RESUMO Objetivo: Examinar a variabilidade espaçotemporal e identificar clusters de hospitalização por diarreia em crianças menores de cinco anos de idade de Mato Grosso, de 2011 a 2020. Métodos: Um estudo ecológico foi conduzido utilizando os registros de hospitalização por diarreia do Sistema de Informação Hospitalar/Sistema Único de Saúde. O risco relativo de hospitalização por diarreia em cada município foi calculado utilizando o software SaTScan, considerando-se o nível de significância estatística de 5% e 999 replicações de Monte Carlo. Resultados: O total de 13.315 hospitalizações por diarreia em crianças menores de cinco anos de idade foram registradas. As taxas anuais de hospitalização por diarreia reduziram de 8,50 para 3,45/1.000 nascidos vivos em crianças menores de um ano de idade e de 4,99 para 1,57 em crianças de 1–4 anos de idade, de 2011 a 2020. Clusters de municípios com alto risco relativo para hospitalização por diarreia, estatisticamente significantes, predominaram nas macrorregiões administrativas de saúde Norte, Nordeste e Sudoeste de Mato Grosso para crianças de ambos os grupos etários, até 2016. De 2016 a 2020, clusters de baixo risco relativo foram identificados nas macrorregiões administrativas de saúde Norte e Centro-Sul para crianças menores de cinco anos de idade. Conclusão: Os resultados mostraram redução das taxas de hospitalização por diarreia em crianças menores de cinco anos de idade, com a presença de clusters de baixo risco em Mato Grosso nos últimos anos estudados. Os monitoramentos de saúde pública devem incorporar análises espaciais na investigação da morbidade por diarreia.

ABSTRACT Objective: To examine spatiotemporal variability and identify clustering patterns of hospitalization rates for diarrhea in children younger than five years in Mato Grosso, Brazil, from 2011 to 2020. Methods: An ecological study was conducted using hospitalization records associated with diarrhea from the Brazilian Hospital Information System/Unified Health System. The relative risk of hospitalization for diarrhea in each municipality was calculated using SaTScan software considering a statistical significance level of 5% and 999 Monte Carlo replications. Results: A total of 13,315 diarrhea-associated hospitalizations for 5-year-old children were recorded. From 2011 to 2020, the annual rates for hospitalizations related to diarrhea decreased from 8.50 to 3.45/1,000 live births among children younger than one year and from 4.99 to 1.57 for children aged 1–4 years. Clusters of municipalities with high relative risk for hospitalizations due to diarrhea, statistically significant, predominated in the North, Northeast, and Southwest health administrative macro-regions of Mato Grosso for both age groups until 2016. From 2016 to 2020, clusters of the lowest relative risk were identified in the North and Center South health administrative macro-regions for children younger than five years. Conclusion: Results showed that hospitalization rates for diarrhea in children younger than five years reduced with the presence of low-risk clusters in Mato Grosso in the final years of the study. Public health surveillance should incorporate spatial analysis to investigate the diarrhea-related morbidity.

RESUMO Objetivo: Examinar a variabilidade espaçotemporal e identificar clusters de hospitalização por diarreia em crianças menores de cinco anos de idade de Mato Grosso, de 2011 a 2020. Métodos: Um estudo ecológico foi conduzido utilizando os registros de hospitalização por diarreia do Sistema de Informação Hospitalar/Sistema Único de Saúde. O risco relativo de hospitalização por diarreia em cada município foi calculado utilizando o software SaTScan, considerando-se o nível de significância estatística de 5% e 999 replicações de Monte Carlo. Resultados: O total de 13.315 hospitalizações por diarreia em crianças menores de cinco anos de idade foram registradas. As taxas anuais de hospitalização por diarreia reduziram de 8,50 para 3,45/1.000 nascidos vivos em crianças menores de um ano de idade e de 4,99 para 1,57 em crianças de 1–4 anos de idade, de 2011 a 2020. Clusters de municípios com alto risco relativo para hospitalização por diarreia, estatisticamente significantes, predominaram nas macrorregiões administrativas de saúde Norte, Nordeste e Sudoeste de Mato Grosso para crianças de ambos os grupos etários, até 2016. De 2016 a 2020, clusters de baixo risco relativo foram identificados nas macrorregiões administrativas de saúde Norte e Centro-Sul para crianças menores de cinco anos de idade. Conclusão: Os resultados mostraram redução das taxas de hospitalização por diarreia em crianças menores de cinco anos de idade, com a presença de clusters de baixo risco em Mato Grosso nos últimos anos estudados. Os monitoramentos de saúde pública devem incorporar análises espaciais na investigação da morbidade por diarreia. Objetivo 201 2020 Métodos HospitalarSistema Hospitalar Saúde SaTScan considerandose considerando se 5 99 Carlo Resultados 13315 13 315 13.31 registradas 850 8 50 8,5 3451000 3 45 1 000 3,45/1.00 499 4 4,9 157 57 1,5 14 1– significantes etários CentroSul Centro Sul Conclusão estudados 20 202 9 1331 31 13.3 85 8, 345100 00 3,45/1.0 49 4, 15 1, 2 133 13. 34510 0 3,45/1. 3451 3,45/1 345 3,45/ 34 3,45 3,4 3,

ABSTRACT Objective: To examine spatiotemporal variability and identify clustering patterns of hospitalization rates for diarrhea in children younger than five years in Mato Grosso, Brazil, from 2011 to 2020. Methods: An ecological study was conducted using hospitalization records associated with diarrhea from the Brazilian Hospital Information System/Unified Health System. The relative risk of hospitalization for diarrhea in each municipality was calculated using SaTScan software considering a statistical significance level of 5% and 999 Monte Carlo replications. Results: A total of 13,315 diarrhea-associated hospitalizations for 5-year-old children were recorded. From 2011 to 2020, the annual rates for hospitalizations related to diarrhea decreased from 8.50 to 3.45/1,000 live births among children younger than one year and from 4.99 to 1.57 for children aged 1–4 years. Clusters of municipalities with high relative risk for hospitalizations due to diarrhea, statistically significant, predominated in the North, Northeast, and Southwest health administrative macro-regions of Mato Grosso for both age groups until 2016. From 2016 to 2020, clusters of the lowest relative risk were identified in the North and Center South health administrative macro-regions for children younger than five years. Conclusion: Results showed that hospitalization rates for diarrhea in children younger than five years reduced with the presence of low-risk clusters in Mato Grosso in the final years of the study. Public health surveillance should incorporate spatial analysis to investigate the diarrhea-related morbidity. Objective Brazil 201 2020 Methods SystemUnified System Unified 5 99 replications 13315 13 315 13,31 diarrheaassociated 5yearold yearold old recorded 850 8 50 8.5 3451000 3 45 1 000 3.45/1,00 499 4 4.9 157 57 1.5 14 1– significant Northeast macroregions macro regions Conclusion lowrisk low diarrhearelated morbidity 20 202 9 1331 31 13,3 85 8. 345100 00 3.45/1,0 49 4. 15 1. 2 133 13, 34510 0 3.45/1, 3451 3.45/1 345 3.45/ 34 3.45 3.4 3.

Abstract INTRODUCTION: The increasing incidence of syphilis among pregnant women (PS) and congenital syphilis (CS) has negatively affected maternal-child health in Brazil. The spatial approach to diseases with social indicators improves knowledge of health situations. Herein, we aimed to evaluate the spatiotemporal distribution of incidences, identify the priority areas for infection control actions, and analyze the relationship of PS and CS clusters with social determinants of health in Mato Grosso. METHODS: This is an ecological study with data from different health information systems. After data procedure linkage, we analyzed the Bayesian incidences of triennial infections during specific periods. We performed SATSCAN screenings to identify spatiotemporal clusters. Further, we verified the differences between the clusters and indicators using Pearson’s chi-square test. RESULTS: The variations in PS incidence were 0.9-20.5/1,000 live births (LB), 0.6-46.3/1,000 LB, and 2.1-23.2/1,000 LB in the first, second, and last triennium, respectively; for CS, the variations were 0-7.1/1,000 LB, 0-7.5/1,000 LB, and 0.3-10.8/1,000 LB in the first, second, and last triennium, respectively. Three clusters each were identified for PS (RR=2.02; RR=0.30; RR=21.45, p<0.0001) and CS (RR=3.55; RR=0.10; RR=0.26, p<0.0001). The high-risk clusters overlapped in time-space; CS incidence was associated with municipalities with a higher proportion of LB mothers of race/non-white color and with poor sanitary conditions, lower proportion of pregnant teenagers, and under 8 years of schooling. CONCLUSIONS: The increase in the spatiotemporal evolution of PS and CS incidences and the extension of areas with persistent infections indicate the need for monitoring, especially of priority areas in the state.

Introduction Congenital syphilis is an important health problem in Brazil. This study assessed measures aimed at the prevention and control of syphilis in the State of Mato Grosso and its capital, Cuiabá. Methods A descriptive study cross-sectional and of time trends assessing the congenital syphilis was performed in Cuiabá and Mato Grosso between 2001 and 2011. We compared maternal sociodemographic characteristics and health care utilization related to cases of congenital syphilis during the periods from 2001 to 2006 and from 2007 to 2011. We assessed the temporal trends in this disease's incidence using a simple linear regression. Results Between 2001 and 2006 in Mato Grosso, 86.8% of the mothers who had live births with congenital syphilis received prenatal care, 90.6% presented with a nontreponemal test reagent at delivery, 96.2% had no information regarding a treponemal confirmatory test at delivery, and 77.6% received inadequate treatment for syphilis; additionally, 75.8% of their partners were not treated. There was a statistically significant reduction in prenatal visits (p = 0.004) and an increase in the proportion of mothers reactive to nontreponemal tests at delivery (p = 0.031) between the two periods. No other variables were found to differ significantly between the periods. In Cuiabá, we observed a similar distribution of variables. In the state and in the capital, the increasing trend of congenital syphilis was not statistically significant. Conclusions The high incidence of congenital syphilis in Mato Grosso and the low levels of health care indicators for pregnant women with syphilis suggest the need to improve the coverage and quality of prenatal care.