SINAN Database Research Articles

Towards XAI agnostic explainability to assess differential diagnosis for Meningitis diseases

Meningitis, characterized by meninges and cerebrospinal fluid inflammation, poses diagnostic challenges due to diverse clinical manifestations. This work introduces an explainable AI automatic medical decision methodology that determines critical features and their relevant values for the differential diagnosis of various meningitis cases. We proceed with knowledge acquisition to define the rules for this research. Currently, we have established the etiological diagnosis of Meningococcaemia, Meningococcal Meningitis, Tuberculous Meningitis, Aseptic Meningitis, Haemophilus influenzae Meningitis, and Pneumococcal Meningitis. The data preprocessing was conducted after collecting data from samples with meningitis diseases at Setif Hospital in Algeria. Tree-based ensemble methods were then applied to assess the model’s performance. Finally, we implement an XAI agnostic explainability approach based on the SHapley Additive exPlanations technique to attribute each feature’s contribution to the model’s output. Experiments were conducted on the collected dataset and the SINAN database, obtained from the Brazilian Government’s Health Information System on Notifiable Diseases, which comprises 6729 patients aged over 18 years. The Extreme Gradient Boosting model was chosen for its superior performance metrics (Accuracy: 0.90, AUROC: 0.94, and F1-score: 0.98). Setif’s hospital data revealed notable performance metrics (Accuracy: 0.7143, F1-Score: 0.7857). This study’s findings showcase each feature’s contribution to the model’s predictions and diagnosis. It also reveals critical biomarker ranges associated with distinct types of Meningitis. Significant diagnostic effect was found for Meningococcal Meningitis with elevated neutrophil levels ( > 40%) and balanced lymphocyte levels (40%–60%). Tuberculous Meningitis demonstrated low neutrophil levels ( < 60%) and elevated lymphocyte levels ( > 60%). H. influenzae meningitis exhibited a predominance of neutrophils ( > 80%), while Aseptic meningitis showed lower neutrophil levels ( < 40%) and lymphocyte levels within the range of 50%–60%. The majority of the AI automatic medical decision results are twinned with validation by our team of infectious disease experts, confirming the alignment of algorithmic diagnoses with clinical practices.

Drastic reduction in the notification of acute cases of Chagas disease in the Northeast region of Brazil. Epidemiological evaluation in the period 2001–2021

Chagas disease (CD), caused by the protozoan Trypanosoma cruzi (T. cruzi), is a neglected disease endemic to some Latin American countries, including Brazil. Soon after infection, individuals develop an acute phase, which in most cases is asymptomatic and may go undetected. However, when CD is detected early, notification in the Notifiable Diseases Information System (SINAN), is mandatory. This study aimed to evaluate the information registered in the SINAN database and to determine the epidemiological profile of acute CD in Northeast Brazil, an endemic region, from 2001 to 2021. According to this survey, 1,444 cases of acute CD were reported in the Northeastern region of Brazil during this period. During the first six years, referred to as period 1, 90.24% of the notifications were registered, while the number of notifications significantly decreased in the subsequent years, referred to as period 2. Most individuals diagnosed with acute CD were Afro-Brazilian adults. All known routes of infection by the parasite were reported. Vector-borne transmission was predominant during period 1 (73.29%) and oral transmission during period 2 (58.87%). All nine states in Northeast Brazil reported cases in both periods. A higher incidence of disease was reported in Rio Grande do Norte (RN) during period 1, and in Maranhão (MA) during period 2. Our results show that CD remains a significant public health challenge.

Unsupervised K-means Analysis of Tuberculosis Data in Brazil: Identifying High Prevalence States and Temporal Trends

This paper aims to demonstrate the findings obtained through the analysis and application of an unsupervised K-means algorithm on the SINAN database from 2001 to 2022 in Brazil, with the objective of understanding which states have the highest number of tuberculosis cases and identifying similarities among them that may contribute to a higher case rate relative to the local population. We will begin with a brief historical introduction, followed by an overview of the characteristics related to tuberculosis transmission. Subsequently, we will discuss the results obtained from the year-to-year analysis of the collected data.

Biogeographic regionalization of human infectious diseases in Brazil based on geographically explicit data.

Biogeographic regionalization represents abstractions of the organisation of life on Earth, and can provide a large-scaled framework for health management and planning. We aimed at determining a biogeographic regionalization for human infectious diseases in Brazil, and at investigating non-mutually exclusive hypotheses predicting the observed regions. Based on the spatial distributions of 12 infectious diseases with mandatory notification (SINAN database, 2007-2020, n = 15,839), we identified regions through a clustering procedure based on beta-diversity turnover. The analysis was repeated 1000 times by randomly shuffling the rows (0.5° cells) in the original matrix. We evaluated the relative importance of variables using multinomial logistic regression models: contemporary climate (temperature and precipitation), human activity (population density and geographic accessibility), land cover (11 classes), and the full model (all variables). We refined the geographic boundaries of each cluster by polygonising their kernel densities to identify clusters' core zones. The two-cluster solution showed the best correspondence between disease ranges and clusters geographic limits. The largest cluster occurred with more density in the central and northeastern regions, while the smaller and complementary cluster occurred in the south and southeastern region. The best model for explaining the regionalization was the full model, supporting the 'complex association hypothesis'. The heatmap showed a NE-S directional display of the cluster's densities, and core zones showed geographic correspondence with tropical + arid (NE) versus temperate (S) climates. Our findings indicate that there is a discernible latitudinal pattern in the turnover of disease in Brazil, and this phenomenon is associated with an intricate interplay between contemporary climate, population activity, and land cover. This generalised biogeographic pattern may offer the earliest insights into the geographic arrangement of diseases in the country. We suggested that the latitudinal pattern could be adopted as a nationwide framework for geographic vaccine allocation.

Epidemiologic characterization of cases of arbovirosis transmitted by mosquitoes of the genus Aedes reported in indigenous Brazilians

This article aims to describe the epidemiological aspects of arbovirosis transmitted by mosquitoes of the genus Aedes in indigenous Brazilians. It is an epidemiologic, descriptive, quantitative, and cross-sectional study. The object of study of this research was the epidemiological aspects of dengue (2016-2021), chikungunya fever (2017-2021), and Zika (2016-2021) in Brazilian indigenous people. Data were collected from the database of the Sistema de Informação de Agravos de Notificação (Sinan) database. 13.871 cases of dengue, 2.004 cases of Chikungunya fever, and 1.239 cases of Zika were reported. The state with the highest prevalence of dengue cases is Mato Grosso do Sul, Chikungunya fever is Ceará, and Zika is Bahia. The most affected by the arboviruses studied are women with a high school education and between 20 and 59 years of age. Arboviruses were diagnosed by the criterion of clinical-epidemiologic confirmation, and cure was the most common evolution.

A Dynamical System Model of Dengue Transmission for Rio de Janeiro, Brazil

The dengue virus is a serious concern in many parts of the world, including Brazil. As data indicates, a prominent vector for dengue is the mosquito Aedes aegypti. By using the dengue incidence records from the Brazilian SINAN database, we estimate the population of A. aegypti within the city of Rio de Janeiro. Using historical climate data for Rio de Janeiro and the computed population estimates, we extend an existing model for the population dynamics of mosquitoes to incorporate precipitation in aquatic stages of development for A. aegypti.

Características epidemiológicas dos casos de sífilis congênita no Estado da Paraíba

Esse estudo teve como objetivo descrever as características epidemiológicas da sífilis congênita, no estado da Paraíba, durante o período de 2014 a 2019. Trata-se de uma pesquisa do tipo transversal, descritiva com abordagem quantitativa, realizada através do banco de dados do SINAN (Sistema de Informações de Agravos de Notificação), disponibilizados pelo DATASUS (Departamento de informação do Sistema Único de Saúde). Após a aplicação dos critérios de inclusão e exclusão, os dados foram organizados no programa Microsoft EXCEL 2013® para análise das variáveis e disposição das tabelas. A incidência de sífilis congênita foi crescente no estado da Paraíba, a qual aumentou de 4,4 casos para 6,7/1.000 nascidos vivos. Dos 1639 casos notificados, 1593 (97,2%) possuíam até 6 dias de vida e 1468 (89,6%) foram classificados como sífilis congênita precoce. Relativo às características da mãe, 851 (51,9%) tinham idade entre 20 e 29 anos, 1377 (84,0%) se autodeclararam pardas, 882 (53,8%) estudaram até o ensino fundamental incompleto ou completo, 1400 (85,4%) realizaram o pré-natal, 791 (48,3%) obtiveram o diagnóstico durante o pré-natal, 1115 (68,0%) foram tratadas inadequadamente e 1010 (61,6%) não tiveram seus parceiros tratados. Assim, verificou-se que a proposta de identificar as características epidemiológicas dos casos notificados de sífilis congênita no estado da Paraíba constitui-se uma ferramenta efetiva para dimensionar a proporção do agravo e para orientar as ações de controle e eliminação da sífilis congênita no estado.

Leprosy Screening Based on Artificial Intelligence: Development of a Cross-Platform App.

BackgroundAccording to the World Health Organization, achieving targets for control of leprosy by 2030 will require disease elimination and interruption of transmission at the national or regional level. India and Brazil have reported the highest leprosy burden in the last few decades, revealing the need for strategies and tools to help health professionals correctly manage and control the disease.ObjectiveThe main objective of this study was to develop a cross-platform app for leprosy screening based on artificial intelligence (AI) with the goal of increasing accessibility of an accurate method of classifying leprosy treatment for health professionals, especially for communities further away from major diagnostic centers. Toward this end, we analyzed the quality of leprosy data in Brazil on the National Notifiable Diseases Information System (SINAN).MethodsLeprosy data were extracted from the SINAN database, carefully cleaned, and used to build AI decision models based on the random forest algorithm to predict operational classification in paucibacillary or multibacillary leprosy. We used Python programming language to extract and clean the data, and R programming language to train and test the AI model via cross-validation. To allow broad access, we deployed the final random forest classification model in a web app via shinyApp using data available from the Brazilian Institute of Geography and Statistics and the Department of Informatics of the Unified Health System.ResultsWe mapped the dispersion of leprosy incidence in Brazil from 2014 to 2018, and found a particularly high number of cases in central Brazil in 2014 that further increased in 2018 in the state of Mato Grosso. For some municipalities, up to 80% of cases showed some data discrepancy. Of a total of 21,047 discrepancies detected, the most common was “operational classification does not match the clinical form.” After data processing, we identified a total of 77,628 cases with missing data. The sensitivity and specificity of the AI model applied for the operational classification of leprosy was 93.97% and 87.09%, respectively.ConclusionsThe proposed app was able to recognize patterns in leprosy cases registered in the SINAN database and to classify new patients with paucibacillary or multibacillary leprosy, thereby reducing the probability of incorrect assignment by health centers. The collection and notification of data on leprosy in Brazil seem to lack specific validation to increase the quality of the data for implementations via AI. The AI models implemented in this work had satisfactory accuracy across Brazilian states and could be a complementary diagnosis tool, especially in remote areas with few specialist physicians.

Retrospective study of leptospirosis in humans in the city of Manaus, Amazonas (2018-2019)

Leptospirosis is an infectious disease of worldwide distribution, transmitted by a highly pathogenic microaerophilic bacterium known as Leptospira spp., from direct contact with infected rodent urine, or in contaminated water and mud. The objective of this study was to carry out an epidemiological characterization of this disease in the city of Manaus, from January 2018 to December 2019, through access to the Notifications Disease Information System - SINAN database, made available by the Foundation of Amazonas Health Surveillance - FVS / AM, and thus make epidemiological inferences through variables such as sex, age, occupation, risk situation occurred in the 30 days prior to the first symptoms, clinical signs, autochthonous case, characteristic of the probable location of the source of infection, work-related disease, the evolution of the case and determination criteria for the characterization of the disease. As a result, 64 cases were confirmed, school distribution as to the regions of the city of 12.5% ​​of cases in the North zone, 10.94% in the South zone, 9.37% in the West zone, 7.82% in the East zone, and 59.37% did not have the area identified. Regarding age, the highest prevalence was identified in those under 50 years of age, representing 75% of total cases. As for gender, 89.06% of the cases involved males. Regarding risk hypotheses, contact with water or mud from floods was the main infection factor, with 64.60% of cases, and the main signs comparable to infected individuals were: fever, myalgia, headache, prostration, vomiting, diarrhea, and jaundice. The results show that leptospirosis is a public health problem in the city of Manaus, mainly due to climatic, sanitary, and social factors, the situation in which those susceptible are inserted. Furthermore, a series of socioeconomic and health deficits are located in this municipality, and thus actions and improvements in local public health must be carried out, thus favoring the control of this disease.

Profile of intoxications by drugs of abuse in Brazil.

In the last decade, there has been an increase in the consumption of drugs of abuse (DA) globally, considered a serious public health problem and, due to this abuse, there has been an increase in the occurrences of intoxications by these substances. Thus, the objective was to build an epidemiological profile of Brazilian intoxications due to DA. Therefore, a compilation of data about poisoning by DA in the National System of Toxic-Pharmacological Information (SINITOX) occurring between 1999 and 2017 was performed, evaluating variables of age group, circumstance, occurrence zones, gender, evolution and deaths. Additionally, a data survey was carried out in the DATASUS - SINAN (Information System for Notifiable Diseases) database, looking for the same parameters, in order to carry out a comparison between the databases. According to the data obtained, it was found that the profile of intoxication by DA is composed mainly of young men aged 20-29 years, coming from urban areas who become intoxicated, mainly by abuse as the main circumstance of intoxication. Intoxications evolve, mainly to cure without sequelae, with less recurrent deaths. Such results are compatible with other studies on DA poisoning. It is a relevant study to know the Brazilian profile on this type of intoxication, considering that it makes it possible to identify potential risk conditions to which individuals are exposed, and thus prioritize strategies to propose preventive measures in these cases of intoxication. However, caution is needed when analyzing the information from the two databases analyzed (SINITOX and DATASUS), as both have gaps.

Spaces of production of cutaneous leishmaniasis in the state of Rio de Janeiro, Brazil

The scope of this research was to identify and characterize spatial units of epidemiological relevance in the state of Rio de Janeiro, through the highest concentrations of cutaneous leishmaniasis (CL) from 1980 to 2012, considering the geographical aspects. SUCAM, FUNASA and SINAN databases were consulted. A method of adjustment of spatially referenced data for demarcation of the regions with the highest concentrations of cases called circuits and poles was applied. These were superimposed on the socioenvironmental indicator maps. Of the total cases registered in the period, 87% occurred in the municipalities located in the resulting circuits and poles. The variations in the occurrence of cases in the different circuits and poles were not related to the socioenvironmental indicators. The identification of the circuits and poles can subsidize the state CL program of the prioritization of strategies of prevention and control actions and the optimization of the resources of the program. These regions, which are more stable than the localities, allow surveillance and control operations in locations with many cases and in other locations in the identified risk area, because they have the same characteristics as those already affected.

Epidemiological Impact and Hospitalization costs applied to dengue in the Midwest region of Minas Gerais state, Brazil, from SUS perspective.

Dengue is considered one of the greatest public health challenges in the world, especially, for tropical and subtropical countries. Brazil highlights with considerable number of registers associated with this arbovirus, with emphasis on the state of Minas Gerais and its municipalities in regions such as the midwest. We aimed to evaluate the economic and epidemiological impact of dengue in the midwest region of minas Gerais, from SUS perspective. Our study evaluated the epidemiological impact of dengue fever in the midwest region of Minas Gerais using data applied to Divinópolis city from SUS perspective between 2000 to 2015 considering SIH/SUS database (hospitalization registers) and 2007 to 2017 using the SINAN database (notification cases). We analyzed the number of notification registers and hospital services, as well as their costs, from a SUS perspective associated with this infection. There were 26,516 notifications associated with dengue, with 21,953 cases being confirmed by SEMUSA, with a median incidence of 211 cases/100,000 inhabitants of dengue notifications between 2007 and 2017. The southeast and southwest regions in the municipality are highlighted with high number of cases. Additionally, 160 hospitalizations were recorded with 33.79% in individuals between 15 and 34 years old and expenses of USD 53,737.21 for SUS between 2000 and 2015. Divinópolis is the reference (social and economic) municipality of the midwest region in Minas Gerais state. Our study is the first conducted involving a long period of follow up applied to dengue context in this locality, especially, including the costs associated with hospitalization services. We hope to contribute to the discussions regarding the coping strategies of the disease, considering the impact in its different regions, highlighting the need for continued efforts and initiatives aimed at combating the vector of this and other arboviruses such as Zika and chikungunya.

Visceral leishmaniasis lethality in Brazil: an exploratory analysis of associated demographic and socioeconomic factors.

INTRODUCTION: It is believed that delays in diagnosis and treatment of Visceral Leishmaniasis (VL) contribute significantly to the burden of VL lethality in Brazil. METHODS: This study included several parts: a descriptive cross-sectional study of the individual characteristics of deaths from disease; a descriptive ecological study of the spatial distribution of deaths from disease; and an ecological analytical study to evaluate the association between disease lethality rates and the demographic, socioeconomic, and health indicators. The study population comprised all cases diagnosed throughout the country per the National Disease Notification System (SINAN) and the total number of disease deaths recorded in the Mortality Information System (SIM) from 2007 to 2012. RESULTS: Of the 223 deaths from disease captured by pairing the databases, 59.1% were reported as "death from other causes". There were significant associations between VL lethality rate and municipalities with the highest proportion of vulnerable individuals (rate ratio (RR)=1.18, 95% confidence interval (CI): 1.01-1.27), with VL lower incidence rate (RR=0.62, 95% CI: 0.58-0.67) and a higher incidence rate of Acquired Immune Deficiency Syndrome (AIDS) (RR=1.20, 95% CI: 1.17-1.51). CONCLUSIONS: Linking the SINAN and SIM databases allowed the inclusion of 14% of otherwise underreported deaths from VL for the study period, showing that this method is useful for the surveillance of VL-related deaths. The size of the municipal population, proportion of the vulnerable population, incidence of disease, and the incidence of AIDS were associated with municipal lethality rates related to VL in Brazil.

EXAGENEOUS INTOXICATIONS IN ALAGOAS: PESTICIDES EMPHASIS

In order to describe the cases of exogenous intoxication in the State of Alagoas, with emphasis on pesticides, a survey was conducted between the period 2007 and 2017, from the SINAN database, provided by the Alagoas State Health Department. They were recorded total of 28,314 cases of exogenous intoxication, wherein medicines (33.9%), food and beverages (11.3%) and pesticides (8.8%) were the main intoxicating agents. The year 2013, with 4,489 notifications, was those with the highest number of records. In relation to pesticides, 1,151 cases were reported, wherein the city of Arapiraca, with 246 records, led the ranking of notifications. Male population (73.7%), aged between 20 and 49 years (60.7%), with a low educational level (21.6%), who became intoxicated at their residence (39.7%), in sprayings (20.8%) of herbicide (28.5%), mainly 2,4D (60.8%), were the main circumstances. It was detected that 90% of the aggravations by pesticides presented cure without sequels, despite the registry of 28 deaths. This information shows that exogenous poisoning is a public health problem and that monitoring of records and on-site monitoring by health workers, investments in rural extension work, and technical assistance could significantly reduce the problem.

Treatment for human visceral leishmaniasis: a cost-effectiveness analysis for Brazil.

To estimate the cost-effectiveness of strategies for the treatment of VL in Brazil. Cost-effectiveness study comparing three therapeutic options: meglumine antimoniate (MA), liposomal amphotericin B (LAMB) and a combination of LAMB plus MA (LAMB plus MA), from public health system and societal perspectives. An analytical decision-making model was used to compare strategies for the following outcomes: early therapeutic failure avoided at 30days, days of hospitalisation avoided and VL cure at 180days. The efficacy and safety parameters of the drugs came from a randomised, open-label trial and the cost data came from a cost-of-illness study, both carried out in Brazil. For all outcomes analysed, the LAMB strategy was more effective. The MA strategy was inferior to the LAMB plus MA strategy for the outcomes early therapeutic failure avoided and cure. When only LAMB and MA were compared from a societal perspective, a cost of US$ 278.56 was estimated for each additional early therapeutic failure avoided, a cost of US$ 26.88 for each additional day of hospitalisation avoided and a cost of US$ 89.88 for each additional case of cured VL, for the LAMB strategy vs. MA. In Brazil, the LAMB strategy proved to be cost-effective for treating VL, considering a GDP per capita as the willingness-to-pay threshold, for all of the outcomes analysed in comparison to MA.

Use of database linkage and scripting rules to upgrade variables in the Sinan-TB database

Brazil's Information System on Diseases of Notification (Sinan) is the main tool used by tuberculosis (TB) control programs to assess control measures and TB incidence. This requires data from the system that are reliable and accurate, among other features. The study thus aimed to upgrade the entry variables, condition at closure, HIV testing, AIDS-related illness, and diabetes. Linkage was performed between the Sinan-TB database, the Mortality Information System (SIM), and the single AIDS database for the city of Rio de Janeiro, Brazil. Criteria for upgrading the variables were based on technical materials on TB and the Sinan database and were implemented in a script in Structured Query Language (SQL). There was a 115% increase in treatment dropout due to the decrease in transfers, records without closure, and patients closed due to cure in less than 150 days. There was a 2.4% increase in records with diseases associated with diabetes in the affirmative category after using data from the SIM. For the variables HIV testing and AIDS-associated illness, the increases were 5.3% and 8.7%, respectively, when the information in the AIDS database was considered. In conclusion, upgrading the Sinan-TB database through integration with other information systems improved the data's quality for decision-making on TB control.

Assessing epidemiology of leprosy and socio-economic distribution of cases.

Leprosy still represents a serious health problem in a number of countries, including Brazil. Although leprosy has been associated with poverty for a long time, it is still difficult to accurately define this relationship. Here, we evaluated in an endemic municipality the progress from 1995 to 2015 of epidemiological indicators to establish if there were any strong associations between social indicators and the occurrence of leprosy. An ecological study was conducted using the SINAN database (Brazilian leprosy-national notifiable diseases information system) in combination with georeferencing of leprosy cases. The georeferencing used the ArcGis programme and occurrence of cases was evaluated in relation to the Health Vulnerability Index (HVI), an indicator that categorises socio-economic and sanitation factors. The data identified a marked decrease in the overall prevalence of leprosy, a reduction in the new case-detection rate and a reduction in the number of cases with grade 2 disabilities (albeit with transient peaks in 2007 and 2015). Logistic regression analysis showed association of detection rates with elevated HVI. Thus, while the epidemiological indicators point to the elimination of leprosy, there is evidence of hidden cases and an association between higher rates of leprosy detection and greater social vulnerability remain.

Snakebites as cause of deaths in the Western Brazilian Amazon: Why and who dies? Deaths from snakebites in the Amazon

Snake envenoming represents a major burden for public health worldwide. In the Amazon, the official number of cases and deaths detected is probably underestimated because of the difficulty riverine and indigenous populations have reaching health centers in order to receive medical assistance. Thus, integrated analysis of health information systems must be used in order to improve adequate health policies. The aim of this work is to describe a series of deaths and identify risk factors for lethality from snakebites in the state of Amazonas, Brazil. All deaths from snakebites reported to the Brazilian Notifiable Diseases Surveillance System (SINAN) and to the Mortality Information System (SIM; ICD10-10th revision, X.29), from 2007 to 2015, were included. Variables were assessed by blocks with distal (ecological variables), intermediate (demographics) and proximal (clinical variables) components to identify predictors of case fatality. A total of 127 deaths from snakebites were recorded, with 58 pairs found through linkage of the SINAN and SIM databases (45.7%), 37 (29.1%) deaths found only in SINAN and 32 (25.2%) found only in the SIM. Deaths occurred mostly in males (95 cases; 74.8%) living in rural areas (78.6%). The most affected age group was the ≥61 years old (36 cases; 28.4%). Snakebites were presumably due to Bothrops snakes in 68.5% of the cases and Lachesis in 29.5% based on clinico-epidemiological diagnosis. A proportion of 26.2% of the cases received treatment over 24 h after the bite ocurred. On admission, cases were mostly classified as severe (65.6%). Overall, 28 patients (22.0%). Deceased without any medical assistance Antivenom was given to 53.5%. In the multivariate analysis, a distance from Manaus >300 km [OR = 3.40 (95%CI = 1.99–5.79); (p < 0.001)]; age ≥61 years [OR = 4.31 (95%CI = 1.22–15.21); (p = 0.023)] and Indigenous status [OR = 5.47 (95%CI = 2.37–12.66); (p < 0.001)] were independently associated with case fatality from snakebites. Severe snakebites [OR = 16.24 (95%CI = 4.37–60.39); (p < 0.001)] and a lack of antivenom administration [OR = 4.21 (95%CI = 1.30–13.19); (p = 0.014)] were also independently associated with case fatality. Respiratory failure/dyspnea, systemic bleeding, sepsis and shock were recorded only among fatal cases. In conclusion, i) death from snakebites was underreported in the mortality surveillance system; ii) older age groups living in remote municipalities and indigenous peoples were the population groups most prone to death; iii) lack or underdosage of antivenom resulted in higher case fatality and iv) systemic bleeding, circulatory shock, sepsis and acute respiratory failure were strongly associated to fatal outcome.

Neglected tropical diseases in Brazilian children and adolescents: data analysis from 2009 to 2013

BackgroundNeglected tropical diseases (NTDs) prevail in conditions of poverty and contribute to the maintenance of social inequality. Out of the NTDs prioritized by the Brazilian Ministry of Health, four parasitic infections require mandatory notification: acute Chagas disease, leishmaniasis, malaria, and schistosomiasis. Data on the behaviour of these NTDs in the young population are currently limited. This study seeks to analyse the epidemiological aspects of these parasitic infections in children and adolescents in Brazil.MethodsA retrospective exploratory ecological study was conducted. A spatial analysis of the cases reported between 2009 and 2013 in individuals aged between 0 and 19 years that were notified through the Health Notification Aggravation Information System (SINAN) was performed.ResultsIn total, 64,567 cases of cutaneous and visceral leishmaniasis, malaria, schistosomiasis, and acute Chagas disease were recorded in the SINAN database, representing a rate of 20.15 cases per 100,000 inhabitants. The average age of the cases was 12.2 years and 62.32% were male. Four hundred and three deaths related to these obligatorily reported parasites were recorded, indicating a case fatality rate of 0.62%. Visceral leishmaniasis and acute Chagas disease had the highest rates of lethality. A heterogeneous spatial distribution of the studied parasites was observed.ConclusionsThe number of cases and the lethality rate described in this study show that these diseases still represent a serious problem for public health in Brazil. This points to the need to encourage new research and the reformulation of social, economic, and public health policies aimed at ensuring better health and living conditions for all individuals, especially those among the populations considered vulnerable, as is the case of the young.

Underreporting of Congenital Syphilis as a Cause of Fetal and Infant Deaths in Northeastern Brazil.

IntroductionOf all syphilis-related pregnancy outcomes, fetal death is certainly the most common one, being directly related to the availability, accessibility and quality of prenatal care. The present study aimed to analyze the underreporting of fetal and infant deaths and other maternal factors associated with congenital syphilis (CS) death.MethodsThis cross-sectional study integrated data of infants that were diagnosed and/or died of CS from the Sistema de Informação de Agravos de Notificação–Sinan (Notifiable Diseases Information System) and the Sistema de Informação de Mortalidade–SIM (Mortality Information System) in Fortaleza, Northeastern Brasil to identify unreported cases of congenital syphilis. We assessed data during the period from 2007 to 2013.ResultsThe underreporting of CS as a cause of fetal or infant death increased from 41 to 415 cases (90.1%) during 2007–2013. Exactly 3,209 cases of CS were identified in Sinan and 6,578 deaths in SIM. After database linkage, we identified 382 cases that were reported in the SIM and SINAN databases consisting of 309 fetal deaths and 73 infant deaths related to CS. From the children notified at Sinan that born alive, 3.0% (78/2,542) died; Out of these, 39 (50.0%) were early and 25 (32.1%) were late neonatal deaths. The proportion of death by CS increased from 0.62 to 5.8 from 2007 to 2013. At logistic regression, the variable that maintained statistical significance with fetal and infant death outcomes was the presence of CS signs and/or symptoms at birth (OR = 3.20; IC 95% 1.54–6.62; p = 0.002).ConclusionsNeonatal and Infant deaths following CS-associated live births are underreported in Northeastern Brazil. Data base linkage identified unreported fetal and neonatal deaths due to CS leading to an increased awareness of fetal/infant mortality due to this infection.