Caracterização da Tungíase e Escabiose no estado do Ceará através de um novo método de avaliação rápida

Abstract

Tungiasis and scabies are neglected tropical skin diseases caused by the flea Tunga penetrans and the mite Sarcoptes scabiei, respectively. There are no systematic data on their occurrence in Ceará State, nor in Brazil. In this sense, both diseases require further studies to describe their epidemiology and to develop effective control measures. The objective was to develop and apply a Rapid Assessment Method (RAM) to collect data on the occurrence of both diseases in an agile and low-cost manner, in addition to identifying unicipalities with occurrence of cases in humans and animals, and municipalities with evere cases, as well as associated socio-environmental determinants. Through the RAM in the form of an online questionnaire on the Googleforms platform, a total of 1,329 responses were collected, indicating, for each disease, its occurrence in 181 of the 184 municipalities. In the bivariate analysis, associations were found between climatic and socioeconomic variables and the occurrence of severe cases of tungiasis at present: altitude of the municipality (tungiasis – median = 88.8 m and no tungiasis – median = 201 m; p < 0.001), air humidity (medians = 66.5% and 63%; p = 0.018), minimum temperature (medians = 23.4°C and 22.7°C; p = 0.002), aridity index (medians = 50.6 and 45.1; p = 0.019), expected precipitation (medians = 950 mm and 821 mm; p = 0.002), observed precipitation (medians = 883 mm and 741 mm; p = 0.037), Municipal Human Development Index (MHDI) (medians = 0.616 and 0.611; p=0.048), Municipal Development Index (MDI) (medians = 27.5 and 21.8; p<.001), and MHDI ongevity (means = 0.769 and 0.759; p=0.007). Municipalities with a predominance of uvisols had a lower occurrence of severe cases (RR = 0.46; 95% CI = 0.27–0.79; p = 0.003), while those with predominantly gleysols had a higher occurrence (RR = 2.44; 95% CI = 1.43–4.15; p = 0.010). The occurrence of severe cases of scabies was associated with altitude (medians = 153 m and 246 m; p = 0.003), air humidity (medians = 65.9% and 61%; p = 0.001), minimum temperature (medians = 23.1°C and 22.3°C; p < 0.001), aridity index (medians = 48.2 and 41.9; p = 0.014), expected precipitation (medians = 900 mm and 782 mm; p = 0.006), observed precipitation (medians = 804 mm and 708 mm; p<0.001), MHDI (medians = 0.616 and 0.608; p=0.012), MDI (medians = 24.3 and 21.1; p=0.005), and MHDI Education (means = 0.559 and 0.541; p=0.014). In the multivariate analysis, only MDI maintained a statistically significant association with the occurrence of severe cases of tungiasis in the final model (RR = 1.04; 95% CI = 1.02 – 1.05; p < 0.001) while scabies showed a significant association with minimum temperature (RR = 1.13; 95% CI = 1.04–1.24; p = 0.003) and the aridity index (RR = 1.01; 95% CI = 1.00–1.01; p = 0.004). The RAM proved successful in collecting data from municipalities in Ceará, establishing itself as a useful tool that can be replicated in other areas and for other diseases. The endemicity and occurrence of severe cases of tungiasis and scabies throughout the state, both in humans and animals, highlights these ectoparasitic diseases as a public health problem. It is essential to develop evidence-based control measures focused on the identified high-risk areas.