Abstract INTRODUCTION Tuberculosis (TB) is an infectious and contagious disease caused by Mycobacterium tuberculosis. TB emerged in the 21st century as an unsolved public health problem. This study aimed to analyze the relationship between the characteristics of basic health units (BHUs) and the number of TB cases detected in Maranhão, Brazil. METHODS An ecological, analytical study was conducted using the municipalities in the state of Maranhão as the unit of analysis. Data regarding the number of detected TB cases was obtained from the Sistema de Informação de Agravos de Notificação database, and the characteristics of the BHUs were obtained from the first cycle of data collection for the Program to Improve Access and Quality of Basic Care. The BHU structure was classified as adequate (80%-100%), partially adequate (60%-79%), poorly adequate (40%-59%), or inadequate (<40%) according to the presence of specified items. The number of BHUs per municipality in each adequacy category was estimated. Inflated Poisson regression analysis was performed to estimate the incidence density ratios (IDRs) and the 95% confidence intervals (95% CIs). RESULTS Municipalities with a higher level of BHU adequacy had a higher number of detected TB cases (IDR = 1.61, 95% CI: 1.01-2.60). CONCLUSIONS Better structured health services in primary care may be associated with better detection and/or notification of TB cases.

ABSTRACT Dengue fever, chikungunya fever, and zika virus infections are increasing public health problems in the world, the last two diseases having recently emerged in Brazil. This ecological study employed spatial analysis of probable cases of dengue fever, chikungunya fever, and zika virus infections reported to the National Mandatory Reporting System (SINAN) in Maranhao State from 2015 to 2016. The software GeoDa version 1.10 was used for calculating global and local Moran indices. The global Moran index identified a significant autocorrelation of incidence rates of dengue (I=0.10; p=0.009) and zika (I=0.07; p=0.03). The study found a positive spatial correlation between dengue and the population density (I=0.31; p<0.001) and a negative correlation with the Performance Index of Unified Health System (PIUHS) by basic care coverage (I=-0.08; p=0.01). Regarding chikungunya fever, there were positive spatial correlations with the population density (I=0.06; p=0.03) and the Municipal Human Development Index (MHDI) (I=0.10; p=0.002), and a negative correlation with the Gini index (I=-0.01; p<0.001) and the PIUHS by basic care coverage (I=-0.18; p<0.001). Lastly, we found positive spatial correlations between Zika virus infections and the population density (I=0.13; p=0.005) and the MHDI (I=0.12; p<0.001), as well as a negative correlation with the Gini index (I=-0.11; p<0.001) and the PIUHS by basic care coverage (I=-0.05; p=0.03). Our results suggest that several socio-demographic factors influenced the occurrence of dengue fever, chikungunya fever, and zika virus infections in Maranhao State.

Abstract: INTRODUCTION Currently, dengue fever, chikungunya fever, and zika virus represent serious public health issues in Brazil, despite efforts to control the vector, the Aedes aegypti mosquito. METHODS: This was a descriptive and ecological study of dengue deaths occurring from 2002 to 2013 in São Luis, Maranhão, Brazil. Geoprocessing software was used to draw maps, linking the geo-referenced deaths with urban/social data at census tract level. RESULTS: There were 74 deaths, concentrated in areas of social vulnerability. CONCLUSIONS: The use of geo-technology tools pointed to a concentration of dengue deaths in specific intra-urban areas.

O objetivo deste estudo foi avaliar a validade das estimativas das taxas de nascimento pré e pós-termo baseadas na data da última menstruação (DUM), em uma coorte pré-natal de duas cidades brasileiras, Ribeirão Preto e São Luís. Foram incluídas gestantes de feto único com < 20 semanas de idade gestacional pela ultrassonografia obstétrica em 2010 e 2011. A DUM foi obtida de 22-25 semanas de idade gestacional e após o nascimento. A sensibilidade da DUM obtida no pré-natal para estimativa da taxa de nascimento pré-termo foi de 65,6% em São Luís e de 78,7% em Ribeirão Preto, e o valor preditivo positivo foi de 57,3% em São Luís e de 73,3% em Ribeirão Preto. Erros na DUM para identificação do nascimento pré-termo foram menores na cidade mais desenvolvida. A sensibilidade e o valor preditivo positivo da DUM para estimativa da taxa de nascimento pós-termo foram muito baixos, com tendência à sua superestimação. A DUM pode ser usada com algum erro para identificação do nascimento pré-termo quando a ultrassonografia obstétrica não estiver disponível, mas não tem validade para a estimativa do nascimento pós-termo.

The aim of this study was to assess the validity of the last menstrual period (LMP) estimate in determining pre and post-term birth rates, in a prenatal cohort from two Brazilian cities, São Luís and Ribeirão Preto. Pregnant women with a single fetus and less than 20 weeks' gestation by obstetric ultrasonography who received prenatal care in 2010 and 2011 were included. The LMP was obtained on two occasions (at 22-25 weeks gestation and after birth). The sensitivity of LMP obtained prenatally to estimate the preterm birth rate was 65.6% in São Luís and 78.7% in Ribeirão Preto and the positive predictive value was 57.3% in São Luís and 73.3% in Ribeirão Preto. LMP errors in identifying preterm birth were lower in the more developed city, Ribeirão Preto. The sensitivity and positive predictive value of LMP for the estimate of the post-term birth rate was very low and tended to overestimate it. LMP can be used with some errors to identify the preterm birth rate when obstetric ultrasonography is not available, but is not suitable for predicting post-term birth.

El objetivo de este estudio fue evaluar la validez de las estimaciones de las tasas de nacimiento pre- y pos-término, basadas en la fecha de la última menstruación (FUM), en una cohorte prenatal de dos ciudades de Brasil, São Luís y Ribeirão Preto. Se incluyeron mujeres embarazadas con un solo feto y < 20 semanas de gestación por ecografía obstétrica en 2010 y 2011. La FUM se obtuvo en 22-25 semanas de gestación y después del nacimiento. La sensibilidad de la FUM, obtenida prenatalmente para estimar la tasa del parto prematuro, fue de un 65,6% en São Luís y 78,7% en Ribeirão Preto y el valor predictivo positivo fue un 57,3% en São Luís y el 73,3% en Ribeirão Preto. La sensibilidad y valor predictivo positivo de la FUM para la estimación de la tasa de nacimiento pos-término fueron muy bajos con tendencia a sobreestimarla. Se puede utilizar la FUM con algunos errores para identificar la tasa de parto prematuro cuando la ecografía obstétrica no está disponible, pero no es adecuada para predecir el parto pos-término.

O objetivo deste estudo foi avaliar a validade das estimativas das taxas de nascimento pré e pós-termo baseadas na data da última menstruação (DUM), em uma coorte pré-natal de duas cidades brasileiras, Ribeirão Preto e São Luís. Foram incluídas gestantes de feto único com < 20 semanas de idade gestacional pela ultrassonografia obstétrica em 2010 e 2011. A DUM foi obtida de 22-25 semanas de idade gestacional e após o nascimento. A sensibilidade da DUM obtida no pré-natal para estimativa da taxa de nascimento pré-termo foi de 65,6% em São Luís e de 78,7% em Ribeirão Preto, e o valor preditivo positivo foi de 57,3% em São Luís e de 73,3% em Ribeirão Preto. Erros na DUM para identificação do nascimento pré-termo foram menores na cidade mais desenvolvida. A sensibilidade e o valor preditivo positivo da DUM para estimativa da taxa de nascimento pós-termo foram muito baixos, com tendência à sua superestimação. A DUM pode ser usada com algum erro para identificação do nascimento pré-termo quando a ultrassonografia obstétrica não estiver disponível, mas não tem validade para a estimativa do nascimento pós-termo.

The aim of this study was to assess the validity of the last menstrual period (LMP) estimate in determining pre and post-term birth rates, in a prenatal cohort from two Brazilian cities, São Luís and Ribeirão Preto. Pregnant women with a single fetus and less than 20 weeks' gestation by obstetric ultrasonography who received prenatal care in 2010 and 2011 were included. The LMP was obtained on two occasions (at 22-25 weeks gestation and after birth). The sensitivity of LMP obtained prenatally to estimate the preterm birth rate was 65.6% in São Luís and 78.7% in Ribeirão Preto and the positive predictive value was 57.3% in São Luís and 73.3% in Ribeirão Preto. LMP errors in identifying preterm birth were lower in the more developed city, Ribeirão Preto. The sensitivity and positive predictive value of LMP for the estimate of the post-term birth rate was very low and tended to overestimate it. LMP can be used with some errors to identify the preterm birth rate when obstetric ultrasonography is not available, but is not suitable for predicting post-term birth.

El objetivo de este estudio fue evaluar la validez de las estimaciones de las tasas de nacimiento pre- y pos-término, basadas en la fecha de la última menstruación (FUM), en una cohorte prenatal de dos ciudades de Brasil, São Luís y Ribeirão Preto. Se incluyeron mujeres embarazadas con un solo feto y < 20 semanas de gestación por ecografía obstétrica en 2010 y 2011. La FUM se obtuvo en 22-25 semanas de gestación y después del nacimiento. La sensibilidad de la FUM, obtenida prenatalmente para estimar la tasa del parto prematuro, fue de un 65,6% en São Luís y 78,7% en Ribeirão Preto y el valor predictivo positivo fue un 57,3% en São Luís y el 73,3% en Ribeirão Preto. La sensibilidad y valor predictivo positivo de la FUM para la estimación de la tasa de nacimiento pos-término fueron muy bajos con tendencia a sobreestimarla. Se puede utilizar la FUM con algunos errores para identificar la tasa de parto prematuro cuando la ecografía obstétrica no está disponible, pero no es adecuada para predecir el parto pos-término.

Objective: The purpose of this case-control study was to evaluate risk factors associated with death in children with severe dengue. Methods: The clinical condition of hospitalized patients with severe dengue who died (cases, n = 18) was compared with that of hospitalized patients with severe dengue who survived (controls, n = 77). The inclusion criteria for this study were age under 13 years; hospital admission in São Luis, northeastern Brazil; and laboratory-confirmed diagnosis of dengue. Results: Severe bleeding (hemoptysis), a defining criterion for dengue severity, was the factor most strongly associated with death in our study. We also found that epistaxis and persistent vomiting, both included as warning signs in the World Health Organization (WHO) classification of dengue, were strongly associated with death. No significant association was observed between any of the laboratory findings and death. Conclusions: The finding that epistaxis and persistent vomiting were also associated with death in children with severe dengue was unexpected and deserves to be explored in future studies. Because intensive care units are often limited in resource-poor settings, any information that can help to distinguish patients with severe dengue with a higher risk to progress to death may be crucial.