ABSTRACT
ABSTRACT Patients with Chagas disease have reduced health-related quality of life (HRQoL). Hence, we aimed to identify the factors that mostly affected their HRQoL. This was a systematic review of qualitative studies. The Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Web of Science, and SciVerse Scopus databases were searched for relevant studies without language or date restrictions. The search and data analysis were performed by independent reviewers; all qualitative studies that reported the factors that had an impact on the HRQoL of patients with Chagas disease were included. The risk of bias was assessed using the Critical Appraisal Skills Program Qualitative Study Checklist; confidence in the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative approach. Five studies were included in this review: four in Brazil and one in California, United States, with immigrants from Central and South America. The sample consisted of 207 patients with chronic Chagas disease. Stigma, physical limitations, work absenteeism, emotional or mental aspects, fear of treatment, and fear of the future had the strongest impact on the HRQoL. All items showed moderate confidence except for fear of treatment (low confidence). The physical, emotional, mental, and cultural aspects affected the HRQoL of patients with chronic Chagas disease. Identification of these factors is important in the development of strategies aimed at improving the HRQoL of this population.
ABSTRACT
ABSTRACT Visceral leishmaniasis (VL) has shown endemic pattern and epidemic episodes in urban and rural areas, however, there are still gaps in knowledge with regards to disease transmission. This study aimed to analyze the spatiotemporal dispersion of VL cases in the municipality of Araçuaí, Minas Gerais. A study of confirmed VL cases was conducted considering the endemic and epidemic periods between 2012 and 2017. The incidence rate was calculated, and for spatial analysis, the kernel map, directional distribution ellipse, and space-time scanning techniques were used. The correlations between VL cases and exposure variables (precipitation, humidity, and temperature) were calculated. The mean incidence of VL in the endemic period was 18.5 (95% confidence interval (CI) 5.9-32.5) and 44.4 in the epidemic period (95%CI, 12.0-28.6) by 100,000 inhabitants. The relative risk for the epidemic period was 2.4 (95% CI 1.4-4.1) when compared to the endemic period. A higher incidence of the disease was observed in rural areas of the municipality. Kernel mapping analysis revealed hotspots in the urban area of the municipality. The directional distribution ellipse encompasses the urban perimeter and part of the rural area of the municipality, expanding eastward during the epidemic period. Spatial analysis revealed a high-risk cluster for VL in rural areas. A positive correlation was observed between VL cases and temperature during the endemic period. Spatial analysis allowed us to outline the epidemiological scenario of human VL cases. These findings may be useful in case surveillance and in the work of health professionals and managers in Brazil.