Fatores de risco para leishmaniose tegumentar americana (lta) no Estado de Alagoas, Brasil / Risk factors for American Tegmentary Leishmaniasis (ATL) in the State of Alagoas, Brazil




The cutaneus leishmaniasis continues to be one of the endemic diseases of greatest occurrence around the world, and it is estimated that 12 million people are affected by the disease. In Brazil, around 30,000 cases are notified every year and in the State of Alagoas, around 100 cases every year. The scarcity of studies identifying the risk factors for American Tegmentary Leishmaniasis (ATL) transmission justifies the present study, with the aim of providing backing for control program actions. The objective of the present study was to identify the risk factors for ATL transmission in the State of Alagoas, Brazil. A prospective case-control study was carried out, matched by sex and age group. Two independent control groups were used: one consisting of neighbors of the case and the other consisting of individuals drawn from a family at the Family Healthcare Unit where the case occurred. A standardized questionnaire consisting of questions relating to potential risk factors for ATL was applied to the participants. Data collection was carried out between July 1, 2004, and February 1, 2007. Ninety-eight cases and an equal number of controls for each group were selected. Individuals with the cutaneous form, clinical cure and laboratory confirmation were considered to be cases. Individuals negative to the Montenegro intradermal reaction were considered to be controls. Multivariate analysis for social and household-related variables showed the closest associations with increased risk for the following factors: lack of gas stove (for both control groups); four years or less of schooling and family income more than one minimum monthly salary (for neighbor controls); and non-durable house wall material and per capita income more than fifty reais (for community controls). Joint analysis of groupings of variables relating to work or study activities, leisure activities, activities outside the home and the home and environmental surrounds showed the closest associations with the following factors: forest less than 200 meters from the house (for both control groups); presence of birds inside the home, leisure activities inside forests and rural work or school activities (for neighbor controls); and presence of animals inside the home and absence of dogs and cats around the home (for community controls). The transmission pattern observed was rural and urban perimeter type, with transmission possibly occurring inside the home or in the surrounds. This can be stated because the disease was strongly associated with living conditions (absence of gas stove and non-durable wall material), proximity of the home to forests and animals reared inside the home. Based on the observed findings, specific control measures can be recommended: protection for individuals who practice leisure activities in forests (adequate clothes and repellants), separation between masonry houses and forests of more than 200 meters and elimination of the practice of rearing birds or other animals inside homes. The general control measure of promotion of improvements in housing and living conditions is also recommended


epidemiologia estudo caso-controle case-control study leishmania epidemiology ciencias da saude lta atl risk factors leishmania leishmaniose tegumentar americana american tegmentary leishmaniasis fatores de risco

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