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Background This study investigated the factors influencing the presentation, diagnosis and treatment of leprosy in primary healthcare. Methods Qualitative research was conducted on patients undergoing treatment in a priority hyperendemic region for leprosy control in northeastern Brazil. Interviews were conducted between September and December 2020 at primary healthcare centers. Data were analysed based on the basic interpretive qualitative structure according to Andersen and Newman's model of healthcare utilisation. Results Knowledge of leprosy symptoms influenced patients' search for a diagnosis. Unfavorable socioeconomic conditions experienced by patients made diagnosis and treatment difficult. Incorrect evaluations by health professionals caused difficulties and delays in obtaining a diagnosis of leprosy. Perceptions about the disease, such as non-acceptance of the disease and the adverse effects of the medications, affected treatment seeking and treatment continuity. Conclusions Patients with leprosy faced delays and healthcare access barriers related to knowledge of the disease, socioeconomic conditions and the structure of healthcare services, which must be considered when creating care plans, surveillance and control actions against leprosy. Appropriate interventions are necessary to reduce delays and better control the disease. [ABSTRACT FROM AUTHOR]

Background Coronavirus disease 2019 (COVID-19) has spread worldwide, causing a high burden of morbidity and mortality, and has affected the various health service systems in the world, demanding disease monitoring and control strategies. The objective of this study was to identify risk areas using spatiotemporal models and determine the COVID-19 time trend in a federative unit of northeastern Brazil. Methods An ecological study using spatial analysis techniques and time series was carried out in the state of Maranhão, Brazil. All new cases of COVID-19 registered in the state from March 2020 to August 2021 were included. Incidence rates were calculated and spatially distributed by area, while the spatiotemporal risk territories were identified using scan statistics. The COVID-19 time trend was determined using Prais–Winsten regressions. Results Four spatiotemporal clusters with high relative risks for the disease were identified in seven health regions located in the southwest/northwest, north and east of Maranhão. The COVID-19 time trend was stable during the analysed period, with higher rates in the regions of Santa Inês in the first and second waves and Balsas in the second wave. Conclusions The heterogeneously distributed spatiotemporal risk areas and the stable COVID-19 time trend can assist in the management of health systems and services, facilitating the planning and implementation of actions toward the mitigation, surveillance and control of the disease. [ABSTRACT FROM AUTHOR]

Background The detection of spatiotemporal clusters of deaths by coronavirus disease 2019 (COVID-19) is essential for health systems and services, as it contributes to the allocation of resources and helps in effective decision making aimed at disease control and surveillance. Thus we aim to analyse the spatiotemporal distribution and describe sociodemographic and clinical and operational characteristics of COVID-19-related deaths in a Brazilian state. Methods A descriptive and ecological study was carried out in the state of Maranhão. The study population consisted of deaths by COVID-19 in the period from 29 March to 31 July 2020. The detection of spatiotemporal clusters was performed by spatiotemporal scan analysis. Results A total of 3001 deaths were analysed with an average age of 69 y, predominantly in males, of brown ethnicity, with arterial hypertension and diabetes, diagnosed mainly by reverse transcription polymerase chain reaction in public laboratories. The crude mortality rates the municipalities ranged from 0.00 to 102.24 deaths per 100 000 inhabitants and three spatiotemporal clusters of high relative risk were detected, with a mortality rate ranging from 20.25 to 91.49 deaths per 100 000 inhabitants per month. The headquarters was the metropolitan region of São Luís and municipalities with better socio-economic and health development. Conclusions The heterogeneous spatiotemporal distribution and the sociodemographic and clinical and operational characteristics of deaths by COVID-19 point to the need for interventions. [ABSTRACT FROM AUTHOR]

Background Congenital syphilis is an infectious disease that affects 1 million children a year worldwide. Methods The objective of this study was to describe a spatial analysis of the epidemiological characteristics of congenital syphilis in the state of Maranhão, Brazil from 2007 to 2018. This was an ecological study using data obtained in May 2020 from three Brazilian information systems. The spatial correlation was analyzed according to local and global Moran indexes. Results During the 12-y period, 1 426 177 children were born. Of these children, 3684 acquired congenital syphilis (0.26%; mean annual rate of 2.62/1000 live births) and 70 died (1.90%; mean annual rate 0.05). The clusters were statistically significant according to the global Moran index of 0.40 (p=0.01). Spearman's correlation coefficient between the rate of detection of syphilis in pregnant women and family health strategy teams was strong, positive and significant (ρ=0.73; p<0.00). Most of the variables studied showed a trend of annual increase (p<0.05). Conclusions The use of spatial analysis tools have made it possible to detect areas with both a greater and a lesser need for intervention, and to more effectively improve and monitor those areas to change the epidemiological profile of the disease. [ABSTRACT FROM AUTHOR]