RESUMO

O câncer de colo de útero é uma neoplasia comum e letal para mulheres no Brasil, com uma estimativa de 17 mil novos casos entre 2023 e 2025. A região Norte apresenta as maiores taxas de incidência e mortalidade, refletindo desigualdades no acesso a serviços de saúde. A detecção precoce e a vacinação são essenciais para a prevenção, mas a cobertura é insuficiente quando se trata de povos indígenas. Trata-se de um estudo descritivo que busca analisar a proporção de exames citopatológicos em mulheres indígenas de 25 a 64 anos, considerando dois triênios, de acordo com as recomendações da Organização Mundial de Saúde (OMS), com base nos dados do Sistema de Informação do Câncer. Os dados foram obtidos a partir de dados populacionais do Distrito Especial de Saúde Indígena do Amapá e Norte do Pará. No primeiro triênio (2018-2020), a proporção de exames foi de 3,37% no DSEI AMP e 0% em Pedra Branca do Amapari, município de referência do povo wajãpi. No segundo triênio (2021-2023), essas proporções aumentaram para 21,95% e 52,38%, respectivamente. A melhora significativa nos indicadores de realização de exames junto aos Wajãpi, é atribuída ao Projeto de Rastreamento de Câncer do Colo do Útero, realizado pelo Instituto de Pesquisa e Formação Indígena (Iepé) em cooperação com o DSEI AMP. Ainda que a colaboração entre as comunidades wajãpi, Iepé e DSEI AMP tenha produzido uma melhoria nos índices, os desafios permanecem, especialmente em relação à cobertura e à qualidade da assistência à saúde fornecida aos povos indígenas.

Cervical cancer is a common and lethal neoplasm for women in Brazil, with an estimated 17 thousand new cases between 2023 and 2025. The North region has the highest incidence and mortality rates, reflecting inequalities in access to health services . Early detection and vaccination are essential for prevention, but coverage is insufficient when it comes to indigenous peoples. This is a descriptive study that seeks to analyze the proportion of cytopathological exams in indigenous women aged 25 to 64 years, considering two three-year periods, in accordance with the recommendations of the World Health Organization (WHO), based on data from the Information System of Cancer. The data were obtained from population data from the Special Indigenous Health District of Amapá and Norte do Pará. In the first three years (2018-2020), the proportion of exams was 3.37% in DSEI AMP and 0% in Pedra Branca do Amapari, a reference municipality for the Wajãpi people. In the second three-year period (2021-2023), these proportions increased to 21.95% and 52.38%, respectively. The significant improvement in indicators for testing among the Wajãpi is attributed to the Cervical Cancer Tracking Project, carried out by the Institute of Indigenous Research and Training (Iepé) in cooperation with the DSEI AMP. Although the collaboration between the Wajãpi, Iepé and DSEI AMP communities has produced an improvement in rates, challenges remain, especially in relation to the coverage and quality of health care provided to indigenous peoples.

RESUMO

Background: Chronic social and health inequities faced by indigenous peoples in Brazil foretell the detrimental impact of COVID-19. Methods: We use de-identified, publicly available data from the Ministry of Health from March/2020 - December/2021 to describe vaccination coverage, cumulative incidence, and cumulative mortality rates due to COVID-19 among indigenous peoples. We also compare vaccination coverage among indigenous peoples with that reported for older adults, who were simultaneously included as a priority group in the vaccination strategy. Finally, we compared COVID-19 incidence and mortality rates in the indigenous population with that reported for the general Brazilian population. Findings: We found important heterogeneities in vaccination coverage across the 34 indigenous districts, and a lower overall coverage among indigenous peoples compared to older adults. We observed higher COVID-19 cumulative incidence rates among indigenous populations compared to the general Brazilian population. Although mortality rates were seemingly lower, data should be interpreted with caution due to a younger age structure and more frequent underreporting of cases and deaths among indigenous populations. After the beginning of COVID-19 vaccination program, we observed a decrease in both incidence and mortality rates among indigenous peoples in all Brazilian regions. Interpretation: The COVID-19 pandemic has had a heavy toll on vulnerable populations. Although social and geographic isolation challenges the implementation of any vaccination program for indigenous populations, prior experience suggests that the COVID-19 vaccination strategy lacked effectiveness. The absence of a coordinated strategy to reinforce the importance of the vaccine and other prevention methods, to guarantee the access to trustworthy information, and to respond with the necessary resources in extreme situations, resulted in lower COVID-19 vaccination coverage, higher incidence rates, and preventable deaths due to COVID-19 among indigenous peoples in Brazil. Funding: This work was not supported by specific funding.