Mortalidade por esquistossomose mansoni no Brasil : modelagem de risco espaço-temporal e associação com indicadores socioeconômicos

• Ano de defesa: 2021
• Autor(a) principal: Paz, Wandklebson Silva da
• Orientador(a): Santos, Márcio Bezerra
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Programa de Pós-Graduação: Pós-Graduação em Biologia Parasitária
• Palavras-chave em Português: Schistosoma mansoni; Esquistossomose; Mortalidade; Análise espacial (Estatística); Epidemiologia; Indicadores socioeconômicos; Distribuição espacial; Série temporal
• Palavras-chave em Inglês: Mortality; Epidemiology; Socioeconomic indicators; Spatial distribution; Time series
• Área do conhecimento CNPq: CIENCIAS BIOLOGICAS::PARASITOLOGIA
• Link de acesso: https://ri.ufs.br/jspui/handle/riufs/14570

Schistosomiasis is a chronic-parasitic disease, caused by worms of the genus Schistosoma and classified into the Neglected Tropical Diseases. It still represents a serious public health problem, with significant mortality rates and socioeconomic impact worldwide, affecting nearly 240 million people in 78 countries in Africa, Asia, and Latin America. In Brazil, schistosomiasis mansoni is endemic in 19 states, with an estimated over 1.5 million infected people. Considering this, our study aimed to assess the epidemiological aspects and spatiotemporal patterns associated with schistosomiasis-related mortality in Brazil, between 1999 and 2018. We conducted an ecological, time series and spatial analysis study using mortality data obtained from the Brazilian Ministry of Health's Mortality Information System (SIM/DATASUS/MSB). First, we analyzed all deaths that occurred in Brazil between 1999 and 2018, in which schistosomiasis was mentioned as a basic or associated cause of death. Next, we calculated the specific mortality coefficients to analyze time trends using segmented linear regression. We also investigated the factors associated to death from schistosomiasis, comparing them with general deaths. Additionally, the causes of death that have often been associated with schistosomiasis have been described. For spatial analysis, we used the spatial autocorrelation analyzes using the global Moran Index and local Moran, and retrospective spatiotemporal scanning statistics. Finally, we carried out herein a correlation analysis between schistosomiasis-related mortality and socioeconomic factors. We observed herein that 14,419 deaths related to schistosomiasis were recorded in Brazil between 1999 and 2018, with an average coefficient of mortality for the entire period of 0.38 per 100,000 inhabitants. During the time series, mortality showed a decreasing trend at the national level, however with different patterns among regions. Importantly, there was a reduction in mortality in all regions through basic and multiple causes and a pattern of stability through associated causes. Additionally, the major mortality causes associated with schistosomiasis as a basic cause were mainly liver complications, such as general diseases of the digestive system (13.51%), general liver diseases (11.28%), shock (8.90%), esophageal varices (8.10%) and fibrosis and liver cirrhosis (7.85%). Spatial analysis identified high-risk clusters for schistosomiasis-related mortality involving states in the Northeast and Southeast regions of Brazil. The correlation analysis showed that mortality related to schistosomiasis had a significant association with 47/48 socioeconomic indicators. As a result, despite the reduction in mortality from schistosomiasis in Brazil, the disease is still a neglected cause of death, with considerable regional differences. Proposals and actions to combat the disease should focus on increasing coverage and intensified control measures targeted at each region, to avoid the occurrence of severe forms of schistosomiasis and associated deaths.