Fatores sociais e ambientais associados com a Leishmaniose Visceral e com a coinfecção LV/HIV-AIDS no Rio Grande do Norte, 1990 a 2014

Abstract

Introduction: Visceral leishmaniasis (VL) is a serious disease and the risks of its development are associated with factors related to comorbidity, environmental transformations and socioeconomic aspects of the geographical area of occurrence. The understanding of these factors is crucial for designing intervention measures to control this endemic disease. Objective: to analyze the social and environmental factors associated with Visceral Leishmaniasis and VL/HIV-AIDS coinfection in Rio Grande do Norte (RN), from 1990 to 2014. Methodology: An ecological study was carried out, analyzing the "time", the existence of spatial dependence of social, and environmental factors influencing the incidence of VL. Results: VL started to be reported in the microregions of Natal, Macaíba and Litoral Norte from 1990 to 1994. From 2000 to 2004, it spreaded to other microregions of the State, between 2010 and 2014 to the micro-regions of Mossoró and Açu. At the same time, HIV-AIDS spreaded in the RN and slowly occurred in areas overlapping with VL, favoring the occurrence of VL/HIVAIDS coinfection, from 1990 to 1994 (p=0.0006) and 2010 to 2014 (p=0.0094), respectively. During the study period, a continuous increase in the incidence of VL in males (p=0.05, β=0.003 and R2 =0.398) was observed. There was also a reduction in the annual mean incidence of the disease in the age groups of 0 to 4 years (p <0.000); β = -0.0117; R2 =0.6564) and 5 to 9 years (p<0.0001; β=-0.0042; R2= 0.4740). At the same time, mean annual growth was observed in the age groups from 20 to 39 (p <0.0071, β=0.0071, R2=0.5636) and 40 years and more (p<0.0001; β=0.0105, R 2 =0.8309). It was observed in most of the microregions of the State a tendency to the association between the improvement of the Nutritional State in children under 5 years with the reduction of the incidence of VL in children. It was also observed that improved coverage of BCG (p <0.0001), Polio (p=0.0036) and Measles (p=0.0276) vaccines were associated with a reduction in the incidence of VL in children under 5 years. On the other hand, the increase in the rainfall index influenced the increase in the density of the vector rate, Lu. longipalpis (p<0.000), linear R2 =0.58); which, in turn, promoted an effect on the increase in LV incidence (p=0.002 and R2 =0.438). The incidence of VL was higher in the majority of microregions that presented higher rainfall rates in the study period. The analysis of the social indicators showed that in microregions with low trash collection the incidence of VL is higher. At the same time, it was observed that the incidence of HIV-AIDS is positively associated with better levels of income, education and population density. Conclusion: The study showed a change in the epidemiological profile of LV in the RN where it was observed that better indices of vaccination coverage and improvement of the nutritional state guarantee protection in the clinical form of VL in children. On the other hand, the prevalence of the disease in adult males showed that L. infantum/chagasi as an opportunistic parasite of immunocompromised and contributes to the growth of LV / HIV-AIDS coinfection. At the same time, the association of LV with rainfall indices in areas with low garbage collection coverage shows that the causes in the spatial and temporal variation of the incidence of VL are multifactorial.