{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T08:45:53Z","timestamp":1785314753763,"version":"3.55.0"},"reference-count":33,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:00:00Z","timestamp":1747353600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Scabies and tungiasis are skin-related neglected tropical diseases (NTDs) associated with poverty and poor living conditions. We performed an ecological study covering a state in northeast Brazil to identify socio-economic and environmental factors associated with the occurrence of severe scabies and severe tungiasis, respectively. Data on disease occurrence on the municipality level were derived from a previous study based on online questionnaires. A total of 47 (26.0%) of the 181 state\u2019s municipalities reported severe tungiasis, and 113 (62.4%) severe scabies. Municipalities with occurrence of severe tungiasis were characterized by higher annual rainfalls (median = 883 mm vs. 741 mm; p = 0.037), higher minimum temperatures (median = 23.4 \u00b0C vs. 22.7 \u00b0C; p = 0.002), higher aridity indices indicating more humid climates (median = 45.1 vs. 50.6; p = 0.019), lower altitudes (median = 88.8 m vs. 201 m; p &lt; 0.001), higher mean air humidity (66.5% vs. 63%; p = 0.018), and better socioeconomic indices (Municipal Human Development Index [MHDI]\u2014median = 0.616 vs. 0.611; p = 0.048\/MHDI Longevity\u2014mean = 0.769 vs. 0.759; p = 0.007\/Municipal Development Index [MDI]\u2014median = 27.5 vs. 21.8; p &lt; 0.001). Municipalities with predominant luvisol soil characteristics had a lower risk for severe tungiasis (RR = 0.46; 95% CI = 0.27\u20130.79; p = 0.003), whereas municipalities with predominant gleysols had a significantly higher risk (RR = 2.44; 95% CI = 1.43\u20134.15; p = 0.010). Municipalities with occurrence of severe scabies were characterized by significantly higher annual rainfalls (median = 804 mm vs. 708 mm; p = 0.001), higher minimum temperatures (23.1 \u00b0C vs. 22.3 \u00b0C; p &lt; 0.001), higher aridity index (median = 48.2 vs. 41.9; p = 0.014), higher air humidity (65.9% vs. 61%; p = 0.001), lower altitudes (median = 153 m vs. 246 m; p = 0.003), and better socio-economic indicators (MHDI\u2014median = 0.616 vs. 608; p= 0.012\/MHDI Education\u2014mean = 0.559 vs. 0.541; p = 0.014\/MDI\u2014median = 24.3 vs. 21.1; p = 0.005). In multivariate regression analysis, MDI remained significantly associated with the presence of severe tungiasis in the final model (RR = 1.04; 95% CI: 1.02\u20131.05; p &lt; 0.001) and the presence of severe scabies with minimum temperature (RR = 1.13; 95% CI: 1.04\u20131.24; p = 0.003) and aridity index (RR = 1.01; 95% CI: 1.00\u20131.01; p = 0.004). Our study underscores the importance of environmental and socioeconomic factors for the occurrence of severe scabies and tungiasis in a semi-arid climatic context, offering a perspective for identification of high-risk areas, and providing evidence for the control of skin NTDs withina One Health approach.<\/jats:p>","DOI":"10.3390\/tropicalmed10050135","type":"journal-article","created":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T05:11:57Z","timestamp":1747372317000},"page":"135","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Environmental and Social Factors Associated with the Occurrence of Severe Tungiasis and Scabies in the State of Cear\u00e1, Brazil: An Ecological Study"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3612-0106","authenticated-orcid":false,"given":"Nathiel","family":"Silva","sequence":"first","affiliation":[{"name":"Postgraduate Course in Public Health, School of Medicine, Federal University of Cear\u00e1, Rua Prof. Costa Mendes 1608-5, Andar, Fortaleza 60430-140, Cear\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2967-532X","authenticated-orcid":false,"given":"Carlos Henrique","family":"Alencar","sequence":"additional","affiliation":[{"name":"Postgraduate Course in Public Health, School of Medicine, Federal University of Cear\u00e1, Rua Prof. Costa Mendes 1608-5, Andar, Fortaleza 60430-140, Cear\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7845-5510","authenticated-orcid":false,"given":"Jorg","family":"Heukelbach","sequence":"additional","affiliation":[{"name":"Postgraduate Course in Public Health, School of Medicine, Federal University of Cear\u00e1, Rua Prof. Costa Mendes 1608-5, Andar, Fortaleza 60430-140, Cear\u00e1, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"152","DOI":"10.2471\/BLT.07.047308","article-title":"Epidermal parasitic skin diseases: A neglected category of poverty-associated plagues","volume":"87","author":"Feldmeier","year":"2009","journal-title":"Bull World Health Organ."},{"key":"ref_2","unstructured":"World Health Organization (2022). 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