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To assess the temporal and spatial dynamics of chikungunya incidence and its association with social vulnerability indicators in Brazil, an ecological and population-based study was conducted herein, with confirmed cases of chikungunya and based on clinical and clinical-epidemiological criteria from 2017 to 2023. Data were obtained from the Notifiable Diseases Information System and social vulnerability indicators were extracted from the official platform of the United Nations Development Program and the Social Vulnerability Atlas. Temporal, spatial, and global spatial regression models were employed. The temporal trend showed that in 2017, the incidence increased by 1.9%, and this trend decreased from 2020 to 2021 (-0.93%). The spatial distribution showed heterogeneity and positive spatial autocorrelation (I: 0.71; p < 0.001) in chikungunya cases in Brazil. Also, the high-risk areas for the disease were concentrated in the northeast and north regions. The social vulnerability indicators associated with the outcome were those related to income, education, and housing conditions. Our analyses demonstrate that chikungunya continues to be a serious health concern in Brazil, but specially in the northeast and north regions. Lastly, mapping risk areas can provide evidence for the development of public health strategies and disease control in endemic regions.

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OBJECTIVE: To identify the epidemiological, spatial, and temporal pattern of TB-HIV coinfection in Brazil during the period from 2001 to 2020. METHODS: Ecological study using space-time analysis techniques. It included cases of TB-HIV coinfection registered in Brazil from 2001 to 2020. The temporal trend analysis was performed using segmented regression by Joinpoint regression. For spatial analysis, Moran indices were calculated and choropleth maps were produced using TerraView and QGIS software. RESULTS: A stable temporal trend was observed in the incidence rates of TB-HIV coinfection in Brazil during the analyzed period. In addition, high-risk areas for coinfection located in states in the North, Southeast, South, and Midwest regions were identified. CONCLUSION: There was stability in the incidence of TB-HIV coinfection in Brazil over the last 20 years and heterogeneous geographic distribution of risk areas for the condition.

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The aim of the study was to assess the impact of the COVID-19 pandemic on the notification of new VL cases in Brazil in 2020. It is an ecological and time-series study (2015-2020) with spatial analysis techniques, whose units of analysis were the 5570 Brazilian municipalities. The study population consisted of all new cases of VL recorded between 2015 and 2020. The P-score was calculated to estimate the percentage variation in new VL cases. Global and local univariate Moran's Indices and retrospective space-time scan statistics were used in spatial and space-time analyses, respectively. It was expected that there would be 3627 new cases of VL in Brazil in 2020, but 1932 cases were reported (-46.73%). All Brazilian regions presented a negative percentage variation in the registration of new VL cases, with the Southeast (-54.70%), North (-49.97%), and Northeast (-44.22%) standing out. There was spatial dependence of the disease nationwide in both periods, before and during the first year of the COVID-19 pandemic. There was a significant reduction in the incidence of new VL cases in Brazil during the first year of the COVID-19 pandemic. These findings reinforce the need for better preparedness of the health system, especially in situations of new epidemics.

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ABSTRACT Objective To identify the epidemiological, spatial, and temporal pattern of TB-HIV coinfection in Brazil during the period from 2001 to 2020. Methods: Ecological study using space-time analysis techniques. It included cases of TB-HIV coinfection registered in Brazil from 2001 to 2020. The temporal trend analysis was performed using segmented regression by Joinpoint regression. For spatial analysis, Moran indices were calculated and choropleth maps were produced using TerraView and QGIS software. Results: A stable temporal trend was observed in the incidence rates of TB-HIV coinfection in Brazil during the analyzed period. In addition, high-risk areas for coinfection located in states in the North, Southeast, South, and Midwest regions were identified. Conclusion: There was stability in the incidence of TB-HIV coinfection in Brazil over the last 20 years and heterogeneous geographic distribution of risk areas for the condition.

RESUMO Objective Identificar o padrão epidemiológico, espacial e temporal da coinfecção TB-HIV no Brasil durante o período de 2001 a 2020. Métodos: Estudo ecológico com técnicas de análise espacial e temporal. Incluiu os casos de coinfecção por TB-HIV registrados no Brasil entre 2001 e 2020. A análise de tendência temporal foi realizada por meio da regressão segmentada, através do Joinpoint regression. Para a análise espacial, foram calculados os índices de Moran e construídos mapas coropléticos através dos softwares TerraView e QGIS. Resultados: Observou-se tendência temporal estável das taxas de incidência da coinfecção por TB-HIV no Brasil durante o período analisado. Adicionalmente, foram identificadas áreas de alto risco para coinfecção localizadas em estados das regiões Norte, Sudeste, Sul e Centro-Peste. Conclusão: Houve estabilidade da incidência da coinfecção TB-HIV no Brasil nos últimos 20 anos e distribuição geográfica heterogênea das áreas de risco para o agravo.

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OBJECTIVE: To analyze the spatiotemporal distribution of mortality in older people living with the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the state of São Paulo, Brazil. METHODS: This is an ecological study with temporal and spatial approaches to analyze mortality from HIV/AIDS in the older adult population in the 2010-2020 period in the state of São Paulo, Brazil. Analysis of temporal trends was performed using the joinpoint regression, and spatial analysis was carried out using the Moran's index and the local empirical Bayesian model. RESULTS: We identified a total of 3,070 deaths from HIV/AIDS among older adults and a mortality rate of 51.71 per 100 thousand inhabitants during the study period. The joinpoint method showed a growing trend for the age groups from 70 to 79 years (annual percent change [APC]=3.45; p=0.01) and ≥80 years (APC=6.60; p=0.006) and stability for the general older adult population (APC=0.99; p=0.226). The spatial distribution of the crude mortality rate was diffuse throughout the state. After smoothing by the Bayesian estimator, we observed greater concentration in the eastern mesoregions. In Moran's analysis, we observed clusters of lower mortality rates in more central regions; and of higher rates in the southern and northern regions of the state. CONCLUSIONS: We found a major growing trend in mortality from HIV/AIDS in the age group of older adults over 69 years during the 2010-2020 period. Clusters of high mortality rates were located in regions further to the south and north of the state, where places of greater social inequalities are concentrated.

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OBJECTIVE: To analyse the spatial, temporal and spatial-temporal patterns of infant mortality associated with congenital toxoplasmosis in Brazil between the years 2000 and 2020. METHODS: Ecological study of time series, with spatial analysis and spatiotemporal scan of infant mortality associated with congenital toxoplasmosis from the records of deaths of the Mortality Information System of the Brazilian Ministry of Health. The rates were smoothed by the Local Empirical Bayesian model. The Global Moran Index, Global Geary's Contiguity and Getis-Ord General statistics were calculated for spatial autocorrelation assessment. The trends were evaluated by the Joinpoint method. RESULTS: We identified 1183 infant deaths associated with congenital toxoplasmosis in Brazil between 2000 and 2020. The predominant characteristics were male sex (52.1%), post-neonatal age group (51.9%), white race/colour (45.7%), and Southeast region of residence (40.0%). The infant mortality rate associated with congenital toxoplasmosis showed an increasing trend in the country in the years analysed. The spatial analysis showed heterogeneous distribution of mortality in the Brazilian territory and found no evidence of spatial autocorrelation; but spatial-temporal analysis identified three risk clusters involving 703 municipalities. CONCLUSION: Infant mortality associated with congenital toxoplasmosis is a persistent public health problem in Brazil. The risk factors male sex, indigenous race/colour, early neonatal age, North and Northeast regions and risk clusters mapped in this study should be observed for future analysis and planning of health care policies in the control of infant deaths associated with congenital toxoplasmosis. Health surveillance strategies and public health policies need to be strengthened.

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Strengthening strategies to improve adherence to the use of pre-exposure prophylaxis (PrEP) in key populations constitutes a global health priority to be achieved across countries, especially in countries that share a high flow of people such as Brazil and Portugal. This study aimed to analyze the factors associated with adherence to PrEP among MSM from two Portuguese-speaking countries, highlighting the opportunities and preventive strategies for the global health scenario. This was a cross-sectional analytical online survey conducted from January 2020 to May 2021 with MSM in Brazil and Portugal. For analysis of the data, the Poisson regression model was used to estimate the prevalence ratio (PR) for developing a model to evaluate the associated factors in both countries in a comparative and isolated way. Adherence to PrEP use corresponded to 19.5% (n = 1682) of the overall sample: 18.3% (n = 970) for Brazil and 21.5% (n = 712) for Portugal. Having more than two sex partners in the last 30 days (aPR: 30.87) and routinely undergoing HIV tests (aPR: 26.21) increased the use of this medication. Being an immigrant (PR: 1.36) and knowing the partner's serological status (PR: 1.28) increased adherence to PrEP in Portugal, whereas, in Brazil, it was being an immigrant (PR: 0.83) and not knowing the serological status (PR: 2.24) that promoted the use of this medication. Our findings reinforce the need to invest in programs and strategies to improve access and adherence to PrEP, especially in key populations.

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Objetivo: Identificar na literatura os principais fatores contribuintes para ocorrência de Eventos Adversos na Atenção Primária à Saúde. Métodos: Trata-se de uma revisão integrativa. A partir da formação da questão norteadora, foi realizada uma pesquisa nas bases de dados: MEDLINE, PubMed, BDENF, SciELO e LILACS. Ao final, foram incluídos 15 artigos. Resultados: 7 dos artigos traziam fatores ligados a medicação como principal, 3 traziam prática e procedimentos, 2 organização e gestão, 1 comunicação e 2 outros fatores. Conclusão: Percebeu-se que erros relacionados a medicação e diagnóstico são os mais comuns nas instâncias de saúde. A falha na comunicação entre funcionários e entre os serviços de saúde, além de fatores organizacionais e diagnósticos tardios também foram apontadas, sendo boa parte, evitável. A subnotificação foi comumente relatada nos artigos, revelando que os dados existentes possam não estar condizentes com a realidade. (AU)

Objective: To identify in the literature the main contributing factors for the occurrence of Adverse Events in Primary Health Care. Methods: This is an integrative review. Based on the formation of the guiding question, a research was carried out in the databases: MEDLINE, PubMed, BDENF, SciELO and LILACS. At the end, 15 articles were included. Results: 7 of the articles included factors related to medication as main, 3 had practice and procedures, 2 organization and management, 1 communication and 2 other factors. Conclusion: Errors related to medication and diagnosis are the most common in health instances. The failure to communicate between employees and between health services, in addition to organizational factors and late diagnoses were also pointed out, being mostly avoidable. Underreporting was commonly reported in the articles, revealing that existing data may not be consistent with reality. (AU)

Objetivo: Identificar en la literatura los principales factores contribuyentes para la ocurrencia de Eventos Adversos en la Atención Primaria a la Salud. Métodos: Se trata de una revisión integrativa. A partir de la formación de la cuestión orientadora, se realizó una investigación en las bases de datos: MEDLINE, PubMed, BDENF, SciELO y LILACS. Al final, se incluyeron 15 artículos. Resultados: 7 de los artículos traían factores ligados à la medicación como principal, 3 traían práctica y procedimientos, 2 orgnización y gestión, 1 comunicación y 2 otros factores. Conclusión: Se dio cuenta que errores relacionados con la medicación y el diagnóstico son los más comunes en las instancias de salud. La falla en la comunicación entre funcionarios y entre los servicios de salud, además de factores organizacionales y diagnósticos tardío también fueron señalados, siendo buena parte, evitable. La subnotificación fue comúnmente relatada en los artículos, revelando que los datos existentes pueden no estar en concordancia con la realidad. (AU)

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Schistosomiasis remains a serious public health concern in Brazil and the Schistosomiasis Control Program (PCE) was elaborated to assist in the control of the disease. Nevertheless, the irruption of the COVID-19 pandemic may have impacted the program. Herein, we assessed the impact of the pandemic on PCE actions in an endemic area in the region with the highest positivity rate for schistosomiasis in Brazil. We conducted an ecological, population-based study using data from the PCE of the state of Alagoas, between 2015 and 2021, to calculate the percentage of change. The temporal trend analysis was performed using the segmented log-linear regression model. To evaluate the spatial distribution of the data, choropleth maps were made showing the values of the% of change. Moran maps was elaborated to indicate the critical areas. Our analysis showed a decrease in the population surveyed in 2020 (-41.00%) and 2021 (-18.42%). Likewise, there was a reduction in the number of Kato-Katz tests performed (2020 = -43.45%; and in 2021 = -19.63%) and, consequently, a drop in the rate of positive tests (-37.98% in 2020 and -26.14% in 2021). Importantly, treatment of positive cases was lower than 80% (77.44% in 2020 and 77.38% in 2021). Additionally, spatial clusters with negative percentage values of up to -100% of the PCE indicators were identified mostly in the municipalities of the coastal areas that are historically most affected by schistosomiasis. Taken together, our analyzes corroborate that PCE actions in endemic municipalities of Alagoas were impacted by the COVID-19 pandemic.

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OBJECTIVE: To analyze the spatiotemporal distribution of homicide mortality and association with social determinants of health in the Northeast Region of Brazil. METHODS: Ecological study with spatiotemporal modeling of homicide deaths between 2000 and 2019. Temporal trends were analyzed by segmented linear regression. Crude mortality was calculated and adjusted by smoothing the local empirical Bayesian method and analyzed by the Global/Local Moran Index and spatiotemporal scan statistics. The association between social determinants of health and homicide mortality was performed using multiple linear regression and autoregressive spatial models. RESULTS: 353,089 deaths were recorded. Mortality increased from 2000 to 2019, with an annual increase of 4.37 in males and 3.57 in females. High risk spatial and spatiotemporal clusters were identified in the coastal region of the states. The spatial regression model showed an association with socioeconomic inequalities. CONCLUSIONS: High risk areas for homicides associated with socioeconomic inequality, which should be considered as a priority for designing and investing in public health policies were investigated.

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We analyzed the knowledge, attitudes and practices (KAP) of schistosomiasis mansoni prevention in an endemic area of Brazil. This cross-sectional study was conducted between March and May 2021, with 412 participants living in the municipality of Feira Grande, Alagoas, Brazil. Data collection occurred through visits to the Health Center Urbano II and Massapê, through an interview with a structured questionnaire to identify the levels of KAP regarding schistosomiasis prevention. Of all respondents, 70.87% lived in rural areas, 22.66% reported a history of past schistosomiasis and 52.71% never participated in schistosomiasis control program actions. Factors associated with better KAP scores were being part of an older age group, not using rainwater and having no history of past schistosomiasis. Specifically, among the domains, attitude was the highest score and knowledge was the lowest. Participation in a health intervention program, knowing someone who had schistosomiasis and having been informed through a public health program seemed to have an important impact on the population's KAP. Our results contributed to broadening perceptions about schistosomiasis prevention, highlighting the positive impacts that health programs and interventions have on disease control.

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Introdução:o Brasil está entre os sete países responsáveis por mais de 90% dos casos de leishmaniose visceral humana (LVH), sendo a região Nordeste a mais endêmica. ALV também afeta cães, que apresentam sintomas debilitantes e podem ser fatais. Os cães são os principais os pedeiros desse parasita. No entanto,há carência de dados epidemiológicos sobre leishmaniose visceral canina (LVC) no Brasil, principalmente na região nordeste. Objetivo:realizar uma revisão sistemática para demonstrar a frequência e a distribuição espacial da LVC nos estados do nordeste do Brasil. Métodos:as seguintes bases de dados foram utilizadas para busca eletrônica: Google Scholar, Lilacs, Scopus, Pubmed, Scielo, Web of Science, Cochrane, OpenGrey e OpenThesis. Os descritores de busca foram: leishmaniose visceral canina, nordeste do Brasil, Alagoas, Bahia, Ceará, Maranhão, Paraíba, Pernambuco, Piauí, Rio Grande do Norte e Sergipe. Resultados:a análise dos 73 artigos selecionados demonstrou uma frequência de LVC de 4,1% no Nordeste do Brasil, entre 1973 a 2022. O estado da Bahia apresentou a frequência (43,9%) e o Piauí a menor (1,9%). Conclusão:os dados demonstram, pela primeira vez, o caráter endêmico da LVC em toda a região nordeste e o caráter propício de disseminação de LVC nessa região. Esses dados também destacam a necessidade de ações governamentais e aprofundamento das pesquisas por parte da comunidade científica

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ABSTRACT Objective: To analyze the spatiotemporal distribution of homicide mortality and association with social determinants of health in the Northeast Region of Brazil. Methods: Ecological study with spatiotemporal modeling of homicide deaths between 2000 and 2019. Temporal trends were analyzed by segmented linear regression. Crude mortality was calculated and adjusted by smoothing the local empirical Bayesian method and analyzed by the Global/Local Moran Index and spatiotemporal scan statistics. The association between social determinants of health and homicide mortality was performed using multiple linear regression and autoregressive spatial models. Results: 353,089 deaths were recorded. Mortality increased from 2000 to 2019, with an annual increase of 4.37 in males and 3.57 in females. High risk spatial and spatiotemporal clusters were identified in the coastal region of the states. The spatial regression model showed an association with socioeconomic inequalities. Conclusions: High risk areas for homicides associated with socioeconomic inequality, which should be considered as a priority for designing and investing in public health policies were investigated.

RESUMEN Objetivo: Analizar distribución espaciotemporal de mortalidad por homicidios y relación con determinantes sociales de salud en el Noreste brasileño. Métodos: Estudio ecológico con modelado espaciotemporal de óbitos por homicidios entre 2000 y 2019. Las tendencias temporales fueron analizadas por regresión lineal segmentada. La mortalidad brutal fue calculada y acordada por moderación del método bayesiano empírico local y analizadas por Índice de Moran Global/Local y estadística de barrido espaciotemporal. La relación entre determinantes sociales de salud y mortalidad por homicidios fue realizada mediante la regresión lineal múltiple y modelos espaciales autorregresivos. Resultados: Fueron registrados 353.089 óbitos. La mortalidad aumentó de 2000 para 2019, con un incremento anual de 4,37 en el sexo masculino y 3,57 y en el femenino. Aglomeraciones espaciales y espaciotemporales de alto riesgo fueron identificadas en la región costera de los estados. El modelo de regresión espacial demostró relación con las desigualdades socioeconómicas. Conclusiones: Identificamos áreas de alto riesgo para homicídios relacionadas con la desigualdad socioeconómica, debiendo ser consideradas como prioridad para el delineamiento e inversión en políticas públicas en salud.

RESUMO Objetivo: Analisar a distribuição espaçotemporal da mortalidade por homicídios e associação com determinantes sociais da saúde na Região Nordeste do Brasil. Métodos: Estudo ecológico com modelagem espaço temporal dos óbitos por homicídios entre 2000 e 2019. As tendências temporais foram analisadas por regressão linear segmentada. A mortalidade bruta foi calculada e ajustada pela suavização do método bayesiano empírico local e analisadas pelo Índice de Moran Global/Local e estatística de varredura espaço temporal. A associação entre os determinantes sociais da saúde e a mortalidade por homicídios foi realizada por meio da regressão linear múltipla e modelos espaciais autorregressivos. Resultados: Foram registrados 353.089 óbitos. A mortalidade aumentou de 2000 para 2019, com um acréscimo anual de 4,37 no sexo masculino e 3,57 no feminino. Aglomerações espaciais e espaçotemporais de alto risco foram identificadas na região costeira dos estados. O modelo de regressão espacial demonstrou associação com as desigualdades socioeconômicas. Conclusões: Identificamos áreas de alto risco para homicídios associadas com a desigualdade socioeconômica, devendo ser consideradas como prioridade para o delineamento e investimento em políticas públicas em saúde.

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ABSTRACT Objective: To analyze the spatiotemporal distribution of mortality in older people living with the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the state of São Paulo, Brazil. Methods: This is an ecological study with temporal and spatial approaches to analyze mortality from HIV/AIDS in the older adult population in the 2010-2020 period in the state of São Paulo, Brazil. Analysis of temporal trends was performed using the joinpoint regression, and spatial analysis was carried out using the Moran's index and the local empirical Bayesian model. Results: We identified a total of 3,070 deaths from HIV/AIDS among older adults and a mortality rate of 51.71 per 100 thousand inhabitants during the study period. The joinpoint method showed a growing trend for the age groups from 70 to 79 years (annual percent change [APC]=3.45; p=0.01) and ≥80 years (APC=6.60; p=0.006) and stability for the general older adult population (APC=0.99; p=0.226). The spatial distribution of the crude mortality rate was diffuse throughout the state. After smoothing by the Bayesian estimator, we observed greater concentration in the eastern mesoregions. In Moran's analysis, we observed clusters of lower mortality rates in more central regions; and of higher rates in the southern and northern regions of the state. Conclusions: We found a major growing trend in mortality from HIV/AIDS in the age group of older adults over 69 years during the 2010-2020 period. Clusters of high mortality rates were located in regions further to the south and north of the state, where places of greater social inequalities are concentrated.

RESUMO Objetivo: O estudo tem como objetivo analisar a distribuição espaço-temporal da mortalidade em idosos que vivem com HIV/AIDS no estado de São Paulo, Brasil. Métodos: Estudo ecológico com abordagens temporal e espacial para análise da mortalidade por HIV/AIDS em pessoas idosas no período de 2010-2020 no estado de São Paulo, Brasil. A análise das tendências temporais foi realizada por meio da regressão joinpoint e as análises espaciais foram realizadas usando o índice de Moran e o modelo bayesiano empírico local. Resultados: Foram identificados 3.070 óbitos por HIV/AIDS entre pessoas idosas e taxa de mortalidade de 51,71 por 100 mil habitantes no período de estudo. O método joinpoint revelou tendência crescente para as faixas etárias de 70 a 79 anos (variação percentual anual — APC=3,45 p=0,01) e 80 anos ou mais (APC=6,60, p=0,006) e de estabilidade para a população idosa geral (APC=0,99, p=0,226). A distribuição espacial da taxa bruta de mortalidade demonstrou-se difusa em todo o estado. Após suavização pelo estimador bayesiano, observou-se maior concentração nas mesorregiões ao leste. Na análise de Moran, foram observados aglomerados das menores taxas de mortalidade em regiões mais centrais e das altas taxas em regiões mais ao sul e norte do estado. Conclusão: O grupo etário em que ocorreu maior tendência de crescimento da mortalidade por HIV/AIDS durante o período de 2010-2020 foi o de pessoas idosas com mais de 69 anos. Os aglomerados das altas taxas de mortalidade foram localizados em regiões mais ao sul e norte do estado, onde se concentram locais de maiores desigualdades sociais.

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The Northeast region of Brazil (NRB) includes the states with the highest prevalence of visceral leishmaniasis (VL), as well as those with significant increases in HIV cases. This study aims to analyze the spatiotemporal patterns of VL-HIV coinfection and its association with the social determinants of health (SDH) in the NRB. Time trend analysis and Bayesian spatial statistical inferences, Moran's autocorrelation, and retrospective space-time scanning were performed. Spatial regression modelling was used to build an explanatory model for the occurrence of VL-HIV coinfection within NRB. A total of 1550 cases of VL-HIV coinfection were confirmed. We observed a higher prevalence among males (1232; 83%), individuals aged from 20 to 59 years (850; 54.8%), non-white skin color (1,422; 91.7%), and with low education (550; 35.48%). NRB showed an increasing and significant trend in the detection rate of coinfection (APC, 5.3; 95% CI, 1.4 to 9.4). The states of Maranhão and Piauí comprised the high-risk cluster. The SDH that most correlated with the occurrence of coinfection were poor housing, low income, and low education. VL-HIV is dispersed in the NRB but chiefly affects states with greater social vulnerability. Taken together, these findings reinforce the necessity to implement surveillance strategies that will contribute to the reduction of cases in these populations.

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BACKGROUND: The pandemic caused by COVID-19 has seriously affected global health, resulting in the suspension of many regular health services, making the diagnosis of other infections difficult. Therefore, this study aimed to assess the impact of the COVID-19 pandemic on the diagnosis of leprosy in Brazil during the year 2020. METHODS: We evaluated the monthly incidence of leprosy and calculated the percentage change to verify whether there was an increase or decrease in the number of leprosy cases in 2020, considering the monthly average of cases over the previous 5 years. We used interrupted time series analysis to assess the trend in the diagnosis of leprosy before and after the start of COVID-19 in Brazil and prepared spatial distribution maps, considering the percentage variation in each state. FINDINGS: We verified a reduction of 41.4% of leprosy cases in Brazil in 2020. Likewise, there was a reduction of leprosy notifications in children under 15 years-old (-56.82%). Conversely, the diagnosis of multibacillary leprosy increased (8.1%). There was a decreasing trend in the leprosy incidence in the general population between 2015 and 2020 in Brazil. Spatial distribution maps depicted a reduction of up to 100% in new cases of leprosy in some states. INTERPRETATION: Along with COVID-19 spread there was a reduction in leprosy diagnosis in the general population and children under 15 years-old, and also an increase in multibacillary cases diagnosed, signalling a serious impact of the pandemic on leprosy control strategies in Brazil. FUNDING: This research received no specific grants.

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Introdução: Anualmente, no Brasil, 15 mil pessoas são diagnosticadas com câncer de boca, e quase metade delas morre. Sergipe está entre os sete Estados brasileiros com maiores índices. Objetivo: Analisar a tendência temporal e a distribuição espacial da mortalidade por câncer de boca em Sergipe entre 2007 e 2016. Método: Estudo ecológico de série temporal de base populacional, utilizando técnicas de análise espacial. Os dados de mortalidade foram obtidos no Sistema de Informação sobre Mortalidade (SIM). A análise das tendências temporais foi realizada no modelo de regressão de Joinpoint por meio da regressão de Poisson. Foram realizadas análises espaciais utilizando o estimador de intensidade Kernel e os índices de Moran Global e Local. Resultados: Foram analisadas 543 mortes por câncer de boca. Os casos mais frequentes ocorreram em homens (74%), com idade média de 64 anos e baixa escolaridade. As taxas de mortalidade global (variação percentual anual ‒ APC=2,5; IC 95% 0,9-6,7) e masculina (APC=2,96; IC 95% 1,2-5,6) aumentaram. Houve também uma tendência crescente de mortalidade por câncer na língua (APC=10,05; IC 95% 3,8-16,7). A mortalidade relacionada a outras localizações anatômicas foi estável. Houve concentração de óbitos nas Regiões Metropolitana, Centro-Sul e Centro-Agreste. Conclusão: Durante o período analisado, a taxa de mortalidade geral mostrou uma tendência crescente, com concentração nas Regiões Centro-Sul, Central e Metropolitana, sendo necessário manter medidas de prevenção e controle contra o câncer de boca em todo o Estado de Sergipe

Introduction: Annually, in Brazil, 15 thousand individuals are diagnosed with oral cancer and almost half of them die. Sergipe is among the seven Brazilian states with the highest rates. Objective: To analyze the temporal trend and the spatial distribution of oral cancer mortality in Sergipe between 2007 and 2016. Method: Population-based time series ecological study, using techniques of spatial analysis. Mortality data were obtained from the Mortality Information System (SIM). The analysis of temporal trends was performed with the Joinpoint regression model using Poisson regression. Spatial analyzes were carried out using the Kernel intensity estimator and the Moran Global and Local indexes. Results: 543 oral cancer deaths were analyzed. The most frequent cases were in men (74%), with an average age of 64 years and low education. The overall and male's mortality rates (annual percent change ‒ APC=2.5; 95% CI 0.9-6.7 and APC=2.96; 95% CI 1.2- 5.6), respectively, increased. There was also an increasing trend of mortality by tongue cancer (APC=10.05; 95% CI 3.8-16.7). Mortality related to other anatomical locations was stable. There was a concentration of deaths in the Metropolitan, Midsouth and Mid-rural regions. Conclusion: During the period investigated, the general mortality rate showed an increasing trend, with concentration in the Midsouth, Mid and Metropolitan regions, and it is necessary to maintain preventive and control measures against oral cancer throughout the State of Sergipe

Introducción: Cada año en Brasil, 15.000 personas son diagnosticadas con cáncer de boca y casi la mitad de ellas mueren. Sergipe es uno de los siete Estados brasileños con las tasas más altas. Objetivo: Analizar la tendencia temporal y la distribución espacial de la mortalidad por cáncer de boca en Sergipe entre 2007 y 2016. Método: Estudio ecológico de series temporales basadas en la población, utilizando técnicas de análisis espacial. Los datos de mortalidad se obtuvieron del Sistema de Información sobre Mortalidad (SIM). Poisson realizó el análisis de las tendencias de tiempo en el modelo de regresión de Punto de unión. Fueron realizadas análisis espaciales utilizando el estimador de intensidad del Kernel y los índices Moran Global y Local. Resultados: Se analizaron un total de 543 muertes por cáncer de boca. Los casos más frecuentes se dieron en hombres (74%), con una edad media de 64 años y baja escolaridad. Aumentaron las tasas de mortalidad global (porcentual cambio anual ‒ PCA=2,5; IC 0,9-6,7) y masculinas (PCA=2,96; IC 95% 1,2-5,6). También hubo una tendencia creciente de mortalidad por cáncer en la lengua (PCA=10,05; IC 95% 3,8-16,7). La mortalidad relacionada con otros lugares anatómicos fue estable. Hubo una concentración de muertes en las regiones Metropolitana, Central-Sur y Centro-Agreste. Conclusión: Durante el período analizado, la tasa general de mortalidad mostró una tendencia creciente, con concentración en las Regiones Centro-Sur, Centro y Metropolitano, y es necesario mantener medidas de prevención y control contra el cáncer de boca en todo el Estado de Sergipe

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Resumo Objetivo Analisar espacialmente os indicadores relacionados às dimensões ao acesso, à abrangência e à resolutividade dos serviços ofertados pela atenção básica à saúde nos municípios da região Nordeste do Brasil. Métodos Estudo ecológico com técnicas de análise espacial, utilizando as médias aritméticas e desvios padrão dos dez indicadores de desempenho pactuados no terceiro ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, cujas unidades de análise foram os 1.794 municípios da região Nordeste do Brasil. Resultados Nenhum estado atingiu o parâmetro mínimo nas dimensões "Resolutividade" e "Abrangência da oferta dos Serviços". Na dimensão "Acesso e Continuidade do Cuidado", houve agrupamentos espaciais baixo-baixo para atendimentos de consultas por demanda espontânea e alto-alto para atendimentos de consulta agendada. Na dimensão "Resolutividade", foi possível observar aglomerados espaciais alto-alto em municípios do Rio Grande do Norte, Paraíba, Pernambuco e Alagoas. Na dimensão "Abrangência da oferta dos Serviços", verificou-se agrupamentos baixo-baixo em municípios do Maranhão, Piauí e Ceará. Conclusão A análise espacial permitiu observar que ainda persistem dificuldades no acesso da população aos serviços da atenção básica na região Nordeste do Brasil, o que acarreta também na diminuição do poder de abrangência e resolutividade deste nível de atenção.

Resumen Objetivo Analizar espacialmente los indicadores relacionados con las dimensiones del acceso, alcance y capacidad resolutiva de los servicios ofrecidos por la atención básica en salud en los municipios de la región nordeste de Brasil. Métodos Estudio ecológico con técnicas de análisis espacial, utilizando los promedios aritméticos y desviaciones típicas de los diez indicadores de desempeño pactados en el tercer ciclo del Programa Nacional de Mejora del Acceso y de la Calidad de la Atención Básica, cuyas unidades de análisis fueron los 1.794 municipios de la región nordeste de Brasil. Resultados Ningún estado alcanzó el parámetro mínimo en las dimensiones "capacidad resolutiva" y "alcance de la oferta de servicios". En la dimensión "acceso y continuidad del cuidado", hubo agrupamientos espaciales bajo-bajo en atención de consultas por demanda espontánea y alto-alto en atención de consultas agendadas. En la dimensión "capacidad resolutiva", fue posible observar aglomerados espaciales alto-alto en municipios de Rio Grande do Norte, Paraíba, Pernambuco y Alagoas. En la dimensión "alcance de la oferta de los servicios", se verificaron agrupamientos bajo-bajo en municipios de Maranhão, Piauí y Ceará. Conclusión El análisis espacial permitió observar que aún persisten dificultades en el acceso de la población a los servicios de atención básica en la región nordeste de Brasil, lo que también conlleva una reducción del poder de alcance y capacidad resolutiva de este nivel de atención.

Abstract Objective To spatially analyze the indicators related to access, scope and resoluteness of services offered by Primary Health Care dimensions in the cities of northeastern Brazil. Methods This is an ecological study using spatial analysis techniques, using the arithmetic means and standard deviations of the ten performance indicators agreed in the third cycle of the Brazilian National Program for Improving Access and Quality of Primary Care (PMAQ-AB - Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica), whose units of analysis were the 1,794 cities from northeastern Brazil. Results No state reached the minimum parameter in the "Resoluteness" and "Service offer scope" dimensions. In the "Access and continuity of care" dimension, there were low-low spatial cluster for consultations on spontaneous demand and high-high for appointments with scheduled consultations. In the "Resoluteness" dimension, it was possible to observe high-high spatial clusters in cities in Rio Grande do Norte, Paraíba, Pernambuco and Alagoas. In the "Service offer scope" dimension, low-low clusters were found in cities of Maranhão, Piauí and Ceará. Conclusion Spatial analysis allowed us to observe that there are still difficulties in the population's access to PC services in northeastern Brazil, which also leads to a decrease in the power of coverage and resoluteness of this level of care.

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