Aspectos ecoepidemiológicos do araneísmo e escorpionismo no Maranhão, Brasil, 2013-2014

Abstract

Spider and scorpion stings of public health concern constitute a significant public health problem in Brazil, representing an illness that compromises the quality of life of those affected, resulting in sequelae, temporary or permanent disabilities, and, in extreme cases, death. In this sense, the objective was to analyze the eco-epidemiological aspects of arachnid and scorpion stings in Maranhão reported during the period 2013-2024. This is an ecological study with distinct analytical measures, using microdata obtained from the files of the Notifiable Diseases Information System. A descriptive analysis of the sociodemographic and clinical epidemiological characteristics of the reported cases was performed. To identify the factors associated with arachnid stings, simple and multiple logistic regression models with odds ratios were used, considering a significance level of 5%. The incidence was determined by arachnid group, year, municipality, and Health Regions, and then a temporal trend analysis was performed using Prais-Winsten regression. Annual lethality was also calculated by arachnid group and according to the time elapsed between the bite and treatment. The association between the incidence of arachnid and scorpion stings and temperature and urbanization was estimated using robust multiple regression. Spatial dependence was confirmed using the Global and Local Moran's I test, while spatiotemporal scanning was employed using the Scan statistic to identify areas of epidemiological risk. The seasonality of accidents was verified using a temporal heat map. All statistical and spatial analyses were performed using RStudio software. The research was approved by the Research Ethics Committee of the Federal University of Maranhão. 21,677 cases of arachnid and scorpion stings were reported, with a predominance of scorpion stings (87.2%) compared to arachnid stings (12.8%). The condition primarily affected males (50.4%; 53.9%), those aged 20 to 39 years (40.7%; 34.6%), those of mixed race (80.8%; 81.8%), and those with primary education (complete and incomplete) (42.2% and 51.2%). Local and systemic complications were rare, while the cure rate (99.4% and 99.7%) exceeded the mortality rate (0.6% and 0.3%). Logistic regression reported that lesions located on the head, thighs, and trunk, accompanied by edema and delays in seeking medical attention, were more associated with spider bites. Investigation of temporal trends revealed increasing patterns of variation in incidence over the years. The analysis of spatial autocorrelation and risk clusters follows different patterns in different periods, highlighting areas of vulnerability throughout the state of Maranhão. Additionally, a significant association was found between arachnidism and urbanization, and between scorpionism and temperature and urbanization. These findings allow for the integration of environmental management actions, basic sanitation, and population education, as well as strengthening the health network with rapid access to diagnosis and appropriate treatment. The use of ecological and epidemiological tools to monitor spatial and temporal patterns improves prevention and control, promoting more effective and locally tailored interventions.