Impacto dos aspectos socioeconômicos e ambientais na incidência da leishmaniose visceral humana em Aracaju: um estudo ecológico uma revisão sistemática

Abstract

Visceral leishmaniasis (VL) is a disease caused by parasites of the genus Leishmania and transmitted by vectors called phlebotomine sand flies. Classified as a zoonosis, this disease is considered a serious public health problem in the country, given that Brazil is endemic, accounting for 90% of cases found in the Americas. In Sergipe, a Brazilian state in the Northeast region, this zoonosis has a high incidence and lethality rate. Therefore, due to the epidemiological situation, it was hypothesized that in Aracaju, the city where cases predominate, socioeconomic factors and environmental changes such as deforestation and disordered urbanization are important risk factors, since there is already scientific evidence that proves these correlations in other regions of the country. In this sense, the present project aims to investigate the impact of socioeconomic indicators and changes in vegetation cover on the incidence of human visceral leishmaniasis in Aracaju between 2019 and 2024. To this end, an ecological study was conducted using the Generalized Additive Model (GAM) and Principal Component Analysis (PCA). These methods complement each other, as GAM is predictive and inferential, aiming to determine the influence of variables individually, while PCA is exploratory and descriptive, aiming to explore multivariate patterns and determine the weight of variables in the occurrence of the disease. The databases used were: reports and official documents from the Brazilian Ministry of Health and the Sergipe State Health Secretariat, MapBiomas, DATASUS, and the Brazilian Institute of Geography and Statistics (IBGE). Evidence suggests that visceral leishmaniasis is concentrated in impoverished populations in Africa, Asia, and Latin America, particularly in Brazil, Ethiopia, India, Kenya, Sudan, and Yemen. This is similar to the findings of this research, as the GAM results indicated that the predictive variables for visceral leishmaniasis in Aracaju are: illiteracy, irregular water supply, irregular garbage collection, irregular sanitation, and population density. In the PCA, the variables with the greatest weight were: illiteracy, poverty, inaccessibility to electricity, irregular water supply, irregular garbage collection, and irregular sanitation. These findings revealed that socioeconomic and demographic determinants had the greatest influence on the incidence of the disease during the study period. Therefore, the need for the implementation of integrated public policies that consider social, economic, and environmental factors is evident in order to effectively control the incidence of the disease and enable health promotion for the municipality as a whole.