ABSTRACT The political dimension of basic sanitation management in Brazil, especially the principle of participatory and democratic management, is one of the main challenges to guaranteeing access to these services as a human right. This article describes a proposal for governance of basic sanitation management guided by the system of guarantees of rights. We used a theoretical and methodological framework drawing on Juan Samaja’s theory of social reproduction. The study area comprises the municipalities that make up the Triangle and Upper Solimões River health regions in the state of Amazonas. The operationality of the management governance model is based on a matrix of elements comprising the responsibilities and competency of state and non-state institutions. These are distributed across different dimensions of social reproduction, which represent the locus of action of each institution, respecting their respective missions. The matrix is made up of transversal and intersectoral components that strengthen joint work processes, with the various subjects involved in the process acting in solidarity within the scope of the committee for the ongoing monitoring of living conditions and health.

RESUMO A dimensão política da gestão do saneamento básico no Brasil, sobretudo no que tange aos princípios da gestão participativa e democrática, constitui um dos maiores desafios a serem vencidos para garantir o acesso aos serviços como um direito humano. O objetivo deste artigo foi descrever uma proposta de governança da gestão de saneamento básico orientada pela noção do sistema de garantias de direitos. O método foi do tipo teórico-metodológico, orientado pela teoria da reprodução social de Juan Samaja. A área de estudo correspondeu aos municípios das Regiões de Saúde do Triângulo e do Alto Solimões do Amazonas. A operacionalidade do modelo de governança da gestão foi baseada no matriciamento de elementos, que compreende as responsabilidades e competências das instituições estatais e não estatais. Essas foram distribuídas segundo as dimensões da reprodução social, a qual representa o lócus de atuação de cada uma delas, respeitando as suas respectivas missões. O dispositivo possui componentes de transversalidade e de intersetorialidade, que fortalecerão o processo de trabalho de forma compartilhada, com os vários sujeitos implicados atuando de forma solidária no âmbito do comitê de monitoração permanente das condições de vida e saúde do local.

ABSTRACT Visceral leishmaniasis (VL) is a neglected disease that is typical of tropical and subtropical parts of the world and is caused by the trypanosomatid Leishmania donovani complex. This disease is a multifactorial condition that involves parasitic, environmental, and immunogenetic characteristics. Genetic changes in genes encoding cytokines may be associated with changes in their expression and, consequently, with the development of clinical resistance or susceptibility to the disease. This systematic review and meta-analysis aimed to assess whether single nucleotide polymorphisms (SNPs) in interleukin genes influence the clinical consequences of visceral leishmaniasis infection. To this end, we carried out a systematic review and meta-analysis with structured searches in the EMBASE, PubMed, Scopus, SciELO, and Web of Science databases without time restrictions. Two independent reviewers examined the studies, performed data extraction, and assessed quality by assigning scores. If there were any discrepancies, a third reviewer with more experience was consulted. After the screening process, 28 articles were included in the systematic review and 9 in the final analysis of the meta-analysis. Statistical analyses were carried out using various genetic models. The odds ratio (OR) and corresponding 95% confidence intervals (CIs) were calculated to estimate the associations. Overall, the main clinical outcomes were classified as not associated or associated when they presented susceptibility, resistance, risk, or protective factors for the development of the disease. Associations between IFN-γ +874T/A polymorphisms in the dominant model (OR 1.64, 95% CI 1.13-2.38, I2 = 0%, p < 0.01) and heterozygous model (OR 1.72, 95% CI 1.15-2.57, I2 = 0%, p < 0.01) and IL-18 -137G/C in the recessive model (OR 1.33, 95% CI 1.02-1.71, I2 = 9%, p = 0.03) and VL were observed. For the IL-10 gene SNPs, there was no significant association. Our findings suggest that SNPs in the IFN-γ and IL-18 genes may be associated with the risk of developing VL. (VL complex parasitic environmental characteristics consequently metaanalysis meta (SNPs infection end EMBASE PubMed Scopus SciELO restrictions studies extraction scores discrepancies consulted process 2 metaanalysis. analysis. models OR 95 CIs (CIs associations Overall IFNγ IFN γ 874TA TA 874T A T 164 1 64 1.64 1.132.38, 113238 1.13 2.38, 13 38 1.13-2.38 I 0 0% 0.01 001 01 172 72 1.72 1.152.57, 115257 1.15 2.57, 15 57 1.15-2.57 IL18 IL 18 IL-1 137G/C 137GC GC 137G C G 133 33 1.33 1.021.71, 102171 1.02 1.71, 02 71 1.02-1.71 9% 0.03 003 03 observed IL10 10 association 16 6 1.6 132 1.132.38 11323 113 1.1 238 2.38 3 1.13-2.3 0.0 00 17 7 1.7 152 1.152.57 11525 115 257 2.57 5 1.15-2.5 IL1 IL- 1.3 021 1.021.71 10217 102 1.0 171 1.71 1.02-1.7 1. 1.132.3 1132 11 23 2.3 1.13-2. 0. 1.152.5 1152 25 2.5 1.15-2. 1.021.7 1021 1.02-1. 1.132. 2. 1.13-2 1.152. 1.15-2 1.021. 1.02-1 1.132 1.13- 1.152 1.15- 1.021 1.02-

ABSTRACT This study aimed to analyze the spatial pattern of natural infection index (NII) for triatomines and the risk of Chagas disease transmission in an endemic area of Northeastern Brazil. An ecological study was conducted, based on 184 municipalities in five mesoregions. The NII for triatomines was evaluated in the Pernambuco State, Brazil, from 2016 to 2018. Spatial autocorrelations were evaluated using Global Moran Index (I) and Local Moran Index (II) and were considered positive when I > 0 and p < 0.05, respectively. In total, 7,302 triatomines belonging to seven different species were detected. Triatoma brasiliensis had the highest frequency (53%; n = 3,844), followed by Triatoma pseudomaculata (25%; n = 1,828) and Panstrongylus lutzi (18.5%; n=1,366). The overall NII was 12%, and the higher NII values were P. lutzi (21%) and Panstrongylus megistus (18%). In the mesoregions of Zona da Mata, Agreste, Sertao, and Sertao do Sao Francisco, 93% of triatomines were detected indoors. The global spatial autocorrelation of I to NII was positive (0.2; p = 0.01), and II values calculated using BoxMap, MoranMap, Lisa Cluster Map were statistically significant for natural infections. With regard to the risk areas for the presence of triatomines, Zone 2 (the Agreste and Sertao regions) presented a relative risk of 3.65 compared to other areas in the state. Our study shows the potential areas of vector transmission of Chagas disease. In this study, the application of different methods of spatial analysis made it possible to locate these areas, which would not have been identified by only applying epidemiological indicators. (NII Brazil conducted 18 State 201 2018 (I (II 005 05 0.05 respectively total 7302 7 302 7,30 53% 53 (53% 3,844, 3844 3,844 , 3 844 3,844) 25% 25 (25% 1,828 1828 1 828 18.5% 185 5 (18.5% n=1,366. n1366 n=1,366 . 366 n=1,366) 12 12% P 21% 21 (21% 18%. 18% (18%) Mata Francisco 93 indoors 0.2 02 (0.2 0.01, 001 0.01 01 0.01) BoxMap MoranMap infections regions 365 65 3.6 state indicators 20 00 0.0 730 30 7,3 (53 384 3,84 84 (25 1,82 182 82 18.5 (18.5 n136 n=1,36 36 (21 (18% 9 0. (0. 6 3. 73 7, (5 38 3,8 8 (2 1,8 18. (18. n13 n=1,3 (18 (0 ( 3, 1, n1 n=1, (1 n=1 n=

ABSTRACT Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients’ care.

ABSTRACT To estimate the prevalence of cases of trachoma in the population at social risk aged 1-9 years in Pernambuco State and its mesoregions. This was a cross-sectional study in which secondary data from the National Household Survey on Trachoma (2014-2015) were analyzed. The study covered 96 census tracts distributed across the mesoregions of Pernambuco State (Metropolitan Region of Recife, Zona da Mata, Agreste, Sertao do Sao Francisco and Sertao Pernambucano). The study included all homes with children aged 1-9 years, and all of them were examined for trachoma, using the WHO criteria. Among the total of 7,423 children aged 1-9 years who participated in this survey, 446 presented with active trachoma. Thus, the prevalence of trachoma in Pernambuco State, in children between 1-9 years old was 6.65%, and it was higher among children aged 5-9 years (7.12%) and among girls (7.23%). This result was seen in the majority of the mesoregions studied, except in the Zona da Mata and Sertao do Sao Francisco, where there were higher prevalences in the age group of 1-4 years (5.55%) and among boys (5.90%). A tendency towards a higher prevalence between 1 and 6 years of age was observed. The follicular trachoma continues to be an important public health problem in Pernambuco State. It particularly affects poor people, including those living in urban areas of the State.

ABSTRACT Leprosy is a public health problem due to the physical disabilities and deformities it causes. This study aimed to describe new leprosy cases using an operational classification and analyzing spatial patterns by means of epidemiological and quality indicators of health services in Pernambuco State, Brazil, between 2005 and 2014. This was an ecological study performed in 184 municipalities grouped into 12 health regions units for analysis. To analyze spatial patterns, the Bayesian local empirical method and Moran's spatial autocorrelation indicator were applied and box and Moran maps were used. Individuals aged ≥15 years old, grade zero physical disability and complete remission as the treatment outcome were predominant in both paucibacillary and multibacillary cases, the only difference was the predominance of females (n=9,286; 63.00%) and males (n=8,564; 60.70%), respectively. These variables were correlated (p<0.05) with the operational classification. The overall detection rate showed three high-priority areas; the indicator rate of grade 2 physical disability revealed clusters in regions IV, V, and VI; and the indicator rate of cases with some degree of disability showed precarious municipalities in seven health regions. Pernambuco maintains an active chain of transmission and ongoing endemicity of leprosy. Therefore, spatial analysis methods allow the identification of priority areas for intervention, thereby supporting the disease elimination strategy.

Abstract INTRODUCTION: Nontuberculous mycobacteria (NTM) species, as human pathogens, are increasing in the world, as is the difficulty of accurately identifying them. Differential diagnosis, especially between the M. tuberculosis complex and NTM species, and the characterization of NTM species is important. This study aimed to evaluate the performance of a molecular system based on multiplex real-time PCR with high-resolution melting (HRM) for the identification and differentiation of NTM species of clinical importance of an endemic area for tuberculosis in northeastern Brazil. METHODS: The technical protocol of the molecular system was based on multiplex real-time PCR-HRM, and evaluated the sensitivity and specificity of the detection of NTM species in mycobacterial clinical isolates from the studied region. The gold standard method was specific gene sequencing. RESULTS: The sensitivity and specificity of multiplex real-time PCR-HRM modified for differentiation between NTM and M. tuberculosis were 90% and 100%, respectively. The PCR-HRM sensitivities for the characterization of NTM species (M. kansasii, M. abscesses, M. avium, and M. fortuitum) were 94.59%, 80%, 57.14%, and 54%, respectively. CONCLUSIONS The multiplex real-time PCR-HRM modified assay has the potential to rapidly and efficiently identify nontuberculous mycobacteria of clinical importance, which is crucial for immediate implementation of the appropriate therapy and thus avoiding complications and sequelae in patients.

ABSTRACT Visceral leishmaniasis is a serious and debilitating infection with high fatality rate in tropical and subtropical countries. As clinical symptoms of visceral leishmaniasis are not so specific, confirmatory diagnostic methods with high sensitivity and specificity are needed. Noninvasive methods have been developed using urine as a clinical sample for visceral leishmaniasis diagnosis. In fact, there is a clear correlation between kidney impairment and Leishmania DNA in urine. However, it has been proved that Leishmania nucleic acid may also be isolated from patients without any sign of renal involvement. Even though urine has become a promissing biological sample, it is still not widely used due to several issues, such as (i) incomprehension of the whole renal pathophysiology process in visceral leishmaniasis, (ii) presence of many amplification inhibitors in urine, and (iii) lack of an efficient urinary DNA extraction method. In this article, we performed a literature review to bring a new perspective for Leishmania DNA isolation in urine.

Resumo Avaliou-se a adequação da investigação do óbito infantil no Recife-PE, Brasil. Estudo transversal com 120 variáveis da ficha de investigação, agrupadas em seis dimensões (pré-natal; parto e nascimento; puericultura; características da família; ocorrência do óbito; e conclusão e recomendações), ponderadas pela técnica de consenso e analisadas quanto ao preenchimento. A investigação foi classificada (adequada, parcialmente adequada e inadequada) segundo um indicador composto de avaliação (ICA). Houve dissenso em 11 variáveis (9, na dimensão pré-natal; 1, no parto e nascimento; 1, na conclusões e recomendações). Dos 568 óbitos estudados, 56,2% apresentam investigação adequada. A ocorrência do óbito foi a dimensão melhor avaliada, e pré-natal, a mais deficiente. A elaboração do ICA possibilita aos profissionais e gestores das políticas de saúde da criança, identificar os pontos de estrangulamento da investigação dos óbitos infantis para um melhor direcionamento das ações e contribui com a reflexão sobre esta vigilância em outros municípios e estados.

Abstract This study is an evaluation of infant death research in Recife, Pernambuco (PE). It is a cross-sectional study with 120 variables grouped into six dimensions (prenatal, birth, child care, family characteristics, occurrence of death, and conclusion and recommendations), weighted by consensus technique. The research was classifiedas adequate, partially adequate or inadequate according to a composite indicator assessment (ICA). There was dissension on 11 variables (9 in prenatal dimension, one in labor and birth, and 1 in the conclusions and recommendations). Of the 568 deaths studied, 56.2% have adequate research. The occurrence of death was the best-evaluated dimension and prenatal the poorest. The preparation of the ICA enables professionals and managers of child health policies to identify bottlenecks in the investigation of infant deaths for better targeting of actions, and contributing to the discussion about surveillance in other cities and states.

Resumo Avaliou-se a adequação da investigação do óbito infantil no Recife-PE, Brasil. Estudo transversal com 120 variáveis da ficha de investigação, agrupadas em seis dimensões (pré-natal; parto e nascimento; puericultura; características da família; ocorrência do óbito; e conclusão e recomendações), ponderadas pela técnica de consenso e analisadas quanto ao preenchimento. A investigação foi classificada (adequada, parcialmente adequada e inadequada) segundo um indicador composto de avaliação (ICA). Houve dissenso em 11 variáveis (9, na dimensão pré-natal; 1, no parto e nascimento; 1, na conclusões e recomendações). Dos 568 óbitos estudados, 56,2% apresentam investigação adequada. A ocorrência do óbito foi a dimensão melhor avaliada, e pré-natal, a mais deficiente. A elaboração do ICA possibilita aos profissionais e gestores das políticas de saúde da criança, identificar os pontos de estrangulamento da investigação dos óbitos infantis para um melhor direcionamento das ações e contribui com a reflexão sobre esta vigilância em outros municípios e estados.

Abstract This study is an evaluation of infant death research in Recife, Pernambuco (PE). It is a cross-sectional study with 120 variables grouped into six dimensions (prenatal, birth, child care, family characteristics, occurrence of death, and conclusion and recommendations), weighted by consensus technique. The research was classifiedas adequate, partially adequate or inadequate according to a composite indicator assessment (ICA). There was dissension on 11 variables (9 in prenatal dimension, one in labor and birth, and 1 in the conclusions and recommendations). Of the 568 deaths studied, 56.2% have adequate research. The occurrence of death was the best-evaluated dimension and prenatal the poorest. The preparation of the ICA enables professionals and managers of child health policies to identify bottlenecks in the investigation of infant deaths for better targeting of actions, and contributing to the discussion about surveillance in other cities and states.

Resumo Objetivos: avaliar a implantação da vigilância do óbito infantil no Recife/PE. Métodos: realizou-se pesquisa avaliativa do tipo análise de implantação da vigilância do óbito infantil. Estudo de caso único que relacionou o grau de implantação aos indicadores de resultados da estratégia. Foi elaborado um modelo lógico da intervenção e uma matriz de indicadores e julgamento por componente do modelo. O grau de implantação foi obtido a partir de indicadores de estrutura e processo e, posteriormente, relacionado aos de resultado, em uma abordagem dedutiva baseada na teoria da intervenção. Resultados: a abordagem estrutura apresentou resultados superiores ao processo em todos os componentes. A vigilância do óbito infantil foi considerada parcialmente implantada (75,7%), entretanto, os componentes 'identificação dos óbitos' (85,7%), 'investigação epidemiológica' (88,1%) e 'encaminhamento das propostas de promoção e atenção à saúde e correção das estatísticas oficiais' (95,8%) foram julgados implantados. Quanto à relação do grau de implantação da intervenção e seus resultados com o modelo lógico, apenas um dos 17 indicadores foi considerado inconsistente. Conclusões: a vigilância do óbito infantil foi classificada como parcialmente implantada. O modelo desta estratégia e a sua avaliação mostraram-se adequados ao assinalar a consistência das inter-relações entre as atividades propostas e os efeitos esperados, passíveis de reprodutibilidade em outros cenários.

Abstract Objectives: assess the implementation of child mortality surveillance in Recife/PE. Methods: an analytical evaluative study was conducted on its implementation. It was a single-case study that correlated degree of implementation with the of the result indicators surveillance. A logic model on this strategy and a matrix of indicators and judgments according to model components were drawn up. The degree of implementation was obtained from structure and process indicators and this was then correlated with result indicators, in a deductive approach based on intervention theory. Results: the structure approach presented superior results to the process in all evaluated components. This strategy was considered to have been partially implemented (75. 7%), however, the components of 'identification of deaths' (85.7%), 'epidemiological research' (88.1%) and 'referral of proposals for promotion and health care and correction of official statistics' (95.8%) were classified implemented. Regarding the relation of the degree of implantation of the surveillance and its results with the logical model, only one of the 17 indicators was considered inconsistent. Conclusions: this strategy was considered to have been partially implemented. The model of child mortality surveillance and its assessment were shown to be adequate for signaling the consistency of the interrelations between the activities proposed and the effects expected, and would be reproducible within other scenarios.

Resumo Trata-se de estudo de corte transversal cujo objetivo foi avaliar a prevalência de fatores associados ao aumento da vulnerabilidade de participantes de pesquisas. Foram entrevistados 116 pacientes e 18 médicos. Entre os pacientes, 15% eram analfabetos, 27% desconheciam o motivo do seu internamento e 45% não sabiam qual tratamento estavam recebendo. Do total da amostra, 43% procediam de zona rural e 70% haviam cursado, no máximo, ensino fundamental, fatores que tornam essa população especialmente vulnerável. Os percentuais de acerto em questões relacionadas à compreensão do termo de consentimento livre e esclarecido e de prescrição médica foram, respectivamente, 12% e 7%. Entre os médicos, 44% não conheciam todas as pesquisas realizadas na enfermaria pela qual eram responsáveis e 17% afirmaram que a permanência hospitalar de pacientes que participam de pesquisas é maior. É elevada a prevalência de fatores que aumentam a vulnerabilidade de participantes em pesquisas médicas.

Abstract A cross-sectional study was carried out that aimed to assess the prevalence of factors associated with the increased vulnerability of research subjects. A total of 116 patients and 18 doctors were interviewed. A proportion of 15% of patients were illiterate, 27% did not know the reason for their hospitalization and 45% did not know what treatment they were receiving. Of the total sample, 43% were from rural areas and 70% had at most an elementary level education, factors that make this population especially vulnerable. The percentage of correct answers on issues related to the understanding of free and informed consent and prescriptions were 12% and 7%, respectively. Among the doctors, 44% were not aware of all the research projects being carried out in the ward for which they were responsible, and 17% said that the hospital stays of patients participating in research were longer. The prevalence of factors that increased the vulnerability of subjects in medical research was high.

Se trata de un estudio de corte transversal que tuvo como objetivo evaluar la prevalencia de los factores asociados con el aumento de vulnerabilidad de los participantes de investigación. Fueron entrevistados 116 pacientes y 18 médicos. Entre los pacientes, el 15% eran analfabetos, el 27% desconocía el motivo de su hospitalización y el 45% no sabía qué tratamiento estaba recibiendo. Del total de la muestra, el 43% era de zonas rurales, y el 70% había cursado, como máximo, la educación básica, factores que tornan a esta población especialmente vulnerable. El porcentaje de respuestas correctas en cuestiones relacionadas con la comprensión del consentimiento libre e informado y de la prescripción médica fue de, respectivamente, 12% y 7%. Entre los médicos, el 44% no conocía todas las investigaciones realizadas en la enfermería de la cual eran responsables y el 17% afirmó que la permanencia hospitalaria de los pacientes que participan de investigaciones es mayor. Es elevada la prevalencia de factores que aumentan la vulnerabilidad de los participantes en investigaciones médicas.

Resumo OBJETIVO: relatar a experiência da vigilância do óbito infantil (VOI) na cidade do Recife-PE, Brasil. MÉTODOS: realizou-se pesquisa documental e consulta a informantes-chave, participantes do processo de implantação e consolidação da VOI; para mensuração da cobertura dos óbitos investigados, utilizaram-se dados do Sistema de Informações sobre Mortalidade (SIM) e das planilhas de monitoramento dessa estratégia. RESULTADOS: a implantação da VOI, gradual, iniciou-se em 2003; a estratégia constitui-se dos componentes (i) identificação dos óbitos, (ii) investigação, (iii) discussão, (iv) recomendações e correção das estatísticas vitais; concluída a implantação (2006), 98,5% (256) dos óbitos haviam sido investigados e discutidos, com participação dos envolvidos na atenção aos casos; em 2015, essa cobertura correspondeu a 97,7%. CONCLUSÃO: as principais recomendações consistiram na ampliação do acesso e cobertura, e melhoria da qualidade da atenção primária, secundária e terciária; a VOI pode subsidiar mudanças nas práticas assistenciais, planejamento e organização da rede de atenção materno-infantil.

Abstract OBJECTIVE: to report the experience on infant mortality surveillance (IMS) in the municipality of Recife-PE, Brazil. METHODS: a documentary research and a query with key-informants who participated in the implementation and consolidation of the IMS were conducted; data of the Mortality Information System (SIM) and of the surveillance worksheets were used to measure the coverage of the investigated deaths. RESULTS: the implementation of the IMS has occurred gradually since 2003; the strategy is composed by (i) identification of deaths, (ii) investigation, (iii) discussion, (iv) recommendations and correction of vital statistics; upon completion of implementation (2006), 98.5% (256) of the deaths had been investigated and discussed, with the participation of those involved in the cases; in 2015, this coverage corresponded to 97.7%. CONCLUSION: the main recommendations consisted of expanding the access, coverage and improvement of primary, secondary and tertiary care quality; IMS is able to support changes in health care practices, as well as planning and organization of maternal and child care.

Resumen OBJETIVO: describir la experiencia de vigilancia de mortalidad infantil (VOI) en la ciudad de Recife-PE, Brasil. MÉTODOS: se realizó una investigación documental y consulta a informantes-clave que participaron en el proceso de implantación y consolidación de esta vigilancia; para medir la cobertura de las muertes investigadas, utilizamos datos del Sistema de Informaciones sobre Mortalidad (SIM) y de las planillas de monitoreo de esta estrategia. RESULTADOS: la implantación de la VOI se produjo gradualmente a partir de 2003, constituida por los componentes (i) identificación de muertes, (ii) investigación, (iii) discusión, (iv) recomendaciones y corrección de las estadísticas vitales; concluyendo la implantación (2006), se investigó y discutió 98,5% (256) de las muertes, con la participación de los implicados en la atención al caso; en 2015, esta cobertura correspondía al 97,7%. CONCLUSIÓN: las principales recomendaciones consistieron en la ampliación de acceso y cobertura y mejoría de la calidad de atención primaria, secundaria y terciaria; la VOI puede subvencionar cambios en las prácticas asistenciales, planificación y organización de la red de atención materno-infantil.

Resumo OBJETIVO: relatar a experiência da vigilância do óbito infantil (VOI) na cidade do Recife-PE, Brasil. MÉTODOS: realizou-se pesquisa documental e consulta a informantes-chave, participantes do processo de implantação e consolidação da VOI; para mensuração da cobertura dos óbitos investigados, utilizaram-se dados do Sistema de Informações sobre Mortalidade (SIM) e das planilhas de monitoramento dessa estratégia. RESULTADOS: a implantação da VOI, gradual, iniciou-se em 2003; a estratégia constitui-se dos componentes (i) identificação dos óbitos, (ii) investigação, (iii) discussão, (iv) recomendações e correção das estatísticas vitais; concluída a implantação (2006), 98,5% (256) dos óbitos haviam sido investigados e discutidos, com participação dos envolvidos na atenção aos casos; em 2015, essa cobertura correspondeu a 97,7%. CONCLUSÃO: as principais recomendações consistiram na ampliação do acesso e cobertura, e melhoria da qualidade da atenção primária, secundária e terciária; a VOI pode subsidiar mudanças nas práticas assistenciais, planejamento e organização da rede de atenção materno-infantil.

Abstract OBJECTIVE: to report the experience on infant mortality surveillance (IMS) in the municipality of Recife-PE, Brazil. METHODS: a documentary research and a query with key-informants who participated in the implementation and consolidation of the IMS were conducted; data of the Mortality Information System (SIM) and of the surveillance worksheets were used to measure the coverage of the investigated deaths. RESULTS: the implementation of the IMS has occurred gradually since 2003; the strategy is composed by (i) identification of deaths, (ii) investigation, (iii) discussion, (iv) recommendations and correction of vital statistics; upon completion of implementation (2006), 98.5% (256) of the deaths had been investigated and discussed, with the participation of those involved in the cases; in 2015, this coverage corresponded to 97.7%. CONCLUSION: the main recommendations consisted of expanding the access, coverage and improvement of primary, secondary and tertiary care quality; IMS is able to support changes in health care practices, as well as planning and organization of maternal and child care.

Resumen OBJETIVO: describir la experiencia de vigilancia de mortalidad infantil (VOI) en la ciudad de Recife-PE, Brasil. MÉTODOS: se realizó una investigación documental y consulta a informantes-clave que participaron en el proceso de implantación y consolidación de esta vigilancia; para medir la cobertura de las muertes investigadas, utilizamos datos del Sistema de Informaciones sobre Mortalidad (SIM) y de las planillas de monitoreo de esta estrategia. RESULTADOS: la implantación de la VOI se produjo gradualmente a partir de 2003, constituida por los componentes (i) identificación de muertes, (ii) investigación, (iii) discusión, (iv) recomendaciones y corrección de las estadísticas vitales; concluyendo la implantación (2006), se investigó y discutió 98,5% (256) de las muertes, con la participación de los implicados en la atención al caso; en 2015, esta cobertura correspondía al 97,7%. CONCLUSIÓN: las principales recomendaciones consistieron en la ampliación de acceso y cobertura y mejoría de la calidad de atención primaria, secundaria y terciaria; la VOI puede subvencionar cambios en las prácticas asistenciales, planificación y organización de la red de atención materno-infantil.

ABSTRACT The aim of this study was to investigate the epidemiological characteristics, antigenic profile, perceptions, attitudes and practices of individuals who have been systematically non-compliant in mass drug administration (MDA) campaigns targeting lymphatic filariasis, in the municipality of Olinda, State of Pernambuco, Northeastern Brazil. A pretested questionnaire was used to obtain information on socioenvironmental demographics, perceptions of lymphatic filariasis and MDA, and reasons for systematic noncompliance with treatment. A rapid immunochromatographic test (ICT) was performed during the survey to screen for filariasis. It was found that the survey subjects knew about filariasis and MDA. Filariasis was identified as a disease (86.2%) and 74.4% associated it with the presence of swelling in the legs. About 80% knew about MDA, and the main source of information was healthcare workers (68.3%). For men the main reasons for systematic noncompliance with MDA were that “the individual had not received the medication” (p=0.03) and for women “the individual either feared experiencing adverse reactions”. According to the ICT, the prevalence of lymphatic filariasis was 2%. The most important causes of systematic noncompliance were not receiving the drug and fear of side-effects. For successful implementation of MDA programs, good planning, educational campaigns promoting the benefits of MDA, adoption of measures to minimize the impact of adverse effects and improvement of drug distribution logistics are needed.