Visceral Leishmaniasis: temporal and spatial distribution in Fortaleza, Ceará State, Brazil, 2007-2017

Almeida, Clarice Pessoa; Cavalcante, Francisco Roger Aguiar; Moreno, Jarier de Oliveira; Florêncio, Caroline Mary Gurgel Dias; Cavalcante, Kellyn Kessiene de Sousa; Alencar, Carlos Henrique

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 29 (5) • Nov 2020 • https://doi.org/10.1590/S1679-49742020000500002 copy

Visceral Leishmaniasis: temporal and spatial distribution in Fortaleza, Ceará State, Brazil, 2007-2017^* * The author Clarice Pessoa Almeida received financial support for this research in the form of a Master’s Degree Fellowship granted by the Coordination for the Improvement of Higher Education Personnel (CAPES), a foundation linked to the Ministry of Education.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the temporal trend and describe the spatial distribution of Visceral Leishmaniasis (VL) in Fortaleza from 2007 to 2017.

Methods:

This was an ecological study using segmented temporal regression and thematic mapping.

Results:

Between 2007-2017, 1,660 new cases and 97 deaths were confirmed. The overall incidence rate showed a rising trend (Annual Percent Change - APC=8.7% - 95%CI -3.3;34.1), while the mortality rate (APC=-25.9 - 95%CI -48.5;-10.6) and lethality (APC=-33.0 - 95%CI -53.7;-17.6) showed a falling trend. From 2010-2015 the incidence rate fell (APC=-15.8 - 95%CI -25.1;-4.0), but mortality (APC=18.7 - 95%CI 9.4;50.6) and lethality (APC=40.1 - 95%CI 22.5;72.0) had an upward trend. In 2015-2017, incidence (APC=-24.6 - 95%CI -36.2;-10.3), and mortality (APC=-44.6 - 95%CI -58.8;-17,6) fell, while lethality remained stable (APC=-13.5 - 95%CI -38.7;3.8). High incidence neighborhoods were clustered in the western region of the city, however, mortality and lethality did not present defined spatial patterns.

Conclusion:

VL is endemic in Fortaleza, although there was a reduction in the last three years studied.

Keywords:
Visceral Leishmaniasis; Temporal Distribution; Spatial Distribution; Epidemiology; Public Health

Characteristics	2007 a 2010 (N=828)		2011 a 2013 (N=465)		2014 a 2017 (N=367)
Characteristics	N	(%)	N	(%)	N	(%)
Sex^a
Female	284	34.3	133	28.6	90	24.5
Male	543	65.6	332	71.4	277	75.5
Age group (in years)^a
0-4	255	30.8	87	18.7	48	13.1
5-9	41	4.9	24	5.2	14	3.8
10-19	85	10.3	41	8.8	27	7.4
20-39	212	25.6	153	32.9	122	33.2
40-59	181	21.9	115	24.7	119	32.4
≥60	53	6.4	45	9.7	36	9.8
Race/skin color
White	50	6.0	13	2.8	12	3.3
Black	5	0.6	4	0.9	2	0.5
Yellow	3	0.4	4	0.9	0	0.0
Brown	680	82.1	401	86.2	337	91.8
Indigenous	2	0.2	0	0.0	0	0.0
Unknown	88	10.6	43	9.2	16	4.4
Schooling^a
Illiterate	6	0.7	4	0.9	5	1.4
Elementary education	122	14.7	28	6.0	17	4.6
Middle school	70	8.5	36	7.7	32	8.7
High school	112	13.5	28	6.0	30	8.2
Higher education	15	1.8	7	1.5	2	0.5
Clinical manifestation
Fever	796	96.1	434	93.3	340	92.6
Weakness	603	72.8	324	69.7	222	60.5
Weight loss	602	72.7	333	71.6	249	67.9
Cough and/or diarrhea	404	48.8	225	48.4	161	43.9
Splenomegaly	658	79.5	338	72.7	226	61.6
Hepatomegaly	610	73.7	305	65.6	203	55.3
VL-HIV Coinfection^b
Yes	70	8.5	61	13.1	83	22.6
No	622	75.1	304	65.4	225	61.3
Unknown	136	16.4	100	21.5	59	16.1
Progression
Cure	683	82.5	366	78.7	287	78.2
Treatment dropout	8	1.0	6	1.3	3	0.8
Death from visceral leishmaniasis	33	4.0	26	5.6	38	10.3
Death from other causes	19	2.3	25	5.4	8	2.2
Transfer	12	1.4	11	2.3	16	4.4
Unknown/blank	73	8.8	31	6.7	15	4.1

Variables	2007 a 2010		2010 a 2015		2015 a 2017
Variables	APC^b	IC95%^c	APC^b	IC95%^c	APC^b	IC95%^c
Incidence rate (per 100,000 inhab.)	8.7	-3.3;34.1	-15.8	-25.1;-4.0	-24.6	-36.2;-10.3
Mortality rate (per 100,000 inhab.)	-25.9	-48.5;-10.6	18.7	9.4;50.6	-44.6	-58.8;-17.6
Lethality (%)	-33.0	-53.7;-17.6	40.1	22.5;72.0	-13.5	-38.7;3.8

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
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[1] Correspondence: Carlos Henrique Alencar - Rua Professor Costa Mendes, No. 1608, Bloco Didático, 5º andar, Rodolfo Teófilo, Fortaleza, CE, Brazil. Postcode: 60430-140. E-mail: carloslaencar@ufc.br