Fatores ambientais e socioenocômicos da distribuição da chikungunya em Fortaleza – Ceará

Abstract

Chikungunya is an arbovirus, that is, a disease transmitted by mosquitoes (Aedes Aegypti), that affects thousands of people annually. Between 2014 and 2019, Ceará was the state with the highest incidence of cases in Brazil. Nearly all those cases were concentrated in Fortaleza. The present study utilizes the hypothesis that the growing number of chikungunya cases in Fortaleza is associated with environmental and socioeconomic factors, which manifest themselves in different ways in the city's neighborhoods. As a general objective, it seeks to identify the determinants of cases of chikungunya in the neighborhoods of Fortaleza. For this purpose, the study used secondary data referring to three levels of observation unit: the city, the neighborhoods and the population diagnosed with Chikungunya in Fortaleza. The variables referring to Fortaleza and its neighborhoods sought to characterize these spaces in terms of environmental, socioeconomic and climatic aspects and were obtained from sources such as the Brazilian Institute of Geography and Statistics, Fundação Cearense de Meteorologia (FUNCEME), National Oceanic and Atmospheric Administration (NOAA), Finance Secretariat (SEFIN), Fortaleza City Hall and Fortaleza Planning Institute (IPLANFOR). The variables referring to the infected population were obtained through the notification form of the Notifiable Diseases Information System (SINAN). The analysis period was from 2016 to 2018. As methods of analysis, univariate statistical procedures (frequency distribution tables and graphs), bivariate statistics (contingency tables and Pearson's correlation coefficient) and multivariate statistics (factor analysis, grouping analysis and multiple regression analysis) were used. The results showed that adults form the most vulnerable group to Chikungunya in Fortaleza. The main clinical symptoms are the presence of fever, severe arthralgia, headache and myalgia. Fever is more common in men, while myalgia is common in women. Chikungunya cases are only slightly associated with climatic characteristics, being significantly influenced solely by rainfall (lagged by one month). Regarding the environmental and socioeconomic factors, the main determinants of the number of cases of the disease were the infrastructure (existence of health and education equipment, as well as parks) and socioeconomic conditions (Human Development Index, income and literacy). Spatial analysis made it possible to identify that the distribution of cases does not occur homogeneously among Fortaleza neighborhoods. Thus, it is concluded that Chikungunya control strategies in Fortaleza should prioritize actions in the most vulnerable areas. However, these actions should focus on factors that have shown to be significantly impactful, such as infrastructure. Special attention should be given to places where great population agglomerations occur, such as health centers, schools and, above all, parks, many of which lead to insect dissemination.