Abstract
Leptospirosis displays a great diversity of routes of exposure, reservoirs, etiologic agents, and clinical symptoms. It occurs almost worldwide but its pattern of transmission varies depending where it happens. Climate change may increase the number of cases, especially in developing countries, like Brazil. Spatial analysis studies of leptospirosis have highlighted the importance of socioeconomic and environmental context. Hence, the choice of the geographical scale and unit of analysis used in the studies is pivotal, because it restricts the indicators available for the analysis and may bias the results. In this study, we evaluated which environmental and socioeconomic factors, typically used to characterize the risks of leptospirosis transmission, are more relevant at different geographical scales (i.e., regional, municipal, and local). Geographic Information Systems were used for data analysis. Correlations between leptospirosis incidence and several socioeconomic and environmental indicators were calculated at different geographical scales. At the regional scale, the strongest correlations were observed between leptospirosis incidence and the amount of people living in slums, or the percent of the area densely urbanized. At the municipal scale, there were no significant correlations. At the local level, the percent of the area prone to flooding best correlated with leptospirosis incidence.
Highlights
IntroductionLeptospirosis is a multifactorial disease that is well correlated with environmental (e.g., rainfall regime, temperature, topography, etc.), as well as, socioeconomic factors (e.g., sanitation conditions, population education, land use, etc.)
Leptospirosis is a multifactorial disease that is well correlated with environmental, as well as, socioeconomic factors
To identify and discuss the environmental and socioeconomic determinants associated with the occurrence of leptospirosis at different geographical scales, three scales were chosen for the study, considering the political hierarchical divisions of the Brazilian Federative Republic: a state level, in which the health surveillance is performed by the state health secretary; a municipal level, where the occurrence of diseases are monitored by the municipal health secretary; and a local level, where the basic health units managers have to report the incidence of notifiable diseases to the municipal health secretary
Summary
Leptospirosis is a multifactorial disease that is well correlated with environmental (e.g., rainfall regime, temperature, topography, etc.), as well as, socioeconomic factors (e.g., sanitation conditions, population education, land use, etc.). The form and intensity of leptospirosis transmission can vary due to its diversity of reservoirs and serovars. It occurs almost worldwide, leptospirosis transmission patterns vary as a function of the region where it arises [1]. The transmission is limited, and usually associated with animal husbandry or some occupational activities, such as when workers are be exposed to contaminated waters [2,3,4,5]. Leptospirosis occurrence in developing countries is related with intense and rapid urbanization without adequate infrastructure, resulting in sanitation problems, especially in poor vulnerable areas (i.e., slums) located close to rivers or channels, prone to periodical flooding.
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