title: Epidemiology of soil-transmitted helminthiases-related mortality in Brazil.
abstract: Soil-transmitted helminth (STH) infections are widely distributed in tropical and subtropical areas, including Brazil. We performed a nationwide population-based study including all deaths in Brazil from 2000 to 2011, in which STHs (ascariasis, trichuriasis and/or hookworm infection) were mentioned on death certificates, either as underlying or as associated causes of death. Epidemiological characteristics, time trends and spatial analysis of STH-related mortality were analysed. STHs was identified on 853/12 491 280 death certificates: 827 (97·0%) deaths related to ascariasis, 25 (2·9%) to hookworm infections, and 1 (0·1%) to trichuriasis. The average annual age-adjusted mortality rate was 0·34/1 000 000 inhabitants (95% confidence interval: 0·27-0·44). Females, children <10 years of age, indigenous ethnic groups and residents in the Northeast region had highest STH-related mortality rates. Nationwide mortality decreased significantly over time (annual percent change: -5·7%; 95% CI: -6·9 to -4·4), with regional differences. We identified spatial high-risk clusters for STH-related mortality mainly in the North, Northeast and South regions. Diseases of the digestive system and infectious/parasitic diseases were the most commonly associated causes of death mentioned in the STH-related deaths. Despite decreasing mortality in Brazil, a considerable number of deaths is caused by STHs, with ascariasis responsible for the vast majority. There were marked regional differences, affecting mainly children and vulnerable populations.
authors.affiliation: Department of Community Health,School of Medicine,Federal University of Ceará,Fortaleza,Brazil.
authors.forename: Francisco R
authors.initials: FR
authors.lastname: Martins-Melo
authors.affiliation: Department of Community Health,School of Medicine,Federal University of Ceará,Fortaleza,Brazil.
authors.forename: Alberto N
authors.initials: AN
authors.lastname: Ramos
authors.affiliation: Department of Community Health,School of Medicine,Federal University of Ceará,Fortaleza,Brazil.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Alencar
authors.affiliation: Department of Community Health,School of Medicine,Federal University of Ceará,Fortaleza,Brazil.
authors.forename: Mauricélia S
authors.initials: MS
authors.lastname: Lima
authors.affiliation: Department of Community Health,School of Medicine,Federal University of Ceará,Fortaleza,Brazil.
authors.forename: Jorg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001196:Ascariasis / Q000453:epidemiology / Q000401:mortality / Q000469:parasitology / Q000635:transmission; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005843:Geography; D006373:Helminthiasis / Q000453:epidemiology / Q000401:mortality* / Q000469:parasitology / Q000635:transmission; D006725:Hookworm Infections / Q000453:epidemiology / Q000401:mortality / Q000469:parasitology / Q000635:transmission; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases; D012987:Soil / Q000469:parasitology*; D062206:Spatial Analysis; D014257:Trichuriasis / Q000453:epidemiology / Q000401:mortality / Q000469:parasitology / Q000635:transmission; D055815:Young Adult
chemical_list: D012987:Soil
keywords: Brazil; mortality; neglected tropical diseases; soil-transmitted helminthiasis; spatial analysis; time trend analysis