Indigenous Population In Brazil Research Articles

HTLV infection in Brazil’s second-largest indigenous reserve

Human T-lymphotropic viruses 1 and 2 (HTLV-1/2) have a worldwide distribution. HTLV-1 has been associated with several diseases, including an aggressive malignant disease known as adult T-cell leukemia/lymphoma and a chronic inflammatory neurological disease called HTLV-1-associated myelopathy, while HTLV-2 has not been definitively associated with diseases. HTLV-2 is most prevalent in specific groups such as injecting drug users and the indigenous population. In Brazil, most studies about HTLV in indigenous are carried out in indigenous communities from the north of the country. Mato Grosso do Sul (MS), Central Brazil, has the second-largest indigenous population in Brazil. However, there is no available data about HTLV infection in this group. We conducted the first investigation of HTLV-1/2 infection prevalence in the indigenous population from Jaguapiru and Bororó villages in Dourados City, MS, to provide the prevalence and molecular characterization of HTLV. For that, a total of 1875 indigenous participated in the study. All the serum samples were screened by an enzyme-linked immunosorbent assay commercial kit for the presence of anti-HTLV-1/2 antibodies. Positive samples were confirmed by HTLV-1/2 Western Blot assay. The HTLV-1 5’LTR region was detected by nested PCR amplification and sequenced by Sanger. Most of the study population declared belonging to Guarani-Kaiowá ethnicity (69.18%), 872 (46.51%), and 1003 (53.49%) were from Jaguapiru and Bororó villages, respectively. The median age of participants was 31 years, and 74.24% were females. Two individuals were detected with HTLV-1 (0.1%; CI 95% 0.1–0.2). The phylogenetic analysis revealed that isolates belong to the Cosmopolitan subtype and the Transcontinental subgroup (HTLV-1aA). The low HTLV-1 prevalence found in this study is similar to that observed among blood donors, and pregnant populations from Mato Grosso do Sul. The absence of HTLV-2 infection among these Brazilian indigenous communities would suggest a distinct behavior pattern from other indigenous populations in Brazil.

The impact of erosive tooth wear related to masticatory quality in an indigenous Brazilian population: A cross-sectional study

The study aimed to associate the impact of tooth wear with the perception of masticatory quality and eating habits in a Brazilian indigenous population. A cross-sectional observational study was carried out with 197 indigenous from the Macuxi tribe (Roraima, Brazil) divided into age groups (adolescents and adults). Tooth wear was determined by the Basic Erosive Wear Examination (BEWE). The masticatory quality was evaluated using the Quality of Masticatory Function Questionnaire (QMFQ). Study participants also answered questions regarding eating habits and frequency of food consumption. Logistic regression models and crude Odds Ratios were estimated with 95% confidence intervals. Variables with P<0.20 in simple analyses were tested in a multiple logistic regression model; those with P ≤ 0.05 remained in the model. Tooth wear was observed in 38.1% of the indigenous, and 48.2% of them reported having their masticatory function affected; banana was the most frequently consumed item (54.3%); there was a significant association between adulthood and the presence of tooth wear (P<0.0001). Tooth wear related to eating habits and poor masticatory quality did not impact the oral health condition of the studied indigenous population. However, adulthood was associated with tooth wear in this sample.

COVID-19, mental health and Indigenous populations in Brazil: The epidemic beyond the pandemic.

The aim of this paper was to report on factors contributing to the deterioration of the mental health of Indigenous populations (IP) in Brazil. Five factors seem to have a direct impact on the mental health of IP in Brazil: (1) The absence of public policies; (2) Intellectual production; (3) Psychiatric medical care for remote areas (e.g., telemedicine) aimed at promoting the mental health of Brazil’s IP, which causes a huge gap in the process of assistance and social, psychological, economic and cultural valorization of native peoples; (4) The dissemination of fake news, which exposed, above all, older IP to risk behaviors in the pandemic, such as refusal of vaccination; and (5) The violence carried out on IP lands due to economic interests with mining/agribusiness.

Severe Acute Respiratory Syndrome by SARS-CoV-2 Infection or Other Etiologic Agents Among Brazilian Indigenous Population: An Observational Study from the First Year of Coronavirus Disease (COVID)-19 Pandemic

BackgroundIndigenous peoples are vulnerable to pandemics, including to the coronavirus disease (COVID)-19, since it causes high mortality and specially, the loss of elderly Indigenous individuals.MethodsThe epidemiological data of severe acute respiratory syndrome (SARS) by SARS-CoV-2 infection or other etiologic agents (OEA) among Brazilian Indigenous peoples during the first year of COVID-19 pandemic was obtained from a Brazilian Ministry of Health open-access database to perform an observational study. Considering only Indigenous individuals diagnosed with SARS by COVID-19, the epidemiology data were also evaluated as risk of death. The type of sample collection for virus screening, demographic profile, clinical symptoms, comorbidities, and clinical evolution were evaluated. The primary outcome was considered the death in the Brazilian Indigenous individuals and the secondary outcome, the characteristics of Brazilian Indigenous infected by SARS-CoV-2 or OEA, as the need for intensive care unit admission or the need for mechanical ventilation support. The statistical analysis was done using Logistic Regression Model. Alpha of 0.05.FindingsA total of 3,122 cases of Indigenous individuals with SARS in Brazil were reported during the first year of the COVID-19 pandemic. Of these, 1,994 were diagnosed with COVID-19 and 730/1,816 (40.2%) of them died. The death rate among individuals with SARS-CoV-2 was three-fold increased when compared to the group of individuals with OEA. Several symptoms (myalgia, loss of smell, and sore throat) and comorbidities (cardiopathy, systemic arterial hypertension, and diabetes mellitus) were more prevalent in the COVID-19 group when compared to Indigenous individuals with OEA. Similar profile was observed considering the risk of death among the Indigenous individuals with COVID-19 who presented several symptoms (oxygen saturation <95%, dyspnea, and respiratory distress) and comorbidities (renal disorders, cardiopathy, and diabetes mellitus). The multivariate analysis was significant in differentiating between the COVID-19-positive and non-COVID-19 patients [X2(7)=65.187; P-value<0.001]. Among the patients’ features, the following contributed in relation to the diagnosis of COVID-19: age [≥43 years-old [y.o.]; OR=1.984 (95%CI=1.480-2.658)]; loss of smell [OR=2.373 (95%CI=1.461-3.854)]; presence of previous respiratory disorders [OR=0.487; 95%CI=0.287-0.824)]; and fever [OR=1.445 (95%CI=1.082-1.929)]. Also, the multivariate analysis was able to predict the risk of death [X2(9)=293.694; P-value<0.001]. Among the patients’ features, the following contributed in relation to the risk of death: male gender [OR=1.507 (95%CI=1.010-2.250)]; age [≥60 y.o.; OR=3.377 (95%CI=2.292-4.974)]; the need for ventilatory support [invasive mechanical ventilation; OR=24.050 (95%CI=12.584-45.962) and non-invasive mechanical ventilation; OR=2.249 (95%CI=1.378-3.671)]; dyspnea [OR=2.053 (95%CI=1.196-3.522)]; oxygen saturation <95% [OR=1.691 (95%CI=1.050-2.723)]; myalgia [OR=0.423 (95%CI=0.191-0.937)]; and the presence of kidney disorders [OR=3.135 (95%CI=1.144-8.539)].InterpretationThe Brazilian Indigenous peoples are in a vulnerable situation during the COVID-19 pandemic and presented an increased risk of death due to COVID-19. Several factors were associated with enhanced risk of death, as male sex, older age (≥60 y.o.), and need for ventilatory support; also, other factors might help to differentiate SARS by COVID-19 or by OEA, as older age (≥43 y.o.), loss of smell, and fever.FundingFundação de Amparo à Pesquisa do Estado de São Paulo (Foundation for Research Support of the State of São Paulo; #2021/05810-7).

All-cause mortality rates for indigenous in the states of Brazil and their (non) correlation with socioeconomic and health indicators in the years 2000 and 2010

In 2010, the indigenous population represented 0.2% of the Brazilian population and was mostly located in the Legal Amazon region. In Brazil, there are laws to protect the indigenous population, in addition to a National Health Care Policy for Indigenous Peoples. However, a large part of the indigenous population is considered under social and sanitary vulnerability, which are more pronounced in certain regions of the country. Therefore, this study aimed to calculate and evaluate the all-cause mortality rate in the Brazilian indigenous population and investigate correlations with socioeconomic and health indicators. This is an ecological study based on official data (2000 and 2010). The number of deaths were extracted from the Mortality Information System. Indigenous population data were extracted from Demographic Censuses of the Brazilian Institute of Geography and Statistics. The all-cause mortality rate were calculated by states and correlated, through Pearson's correlation test, with socioeconomic and health indicators extracted from the Atlas Brazil platform. In Brazil, an increase in the overall indigenous mortality rate was observed of 15.0% between 2000 and 2010. Among the regions, the Midwest had the highest rates in 2000 and 2010 (4.54 and 5.56 deaths/1,000 indigenous people, respectively). In 2000, the state with the highest all-cause mortality rate was Piauí (9.76/1,000) and in 2010 it was Mato Grosso do Sul (6.54/1,000). All-cause mortality rate did not present a significant correlation (p-value ≤0.05) with the analyzed indicators. The findings of this study indicated that the all-cause mortality rate in Brazil increased unevenly, according to regions/states, and without any correlation with the socioeconomic and health indicators analyzed.

Taxas de mortalidade geral indígena nas unidades federativas do Brasil e sua (não) correlação com indicadores socioeconômicos e de saúde nos anos de 2000 e 2010

In 2010, the indigenous population represented 0.2% of the Brazilian population and was mostly located in the Legal Amazon region. In Brazil, there are laws to protect the indigenous population, in addition to a National Health Care Policy for Indigenous Peoples. However, a large part of the indigenous population is considered under social and sanitary vulnerability, which are more pronounced in certain regions of the country. Therefore, this study aimed to calculate and evaluate the all-cause mortality rate in the Brazilian indigenous population and investigate correlations with socioeconomic and health indicators. This is an ecological study based on official data (2000 and 2010). The number of deaths were extracted from the Mortality Information System. Indigenous population data were extracted from Demographic Censuses of the Brazilian Institute of Geography and Statistics. The all-cause mortality rate were calculated by states and correlated, through Pearson's correlation test, with socioeconomic and health indicators extracted from the Atlas Brazil platform. In Brazil, an increase in the overall indigenous mortality rate was observed of 15.0% between 2000 and 2010. Among the regions, the Midwest had the highest rates in 2000 and 2010 (4.54 and 5.56 deaths/1,000 indigenous people, respectively). In 2000, the state with the highest all-cause mortality rate was Piauí (9.76/1,000) and in 2010 it was Mato Grosso do Sul (6.54/1,000). All-cause mortality rate did not present a significant correlation (p-value ≤0.05) with the analyzed indicators. The findings of this study indicated that the all-cause mortality rate in Brazil increased unevenly, according to regions/states, and without any correlation with the socioeconomic and health indicators analyzed.

Epidemiology of COVID-19 Among Indigenous Populations in Brazil.

BackgroundDue to social and geographical isolation, indigenous people are more vulnerable to adverse conditions; however, there is a lack of data on the epidemics’ impact on these populations. Thus, this article’s objective was to describe the epidemiological situation of COVID-19 in indigenous communities in Brazil.MethodsThis descriptive observational study was carried out in indigenous communities in the municipality of Amaturá (Amazonas, Brazil). Individuals from the Alto Rio Solimões Special Indigenous Sanitary District (DSEI) who met the Sars-Cov-2 infection case definitions during the period between January and August 2020 were included. For case notification, the definitions adopted by the Ministry of Health of Brazil and by the Special Secretariat for Indigenous Health were considered.ResultsOut of the entire population served by the Alto Rio Solimões DSEI (n = 2890), 109 indigenous people were suspected of having been infected with Sars-Cov-R during the study period; a total of 89 cases were actually confirmed (rate: 3.08 cases/100,000 inhabitants). Most patients diagnosed with COVID-19 were female (56.2%), with a mean age of 32.4 (± 23.6) years. Predominant symptoms were fever (76.4%), dry cough (64%), and headache (60.7%). Complications occurred in 7.9% of the patients; no deaths were reported.ConclusionThese results enhance the observation that indigenous populations, even if relatively isolated, are exposed to COVID-19. The disease cases assessed showed a favorable evolution, which does not mean reducing the need for caring of this population.

COVID-19 pandemic evolution in the Brazilian Indigenous population.

IntroductionThe COVID-19 pandemic has affected several neglected populations such as the Indigenous peoples, which have suffered a high impact from the pandemic.ObjectivesTo analyze the impact on the health and disease process according to the COVID-19 evolution in the Brazilian Indigenous population.MethodsData was collected from press releases by the Health Ministry and a descriptive analysis of the numbers of Indigenous individuals infected with the SARS-CoV-2 in Brazil was carried out.ResultsIn February 2021, there were 41,855 confirmed cases of Indigenous individuals infected by the SARS-CoV-2, including 4,387 active cases, 36,809 recovered cases, and 549 deaths. The Brazilian Indigenous population is distributed in over 300 ethnic groups and, due to the high number of deaths by the COVID-19, many of these groups are endangered. The elderly are the most affected age group, and they play a fundamental role among the Indigenous population for transmitting their customs mainly orally. Indigenous populations do not have proper access to transport to specialized health centers, since many areas are inaccessible and other cases require air or river transportation, which many times results in late assistance. When managing the COVID-19, it is important to emphasize the need for social isolation to prevent the virus from spreading among the Indigenous groups, mainly due to their contact with other ethnic groups represented by missionaries, hunters, and wood explorers, among others.ConclusionThe adoption of practices that can reduce the virus transmission among the Indigenous population and provide them with better access to treatment, mainly for the elderly, must be prioritized in Brazil.

Cancer incidence in indigenous populations of Western Amazon, Brazil

ABSTRACT Objectives This study aims to estimate a population-based cancer incidence among indigenous populations in the State of Acre, Brazilian Western Amazon, to provide knowledge about cancer epidemiological profiles contributing to healthcare policies and service planning. Although cancer epidemiology in Brazil is well described through incidence and mortality estimate in the general population, cancer estimates among indigenous peoples are still unknown. Design This is a descriptive study of cancer incidence among the indigenous population (2000–2012) in the State of Acre, Brazil. The sources used were population-based cancer registries of Goiânia, hospital-based cancer registry of Acre, São Paulo, and Porto Velho; Special Indigenous Health Districts databases of Acre, Goiânia, and São Paulo; Mortality Information System, and Rio Branco’s public and private laboratories’ reports. Standardized Incidence Ratio (SIR) was calculated using cancer incidence rates of Goiânia as reference. Results From 137 cancer cases, 51.8% occurred in women and 32.1% in people aged 70 + . Among men, the most frequent cancer sites were stomach (25.8%), liver (15.1%), colorectal (7.6%), leukemia (7.6%), and prostate (6.1%). Among women, the most frequent were cervical (50.7%), stomach (8.5%), leukemia (5.6%), liver (4.3%), and breast (4.3%). Among men, there was an excess of cancer cases for stomach (SIR=1.75; 95%CI:1.67–1.83), liver (SIR=1.77; 95%CI:1.66–1.88), and leukemia (SIR=1.64; 95%CI:1.49–1.78). In women, an excess of cancer cases was observed for cervical (SIR=4.49; 95%CI:4.34–4.64) and liver (SIR=2.11; 95%CI:1.88–2.34). A lower cancer incidence for prostate (SIR=0.06; 95%CI:0.05–0.07) and female breast (SIR=0.12; 95%CI:0.11–0.14) was observed. Conclusions Cervical, stomach, and liver cancers corresponded to 52% of the cases and were highly incident among the Brazilian indigenous population of Western Amazon compared to non-indigenous counterparts. Despite the low frequency of breast and prostate cancer, the fact they were present among indigenous peoples suggests a complex epidemiological transition framework in these populations.

Síndrome respiratória aguda grave em indígenas no contexto da pandemia da COVID-19 no Brasil: uma análise sob a perspectiva da vigilância epidemiológica

Introdução: As populações indígenas são mais vulneráveis a infecções respiratórias e enfrentam situações que podem agravar a evolução e o prognóstico da COVID-19. Nesse contexto, identificar os grupos expostos a maior risco e propor estratégias de predição, prevenção e controle são as premissas da vigilância epidemiológica. Objetivo: Analisar o impacto da pandemia da COVID-19 na população indígena brasileira a partir das internações por síndrome respiratória aguda grave (SRAG). Método: Estudo epidemiológico, descritivo e quantitativo dos casos de SRAG em pacientes autodeclarados indígenas notificados ao Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) da Secretaria de Vigilância em Saúde do Ministério da Saúde (SVS/MS) do Brasil, de 1º de janeiro a 16 de junho de 2017, 2018, 2019 e 2020. Resultados: O total de casos de SRAG foi de 688, com 318 confirmados para a COVID-19. Dos pacientes com a SRAG, 237 evoluíram com alta e 211 com óbito. Para a COVID-19, 81 evoluíram com alta e 155 com óbito. Casos e óbitos por SRAG e COVID-19 predominaram no sexo masculino. Houve pico de casos e óbitos entre os menores de 1 ano e entre maiores de 50 anos. Para SRAG, predominaram casos e óbitos rurais e para COVID-19, urbanos. Houve predomínio de casos da SRAG e COVID-19 nos estados do Amazonas, São Paulo e Pará. Já os óbitos predominaram nos estados do Amazonas, Pará e Roraima. Conclusões: As populações ficam sujeitas a situações de maior vulnerabilidade durante a pandemia, constituindo risco para suas saúdes e para o seu patrimônio. Mais pesquisas e ações de vigilância epidemiológica efetivas voltadas para essa população se mostram essenciais.

Identification of a predominant genotype of Mycobacterium tuberculosis in Brazilian indigenous population

After nearly a century of vaccination and six decades of drug therapy, tuberculosis (TB) kills more people annually than any other infectious disease. Substantial challenges to disease eradication remain among vulnerable and underserved populations. The Guarani-Kaiowá people are an indigenous population in Paraguay and the Brazilian state of Mato Grosso do Sul. This community, marginalized in Brazilian society, experiences severe poverty. Like other South American indigenous populations, their TB prevalence is high, but the disease has remained largely unstudied in their communities. Herein, Mycobacterium tuberculosis isolates from local clinics were whole genome sequenced, and a population genetic framework was generated. Phylogenetics show M. tuberculosis isolates in the Guarani-Kaiowá people cluster away from selected reference strains, suggesting divergence. Most cluster in a single group, further characterized as M. tuberculosis sublineage 4.3.3. Closer analysis of SNPs showed numerous variants across the genome, including in drug resistance-associated genes, and with many unique changes fixed in each group. We report that local M. tuberculosis strains have acquired unique polymorphisms in the Guarani-Kaiowá people, and drug resistance characterization is urgently needed to inform public health to ensure proper care and avoid further evolution and spread of drug-resistant TB.

Impact of COVID-19 on the indigenous population of Brazil: a geo-epidemiological study.

This study aimed to analyse the geographical distribution of coronavirus disease 2019 (COVID-19) and to identify high-risk areas in space and time for the occurrence of cases and deaths in the indigenous population of Brazil. This is an ecological study carried out between 24 March and 26 October 2020 whose units of analysis were the Special Indigenous Sanitary Districts. The Getis-Ord General G and Getis-Ord Gi* techniques were used to verify the spatial association of the phenomena and a retrospective space-time scan was performed. There were 32 041 confirmed cases of COVID-19 and 471 deaths. The non-randomness of cases (z score = 5.40; P < 0.001) and deaths (z score = 3.83; P < 0.001) were confirmed. Hotspots were identified for cases and deaths in the north and midwest regions of Brazil. Sixteen high-risk space-time clusters were identified for the occurrence of cases with a higher RR = 21.23 (P < 0.001) and four risk clusters for deaths with a higher RR = 80.33 (P < 0.001). These clusters were identified from 22 May and were active until 10 October 2020. The results indicate critical areas in the indigenous territories of Brazil and contribute to better directing the actions of control of COVID-19 in this population.

The contribution of stigma to the transmission and treatment of tuberculosis in a hyperendemic indigenous population in Brazil

BackgroundThe Guarani-Kaiowá are Brazil's second-largest indigenous group. Average annual tuberculosis (TB) incidence rates among the Guarani-Kaiowá are nearly 400/100,000 in Mato Grosso do Sul state, ten times the national average. Although stigma is considered crucial for TB control in indigenous communities, few studies have investigated TB stigma among indigenous populations. This study sought to understand the role of TB-related stigma and perceptions of TB in maintaining hyperendemic TB transmission in the Guarani-Kaiowá communities.MethodsVarious forms of stigma were explored through semi-structured interviews with 19 patients, 11 relatives, and 23 community members. Patients were identified from the registry of the healthcare service. Community members, selected by snowball sampling, were matched by gender and village of residence. Interviews were conducted in Guarani and Portuguese and later translated into English. Framework analysis was performed using NVivo.ResultsTraditional beliefs of a weakening of the body allowing the disease to enter were common, but the exact mechanism of transmission was unknown. Strong community/public stigma associated TB with uncleanliness, abuse, and irresponsibility. Anticipated stigma led to significant treatment delays for fear of exclusion and losing employment. While most patients felt supported by their families, nearly all patients related experienced/enacted stigma in the community such as gossip, avoidance, and social exclusion, leading to long-lasting internalized/self-stigma. Secondary stigmatization of relatives was widespread, and blanket latent TB infection (LTBI) treatment of patients’ households was a contributing factor in treatment delay. The healthcare service unnecessarily added to stigmatization by enforcing separate utensils and sleeping arrangements for patients.ConclusionsOur findings suggest that stigma is a driver for treatment delay and continued transmission of TB in the community. The stigmatization of TB was rooted in a poor understanding of TB transmission, partly because of incorrect orientation by the healthcare service. Interventions to reduce TB-associated stigma are urgently needed.

Inatividade física em populações indígenas residentes em zona urbana na América do Sul

Embora a inatividade física esteja relacionada ao risco aumentado de doenças crônicas não-transmissíveis, existe pouca pesquisa publicada sobre a saúde de populações indígenas em área urbana nos países da América do Sul. O presente estudo conduziu revisão sistemática da literatura investigando a inatividade física em populações indígenas residindo em área urbana na América do Sul, identificando as prevalências encontradas, o instrumento utilizado para mensuração e o país de publicação. Realizou-se busca nas bases de dados Medline, Embase, ERIC, PsycInfo, Scopus, Web of Science, Scielo, teses e dissertações considerando descritores definidos. Considerou-se como critérios de inclusão: ser estudo com dados populacionais primários ou secundários, com populações indígenas residindo em área urbana em país da América do Sul, publicados entre os anos de 2008 a 2018. Ao final, 5 registros foram analisados na íntegra e tratavam de populações indígenas no Brasil, com prevalências de inatividade física variando de 28,8% a 64,5% da população, coletadas por meio de questionários variados. Em 3 estudos a inatividade física mensurada foi maior que a registrada para a população não-indígena urbana no Brasil no ano de 2013. Constituem limitações a pouca generalização dos dados dos estudos e a diversidade dos instrumentos utilizados. A temática da inatividade física em populações indígenas em área urbana é recente e necessária a um novo conceito de saúde indígena que considere esta parcela da população. Sugere-se que futuros estudos abranjam os países do Caribe e América Central, em especial. Palavras-chave: Exercício Físico. Povos indígenas. América do Sul.

COVID-19 in the Indigenous Population of Brazil.

Brazil has 896,917 Indigenous individuals distributed among 505 Indigenous lands. There are 274 different Indigenous languages within 305 Indigenous ethnic groups. The Indigenous population is susceptible to pandemics, especially to the current pandemic of COVID-19, which has spread rapidly. In Brazil, after the first COVID-19-confirmed Indigenous case on 05th June 2020, more 420 suspected cases, 1727 confirmed cases being 934 active cases, 715 cases with clinical cure, and 70 cases of death were accounted through the first week of June. The number of cases is underestimated, according to the Special Secretariat for Indigenous Health (SESAI) database, since the deaths are due to respiratory failure, possibly caused by COVID-19, but not confirmed. The first COVID-19-caused death was a 15-year-old Indigenous Yanomami teenage from Roraima State without known previous diseases history and/or comorbidities. In the present study, the importance of social isolation, especially for Indigenous people who are more vulnerable to the COVID-19, was highlighted by the identification of the infection community. An Indigenous of the Kokama ethnicity was infected after coming in contact with a Medical Doctor who was infected with the disease. Later, it was noticed that both, Indigenous and doctor, were responsible for COVID-19’s transmission to 43 other Indigenous individuals (30 in Alto Rio Solimões and 13 in Parintis), causing possibly other confirmed deaths. The impact of COVID-19 for Indigenous population might be an unprecedented tragedy, and the government in Brazil must take emergency measures as the social isolation.

Collective oral health care at Xukuru do Ororubá Indigenous Territory (Pesqueira, Brazil) in 2018

Abstract Background Primary oral health care services are responsible for performing collective actions, in order to prevent diseases and promote health through education. Brazilian indigenous populations, especially from the Northeast Region, suffer from insufficient access to oral health services. From this perspective, this study aims to verify the performance of oral health collective actions indicators in the territory of the Xukuru do Ororubá indigenous ethnic group (Pesqueira, Brazil) in 2018. Methods An observational and ecological study. Secondary data for 2018 were extracted from the Indigenous Health Care Information System, part of the Brazilian Unified Health System (SUS). Performance of collective oral procedures conducted by the oral health teams in the Xukuru territory was analyzed through indicators applied for the evaluation of oral health actions and services related to primary care. Results There was an average monthly coverage of the collective supervised toothbrushing (CST) of 47.8% for the entire Xukuru territory. The average monthly coverage of the collective topical fluoride application (CTFA) was 2.8%. There was an annual average of 6.2 collective dental procedures (CDP) per capita. Conclusions Less than half of the population participated in CST actions. CTFA proved to be almost nonexistent, with poor coverage for the general territory population. The annual average of CDP was satisfactory which may, in general terms, demonstrate greater concern with preventive measures. However, it appears that such average gains strength due to the volume of health education actions, which is part of the indicator sum. Analyzing the low coverage of CST and CTFA in isolation, a reality of low access to fluoride in this indigenous population can be seen. Results points to the need for greater provision of collective actions in the indigenous territory studied, aiming at strengthening the prevention of diseases and/or aggravations of oral health, in all life cycles. Key messages Measurement of the performance of oral health teams regarding the collective oral health actions in the territory of the Xukuru do Ororubá ethnic group. Analysis of the indigenous oral health stored data quality, aiming to offer support for system management decision making and to the services organization improvement.

Serum 25-hydroxyvitamin D concentration and its association with glucose intolerance in an indigenous population

Type 2 diabetes is a multifactorial disease resulting from diverse genetic and environmental factors as well as the interaction between them. Low levels of 25-hydroxyvitamin D [25(OH)D], an indicator of vitamin D status, have been associated with an increased risk of type 2 diabetes, but not consistently. Also, it remains to be determined if this association differs among ethnic groups. Therefore, we aimed to evaluate vitamin D status and its association with glucose intolerance in a Brazilian indigenous population, the Xavante Indians. The study population consisted of 819 full Xavante Indians (410 women), aged ≥18 years and living in two indigenous reserves located in Mato Grosso State, central region of Brazil. Clinical examination and anthropometrical measurements were made, blood samples were obtained for total cholesterol, HDL-cholesterol, triglycerides and 25(OH)D measurement. Fasting and 2-h post 75g oral glucose load capillary glucose was measured. Vitamin D status was defined by serum 25(OH)D levels: vitamin D sufficiency (25(OH)D: 30-100ng/mL), vitamin D insufficiency (25(OH)D: 20- <30ng/mL) and vitamin D deficiency (25(OH)D: < 20ng/mL). Multiple logistic regression was performed to identify independent associations between 25(OH)D levels and impaired glucose tolerance or diabetes mellitus. Analyses stratified by 25(OH)D levels shows that 65.5% of the population had vitamin D deficiency/insufficiency (25(OH)D<30ng/mL). 25(OH)D concentrations were lower in individuals with impaired glucose tolerance or diabetes mellitus than in normal glucose tolerant individuals. Multiple logistic regression analysis showed an inverse association between increments of 25(OH)D and presence of diabetes mellitus (OR per 1ng/mL increase in 25(OH)D: 0.97; 95% confidence interval: 0.95-0.99), or impaired glucose tolerance (OR per 1ng/mL increase in 25(OH)D: 0.87; 95% confidence interval: 0.85-0.89), in an age, sex, BMI and season of sampling-adjusted model. The present population-based study found a high prevalence of hypovitaminosis D among Xavante Indians. In this at-risk population of type 2 diabetes, a significant association of higher serum 25(OH)D with a decreased prevalence of diabetes mellitus and impaired glucose tolerance was observed.

Analysis of the mortality trend in the indigenous population of Brazil, 2000–2016

ObjectivesThe objective of the study is to analyze the mortality trend in indigenous peoples in Brazil. Study designThe study design used is an ecological study. MethodsA study carried out with data from the indigenous deaths recorded on the Mortality Information System in Brazil between 2000 and 2016. The Prais Winsten regression was used to analyze the trend of overall mortality in the country and in its geopolitical regions, in addition to the trend by sex, age groups, and groups of basic causes of death. ResultsOf all deaths, 47,806 indigenous deaths were recorded between 2000 and 2016. The majority was male (56.5%) and 27.2% in children aged younger than 5 years. The major groups of causes of death were the circulatory diseases (15.8%) and external causes (14.9%). The affections of the perinatal period (23.7%) and infectious and parasitic diseases (18.5%) were the main causes in children aged younger than 5 years. The indigenous mortality rates showed an increasing trend in the country (annual percent change [APC] = 2.37%). There was growth in both sexes and in most age ranges. Mortality from external causes (APC = 4.71%), neoplasms (APC = 4.67%), and respiratory causes (APC = 4.14%) also presented growth. The infectious and parasitic causes and genitourinary causes showed a stable trend in the studied period. ConclusionsThe increasing trend of mortality in the analyzed variables showed disparities between indigenous and non-indigenous peoples in Brazil, pointing to the need for greater investment in basic social sectors, such as health, education, housing, and sanitation.

Aleitamento materno e introdução da alimentação complementar: uma análise de povos indígenas

A população indígena no Brasil vem crescendo nos últimos anos, estima-se que o alcance dessa população seja maior que 900 mil nativos declarados e situem-se em 305 etnias e 274 idiomas. É recomendável o aleitamento materno exclusivo até os 6 meses de idade e que a alimentação complementar saudável seja introduzida a partir dos 6 meses. No entanto, entende-se que os povos indígenas apresentam uma complexa circunstância de saúde que está relacionada diretamente com as mudanças sociais, econômicas e ambientais, processo histórico que agravou as condições de saúde. Este estudo teve como objetivo analisar por meio de uma revisão da literatura os impactos do aleitamento materno e introdução da alimentação complementar em crianças de até 2 anos de povos indígenas. A pesquisa bibliográfica foi realizada utilizando a bases de dados BIREME, LILACS, SCIELO, MEDLINE e foram selecionados artigos publicados nos últimos dez anos e nacionais. Após a revisão da literatura, ficou evidente que o tempo de aleitamento materno nas populações indígenas é bem menor que o recomendado pela OMS. Portanto, impactando não só na saúde das crianças indígenas, mas também na relação de vínculo, acolhimento, admiração entre mãe e filho.

HTLV in South America: Origins of a silent ancient human infection.

The description of the first human retrovirus, human T-lymphotropic virus 1 (HTLV-1), was soon associated with an aggressive lymphoma and a chronic inflammatory neurodegenerative disease. Later, other associated clinical manifestations were described, affecting diverse target organs in the human body and showing the enormous burden carried by the virus and the associated diseases. The epidemiology of HTLV-1 and HTLV-2 showed that they were largely distributed around the world, although it is possible to locate geographical areas with pockets of low and very high prevalence and incidence. Aboriginal Australians and indigenous peoples of Brazil are examples of the large spread of HTLV-1 and HTLV-2, respectively. The epidemiological link of both situations is their occurrence among isolated, epidemiologically closed or semi-closed communities. The origin of the viruses in South America shows two different branches with distinct timing of entry. HTLV-1 made its probable entrance in a more recent route through the east coast of Brazil at the beginning of the slave trade from the African continent, starting in the 16th century and lasting for more than 350 years. HTLV-2 followed the ancient route of human migration from the Asian continent, crossing the Behring Strait and then splitting in South America as the population became separated by the Andes Mountains. By that time, HTLV-2c probably arose and became isolated among the indigenous populations in the Brazilian Amazon. The study of epidemiologically closed communities of indigenous populations in Brazil allowed tracing the most likely route of entry, the generation of a new molecular subtype (HTLV-2c), the elucidation of the vertical transmission of HTLV-2, the intrafamilial aggregation of cases and the escape and spread of the virus to other areas in Brazil and abroad. Despite the burden and impact of both viruses, they are maintained as silent infections among human populations because 1, health authorities in most South American countries in which national surveillance is poor have little interest in the disease, 2, the information is commonly lost as indigenous groups do not have specific policies for HTLV and other sexually transmitted infections, and 3, health access is not feasible or properly delivered.