Sociodemographic and Environmental Risk Factors for American Cutaneous Leishmaniasis (ACL) in the State of Alagoas, Brazil

The multiplicity of factors involved in the transmission of the American cutaneous leishmaniasis (ACL) constitutes a challenge to its control. Thus, knowledge of such factors may contribute extremely toward redefining the control strategies. The aim of this study was to identify sociodemographic and environmental factors relating to ACL transmission in the State of Alagoas, Brazil. A case-control study with incident cases was conducted. Diagnostic criteria were the presence of compatible skin lesions, laboratory confirmation, and clinical cure after treatment. Two control groups were matched to cases by sex and age: one comprising neighbors and the other from a community-based draw; controls were individuals with no lesion and a negative Montenegro intradermal reaction. Between July 1, 2004 and February 1, 2007, 98 cases and the same number of controls per group were selected. In the multivariate analysis, for both control groups, ACL was associated with absence of a gas stove and forest less than 200 m away; for neighborhood controls with schooling of 4 years or less, family income greater than one minimum salary, birds inside the home, forest-related leisure activities, and rural work or school activities; and for community controls with non-durable wall material in the house, per capita income greater than US$ 28.31, animals inside the house, and absence of dogs and cats around the house. Specific control measures are recommended for areas with similar characteristics: protection for individuals undertaking forest-related leisure activities; distancing houses from forests by more than 200 m; and elimination of bird or other animal-rearing inside homes. General measures of improved housing and living conditions are also recommended.