Premature deaths by visceral leishmaniasis in Brazil investigated through a cohort study: A challenging opportunity?

BACKGROUND: Visceral Leishmaniasis (VL) is the most severe form of leishmaniasis because it can lead to death. In the Americas, 96% of cases are in Brazil, and despite efforts, the fatality rate has increased in the past years. We analyzed deaths associated to VL in Brazil and investigated the factors that could influence on the timeliness of fatal outcome with emphasis on time (tStoD). METHODOLOGY: The registered deaths by VL were sourced from the Brazilian National Notification System from 2007-2014. Through a retrospective cohort study, univariate and multivariable Cox proportional hazards model analysis were performed and investigated the factors that could influence the time (tStoD). These factors were analyzed through survival models. RESULTS: Out of the 1,589 reported deaths, the median for onset of the symptoms and the case notification date (tStoN) is 25 days (10-61), and for date of case notification and death (tNotD) is 9 days (4-17). The time (tStoN) to event investigation for HIV non-infected individuals was 1.4 (1.16-1.68) greater than the HIV positive group. At the same time peri-urban and urban area were 0.83 (0.47-1.44) and 1.33 (1.16-1.52), respectively. The explorations revealed apparent differences between the time to event investigation (both for tStoN and tNotD) and the age at the onset of the symptoms. According to the tStoN the rate of notification is 1.73 times greater in patients under 5 years old at the onset of the clinical symptoms compared to older patients. CONCLUSION: VL patients under 5 years old were diagnosed earlier and had shorter survival. It could mean that in younger population, although properly diagnosed, the fatality pattern might be related to the severity of the disease. Main host characteristics were evaluated, and age and co-infections seem to have an impact in the disease progression.

SisLeish: A multi-country standardized information system to monitor the status of Leishmaniasis in the Americas.

BACKGROUND: In the Americas, leishmaniasis is endemic in 18 countries, and from 2001 through 2015, 17 countries reported 843,931 cases of cutaneous and mucocutaneous leishmaniasis, and 12 countries reported 52,176 cases of visceral leishmaniasis. A Regional Information System (SisLeish) was created in order to provide knowledge of the distribution and tendency of this disease to analyze and monitor the leishmaniasis status. This article analyses the performance and progress of SisLeish from 2012-2015. METHODOLOGY: The performance of SisLeish was evaluated by country adhesion, data completeness and delay in entering the data, and also by the SWOT technique. Furthermore, we outlined the structure and modus operandi of the system and indicators utilized. RESULTS: In 2012, only 18% of the countries entered the data in SisLeish before the deadline, where 66.7% and 50% of the countries with autochthonous CL/ML and VL reported their cases to the system, respectively. Whereas in 2015, 59% of the countries reached the deadline, where 94.4% and 58.3% of the countries reported their CL/ML and VL data, respectively. Regarding data completeness, there was great progress for different variables since its launch, such as gender, which had an approximately 100% improvement from 2012 to 2015. The SWOT analysis of SisLeish showed 12 strengths, 11 opportunities, seven weaknesses and six threats. CONCLUSIONS: From 2012-2015 there has been an improvement in the adhesion, quality and data completeness, showing the effort of the majority of the countries to enhance their national database. The SWOT analysis demonstrated that strengths and opportunities exceed weaknesses and threats; however, it highlighted the system frailties and challenges that need to be addressed. Furthermore, it has stimulated several National Programs to advance their surveillance system. Therefore, SisLeish has become an essential tool to prioritize areas, assist in decision-making processes, and to guide surveillance and control actions.