Objectives We aim to identify trajectories of probable maternal common mental disorders (CMD), as well as risk and protective factors associated with maternal mental health among postpartum women during the pandemic using life course theory approach.Design Prospective individual level cohort study from the Iracema-COVID Study.Population Mothers (n=335) at postpartum period who delivered during the COVID-19 pandemic in the fourth largest city in Brazil.Methods Probable CMDs were accessed using validated instruments in five cohort waves at postpartum period. Sequence analyses (SA) were employed to extract CMD trajectories, and a set of generalised binomial logistic and log-Poisson multivariable regression models with robust variance were employed to assess risk and protective factors for probable CMDs diagnosis.Outcome measures Trajectories patterns of probable maternal common mental disorders.Results Fit indices demonstrated a two-cluster-SA solution of probable CMD. The patterns of probable CMDs indicated that 335 mothers were clustered into occasional/transitory (n=240, 71.64%) and mostly/persistent (n=95, 28.36%) CMD trajectories. We found that mothers with low education (OR: 2.44; 95% CI 1.13 to 5.23), single (OR: 1.97; 95% CI 1.03 to 3.75) or in a stable union (OR: 2.00; 95% CI 1.02 to 3.90) and travel time spent to access the nearest primary healthcare unit (OR: 1.02; 95% CI 1.006 to 1.04) were associated with increased OR of belonging to the mostly/persistent CMD trajectory. Deprived green areas acted as a risk factor to maternal CMDs prevalence (OR: 1.37; 95% CI 1.002 to 1.87).Conclusions This study provides evidence that individual vulnerabilities and neighbourhood deprivation play an important role in understanding maternal mental health, beyond the patterns and trajectories of probable maternal CMD due to issues confronted during the COVID-19 outbreak in the northeastern region of Brazil. Policies to prevent and treat maternal mental health issues and improvement in neighbourhood deprivation need to be developed and addressed to avoid exacerbation of probable maternal CMDs.

This study aimed to identify patterns of child abuse and neglect and to examine the associations between these patterns and psychological distress during adolescence. A school-based survey was conducted with 693 high school students in Rio de Janeiro, Brazil, during 2016-2017. Latent class analysis was used to identify child abuse and neglect patterns based on the Childhood Trauma Questionnaire items’ combination. Psychological distress was measured using the General Health Questionnaire (GHQ-12). Multiple linear regression models were employed to examine the associations between child abuse and neglect patterns and psychological distress. Three classes of child abuse and neglect were identified for both sexes: (1) mild emotional violence and physical punishment, (2) emotional maltreatment, physical punishment, and neglect, and (3) poly-victimization. Being classified within the poly-victimization was significantly associated with higher psychological distress in both boys and girls. The class characterized by emotional maltreatment, physical punishment, and neglect was significantly associated with increased psychological distress among girls only. Health and educational services should assess child abuse and neglect when working with adolescents presenting psychological distress, as many may experience multiple forms of victimization. The high prevalence of childhood poly-victimization classes and their strong association with psychological distress highlight the urgent need for intersectoral strategies aiming at reducing child abuse and neglect.

Background:Directly Observed Therapy (DOT) is a recommended modality for tuberculosis (TB) treatment, yet is underutilized in many settings. Although DOT has been evaluated in clinical trials, less is known about its effectiveness in routine programs. We estimated the contribution of DOT to TB treatment success in Brazil. Methods:Using data from Brazil's National Disease Notification System for 2015-2018, we fit regression models estimating the relationship between DOT coverage and individual treatment success, leveraging municipality-level variation in DOT usage to avoid confounding due to nonrandom DOT receipt at the individual level. Models were adjusted for demographic and clinical covariates, using generalized estimating equations to account for correlation of outcomes within municipalities. Fitted models were used to project the impact of expanded DOT coverage, with robustness tested using alternative specifications. Results:The study included 278 007 individuals from 4783 municipalities. Average DOT coverage was 45.3%, with significant geographic variability. Treatment success was 86.9% with DOT and 73.2% without DOT. DOT coverage was associated with a 1.46 (95% confidence interval: 1.38, 1.55) odds ratio (OR) of treatment success. ORs ranged from 1.11 to 2.52 under alternative specifications, consistently indicating a positive impact. Scenario analyses indicated that reducing DOT nonutilization in each municipality by 50% would reduce the proportion of unsuccessful treatment outcomes by 7.1% (6.1, 8.2), equivalent to an average 5.5 (4.7, 6.3) percentage point increase in success probability for individuals newly receiving DOT. Conclusions:In this routine programmatic setting, higher DOT utilization was associated with better treatment outcomes, underscoring the importance of adherence-supported interventions for TB care.

Background:Community Health Workers (CHWs) play a critical role in frontline public health, especially in vulnerable regions. However, their exposure to violence remains an understudied issue. This study explores how CHWs gender shape the perception and experience of different types of violence in Northeastern Brazil during and after the COVID-19 pandemic. Methods:We conducted a cross-sectional analysis using data collected from 3800 CHWs in 2021 and 2023, across eight municipalities in Northeastern Brazil. Data were analyzed by gender, comparing perceptions and reported experiences of domestic (DV) and urban violence (UV). Inference used Cochran-Mantel-Haenszel (CMH) pooled odds ratios with Breslow-Day tests for homogeneity. Findings:Male CHWs consistently reported higher perception to urban violence (CMH OR 0.67 [95% CI 0.53-0.83]; p < 0.001), while female CHWs reported greater awareness of domestic violence (CMH OR 1.18 [1.00-1.40]; p = 0.058). Direct victimization was higher among males, particularly for physical aggression (CMH OR 0.80 [0.67-0.97]; p = 0.023), stabbing (CMH OR 0.75 [0.59-0.95]; p = 0.022), and non-lethal gunshot incidents (CMH OR 0.71 [0.58-0.87]; p < 0.001). In contrast, females consistently reported higher awareness of rape across both years (CMH OR 1.40 [1.15-1.70]; p < 0.001). Interpretation:Violence is not experienced or perceived uniformly, rather, it is shaped by gender roles and context. Female CHWs demonstrated greater sensitivity to domestic and sexual violence, while male CHWs were more attuned to urban violence and criminal dynamics. These are self-reported signals and should be interpreted with appropriate caution, yet they provide actionable intelligence for local prevention. Recognizing CHWs as strategic observers of community suffering, this study underscores the urgent need for intersectional, gender-responsive, and territorially differentiated public policies. Funding:This project was funded by FUNCAP, Fiocruz-PMA, and the Lemann Research Fund from Harvard University.

Background:The Fundão dam collapse, which occurred in 2015 in Minas Gerais, Brazil, was the largest tailings dam failure in history, releasing 60 million tons of mining waste onto 3.5 million people and contaminating 660 km of rivers and water sources. Methods:This study analyzed data from the Brazilian Water Quality Information System (SISAGUA, 2014-2023) for water-quality records and SIM/DATASUS (2011-2023) for mortality, focusing on municipalities affected by the 2015 Fundão dam collapse in the Doce River Basin, Minas Gerais, Brazil. The dataset included records of micropollutants that exceeded Brazilian Maximum Residual Limits (MRLs) across 203 cities. Contamination levels were compared with those in unaffected municipalities in the Grande and Jequitinhonha River Basins. Micropollutant profiles, cancer risk indexes, estimated cancer cases, and global and cancer mortality data were evaluated. Findings:We found extensive contamination in the Doce River Basin, particularly by metals such as cadmium, arsenic, lead, and antimony. A total of 300 cancer cases were estimated. All-cause mortality in the Doce River Basin increased between the pre-disaster period (2011-2014) and the post-disaster period (2015-2023; +0.005 deaths per population, 95% CI 0.0022 to 0.0078, p = 0.028). A formal difference-in-differences (DID) test against comparison basins yielded a positive but non-significant estimate. Cancer-specific mortality rates for ovarian, rectal, oropharyngeal, and central nervous system were higher in affected municipalities than in comparison basins. Interpretation:The study highlights the need for improved water treatment and health monitoring in the region, as well as further research into the long-term health impacts of mining-related contamination. Funding:Brazilian National Council for Scientific and Technological Development (CNPq; Grants 402364/2021-0 and 303076/2025-9).

Studies examining the associations between violence against children (VAC) and patterns of adolescent dating violence (DV) perpetration and victimization using person-centered analytic approaches remain limited and have yielded inconsistent findings. This study addresses whether emotional, physical, and sexual violence against children (VAC) are risk factors for distinct patterns of adolescent dating violence (DV), considering adolescents’ gender and their roles as victims or perpetrators. This is a school based cross-sectional study that involved a stratified cluster sample of 550 s-year high school students from thirteen schools in Rio de Janeiro, Brazil. The Childhood Trauma Questionnaire (CTQ) was used to detect VAC, while DV was identified using the Brazilian version of the Conflict in Adolescent Dating Relationships Inventory (CADRI). Latent Class Analysis (LCA) was used to identify classes of individuals based on their response patterns to the CADRI items. Multinomial regression analysis examined the relationships between VAC and DV patterns. Among girls, no single type of VAC increased the odds of belonging to the most severe perpetration class of DV. However, childhood sexual abuse increased fivefold (OR: 5.72; 95

Urban scaling theory posits that urban indicators follow power-law relations with population, yet the evolution of these patterns—and the role of regional differences in settings marked by social inequalities and unplanned urbanization—remains poorly understood. Here, we analyze nearly three decades of mortality data from Brazilian cities to investigate the scaling of external causes of death: homicides, suicides, and accidents. Using a hierarchical Bayesian framework and spatial correlation analysis, we find that these mortality indicators exhibit distinct, regionally heterogeneous scaling trajectories. Homicide mortality has significantly attenuated its typical superlinear scaling with increased spatial clustering, suggesting a redistribution of violence to smaller cities and intensified intercity interactions, possibly linked to the consolidation of organized crime. Suicide mortality, usually sublinear, has trended upward, implying a weakening of urban agglomerations’ protective effect. Accident mortality remains superlinear, with transport fatalities scaling nearly proportionally, and non-transport accidents becoming superlinear. The scaling changes for suicides and accidents coincide with less correlated and stable spatial patterns, suggesting that the underlying processes predominantly operate within city boundaries. Finally, while scaling exponents have evolved more homogeneously across Brazilian states, scale-adjusted mortality remains highly heterogeneous, indicating that fundamental processes govern scaling laws, whereas state-specific factors drive scale-adjusted metrics.

Malaria in South America remains a serious public health problem. Anopheles (Nyssorhynchus) darlingi is the most important malaria vector across tropical Latin America. Vector-targeted disease control efforts require a thorough understanding of mosquito demographic and evolutionary patterns. We present and analyze whole genomes of 1094 An. darlingi (median depth 18x) from six South American countries. We observe deep geographic population structure, high genetic diversity including 13 putative segregating inversions, and no evidence for sympatric cryptic taxa despite high interpopulation divergence. Strong signals of selection are plausibly driven by insecticides, especially on cytochrome P450 genes. Our results will facilitate effective mosquito surveillance and control while highlighting ongoing challenges that a diverse vector poses for malaria elimination in the Western hemisphere.

BACKGROUND:Even after successful treatment, individuals surviving tuberculosis (TB) disease experience elevated mortality rates. However, there is limited evidence on how these risks vary over time and by individual characteristics. METHODS:We conducted a retrospective cohort study of individuals diagnosed with TB in Brazil, using national TB notifications and linked mortality records for 2007-2016. We estimated mortality rate ratios (MRRs) and cumulative mortality by year since TB diagnosis, compared to general population mortality matched on age, sex, year, and state. We identified clinical and sociodemographic factors associated with elevated post-TB mortality, and compared the distribution of causes of death to the general population. RESULTS:The study sample included 834 594 individuals, with 4.1 million person-years of follow-up (average, 4.9 years). The TB cohort had elevated mortality compared to the general population, particularly in the first year postdiagnosis (MRR, 11.28 [95% confidence interval {CI}, 11.18-11.37]). Post-TB MRRs declined from 3.59 (95% CI, 3.53-3.64) in year 2 to 1.46 (95% CI, 1.34-1.59) in year 10. Cumulative excess mortality was 6.12% (95% CI, 6.07%-6.17%) after 1 year and 9.90% (95% CI, 9.58%-10.24%) after 10 years. MRRs were highest for individuals 30-44 years old at diagnosis. Relapse, loss to follow-up, and co-prevalent conditions like human immunodeficiency virus (HIV) and alcohol use disorder were strongly associated with higher MRRs. Over time, major causes of death in the TB cohort shifted from TB and HIV to cardiovascular disease, cancer, and non-TB respiratory diseases. CONCLUSIONS:Individuals developing TB disease face elevated mortality up to 10 years after diagnosis. These excess risks vary across demographic and clinical characteristics.

Background South Africa experiences high levels of ambient air pollution, with PM2.5 concentrations routinely exceeding WHO guidelines of 5 mu g/m(3). Early childhood represents a critical window of neurodevelopmental vulnerability, yet the impacts of postnatal PM2.5 exposure on developmental outcomes remain underexplored in this context. Methods We analysed nationally representative data on 5222 children aged 50-59 months attending 1248 Early Learning Programmes (ELPs) across South Africa, using the Early Learning Outcomes Measure 4&5 (ELOM) to assess development across five domains. Twelve-month cumulative PM2.5 exposure at each ELP was estimated using satellite-derived, ground-calibrated data. Spatial lag and error models were employed to account for residual spatial autocorrelation. Results A 10 mu g/m(3) increase in PM2.5 exposure was associated with lower total ELOM scores (beta = -0.12 SD, p < .05), with the largest associations observed for gross motor development (beta = -0.17 SD, p < .01) and fine motor coordination (beta = -0.12 SD, p < .05). No significant associations were detected for executive functioning, literacy, or numeracy domains. Conclusion This study provides evidence of associations between ambient PM2.5 exposure and specific developmental domains in preschool-aged children in South Africa. The findings highlight the need to integrate air quality interventions into early childhood policy and to further research mechanisms, exposure timing, and mitigation.

Malaria remains a global health challenge, imposing a substantial economic burden on health systems and society. Comprehensive assessments of this burden have been limited. This study aimed to provide a detailed estimate of the economic burden of malaria in the Brazilian Amazon. Public health expenditures were derived from a previous study. Direct, and indirect household costs and Health-Related Quality-of-Life (HRQoL) losses were estimated using a household survey conducted in nine municipalities in five states of the Brazilian Amazon. Expenditure data were collected from 1,131 individuals who experienced a malaria episode between January 2019 and May 2022. All costs were monetized and converted to 2024 purchasing power parity US dollars (PPP-USD). The total economic burden of malaria in the Amazon in 2019 was approximately US$181.9 million PPP-USD. The Unified Health System (SUS) bore the largest share (72.4%), which was allocated primarily to control and prevention activities. The states of Amazonas, Pará, and Roraima bore the highest total burden. Household burden was predominantly driven by indirect and mortality costs, and HRQoL losses. Major limitations of the study included convenience sampling and potential recall bias regarding expenditures; the latter was mitigated by surveying items and quantities rather than monetary values. This study offers a comprehensive and unparalleled assessment of the economic burden of malaria, providing a foundation for developing effective malaria control policies at the national and local levels in Brazil. Our findings underscore the critical role of the SUS in shielding families from direct medical costs, while revealing the substantial indirect costs, health-related quality-of-life losses, and mortality-related losses borne by households. These insights are essential for informing resource allocation and strengthening malaria control and elimination strategies in the Brazilian Amazon. The study provides a conceptual framework for estimating the economic cost of malaria that can be adapted to other malaria-endemic countries.

Dating violence during adolescence is a global public health issue due to its widespread occurrence and negative health consequences. Unfortunately, research addressing this topic in Latin American countries remains limited. Seeking to bridge this gap, the present study estimated the prevalence of both dating violence victimization and perpetration among high schoolers considering sociodemographic factors, exposure to other forms of violence, and school-related characteristics. A total of 539 students participated in the study selected by means of probabilistic sampling from private and public schools in Rio de Janeiro, Brazil. Dating violence was identified using the Conflict in Adolescent Dating Relationships Inventory. Victimization prevalence ranged from 16.7% (sexual) to 94.6% (emotional), whereas perpetration prevalence varied between 9.9% (sexual) and 94.6% (emotional). Boys were more physically victimized (37.2% vs. 24.5%) and perpetrated more sexual abuse (13.7% vs. 6.9%) than girls. Adolescents reporting child abuse, living in violent areas, and those who consumed alcoholic beverages more frequently had greater dating violence prevalence overall. However, some differences between male and female vulnerability characteristics merit debate. These heterogeneous profiles of victimization/perpetration between boys and girls indicate the need for specific dating violence prevention interventions.

From 1950 to 2019, all countries experienced an increase in life expectancy at birth. However, the magnitude and pace of change varied. Lower income countries experienced relatively larger increases, leading to a convergence process. Nevertheless, disparities remained pronounced in comparison to wealthier countries. In accordance with the health transition model, countries typically observe a decline in mortality rates by first achieving greater gains in young and adult ages. In this study, we build on the existing literature on health transition to demonstrate that by 2019, 55 percent of the 118 low‐ and middle‐income countries analyzed had reached a life expectancy at birth of at least 70 years. Notably, only two countries from sub‐Saharan Africa met this threshold. Additionally, 54 percent of the countries transitioned into the “cardiovascular revolution” stage, where improvements in adult mortality significantly increased life expectancy at birth. Meanwhile, 49 percent advanced to the “slowing the aging process” stage, characterized by greater gains in life expectancy from ages 65 and older than those aged 30–60. However, when applying a more restrictive criterion focused on ages above 80, this proportion drops to 19 percent. The results demonstrate an ongoing process of divergence–convergence between high‐ and low‐income countries and within middle‐ and low‐income groups.

A resiliência de um sistema de saúde refere-se à capacidade dos atores de saúde, das instituições e da população de manter suas funções essenciais quando uma adversidade surge e de se reorganizar, embasados pelas lições aprendidas. Sistemas resilientes podem alcançar e manter a equidade na saúde e bem-estar das populações e responder a emergências de saúde pública. Esta revisão de escopo utilizou as plataformas PubMed e Biblioteca Virtual em Saúde e as bases de dados Web of Science e SciELO, além do protocolo do Instituto Joanna Briggs para responder à questão: “O que as evidências científicas apontam como estratégias e barreiras para o alcance de um sistema de saúde resiliente?”. Constatou-se que as estratégias mais fortemente abordadas são: descentralização do sistema, força de trabalho comprometida e motivada, governança e liderança, parcerias multissetoriais, comunidade envolvida, sistema de informação adequado e investimentos que favoreçam a sustentabilidade do sistema de saúde. Contudo, gestão ineficaz e sem liderança, monitoramento inadequado, força de trabalho ineficaz, falta de solidariedade global e falha em aprender com as experiências passadas são barreiras à resiliência. Compreender as estratégias e barreiras é fundamental para a construção de um sistema de saúde resiliente, capaz de enfrentar estressores crônicos e agudos.

Illegal mining expanded in the Brazilian Amazon since 2018, leading to increases in malaria among indigenous populations, particularly the Yanomami. We describe the temporal and spatial pattern of malaria and mining in indigenous lands and quantify the impact of mining on malaria among the Yanomami. We estimate that a 1% increase in the annual mining area was associated with a 24% (95% CrI: 17%, 32%) increase in monthly malaria cases in the Yanomami. Also, malaria cases in 2022 in the Yanomami were likely underreported by 83%, and an estimated excess of 102,870 malaria cases occurred from 2018 to 2023 due to increased mining activity (an additional cost to the public health system of approximately US$6.9 million). Rethinking and intensifying malaria control in Brazil is a matter of health, environmental, and indigenous justice.

Children affected by orphanhood of any cause may benefit from assessment and referral to appropriate services. Timely and accurate data can guide policy. We leveraged new data sources expanding previous reports on national COVID-19-associated orphanhood to estimate national and sub-national numbers of children newly affected by death of parents and co-residing elderly caregivers due to all-causes and to COVID-19-associated causes in 2020-2021 in Brazil. We estimated that 1,300,000 (95% uncertainty interval 1,190,000, 1,430,000) children in Brazil experienced loss of one or multiple parents and/or co-residing caregivers 60+. 673,000 (652,000, 690,000) children were estimated to have lost one or both parents, of which 149,000 (144,000, 154,000) were COVID-19-associated; 635,000 (534,000, 758,000) children were estimated to have lost a co-residing grandparent or other kin, of which 135,000 (85,900, 199,000) were COVID-19-associated. Orphanhood estimates varied across states. The highest all-cause rate of parental orphanhood was in Roraima, at 17.5 (95% uncertainty interval 15.6, 20.6) per 1000 children, and the lowest was in Santa Catarina, at 9.5 (8.7, 10.4) per 1000 children. COVID-19-associated orphanhood was also unevenly distributed, with Mato Grosso experiencing the greatest rate, at 4.4 (3.9, 5.3) per 1000 children, while Pará experienced the lowest rate of 1.4 (1.2, 1.8) per 1000 children. We compared our estimates with administrative data for COVID-19-associated orphanhood (from Brazil’s civil registry offices and manually reviewed death certificates in Campinas) and found that a similar demographic distribution of orphanhood. However, our estimates suggested that administrative sources undercount orphanhood, suggesting that approximately 32% and 56% of total orphanhood was captured in the two datasets, respectively. Our findings highlight the extent of orphanhood in Brazil and the large inequalities between states. Our comparisons with administrative data both validate our model and suggest that strengthening vital registration systems can put children at the center of public health responses globally. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement N.S. acknowledges support from the Oxford-Radcliffe Scholarship from University College, Oxford, the EPSRC CDT in Modern Statistics and Statistical Machine Learning (Imperial College London and University of Oxford), A. Maslov for studentship support, EPSRC EP/V002910/2, and US Centers for Disease Control and Prevention and World Health Organization, “Building Global Public Health Capacity to Link Real-Time Modelling Data on COVID-19-associated Orphanhood and Caregiver Deaths to Inform Prevention, Preparedness and Protection from COVID-19 consequences,” 2023 (CDC/WHO grant). H.T.J.U. acknowledges funding from the Moderna Charity Foundation. A.B. acknowledges funding from EPSRC EP/X038440/1. E.S. acknowledges funding from EPSRC EP/V002910/2 and support from the AI2050 program at Schmidt Sciences (Grant [G-22-64476]). A.V.R.A and O.R. acknowledge funding from the Moderna Charity Foundation. L.C. acknowledges funding from the European Research Council (#771468). L.B. acknowledges CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)), Grant (312475/2022-5) and Fapesp (Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp)), Grant (2021/08772-9). S.F. acknowledges funding from CDC/WHO grant and EPSRC EP/V002910/2. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable All code and data (where we are able to provide directly) required to reproduce these results are available at https://github.com/MLGlobalHealth/BrazilOrphanhood. Where we are unable to provide original data, instructions are provided in this repository on how to obtain the data.

Aquaculture can contribute to the increased abundance of malaria vectors in endemic settings across the Amazon Basin. Accurate identification of anopheline larvae breeding in fish-farming ponds is essential for the effectiveness of mosquito control interventions through entomological surveillance. A protocol was developed for bulk molecular identification, at the species level, of anopheline larvae present in fishponds before, during, and after an intervention with biolarvicides. DNA was extracted from total 14,994 third (L3) and fourth (L4) larval instar stages, grouped into 161 pools. The D2 region of the 28S RNA gene was amplified in each larvae pool. Taxonomic assignment was performed for 1,357 Amplicon Sequence Variants (ASVs). The following species were assigned to 1,315 ASVs: Nyssorhynchus albitarsis H / Nyssorhynchus marajoara (7.60%), Nyssorhynchus braziliensis (0.53%), Nyssorhynchus goeldii / Nyssorhynchus dunhami (0.53%), Anopheles costai G1 (0.08%), Anopheles near malefactor (0.46%), Nyssorhynchus tadei (0.46%), Anopheles peryassui (34.07%), Nyssorhynchus rangeli (11.79%), Nyssorhynchus darlingi (15.36%), and Nyssorhynchus triannulatus (29.12%). Identification to species level was not possible for 42 ASVs. These ASVs were designated as Nyssorhynchus sp. and Anopheles sp. Interspecific genetic distances of the D2 region were calculated using the Kimura 2-parameter distance and ranged from 0% to 24.93%. All mosquito species mentioned above were found in fishponds prior to the application of biolarvicide. During treatment, Nyssorhynchus sp., Ny. goeldii / Ny. dunhami, Ny. braziliensis, An. costai G1, and An. near malefactor were not collected. In the post-treatment period, only Ny. albitarsis H / Ny. marajoara, Ny. triannulatus, and Ny. darlingi were found. Here a protocol for bulk molecular identification of anopheline larvae is described and it can be promising to entomological surveillance during larval control.

Resumo Este estudo tem como objetivo apresentar e discutir os avanços, desafios e perspectivas futuras da resiliência do SUS. Para atingir este objetivo, foi realizado um estudo exploratório e qualitativo com a realização de 30 entrevistas com especialistas acadêmicos e práticos nas dimensões de análise da resiliência de sistemas de saúde. Os dados coletados foram analisados por meio da análise de conteúdo indutiva. Os resultados indicam 32 avanços, 40 desafios e 32 perspectivas futuras da resiliência do SUS divididos nas seguintes dimensões e subdimensões: Governança - liderança, política e complexo regulatório; Financiamento - geração e alocação; Recursos - força de trabalho, infraestrutura, medicamentos e tecnologia da informação; Prestação de serviços - atenção primária e atenção especializada; e Contexto - determinantes sociais da saúde. Portanto, estes resultados demonstram a resiliência do SUS frente aos dois últimos grandes choques externos - político e pandemia da COVID-19 - e apontam aspectos a serem implementados, monitorados e avaliados pelos gestores públicos de saúde no futuro.

Background:Since 1950, there have been increasingly atypical climatological patterns in the Amazon, some caused by El Niño-Southern Oscillation (ENSO) events (El Niño or La Niña). In 2023-2024, the region faced the most severe droughts in recorded history. These weather patterns are major drivers of malaria. Deforestation has exacerbated these impacts. This study estimates the impact of weather and ENSO events on malaria transmission in the Brazilian Amazon from 2003 to 2022. Methods:We used daily individual-level data on reported malaria cases from the Brazilian Malaria Epidemiological Surveillance Information System (Sivep-Malaria). A case-crossover approach was used to analyze the effects of lagged weather variables and ENSO events on malaria transmission at the Amazon-wide and state levels. Generalized additive quasi-Poisson models were used to assess the influence of ENSO events on malaria cases. Findings:From 2003 to 2022, 5,381,105 malaria cases were recorded in the Brazilian Amazon. Temperatures between 25.64 and 30.85 °C and precipitation >4.46 cm in the week prior to infection increased malaria infection risk up to 9% (95% CI: 8-10%) and 86% (95% CI: 35-155%), respectively. Two- and three-week lagged temperatures >25.64 °C and diurnal variation >6.75 °C reduced malaria infection risk by a maximum of 27% (95% CI: 19-33%) and 59% (95% CI: 52-69%). State-specific variations in relationships were notable. ENSO events significantly influenced weather conditions and malaria transmission, with El Niño and La Niña associated with a net reduction in malaria cases of 2179 (95% CI: 1837, 2520) and 37,258 (95% CI: 37,171, 37,345), respectively, with marked spatiotemporal heterogeneity in effect. Interpretation:This study clarifies the short- and long-term influences of weather and ENSO events on malaria transmission in the Brazilian Amazon. The results underscore the high degree of heterogeneity in the effects of weather on malaria transmission in the region, and the need for proactive and fine-scale malaria control based on weather forecasting and the development of early warning systems to achieve malaria elimination. Funding:This research was supported by the Division of Intramural Research at the National Institute of Allergy and Infectious Diseases (Award Number: 2U19AI089681-08) and the Foundation for the National Institutes of Health (Award Number: NIH/T32 AI007535).