidence of a change in the state epidemiological profile, indicating a decreasing positive trend of schistosomiasis in the coming years. Despite the fact that the hypothesis of a reduction in prevalence was confirmed, human infection rates were found to be very high in almost all of Sergipe, indicating the endemism of the disease in the state. The developed analyzes revealed indicators involved in the conformation and maintenance of the endemic structure, as well as identified areas of priority attention. It was also observed that indicators of quality of life and environmental variables are associated with the transmission of the disease in the state. Density estimators showed high vulnerability in the territories of Grande Aracaju, Baixo São Francisco e Sul Sergipano, historically endemic areas that present population groups with high risk of infection, validating the proposed model. In addition, they pointed out vulnerable areas in regions where there is a lack of concrete data on the endemic disease, the territory of the Sergipe Sertão Sertão is cited as an example. The logistic regression analysis showed a significant association between Schistosoma mansoni human infection and the variables: gender, occupation, schooling, income, habitability conditions and time of contact with water sources in both areas investigated, indicating diversity in risk and transmission of the disease. The products generated in the scope of this doctoral thesis will assist in planning and management of integrative actions aimed at health promotion, disease prevention and control programs.