Perfil epidemiológico e padrões espaciais da doença de chagas no Estado do Maranhão entre os anos de 2001 e 2020

Abstract

Chagas disease (CD) is a neglected parasitic disease, caused by the hemoflagellate protozoan Trypanosoma cruzi (CHAGAS, 1909). In the state of Maranhão, the disease does not have a clear pattern of distribution. The present study aimed to discuss the epidemiological aspects and spatial distribution of Chagas disease in the state of Maranhão, between the years 2001 and 2020. Acute cases of CD obtained from the Notifiable Diseases Information System database were analyzed. (SINAN). The following variables were analyzed: year of notification, sex, age group, race/color, area of residence, likely location of infection, mode of infection, autochthonous case, criteria and evolution of the case. To examine whether there was a difference in the medians of confirmed cases by age group, race/color, mode of infection and confirmation criteria, the Kruskal-Wallis (H) analysis was used. To examine whether there was a difference in the medians of confirmed cases by sex, area of residence, place of infection, autochthonous case and case evolution, the Mann-Whitney (U) test was used. The significance level adopted was 5% (p < 0.05). To create maps of the regions of Maranhão, the software QGIS 3.14 was used. The calculation of spatial autocorrelation and covariance based on the product of deviations in relation to the mean was carried out using the Moran’s index (I) Global Moran index. 77 cases of acute CD were confirmed from 2001 to 2020 in the state. The majority of cases were reported in males (45 cases; 58.5%; U = 179.5; p = 0.28), aged between 20 and 39 years (26 cases; 34.6%; H = 28.4; p = 0.0008), in individuals of mixed race/color (41 cases; 53.6%; H = 26.7; p < 0.0001), in individuals living in rural areas (33 cases; 68.8%; H = 11.36; p = 0.0034), with the home as the place of infection (40 cases; 71.5%; U = 165.0; p = 0.11), form of oral infection (43 cases; 68.4%; U = 168.0; p = 0.13) and diagnosis laboratory (69 cases; 93.2%; U = 88.0; p = 0.0001). Autochthonous cases predominated (50 cases, 86.8%; U = 163.5; p = 0.08), while for case evolution the prevalence of survival was verified (55 cases; 90.2%; U = 169, 5; p = 0.11). The spatial autocorrelation was random, with global Moran values between 0.013 and 0.001 (Municipalities), 0.100 and 0.185 (Macroregion), 0.114 and 0.100 (Microregion) and 0.141 and 0.087 (Immediate Region), however, the formation of significant clusters. Identification of the epidemiological profile of CD in the state of Maranhão is extremely important to generate information for health surveillance, as well as to motivate discussion about new intervention alternatives for preventing the disease.