Factors Affecting the Spatial Distribution of Visceral Leishmaniasis in an Urban Area of Recent Emergence in Inner Brazil

Abstract

Introduction: The expansion of Visceral Leishmaniasis in areas of recent emergency in the last two decades in Brazil can be understood by spatial analysis. Methodology: Study of the spatial distribution of general VL and VL-HIV coinfection in the city of Bauru SP, Brazil between 2003 to 2016. The cases were georeferenced and attributed to the Census sectors using demographic, socioeconomic and urban infrastructure predictors. The incidence in these sectors was analyzed in univariate and multivariate one-step Poisson regression models. Results: The cumulative incidence rates of LV and LVHIV (per 100,000 inhab.) In this period were 131.1 and 19.7, respectively. In the univariate analysis, the spatial distribution of VL and VL-HIV co-infection was negatively associated with per capita income, population density, paving and proportion of streets in sidewalks and rain drainage. In multivariable models, the incidence of VL was negatively associated with per capita income (Incident Rate Ratio [IRR], 0.89; 95% confidence interval [CI], 0.860.92) and population density (IRR, 94; 95% CI, 0.90-0.97), while co-infection was negatively associated with per capita income (IRR, 0.80; 95% CI, 0.71-0.91) and proportion of streets with rain drainage (TIR, 0.87; 95% CI, 0.78-0.98). Conclusion: Demographic, socioeconomic and infrastructure deficits can influence the emergence patterns of VL in urban areas in developing countries.