Leishmaniose visceral humana: análise do tempo da suspeição ao tratamento dos casos positivos no município de Araguaína- TO

Abstract

Leishmaniasis are complex zoonoses that are widespread throughout the world. The visceral form (LVH) is a persistent public health problem, and it is a challenge to reduce its lethality by assuming a systemic, severe and fatal condition, especially when associated with late diagnosis. In Tocantins, the municipality of Araguaína stands out for being an area of intense transmission and for a better understanding of the behavior of the disease in the municipality, this study describes the epidemiological profile of LVH with emphasis on the time elapsed from suspicion to treatment in the period from 2015 to 2019. To this end, a search was conducted in the database of the Municipal Health Secretariat of Araguaína and in the Information System for Notifiable Diseases, including only information on new cases of residents in the municipality disregarding recurrence situations. It followed with the tabulation of epidemiological indicators, later geographic maps of case distribution by neighborhoods were generated using the QGIS® 3.4.10 software and descriptive and inferential statistical analysis, using relative risk (RR), as a measure of strength of association for death, being calculated with the respective confidence intervals (95% CI) estimated by the Wald test, using the riskratio.wald () function of the epitools package in software R © version 3.6.1. The time elapsed from suspicion to treatment were represented in days by the median box diagram (Md) comparing the groups of patients: total group of records, group composed of children, adults, those who were cured and those who came to death. The results revealed 191 confirmations of LVH, informed by UPA Anatólio Dias Carneiro (59%) and Hospital de Tropical Diseases- HDT / UFT (28%), reaching more children (57.6%), males (58%), and brown (88.5%) residents, mostly in the Araguaína Sul sector, with a higher incidence in the Daiara sector. There was no significant association of risk of death by sex, education, race or color, being significant only by age (p <0.001) in the age groups of young adults (RR = 16.09) and elderly (RR = 7.08). In the analysis of the time from suspicion to treatment, children had shorter intervals (0-35 days, Md = 12) in contrast to older patients (4-44 days, Md = 18) and those who died (7-65 days; Md = 20) highlighting greater inopportunity for healing in these last two groups. It was possible to ascertain that although there were shorter intervals for suspicion and therapeutic intervention for LVH in Araguaína compared to national data, there is still a need to shorten this waiting time, through health education actions and facilitating access to services. strengthening the health care network in the municipality.