{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T02:04:54Z","timestamp":1747188294537,"version":"3.40.5"},"reference-count":33,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T00:00:00Z","timestamp":1691366400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To analyse the flow of cases of visceral leishmaniasis (VL) in the state of Cear\u00e1, Brazil, between 2007 and 2021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An ecological study was conducted using a spatial approach of newly confirmed cases of VL recorded in the Notifiable Diseases Information System. We identified individuals whose municipality of diagnosis differed from that of their residence. Flow maps, constructed using Tabwin 32 and ArcMap 9.2, allowed for the identification of the volume of traffic between the municipality of residence and that of initial care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 6775 confirmed VL cases. As a flow indicator, 178 counties had at least one resident diagnosed in another municipality in Cear\u00e1, with 2491 VL cases and an average trip of 79\u2009km. The largest hub for receiving cases for diagnosis was the capital Fortaleza (1478 patients from 129 other municipalities), followed by Sobral, located in the northwestern region of Cear\u00e1 (599 from 55 municipalities), and Barbalha, in the southern region (171 from 29 municipalities). In this southern region, 25 municipalities moved 55 people for treatment to Juazeiro do Norte and 11 municipalities moved 39 patients to Crato. A total of 255 patients with VL from 11 municipalities in other Brazilian states, mainly from the Northeast and North, were observed and notified in health services in Cear\u00e1.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The major centres of VL diagnosis outside residence were in the cities of Fortaleza, Sobral, Barbalha, Juazeiro do Norte and Crato. There was also an outflow of cases from other municipalities located in the northeastern and northern regions of Brazil. The flows were more intense during the first triennium of the analysis and milder from 2019 to 2021. Understanding the diagnostic flow of VL helps in decision making and the development of public policies to improve the lives of the population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13918","type":"journal-article","created":{"date-parts":[[2023,8,7]],"date-time":"2023-08-07T08:51:09Z","timestamp":1691398269000},"page":"780-789","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis of visceral leishmaniasis in Cear\u00e1 state, Brazil: A flow analysis of cases between 2007 and 2021"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7501-3995","authenticated-orcid":false,"given":"Kellyn Kessiene","family":"de Sousa Cavalcante","sequence":"first","affiliation":[{"name":"Federal University of Cear\u00e1, Pos\u2010graduated program of Public Health Medicine College  Fortaleza Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1299-9133","authenticated-orcid":false,"given":"Francisco Roger Aguiar","family":"Cavalcante","sequence":"additional","affiliation":[{"name":"Centro Universit\u00e1rio INTA\u2014UNINTA  Sobral Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4487-5509","authenticated-orcid":false,"given":"Reagan Nzundu","family":"Boigny","sequence":"additional","affiliation":[{"name":"Centro Universit\u00e1rio INTA\u2014UNINTA  Sobral Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3554-1918","authenticated-orcid":false,"given":"Kelvia Maria Oliveira","family":"Borges","sequence":"additional","affiliation":[{"name":"Secretaria de Sa\u00fade do Estado do Cear\u00e1\u2014SESA, Coordenadoria de Vigil\u00e2ncia e Preven\u00e7\u00e3o em Sa\u00fade  Fortaleza Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2967-532X","authenticated-orcid":false,"given":"Carlos Henrique","family":"Alencar","sequence":"additional","affiliation":[{"name":"Federal University of Cear\u00e1, Pos\u2010graduated program of Public Health Medicine College  Fortaleza Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,8,7]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.5123\/S1679-49742016000300012"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0007639"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.36489\/saudecoletiva.2021v11i68p7629-7646"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/281572"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.25248\/reas.e6931.2021"},{"volume-title":"Leishmaniasis: epidemiological report in the Americas","year":"2021","author":"Pan American Health Organization","key":"e_1_2_7_7_1"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0009567"},{"issue":"28","key":"e_1_2_7_9_1","first-page":"121","article-title":"A import\u00e2ncia da an\u00e1lise de distribui\u00e7\u00e3o espacial da leishmaniose visceral humana e canina para as a\u00e7\u00f5es de vigil\u00e2ncia em sa\u00fade","volume":"14","author":"D'Andrea LAZ","year":"2018","journal-title":"Hygeia"},{"volume-title":"Secretaria de Vigil\u00e2ncia em Sa\u00fade. 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