Banca de DEFESA: KLAUSS KLEYDMANN SABINO GARCIA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : KLAUSS KLEYDMANN SABINO GARCIA
DATE: 06/11/2023
TIME: 14:00
LOCAL: Plataforma Teams
TITLE:

Brazil's Progress towards Malaria Elimination: Time Series Analysis of Malaria Cases and Case-Control Study of Factors Associated with Malaria Mortality in Brazil from 2011 to 2022

KEY WORDS:

Epidemiological Surveillance; Time Series Analysis; Public Health; Epidemiology.

PAGES: 181
BIG AREA: Ciências da Saúde
AREA: Saúde Coletiva
SUBÁREA: Epidemiologia
SUMMARY:

INTRODUCTION: The World Health Organization estimates that in 2021, approximately 247 million people worldwide were afflicted by malaria, resulting in over 619,000 deaths. In Brazil, malaria is a serious public health issue, particularly in the Amazon region (AMZ), which accounts for 99% of the country's cases. The extra-Amazon region of Brazil registers a higher incidence of imported malaria cases compared to autochthonous cases. Therefore, one of the strategies of the National Malaria Control and Prevention Program is to eliminate the disease by 2035. To reach that the program focus on control strategies in the AMZ region and the prevention of outbreaks in the extra-Amazon region. In 2021, Brazil reported more than 137,000 autochthonous cases of malaria and 61 deaths. Despite the magnitude of malaria in Brazil, uncertainties still exist regarding the factors related to deaths in the country. OBJECTIVES: This thesis aims to describe and analyze the epidemiological scenario of malaria in Brazil from 2011 to 2022 to understand the current situation and anticipate case occurrences in the coming years. Additionally, it seeks to identify factors associated with malaria deaths in Brazil in order to prevent and eliminate such occurrences. METHODS: This thesis comprises four studies analyzing malaria case and death data from 2011 to 2022. Two of these studies have a cross-sectional design, describing and characterizing the epidemiological profiles and scenarios of the AMZ and non- AMZ regions of Brazil, including the development of predictive models (forecasting). The third study is of cross-sectional and methodological nature, reports data record linkage processes that can contribute to improving the quality of malaria death information and enhance death investigation activities. The fourth study is a case-control study, describing the epidemiological profile of malaria deaths among Brazilian residents and investigating factors associated with these deaths. Open data were used for the first two studies, while nominal data were used for the latter two. The research was approved by the Research Ethics Committee of the School of Medicine at the University of Brasília. RESULTS: In the extra-AMZ region, a predominance of imported cases from other countries and the Brazilian AMZ region was identified, mainly related to individuals' occupational activities. In the AMZ region, locally transmitted cases predominate, and the prospective scenario suggests the possibility of malaria elimination in Brazil by 2035. However, this requires overcoming challenges, especially in the states of Amazonas and Roraima, as well as in mining areas and among indigenous populations. Deaths in the country have been increasing since 2019, with higher lethality in the extra-AMZ region, mainly due to cases imported from other countries and high parasitemia infections caused by species such as P. falciparum, P. ovale, and P. malariae. In the AMZ region, deaths are predominantly due to P. vivax infections, with risk factors associated with delays in detection/diagnosis, infections in indigenous areas, infections in children under one year old and adults over 40 years old, high parasitemia, and passive case detection. CONCLUSIONS: This thesis provided a comprehensive understanding of the malaria scenario and epidemiological profile in Brazil, highlighting temporal variations over the years and future case occurrence trends. Furthermore, record linkage techniques allowed investigation of related and associated causes of malaria deaths, offering insights into how this knowledge and these techniques can strengthen public health policies and assist Brazil in its goal to eliminate malaria by 2035.

COMMITTEE MEMBERS:
Presidente - 1773755 - WALTER MASSA RAMALHO
Interna - 484663 - ELISABETH CARMEN DUARTE
Externo à Instituição - GABRIEL ZORELLO LAPORTA
Externo à Instituição - MARCUS VINICIUS GUIMARAES DE LACERDA
Externa à Instituição - SHEILA RODRIGUES RODOVALHO - OPAS