Federal University of Ceará, Pos-graduated program of Public Health, Medicine College, Fortaleza, Brazil.
Centro Universitário INTA-UNINTA, Sobral, Brazil.
Trop Med Int Health. 2023 Sep;28(9):780-789. doi: 10.1111/tmi.13918. Epub 2023 Aug 7.
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.
分析 2007 年至 2021 年巴西塞阿拉州内脏利什曼病（VL）病例的流动情况。
采用空间方法对传染病报告系统中记录的新确诊 VL 病例进行生态研究。我们确定了其诊断所在城市与居住城市不同的患者。使用 Tabwin 32 和 ArcMap 9.2 构建流动图，以识别居住城市与初始护理城市之间的交通量。
共确诊 6775 例 VL 病例。作为流量指标，有 178 个县至少有一名居民在塞阿拉州的另一个城市被诊断为 VL，共有 2491 例 VL 病例，平均行程为 79 公里。接收诊断病例的最大枢纽是首府福塔莱萨（1478 例，来自 129 个其他城市），其次是塞阿拉州西北部的索布拉尔（599 例，来自 55 个城市）和南部的巴拉阿（171 例，来自 29 个城市）。在这个南部地区，有 25 个城市将 55 人送往若泽城治疗，有 11 个城市将 39 名患者送往克鲁塔。还观察到来自巴西其他州的 11 个城市的 255 例 VL 患者，主要来自东北部和北部，这些患者在塞阿拉州的卫生服务中得到了通知。
除居住地外，主要的 VL 诊断中心在福塔莱萨、索布拉尔、巴拉阿、若泽城和克鲁塔。来自巴西东北部和北部地区的其他城市也有病例外流。分析的前三年流量更为密集，而 2019 年至 2021 年流量较为温和。了解 VL 的诊断流量有助于决策制定和制定改善人口生活的公共政策。
