CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Embora evidenciados importantes avanÃos no controle da aids, a epidemia ainda à um problema de saÃde pÃblica, mais incidente em grupos de vulnerabilidade, em que se citam as questÃes sociais e condiÃÃes de vida. Objetivou-se realizar a anÃlise espacial dos casos de gestantes soropositivas para o HIV e as caracterÃsticas socioeconÃmicas de bairros de Fortaleza, CearÃ, Brasil. Estudo ecolÃgico com abordagem espacial. Os dados socioeconÃmicos foram obtidos a partir do Censo DemogrÃfico de 2010 e os casos de HIV em gestantes, notificados entre 2001 e 2011, nos Sistemas de NotificaÃÃo de Agravos, InformaÃÃo de Mortalidade, InternaÃÃes Hospitalares. Analisaram-se 733 de HIV em gestantes. Utilizaram-se como unidade de anÃlise os 119 bairros de Fortaleza compatibilizados com a malha censitÃria do Instituto Brasileiro de Geografia e EstatÃstica. Realizou-se anÃlise de correlaÃÃo de Pearson entre os casos e os indicadores socioeconÃmicos. A transformaÃÃo de Freman-Tukey foi realizada para solucionar a instabilidade dos indicadores de desfecho. Empreendeu-se a regressÃo linear mÃltipla, identificando indicadores que melhor explicam o evento e em seguida, foi aplicado o modelo de regressÃo linear espacial. Utilizou-se o Ãndice de Moran para verificar a autocorrelaÃÃo espacial. Na anÃlise socioeconÃmica, verificou-se renda mensal mÃdia de R$1.766,6 e proporÃÃo mÃdia de pessoas na faixa da pobreza de 4,7%. Entre os indicadores com Ãndice de Moran significativo, citam-se a proporÃÃo de domicÃlios com 4 a 6 banheiros, a proporÃÃo de pessoas na faixa de pobreza e a proporÃÃo de domicÃlios com banheiros ou sanitÃrio de uso exclusivo com esgotamento. Os bairros com melhores condiÃÃes socioeconÃmicas estÃo a norte e nordeste da cidade. Houve associaÃÃo significativa entre realizar o prÃ-natal e aderir ao tratamento durante a gestaÃÃo (p=0,001) e durante o parto, realizar o parto cirÃrgico, e iniciar o tratamento nas crianÃas nas primeiras 24 horas (p<0,001). Houve correlaÃÃo espacial entre a razÃo de gestantes com HIV e renda mÃdia dos responsÃveis, proporÃÃo de moradias adequadas, proporÃÃo de domicÃlios com lixo acumulado e proporÃÃo de domicÃlios com 4 a 6 moradores. Estes bairros estÃo principalmente a noroeste e sudoeste da cidade. A associaÃÃo geogrÃfica dos casos de gestantes soropositivas para o HIV com os indicadores socioeconÃmicos evidencia a necessidade de intervenÃÃes voltadas à saÃde e melhoria das condiÃÃes de vida. CondiÃÃes precÃrias, vistas em regiÃes de baixa renda, inadequaÃÃes de moradia e saneamento foram preditores para a ocorrÃncia dos casos. Aponta-se para a necessidade de intervenÃÃes mais eficazes e efetivas no combate à transmissÃo primÃria e à transmissÃo vertical do HIV, considerando intervenÃÃes relativas ao contexto social, principalmente em regiÃes socialmente desfavorecidas. / Although important advances are seen in aids control, its epidemic is still a public health issue and it is more prevalent among vulnerabilities groups in which social matters and life conditions are reported. The aimed was to realized the spatial analyzsis of the HIV positive pregnant women cases, and the socioeconomic features of Fortaleza suburbs, Cearà State â Brazil. It is an environmental study with spatial approach. Socioeconomic data were gathered from the 2010 Demographic census and the HIV positive pregnant women cases recorded between 2001 and 2011 in the Systems for Disease Notification, Mortality Information and Hospitalizations. Was analised 733 HIV pregnant women were analyzed. The 119 Fortaleza suburbs were used as analysis units. They were compatible with the census mesh of the Brazilian Institute on Geography and Statistics- IBGE. Was held the Pearson correlation analysis was performed between the cases and the socioeconomic indicators. The Freman-Tukey transformation was done to solve the instability of outcome indicators. As for the HIV cases among pregnant women, the multiple linear regression was applied and it identified the indicators that better explain the event. Next, the spatial linear regression model was then applied. The Moran index was used to assess the spatial autocorrelation. Mean month income of R$1,766.60 was identified by socioeconomic analysis as well as the mean ratio of people on the poverty line of 4.7%. Among the indicators with significant Moran index, the ratio of domiciles with 4 to 6 bathrooms, the ratio of people on the poverty line and the ratio of domiciles with bathroom or exclusive toilet with disposal system were cited. Suburbs with better socioeconomic conditions are located in the north and northeast regions of the town. There was a significant association between having prenatal care and adhering to treatment during pregnancy (p=0.001) and labor, having a cesarean delivery, and initiating treatment in children within the first 24 hours of life (p<0.001). There was spatial correlation between the ratio of HIV pregnant women and the parents mean income, the ratio of adequate housing, the ratio of domiciles with accumulated garbage and the ratio of domiciles with 4 to 6 inhabitants. These suburbs are mainly located in the northwest and southwest regions of the city. The spatial correlation was verified between the HIV positive pregnant women cases income, the ratio of poor people and the ratio of illiterate, and there is a cluster of it in regions located in the northwest of the town. The geographic association of HIV positive pregnant women cases with the socioeconomic indicators prove the need of interventions focused on health and on life condition improvements. The precarious conditions seen in the low income regions with inadequate infrastructure and sewage system are the predictors of case occurrences. Thus, it points towards the need of more effective and efficient interventions to fight against primary transmission and the vertical HIV transmission by taking under consideration interventions related to social contexts mainly in socially underprivileged regions.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:9187 |
| Date | 05 December 2014 |
| Creators | Emeline Moura Lopes |
| Contributors | Marli Teresinha Gimeniz GalvÃo, Elucir Gir, Adryane Gorayeb Nogueira Caetano, Maria do Socorro Cavalcante, Julyana Gomes Freitas |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em Enfermagem, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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