Field Epidemiology Training Program, Department of Public Health Emergencies, Ministry of Health, Brasília, Brazil.
Graduate Nursing Programme, Federal University of Sergipe, Aracaju, Brazil.
Trop Med Int Health. 2023 Jun;28(6):476-485. doi: 10.1111/tmi.13877. Epub 2023 Apr 15.
To analyse the spatial, temporal and spatial-temporal patterns of infant mortality associated with congenital toxoplasmosis in Brazil between the years 2000 and 2020.
Ecological study of time series, with spatial analysis and spatiotemporal scan of infant mortality associated with congenital toxoplasmosis from the records of deaths of the Mortality Information System of the Brazilian Ministry of Health. The rates were smoothed by the Local Empirical Bayesian model. The Global Moran Index, Global Geary's Contiguity and Getis-Ord General statistics were calculated for spatial autocorrelation assessment. The trends were evaluated by the Joinpoint method.
We identified 1183 infant deaths associated with congenital toxoplasmosis in Brazil between 2000 and 2020. The predominant characteristics were male sex (52.1%), post-neonatal age group (51.9%), white race/colour (45.7%), and Southeast region of residence (40.0%). The infant mortality rate associated with congenital toxoplasmosis showed an increasing trend in the country in the years analysed. The spatial analysis showed heterogeneous distribution of mortality in the Brazilian territory and found no evidence of spatial autocorrelation; but spatial-temporal analysis identified three risk clusters involving 703 municipalities.
Infant mortality associated with congenital toxoplasmosis is a persistent public health problem in Brazil. The risk factors male sex, indigenous race/colour, early neonatal age, North and Northeast regions and risk clusters mapped in this study should be observed for future analysis and planning of health care policies in the control of infant deaths associated with congenital toxoplasmosis. Health surveillance strategies and public health policies need to be strengthened.
分析 2000 年至 2020 年巴西先天性弓形虫病相关婴儿死亡率的时空模式。
采用时间序列生态学研究方法，对巴西卫生部死因监测系统记录的先天性弓形虫病相关婴儿死亡率进行空间分析和时空扫描。采用局部经验贝叶斯模型对死亡率进行平滑处理。计算全局 Moran 指数、全局 Geary 连续性和 Getis-Ord 普通统计量，评估空间自相关。采用 Joinpoint 法评估趋势。
我们在 2000 年至 2020 年期间在巴西发现了 1183 例与先天性弓形虫病相关的婴儿死亡。主要特征为男性（52.1%）、新生儿后期年龄组（51.9%）、白种人/肤色（45.7%）和东南部居住地区（40.0%）。分析期间，巴西先天性弓形虫病相关婴儿死亡率呈上升趋势。空间分析显示巴西境内死亡率分布不均，无空间自相关证据；但时空分析确定了三个涉及 703 个城市的风险集群。
先天性弓形虫病相关婴儿死亡率是巴西持续存在的公共卫生问题。本研究中发现的男性、土著种族/肤色、新生儿早期、北部和东北部地区等风险因素以及映射的风险集群，应在未来分析和规划先天性弓形虫病相关婴儿死亡的卫生保健政策时加以关注。需要加强卫生监测策略和公共卫生政策。
