Distribuição espacial da leishmaniose visceral no Estado do Rio Grande do Norte, Brasil.

Abstract

Visceral leishmaniasis is considered to be one of the most neglected diseases in the world and in Brazil the largest number of cases in the Americas is concentrated. It is known that the dog is the main reservoir of the disease in the urban cycle, assuming an important epidemiological role in the cycle of transmission of the disease to humans and other animals. Chapter I analyzed canine visceral leishmaniasis (CVL) in the state of Rio Grande do Norte and its spatial distribution between the years 2011 and 2018. Secondary data from blood samples from dogs seroreagent for CVL, provided by the Epidemiological Surveillance Subcoordination were used, Natal-RN. During the study period, 24.642 positive animals were found and the municipalities that presented the largest cases were Natal and Mossoró. The year with the highest occurrence of cases was in 2014, with 4.982 and the smallest, in 2016 with 2,192. The presence of significant clusters was detected in all years. Among the municipalities, Açu, presented clusters in the last eight years. Some clusters have been identified in regions bordering the state of Ceará, cases of Governor Dix-Sept Rosado and Baraúnas. The study showed a wide distribution of the disease in the state and in 22.16% of the municipalities did not present data, showing the need for monitoring actions in the municipalities aiming at preventive measures to reduce the number of cases in animals. Chapter II presented the importance of spatial tools in the monitoring of human visceral leishmaniasis (HVL) in Rio Grande do Norte. Secondary data from the period 2011 to 2018, from the Notifiable Diseases Information System (SINAN), were used. 713 cases of the disease were recorded during the study period, with an average of 89.1 cases/year. Natal was the municipality with the highest number of cases (178 cases, with an average of 18.5 cases/year). The overall incidence rate was 2.64 cases/100,000 inhabitants. It found that the disease was distributed in almost the entire state, 64.1% of the municipalities had at least one case of the disease, while in 35.9% there were no records. With the aid of Terraview 4.2.2, a spatial statistical analysis was performed using the Moran index, identifying clusters in the four-year period (2011-2014 and 2015-2018), based on the p-value equal to 0.001. The mesoregions with high and low risk clusters were Oeste Potiguar (Mossoró, Açu and Pau dos Ferros); Central Potiguar (Caicó and surrounding municipalities) and Agreste Potiguar (São Tomé, Barcelona, Sítio Novo and the surrounding municipalities to Várzea) and Pedro Velho (Leste Potiguar). The importance of georeferencing is highlighted in the monitoring of neglected diseases such as HVL, where through a spatial tool it was possible to detect the presence of clusters in several locations in the state. It is hoped that through the provision of information from this work, it can assist in the monitoring of VL, being used by public agencies in situational diagnosis, assisting in health promotion and prevention actions in the state, in addition to support for research related to the theme.