Abstract
Background Despite visceral leishmaniasis (VL) being epidemic in most Brazilian regions, the Northeast region is responsible for the highest morbidity and mortality outcomes within the country. Objective To analyse the spatiotemporal dynamics of VL cases to identify the temporal trends and high-risk areas for VL transmission, as well as the association of the disease with social vulnerability in Brazilian Northeast. Methods We carried out an ecological time series study employing spatial analysis techniques using all VL confirmed cases of 1,794 municipalities of Brazilian Northeast between the years 2000 to 2017. The Social Vulnerability Index (SVI) was used to represent the social vulnerability. Incidence rates were standardized and smoothed by the Local Empirical Bayesian Method. Time trends were examined through segmented linear regression. Spatiotemporal analysis con-sisted of uni-and bivariate Global and Local Moran indexes and space-time scan statistics. Results Incidence rate remained stable and ranged from 4.84 to 3.52 cases/100,000 inhabitants. There was higher case prevalence between males (62.71%), children and adolescents (63.27%), non-white (69.75%) and urban residents (62.58%). Increasing trends of new cases were observed among adult male subjects (≥ 40 years old) and urban residents. Importantly, VL incidence showed a direct spatial dependence. Spatial and space-time clusters were iden-tified in sertão and meio-norte sub-regions, overlapping with high social vulnerability areas. Conclusions VL is a persistent health issue in Brazilian Northeast and associated with social vulnerability. Space-time clustering of VL cases in socially vulnerable municipalities demands intersec-toral public policies of surveillance and control, with focus on reducing inequalities and improving living conditions for regional inhabitants.
Original language | English (US) |
---|---|
Article number | e0009006 |
Pages (from-to) | 1-20 |
Number of pages | 20 |
Journal | PLoS neglected tropical diseases |
Volume | 15 |
Issue number | 1 |
DOIs | |
State | Published - 2021 |
Bibliographical note
Funding Information:This work was supported by National Council for Scientific and Technological Development of Brazil (CNPq) (MCTI/CNPQ/28/ 2018: 434623/2018-0) www.cnpq.br (TRdeM); Support Foundation for Research and Technological Innovation of the State of Sergipe (FAPITEC) (MS/CNPq/FAPITEC/SE/SES/850226/ 2017: 019.203.00933/2018-0) www.fapitec.se.gov. br/ (TRdeM); Coordination for the Improvement of Higher Education Personnel (CAPES) through Graduate Support Program of Federal University of Sergipe (PROAP/UFS) (Processes: N˚ 23113.062217/2019-50, 23113.062290/2019-21, and 23113.062214/2019-16) www.gov.br/capes/ (TRdeM, PLdosS, KCGMdeA); and U.S. National Institutes of Health (SC1GM127207) https://www. nih.gov/ (MWL). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2021 Ribeiro et al.