OBJECTIVE To analyze the determinants for the occurrence of human visceral leishmaniasis linked to the conditions of vulnerability.METHODS This is an ecological study, whose spatial analysis unit was the Territorial Analysis Unit in Araguaína, State of Tocantins, Brazil, from 2007 to 2012. We have carried out an analysis of the sociodemographic and urban infrastructure situation of the municipality. Normalized primary indicators were calculated and used to construct the indicators of vulnerability of the social structure, household structure, and urban infrastructure. From them, we have composed a vulnerability index. Kernel density estimation was used to evaluate the density of cases of human visceral leishmaniasis, based on the coordinates of the cases. Bivariate global Moran’s I was used to verify the existence of spatial autocorrelation between the incidence of human visceral leishmaniasis and the indicators and index of vulnerability. Bivariate local Moran’s I was used to identify spatial clusters.RESULTS We have observed a pattern of centrifugal spread of human visceral leishmaniasis in the municipality, where outbreaks of the disease have progressively reached central and peri-urban areas. There has been no correlation between higher incidences of human visceral leishmaniasis and worse living conditions. Statistically significant clusters have been observed between the incidences of human visceral leishmaniasis in both periods analyzed (2007 to 2009 and 2010 to 2012) and the indicators and index of vulnerability.CONCLUSIONS The environment in circumscribed areas helps as protection factor or increases the local vulnerability to the occurrence of human visceral leishmaniasis. The use of methodology that analyzes the conditions of life of the population and the spatial distribution of human visceral leishmaniasis is essential to identify the most vulnerable areas to the spread/maintenance of the disease.
Imported malaria is a malaria infection diagnosed outside the area where it was acquired and is induced by human migration and mobility. This retrospective study was performed based on secondary data from 2007 to 2015. In total, 736 cases of imported malaria (79.7% of 923 cases) were recorded in Rio de Janeiro state. Of the imported cases, 55.3% came from abroad, while 44.7% came from other regions of Brazil. Most cases of imported malaria in Brazil (85.5%) originated in Amazônia Legal, and Burundi (Africa) accounted for 59% of the cases from abroad. Analyses of the determinants of imported malaria in Rio de Janeiro state must be continued to understand the relationship between the origin and destination of cases.
As abordagens ecossistêmicas surgem como enfoques alternativos que integram múltiplos aspectos para a compreensão e busca de soluções de problemas de saúde oriundos de precárias condições sociossanitárias. A vulnerabilidade para a leptospirose é marcada por áreas onde há propensão a ocorrer desastres naturais de alagamento associados a precárias condições sociossanitárias. O presente artigo traz a identificação de áreas de risco para leptospirose no município de Itaboraí considerando características ambientais e sociossanitárias relacionadas a produção da doença. A análise espacial foi realizada por meio de sobreposição dos temas de interesse: áreas de maior risco de inundação (28% do território), áreas críticas (0,9% do território e 9,3% da população do município) e casos notificados de leptospirose, através da análise visual. Dos 89 casos de leptospirose notificados, 71% foram localizados dentro das áreas de influência de inundação e 34% em localidades com precárias condições sociossanitárias. Os resultados alcançados com a integração das informações socioambientais do território e análise da distribuição espacial da leptospirose demonstra a ocorrência injusta, desproporcional e evitável de leptospirose naquelas localidades, ressaltando uma situação de iniquidade social em saúde na qual populações com menores condições econômicas são impelidas a ocupar porções do território ambientalmente degradadas e com menor disponibilidade de serviços. Essa se mostra uma promissora abordagem para a área da vigilância.
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