Magnitude, tendência e padrões espaço-temporais da Leishmaniose Visceral no Ceará, 2007-2021

Abstract

Visceral Leishmaniasis (VL) is a neglected disease in Brazil, with increasing incidence and lethality. It is essential to consider the heterogeneity in transmission in different scenarios to adequately support the choice of intervention strategies. The objective of this thesis was to analyze the magnitude, trend and spatiotemporal patterns of VL in Ceará, from 2007 to 2021. The study, organized in four stages, was based on confirmed cases and deaths of VL registered in the Information System of Notifiable Diseases and the Mortality Information System. Three ecological studies (Steps 1, 2 and 4) and one cross-sectional study (3) were carried out: Step 1 - temporal and spatial approach to incidence, mortality and lethality; Step 2 - spatial and temporal approach to epidemiological indicators and composite indices of incidence and mortality; Step 3 - epidemiological and clinical factors associated with lethality; and Step 4 - spatial approach to describe the flow of VL cases diagnosed in Ceará. Data were organized in Stata 15.1. Temporal and spatial analyzes were performed, respectively, by Joinpoint Regression Program 4.0.4 and SaTScan 9.6. For flow analysis, Tabwin 4.2 was used. All maps were made by ArcMap 9.2. There were 6,775 confirmed cases and 343 deaths from VL, with higher incidence rates in 2009 (6.96 cases/100,000 inhabitants) and 2011 (9.83 cases/100,000 inhabitants), a year in which it also stood out for its mortality (6. 96 deaths/100,000 inhabitants). Furthermore, the composite indices of incidence and mortality characterized the municipalities in the north, northwest and south regions as those with the highest risk for VL. There was an upward temporal trend in incidence from 2007 to 2014 (APC=3.8;CI:0.5 -7.3), and declines in mortality (APC=-0.3;CI:-2.5 to 1.9) and lethality (APC=-3.0;CI:- 4.3 to -1.7), but not significant. The northwest and south regions of Ceará recorded 11 clusters with high incidence rates from 2007 to 2010, seven clusters in 44 municipalities from 2011 to 2014, and six clusters in 49 municipalities between 2015 and 2018. From 2007 to 2010, only a significant group of mortality was identified in the southern region (RR=7.6); and two clusters in the northwest region from 2011 to 2014 (RR=3.9; RR=4.6). In the last quadrennium (2018 to 2021), a grouping of 11 municipalities was identified in the southern region (RR=4.2). There were mortality clusters in the south- central (2007 to 2010), northwest and south (both from 2011 to 2018). The risk factors associated with lethality were: age group (RR=8.69;CI:3.56-21.20); black race (RR=2.21;CI:1.45-3.35); symptoms of jaundice (RR=1.72;CI:1.38- 2.14); edema (RR=2.62;CI:2.10-3.26), hemorrhagic phenomena (RR=1.63;CI:1.26-2.10) and absence of medication prescription (RR=4.03; IC:2.98-5.46). As a flow indicator, 30 municipalities had at least one resident diagnosed with VL in another municipality in Ceará. The largest center for receiving cases for diagnosis was Fortaleza (1,488 patients from 139 municipalities), followed by Sobral, in the northwest region (599 out of 55 municipalities) and Barbalha, in the south (171 out of 29 municipalities). Continuity and intensification of VL surveillance and control actions are needed, especially when identifying priority areas to help local management and thus break the disease transmission chain.