ABSTRACT

OBJECTIVE

To analyze the scientometric profile of research on trachoma in Brazil.

METHODS

Bibliographic research of publications on trachoma in Brazil indexed by the Scopus database from 2000 to 2020, based on specific criteria. Data on authorship, country of origin, institutions, and keywords were collected and analyzed with analysis of time trends. Bibliographic networks were constructed via a scientometric visualization software—VOSviewer^® 1.6.16.

RESULTS

We analyzed 42 publications on trachoma in Brazil. The annual average was two articles, with an increase of about 50% during the period. The average number of authors was three per document and school surveys were the most common subject category. Most published articles came from Brazilian institutions (95.2%), mainly those based in Southeast and North Brazil. Of the most productive authors, 10 were mentioned as first author in 26.2% of publications (11/42) and the predominant institutions are based in the state of São Paulo. The term “trachoma” (n = 18) was the most recurrent keyword.

CONCLUSION

This first scientometric analysis of research on trachoma in Brazil showed a limited number of studies on this disease. The scientific production slightly increased, although the origin of many studies is geographical areas with lower endemicity of this disease. Greater investments are needed for a better understanding and control of this neglected tropical disease. The analysis of bibliographic production on this topic is important to strengthen the development of research and strategic planning of programs for the control of trachoma and neglected tropical diseases in general.

DESCRIPTORS
Trachoma; Scientific and Technical Publications; Citation Databases; Bibliometrics; Bibliometric Indicators

INTRODUCTION

Trachoma is a neglected tropical disease (NTD)¹1 Saboyá-Díaz MI, Betanzos-Reyes AF, West SK, Muñoz B, Castellanos LG, Espinal M. Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities. Rev Panam Salud Publica. 2019;43:e93. https://doi.org/10.26633/RPSP.2019.93
https://doi.org/10.26633/RPSP.2019.93... caused by the bacterium Chlamydia trachomatis and critically affects people's health by chronic and associated recurrent keratoconjunctivitis²2 Ministério da Saúde (BR), Secretaria de Vigilância em Saúde, Departamento de Vigilância das Doenças Transmissíveis. Manual de vigilância do tracoma e sua eliminação como causa de cegueira. 2.ed rev. Brasília, DF; 2014 [cited 2021 Jul 10]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/manual_vigilancia_tracoma_eliminacao_cegueira.pdf
https://bvsms.saude.gov.br/bvs/publicaco... ,³3 WHO Alliance for the Global Elimination of Trachoma by 2020: progress report. Wkly Epidemiol Rec. 2020 [cited 2021 Jul 20];95(30):349-60. Available from: https://www.who.int/publications/i/item/who-wer9530
https://www.who.int/publications/i/item/... . In the world, it is the main cause of blindness of infectious origin¹1 Saboyá-Díaz MI, Betanzos-Reyes AF, West SK, Muñoz B, Castellanos LG, Espinal M. Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities. Rev Panam Salud Publica. 2019;43:e93. https://doi.org/10.26633/RPSP.2019.93
https://doi.org/10.26633/RPSP.2019.93... .

Its high morbidity is associated with poverty in different contexts of vulnerability, such as low schooling level, lack of basic sanitation and hygiene, and restriction on access to health services¹1 Saboyá-Díaz MI, Betanzos-Reyes AF, West SK, Muñoz B, Castellanos LG, Espinal M. Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities. Rev Panam Salud Publica. 2019;43:e93. https://doi.org/10.26633/RPSP.2019.93
https://doi.org/10.26633/RPSP.2019.93... . Its occurrence, therefore, prevents carriers of the disease from having a good eye health and affects their overall well-being, functional capacity, social inclusion, and quality of life⁴4 Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021;9(4):e489-551. https://doi.org/10.1016/S2214-109X(20)30488-5
https://doi.org/10.1016/S2214-109X(20)30... .

In 2019, 142.2 million people lived in endemic areas for trachoma worldwide³3 WHO Alliance for the Global Elimination of Trachoma by 2020: progress report. Wkly Epidemiol Rec. 2020 [cited 2021 Jul 20];95(30):349-60. Available from: https://www.who.int/publications/i/item/who-wer9530
https://www.who.int/publications/i/item/... and 1.9 million of them at risk of evolution to visual impairment or irreversible blindness⁵5 Organização Pan-Americana da Saúde. Brasil inicia inquérito para validar eliminação do tracoma, conforme metodologia da OPAS/OMS. Brasília, DF: OPAS; 2018 [cited 2021 Jul 20]. Available from: https://www.paho.org/pt/noticias/11-9-2018-brasil-inicia-inquerito-para-validareliminacao-do-tracoma-conforme-metodologia
https://www.paho.org/pt/noticias/11-9-20... .

Until 2020, nine countries in the world had the elimination of trachoma as a public health problem⁶6 Bradley M, Taylor R, Jacobson J, Guex M, Hopkins A, Jensen J, et al. Medicine donation programmes supporting the global drive to end the burden of neglected tropical diseases. Trans R Soc Trop Med Hyg. 2021;115(2):136-44. https://doi.org/10.1093/trstmh/traa167
https://doi.org/10.1093/trstmh/traa167... . In at least 44 countries, this disease is recognized as a public health problem. In Latin America, it persists in different areas of Brazil, Colombia, Guatemala, and Peru, and Mexico validates its elimination¹1 Saboyá-Díaz MI, Betanzos-Reyes AF, West SK, Muñoz B, Castellanos LG, Espinal M. Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities. Rev Panam Salud Publica. 2019;43:e93. https://doi.org/10.26633/RPSP.2019.93
https://doi.org/10.26633/RPSP.2019.93... .

The first stage of the Inquérito Nacional para Validação da Eliminação do Tracoma como Problema de Saúde Pública (Survey for Validation of Elimination of Trachoma as a Public Health Problem), performed in Brazil in from 2018 to 2019, showed that the prevalence of the active form of the disease (follicular trachoma) was below 5% among children from one to nine years of age in non-indigenous areas. The sequelar form of the disease (trachomatous trichiasis), which is unknown by the health system, was lower than the critical value of 0.2%, except for the Northeast Ceará evaluation unit, which presented a prevalence of 0.22%⁷7 Szwarcwald CL, Lopes MFC, Souza Junior PRB, Gómez DVF, Luna EJA, Almeida WS, et al. Population prevalence of trachoma in nine rural non-indigenous evaluation units of Brazil. Ophthalmic Epidemiol. 2021 oct 29:1-10. https://doi.org/10.1080/09286586.2021.1941127. Epub ahead of print.
https://doi.org/10.1080/09286586.2021.19... ; however, this value was included in the confidence interval.

In line with the agenda to achieve the Sustainable Development Goals (SDG), the World Health Organization proposes the elimination of trachoma as a public health problem in the world as one of the specific targets for NTD from 2021 to 2030⁸8 Coalizão Internacional para o Controlo do Tracoma (CICT). Eliminando o Tracoma: acelerar rumo ao 2020GET 2020. Relatório executivo da Aliança da OMS para a eliminação global do tracoma até 2020. Genebra (CH): CICT; 2016 [cited 2021 Jul 20]. Available from: https://www.trachomacoalition.org/sites/all/themes/report-2016/PDF/GET2020_2016_PT.pdf
https://www.trachomacoalition.org/sites/... . Eye health is considered essential to achieve many of the SDG⁴4 Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021;9(4):e489-551. https://doi.org/10.1016/S2214-109X(20)30488-5
https://doi.org/10.1016/S2214-109X(20)30... .

Although Brazil continues to be a priority area for trachoma control¹1 Saboyá-Díaz MI, Betanzos-Reyes AF, West SK, Muñoz B, Castellanos LG, Espinal M. Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities. Rev Panam Salud Publica. 2019;43:e93. https://doi.org/10.26633/RPSP.2019.93
https://doi.org/10.26633/RPSP.2019.93... , the number of scientific publications considering the epidemiological context and different patterns of endemicity in states and municipalities is still limited¹1 Saboyá-Díaz MI, Betanzos-Reyes AF, West SK, Muñoz B, Castellanos LG, Espinal M. Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities. Rev Panam Salud Publica. 2019;43:e93. https://doi.org/10.26633/RPSP.2019.93
https://doi.org/10.26633/RPSP.2019.93... . Identifying patterns of production of studies on trachoma in Brazil is a strategy to support researchers, governments, and funding agencies to make more efficient decisions.

Scientometric analyses show patterns of scientific production and support researchers, governments, and funding agencies to identify areas and topics with little investment (such as trachoma) and make more efficient decisions. The trend of use of this research method is increasing, including in Brazil, which enables the recognition of research efforts from the quantitative description of documents⁹9 Bai J, Li W, Huang YM, Guo Y. Bibliometric study of research and development for neglected diseases in the BRICS. Infect Dis Poverty. 2016;5(1):89. https://doi.org/10.1186/s40249-016-0182-1
https://doi.org/10.1186/s40249-016-0182-... , scientific collaboration, and the characterization of scientific social networks related to the topic¹⁰10 Sobral NV, Duarte Z, Santos RNM, Mello RC. Redes de colaboração científica na produção de conhecimento em doenças tropicais negligenciadas no Brasil: estudo a partir da plataforma LATTES do CNPq. Encontros Bibli. 2020;25:1-22. https://doi.org/10.5007/1518-2924.2020.e72981
https://doi.org/10.5007/1518-2924.2020.e... .

Thus, this study aims to develop the first scientometric analysis on trachoma in Brazil, analyzing the profile of research on the topic from 2000 to 2020 in order to generate subsidies for the proposal of actions and policies on the research, surveillance, and control of trachoma in the country.

METHODS

This is a scientometric research on publications related to trachoma in Brazil, which used scientific productions from this country or epidemiological data related to the disease.

Data were collected in July 2021 from all publications from January 2000 to December 2020, totaling a 21-year analysis series.

The scientific productions analyzed were indexed in the Scopus (https://www.scopus.com/home.uri), PubMed (https://pubmed.ncbi.nlm.nih.gov/), Web of Science (https://mjl.clarivate.com/search-results), and Dimensions (https://app.dimensions.ai/discover/publication) databases and were accessed by the Comunidade Acadêmica Federada da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAFe-CAPES – Federated Academic Community of the Coordination of Superior Level Staff Improvement). All data presented analytical compatibility in the scientometric visualization software—VOSviewer^® 1.6.16 (https://www.vosviewer.com/). This software can be used to build a scientific knowledge network and shows research structure, evolution, and cooperation¹¹11 Eck NJ, Waltman L. Software survey: VOSviewer, a computer program Dec 31 for bibliometric mapping. Scientometrics. 2010;84(2):523-38. https://doi.org/10.1007/s11192-009-0146-3
https://doi.org/10.1007/s11192-009-0146-... .

Based on specific criteria, an advanced search was performed with keywords. In the Scopus database, the following terms were searched: ((AUTHKEY (“Trachoma”) OR TITLE (“Trachoma”) OR ABS (“Trachoma”)) and (AUTHKEY (“Brazil”) OR TITLE (“Brazil”) OR ABS (“Brazil”)) OR (AUTHKEY (“Tracoma”) OR TITLE (“Tracoma”) OR ABS (“Tracoma”)) OR (AUTHKEY (“Brasil”) OR TITLE (“Brasil”) OR ABS (“Brasil”))). In PubMed: (((tracoma[MeSH Terms]) OR (Tracoma[Title])) OR (Tracoma[Title/Abstract])) and (((Brasil[MeSH Terms]) OR (Brasil[Title])) OR (Brasil[Title/Abstract]))) OR (((trachoma[MeSH Terms]) OR (Trachoma[Title])) OR (Trachoma[Title/Abstract])) and (((Brazil[MeSH Terms]) OR (Brazil[Title])) OR (Brazil[Title/Abstract]))). In Web of Science: ((TI=(trachoma) OR AB=(trachoma) OR AK=(trachoma)) AND (TI=(Brazil) OR AB=(Brazil) OR AK=(Brazil))) OR ((TI=(tracoma) OR AB=(tracoma) OR AK=(tracoma)) and (TI=(Brasil) OR AB=(Brasil) OR AK=(Brasil)))]. And, finally, in Dimensions: (trachoma and Brazil) OR (tracoma and Brasil)].

The Scopus database was selected for the analysis of indicators and scientometric relationships due to its greater number of documents used, the availability of variables, and VOSviewer^® specificities. However, certain periods of time presented limitations due to issues related to the indexation of some important national and international journals, as well as expert opinions.

Scientometric analysis indicators related to co-authorship were used for the analysis units “author” (co-authorship versus author), “institution” (co-authorship versus organizations), and “country” (co-authorship versus countries), and for the co-occurrence for the unit “author keywords” (co-occurrence versus author keywords), following parameters with maximum limit of ‘25’ and minimum of ‘1’ for scientometric visualization items.

In the unit “author”, the authors of the selected studies were analyzed within the period. The unit “institution” is related to the affiliation of each author and “country” refers to the nationality of the institutions of the authors. For the presentation of the results, the 10 highest occurrences of each analysis unit were highlighted and presented.

For structuring bibliographic networks, the specificities of references associated with each record were considered along with author keywords data. The most frequent terms in publications and cluster analysis were provided by VOSviewer¹¹11 Eck NJ, Waltman L. Software survey: VOSviewer, a computer program Dec 31 for bibliometric mapping. Scientometrics. 2010;84(2):523-38. https://doi.org/10.1007/s11192-009-0146-3
https://doi.org/10.1007/s11192-009-0146-... .

Then, images representing the relationships (maps) between authors, countries, institutions, and keywords (nodes), the strength between these relationships (arc thickness), and the number of their total contributions (node size) were observed. A thesaurus was also applied to consolidate the analyzed terms.

This study was approved by the Research Ethics Committee of the Hospital São José de Doenças Infecciosas (HSJ)/Ceará Health Department, under Opinion No. 3,634,979 (CAAE 18663119.7.0000.5044).

RESULTS

Scientific Literature, Spatial Distribution, and Time Trends

Initially, after excluding duplicates, we selected scientific publications in the Scopus (identified: 59; selected: 42), Dimensions (identified: 52; selected: 44), PubMed (identified: 34; selected: 29), and Web of Science (identified: 31; selected: 26) databases during the period studied. We identified 52 publications in common to all databases (Table 1).

For analysis, we considered 42 scientific publications from the Scopus database and 138 authors. The scientometric analysis software used (VOSviewer^®) processes one database in its routine (Table 1). The typology “original article” was the main type of publication, as it represented 95.2% (40/42) of all studies analyzed (Table 1).

Surveys among schoolchildren (n = 14), analysis in indigenous populations (n = 4), sequelae of the disease (n = 4), laboratory diagnoses (n = 4), trachoma risk factors (n = 3), “gray literature” (n = 6), population-based surveys (n = 2), spatial distribution (n = 1), epidemiological categorization of municipalities for surveillance purposes (n = 1), and other subjects (n = 3) are among the most common study topics.

We observed bibliographic production in all regions of Brazil and a general increase of 50% in it during the second decade of this study (2010–2020) (Figure 1).

We found studies on trachoma in 13 Brazilian states: São Paulo (n = 12), Amazonas (n = 5), Pernambuco (n = 3), Ceará (n = 2), Minas Gerais (n = 2), Alagoas (n = 1), Espírito Santo (n = 1), Maranhão, Amapá (n = 1), Pará (n = 3), Paraíba (n = 1), Roraima (n = 1), and Santa Catarina (n = 1). We also found a representation of general data of Brazil (n = 3) and Latin America (n = 1). We considered other studies “gray literature” (n = 6) (Table 1).

Scientometric Analysis

The scientometric analysis on trachoma showed an annual average of two articles during the last two decades in Brazil. The average number of authors were three per document and ranged from two to 10 authors for each publication (Table 1).

The 10 most productive researchers were the first author in 26.2% (11/42) of publications. Medina N.H. presented greater contributions, as she participated in 35.7% (15/42) of scientific publications. Cruz A.A.V. is proportionally the most cited author (Table 2). In the relationship “co-authorship versus author,” the productivity of Medina N.H. (blue cluster) and the connection with other clusters stand out, followed by the scientific production network of the authors Schellini S.A. (pink cluster), Cruz A.A.V. (green cluster), and Cardoso M.R.A. (blue cluster) (Figure 2A).

Studies on trachoma in Brazil were from institutions from seven countries. We identified publications by authors from institutions in Brazil (n = 40) and simultaneously in the United Kingdom (n = 1), Australia (n = 1), and Saudi Arabia (n = 1). Publications of authors exclusively outside the country came from institutions in the United States and Mexico (n = 1) and Colombia (n = 1) (Table 2). The analysis of “co-authorship versus countries” showed the relationship between publications and institutions from the Americas (n = 4), Europe (n = 1), Asia (n = 1), and Oceania (n = 1) (Figure 2B).

In total, scientific publications included 55 institutions, with a predominance of the 10 most productive from the state of São Paulo (6/10; 60%) and Southeast Brazil and more expressive participation of the São Paulo Health Department (33.3%) and the Universidade de São Paulo (USP) (26.2%) (Table 3). The relationship “co-authorship versus organizations” stands out the relationship between institutions from the Southeast (São Paulo) and North (Amazonas) Brazil and the Ministry of Health, which acts as a connection point with other states (Figure 2C).

We identified the 10 keywords most frequently mentioned in the scientific publications analyzed. The term “trachoma” (n = 18) was the most frequent keyword—twice as frequent as “Chlamydia trachomatis” (n = 8) and “trachoma/epidemiology” (n = 7) (Figure 1). The analysis of “co-occurrence versus author keywords” showed a greater relationship between the keywords aforementioned (Figure 2D).

DISCUSSION

This unprecedented study proves the limited number of studies on trachoma in Brazil and shows that most of them were performed by researchers outside the main endemic areas of Brazil. Despite the increasing trend observed during the last decade, critical gaps still persist, restating the character of neglected disease⁹9 Bai J, Li W, Huang YM, Guo Y. Bibliometric study of research and development for neglected diseases in the BRICS. Infect Dis Poverty. 2016;5(1):89. https://doi.org/10.1186/s40249-016-0182-1
https://doi.org/10.1186/s40249-016-0182-... not only because of failures of science, but failures of public policies¹²12 Mahoney RT, Morel CM. A Global Health Innovation System (GHIS). Innov Strategy Today. 2006 [cited 2021 Jul 22];2(1):1-12. Available from: https://www.arca.fiocruz.br/handle/icict/16466
https://www.arca.fiocruz.br/handle/icict... .

Although the Global Trachoma Mapping Project encourages research worldwide to define the baseline trachoma map in endemic countries¹³13 Solomon AW, Pavluck A, Courtright P, Aboe A, Adamu L, Alemayehu W, et al. The Global Trachoma Mapping Project: methodology of a 34-country population-based study. Ophthalmic Epidemiol. 2015;22(3):214-25. https://doi.org/10.3109/09286586.2015.1037401
https://doi.org/10.3109/09286586.2015.10... , the insufficient number of research on trachoma in Brazil reduces the recognition of the disease, as well as the planning and implementation of control actions¹⁴14 Brito CMG, Barbosa CC, Andrade SMC, Oliveira ALS, Montarroyos UR, Ferraz C, et al. Household survey of trachoma among children living in Pernambuco, Brazil. Pathogens. 2019;8(4):263. https://doi.org/10.3390/pathogens8040263
https://doi.org/10.3390/pathogens8040263... . This context indirectly points to low prioritization of investments in research on the topic to overcome this chronic condition in endemic countries¹⁵15 Fontecha G, Sánchez A, Ortiz B. Publication trends in Neglected Tropical Diseases of Latin America and the Caribbean: a bibliometric analysis. Pathogens. 2021;10(3):356. https://doi.org/10.3390/pathogens10030356
https://doi.org/10.3390/pathogens1003035... , as the limitations highlighted by this study showed.

Brazil represents a recognized scientific leadership in topics of tropical medicine, especially in Latin America, with a remarkable contribution to several NTD¹1 Saboyá-Díaz MI, Betanzos-Reyes AF, West SK, Muñoz B, Castellanos LG, Espinal M. Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities. Rev Panam Salud Publica. 2019;43:e93. https://doi.org/10.26633/RPSP.2019.93
https://doi.org/10.26633/RPSP.2019.93... , however, the number of publications on topics related to trachoma is limited.

Eye health and vision have important general implications for various dimensions of life, health, sustainable development, and economics⁴4 Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021;9(4):e489-551. https://doi.org/10.1016/S2214-109X(20)30488-5
https://doi.org/10.1016/S2214-109X(20)30... . These aspects significantly hinder the achievement of the SDG, especially the goal of eliminating the disease by 2030. They restate the Brazil's responsibility as an endemic country to ensure additional investments to intensify surveillance and control actions¹⁵15 Fontecha G, Sánchez A, Ortiz B. Publication trends in Neglected Tropical Diseases of Latin America and the Caribbean: a bibliometric analysis. Pathogens. 2021;10(3):356. https://doi.org/10.3390/pathogens10030356
https://doi.org/10.3390/pathogens1003035... and to establish strategies based on consistent partnerships for technological and scientific development¹⁶16 González-Alcaide G, Salinas A, Ramos JM. Scientometrics analysis of research activity and collaboration patterns in Chagas cardiomyopathy. PLoS Negl Trop Dis. 2018;12(6):e0006602. https://doi.org/10.1371/journal.pntd.0006602
https://doi.org/10.1371/journal.pntd.000... .

Thus, eye health is essential to achieve many of the SDG by 2030. Since the 1990s, the estimated prevalence of onchocerciasis and trachoma, the major infectious causes of blindness, decreased significantly. By 2030, the onchocerciasis transmission is expected to finally stop and trachoma to be eliminated as a public health problem in all countries worldwide⁴4 Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021;9(4):e489-551. https://doi.org/10.1016/S2214-109X(20)30488-5
https://doi.org/10.1016/S2214-109X(20)30... .

Scientific production on trachoma is significantly concentrated in North and Southeast Brazil, so that São Paulo and Amazonas are the most prominent federative units. This distribution, in regard to North Brazil, may be linked to the production of research on trachoma with indigenous populations in endemic contexts¹⁷17 Soares OE, Cruz AAV. Community-based transconjunctival marginal rotation for cicatricial trachoma in Indians from the Upper Rio Negro basin. Brazilian J Med Biol Res. 2004;37(5):669-74. https://doi.org/10.1590/S0100-879X2004000500007
https://doi.org/10.1590/S0100-879X200400... .

However, research in this region was more frequent in the past decade, which shows the need to sustain the capacity to develop research focused on more vulnerable populations in endemic areas¹⁵15 Fontecha G, Sánchez A, Ortiz B. Publication trends in Neglected Tropical Diseases of Latin America and the Caribbean: a bibliometric analysis. Pathogens. 2021;10(3):356. https://doi.org/10.3390/pathogens10030356
https://doi.org/10.3390/pathogens1003035... .

The most participatory institutions in bibliographic production are from Southeast Brazil, especially São Paulo, which is probably associated with the greater funding, infrastructure, and research development capacity of these institutions¹⁸18 McManus C, Baeta Neves AA, Maranhão AQ, Souza Filho AG, Santana JM. International collaboration in Brazilian science: financing and impact. Scientometrics. 2020;125:2745-72. https://doi.org/10.1007/s11192-020-03728-7
https://doi.org/10.1007/s11192-020-03728... . We can also consider the capacity of promoting technical and scientific cooperation between groups of researchers from Brazil and abroad¹⁹19 Medrano JF. A scientometric and bibliometric analysis of world scientific production on dengue in Microsoft Academic (1828-2019). In: Engineering, integration, and alliances for a sustainable development. Hemispheric cooperation for competitiveness and prosperity on a knowledge-based economy: proceedings of the 18th LACCEI International Multi-Conference for Engineering, Education and Technology [virtual]; 2020 Jul 27-31. https://doi.org/10.18687/LACCEI2020.1.1.625
https://doi.org/10.18687/LACCEI2020.1.1.... .

The origin of the publications shows a critical contrast in the production on trachoma in institutions from geographical areas with lower endemicity of this disease¹⁶16 González-Alcaide G, Salinas A, Ramos JM. Scientometrics analysis of research activity and collaboration patterns in Chagas cardiomyopathy. PLoS Negl Trop Dis. 2018;12(6):e0006602. https://doi.org/10.1371/journal.pntd.0006602
https://doi.org/10.1371/journal.pntd.000... . The existence of research is directly related to human and social development. Moreover, access to specific funding for research on NTD, especially those more neglected, such as trachoma¹⁵15 Fontecha G, Sánchez A, Ortiz B. Publication trends in Neglected Tropical Diseases of Latin America and the Caribbean: a bibliometric analysis. Pathogens. 2021;10(3):356. https://doi.org/10.3390/pathogens10030356
https://doi.org/10.3390/pathogens1003035... , is limited.

The mobilizing power of authors for a topic and the collaboration between them, which are indispensable elements for scientific production capacity²⁰20 Morel CM, Serruya SJ, Penna GO, Guimarães R. Co-authorship network analysis: a powerful tool for strategic planning of research, development and capacity building programs on neglected diseases. PLoS Negl Trop Dis. 2009;3(8):e501. https://doi.org/10.1371/journal.pntd.0000501
https://doi.org/10.1371/journal.pntd.000... , are other important aspects. However, almost in the two decades of this analysis, the average number of authors of research on trachoma slightly increased and it reinforces the lack of prioritization. Greater investments in scientific cooperation can expand integration with institutions in areas that present less research development²⁰20 Morel CM, Serruya SJ, Penna GO, Guimarães R. Co-authorship network analysis: a powerful tool for strategic planning of research, development and capacity building programs on neglected diseases. PLoS Negl Trop Dis. 2009;3(8):e501. https://doi.org/10.1371/journal.pntd.0000501
https://doi.org/10.1371/journal.pntd.000... . However, this process can cause dependence on the definition of topics, without considering the needs of the places where the disease affects the most¹⁶16 González-Alcaide G, Salinas A, Ramos JM. Scientometrics analysis of research activity and collaboration patterns in Chagas cardiomyopathy. PLoS Negl Trop Dis. 2018;12(6):e0006602. https://doi.org/10.1371/journal.pntd.0006602
https://doi.org/10.1371/journal.pntd.000... .

Researchers with first authorship are important to promote collaboration between other authors. Besides having a considerable scientific production, those researchers establish important links and cooperate in conducting studies in institutions with possible access to research funding¹⁶16 González-Alcaide G, Salinas A, Ramos JM. Scientometrics analysis of research activity and collaboration patterns in Chagas cardiomyopathy. PLoS Negl Trop Dis. 2018;12(6):e0006602. https://doi.org/10.1371/journal.pntd.0006602
https://doi.org/10.1371/journal.pntd.000... . Thus, they act as an important link to construct the bibliographic networks analyzed in this study¹⁰10 Sobral NV, Duarte Z, Santos RNM, Mello RC. Redes de colaboração científica na produção de conhecimento em doenças tropicais negligenciadas no Brasil: estudo a partir da plataforma LATTES do CNPq. Encontros Bibli. 2020;25:1-22. https://doi.org/10.5007/1518-2924.2020.e72981
https://doi.org/10.5007/1518-2924.2020.e... . Despite the increase, the cooperation between researchers on trachoma in Brazil still shows a relative distance between authors of studies not linked to institutions with more recurrent affiliation in publications and co-authorship. It also shows that, despite the participation in the same publication, they may not maintain sustainable scientific interaction with each other.

The higher percentage of the use of the term “trachoma” as a keyword in publications may be related to the most common use of the name of this disease, besides its availability as a scientific keyword in the main databases for indexing publications, such as the Medical Subject Headings (MeSH, PubMed) and the Health Sciences Descriptors (DeCS, by the Biblioteca Regional de Medicina [BIREME – Regional Library of Medicine] of the Latin American and Caribbean Center on Health Sciences Information). It may also involve an interest in ensuring greater specificity to the study, as it identifies studies directly related to the disease¹⁶16 González-Alcaide G, Salinas A, Ramos JM. Scientometrics analysis of research activity and collaboration patterns in Chagas cardiomyopathy. PLoS Negl Trop Dis. 2018;12(6):e0006602. https://doi.org/10.1371/journal.pntd.0006602
https://doi.org/10.1371/journal.pntd.000... .

The analyzed publications present the main focuses of research on trachoma in Brazil over time, addressing various aspects about the disease. Historically, during the 1930s and 1940s, trachoma was considered endemic because of its high incidence in the so-called Dispensários de Tracoma. From the 1970s on, it ceased to be considered a public health problem, but reemerged around the 1980s among schoolchildren and preschoolers²¹21 Medina NH, Gattás VL, Anjos GL, Montuori C, Gentil RM. Prevalência de tracoma em pré-escolares e escolares no Município de Botucatu, São Paulo, Brasil, 1992. Cad Saude Publica. 2002;18:1537-42. https://doi.org/10.1590/S0102-311X2002000600006
https://doi.org/10.1590/S0102-311X200200... .

As it is a disease strongly related to poverty²²22 Cavaca AG, Emerich TB, Vasconcellos-Silva PR, Santos-Neto ET, Oliveira AE. Diseases neglected by the Media in Espírito Santo, Brazil in 2011-2012. PLoS Negl Trop Dis. 2016;10(4):e0004662. https://doi.org/10.1371/journal.pntd.0004662
https://doi.org/10.1371/journal.pntd.000... , trachoma is associated with low income, limited schooling, and inadequate sanitarycondition¹1 Saboyá-Díaz MI, Betanzos-Reyes AF, West SK, Muñoz B, Castellanos LG, Espinal M. Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities. Rev Panam Salud Publica. 2019;43:e93. https://doi.org/10.26633/RPSP.2019.93
https://doi.org/10.26633/RPSP.2019.93... , which explain it higher incidence in areas with greater social inequality¹1 Saboyá-Díaz MI, Betanzos-Reyes AF, West SK, Muñoz B, Castellanos LG, Espinal M. Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities. Rev Panam Salud Publica. 2019;43:e93. https://doi.org/10.26633/RPSP.2019.93
https://doi.org/10.26633/RPSP.2019.93... . This aspect reinforces the need to expand the development of epidemiological studies with critical analysis of processes of social determination in previously endemic locations, especially those with low socioeconomic status¹1 Saboyá-Díaz MI, Betanzos-Reyes AF, West SK, Muñoz B, Castellanos LG, Espinal M. Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities. Rev Panam Salud Publica. 2019;43:e93. https://doi.org/10.26633/RPSP.2019.93
https://doi.org/10.26633/RPSP.2019.93... .

The limitation of studies in Brazil, especially on the spread of C. trachomatis, explains the varied detection of cases with the presence of a serotype associated with trachoma in different areas of occurrence of the disease²³23 Ishak MOG, Costa MM, Almeida NCC, Santiago AM, Brito WB, Vallinoto ACR, et al. Chlamydia trachomatis serotype A infections in the Amazon region of Brazil: prevalence, entry and dissemination. Rev Soc Bras Med Trop. 2015;48(2):170-4. https://doi.org/10.1590/0037-8682-0038-2015
https://doi.org/10.1590/0037-8682-0038-2... . In past decades, school surveys¹⁰10 Sobral NV, Duarte Z, Santos RNM, Mello RC. Redes de colaboração científica na produção de conhecimento em doenças tropicais negligenciadas no Brasil: estudo a partir da plataforma LATTES do CNPq. Encontros Bibli. 2020;25:1-22. https://doi.org/10.5007/1518-2924.2020.e72981
https://doi.org/10.5007/1518-2924.2020.e... and population-based studies¹⁴14 Brito CMG, Barbosa CC, Andrade SMC, Oliveira ALS, Montarroyos UR, Ferraz C, et al. Household survey of trachoma among children living in Pernambuco, Brazil. Pathogens. 2019;8(4):263. https://doi.org/10.3390/pathogens8040263
https://doi.org/10.3390/pathogens8040263... presented prevalence estimates that suggested that trachoma in Brazil¹⁰10 Sobral NV, Duarte Z, Santos RNM, Mello RC. Redes de colaboração científica na produção de conhecimento em doenças tropicais negligenciadas no Brasil: estudo a partir da plataforma LATTES do CNPq. Encontros Bibli. 2020;25:1-22. https://doi.org/10.5007/1518-2924.2020.e72981
https://doi.org/10.5007/1518-2924.2020.e... is an important cause of avoidable blindness²2 Ministério da Saúde (BR), Secretaria de Vigilância em Saúde, Departamento de Vigilância das Doenças Transmissíveis. Manual de vigilância do tracoma e sua eliminação como causa de cegueira. 2.ed rev. Brasília, DF; 2014 [cited 2021 Jul 10]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/manual_vigilancia_tracoma_eliminacao_cegueira.pdf
https://bvsms.saude.gov.br/bvs/publicaco... and evidence of ophthalmic sequelae of corneal lesions secondary to the disease in indigenous populations¹⁷17 Soares OE, Cruz AAV. Community-based transconjunctival marginal rotation for cicatricial trachoma in Indians from the Upper Rio Negro basin. Brazilian J Med Biol Res. 2004;37(5):669-74. https://doi.org/10.1590/S0100-879X2004000500007
https://doi.org/10.1590/S0100-879X200400... .

Women were significantly more affected, when compared them with each other, and active forms were more present among children. On the other hand, cicatricial lesions were more prevalent among adults and older adults²⁴24 Lucena AR, Cruz AAV, Akaishi P. Epidemiologia do tracoma em povoado da chapada do Araripe - CE. Arq Bras Oftalmol. 2010;73(3):271-5. https://doi.org/10.1590/S0004-27492010000300012
https://doi.org/10.1590/S0004-2749201000... , which shows late effects of an active disease that occurred in when younger²⁴24 Lucena AR, Cruz AAV, Akaishi P. Epidemiologia do tracoma em povoado da chapada do Araripe - CE. Arq Bras Oftalmol. 2010;73(3):271-5. https://doi.org/10.1590/S0004-27492010000300012
https://doi.org/10.1590/S0004-2749201000... .

In some regions of Brazil, the low estimated prevalence of the disease, an aspect of national interest, may suggest successful control actions, with timely diagnosis and treatment of cases and contacts to eliminate the disease as a cause of blindness in the country²⁵25 Meneghim RLFS, Padovani CR, Schellini SA. Trachoma in schoolchildren of the city of Botucatu, Sao Paulo, Brazil: detection and health promotion of a neglected disease. Rev Bras Oftalmol 2016;75(5):360-4. https://doi.org/10.5935/0034-7280.20160072
https://doi.org/10.5935/0034-7280.201600... . However, it may present the possibility of undernotification in traditionally endemic areas due to the low sensitivity of the health care and surveillance network in the Brazilian Unified Health System (SUS)²⁶26 GBD 2019 Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease Study. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: The Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2021;9(2):e144-60. https://doi.org/10.1016/S2214-109X(20)30489-7
https://doi.org/10.1016/S2214-109X(20)30... . Therefore, the need to strengthen the SUS to expand its responsiveness on neglected topics, such as trachoma, is clear.

The quality of specific treatment monitoring has been a critical issue regarding trachoma control. A study performed in a municipality in the state of Ceará showed a considerable treatment abandonment in the first and second returns, which compromises the control of this disease²⁷27 Maciel AMS, Almeida NMGS, Silva AC, Almeida PC. Factors associated with trachoma treatment and control treatment in schools of municipality of the Northeast Region, Brazil. Rev Bras Epidemiol. 2020;23:e200011. https://doi.org/10.1590/1980-549720200011
https://doi.org/10.1590/1980-54972020001... . Developing studies to expand knowledge about possible failures in the implementation of control actions²⁸28 Ministério da Saúde (BR), Secretaria de Vigilância em Saúde, Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção da Saúde. SAÚDE BRASIL 2017: uma análise da situação de saúde e os desafios para o alcance dos Objetivos de Desenvolvimento Sustentável. Brasília, DF; 2018 [cited 2021 Jul 10]. Capítulo 5, Doenças negligenciadas no Brasil: vulnerabilidade e desafios; p. 99-141. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/saude_brasil_2017.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... and the recognition of its causes is essential. This process is important to strengthen trachoma surveillance and control actions in municipalities in Brazil, especially those considered a high priority¹1 Saboyá-Díaz MI, Betanzos-Reyes AF, West SK, Muñoz B, Castellanos LG, Espinal M. Trachoma elimination in Latin America: prioritization of municipalities for surveillance activities. Rev Panam Salud Publica. 2019;43:e93. https://doi.org/10.26633/RPSP.2019.93
https://doi.org/10.26633/RPSP.2019.93... ,²¹21 Medina NH, Gattás VL, Anjos GL, Montuori C, Gentil RM. Prevalência de tracoma em pré-escolares e escolares no Município de Botucatu, São Paulo, Brasil, 1992. Cad Saude Publica. 2002;18:1537-42. https://doi.org/10.1590/S0102-311X2002000600006
https://doi.org/10.1590/S0102-311X200200... . Developing epidemiological studies to analyze this public health problem and contribute to governmental agendas²²22 Cavaca AG, Emerich TB, Vasconcellos-Silva PR, Santos-Neto ET, Oliveira AE. Diseases neglected by the Media in Espírito Santo, Brazil in 2011-2012. PLoS Negl Trop Dis. 2016;10(4):e0004662. https://doi.org/10.1371/journal.pntd.0004662
https://doi.org/10.1371/journal.pntd.000... and the use of resources for health actions²⁹29 Macharelli CA, Schellini SA, Opromolla PA, Dalben I. Spatial distribution of trachoma cases in the City of Bauru, State of São Paulo, Brazil, detected in 2006: defining key areas for improvement of health resources. Rev Soc Bras Med Trop. 2013;46(2):190-5. https://doi.org/10.1590/0037-8682-1632-2013
https://doi.org/10.1590/0037-8682-1632-2... and health research and innovation²⁰20 Morel CM, Serruya SJ, Penna GO, Guimarães R. Co-authorship network analysis: a powerful tool for strategic planning of research, development and capacity building programs on neglected diseases. PLoS Negl Trop Dis. 2009;3(8):e501. https://doi.org/10.1371/journal.pntd.0000501
https://doi.org/10.1371/journal.pntd.000... is fundamental.

The Brazilian Ministry of Health, by Ordinance No. 67 of 2005, established the inclusion of the use of azithromycin, in a single dose at the time of detection, for systemic treatment of cases of trachoma in order to reduce abandonment³⁰30 Ministério da Saúde (BR), Secretaria de Vigilância em Saúde. Portaria N° 67, de 22 de dezembro de 2005. Inclui Azitromicina no tratamento sistêmico de tracoma. Brasília, DF; 2005 [cited 2021 Jul 20]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/svs/2005/prt0067_22_12_2005.html
https://bvsms.saude.gov.br/bvs/saudelegi... . Future research may explore the potential effect of availability and access to research funding in different regions of Brazil as a possible influencing factor in scientific production on trachoma.

The limitations of this study were related to the scope of data collection and the indexing process of the Scopus database. Despite the significant scope of this database, with a considerable number of scientific journals and other research publication sites, no database alone includes all journals in which relevant research on trachoma is published. Even with the scope of the literature research in this study, the number of Brazilian bibliographic publications is still small, especially considering population-based prevalence studies in endemic regions and states. Finally, the use of “gray literature” in this study was low. Despite these limitations, the care undertaken in the methodological procedures and the long period analyzed make our analysis and findings considerably robust.

CONCLUSION

This first scientometric analysis on trachoma in Brazil shows the low development of scientific production on this disease. Although the literature presents a slight increase in it, we observed by the scientometric indicators a higher participation of researchers from outside the areas with greater endemicity and in consolidated Brazilian research centers.

Expanding the funding for research on trachoma in Brazil is important, aiming at mechanisms to ensure access by institutions and researchers from more endemic areas.

The analysis of scientific production on this topic is important to strengthen the development of research and strategic planning of programs for the control of trachoma and neglected tropical diseases in general.

REFERENCES

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