Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional da Universidade Federal do Ceará (UFC) |
Texto Completo: | http://www.repositorio.ufc.br/handle/riufc/58369 |
Resumo: | Leprosy contacts represent a priority population for the achievement of leprosy control, based on surveillance and care actions in Primary Health Care (PHC). In order to analyze operational patterns of leprosy case contact surveillance and possible epidemiological and operational factors that may influence the coverage of this action in the state of Ceará, we conducted a cross-sectional analytical study of time series and spatial analysis. We used the database of the Sistema de Informação de Agravos de Notificação (SINAN) for the 2008-2019 cohort for the analysis of coverage indicators and performance of contact examination, as well as the overall detection coefficient of new cases (NC). Binary logistic regression analysis was performed to verify the potential association between sociodemographic and clinical variables of NC with the performance of the evaluation of contacts examined among those registered (100% of contacts examined). The odds ratio (OR) was calculated for each independent variable, with 95% confidence intervals (95% CI). Variables with p-values less than 0.20 were included in the model for multivariate logistic regression analysis, with estimates of crude and adjusted OR and their respective 95% CI. Time trend analysis was based on Joinpoint regression, in addition to the analysis of time and space dimensions, respectively, by means of the Monte Carlo permutation method and spatial distribution over time. The worst proportion of assessed contacts among those registered occurred in the macro-region of Fortaleza (58.7%) and only the macro-region of Sobral recognized a tendency to increase. The proportion of CN among the contacts assessed, for the state varied between 0,6-1,2%, values close to those of the macro- region of Fortaleza (1,3-2,5%), but distant from the macro-region of Cariri (29,7%). There was a significant downward trend in the state in the period 2011-2019 (APC -17.6a 95%CI [-26.4 to -7.8]). A total of 234 potential cases were estimated among unexamined contacts in the state. We found a higher risk for not assessing all contacts registered mainly when the person with leprosy was: resident in rural area (OR - adjusted 2.01; 95%CI 1.81-2.22) and multibacillary case (OR - adjusted 1.19; 95%CI 1.11-1.28). For the analysis by Joinpoint, the general trend was an increase in leprosy cases where all contacts among the registered contacts were examined (APC 2.1*, 95%CI 1.2 to 3.0). There are gaps in the contact surveillance process, especially in the macro-region of Fortaleza and in the state capital. The Cariri macro-region has the highest detection coefficients with the best performance in contact surveillance and also stood out for having had the highest yield for detection of NC among the contacts examined. It is essential to understand to what extent the tendency of decrease of NC throughout the state is not related to failures in surveillance actions. We hope that the evidence generated can encourage the planning of surveillance actions of contacts directed to local realities, focusing on macro-regions with the worst performance, including those with of low PHC coverage. |
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Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019HanseníaseEpidemiologiaMonitoramento EpidemiológicoBusca de ComunicanteLeprosy contacts represent a priority population for the achievement of leprosy control, based on surveillance and care actions in Primary Health Care (PHC). In order to analyze operational patterns of leprosy case contact surveillance and possible epidemiological and operational factors that may influence the coverage of this action in the state of Ceará, we conducted a cross-sectional analytical study of time series and spatial analysis. We used the database of the Sistema de Informação de Agravos de Notificação (SINAN) for the 2008-2019 cohort for the analysis of coverage indicators and performance of contact examination, as well as the overall detection coefficient of new cases (NC). Binary logistic regression analysis was performed to verify the potential association between sociodemographic and clinical variables of NC with the performance of the evaluation of contacts examined among those registered (100% of contacts examined). The odds ratio (OR) was calculated for each independent variable, with 95% confidence intervals (95% CI). Variables with p-values less than 0.20 were included in the model for multivariate logistic regression analysis, with estimates of crude and adjusted OR and their respective 95% CI. Time trend analysis was based on Joinpoint regression, in addition to the analysis of time and space dimensions, respectively, by means of the Monte Carlo permutation method and spatial distribution over time. The worst proportion of assessed contacts among those registered occurred in the macro-region of Fortaleza (58.7%) and only the macro-region of Sobral recognized a tendency to increase. The proportion of CN among the contacts assessed, for the state varied between 0,6-1,2%, values close to those of the macro- region of Fortaleza (1,3-2,5%), but distant from the macro-region of Cariri (29,7%). There was a significant downward trend in the state in the period 2011-2019 (APC -17.6a 95%CI [-26.4 to -7.8]). A total of 234 potential cases were estimated among unexamined contacts in the state. We found a higher risk for not assessing all contacts registered mainly when the person with leprosy was: resident in rural area (OR - adjusted 2.01; 95%CI 1.81-2.22) and multibacillary case (OR - adjusted 1.19; 95%CI 1.11-1.28). For the analysis by Joinpoint, the general trend was an increase in leprosy cases where all contacts among the registered contacts were examined (APC 2.1*, 95%CI 1.2 to 3.0). There are gaps in the contact surveillance process, especially in the macro-region of Fortaleza and in the state capital. The Cariri macro-region has the highest detection coefficients with the best performance in contact surveillance and also stood out for having had the highest yield for detection of NC among the contacts examined. It is essential to understand to what extent the tendency of decrease of NC throughout the state is not related to failures in surveillance actions. We hope that the evidence generated can encourage the planning of surveillance actions of contacts directed to local realities, focusing on macro-regions with the worst performance, including those with of low PHC coverage.Os contatos de casos de hanseníase representam população prioritária para o alcance do controle desta doença, a partir de ações de vigilância e cuidado na Atenção Primária a Saúde (APS). Com o objetivo de analisar padrões operacionais da vigilância de contatos de casos de hanseníase e possíveis fatores epidemiológicos e operacionais que podem influenciar a cobertura desta ação no estado do Ceará, foi realizado estudo transversal analítico, de série temporal e com análise espacial. Utilizou-se a base de dados do Sistema de Informação de Agravos de Notificação (SINAN) referente à coorte de 2008-2019 para a análise dos indicadores de cobertura e de rendimento do exame de contatos, além do coeficiente de detecção geral de casos novos (CN). Realizada análise por regressão logística binária para verificar potencial associação entre variáveis sociodemográficas e clínicas de CN com o desempenho da avaliação de contatos examinados entre os registrados (100% dos contatos examinados). Calculou-se a odds ratio (OR) para cada variável independente, com intervalos de confiança de 95% (IC 95%). As variáveis com p-valor inferior a 0,20 foram incluídas no modelo para análise por regressão logística multivariada, com estimativas de OR bruta e ajustada e seus respectivos IC 95%. A análise de tendência temporal foi baseada em regressão por Joinpoint, além da análise de dimensões tempo e espaço, respectivamente, por meio do método de permutação de Monte Carlo e de distribuição espacial no tempo. A pior proporção de contatos avaliados entre os registrados ocorreu na macrorregião de Fortaleza (58,7%) e somente na macrorregião de Sobral reconheceu tendência de incremento. A proporção de CN entre os contatos avaliados, para o estado variou entre 0,6–1,2%, valores próximos aos da macrorregião de Fortaleza (1,3– 2,5%), mas distantes da macrorregião do Cariri (29,7%). Verificou-se tendência significativa de redução no estado no período de 2011–2019 (APC -17,6a IC95% [-26,4 a -7,8]). Estimou-se um total de 234 casos potenciais entre contatos não examinados no estado. Verificou-se maior risco para a não avaliação de todos os contatos registrados principalmente quando a pessoa com hanseníase era: residência na zona rural (OR – ajustado 2,01; IC95% 1,81-2,22) e caso multibacilar (OR – ajustado 1,19; IC95% 1,11-1,28). Para a análise por Joinpoint, a tendência geral foi de incremento dos casos de hanseníase em que todos os contatos examinados entre os registrados fossem examinados (APC 2,1*, IC95% 1,2 a 3,0). Há falhas no processo de vigilância do contato, em especial na macrorregião de Fortaleza e na capital do Estado. A macrorregião Cariri tem os maiores coeficientes de detecção com o melhor desempenho na vigilância dos contatos e destacou-se, ainda, por ter tido o maior rendimento para detecção de CN entre os contatos examinados. Torna-se central compreender em que medida a tendência de decréscimo de CN em todo o Estado não está relacionada a falhas em ações de vigilância. Espera-se que as evidências geradas possam fomentar o planejamento de ações de vigilância de contatos direcionadas as realidades locais, com foco nas macrorregiões de pior desempenho, incluindo aquelas com baixa cobertura da APS.Ramos Júnior, Alberto NovaesSouza, Eliana Amorim deSoares, Gerlânia Maria Martins de Melo2021-05-13T18:42:48Z2021-05-13T18:42:48Z2020-08-28info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfSOARES, G. M. M. M. Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019. 2020. 153 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2020.http://www.repositorio.ufc.br/handle/riufc/58369porreponame:Repositório Institucional da Universidade Federal do Ceará (UFC)instname:Universidade Federal do Ceará (UFC)instacron:UFCinfo:eu-repo/semantics/openAccess2022-05-20T13:49:24Zoai:repositorio.ufc.br:riufc/58369Repositório InstitucionalPUBhttp://www.repositorio.ufc.br/ri-oai/requestbu@ufc.br || repositorio@ufc.bropendoar:2024-09-11T18:37:29.824071Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)false |
dc.title.none.fl_str_mv |
Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019 |
title |
Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019 |
spellingShingle |
Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019 Soares, Gerlânia Maria Martins de Melo Hanseníase Epidemiologia Monitoramento Epidemiológico Busca de Comunicante |
title_short |
Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019 |
title_full |
Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019 |
title_fullStr |
Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019 |
title_full_unstemmed |
Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019 |
title_sort |
Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019 |
author |
Soares, Gerlânia Maria Martins de Melo |
author_facet |
Soares, Gerlânia Maria Martins de Melo |
author_role |
author |
dc.contributor.none.fl_str_mv |
Ramos Júnior, Alberto Novaes Souza, Eliana Amorim de |
dc.contributor.author.fl_str_mv |
Soares, Gerlânia Maria Martins de Melo |
dc.subject.por.fl_str_mv |
Hanseníase Epidemiologia Monitoramento Epidemiológico Busca de Comunicante |
topic |
Hanseníase Epidemiologia Monitoramento Epidemiológico Busca de Comunicante |
description |
Leprosy contacts represent a priority population for the achievement of leprosy control, based on surveillance and care actions in Primary Health Care (PHC). In order to analyze operational patterns of leprosy case contact surveillance and possible epidemiological and operational factors that may influence the coverage of this action in the state of Ceará, we conducted a cross-sectional analytical study of time series and spatial analysis. We used the database of the Sistema de Informação de Agravos de Notificação (SINAN) for the 2008-2019 cohort for the analysis of coverage indicators and performance of contact examination, as well as the overall detection coefficient of new cases (NC). Binary logistic regression analysis was performed to verify the potential association between sociodemographic and clinical variables of NC with the performance of the evaluation of contacts examined among those registered (100% of contacts examined). The odds ratio (OR) was calculated for each independent variable, with 95% confidence intervals (95% CI). Variables with p-values less than 0.20 were included in the model for multivariate logistic regression analysis, with estimates of crude and adjusted OR and their respective 95% CI. Time trend analysis was based on Joinpoint regression, in addition to the analysis of time and space dimensions, respectively, by means of the Monte Carlo permutation method and spatial distribution over time. The worst proportion of assessed contacts among those registered occurred in the macro-region of Fortaleza (58.7%) and only the macro-region of Sobral recognized a tendency to increase. The proportion of CN among the contacts assessed, for the state varied between 0,6-1,2%, values close to those of the macro- region of Fortaleza (1,3-2,5%), but distant from the macro-region of Cariri (29,7%). There was a significant downward trend in the state in the period 2011-2019 (APC -17.6a 95%CI [-26.4 to -7.8]). A total of 234 potential cases were estimated among unexamined contacts in the state. We found a higher risk for not assessing all contacts registered mainly when the person with leprosy was: resident in rural area (OR - adjusted 2.01; 95%CI 1.81-2.22) and multibacillary case (OR - adjusted 1.19; 95%CI 1.11-1.28). For the analysis by Joinpoint, the general trend was an increase in leprosy cases where all contacts among the registered contacts were examined (APC 2.1*, 95%CI 1.2 to 3.0). There are gaps in the contact surveillance process, especially in the macro-region of Fortaleza and in the state capital. The Cariri macro-region has the highest detection coefficients with the best performance in contact surveillance and also stood out for having had the highest yield for detection of NC among the contacts examined. It is essential to understand to what extent the tendency of decrease of NC throughout the state is not related to failures in surveillance actions. We hope that the evidence generated can encourage the planning of surveillance actions of contacts directed to local realities, focusing on macro-regions with the worst performance, including those with of low PHC coverage. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-08-28 2021-05-13T18:42:48Z 2021-05-13T18:42:48Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
SOARES, G. M. M. M. Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019. 2020. 153 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2020. http://www.repositorio.ufc.br/handle/riufc/58369 |
identifier_str_mv |
SOARES, G. M. M. M. Vigilância de contatos da hanseníase no estado do Ceará: fatores epidemiológicos e operacionais associados à cobertura de 2008-2019. 2020. 153 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2020. |
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http://www.repositorio.ufc.br/handle/riufc/58369 |
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Universidade Federal do Ceará (UFC) |
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