title: Morbidity of mansoni schistosomiasis in Pernambuco-Brazil: Analysis on the temporal evolution of deaths, hospital admissions and severe clinical forms (1999-2014).
abstract: BACKGROUND
  Current scientific information reported that due to successive treatments of schistosomiasis cases in endemic areas of Brazil in the last 30 years, there has been a decrease in severe clinical form (hepatosplenic) and mortality from upper gastrointestinal bleeding due to this disease. Against this information, literature data show that the state of Pernambuco presents significant percentage of deaths and hospitalizations due to schistosomiasis, and occurrence of severe clinical forms as schistosomiasis myeloradiculopathy and persistence of localities with high parasite loads. This scenario justified this research which seeking to update the morbidity and mortality of schistosomiasis in Pernambuco.
  
  
  OBJECTIVE
  To conduct a temporal analysis on the evolution of deaths, hospital admissions and severe forms of Manson's schistosomiasis over the last 16 years in Pernambuco, Brazil.
  
  
  METHODS
  It was performed a gathering secondary data on schistosomiasis, from healthcare information systems and from the records of Hospital das Clínicas, Federal University of Pernambuco (HC-UFPE), covering the period from 1999 to 2014.
  
  
  RESULTS
  From 1999 to 2013 were registred 2578 deaths due to schistosomiasis and between 2008 and 2014 were recorded 473 hospitalizations for this disease. Among 1999-2014 were identified 1943 cases of schistosomiasis treated at the Hospital das Clínicas of Pernambuco. Among these cases, 72.6% (n. 1411) of the individuals presented the hepatosplenic clinical form (HE), 60.8% (n. 858) were at the age group 30-59 years (adults) and 58% were female. Among the HE cases, 4.6% (n. 58) had ascites, 43.2% (n. 556) had upper gastrointestinal bleeding and 39.1% (n. 489) had collateral circulation. The pattern of fibrosis in the liver E/EC (advanced fibrosis) and F/FC (very advanced fibrosis) occurred in 65.5% (n. 793) of cases. Between 1999-2014 the evolution curve of severe clinical forms of schistosomiasis remained stable, showing a tendency to decline from 2012.
  
  
  CONCLUSIONS
  When compared to other states of Brazil, Pernambuco shows high numbers of deaths and hospital admissions due to schistosomiasis. The actions of the Schistosomiasis Control Program (PCE) have been developed in a disintegrated, disjointed and discontinuous way, which may explain the magnitude of deaths, hospitalizations and severe forms of the disease in Pernambuco, showing a lack of control and the maintenance of severe frame morbidity of schistosomiasis in this state.
authors.affiliation: Schistosomiasis Laboratory and Reference Service, Department of Parasitology, Aggeu Magalhães Research Center, Fiocruz-Ministry of Health, Recife, Pernambuco, Brazil. Electronic address: constanca.barbosa@gmail.com.
authors.forename: Constança Simões
authors.initials: CS
authors.lastname: Barbosa
authors.affiliation: Schistosomiasis Laboratory and Reference Service, Department of Parasitology, Aggeu Magalhães Research Center, Fiocruz-Ministry of Health, Recife, Pernambuco, Brazil.
authors.forename: Elainne Christine
authors.initials: EC
authors.lastname: de Souza Gomes
authors.affiliation: Graduate Program in Public Health, Federal University of Pernambuco, Brazil.
authors.forename: Julyana Viegas
authors.initials: JV
authors.lastname: Campos
authors.affiliation: Department of Health of Pernambuco-Department of Management of Health Information, Brazil.
authors.forename: Fernando José Moreira
authors.initials: FJM
authors.lastname: de Oliveira
authors.affiliation: Schistosomiasis Laboratory and Reference Service, Department of Parasitology, Aggeu Magalhães Research Center, Fiocruz-Ministry of Health, Recife, Pernambuco, Brazil.
authors.forename: Millena Carla
authors.initials: MC
authors.lastname: da Silva Mesquita
authors.affiliation: Schistosomiasis Laboratory and Reference Service, Department of Parasitology, Aggeu Magalhães Research Center, Fiocruz-Ministry of Health, Recife, Pernambuco, Brazil. Electronic address: emiliacarolle@hotmail.com.
authors.forename: Emilia Carolle Azevedo
authors.initials: ECA
authors.lastname: de Oliveira
authors.affiliation: Clinical Hospital-Federal University of Pernambuco, Department of Gastroenterology, Brazil.
authors.forename: Ana Lucia Coutinho
authors.initials: ALC
authors.lastname: Domingues
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001201:Ascites / Q000453:epidemiology / Q000469:parasitology; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008103:Liver Cirrhosis / Q000401:mortality / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality / Q000639:trends; D012555:Schistosomiasis mansoni / Q000150:complications / Q000401:mortality*; D013997:Time Factors; D055815:Young Adult
keywords: Clinical forms of schistosomiasis; Epidemiology of schistosomiasis; Hepatosplenomegaly; Schistosomiasis; Schistosomiasis deaths