Dengue no Nordeste brasileiro: aspectos climáticos e socioambientais em áreas de influência sob alto risco e recomendações para políticas públicas

• Autor(a) principal: Silva, Julio Cesar Barreto da
• Data de Publicação: 2020
• Outros Autores: [e-mail]
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/18272
• topic: Areas of Influence; Heat Maps; Moran Bivariate; National Basic Sanitation Policy; Excess Risk of Dengue; Áreas de Influência; Mapas de Calor; Moran Bivariado; Política Nacional de Saneamento Básico; Risco em excesso de Dengue; OUTROS

Brazil is a country with a large territorial extension and specific and well-defined climates for each region, which helps for an accurate analysis of dengue under different socio-environmental aspects. This disease has been expanding in the last years, highlighting the 2015-2016 outbreaks, with 20% of the total of cases notified in the Brazilian Northeast (NEB), with Rio Grande do Norte (RN) being one of the five Brazilian States under the largest disease incidence rates. This Region has the worst conditions of sanitation and social development in the country, with urban infrastructure and planning, in general, precarious or absent, which makes it associated with significant and constant socioeconomic impacts. In addition to these low living conditions, there is the issue of drought, which further favors the spread of the disease, as lack of water leads to its irregular storage and, under inadequate care, allows the proliferation of Aedes aegypti, its main vector-transmitter, with temperature and water being the main determinants of its reproductive cycle. In view of this problem, the objective is to raise the relative risk of dengue among the 1,794 NEB municipalities, by probabilistic study, via exploratory analysis of spatial data (AEDE), in order to elucidate regional characteristics between dengue and environment, considering, above all, climatic and socio-environmental aspects. It is about demonstrating the thesis that the average incidence of dengue (IDmed), in the NEB municipalities, suffers the effect of environmental interaction under a multicausal aspect. Thus, we seek to 1) understand these associations and identify areas of influence at high risk, to 2) proposed recommendations regarding possible actions in public health and socio-environmental governance policies, to minimize the degradation of the impacted population regarding the problem treated. For this, associations of IDmed with the environmental variables were analyzed, between 2001-2017, under different probabilistic methods. There was a greater statistical correlation of these IDmed, via Pearson's Determinant, to precipitation (PRP; -30.32%) and to the percentage of the population in high school (MED1824; 28.86%), both at p-value <0.0001, corroborating for t-test values. Regarding the spatial correlation, there was a greater response to: PRP (-0.2874), aging rate (02462), percentage of the population in households with garbage collection (0.2332) and macro-measurement index of water volume (IN011AE; 0.2020), all at p-value <0.001, via Moran Global; while, by Moran Bivariate Local and Excess Risk Map, to PRP and IN011AE. Heatmaps identified the State of RN as area under the highest IDmed, corroborating for analysis by Spatial Cluster, which measured its multicausal effect, with close z-values, to the multiple socio-environmental factors, especially to the poorest 60% of the population, PRP and MED1824. Finally, it is expected, with the data described and analyzed from the reality in focus, to have contributed to the ongoing improvement process, of public policy instruments aimed at tackling dengue, especially the National Basic Sanitation Policy, Law n. 11,445/2007, which proved to be effective in reducing IDmed increases, observed in only 4 of 230 of those municipalities that implemented it until 2018, meeting the correlations found in the demonstration of this thesis.