# Spatio-Temporal Analysis and Clinical-Epidemiological Characterization of Visceral Leishmaniasis in Maranhão, Brazil, from 2009 to 2020

## TL;DR

This study maps the spread and characteristics of visceral leishmaniasis in Brazil's Maranhão state from 2009 to 2020, identifying high-risk areas and patient profiles.

## Contribution

The study provides a spatio-temporal and clinical-epidemiological analysis of VL in Maranhão, revealing trends and risk factors previously unquantified in the region.

## Key findings

- VL incidence increased from 2009 to 2018 but decreased in 2019-2020.
- High-risk areas are concentrated in central-west and central-east regions of Maranhão.
- Most affected patients are young males with incomplete schooling and brown skin.

## Abstract

This study was carried out to identify the spatial distribution and characterize the clinical–epidemiological profile of Visceral Leishmaniasis (VL) in Maranhão state, Brazil, from 2009 to 2020. This descriptive ecological study collected sociodemographic and clinical data of VL cases from the Brazilian Notifiable Diseases Information System database. A spatial autocorrelation analysis (Moran statistics) was performed. From 2009 to 2020, 5699 cases of VL were reported, with incidence of 6.5 cases/100,000 and prevalence of 7.1 cases/100,000. The temporal analysis showed a significant growth in incidence from 2009 to 2018, followed by a significant decrease between 2019 and 2020. The Moran map shows hotspots of high values in the central–west and central–east regions, and hotspots of low values in the northern region of Maranhão. The profile of patients affected by VL comprises males (OR = 1.8; IC95% = 1.72–1.92), aged under 14 years, brown, and with incomplete elementary schooling. The main symptoms reported were fever, fatigue, and edema. The main diagnostic method was laboratory. The mortality rate was 6.8%, and co-infection with HIV was reported by 8.5% of patients. The results of this study indicated the increase in incidence and lethality, as well as the expansion, of leishmaniasis in the state of Maranhão.