Diagnosis of visceral leishmaniasis in Ceará state, Brazil: A flow analysis of cases between 2007 and 2021

• Published in: Tropical medicine & international health Vol. 28; no. 9; pp. 780 - 789
• Main Authors: de Sousa Cavalcante, Kellyn Kessiene, Cavalcante, Francisco Roger Aguiar, Boigny, Reagan Nzundu, Borges, Kelvia Maria Oliveira, Alencar, Carlos Henrique
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-09-2023
• Subjects: Decision making; Diagnosis; Ecological studies; Epidemiology; Flow mapping; Medical diagnosis; Municipalities; Parasitic diseases; Public health; Public policy; Spatial analysis; Vector-borne diseases; Visceral leishmaniasis; Brazil; epidemiological surveillance; visceral; ecological studies; leishmaniasis; flow profiles
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.13918

To analyse the flow of cases of visceral leishmaniasis (VL) in the state of Ceará, Brazil, between 2007 and 2021.
An ecological study was conducted using a spatial approach of newly confirmed cases of VL recorded in the Notifiable Diseases Information System. We identified individuals whose municipality of diagnosis differed from that of their residence. Flow maps, constructed using Tabwin 32 and ArcMap 9.2, allowed for the identification of the volume of traffic between the municipality of residence and that of initial care.
There were 6775 confirmed VL cases. As a flow indicator, 178 counties had at least one resident diagnosed in another municipality in Ceará, with 2491 VL cases and an average trip of 79 km. The largest hub for receiving cases for diagnosis was the capital Fortaleza (1478 patients from 129 other municipalities), followed by Sobral, located in the northwestern region of Ceará (599 from 55 municipalities), and Barbalha, in the southern region (171 from 29 municipalities). In this southern region, 25 municipalities moved 55 people for treatment to Juazeiro do Norte and 11 municipalities moved 39 patients to Crato. A total of 255 patients with VL from 11 municipalities in other Brazilian states, mainly from the Northeast and North, were observed and notified in health services in Ceará.
The major centres of VL diagnosis outside residence were in the cities of Fortaleza, Sobral, Barbalha, Juazeiro do Norte and Crato. There was also an outflow of cases from other municipalities located in the northeastern and northern regions of Brazil. The flows were more intense during the first triennium of the analysis and milder from 2019 to 2021. Understanding the diagnostic flow of VL helps in decision making and the development of public policies to improve the lives of the population.