Prevalência de tracoma em Jaú e fatores associados
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2022-02-21
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Universidade Estadual Paulista (Unesp)
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O tracoma é considerado a primeira causa infecciosa de cegueira, sendo que a presença e persistência da doença estão diretamente relacionadas com condições socioeconômicas e fatores ambientais. É uma doença de notificação compulsória no estado de São Paulo – Brasil; porém, em Jaú, um município localizado no estado não há registros de casos de tracoma há cerca de 10 anos. Em 2006, Bauru apresentava prevalência de 3,8% da doença e Botucatu, no ano de 2013 apresentava prevalência de 3,14%. O município de Jaú é bastante próximo a Bauru e a Botucatu. Considerando isso, a pergunta que fica é se há um controle da doença no município ou se o diagnóstico de tracoma em Jaú não tem sido feito nos últimos anos. A realização de uma busca ativa de tracoma em escolares poderia responder a esta pergunta. Além disso, para a pesquisa de fatores de risco para a doença na comunidade o padrão-ouro é a busca ativa nos domicílios, porém requerem dispêndio de grande energia e recursos. Portanto, o uso de dados oficiais, como os do censo demográfico nacional, talvez pudesse auxiliar na detecção das condições associadas para manutenção da doença. Desde o início do século XX tem-se hipotetizado a associação do tracoma com fatores climáticos e geográficos. Os diversos fatores interagem entre si, portanto, é plausível predizer a distribuição espacial usando associação entre prevalência e variáveis ambientais. Objetivo: Avaliar se a forma inflamatória do tracoma está presente em escolares de 1 a 9 anos no município de Jaú, assim como avaliar se há possíveis bolsões da doença nesse município para permitir estratégias de controle da doença. Verificar se os dados obtidos de fontes oficiais podem ser úteis para identificar possíveis fatores de risco associados a bolsões de tracoma. Além disso, comparar as diferentes taxas de prevalência do tracoma encontradas no Brasil com as variáveis climáticas de cada localidade, para identificar possíveis fatores associados com a doença. Material e métodos: Estudo transversal, randomizado, com amostra estratificada e aleatória, envolvendo escolares de 1 a 9 anos de idade, das creches e escolas municipais do Município de Jaú, no ano de 2018. Exames seguindo os critérios da Organização Mundial de Saúde foram realizados nas escolas. A distribuição dos casos dentro do município foi avaliada por geoprocessamento. Dados recuperados do último Censo Demográfico do Instituto Brasileiro de Geografia e Estatística (IBGE, 2010) e o mapa de abrangência das escolas municipais foram utilizados para determinar os setores censitários contendo crianças portadoras de tracoma (grupo tracoma), sendo estes comparados a dados dos setores de crianças que não apresentaram a doença (grupo controle). Foram comparadas variáveis socioeconômicas e sanitárias disponíveis no Censo. Dados de prevalência de treze pesquisas para tracoma realizados no Brasil, publicadas a partir de 2010 em diferentes localidades e seus respectivos IDH, densidade populacional e variáveis climáticas foram comparados. Resultados: Foram incluídas 44 escolas, sendo examinadas 4.619 crianças, com detecção de 126 casos de tracoma e prevalência total de 2,65%. A prevalência foi maior nas crianças de 6 a 9 anos (3,01%) que nas crianças de 1 a 5 anos (2,42%). O município apresentou regiões de maior concentração de casos positivos da doença, próximos a três escolas localizadas em bairros de menor condição socioeconômica. O município contém 17 áreas de abrangência escolares, sendo que para cada área de abrangência a média do número de escolas foi de 2,5. A média de moradores por domicílio foi de 3,3, sem diferença estatística entre os setores com casos de tracoma e os sem casos. Das variáveis do censo analisadas, apenas o número de domicílios próprios e quitados se correlacionou com a presença de casos de tracoma. Treze estudos foram selecionados para análise dos fatores climáticos, com 27 localidades diferentes e coleta de dados entre 2000 a 2019. No total 42.944 crianças foram examinadas, com média de 1590 crianças em cada município e prevalência variando de 0 a 54,3%, com média 6,2%. 50% dos municípios apresentam IDH acima de 0,67, considerado como médio. A temperatura média foi de 24,6oC com pouca variabilidade. Houve grande variabilidade da precipitação anual e nos meses mais secos e mais chuvosos. No modelo de regressão linear múltipla observou-se apenas que a prevalência de tracoma diminuiu significativamente para amostras mais recentes. Conclusão: A prevalência de tracoma inflamatório em crianças de 1 a 9 anos no município de Jau foi de 2,65% e os casos positivos estavam localizados em áreas de menores condições socioeconômicas. O uso dos dados do censo demográfico não é útil para identificar possíveis fatores de risco associados aos bolsões de tracoma no município de Jaú. A análise de fatores climáticos associados à doença no Brasil não é a melhor estratégia para a programação de ações de combate à doença em nosso país. Porém, a prevalência do tracoma sofre influência de diversos fatores associados.
Trachoma is considered the number one cause of infectious blindness, and the presence and persistency of the disease is directly related to socioeconomic and environmental factors. It is a notifiable disease in the state of São Paulo – Brazil. However, in Jaú, a municipality located in this state, in the last 10 years there are no records of cases. The disease was detected in the central region of the state in two cities – in the city of Bauru in 2006 there was a prevalence of 3.8% and in Botucatu a prevalence of 3.14% in 2013. With the region historical backgrounds, the question is if trachoma is controlled in the city or if it is underdiagnosed. An active in search in schoolchildren can be used to answer this question. The gold standard for an active search for the disease risk factors in the community is household surveys. However, the search for these factors requires great human and finance resources. The use of data available in official databases, from reliable sources, like the national demographic census, could be useful to outline strategies to fight against this disease. Since the beginning of the 20th century the association between trachoma, climatic and geographic factors have been hypothesized. The different risk factors interact with each other; therefore, it is plausible to predict that the trachoma prevalence can be associated to climatic variables. Purpose: To assess if there are no cases of inflammatory trachoma in schoolchildren aged 1 to 9 years old in the municipality of Jaú as well if is possible to detect clusters areas of the disease to establish elimination programs. To verify if data obtained from governmental sources can be useful to identify possible risk factors associated to areas of trachoma concentration and to compare different prevalence rates found in Brazil with climatic variables to identify possible factors associated to the disease. Methods: A cross-sectional study was performed in 2018, involving a stratified random sample of schoolchildren aged 1- to 9-year-old, from public day care centers and elementary schools in the municipality of Jaú. A trachoma screening for inflammatory trachoma carriers was conducted following the criteria of the World Health Organization (WHO). The distribution of cases was assessed using geoprocessing. Data from the geographical location (censuses sectors) and variables of socioeconomic and sanitary of children with trachoma (trachoma group) retrieved from the latest demographic national censuses held by the Brazilian Institute of Geography and Statistics (IBGE,2010) were used to compare to data from the censuses sectors of 10 children without the disease (control group). Prevalence data from thirteen previous searches performed in Brazil in different locations and their respective HDI, populational density and climatic variables were compared. Results: Four thousand six hundred and nineteen children from 44 elementary schools were examined, and 126 cases were detected, with a prevalence rate of 2.65%. The prevalence was higher (3.01%) in children aged 6- to 9-year-old than in children aged 1-to 5-year-old (2.42%). There were clusters with a higher concentration of positive cases of the disease in three schools located in the neighborhoods with lower socioeconomic conditions. The schoolchildren were distributed in 17 school areas, being the average number of schools for each area 2.5. The average number of residents per household was 3.3, with no statistic difference between areas with or without trachoma cases. Only the number of households with property ownership was correlated to trachoma cases. Thirteen studies were selected for climate variables analysis from 27 different locations nationwide with data collected between 2000 and 2019. A total of 42,944 children were examined, with an average of 1,590 in each municipality and prevalence ranging from 0 to 54.3%, with an average of 6.2%. 50% of the municipalities have an HDI above 0.67, considered medium. The average temperature was 24.6oC with little variability. There was great variation in annual precipitation and in the driest and wettest months. In the multiple linear regression model the prevalence of trachoma decreased significantly for more recent studies. Conclusion: Our screening showed there are trachoma cases in Jaú, with the prevalence of 2.65% in children aged 1- to 9-year-old and positive cases were located in areas of lower socioeconomic conditions. The demographic censuses data is not useful to identify possible risk factors associated to trachoma in Jaú municipality. The analysis of climatic factors is not the best strategy for programming actions to fight the disease in our country. However, the trachoma prevalence is influenced by several different factors in association.
Trachoma is considered the number one cause of infectious blindness, and the presence and persistency of the disease is directly related to socioeconomic and environmental factors. It is a notifiable disease in the state of São Paulo – Brazil. However, in Jaú, a municipality located in this state, in the last 10 years there are no records of cases. The disease was detected in the central region of the state in two cities – in the city of Bauru in 2006 there was a prevalence of 3.8% and in Botucatu a prevalence of 3.14% in 2013. With the region historical backgrounds, the question is if trachoma is controlled in the city or if it is underdiagnosed. An active in search in schoolchildren can be used to answer this question. The gold standard for an active search for the disease risk factors in the community is household surveys. However, the search for these factors requires great human and finance resources. The use of data available in official databases, from reliable sources, like the national demographic census, could be useful to outline strategies to fight against this disease. Since the beginning of the 20th century the association between trachoma, climatic and geographic factors have been hypothesized. The different risk factors interact with each other; therefore, it is plausible to predict that the trachoma prevalence can be associated to climatic variables. Purpose: To assess if there are no cases of inflammatory trachoma in schoolchildren aged 1 to 9 years old in the municipality of Jaú as well if is possible to detect clusters areas of the disease to establish elimination programs. To verify if data obtained from governmental sources can be useful to identify possible risk factors associated to areas of trachoma concentration and to compare different prevalence rates found in Brazil with climatic variables to identify possible factors associated to the disease. Methods: A cross-sectional study was performed in 2018, involving a stratified random sample of schoolchildren aged 1- to 9-year-old, from public day care centers and elementary schools in the municipality of Jaú. A trachoma screening for inflammatory trachoma carriers was conducted following the criteria of the World Health Organization (WHO). The distribution of cases was assessed using geoprocessing. Data from the geographical location (censuses sectors) and variables of socioeconomic and sanitary of children with trachoma (trachoma group) retrieved from the latest demographic national censuses held by the Brazilian Institute of Geography and Statistics (IBGE,2010) were used to compare to data from the censuses sectors of 10 children without the disease (control group). Prevalence data from thirteen previous searches performed in Brazil in different locations and their respective HDI, populational density and climatic variables were compared. Results: Four thousand six hundred and nineteen children from 44 elementary schools were examined, and 126 cases were detected, with a prevalence rate of 2.65%. The prevalence was higher (3.01%) in children aged 6- to 9-year-old than in children aged 1-to 5-year-old (2.42%). There were clusters with a higher concentration of positive cases of the disease in three schools located in the neighborhoods with lower socioeconomic conditions. The schoolchildren were distributed in 17 school areas, being the average number of schools for each area 2.5. The average number of residents per household was 3.3, with no statistic difference between areas with or without trachoma cases. Only the number of households with property ownership was correlated to trachoma cases. Thirteen studies were selected for climate variables analysis from 27 different locations nationwide with data collected between 2000 and 2019. A total of 42,944 children were examined, with an average of 1,590 in each municipality and prevalence ranging from 0 to 54.3%, with an average of 6.2%. 50% of the municipalities have an HDI above 0.67, considered medium. The average temperature was 24.6oC with little variability. There was great variation in annual precipitation and in the driest and wettest months. In the multiple linear regression model the prevalence of trachoma decreased significantly for more recent studies. Conclusion: Our screening showed there are trachoma cases in Jaú, with the prevalence of 2.65% in children aged 1- to 9-year-old and positive cases were located in areas of lower socioeconomic conditions. The demographic censuses data is not useful to identify possible risk factors associated to trachoma in Jaú municipality. The analysis of climatic factors is not the best strategy for programming actions to fight the disease in our country. However, the trachoma prevalence is influenced by several different factors in association.
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Tracoma, Inquérito epidemiológico, Prevalência, Brasil, Clima, Trachoma, Prevalence, Epidemiology survey, Brazil, Climate