Padrões espaço-temporais, definição de áreas prioritárias e fatores associados à ocorrência de Leishmaniose Visceral Humana em Belo Horizonte

Abstract

Introduction: In the Americas, visceral leishmaniasis (VL) results from the zoonotic transmission of Leishmania infantum. Brazil is responsible for about 96% of cases in the Americas, and Minas Gerais (MG) stands out with a high number of cases. The high occurrence of the disease in the Metropolitan Region of Belo Horizonte reinforces its urbanized profile in the country, and it has spread rapidly throughout the city since the first record of the disease in the city of Belo Horizonte-MG. Objectives: 1) To analyze, in a historical perspective over the initial 25 years, human VL in Belo Horizonte-MG, Brazil; 2) To analyze factors associated with the occurrence of human VL in Belo Horizonte-MG. Methods: 1) Ecological study of human VL cases from January 1994 to December 2018 in Belo Horizonte-MG. The total incidence, by gender and by age group, the annual lethality rates of human VL and the VL/human immunodeficiency virus (HIV) co-infection in the municipality were analyzed. To explore and describe the changes in the spatio-temporal patterns of transmission in the different periods, the human VL was analyzed having as the temporal unit of study the five-year period included in the study period. As a spatial unit, the 152 areas covered by the city's health centers were analyzed. Bayesian incidence smoothing, directional distribution and scan analysis of spatio-temporal clusters were used as spatial and temporal analysis approaches. 2) Ecological study with emphasis on the analysis of factors associated with the occurrence of human VL, referring to the period from 2008 to 2012, in the 152 areas covered by health centers in Belo Horizonte. The association between human VL and factors related to canine VL infection, basic sanitation, socioeconomic conditions and environmental factors was analyzed. A global regression model for the exploratory phase (spatial lag model) and geographically weighted regression were used. Results: 1) Human VL was introduced in Belo Horizonte by the East and Northeast regions, from where it expanded to the North, Venda Nova and Pampulha regions. The study demonstrated the endemicity of VL in Belo Horizonte during the period evaluated. In the last 10 years, there has been a slight change in the demographic pattern of the disease, with more patients at an advanced age and fewer children under 4 years of age. Even though the female population of the municipality was larger, throughout the study period, the incidence of VL cases in men was higher than in women. The LV/HIV co-infection showed a growing trend. The scan analysis detected areas/periods of greater relative risk for human VL, suggesting that they should be prioritized for surveillance and control of human VL. Among these, the areas covered by the São Miguel Arcanjo and Cafezal health centers (both in the Center-South region) and other areas in the Northeast, Northwest, Pampulha, Venda Nova, North and East regions stand out. 2) The final model explains about 56% of the smoothed incidence of human VL, which is associated in the areas covered by the Health Vulnerability Index and the accumulated cases of canine VL. Conclusion: The study contributes to a better understanding of the epidemiological profile and to the identification of priority areas and actions for the development of control and monitoring actions, with the possibility of more effective allocation of resources.