Leishmaniose visceral: tendência, fatores associados e distribuição espacial no Sudoeste Maranhense

Abstract

Visceral Leishmaniasis (VL) is a serious public health problem worldwide, with high rates of morbidity and mortality, especially in regions of greater social and economic vulnerability, requiring additional local studies, with the purpose of instructing the design of effective control and prevention strategies. In this sense, the objective was to analyze an incidence trend, the factors associated with Visceral Leishmaniasis and its spatial distribution in the municipalities that integrate a Regional Health Management Unit of Empress (UGRSI) between January 2008 and December 2019. This is an ecological and time series study, with data from the Notifiable Diseases Information System (SINAN). Data were collected from the Health Surveillance Department of Imperatriz, Maranhão. A descriptive analysis of the sociodemographic and clinical-epidemiological characteristics of the notified cases was carried out. Incidence rates were determined for each year and municipality of the UGRSI and, subsequently, trend analysis was performed using Prais-Winsten regression. To identify the factors associated with new cases, simple and multiple logistic regression models and odds ratios were used, using the Statistical Package for Social Sciences software, considering 5% significance. Incidence rates were distributed and spatially represented on maps, produced in the Qgis software version 3.16.2, in which municipalities were classified, according to cutoff points adopted by the Pan American Health Organization. To analyze the spatial dependence of the data, the analysis of Moran Global and Moran Local was applied, using the GeoDa software version 3.16.2. The research was approved by the Research Ethics Committee involving human beings at the Federal University of Maranhão (UFMA), as per opinion no 4.411,716. 914 cases of VL were reported, of which 873 (95.5%) were new cases. VL mainly affected males (63.7%), aged between 10 and 19 years (32.9%), brown (73.2%), education less than or equal to eight years (41, 8%), who lived in the urban area (87.3%). The main clinical manifestations mentioned were fever (93.9%), weakness (87.2%), weight loss (80.7%) and splenomegaly (82.2%). 762 cases (84.9%) were confirmed, using laboratory confirmation (68.2%), with immunological diagnosis (35.3%) being the most used. Pentavalent antimony was the drug of first choice (73.8%) and, in cases of treatment failure, amphotericin B (8.3%) was used. Most cases were classified as autochthonous (86.1%) and not work-related (94.4%). There were cases of VL/HIV coinfection (5.4%), most patients progressed to cure (79.5%) and 6.1% of patients died from VL. The incidence of VL ranged from 27.4 cases per 100,000 inhabitants in 2008 to 12.5 cases in 2019, showing a downward trend over the years. No variables associated with the incidence of VL were identified in this study. The spatial distribution of incidence rates showed that most of the municipalities that had a high incidence in the three years analyzed were located in the western portion of the region. The Moran Global analysis indicated negative autocorrelation and absence of spatial dependence, and the Moran Local analysis did not identify significant clusters, indicating that, in the same macro-region, surveillance actions are not equivalent or similar between municipalities. These findings raise the need to intensify VL monitoring and control strategies, strengthening advances in disease elimination programs in this region, in addition to offering permanent training for professionals involved in care management.