Socioeconomic Status of Guardians as a Risk Factor for Canine Visceral Leishmaniasis: A Cohort Study in an Endemic Area of the Federal District, Brazil

Current control measures of canine visceral leishmaniasis (CVL), a chronic and fatal zoonosis with potential transmission to humans, are not efficient enough to reduce its spread. The search for improved control measures should include studies of risk factors for infection and illness. This study aimed to identify the risk factors for CVL in an endemic locality of the Federal District, Brazil, from June 2016 to December 2018. Biologic samples and data on dog characteristics, owner household characteristics, and dog care were collected. A combination of serological and molecular tests was used to identify infected animals. The 248 dogs screened for inclusion were predominantly asymptomatic/oligosymptomatic. The baseline prevalence of infection was 27.5%. One hundred six of 162 susceptible dogs were monitored for an average period of 10.7 months. The estimated CVL incidence was 1.91 cases/100 dog-months. The multivariate analysis using a proportional Cox model included the potential risk factors, with P <= 0.25 in the univariate analyses. Greater purchasing power (hazard ratio [HR], 1.04; 95% CI, 1.01-1.06; P = 0.03) and paved yard (HR, 0.19; 95% CI, 0.13-1.01; P = 0.05) remained in the final model as risk and protection factors, respectively. The use of repellent collars in dogs was associated moderately (P = 0.08) with protection against CVL. Our findings reflect the challenge of identifying strong interventions for reducing CVL incidence. Increased owner wealth had a counterintuitive effect on CVL, making the intervention scenario more complex for a zoonosis traditionally associated with poverty.