Índice de vulnerabilidade socioambiental para o enfrentamento da dengue no Estado do Pará

Abstract

Dengue is one of the neglected tropical diseases that is important for public health in Brazil, as it inspires attention due to the increased incidence of cases influenced by macro and microfactors that provide favorable conditions for the expansion of mosquito vectors and transmission of the dengue virus (DENV). The research proposes the ecological study of dengue and the construction of a Dengue Socio-environmental Vulnerability Index (IVD) to analyze 143 municipalities in the state of Pará. The IVD design considered the selection of 34 indicators of the three fundamental components of the vulnerability concept: exposure, sensitivity and adaptive capacity. The methodology consisted of the following steps: (i) selection and grouping of indicators; (ii) definition of indicators; (iii) statistical treatments; (iv) calculation of the index by multivariate analysis; (v) index normalization; and (vi) index classification using the percentile technique. In the survey, 184,000 cases of dengue were considered, of which 92,000 progressed to hospitalization by the SUS, in the period from 2001 to 2017. The epidemiological profile of dengue indicated a seasonal behavior of the disease, occurring mainly in the quarter from January to March . For the construction of the IVD, the period from 2007 to 2017 was considered, in the mapping results it was observed that 43 municipalities (30%) were classified as "Low vulnerability", with values ranging from 0.483 to 0.262. About 57 municipalities (40%) presented values with “Medium vulnerability” in the range of 0.581 to 0.483. With reference to “High vulnerability”, 43 municipalities (30%) stood out, distributed in the range from 0.771 to 0.582. The results obtained from the profile that characterized the IVD showed a predominance of “Medium to Low vulnerability”. The city of Belém, capital of Pará and located in the Guajará region, presented the lowest value for IVD (0.262). On the other hand, most municipalities in the Marajó region had the highest IVD values, namely: Cachoeira do Arari, Chaves, Ponta de Pedras, Melgaço, Santa Cruz do Arari and Anajás. The indicators that most influenced the result of the index was the “socioeconomic” factor of the populations, especially related to poverty, income, urbanization, illiteracy and solid waste management. From the application of the IVD, it can be stated that it can be used as a relevant tool for the management of dengue health surveillance in the municipalities of the Amazon region, with the potential to be studied in other regions of Brazil.