Risk factors, representations and practices associated with emerging urban human visceral leishmaniasis in Posadas, Argentina.

INTRODUCTION: Visceral leishmaniasis is an often overlooked disease with high lethality rates about which there is need of additional local studies to inform the design of effective control strategies. The urbanization of its transmission has already been verified in America, with domestic dogs being the primary reservoirs and vectors of the disease. Socio-economic conditions, demographics and practices of domestic groups typically present in urban settings may play a specific role in the transmission of the infection, which is still poorly understood.  OBJECTIVE: To analyze the sociodemographic characteristics, risk factors and overall practices concerning prevention and coping strategies of visceral leishmaniasis, in both human beings and canines.  MATERIALS AND METHODS: This study utilized a cross-sectional case-control design. Cases were defined as a domestic group where the Public Health Ministry had at least one record of a member with human visceral leishmaniasis. Control cases were defined as a domestic group without a clinical record of the disease. The populations were characterized demographically and socially using primary information sources. Measures of household quality and a ranking of knowledge and attitudes towards visceral leishmaniasis were constructed, and practices associated with the presence, and the risk for canine visceral leishmaniasis were described.  RESULTS: Low household quality (p≤0.001), a member of the domestic group out of the household after 6:00 pm (OR=4.4; 95% CI: 1.69-12.18), the uncontrolled racial breeding of dogs (OR=15.7; 95% CI: 3.91-63.2), and the presence of infected dogs infected in the household (OR=120.3; 95% CI: 18.51-728.3) were variables positively associated with the risk of infection.  CONCLUSION: We observed certain social risk factors, primarily low household quality and overcrowding, associated with structural poverty that could increase human-vector contact probability. The most important risk factor for human visceral leishmaniasis was the possession of infected dogs in the household.

Factores de riesgo, representaciones y prácticas asociadas con la leishmaniasis visceral humana en un foco urbano emergente en Posadas, Argentina / Risk factors, representations and practices associated with emerging urban human visceral leishmaniasis in Posadas, Argentina

Introducción. La leishmaniasis visceral es una enfermedad desatendida de alta letalidad que amerita que se profundice en los estudios locales para diseñar estrategias efectivas de control. En América, su transmisión ya se ha evidenciado en las zonas urbanas, en donde el reservorio principal es el perro doméstico. Las condiciones socioeconómicas, así como las representaciones y las prácticas de los grupos domésticos podrían desempeñar un papel crucial y poco conocido en su transmisión. Objetivo. Analizar las representaciones y las prácticas de prevención y afrontamiento de la leishmaniasis visceral humana y canina, así como los factores socioeconómicos de riesgo. Materiales y métodos. Se hizo un estudio transversal de casos y controles. Se definió´caso´ como un grupo doméstico en el que, al menos, un integrante tuviera antecedentes de leishmaniasis visceral humana y hubiera sido notificado por el Ministerio de Salud Pública. El´control´ se definió como un grupo doméstico sin integrantes con antecedentes de la enfermedad. A partir de la información primaria, se caracterizó demográfica y socialmente a la población, se estableció la calidad de las viviendas, se hizo una clasificación de los conocimientos y las actitudes en torno a la enfermedad, y se describieron las prácticas asociadas al riesgo y la presencia de leishmaniasis visceral canina. Resultados. La mala calidad de la vivienda (p=0,001), las personas del grupo doméstico que permanecían fuera de esta después de las 18 horas (razón de momios, OR ( odds ratio) =4,5; IC 95% 1,69-12,18), la reproducción sin control de la raza canina (OR=15,7; IC 95% 3,91-63,2) y la presencia de leishmaniasis visceral canina en el domicilio (OR=120,3; IC 95% 18,51-728,3), se asociaron positivamente o incrementaron el riesgo de contraer leishmaniasis visceral humana. Conclusión. Se observó que la pobreza estructural constituía un factor social determinante del riesgo, y que aumentaba la probabilidad de contacto entre humanos y vectores por la mala calidad de la vivienda y el hacinamiento. El factor de riesgo más importante para la leishmaniasis visceral humana fue la tenencia en el domicilio de perros con la enfermedad.

Introduction: Visceral leishmaniasis is an often overlooked disease with high lethality rates about which there is need of additional local studies to inform the design of effective control strategies. The urbanization of its transmission has already been verified in America, with domestic dogs being the primary reservoirs and vectors of the disease. Socio-economic conditions, demographics and practices of domestic groups typically present in urban settings may play a specific role in the transmission of the infection, which is still poorly understood. Objective: To analyze the sociodemographic characteristics, risk factors and overall practices concerning prevention and coping strategies of visceral leishmaniasis, in both human beings and canines. Materials and methods: This study utilized a cross-sectional case-control design. Cases were defined as a domestic group where the Public Health Ministry had at least one record of a member with human visceral leishmaniasis. Control cases were defined as a domestic group without a clinical record of the disease. The populations were characterized demographically and socially using primary information sources. Measures of household quality and a ranking of knowledge and attitudes towards visceral leishmaniasis were constructed, and practices associated with the presence, and the risk for canine visceral leishmaniasis were described. Results: Low household quality (p=0.001), a member of the domestic group out of the household after 6:00 pm (OR=4.4; 95% CI: 1.69-12.18), the uncontrolled racial breeding of dogs (OR=15.7; 95% CI: 3.91-63.2), and the presence of infected dogs infected in the household (OR=120.3; 95% CI: 18.51-728.3) were variables positively associated with the risk of infection. Conclusion: We observed certain social risk factors, primarily low household quality and overcrowding, associated with structural poverty that could increase human-vector contact probability. The most important risk factor for human visceral leishmaniasis was the possession of infected dogs in the household.

Cambio organizacional en el Estado Local como estrategia para enfrentar la emergencia de Leishmaniasis Visceral en la ciudad de Posada, Misiones: 2006-2011 / Organizational Change in Local State as a strategy to tackle the emergence of Visceral Leishmaniasis in the city of Posada, Misiones: 2006-2011

La problemática epidemiológica representada por la aparición de casos autóctonos de Leishmaniasis Visceral Humana (LVH) en la ciudad de Posadas/Provincia de Misiones - República Argentina, a partir de 2006 y el accionar de la Municipalidad de Posadas orientado a hacer frente a esa enfermedad emergente, demarca un contexto particular para intentar estudiar en profundidad lógicas organizativas y de gestión de las instituciones de salud a partir de un escenario de crisis. ¿Qué condiciones, desarrollo y resultados ha implicado la estrategia del sistema sanitario local (municipal) para enfrentar la emergencia en la población humana de una enfermedad parasitaria de carßcter endémica y de transmisión vectorial como el representado por la LV, por cierto, sin antecedentes para la ciudad?. ¿Cómo ha evolucionado esa respuesta a lo largo de los últimos seis a±os?. Frente a esas preguntas y problemas que formulamos, este documento apunta a presentar las respuestas elaboradas a partir de un estudio de tipo descriptivo cuanti-cualitativo y longitudinal cuya principal estrategia de producción de datos fue la colecta, sistematización y anßlisis de información primaria, y en menor medida, secundaria en el ßmbito del Estado local, particularmente de la Secretaría de Calidad de Vida de la Municipalidad de Posadas, ciudad capital de la provincia...

The epidemiological problem represented by the appearance of native cases of human Visceral Leishmaniasis (HVL) in the city of Posadas, Misiones Province - Argentine Republic since 2006 and the actions of the municipality of Posadas aimed to address this emerging disease, defines a particular context to try studying in depth the organizational logic and management of health institutions during a crisis scenario. What conditions, development and results have involved the strategy of the local (municipal) health system to confront the emergency in the human population of a parasitic disease of endemic characteristics and vector transmitted such as that of VL, certainly unprecedented for the city? How has that response evolved over the past six years? Faced with those questions and problems that we formulated, this document aims to provide answers elaborated from a qualitative, quantitative and longitudinal descriptive study whose main strategy of data production was the collection, systematization and analysis of primary data, and to a lesser extent, secondary in the realm of local State, particularly the Secretary of Quality of Life of Posadas municipality, capital city of the province...