FACTORS ASSOCIATED WITH HUMAN INFECTION BY Leishmania infantum AND ITS SPATIAL PATTERN IN A NORTHEAST DENMARK AREA OF BRAZIL
Visceral leishmaniasis, Leishmania infantum, Spatial Distribution, canine infection, Lu. longipalpis
Visceral leishmaniasis (VL) or kala-azar, is one of the most deadly parasitic diseases and tends to affect mainly the poorest and most vulnerable populations. In Brazil, the disease had a predominantly rural distribution, but from the 1980s was its expansion to urban and peri-urban areas of medium and large, like Natal-RN. The aim of this study was to evaluate the factors associated with human infection with Leishmania infantum and its spatial distribution in Natal-RN municipality. This is an exploratory descriptive epidemiological study, ecological analysis, considering as the unit of analysis neighborhoods (n = 36) that make up the municipality. A temporal analysis was performed (1990-2014) for the demographic characteristics of cases of human VL and VL-HIV coinfection, and spatial analysis (2007-2014) and correlation with socioeconomic and environmental factors, canine infection and potentially influencing entomological indicators transmission of Leishmania. The data of human infection show strong endemism of VL in Natal. Were observed high density Lu. longipalpis and high Leishmania infection in dogs over the years. Human VL, measured by the number of case rate per 100,000 population, showed heterogeneous distribution and spatial expansion over time, with the highest concentration of cases in the north of the city. Males under the age of 4 years were the most affected and there was a growing number of cases of VL-HIV coinfection. Socio-economic and structural variables, which increase implies improving the standard of the neighborhood, such as garbage collection, earning more than three minimum wages and literate population, led to a reduction in the incidence rate of VL, while lack of sanitation and income below the minimum wage, promoted its increase. VL in Natal has its expansion associated with poverty and people in more vulnerable population, such as children and immunocompromised, dwelling areas of recent development with poor public infrastructure and the presence of infected dogs.