Visceral leishmaniasis in Piauí, Brazil, 2007-2019: an ecological time series analysis and spatial distribution of epidemiological and operational indicators

Chaves, André Felipe de Castro Pereira; Costa, Igor Vinícius Soares; Brito, Matheus Oliveira de; Sousa Neto, Francisco Aragão de; Mascarenhas, Márcio Dênis Medeiros

André Felipe de Castro Pereira Chaves

Universidade Federal do Piauí, Centro de Ciências da Saúde, Teresina, PI, Brasil

http://orcid.org/0000-0002-5965-0011

Igor Vinícius Soares Costa

Universidade Federal do Piauí, Centro de Ciências da Saúde, Teresina, PI, Brasil

http://orcid.org/0000-0002-2024-4366

Matheus Oliveira de Brito

Universidade Federal do Piauí, Centro de Ciências da Saúde, Teresina, PI, Brasil

http://orcid.org/0000-0002-2203-0265

Francisco Aragão de Sousa Neto

Universidade Estadual do Piauí, Centro de Ciências da Saúde, Teresina, PI, Brasil

http://orcid.org/0000-0003-2060-1324

Márcio Dênis Medeiros Mascarenhas

Universidade Federal do Piauí, Centro de Inteligência em Agravos Tropicais Emergentes e Negligenciados, Teresina, PI, Brasil

http://orcid.org/0000-0001-5064-2763

Correspondence: André Felipe de Castro Pereira Chaves E-mail: andre_cchavez14@hotmail.com

Associate editor: Lúcia Rolim Santana de Freitas -https://orcid.org/0000-0003-0080-2858

AuthorS’ contribution

Chaves AFCP contributed to the study concept and design, data analysis and interpretation, drafting and critical reviewing the intellectual content of the manuscript. Costa IVS, De Sousa Neto FA and Brito MO contributed to data analysis and interpretation, and drafting the preliminary versions. Mascarenhas MDM contributed to the study design, data analysis, drafting and critically reviewing the intellectual content of the manuscript. All authors have approved the final version of the manuscript and are responsible for all aspects thereof, including ensuring its accuracy and integrity.

conflicts of interest

The authors declared that they have no conflicts of interest.

Figures (3)
Tables (3)

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Figure 1
– Visceral leishmaniasis incidence rate progression, total and by sex, Piauí, 2007-2019

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Figure 2
– Visceral leishmaniasis operational indicator proportion progression and VL-HIV coinfection case proportion progression, Piauí, 2007-2019

a) Data with effect from 2008; b) VL: Visceral leishmaniasis; c) HIV: Human immunodeficiency virus.

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Figure 3
– Visceral leishmaniasis mean incidence rate and operational indicator spatial distribution, Piauí, 2007-2019

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Study contributions Main results Visceral Leishmaniose (VL) predominated in males and children, was associated with social vulnerability and was a significantly underreported disease. Moreover, it had a strong endemic trend in most of the state of Piauí. Implications for services This study offers health services a broad panorama of the VL profile in Piauí, both in relation to the population most affected by the disease and also the locations where the government needs to be more incisive in promoting health actions. Perspectives Greater efforts are expected from the government to change the epidemiological scenario of VL in Piauí. Actions to combat the disease should be adopted, focusing on the main vulnerabilities presented in this study.

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Table 1
– Sociodemographic and clinical characteristics of new visceral leishmaniasis cases (n=2,521), Piauí, 2007-2019

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Table 2
– Visceral leishmaniasis incidence rate trend (per 100,000 inhabitants), case fatality ratio trend (%) and operational indicator trend (%), Piauí, 2007-2019

Variables	Total		Male		Female		p-value^a
Variables	n	%	n	%	n	%	p-value^a
Age group (in years)							<0.001
0-9	1,077	42.7	557	33.0	520	62.4
10-19	212	8.4	143	8.5	69	8.3
20-39	646	25.6	529	31.3	117	14.0
40-59	415	16.5	331	19.6	84	10.1
≥60	171	6.8	128	7.6	43	5.2
Race/skin color							0.150
Black/brown	2,311	91.7	1,562	92.5	749	89.9
White	115	4.6	67	4.0	48	5.8
Yellow	18	0.7	10	0.6	8	1.0
Indigenous	7	0.2	6	0.4	1	0.1
No information	70	2.8	43	2.5	27	3.2
Schooling^b							0.678
Illiterate/elementary education	1,065	80.1	825	79.8	240	81.1
High school education	246	18.5	200	19.3	46	15.5
Higher education	19	1.4	9	0.9	10	3.4
Zone of residence							0.438
Urban	1,713	67.9	1,149	68.1	564	67.7
Rural/periurban	726	28.8	492	29.1	234	28.1
No information	82	3.3	47	2.8	35	4.2
Confirmation criterion							0.603
Laboratory	2,203	87.4	1471	87.1	732	87.9
Clinical-epidemiological	318	12.6	217	12.9	101	12.1
Diagnostic parasitology							0.002
Positive	1,374	54.5	949	56.2	425	51.0
Negative	464	18.4	315	18.7	149	17.9
Not performed	683	27.1	424	25.1	259	31.1
Diagnosis using indirect immunofluorescence							0.002
Positive	588	23.3	363	21.5	225	27.0
Negative	271	10.7	180	10.7	91	10.9
Not performed	1,662	65.9	1,145	67.8	517	62.1
VL^c-HIV^d coinfection							<0.001
Yes	261	10.4	210	12.5	51	6.1
No	1,906	75.6	1,265	74.9	641	77.0
No information	354	14.0	213	12.6	141	16.9
Clinical progression							0.071
Cure	1,321	52.4	873	51.7	448	53.8
Death from VL^c	153	6.1	95	5.6	58	7.0
Transfer	110	4.4	68	4.0	42	5.0
Death from other cause	23	0.9	17	1.0	6	0.7
Dropout	9	0.3	8	0.5	1	0.1
No information	905	35.9	627	37.2	278	33.4

Variables	Annual percent change (%)	95%CI^a		p-value	Trend
Variables	Annual percent change (%)	LL	UL	p-value	Trend
Epidemiological indicators
Overall incidence rate	-1.16	-4.47	2.27	0.468	Stable
Incidence rate per health region
Carnaubais	3.52	-5.81	13.77	0.437	Stable
Chapada das Mangabeiras	12.15	6.69	24.96	0.040	Rising
Cocais	-2.47	-6.76	2.01	0.246	Stable
Entre Rios	-1.99	-5.61	1.76	0.263	Stable
Planície Litorânea	-8.77	-14.45	-2.71	0.009	Falling
Serra da Capivara	-1.90	-12.15	9.54	0.709	Stable
Tabuleiros do Alto Parnaíba	14.19	3.91	25.50	0.010	Rising
Vale do Canindé	2.15	-11.21	17.53	0.745	Stable
Vale do Rio Guaribas	-1.85	-6.83	3.40	0.448	Stable
Vale do Sambito	-2.56	-21.26	20.59	0.794	Stable
Vale dos Rios Piauí e Itaueiras	-4.14	-11.50	3.82	0.268	Stable
Casa fatality ratio (%)	-2.62	-6.72	1.66	0.202	Stable
Operational indicators (%)
Laboratory confirmation	0.58	0.29	0.87	0.001	Rising
HIV^b,c testing	0.66	-0.20	1.53	0.120	Stable
Parasitology	-1.48	-2.94	0.00	0.050	Stable
Immune testing	-10.69	-18.59	-2.03	0.021	Falling
VL^d-HIV^b,c coinfection	1.90	-2.34	6.33	0.347	Stable
Progression to clinical cure	-5.67	-8.05	-3.23	<0.001	Falling
Progression unknown	7.02	2.18	12.09	0.008	Rising

[1] Correspondence: André Felipe de Castro Pereira Chaves E-mail: andre_cchavez14@hotmail.com

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Visceral leishmaniasis in Piauí, Brazil, 2007-2019: an ecological time series analysis and spatial distribution of epidemiological and operational indicators

Abstract

Objective

Methods

Results

Conclusion