Visceral leishmaniasis (VL) is endemic in 70 countries and has been reported in 12 countries of Latin America, with over 90% of the cases reported in Brazil, where epidemics have occurred since 1980. The objective of this review is to describe the factors associated with the occurrence of VL epidemics in humans in urban areas. A systematic review was conducted according to the PRISMA-P guidelines. The databases PubMed (by Medline), Cochrane Library, Embase, Amed, LILACS and grey literature [Google Scholar and handsearch of the database of the Information System for Notifiable Diseases (SINAN) of Brazil's Unified Health System] were used. The protocol was registered under PROSPERO (CRD42019128998). Climatic, environmental factors and indicators of urban social structure were described as influencing the outbreaks in the North and Northeast regions. Gender and age characteristics were related to a greater chance of developing VL in the Central-West, Northeast and Southeast regions. Vector indicators showed a positive correlation with the incidence of VL in studies in the Northeast region. In the Southeast and Northeast regions, studies revealed the presence of dogs with positive correlation with VL. Knowledge gaps remain regarding the contribution to the increase in the risk factors described in ecological approaches, as no analysis was performed at the individual level, and it is still necessary to discuss the influence of other associated elements in epidemic episodes in the spread of VL.

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.

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O presente estudo buscou investigar o impacto da implantação da Rede Cegonha sobre a mortalidade materna e os números de partos cesárea realizados na Macrorregião de Saúde Jequitinhonha, MG, comparativamente aos índices nacionais. Tratou-se de uma pesquisa quanti-qualitativa. A abordagem foi feita pela coleta de dados relativos ao período de 1994 a 2019, a partir do Sistema de Informações sobre Nascidos Vivos. Em relação aos dados de mortalidade materna, foi abordado o período de 2000 a 2019 (Brasil) e 2006 a 2019 (Macrorregião) com a busca de dados no Sistema de Informações sobre Mortalidade, sendo aplicado o teste “t” de Student para avaliar possíveis diferenças antes e após a implantação da Rede Cegonha. Os resultados indicam a inexistência de diferença significativa entre o número de mortes maternas antes e após a implantação da Rede Cegonha, mas uma reversão muito significativa da Razão de Mortalidade Materna e do número de partos cesárea, quando se avaliou a linha de tendência em ambos os casos, tanto no Brasil, quanto na Macrorregião de Saúde Jequitinhonha, MG. Estes resultados demonstram a eficácia e a importância da adesão a esta estratégia governamental, bem como do acompanhamento rotineiro dos indicadores relativos à Rede Cegonha no país.