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Mortality and case fatality due to visceral leishmaniasis in Brazil: a nationwide analysis of epidemiology, trends and spatial patterns.

Martins-Melo FR, Lima Mda S, Ramos AN, Alencar CH, Heukelbach J - PLoS ONE (2014)

Bottom Line: Mortality and case fatality rates showed a significant increase in Brazil over the period, with different patterns between regions: increasing mortality rates in the North (Annual Percent Change--APC: 9.4%; 95% confidence interval--CI: 5.3 to 13.6), and Southeast (APC: 8.1%; 95% CI: 2.6 to 13.9); and increasing case fatality rates in the Northeast (APC: 4.0%; 95% CI: 0.8 to 7.4).Spatial analysis identified a major cluster of high mortality encompassing a wide geographic range in North and Northeast Brazil.Early diagnosis and treatment are fundamental strategies for reducing case fatality of VL in Brazil.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.

ABSTRACT

Background: Visceral leishmaniasis (VL) is a significant public health problem in Brazil and several regions of the world. This study investigated the magnitude, temporal trends and spatial distribution of mortality related to VL in Brazil.

Methods: We performed a study based on secondary data obtained from the Brazilian Mortality Information System. We included all deaths in Brazil from 2000 to 2011, in which VL was recorded as cause of death. We present epidemiological characteristics, trend analysis of mortality and case fatality rates by joinpoint regression models, and spatial analysis using municipalities as geographical units of analysis.

Results: In the study period, 12,491,280 deaths were recorded in Brazil. VL was mentioned in 3,322 (0.03%) deaths. Average annual age-adjusted mortality rate was 0.15 deaths per 100,000 inhabitants and case fatality rate 8.1%. Highest mortality rates were observed in males (0.19 deaths/100,000 inhabitants), <1 year-olds (1.03 deaths/100,000 inhabitants) and residents in Northeast region (0.30 deaths/100,000 inhabitants). Highest case fatality rates were observed in males (8.8%), ≥ 70 year-olds (43.8%) and residents in South region (17.7%). Mortality and case fatality rates showed a significant increase in Brazil over the period, with different patterns between regions: increasing mortality rates in the North (Annual Percent Change--APC: 9.4%; 95% confidence interval--CI: 5.3 to 13.6), and Southeast (APC: 8.1%; 95% CI: 2.6 to 13.9); and increasing case fatality rates in the Northeast (APC: 4.0%; 95% CI: 0.8 to 7.4). Spatial analysis identified a major cluster of high mortality encompassing a wide geographic range in North and Northeast Brazil.

Conclusions: Despite ongoing control strategies, mortality related to VL in Brazil is increasing. Mortality and case fatality vary considerably between regions, and surveillance and control measures should be prioritized in high-risk clusters. Early diagnosis and treatment are fundamental strategies for reducing case fatality of VL in Brazil.

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Related in: MedlinePlus

Spatial distribution of average annual mortality rates related to VL (per 100,000 inhabitants) based on multiple causes of death by municipalities of residence, Brazil, 2000–2011.
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pone-0093770-g004: Spatial distribution of average annual mortality rates related to VL (per 100,000 inhabitants) based on multiple causes of death by municipalities of residence, Brazil, 2000–2011.

Mentions: In the period, 18.1% (1,010/5,565) of the Brazilian municipalities in 25 of 27 states reported at least one death related to VL. Figures 4 and 5 present the spatial distribution of the average annual crude and smoothed mortality rates, respectably. The Bayesian method generated more stable corrected mortality rates (Figure 5). Average annual crude rate reached a maximum of 9.5 deaths per 100,000 inhabitants, while the maximum of the smoothed indicator was 3.6 deaths per 100,000 inhabitants. In general, the thematic maps show the presence of municipalities and/or clusters of municipalities with high mortality rates related to VL (>0.5 deaths per 100,000 inhabitants) in states of North, Northeast, Southeast and Central-West regions. The largest concentration was found in the Northeast, covering areas in all nine states of this region (Figures 4–5). There were also areas with high mortality rates encompassing most of Tocantins and Mato Grosso do Sul states, central-north and west regions of Minas Gerais state, west region of São Paulo state, east and north regions of Goiás state and northeast region of Pará and Roraima states (Figures 4–5).


Mortality and case fatality due to visceral leishmaniasis in Brazil: a nationwide analysis of epidemiology, trends and spatial patterns.

Martins-Melo FR, Lima Mda S, Ramos AN, Alencar CH, Heukelbach J - PLoS ONE (2014)

Spatial distribution of average annual mortality rates related to VL (per 100,000 inhabitants) based on multiple causes of death by municipalities of residence, Brazil, 2000–2011.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3974809&req=5

pone-0093770-g004: Spatial distribution of average annual mortality rates related to VL (per 100,000 inhabitants) based on multiple causes of death by municipalities of residence, Brazil, 2000–2011.
Mentions: In the period, 18.1% (1,010/5,565) of the Brazilian municipalities in 25 of 27 states reported at least one death related to VL. Figures 4 and 5 present the spatial distribution of the average annual crude and smoothed mortality rates, respectably. The Bayesian method generated more stable corrected mortality rates (Figure 5). Average annual crude rate reached a maximum of 9.5 deaths per 100,000 inhabitants, while the maximum of the smoothed indicator was 3.6 deaths per 100,000 inhabitants. In general, the thematic maps show the presence of municipalities and/or clusters of municipalities with high mortality rates related to VL (>0.5 deaths per 100,000 inhabitants) in states of North, Northeast, Southeast and Central-West regions. The largest concentration was found in the Northeast, covering areas in all nine states of this region (Figures 4–5). There were also areas with high mortality rates encompassing most of Tocantins and Mato Grosso do Sul states, central-north and west regions of Minas Gerais state, west region of São Paulo state, east and north regions of Goiás state and northeast region of Pará and Roraima states (Figures 4–5).

Bottom Line: Mortality and case fatality rates showed a significant increase in Brazil over the period, with different patterns between regions: increasing mortality rates in the North (Annual Percent Change--APC: 9.4%; 95% confidence interval--CI: 5.3 to 13.6), and Southeast (APC: 8.1%; 95% CI: 2.6 to 13.9); and increasing case fatality rates in the Northeast (APC: 4.0%; 95% CI: 0.8 to 7.4).Spatial analysis identified a major cluster of high mortality encompassing a wide geographic range in North and Northeast Brazil.Early diagnosis and treatment are fundamental strategies for reducing case fatality of VL in Brazil.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.

ABSTRACT

Background: Visceral leishmaniasis (VL) is a significant public health problem in Brazil and several regions of the world. This study investigated the magnitude, temporal trends and spatial distribution of mortality related to VL in Brazil.

Methods: We performed a study based on secondary data obtained from the Brazilian Mortality Information System. We included all deaths in Brazil from 2000 to 2011, in which VL was recorded as cause of death. We present epidemiological characteristics, trend analysis of mortality and case fatality rates by joinpoint regression models, and spatial analysis using municipalities as geographical units of analysis.

Results: In the study period, 12,491,280 deaths were recorded in Brazil. VL was mentioned in 3,322 (0.03%) deaths. Average annual age-adjusted mortality rate was 0.15 deaths per 100,000 inhabitants and case fatality rate 8.1%. Highest mortality rates were observed in males (0.19 deaths/100,000 inhabitants), <1 year-olds (1.03 deaths/100,000 inhabitants) and residents in Northeast region (0.30 deaths/100,000 inhabitants). Highest case fatality rates were observed in males (8.8%), ≥ 70 year-olds (43.8%) and residents in South region (17.7%). Mortality and case fatality rates showed a significant increase in Brazil over the period, with different patterns between regions: increasing mortality rates in the North (Annual Percent Change--APC: 9.4%; 95% confidence interval--CI: 5.3 to 13.6), and Southeast (APC: 8.1%; 95% CI: 2.6 to 13.9); and increasing case fatality rates in the Northeast (APC: 4.0%; 95% CI: 0.8 to 7.4). Spatial analysis identified a major cluster of high mortality encompassing a wide geographic range in North and Northeast Brazil.

Conclusions: Despite ongoing control strategies, mortality related to VL in Brazil is increasing. Mortality and case fatality vary considerably between regions, and surveillance and control measures should be prioritized in high-risk clusters. Early diagnosis and treatment are fundamental strategies for reducing case fatality of VL in Brazil.

Show MeSH
Related in: MedlinePlus