Leishmaniose Visceral no Estado do Tocantins: padrões espaciais, espaço-temporais, temporais e fatores associados ao óbito Belo Horizonte 2025

Abstract

Visceral leishmaniasis (VL) is an urgent public health problem with widespread distribution in Brazil and rapid expansion in the state of Tocantins. The aim of this study was to analyze the spatial, spatiotemporal, and temporal distribution of incidence and mortality rates, as well as the factors associated with death due to VL in Tocantins. Ecological studies and a historical cohort of confirmed incident cases reported in the Notifiable Diseases Information System (SINAN) were conducted. The spatial units of analysis were the eight health regions of the state. The first chapter analyzed the spatial and spatiotemporal distribution of VL incidence rates by municipality in Tocantins between 2000 and 2022. Global Moran’s I, Local Moran’s I, space-time scan analysis, and directional distribution ellipse analysis of average incidence rates per municipality were performed across five four-year periods and one three-year period. The second chapter conducted a temporal trend and seasonality analysis of VL incidence rates by health region of Tocantins from 2000 to 2022. Seasonality analysis and temporal generalized additive models (GAM) were applied. The third chapter addresses the spatial and spatiotemporal distribution of mortality rates and the prognostic factors associated with death due to VL in Tocantins, using Global Moran’s I, Local Moran’s I, space-time scan analysis of average mortality rates, and multilevel logistic regression, between 2010 and 2019. This study observed fluctuations in annual VL incidence rates in Tocantins, with an increase after 2004 and a decline after 2012. The average incidence rate for the entire period was 17.4 cases per 100,000 inhabitants. Spatial and spatiotemporal distribution was heterogeneous, with higher- risk areas for VL mainly in the northern region of the state. Until 2003, cases were concentrated in the more central regions of the state, with a subsequent shift and persistence in the central-northern regions of Tocantins. The disease showed seasonality, especially between April and June. VL mortality rates were heterogeneously distributed in Tocantins. Deaths were associated with age (≤1 year and >60 years) and clinical manifestations such as hemorrhagic phenomena, splenomegaly, and HIV coinfection. VL remains persistent in certain regions of Tocantins, and the findings of this study suggest the need for tailored strategies for these areas. Identifying potential seasonal patterns allows for the planning of regular and proactive preventive actions, such as intensified vector control, health education campaigns, and community mobilization.The results also reinforce the need for actions targeting vulnerable groups through the strengthening of primary health care, training of multiprofessional teams, and timely access to diagnosis and treatment. Improving living conditions should be an integral part of VL control strategies. Additionally, the application of statistical tools can be incorporated into routine epidemiological surveillance. Ongoing training of technical teams responsible for monitoring is also a strategic measure.