Distribuição espacial e tendência temporal da morbimortalidade por Leishmaniose visceral humana em Fortaleza - CE : 2007 a 2017

Abstract

Visceral leishmaniasis (VL) is widely distributed around the world, and Fortaleza is an endemic area, considered an area of intense transmission. The aim of this work was to characterize the spatial distribution and the temporal trend of morbidity and mortality due to human visceral leishmaniasis in Fortaleza-CE, 2007-2017. The study data is secondary from SINAN, and has four stages. In the first, a cross-sectional descriptive study of the epidemiological characteristics of the new confirmed cases was performed, with the help of Stata® to make calculations of frequencies and proportions. Incidence and mortality rates per 100 thousand inhabitants and lethality in percentage were also calculated. Then, a cross-sectional analytical study on factors associated with lethality was carried out, using the chi-square test. The two subsequent stages covered an ecological study by analyzing the temporal trend of incidence, mortality and lethality and characterizing the spatial distribution of the same indicators in Fortaleza, with the neighborhood as the unit of analysis. For this analysis, Terraview® was used and the maps were visualized in ArcGIS®. The indicators were smoothed using LISA and the spatial autocorrelation was verified. Poisson regression was applied in Joinpoint® and the time trend was verified. A significance level of 95% was established for all analyzes. 1660 new cases were confirmed, of these, almost 70% were men, with 23.5% and 54.3% occurring in the 0 to 4 years old and 20 to 59 years old groups, respectively; 85.4% of the brown race and 28.6% of the cases had schooling between elementary I and high school. They had a higher risk of dying: male, 20 years old or more, presenting weakness, infectious condition, edema, jaundice and hemorrhagic phenomena, being treated with amphotericin B, liposomal amphotericin B. The incidence showed a declining trend from 2010 to 2015 (APC = -15.79; 95% CI: -25.1 to -4.0) and from 2015 to 2017 (APC = -24.6; 95% CI: -36, 2 to -10.3), but mortality and lethality showed a varied tendency. Lethality declined in 2007 to 2010 (APC = -33.0; 95% CI: -53.7 to -17.6) and increased in 2010 to 2014 (APC = 40.1; 95% CI: 22.5 to 72, 0). The Sapiranga Coité, Ancuri and Jangurussu neighborhoods were areas of risk for incidence, and Paupina and Demócrito Rocha were areas of risk for lethality.