Geografia e epidemiologia da dengue na cidade de Uberlândia, MG (2003-2010): uma abordagem holística

Abstract

Dengue is a viral disease transmitted by mosquitoes, most common among humans. Over the past years, has become an important public health problem worldwide. The geographical distribution of vectors and viruses led to the global resurgence of the epidemical and the emergence of dengue hemorrhagic, which is affecting mainly the adult population. Since 1993, yearly outbreaks of dengue occur in Uberlândia, MG. The interventions at the urban space, caused by the rapid growth of the city throughout recent years intensified the pressures on the natural environment, enhancing the negative effects of determinants and conditions of dengue epidemiological chain. The present study aimed to analyze the distribution of dengue through time and space in urban area of Uberlândia, establishing comparisons, identifying possible factors physical/chemical, biological and social environmental that includes the disease and its dynamics; also to analyze the possible association rates of infection and infestation with selected environmental variables, including temperature, air relative humidity, rainfall, population density, household density, as well as the level of knowledge and community participation at Martins neighborhood in the actions in order to control dengue. The epidemiological situation of dengue was determined by the incidence of disease and infestation by Aedes aegypti, with reference data from the years 2003 to 2010, obtained from the Uberlândia Department of Health. The zoning of the study area was conducted through a graphical analysis of the distribution of neighborhoods in the urban area (mapping). The division of the city into sectors occurred the same way as the new model of integrated neighborhoods. Each sector included ten spatial units (corresponding to neighborhoods and/or integrated neighborhoods). We applied statistical methods nonparametric, with a significance level of 0.05 and the technique of triangulation of methods, combining questionnaire, interview and observation. There was significant difference of dengue coefficients during the study period. Regarding space, the dengue incidence was significantly different throughout the years of study, with rotation of higher levels between sectors and districts, with the highest rates has occurred in the neighborhoods of Central sectors, North and West. The dengue coefficients, higher in the years 2003 to 2010 were repeated in neighborhoods Martins, Daniel Fonseca, Brasil, Umuarama, Morumbi, Custódio Pereira, Luizote de Freitas, Planalto/Jaraguá, Jardim das Palmeiras, Tocantins, Tubalina, Santa Luzia, Presidente Roosevelt, Nossa Senhora das Graças e Pacaembu. At Martins surroundings, there was a permanent source of dengue, with reported cases in all months over the eight years of study. There was significant difference in the incidence of dengue among seasons, being higher in the rainy seasons however there was a significant increase in incidence during the dry seasons during the study period. There was significant difference of infestation of Aedes aegypti across sectors and districts, with isolated foci with high vector density in dry seasons, especially in districts of northern and western sectors. Multiple correlations were found among infection and infestation often contradictory to the installation of an infectious process. There was a correlation of infection and infestation with relative humidity, population density and household density and infestation of Aedes aegypti related to rainfall. The problems of poor housing infrastructure, unoccupied areas and the lack of a health policy of education focusing on rescuing citizenship, were undoubtedly the main determinants for the reproduction of Aedes aegypti at Martins neighborhood. The interviewed population at Martins neighborhood proved to be very skeptical in dengue prevention work focused on eliminating breeding places of Aedes aegypti mosquito, and mainly due to the contradictions between hard work and the methods used in vector control and the high incidence of dengue in the neighborhood. It is concluded that the epidemiological situation of dengue fever in Uberlândia, MG is very complex, with multiple maintaining factors of infection, which requires a review of the strategies adopted for controlling dengue in the city and the use of social and environmental indicators to measure the dengue risk epidemic. Another relevant factor in the effective fight against dengue is to recognize the importance of closer coordination of the activities of epidemiological and entomological surveillance, as well as to continue the relentless and continuous environmental health surveillance.