Análise espacial dos casos e fatores associados aos óbitos por dengue em área urbana na região metropolitana de Belo horizonte, Minas Gerais

Abstract

Introduction: Dengue is an important public health problem in Brazil and its control has shown weaknesses, resulting in constant epidemics. In Minas Gerais, the incidence of the arboviruses has increased in recent decades as in other Brazilian regions. Thus, this research Aimed to: 1) To review the factors associated with the occurrence of dengue epidemics; 2) To analyze the temporal evolution of dengue incidence considering the non-epidemic and epidemic periods of the disease in the municipality of Contagem, Minas Gerais; 3) To analyze the temporal, spatial and spatiotemporal evolution of dengue incidence and associated factors considering non-epidemic and epidemic periods of the disease in the city of Contagem, Minas Gerais; and, 4) To analyze the factors associated with deaths from dengue in the city of Contagem, Minas Gerais. Methods: 1) Systematic review of factors associated with the occurrence of dengue during epidemics in Brazil. The search included studies published in Medline, Lilacs, PubMed, Cochrane, BVS, Web of Science, Scopus and Bancos de Dados de Teses e Dissertações using descriptors cataloged in DeCs and MeSH on dengue and factors associated with the occurrence of epidemics, published from 2008 to 2018; 2) Retrospective epidemiological analytical study of probable dengue cases reported in the Sistema de Informação de Agravos de Notificação (SINAN). To this end, epidemiological cycles starting in epidemiological week (EW) 40 in 2011 and ending in EW 39 in 2017 were considered; 3) Ecological study using aggregated secondary data referring to reported probable cases of dengue among residents of the municipality of Contagem between 2011 and 2017; 4) Case-control study of factors associated with death from dengue in the 2016 epidemic year using a logistic regression model. Results and conclusions: 1) Thirty-five studies conducted in the country were selected. It was found that the factors associated with the occurrence of dengue epidemics are complex and multifactorial. Furthermore, the discontinuity of control actions is relevant for the maintenance of Aedes aegypti and for the disease; 2) Dengue epidemics in Contagem occurred in the 2012-2013 and 2015-2016 cycles, and had the highest incidences in the period studied (incidence of 3,497.10 per 100,000 inhabitants and 5,273.08 per 100,000 inhabitants, respectively); 3) There was a distribution of dengue cases throughout the city and spatiotemporal autocorrelation was identified in all cycles. It was possible to observe spatiotemporal patterns of probable dengue cases at different times: pre-epidemic and post-epidemic. In epidemic years, hot areas for disease transmission were detected. The spatial analysis showed areas of spatial clusters and the distribution of dengue in the municipality of Contagem; 4) The factors associated with death from dengue were age and bleeding. These findings indicate that the warning signs for dengue should be routinely monitored, as well as that patients should be instructed to seek medical assistance in their occurrence. It is also highlighted the need to continuously investigate the clinical and epidemiological parameters of dengue patients, in order to avoid fatal outcomes.