Application of the Rural Water Sustainability Index (RWSI) in Amazon rural communities, Pará, Brazil

This paper proposes an adaptation of the Rural Water Sustainability Index (RWSI) to the Brazilian Amazon region. Policymakers can use this tool to identify areas of water stress and develop actions to guarantee water access to rural communities. Multi-criteria analysis and a geographical information system were integrated to incorporate various indicators and produce maps displaying spatial water sustainability levels in rural communities. The RWSI was employed on a case study at 16 rural communities in Santa Luzia do Pará, Pará, Brazil. In total, 380 closed and structured interviews were conducted with people living in the area to collect local information for the model application. The results showed a varied spatial behavior between rural communities of Santa Luzia do Pará, with similarities and differences based on the overall condition of water resources (final index values). Half of the locations had ‘Poor’ or ‘Poor-Medium’ water quality. The remaining sample obtained scores ranging from ‘Medium-Good’ to ‘Good’ water sustainability. RWSI’ scores varied widely (from 5.7 to 6.5) among the communities. It was also found that localities more distant from surface water presented more water stress.

Anopheline species (Diptera: Culicidae) from the Maracá Ecological Station, Roraima State, Brazil

Anopheline species were sampled in different ecotones at Maracá Ecological Station and in Cantá municipality, both in Roraima State, Brazil, in June 2016. Nine species were recorded. Six species belong to the subgenus Nyssorhynchus and three species to the subgenus Anopheles. The most abundant species collected were Anopheles triannulatus s.l., Anopheles nuneztovari s.l. and Anopheles oswaldoi species B. The remaining species had frequencies lower than 10%. While A. triannulatus s.l. was the most frequent and the most widely distributed species in the studied area, Anopheles darlingi Root, the main malaria vector in the Brazilian Amazon region, was captured in two different ecotones and in low frequency. Our findings suggest that the risk of malaria outbreaks at Maracá Ecological Station may be low. This study also describes the first record of Anopheles costai Fonseca & Ramos in Maracá Ecological Station, Roraima State, increasing the distribution range of this taxon.

The Spread of NDM-1 and NDM-7-Producing Klebsiella pneumoniae Is Driven by Multiclonal Expansion of High-Risk Clones in Healthcare Institutions in the State of Pará, Brazilian Amazon Region

Carbapenem resistance among Klebsiella pneumoniae isolates is often related to carbapenemase genes, located in genetic transmissible elements, particularly the blaKPC gene, which variants are spread in several countries. Recently, reports of K. pneumoniae isolates harboring the blaNDM gene have increased dramatically along with the dissemination of epidemic high-risk clones (HRCs). In the present study, we report the multiclonal spread of New Delhi metallo-beta-lactamase (NDM)-producing K. pneumoniae in different healthcare institutions in the state of Pará, Northern Brazil. A total of 23 NDM-producing isolates were tested regarding antimicrobial susceptibility testing features, screening of carbapenemase genes, and genotyping by multilocus sequencing typing (MLST). All K. pneumoniae isolates were determined as multidrug-resistant (MDR), being mainly resistant to carbapenems, cephalosporins, and fluoroquinolones. The blaNDM-7 (60.9%—14/23) and blaNDM-1 (34.8%—8/23) variants were detected. MLST genotyping revealed the predomination of HRCs, including ST11/CC258, ST340/CC258, ST15/CC15, ST392/CC147, among others. To conclude, the present study reveals the contribution of HRCs and non-HRCs in the spread of NDM-1 and NDM-7-producing K. pneumoniae isolates in Northern (Amazon region) Brazil, along with the first detection of NDM-7 variant in Latin America and Brazil, highlighting the need for surveillance and control of strains that may negatively impact healthcare and antimicrobial resistance.

Prevalence of ocular findings regardless of visual acuity status in older adults from the Brazilian Amazon Region

Recently, it has been recommended that population-based studies report not only frequencies of vision impairment and blindness but also any ocular abnormalities that might lead an individual to seek for eyecare services. The current study aimed to determine prevalence of ocular findings regardless of visual acuity (VA) status in older adults from the Brazilian Amazon Region. Disturbances were grouped into: Eyelids; Anterior Segment; Posterior Segment; Increased intraocular pressure; and Overall Globe. The presence of an ocular finding was considered positive when any abnormality was noted, regardless of VA. Refractive errors were not considered. A total 2384 eligible persons were enumerated and 2041 (85.6%) examined. The prevalence of ocular disturbances in either eye was 87.0% and was associated with male gender, older age, lower education, and rural residence. Overall, main findings were pterygium, cataract, and pinguecula, occurring in 58.8%, 45.4% and 17.4%, respectively. Among individuals with 20/20 VA in both eyes, the most frequent findings were pterygium, pinguecula, and glaucoma cupping, occurring in 47.4%, 31.2% and 6.5%, respectively. The high prevalence of ocular findings observed in this population reinforces that different conditions might not immediately decrease VA but can indicate risk and/or discomfort symptoms and should be considered when planning public health ophthalmic services.

HIV epidemic in a province of the Brazilian Amazon region: Temporal trend analysis

Background: Although considerable progress has been made over the last decades, human immunodeficiency virus (HIV) incidence and acquired immunodeficiency syndrome (AIDS) mortality rates have remarkably increased in the Brazilian Amazon region. Here, we employed temporal analysis to determine the impact of public policies on the HIV epidemic in the state of Pará, Brazil, which has the second highest HIV incidence rate in the Amazon region.Design and Methods: This is an ecological study conducted in the state of Pará, employing secondary data of HIV/AIDS cases notified to the Information System for Notifiable Diseases, 2007–2018. The following epidemiological variables were collected: year of notification, municipality of residence, age, sex, education, exposure category, and HIV/AIDS diagnostic criteria. The study population was composed of 21,504 HIV/AIDS cases. The HIV/AIDS incidence rates were analyzed employing the temporal trend analysis (TTA) followed by the chi-square test and residue analysis to determine the association between the epidemiological variables and time series periods.Results: A total of 50% of the notifications were composed of AIDS cases. TTA identified two periods in HIV/AIDS incidence, with stabilization of cases in the first period (G1, 2007–2012) and an upward trend in the second period (G2, 2012–2018). The most prevalent epidemiological characteristics in G2 (versus G1) were as follows: young people, brown skin color, higher schooling, and homosexuals.Conclusion: Public policy to control HIV infection in the Brazilian Amazon region has been partially effective. HIV screening tests and treatment should be made widely available to eradicate HIV infection in the Amazon region by 2030.

Malaria Trigram: improving the visualization of recurrence data for malaria elimination

Background Although considerable success in reducing the incidence of malaria has been achieved in Brazil in recent years, an increase in the proportion of cases caused by the harder-to-eliminate Plasmodium vivax parasite can be noted. Recurrences in P. vivax malaria cases are due to new mosquito-bite infections, drug resistance or especially from relapses arising from hypnozoites. As such, new innovative surveillance strategies are needed. The aim of this study was to develop an infographic visualization tool to improve individual-level malaria surveillance focused on malaria elimination in the Brazilian Amazon. Methods Action Research methodology was employed to deal with the complex malaria surveillance problem in the Amazon region. Iterative cycles were used, totalling four cycles with a formal validation of an operational version of the Malaria Trigram tool at the end of the process. Further probabilistic data linkage was carried out so that information on the same patients could be linked, allowing for follow-up analysis since the official system was not planned in such way that includes this purpose. Results An infographic user interface was developed for the Malaria Trigram that incorporates all the visual and descriptive power of the Trigram concept. It is a multidimensional and interactive historical representation of malaria cases per patient over time and provides visual input to decision-makers on recurrences of malaria. Conclusions The Malaria Trigram is aimed to help public health professionals and policy makers to recognise and analyse different types of patterns in malaria events, including recurrences and reinfections, based on the current Brazilian health surveillance system, the SIVEP-Malária system, with no additional primary data collection or change in the current process. By using the Malaria Trigram, it is possible to plan and coordinate interventions for malaria elimination that are integrated with other parallel actions in the Brazilian Amazon region, such as vector control management, effective drug and vaccine deployment strategies.

Risk factors associated with the severity of COVID-19 in a region of the Brazilian Amazon

The Brazilian Northern region registered a high incidence of COVID-19 cases, particularly in the state of Pará. The present study investigated the risk factors associated with the severity of COVID-19 in a Brazilian Amazon region of 100,819 cases. An epidemiological, cross-sectional, analytical and demographic study, analyzing data on confirmed cases for COVID-19 available at the Brazilian Ministry of Health's surveillance platform, was conducted. Variables such as, municipalities of residence, age, gender, signs and symptoms, comorbidities were included and associated with COVID-19 cases and outcomes. The spatial distribution was performed using the ArcGIS program. A total of 100,819 cases were evaluated. Overall, patients had the mean age of 42.3 years, were female (51.2%) and with lethality reaching 4.79% of cases. Main symptoms included fever (66.5%), cough (61.9%) and sore throat (39.8%). Regarding comorbidities, most of the patients presented cardiovascular disease (5.1%) and diabetes (4.2%). Neurological disease increased risk of death by nearly 15 times, followed by obesity (5.16 times) and immunodeficiency (5.09 time). The municipalities with the highest incidence rate were Parauapebas, Canaã dos Carajás and Jacareacanga. Similarity between the Lower Amazon, Marajó and Southwest mesoregions of Pará state were observed concerning the highest morbidity rates. The obtained data demonstrated that the majority of cases occurred among young adults, females, with the classic influenza symptoms and chronic diseases. Finally, data suggest that the highest incidences were no longer in the metropolitan region of the state. The higher lethality rate than in Brazil may be associated with the greater impacts of the disease in this Amazonian population, or factors associated with fragile epidemiological surveillance in the notification of cases of cure.

Socio-Epidemiological Features and Spatial Distribution of Malaria in an Area under Mining Activity in the Brazilian Amazon Region

Malaria is an acute febrile infectious disease that represents an important public health problem in the Brazilian amazon region. The present study described the socio-epidemiological and spatial characteristics of malaria in a population from the Tapajós mining areas, Pará, Brazilian Amazon. A cross-sectional study, including individuals from Itaituba city, an area under mining activity influence, was conducted. The geographic coordinates were obtained in the field using the Global Positioning System (GPS) Garmin 78csx; for spatial analysis, we used the Kernel Density Estimator with the application of scanning statistics with the SaTScan software. Of the 908 individuals, 311 were positive for malaria. Most of the malaria cases were associated with male individuals, gold miners and with a monthly income of 4-6 salaries. Binary logistic regression analysis demonstrated that gold miners were nearly five times more likely to acquire malaria. In addition, a context of risk for sexually transmitted infections, substance abuse and poor support conditions was observed, worsening the healthcare scenario in this endemic area for malaria. The spatial distribution of malaria cases is irregular in the municipality with hotspot areas located in the Amana Flona that coincide with areas of illegal mining and high human mobility. Finally, the presented socio-epidemiological and spatial distribution data may aid in the development of more effective control measures for malaria in the area.

Antimicrobial activity of Amazonian plant species against the causative agents of secondary infection in snakebites

Riverine communities in the Brazilian Amazon region use a variety of plants to treat snakebites. These plants can be effective against secondary infections, one of the main complications of snakebites. The aim of this study was to determine whether plants traditionally used to treat snakebites in the Brazilian Amazon may also have antimicrobial and antioxidant activities, and if so, which classes of chemicals may be responsible for these activities. Aqueous extracts of nine plants were tested in microdilution assays and the more active were prepared using solvents (hexane, methanol and water) and decoction, and nine assays were performed. Assays to determine the antioxidant activity of the most active species were carried out, as well as phytochemistry studies to determine the active components of this species. Bellucia dichotoma exhibited the greatest antimicrobial potential, particularly the hexane, methanol and decoction extracts. In comparative TLC, extracts of this species showed characteristics of terpenoids, compounds with double bonds and flavonoids. In 1H NMR, characteristic signals of sterols such as β-sitosterol, stigmasterols or triterpenes were observed, as well as signals indicating the presence of aromatic hydrogens, characteristic of aromatic substances, and sugars. The methanol extracts and decoction were considered active in the antioxidant assay.

Sustainable University: From the Worldwide Conception to the Brazilian Amazonia

Higher Education as a transforming instrument in societies raises the need for universities and Higher Education Institutions (HEIs) as a whole to be leaders in the current paradigm of the time. The objectives of this study are to verify and analyze the movement and actions around the world that drove and started the conceptual model of Sustainable University (SU), as well as these ideas that started in Brazil and their implications for the reality of the Brazilian Amazon Region. A timeline has been sketched and provides additional theoretical insights into universities’ involvement in events before and after the sustainable development process. The methodological procedures were based on a wide literature review in scientific databases that gather journals with satisfactory impact factors; with the refinement of the searches, 87 scientific articles supported the analysis of this study. The results show that universities have played a prominent role on the world stage since 1950, in the post-war period. In the 1970s, HEIs sought to engage in the design of the new paradigm, and in the 1980s it is enunciated as Sustainable Development and conceptualized by the Sustainability approach. Universities, which had been active in discussions and events related to sustainability from the late 1980s onwards, began to organize themselves more effectively and promote sustainable initiatives to become examples of sustainability. Currently, many HEIs from countries in Europe and North America stand out in the initiatives. In Brazil, according to a global classifier, some HEIs seek to align themselves towards the SU model. Until 2019, no university in the Brazilian Amazon region had integrated the ranking, but in 2020, two appear in the list. It appears that information on the sustainability of universities inserted in the context of the Brazilian Amazon is still incipient.