Silva Nathiel, Alencar Carlos Henrique, Heukelbach Jorg
Postgraduate Course in Public Health, School of Medicine, Federal University of Ceará, Rua Prof. Costa Mendes 1608-5, Andar, Fortaleza 60430-140, Ceará, Brazil.
Trop Med Infect Dis. 2025 May 16;10(5):135. doi: 10.3390/tropicalmed10050135.
Scabies and tungiasis are skin-related neglected tropical diseases (NTDs) associated with poverty and poor living conditions. We performed an ecological study covering a state in northeast Brazil to identify socio-economic and environmental factors associated with the occurrence of severe scabies and severe tungiasis, respectively. Data on disease occurrence on the municipality level were derived from a previous study based on online questionnaires. A total of 47 (26.0%) of the 181 state's municipalities reported severe tungiasis, and 113 (62.4%) severe scabies. Municipalities with occurrence of severe tungiasis were characterized by higher annual rainfalls (median = 883 mm vs. 741 mm; = 0.037), higher minimum temperatures (median = 23.4 °C vs. 22.7 °C; = 0.002), higher aridity indices indicating more humid climates (median = 45.1 vs. 50.6; = 0.019), lower altitudes (median = 88.8 m vs. 201 m; < 0.001), higher mean air humidity (66.5% vs. 63%; = 0.018), and better socioeconomic indices (Municipal Human Development Index [MHDI]-median = 0.616 vs. 0.611; = 0.048/MHDI Longevity-mean = 0.769 vs. 0.759; = 0.007/Municipal Development Index [MDI]-median = 27.5 vs. 21.8; < 0.001). Municipalities with predominant luvisol soil characteristics had a lower risk for severe tungiasis (RR = 0.46; 95% CI = 0.27-0.79; = 0.003), whereas municipalities with predominant gleysols had a significantly higher risk (RR = 2.44; 95% CI = 1.43-4.15; = 0.010). Municipalities with occurrence of severe scabies were characterized by significantly higher annual rainfalls (median = 804 mm vs. 708 mm; = 0.001), higher minimum temperatures (23.1 °C vs. 22.3 °C; < 0.001), higher aridity index (median = 48.2 vs. 41.9; = 0.014), higher air humidity (65.9% vs. 61%; = 0.001), lower altitudes (median = 153 m vs. 246 m; = 0.003), and better socio-economic indicators (MHDI-median = 0.616 vs. 608; = 0.012/MHDI Education-mean = 0.559 vs. 0.541; = 0.014/MDI-median = 24.3 vs. 21.1; = 0.005). In multivariate regression analysis, MDI remained significantly associated with the presence of severe tungiasis in the final model (RR = 1.04; 95% CI: 1.02-1.05; < 0.001) and the presence of severe scabies with minimum temperature (RR = 1.13; 95% CI: 1.04-1.24; = 0.003) and aridity index (RR = 1.01; 95% CI: 1.00-1.01; = 0.004). Our study underscores the importance of environmental and socioeconomic factors for the occurrence of severe scabies and tungiasis in a semi-arid climatic context, offering a perspective for identification of high-risk areas, and providing evidence for the control of skin NTDs withina One Health approach.
疥疮和潜蚤病是与贫困及恶劣生活条件相关的皮肤类被忽视热带病（NTDs）。我们开展了一项生态研究，覆盖巴西东北部一个州，以分别确定与严重疥疮和严重潜蚤病发生相关的社会经济及环境因素。市级层面的疾病发生数据源自之前一项基于在线问卷的研究。该州181个市中，共有47个（26.0%）报告了严重潜蚤病，113个（62.4%）报告了严重疥疮。发生严重潜蚤病的市具有年降雨量较高（中位数 = 883毫米 vs. 741毫米；P = 0.037）、最低温度较高（中位数 = 23.4℃ vs. 22.7℃；P = 0.002）、表明气候更湿润的干旱指数较高（中位数 = 45.1 vs. 50.6；P = 0.019）、海拔较低（中位数 = 88.8米 vs. 201米；P < 0.001）、平均空气湿度较高（66.5% vs. 63%；P = 0.018）以及社会经济指数较好（市人类发展指数[MHDI] - 中位数 = 0.616 vs. 0.611；P = 0.048 / MHDI寿命 - 均值 = 0.769 vs. 0.759；P = 0.007 / 市发展指数[MDI] - 中位数 = 27.5 vs. 21.8；P < 0.001）的特征。以淋溶土为主的市严重潜蚤病风险较低（相对风险[RR] = 0.46；95%置信区间[CI] = 0.27 - 0.79；P = 0.003），而以潜育土为主的市风险显著更高（RR = 2.44；95% CI = 1.43 - 4.15；P = 0.010）。发生严重疥疮的市具有年降雨量显著较高（中位数 = 804毫米 vs. 708毫米；P = 0.001）、最低温度较高（23.1℃ vs. 22.3℃；P < 0.001）、干旱指数较高（中位数 = 48.2 vs. 41.9；P = 0.014）、空气湿度较高（65.9% vs. 61%；P = 0.001）、海拔较低（中位数 = 153米 vs. 246米；P = 0.003）以及社会经济指标较好（MHDI - 中位数 = 0.616 vs. 608；P = 0.012 / MHDI教育 - 均值 = 0.559 vs. 0.541；P = 0.014 / MDI - 中位数 = 24.3 vs. 21.1；P = 0.005）的特征。在多变量回归分析中，MDI在最终模型中仍与严重潜蚤病的存在显著相关（RR = 1.04；95% CI：1.02 - 1.05；P < 0.001），而严重疥疮的存在与最低温度（RR = 1.13；95% CI：1.04 - 1.24；P = 0.003）和干旱指数（RR = 1.01；95% CI：1.00 - 1.01；P = 0.004）相关。我们的研究强调了环境和社会经济因素在半干旱气候背景下对严重疥疮和潜蚤病发生的重要性，为确定高风险地区提供了视角，并为在“同一健康”方法内控制皮肤NTDs提供了证据。
