Spatial distribution of human visceral leishmaniasis and its relationship with socio-environmental indicators in são luís, maranhão, brazil

Human visceral leishmaniasis (HVL) is a neglected tropical disease undergoing urbanization in Brazil, and its intra-urban distribution reflects socio-environmental inequalities. This study analyzed the spatial and temporal distribution of HVL cases in the municipality of São Luís, Maranhão, from 2017 to 2020, and their relationship with socio-environmental indicators. This is a descriptive ecological study based on secondary data from the Notifiable Diseases Information System (Sinan), provided by the Municipal Health Department and aggregated by health district. Epidemiological indicators recommended by the Brazilian Ministry of Health were calculated, areas of case concentration were estimated with the Kernel estimator, and layers of per capita income, waste collection, sewage collection, population density, degree of urbanization, illegal waste dumping sites, and land use and land cover were overlaid. A total of 185 cases were recorded, decreasing from 59 in 2017 to 33 in 2020. The Tirirical district accounted for 33.0% of cases and the highest annual mean. Males (73.0%), children under 10 years of age (45.9%), and urban residents (81.6%) predominated. Case fatality over the period was 10.3%, reaching 18.2% in 2020. Disease epicenters coincided with areas of high population density, greater degree of urbanization, per capita income up to R$ 476.00, and illegal waste dumping, even where collection coverage was high. The results identify priority territories for surveillance, vector control, and early diagnosis, and reinforce the need for intersectoral action linking health, sanitation, and urban planning.