Resumo Esse artigo analisa o conhecimento, atitudes e práticas sobre tuberculose de agentes comunitários de saúde (ACS) no Recife, município com altas taxas de incidência e de abandono do tratamento no Brasil. O estudo transversal foi conduzido em uma amostra representativa dos ACS utilizando questionário padronizado. Descreveram-se as frequências das variáveis referentes ao conhecimento, atitudes e práticas e analisou-se a associação do conhecimento satisfatório e práticas adequadas com características dos ACS. Dos 401 ACS elegíveis, 385 (96,0%) foram entrevistados. A maioria era composta por mulheres (87,5%), com idade ≥ 40 anos (66,0%) e desempenhando a função há mais de nove anos (74,5%). Um percentual de 61,7% tinha conhecimento satisfatório e esse conhecimento (75,8%) esteve associado às práticas adequadas (p = 0,008). Quanto às atitudes, 97,1% dos ACS acreditavam estar sob risco de contrair tuberculose e 53,2% atribuíram o risco à função. Parcela significativa dos ACS apresentou conhecimento satisfatório sobre tuberculose e esse conhecimento esteve associado às práticas adequadas. Esse resultado sugere a necessidade de investimentos em ações de capacitação que podem contribuir para a melhoria dos indicadores de tuberculose no município.

The diagnostic of arbovirus-related obstetric complications in high-risk pregnancy and childbirth care is challenging, especially in endemic areas. We conducted a prospective study to track active or recent Zika (ZIKV), dengue (DENV), or chikungunya (CHIKV) virus infection among hospitalized pregnant women (PW) with obstetric complications in a hospital at the epicenter of Zika outbreak and ZIKV-related microcephaly in Brazil. Clinical data and blood samples were collected at enrollment and 10 days after the admission of study participants, between October 2018 and May 2019. Further clinical data were extracted from medical records. Samples were screened by molecular and serological tests. Out of 780 participants, 93.1% (95% CI: 91.1–94.7%) presented previous DENV exposure (IgG). ZIKV, CHIKV, and/or DENV laboratory markers of recent or active infection were detected in 130 PW, yielding a prevalence of 16.6% (95% CI: 14.2–19.5%); 9.4% (95% CI: 7.4–11.7%), 7.4% (95% CI: 5.7–9.7%), and 0.38% (95% CI: 0.1–1.2%) of CHIKV, ZIKV, and DENV infections, respectively. Most ZIKV infections were detected by molecular assays (89.6%), while CHIKV infections were detected by serology (95.9%). Our findings highlight the need for arbovirus infections screening in PW with obstetrical complications, potentially associated to these infections in endemic areas regardless of the signs or symptoms suggestive of arboviral disease.

Objectives We assessed the prevalence of SARS-CoV-2 infection, personal protective equipment (PPE) shortages and occurrence of biological accidents among front-line healthcare workers (HCW). Design, setting and participants Using respondent-driven sampling, the study recruited distinct categories of HCW attending suspected or confirmed patients with COVID-19 from May 2020 to February 2021, in the Recife metropolitan area, Northeast Brazil. Outcome measures The criterion to assess SARS-CoV-2 infection among HCW was a positive self-reported PCR test. Results We analysed 1525 HCW: 527 physicians, 471 registered nurses, 263 nursing assistants and 264 physical therapists. Women predominated in all categories (81.1%; 95% CI: 77.8% to 84.1%). Nurses were older with more comorbidities (hypertension and overweight/obesity) than the other staff. The overall prevalence of SARS-CoV-2 infection was 61.8% (95% CI: 55.7% to 67.5%) after adjustment for the cluster random effect, weighted by network, and the reference population size. Risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2.56; 95% CI: 1.42 to 4.61), not always using all recommended PPE while assisting patients with COVID-19 (OR adj: 2.15; 95% CI: 1.02 to 4.53) and reporting a splash of biological fluid/respiratory secretion in the eyes (OR adj: 3.37; 95% CI: 1.10 to 10.34). Conclusions This study shows the high frequency of SARS-CoV2 infection among HCW presumably due to workplace exposures. In our setting, nursing assistant comprised the most vulnerable category. Our findings highlight the need for improving healthcare facility environments, specific training and supervision to cope with public health emergencies.

Introduction: The disparities in the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among frontline health care workers (HCWs) and the unique work circumstances are poorly documented for low-and middle-income countries. Methods: We assessed the frequency of SARS-CoV-2 infection, personal protective equipment (PPE) shortages, PPE use, and accidents involving biological material among HCWs in the Recife metropolitan area, Northeast Brazil. Using respondent driven sampling, we included HCWs attending suspected or confirmed COVID-19 patients from May 2020 to February 2021. Results: We analyzed 1,525 HCWs (527 physicians, 471 registered nurses, 263 nursing assistants/technicians, and 264 physical therapists). Women predominated in all categories (81.1%). Nurses were older and had more comorbidities (hypertension and overweight/obesity) than the other HCWs. The overall prevalence of SARS-CoV-2 infection was 61.8% after adjustment for the cluster random effect, weighted by network, and reference population size. The independent risk factors for a positive RT-PCR test were being a nursing assistant (OR adjusted: 2.56), not always using all recommended PPE in routine practice (ORadj: 2.15), and reporting a splash of biological fluid/respiratory secretion in the eyes (ORadj: 3.37). Conclusions: The high risk of infection among HCWs reflects PPE shortages and younger, possibly less experienced, frontline HCWs. There were disparities in the risk of SARS-CoV-2 infection among HCWs, with nursing assistants being the most vulnerable, possibly due to their longer and frequent contact with COVID-19 patients.

Background: Arboviruses, including dengue (DENV), Zika (ZIKV), and chikungunya (CHIKV), pose serious threats to neonatal health; however, the consequences of maternal peripartum infections, particularly those that are asymptomatic, remain poorly characterized. Methods: This hospital-based cross-sectional study investigated the adverse neonatal outcomes associated with maternal arbovirus infection among pregnant women hospitalized for obstetric complications in Northeast Brazil (October 2018 to May 2019). Maternal and neonatal data were collected through interviews and reviewing medical records. Acute/recent maternal infections were confirmed by molecular or serological assays. Associations between maternal infection (categorized as any arbovirus, ZIKV-only, or CHIKV-only) and neonatal outcomes were assessed using Poisson’s regression with robust variance, yielding adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs), controlled for maternal covariates. Results: Among 806 neonates, 131 (16.3%) were born to arbovirus-infected mothers and had a higher prevalence of prematurity (aPR=1.25, 95% CI: 1.00-1.56) and sepsis (aPR=1.74, 95% CI: 1.07-2.83) compared with those born to non-infected mothers. Neonates of ZIKV-infected mothers had a two-fold higher prevalence of sepsis (aPR=2.02, 95% CI: 1.00-4.11) than neonates of non-infected mothers, and a trend was observed for CHIKV (aPR=1.76, 95% CI: 0.97-3.20). Conclusions: In this hyperendemic region, a high frequency of newborns were exposed to maternal arbovirus infection during the inter-epidemic period, which was associated with increased premature births and neonatal sepsis. These findings underscore the need for increased clinical vigilance and routine screening in endemic areas, necessitating further longitudinal studies to confirm causality and guide management.