Interação entre os determinantes ambientais e socioeconômicos para o risco de leishmaniose cutânea na América Latina

Objetivo. Determinar y caracterizar áreas de riesgo potencial de la ocurrencia de leishmaniasis cutánea (LC) en América Latina (AL).Método. Estudio observacional ecológico con unidades de observación definidas por municipios con transmisión de LC entre 2014-2018. Se utilizaron variables medioambientales y socioeconómicas disponibles para al menos 85% de los municipios, combinados en una sola base de datos, a través del software R. Se combinó la metodología de análisis de componentes principales con un análisis de conglomerados jerárquicos parala formación de conglomerados de municipios en función de su similitud. Se estimó el V-test para definir la asociación positiva o negativa de las variables con los conglomerados y separación por divisiones naturales para determinar cuáles contribuyeron más a cada conglomerado. Se incorporaron los casos para atribuir el riesgo de LC para cada conglomerado.Resultados. Se incluyeron en el estudio 4 951 municipios con transmisión de LC (36,5% del total en AL) y se definieron siete conglomerados por su asociación con 18 variables medioambientales y socioeconómicas. El riesgo histórico de LC se asocia de manera positiva y en forma decreciente con los conglomerados Amazónico, Andino y Sabana; y de manera negativa con los conglomerados Boscoso/perenne, Boscoso/cultivo y Boscoso/poblado. El conglomerado Agrícola no reveló ninguna asociación con los casos de LC.Conclusiones. El estudio permitió identificar y caracterizar el riesgo de LC por conglomerados de municipios y conocer el patrón propio epidemiológico de distribución de la transmisión, lo que proporciona a los gestores una mejor información para las intervenciones intersectoriales para el control de la LC.Objective. Determine and characterize areas at potential risk for the occurrence of cutaneous leishmaniasis (CL) in Latin America. Method. Ecological observational study with observation units defined by municipalities with CL transmission during 2014-2018. Environmental and socioeconomic variables available for at least 85% of municipalities were combined in a single database, using R software. Principal component analysis was combined with hierarchical cluster analysis for the formation of clusters of municipalities according to their similarity. The V-test was used to define positive or negative association of variables with clusters and separation by natural divisions to determine which contributed more to each cluster. Cases were included to attribute CL risk for each cluster. Results. The study included 4 951 municipalities with CL transmission (36.5% of municipalities in Latin America); seven clusters were defined by their association with 18 environmental and socioeconomic variables. Historical risk of CL is associated positively and in descending order with the Amazonian, Andean, and Savanna clusters; and negatively with the Forest/perennial, Forest/cultivated, and Forest/populated clusters. The Agricultural cluster showed no association with CL cases. Conclusions. The study made it possible to identify and characterize CL risk by clusters of municipalities and to understand the characteristic epidemiological distribution patterns of transmission, providing program managers with better information for intersectoral interventions to control CL.Objetivo. Determinar e caracterizar as áreas de risco de ocorrência de leishmaniose cutânea na América Latina. Método. Estudo observacional ecológico com unidades de observação definidas por municípios com transmissão de leishmaniose cutânea entre 2014 e 2018. Foram usadas as variáveis ambientais e socioeconômicas disponíveis em 85% ou mais dos municípios, reunidas em uma única base de dados com o uso do software R. A metodologia de análise de componentes principais foi combinada a uma análise de conglomerados com agrupamento hierárquico para formar conglomerados de municípios por semelhança. O teste V foi usado para estabelecer a associação (positiva ou negativa) das variáveis com os conglomerados e uma separação por divisões naturais foi usada para determinar as variáveis que mais contribuíram em cada conglomerado. Os casos foram incluídos para avaliar o risco de leishmaniose cutânea em cada conglomerado. Resultados. A amostra do estudo compreendeu 4.951 municípios com transmissão de leishmaniose cutânea (36,5% do total na América Latina). Foram definidos sete conglomerados por apresentarem associação com 18 variáveis ambientais e socioeconômicas. Foi observada associação positiva e decrescente do risco histórico de leishmaniose cutânea com os conglomerados Amazônico, Andino e Savana e negativa com os conglomerados Mata/perene, Mata/cultivo e Mata/povoado. O conglomerado Agrícola não demonstrou associação com casos de leishmaniose cutânea. Conclusões. Este estudo permitiu identificar e caracterizar o risco de leishmaniose cutânea por conglomerados de municípios e conhecer o padrão epidemiológico de distribuição da transmissão da doença, oferecendo às autoridades dados melhores para subsidiar as intervenções intersetoriais para o controle da leishmaniose cutânea.Fil: Maia Elkhoury, Ana Nilce S.. Organización Panamericana de la Salud; Estados UnidosFil: Magalhães Lima, Daniel. Centro Panamericano de Fiebre Aftosa; BrasilFil: Salomón, Oscar Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina. Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán". Instituto Nacional de Medicina Tropical; ArgentinaFil: Buzanovsky, Lia Puppim. Centro Panamericano de Fiebre Aftosa; BrasilFil: Saboyá Díaz, Martha Idalí. Organización Panamericana de la Salud; Estados UnidosFil: Valadas, Samantha Y.O.B.. Organización Panamericana de la Salud (ops); Estados UnidosFil: Sanchez Vazquez, Manuel J.. Centro Panamericano de Fiebre Aftosa; Brasi

Neglected infectious diseases in the Americas: current situation and perspectives for the control and elimination by 2030

Neglected infectious diseases (NID) are a diverse group of conditions including more than 20 parasitic, bacterial, and fungal diseases, and envenoming by poisonous animals. Their risk factors include poverty, income inequality, lack of access to safe drinking water and proper sanitation, and barriers to education and health services, among other social determinants of health. They impose a large burden on marginalized populations globally and in the region of the Americas, including women and ethnic minorities. The region of the Americas has a track record of elimination of communicable diseases and countries have made significant progress in the elimination of NID in recent years. Between 2011 and 2020, one country eliminated trachoma, four eliminated onchocerciasis, one eliminated human rabies transmitted by dogs, and three were declared free of lymphatic filariasis. The COVID-19 pandemic impacted the continuity of actions to eliminate NID and there are challenges in controlling and eliminating NID, particularly in vulnerable and hard-to-reach populations with issues in accessing health services. There are still difficulties in the coordination between health and other sectors to work together on the socioeconomic and environmental determinants of NID. Forwarding the elimination of NID in the Americas involves continuous advocacy and resource mobilization at various levels (international, regional, national, and subnational), ensuring sufficient allocation of human and financial resources, access to essential health supplies, and implementing people-centered services. It also entails engaging and empowering civil society, communities, local governments, and public-private partnerships, while collaborating with stakeholders and donors for effective action

Premature deaths by visceral leishmaniasis in Brazil investigated through a cohort study: A challenging opportunity?

BackgroundVisceral Leishmaniasis (VL) is the most severe form of leishmaniasis because it can lead to death. In the Americas, 96% of cases are in Brazil, and despite efforts, the fatality rate has increased in the past years. We analyzed deaths associated to VL in Brazil and investigated the factors that could influence on the timeliness of fatal outcome with emphasis on time (tStoD).MethodologyThe registered deaths by VL were sourced from the Brazilian National Notification System from 2007-2014. Through a retrospective cohort study, univariate and multivariable Cox proportional hazards model analysis were performed and investigated the factors that could influence the time (tStoD). These factors were analyzed through survival models.ResultsOut of the 1,589 reported deaths, the median for onset of the symptoms and the case notification date (tStoN) is 25 days (10-61), and for date of case notification and death (tNotD) is 9 days (4-17). The time (tStoN) to event investigation for HIV non-infected individuals was 1.4 (1.16-1.68) greater than the HIV positive group. At the same time peri-urban and urban area were 0.83 (0.47-1.44) and 1.33 (1.16-1.52), respectively. The explorations revealed apparent differences between the time to event investigation (both for tStoN and tNotD) and the age at the onset of the symptoms. According to the tStoN the rate of notification is 1.73 times greater in patients under 5 years old at the onset of the clinical symptoms compared to older patients.ConclusionVL patients under 5 years old were diagnosed earlier and had shorter survival. It could mean that in younger population, although properly diagnosed, the fatality pattern might be related to the severity of the disease. Main host characteristics were evaluated, and age and co-infections seem to have an impact in the disease progression