Papers by Francisco Rogerlândio Martins-Melo
The Lancet HIV, 2021
Background The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat... more Background The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident ...
Lancet, 2020
Background In an era of shifting global agendas and expanded emphasis on non-communicable disease... more Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries.
PLOS Negleted Tropical Diseases, 2018
Leishmaniasis are diseases caused by obligatory intracellular parasites of the genus Leishmania a... more Leishmaniasis are diseases caused by obligatory intracellular parasites of the genus Leishmania and are transmitted to humans through the bite of female sandflies during blood repast. Untreated visceral leishmaniasis can lead to death, while cutaneous and mucocutaneous forms generally do not pose risk of death but can cause disability and permanent injury, which raises stigma and social prejudice. The Global Burden of Disease Study (GBD) is a systematic and scientific effort to quantify the health loss caused by infectious and non-infectious diseases and injury and their risk factors categorized by age, sex, and geographic distribution at specific periods of time. The present article describes, for the first time, the burden of leishmaniasis in the 27 Brazilian federated units. The VL burden increased in some states in the Northeast and Southeast regions and decreased for CML in some Northern states. Understanding the burden of these diseases and their regional differences is of great relevance for the establishment of adequate and region-specific surveillance and control measures. In addition, it can help in the rational use of available resources and in decision making aimed at reducing the transmission of the parasite and the burden of this disabling and potentially lethal disease.
To describe mortality from neglected tropical diseases (NTDs) in Brazil, 2000-2011. Methods We ex... more To describe mortality from neglected tropical diseases (NTDs) in Brazil, 2000-2011. Methods We extracted information on cause of death, age, sex, ethnicity and place of residence from the nationwide mortality information system at the Brazilian Ministry of Health. We selected deaths in which the underlying cause of death was a neglected tropical disease (NTD), as defined by the World Health Organization (WHO) and based on its International statistical classification of diseases and related health problems, 10th revision (ICD-10) codes. For specific NTDs, we estimated crude and age-adjusted mortality rates and 95% confidence intervals (CI). We calculated crude and age-adjusted mortality rates and mortality rate ratios by age, sex, ethnicity and geographic area. Findings Over the 12-year study period, 12 491 280 deaths were recorded; 76 847 deaths (0.62%) were caused by NTDs. Chagas disease was the most common cause of death (58 928 deaths; 76.7%), followed by schistosomiasis (6319 deaths; 8.2%) and leishmaniasis (3466 deaths; 4.5%). The average annual age-adjusted mortality from all NTDs combined was 4.30 deaths per 100 000 population (95% CI: 4.21-4.40). Rates were higher in males: 4.98 deaths per 100 000; people older than 69 years: 33.12 deaths per 100 000; Afro-Brazilians: 5.25 deaths per 100 000; and residents in the central-west region: 14.71 deaths per 100 000. Conclusion NTDs are important causes of death and are a significant public health problem in Brazil. There is a need for intensive integrated control measures in areas of high morbidity and mortality.
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The present study reports the experience of a student/professional undertaking a Distance e-learn... more The present study reports the experience of a student/professional undertaking a Distance e-learning (DeL) specialization course in Family Health at the Federal University of Ceará, Brazil. The target group consisted of physicians, nurses and dentists of the primary health care teams in the Family Health Strategy of the municipalities of Ceará state. The Modular Object-Oriented Dynamic Learning Environment (Moodle) was used. This is an online teaching and learning system with various communication tools integrated in a web page, where the disciplines offered are accessed and interaction with a teacher/tutor occurs. The pedagogical assumptions of the course were based on contextually decentralized education and collaborative problematizing learning processes articulated through theory-practice and teaching-health service demands. The incorporation of DeL into the vocational training processes of primary health care professionals constitutes an example, as well as an encouragement, to...
We analyzed spatiotemporal patterns of 8,756 schistosomiasis-related deaths in Brazil during 2000... more We analyzed spatiotemporal patterns of 8,756 schistosomiasis-related deaths in Brazil during 2000–2011 and identified high-risk clusters of deaths, mainly in highly schistosomiasis-endemic areas along the coast of Brazil’s Northeast Region. Schistosomiasis remains a neglected public health problem with a high number of deaths in disease-endemic and emerging focal areas.
Revista de Saúde Pública
OBJETIVO Analisar tendências temporais e padrões de distribuição espacial do aborto inseguro no B... more OBJETIVO Analisar tendências temporais e padrões de distribuição espacial do aborto inseguro no Brasil. MÉTODOS Estudo ecológico realizado com base nos registros das internações hospitalares de mulheres por abortamento no Brasil, no período de 1996-2012, obtidos do Sistema de Informações Hospitalares do Ministério da Saúde. Estimou-se o número de abortos inseguros segundo local de residência, utilizando-se técnicas de estimativas indiretas. Foram calculados os indicadores: razão de aborto inseguro por 100 nascidos vivos e coeficiente de aborto inseguro por 1.000 mulheres em idade fértil. As tendências temporais foram analisadas por regressão polinomial e a distribuição espacial utilizando os municípios brasileiros como unidade de análise. RESULTADOS Foram registradas 4.007.327 internações hospitalares por abortamento no Brasil no período. Estimou-se um total de 16.905.911 abortos inseguros, com média anual de 994.465 abortos (coeficiente médio de aborto inseguro de 17,0 abortos/1.00...
Journal of Tropical Medicine
Chagas disease in patients with HIV infection represents a potentially serious event with high ca... more Chagas disease in patients with HIV infection represents a potentially serious event with high case fatality rates. This study describes epidemiological and clinical aspects of deaths related to Chagas disease and HIV/AIDS coinfection in Brazil, 1999-2007. We performed a descriptive study based on mortality data from the nationwide Mortality Information System. Of a total of about 9 million deaths, Chagas disease and HIV/AIDS were mentioned in the same death certificate in 74 cases. AIDS was an underlying cause in 77.0% (57) and Chagas disease in 17.6% (13). Males (51.4%), white skin color (50%), age group 40-49 years (29.7%), and residents in the Southeast region (75.7%) were most common. Mean age at death was significantly lower in the coinfected (47.1 years [SD ± 14.6]), as compared to Chagas disease deaths (64.1 years [SD ± 14.7], P < 0.001). Considering the lack of data on morbidity related to Chagas disease and AIDS coinfection, the use of mortality data may be an appropria...
Cadernos de Saúde Pública, 2015
Objective To describe patterns of spatial distribution of mortality associated with Chagas’ dise... more Objective To describe patterns of spatial distribution of mortality associated with Chagas’ disease in Brazil.Methods Nationwide study of all deaths in Brazil from 1999 to 2007, where Chagas’ disease was recorded as a cause of death. Data were obtained from the national Mortality Information System of the Ministry of Health. We calculated the mean mortality rate for each municipality of residence in three-year intervals and the entire period. Empirical Bayes smoothing was used to minimise random variation in mortality rates because of the population size in the municipalities. To evaluate the existence of spatial autocorrelation, global and local Moran’s I indices were used.Results The nationwide mean mortality rate associated with Chagas’ disease was 3.37/100 000 inhabitants/year, with a maximum of 138.06/100 000 in one municipality. Independently from the statistical approach, spatial analysis identified a large cluster of high risk for mortality by Chagas’ disease, involving nine states in the Central region of Brazil.Conclusion This study defined geographical priority areas for the management of Chagas’ disease and consequently reducing disease-associated mortality in Brazil. Different spatial-analytical approaches can be integrated to provide data for planning, monitoring and evaluating specific intervention measures.Objectif: Décrire les modes de distribution spatiale de la mortalité associée à la maladie de Chagas au Brésil.Méthodes: Etude nationale de tous les décès au Brésil de 1999 à 2007, pour lesquels la maladie de Chagas a été enregistrée comme une cause du décès. Les données ont été obtenues du Système d’Information Nationale sur la Mortalité, du Ministère de la Santé. Nous avons calculé le taux moyen de mortalité pour chaque municipalité de résidence par intervalles de trois ans et pour toute la période. La méthode empirique Bayes d’ajustement a été utilisée pour minimiser la variation aléatoire dans les taux de mortalité due à la taille de la population dans les municipalités. Afin d’évaluer l’existence d’une auto corrélation spatiale, les indices I globaux et locaux de Moran ont été utilisés.Résultats: Le taux moyen de mortalité nationale associée à la maladie de Chagas était de 3,37/100.000 habitants par an, avec un maximum de 138.06/100.000 dans une seule municipalité. Indépendamment de l’approche statistique, l’analyse spatiale a identifié un grand regroupement à risque élevé de mortalité par la maladie de Chagas, englobant 9 états dans la région centrale du Brésil.Conclusion: Cette étude a défini les zones géographiques prioritaires pour la prise en charge de la maladie de Chagas et par conséquent pour la réduction de la mortalité associée à la maladie au Brésil. Différentes approches analytiques spatiales peuvent être intégrées afin de fournir des données pour la planification, le suivi et l’évaluation de mesures d’intervention spécifiques.Objectif: Décrire les modes de distribution spatiale de la mortalité associée à la maladie de Chagas au Brésil.Méthodes: Etude nationale de tous les décès au Brésil de 1999 à 2007, pour lesquels la maladie de Chagas a été enregistrée comme une cause du décès. Les données ont été obtenues du Système d’Information Nationale sur la Mortalité, du Ministère de la Santé. Nous avons calculé le taux moyen de mortalité pour chaque municipalité de résidence par intervalles de trois ans et pour toute la période. La méthode empirique Bayes d’ajustement a été utilisée pour minimiser la variation aléatoire dans les taux de mortalité due à la taille de la population dans les municipalités. Afin d’évaluer l’existence d’une auto corrélation spatiale, les indices I globaux et locaux de Moran ont été utilisés.Résultats: Le taux moyen de mortalité nationale associée à la maladie de Chagas était de 3,37/100.000 habitants par an, avec un maximum de 138.06/100.000 dans une seule municipalité. Indépendamment de l’approche statistique, l’analyse spatiale a identifié un grand regroupement à risque élevé de mortalité par la maladie de Chagas, englobant 9 états dans la région centrale du Brésil.Conclusion: Cette étude a défini les zones géographiques prioritaires pour la prise en charge de la maladie de Chagas et par conséquent pour la réduction de la mortalité associée à la maladie au Brésil. Différentes approches analytiques spatiales peuvent être intégrées afin de fournir des données pour la planification, le suivi et l’évaluation de mesures d’intervention spécifiques.Objetivo: Describir los patrones de distribución espacial de la mortalidad asociada a la enfermedad de Chagas en Brasil.Métodos: Estudio a nivel nacional de todas las muertes acontecidas en Brasil entre 1999 y el 2007, en las que se identificó la enfermedad de Chagas como causa de muerte. Los datos se obtuvieron del Sistema Nacional de Información sobre Mortalidad del Ministerio de Salud. Calculamos la tasa media de mortalidad para cada municipio de residencia en intervalos de tres años y en el periodo completo. Se realizó un suavizado por el método empírico Bayesiano para minimizar la variación aleatoria en las tasas de mortalidad debidas al tamaño de la población en los municipios.Resultados: La tasa media de mortalidad a nivel nacional asociada a la enfermedad de Chagas era de 3.37/100,000 habitantes/año, con un máximo de 138.06/100,000 en una municipalidad. Independientemente del enfoque estadístico, el análisis espacial identificó un gran conglomerado de alto riesgo para mortalidad por enfermedad de Chagas, que involucraba 9 estados de la región Central del Brasil.Conclusión: Este estudio definióáreas geográficas de prioridad para el manejo de la enfermedad de Chagas y consecuentemente, la reducción de la mortalidad asociada a esta enfermedad en Brasil. Se pueden integrar diferentes enfoques de análisis espacial que provean datos para planear, monitorizar y evaluar medidas específicas de intervención.Objetivo: Describir los patrones de distribución espacial de la mortalidad asociada a la enfermedad de Chagas en Brasil.Métodos: Estudio a nivel nacional de todas las muertes acontecidas en Brasil entre 1999 y el 2007, en las que se identificó la enfermedad de Chagas como causa de muerte. Los datos se obtuvieron del Sistema Nacional de Información sobre Mortalidad del Ministerio de Salud. Calculamos la tasa media de mortalidad para cada municipio de residencia en intervalos de tres años y en el periodo completo. Se realizó un suavizado por el método empírico Bayesiano para minimizar la variación aleatoria en las tasas de mortalidad debidas al tamaño de la población en los municipios.Resultados: La tasa media de mortalidad a nivel nacional asociada a la enfermedad de Chagas era de 3.37/100,000 habitantes/año, con un máximo de 138.06/100,000 en una municipalidad. Independientemente del enfoque estadístico, el análisis espacial identificó un gran conglomerado de alto riesgo para mortalidad por enfermedad de Chagas, que involucraba 9 estados de la región Central del Brasil.Conclusión: Este estudio definióáreas geográficas de prioridad para el manejo de la enfermedad de Chagas y consecuentemente, la reducción de la mortalidad asociada a esta enfermedad en Brasil. Se pueden integrar diferentes enfoques de análisis espacial que provean datos para planear, monitorizar y evaluar medidas específicas de intervención.
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2014
Visceral leishmaniasis (VL)-HIV/AIDS co-infection is an emerging health problem with high case fa... more Visceral leishmaniasis (VL)-HIV/AIDS co-infection is an emerging health problem with high case fatality. This study presents the epidemiological and clinical aspects of deaths related to VL-HIV/AIDS co-infection in Brazil. This was a nationwide population-based study based on mortality data obtained from the Brazilian Mortality Information System. We included all deaths between 2000 and 2011 (about 12.5 million), and analyzed those in which VL and HIV/AIDS were mentioned in the same death certificate. VL and HIV/AIDS were mentioned in 272 deaths. HIV/AIDS was the underlying cause in 59.6% (162/272) of deaths by VL-HIV/AIDS co-infection, and VL the underlying cause in 39.3% (107/272). Predominating characteristics were: male gender (79.0%, 215/272), age 30-39 years (41.0%, 111/271), brown race/color (61.6%, 159/258) and residence in the Northeast region (47.4%, 129/272). Average annual age-adjusted mortality rate was 0.13 deaths/1 000 000 inhabitants. Deaths were distributed in 20 of...
Revista de Saúde Pública
OBJETIVO Analisar tendências temporais e padrões de distribuição espacial do aborto inseguro no B... more OBJETIVO Analisar tendências temporais e padrões de distribuição espacial do aborto inseguro no Brasil. MÉTODOS Estudo ecológico realizado com base nos registros das internações hospitalares de mulheres por abortamento no Brasil, no período de 1996-2012, obtidos do Sistema de Informações Hospitalares do Ministério da Saúde. Estimou-se o número de abortos inseguros segundo local de residência, utilizando-se técnicas de estimativas indiretas. Foram calculados os indicadores: razão de aborto inseguro por 100 nascidos vivos e coeficiente de aborto inseguro por 1.000 mulheres em idade fértil. As tendências temporais foram analisadas por regressão polinomial e a distribuição espacial utilizando os municípios brasileiros como unidade de análise. RESULTADOS Foram registradas 4.007.327 internações hospitalares por abortamento no Brasil no período. Estimou-se um total de 16.905.911 abortos inseguros, com média anual de 994.465 abortos (coeficiente médio de aborto inseguro de 17,0 abortos/1.00...
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A doença de Chagas é uma Doença Tropical Negligenciada e um problema de saúde pública, com signif... more A doença de Chagas é uma Doença Tropical Negligenciada e um problema de saúde pública, com significativas implicações socioeconômicas na maioria dos países latino-americanos, incluindo o Brasil. Este estudo objetivou caracterizar a magnitude e os padrões da mortalidade relacionada à doença de Chagas no Brasil. Foi realizado estudo analítico com dados de mortalidade obtidos do Sistema de Informação sobre Mortalidade do Ministério da Saúde (SIM/DATASUS/MS). Analisaram-se todos os óbitos ocorridos no Brasil entre 1999 e 2007, nos quais a doença de Chagas foi mencionada como causa básica ou associada de morte. Calcularam-se os coeficientes de mortalidade específicos e a mortalidade proporcional para analisar as tendências temporais por meio de regressão polinomial. Fatores associados ao óbito pela doença de Chagas foram investigados por meio da comparação com os óbitos gerais. Para a análise de autocorrelação espacial com os municípios como unidade de observação foram utilizados os métodos: Moran global, Getis-Ord General G, Moran local e estatística Gi*. Entre 1999 e 2007, houve 53.930 óbitos relacionados à doença de Chagas no Brasil (44.543 como causa básica e 9.387 como causa associada), com coeficiente médio de mortalidade de 3,78/100.000 habitantes e mortalidade proporcional de 0,6%. Durante o período de estudo, a mortalidade apresentou tendência de declínio a nível nacional (p=0,011), porém com padrões diferenciados entre as regiões. Observou-se redução da mortalidade nas regiões Centro-Oeste (p=0,001), Sudeste (p=0,007) e Sul (p=0,028), mas a região Nordeste apresentou tendência de crescimento (p=0,047) e a Norte de estabilidade da mortalidade (p=0,309). Na análise multivariada foram independentemente associados à mortalidade: idade maior de 30 anos (odds ratio -OR ajustada=10,60; IC95% 9,90-11,33; p<0,001); residir nos estados de Minas Gerais, Goiás e Distrito Federal (OR ajustada=4,89; IC95% 4,80-4,98; p<0,001); não morar em capital de estado (OR ajustada=1,04; IC95% 1,02-1,06; p<0,001) e sexo masculino (OR ajustada=1,02; IC95% 1,00-1,03; p=0,045). As principais causas associadas à doença de Chagas como causa básica foram as complicações diretas do envolvimento cardíaco, incluindo os transtornos de condução/arritmias (41,4%) e a insuficiência cardíaca (37,7%). As doenças cerebrovasculares (13,2%), isquêmicas do coração (13,2%) e hipertensivas (9,3%) foram as principais causas básicas nos óbitos em que a doença de Chagas foi causa associada. A análise espacial identificou um extenso agregado espacial (cluster) de alto risco para mortalidade relacionada à doença de Chagas envolvendo oito estados na região central do Brasil e mais quatro clusters menores. Apesar do declínio da mortalidade relacionada à doença de Chagas no Brasil, esta continua sendo uma importante causa de morte em áreas endêmicas e com marcantes diferenças regionais. Com o declínio da transmissão vetorial, as deficiências no sistema público para a sua prevenção, controle e tratamento, principalmente nas regiões Norte e Nordeste, precisam ser superadas. O desafio é garantir acesso adequado aos serviços de saúde e assistência social para o grande número de indivíduos com doença de Chagas na fase crônica, que se acumularam durante as últimas décadas.
Revista de Saúde Pública, 2014
To analyze temporal trends and distribution patterns of unsafe abortion in Brazil.
Rev. Soc. Bras. Med. Trop., 2012
Introduction: Chagas' disease is a major public health problem in Brazil and needs extensive and ... more Introduction: Chagas' disease is a major public health problem in Brazil and needs extensive and reliable information to support consistent prevention and control actions. This study describes the most common causes of death associated with deaths related to Chagas' disease (underlying or associated cause of death). Methods: Mortality data were obtained from the Mortality Information System of the Ministry of Health (approximately 9 million deaths). We analyzed all deaths that occurred in Brazil between 1999 and 2007, where Chagas' disease was mentioned on the death certificate as underlying or associated cause (multiple causes of death). Results: There was a total of 53,930 deaths related to Chagas' disease, 44,543 (82.6%) as underlying cause and 9,387 (17.4%) as associated cause. The main diseases and conditions associated with death by Chagas' disease as underlying cause included direct complications of cardiac involvement, such as conduction disorders/arrhythmias (41.4%) and heart failure (37.7%). Cerebrovascular disease (13.2%), ischemic heart disease (13.2%) and hypertensive diseases (9.3%) were the main underlying causes of deaths in which Chagas' disease was identified as an associated cause. Conclusions: Cardiovascular diseases were often associated with deaths related to Chagas' disease. Information from multiple causes of death recorded on death certificates allows reconstruction of the natural history of Chagas' disease and suggests preventive and therapeutic potential measures more adequate and specifics.
J Infect Dev Ctries, 2012
Introduction: Studies on mortality due to parasitic diseases such as Chagas disease are useful to... more Introduction: Studies on mortality due to parasitic diseases such as Chagas disease are useful to understand the epidemiology and to plan and guide control measures for these diseases. We analyzed mortality trends due to Chagas disease in Brazil and regions, between 1979 and. Methodology: Mortality data (underlying cause of death) were obtained from the nationwide Mortality Information System (SIM) of the Ministry of Health. We calculated crude mortality rates and rates standardized by age, as well as proportional mortality. Results: In total, 27,560,043 deaths occurred in the study period. In 172,066 deaths, Chagas disease was mentioned as the underlying cause (proportional mortality: 0.62%). The mean crude and age-standardized mortality rates were 3.61 and 5.19 deaths/100,000 inhabitants/year, respectively. During the observation period, Chagas mortality declined significantly at the national level (R 2 =97%, p<0.001), with different patterns between regions. There was a significant reduction in mortality in the Central-West (R 2 =90%, p<0.001), Southeast (R 2 =98%, p<0.001) and South (R 2 =94%, p< 0.001), but in the North (R 2 =34%, p=0.001) and Northeast (R 2 =65%, p<0.001) regions mortality increased. Conclusions: Despite the overall decline in mortality due to Chagas disease in Brazil, it remains an important public health problem. After successful control of the primary vector Triatoma infestans, intervention measures must focus on improved access to health care and secondary prevention. The North and Northeast regions, where vectors other than T. infestans have a primary role, need special attention.
Journal of Tropical Medicine, 2012
Tropical Medicine & International Health, 2014
objective To estimate the prevalence of Chagas disease in pregnant women and the risk of congenit... more objective To estimate the prevalence of Chagas disease in pregnant women and the risk of congenital transmission of Trypanosoma cruzi infection in Brazil, through a systematic review and meta-analysis.
Tropical Medicine & International Health, 2012
Objective To describe patterns of spatial distribution of mortality associated with Chagas’ dise... more Objective To describe patterns of spatial distribution of mortality associated with Chagas’ disease in Brazil.Methods Nationwide study of all deaths in Brazil from 1999 to 2007, where Chagas’ disease was recorded as a cause of death. Data were obtained from the national Mortality Information System of the Ministry of Health. We calculated the mean mortality rate for each municipality of residence in three-year intervals and the entire period. Empirical Bayes smoothing was used to minimise random variation in mortality rates because of the population size in the municipalities. To evaluate the existence of spatial autocorrelation, global and local Moran’s I indices were used.Results The nationwide mean mortality rate associated with Chagas’ disease was 3.37/100 000 inhabitants/year, with a maximum of 138.06/100 000 in one municipality. Independently from the statistical approach, spatial analysis identified a large cluster of high risk for mortality by Chagas’ disease, involving nine states in the Central region of Brazil.Conclusion This study defined geographical priority areas for the management of Chagas’ disease and consequently reducing disease-associated mortality in Brazil. Different spatial-analytical approaches can be integrated to provide data for planning, monitoring and evaluating specific intervention measures.Objectif: Décrire les modes de distribution spatiale de la mortalité associée à la maladie de Chagas au Brésil.Méthodes: Etude nationale de tous les décès au Brésil de 1999 à 2007, pour lesquels la maladie de Chagas a été enregistrée comme une cause du décès. Les données ont été obtenues du Système d’Information Nationale sur la Mortalité, du Ministère de la Santé. Nous avons calculé le taux moyen de mortalité pour chaque municipalité de résidence par intervalles de trois ans et pour toute la période. La méthode empirique Bayes d’ajustement a été utilisée pour minimiser la variation aléatoire dans les taux de mortalité due à la taille de la population dans les municipalités. Afin d’évaluer l’existence d’une auto corrélation spatiale, les indices I globaux et locaux de Moran ont été utilisés.Résultats: Le taux moyen de mortalité nationale associée à la maladie de Chagas était de 3,37/100.000 habitants par an, avec un maximum de 138.06/100.000 dans une seule municipalité. Indépendamment de l’approche statistique, l’analyse spatiale a identifié un grand regroupement à risque élevé de mortalité par la maladie de Chagas, englobant 9 états dans la région centrale du Brésil.Conclusion: Cette étude a défini les zones géographiques prioritaires pour la prise en charge de la maladie de Chagas et par conséquent pour la réduction de la mortalité associée à la maladie au Brésil. Différentes approches analytiques spatiales peuvent être intégrées afin de fournir des données pour la planification, le suivi et l’évaluation de mesures d’intervention spécifiques.Objectif: Décrire les modes de distribution spatiale de la mortalité associée à la maladie de Chagas au Brésil.Méthodes: Etude nationale de tous les décès au Brésil de 1999 à 2007, pour lesquels la maladie de Chagas a été enregistrée comme une cause du décès. Les données ont été obtenues du Système d’Information Nationale sur la Mortalité, du Ministère de la Santé. Nous avons calculé le taux moyen de mortalité pour chaque municipalité de résidence par intervalles de trois ans et pour toute la période. La méthode empirique Bayes d’ajustement a été utilisée pour minimiser la variation aléatoire dans les taux de mortalité due à la taille de la population dans les municipalités. Afin d’évaluer l’existence d’une auto corrélation spatiale, les indices I globaux et locaux de Moran ont été utilisés.Résultats: Le taux moyen de mortalité nationale associée à la maladie de Chagas était de 3,37/100.000 habitants par an, avec un maximum de 138.06/100.000 dans une seule municipalité. Indépendamment de l’approche statistique, l’analyse spatiale a identifié un grand regroupement à risque élevé de mortalité par la maladie de Chagas, englobant 9 états dans la région centrale du Brésil.Conclusion: Cette étude a défini les zones géographiques prioritaires pour la prise en charge de la maladie de Chagas et par conséquent pour la réduction de la mortalité associée à la maladie au Brésil. Différentes approches analytiques spatiales peuvent être intégrées afin de fournir des données pour la planification, le suivi et l’évaluation de mesures d’intervention spécifiques.Objetivo: Describir los patrones de distribución espacial de la mortalidad asociada a la enfermedad de Chagas en Brasil.Métodos: Estudio a nivel nacional de todas las muertes acontecidas en Brasil entre 1999 y el 2007, en las que se identificó la enfermedad de Chagas como causa de muerte. Los datos se obtuvieron del Sistema Nacional de Información sobre Mortalidad del Ministerio de Salud. Calculamos la tasa media de mortalidad para cada municipio de residencia en intervalos de tres años y en el periodo completo. Se realizó un suavizado por el método empírico Bayesiano para minimizar la variación aleatoria en las tasas de mortalidad debidas al tamaño de la población en los municipios.Resultados: La tasa media de mortalidad a nivel nacional asociada a la enfermedad de Chagas era de 3.37/100,000 habitantes/año, con un máximo de 138.06/100,000 en una municipalidad. Independientemente del enfoque estadístico, el análisis espacial identificó un gran conglomerado de alto riesgo para mortalidad por enfermedad de Chagas, que involucraba 9 estados de la región Central del Brasil.Conclusión: Este estudio definióáreas geográficas de prioridad para el manejo de la enfermedad de Chagas y consecuentemente, la reducción de la mortalidad asociada a esta enfermedad en Brasil. Se pueden integrar diferentes enfoques de análisis espacial que provean datos para planear, monitorizar y evaluar medidas específicas de intervención.Objetivo: Describir los patrones de distribución espacial de la mortalidad asociada a la enfermedad de Chagas en Brasil.Métodos: Estudio a nivel nacional de todas las muertes acontecidas en Brasil entre 1999 y el 2007, en las que se identificó la enfermedad de Chagas como causa de muerte. Los datos se obtuvieron del Sistema Nacional de Información sobre Mortalidad del Ministerio de Salud. Calculamos la tasa media de mortalidad para cada municipio de residencia en intervalos de tres años y en el periodo completo. Se realizó un suavizado por el método empírico Bayesiano para minimizar la variación aleatoria en las tasas de mortalidad debidas al tamaño de la población en los municipios.Resultados: La tasa media de mortalidad a nivel nacional asociada a la enfermedad de Chagas era de 3.37/100,000 habitantes/año, con un máximo de 138.06/100,000 en una municipalidad. Independientemente del enfoque estadístico, el análisis espacial identificó un gran conglomerado de alto riesgo para mortalidad por enfermedad de Chagas, que involucraba 9 estados de la región Central del Brasil.Conclusión: Este estudio definióáreas geográficas de prioridad para el manejo de la enfermedad de Chagas y consecuentemente, la reducción de la mortalidad asociada a esta enfermedad en Brasil. Se pueden integrar diferentes enfoques de análisis espacial que provean datos para planear, monitorizar y evaluar medidas específicas de intervención.
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Papers by Francisco Rogerlândio Martins-Melo
Neglected Tropical Diseases (NTDs) are important causes of morbidity, disability, and mortality among poor and vulnerable populations in several countries worldwide, including Brazil. We present the burden of NTDs in Brazil from 1990 to 2016 based on findings from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016).
Methodology
We extracted data from GBD 2016 to assess years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for NTDs by sex, age group, causes, and Brazilian states, from 1990 to 2016. We included all NTDs that were part of the priority list of the World Health Organization (WHO) in 2016 and that are endemic/autochthonous in Brazil. YLDs were calculated by multiplying the prevalence of sequelae multiplied by its disability weight. YLLs were estimated by multiplying each death by the reference life expectancy at each age. DALYs were computed as the sum of YLDs and YLLs.
Principal findings
In 2016, there were 475,410 DALYs (95% uncertainty interval [UI]: 337,334–679,482; age-standardized rate of 232.0 DALYs/100,000 population) from the 12 selected NTDs, accounting for 0.8% of national all-cause DALYs. Chagas disease was the leading cause of DALYs among all NTDs, followed by schistosomiasis and dengue. The sex-age-specific NTD burden was higher among males and in the youngest and eldest (children <1 year and those aged ≥70 years). The highest age-standardized DALY rates due to all NTDs combined at the state level were observed in Goiás (614.4 DALYs/100,000), Minas Gerais (433.7 DALYs/100,000), and Distrito Federal (430.0 DALYs/100,000). Between 1990 and 2016, the national age-standardized DALY rates from all NTDs decreased by 45.7%, with different patterns among NTD causes and Brazilian states. Most NTDs decreased in the period, with more pronounced reduction in DALY rates for onchocerciasis, lymphatic filariasis, and rabies. By contrast, age-standardized DALY rates due to dengue, visceral leishmaniasis, and trichuriasis increased substantially. Age-standardized DALY rates decreased for most Brazilian states, increasing only in the states of Amapá, Ceará, Rio Grande do Norte, and Sergipe.
Conclusions/Significance
GBD 2016 findings show that, despite the reduction in disease burden, NTDs are still important and preventable causes of disability and premature death in Brazil. The data call for renewed and comprehensive efforts to control and prevent the NTD burden in Brazil through evidence-informed and efficient and affordable interventions. Multi-sectoral and integrated control and surveillance measures should be prioritized, considering the population groups and geographic areas with the greatest morbidity, disability, and most premature deaths due to NTDs in the country.