Social and environmental determinants of Neglected infectious diseases in quilombola communities of the Brazilian Amazon: An epidemiological and machine learning analysis

Neglected infectious diseases (NIDs) remain a major public health challenge in the Amazon, particularly among quilombola populations living in rural and riverside territories marked by historical inequalities and structural limitations. This study examined the occurrence of NIDs in eight quilombola communities in the Lower Amazon, identified socioenvironmental factors associated with these conditions, and evaluated the performance of machine learning models in predicting individual risk of illness. This analytical cross-sectional study included 518 participants, with data collected through a structured questionnaire. Descriptive and bivariate analyses were conducted, followed by multivariable logistic regression, Poisson regression, cluster analysis, and predictive modeling using Random Forest, XGBoost, and Logistic Regression. Spatial analysis was performed in Google Colab. The overall prevalence of at least one NID was 34.7%. Lack of sanitation facilities, use of river or well water, precarious housing, inadequate waste disposal, low income, and residence in rural areas were significantly associated with both the occurrence and number of NIDs per individual. XGBoost and Random Forest achieved the best predictive performance (AUC-ROC 0.87 and 0.85, respectively). Cluster analysis revealed distinct vulnerability profiles, with the highest burden observed among groups characterized by multidimensional poverty and limited sanitation. The findings highlight the overlapping social and environmental determinants that sustain the persistence of NIDs in these territories, underscoring the need for structural, territorialized policies tailored to the specific realities of quilombola communities in the Amazon. The cross-sectional design and reliance on self-reported disease history should be considered when interpreting the findings.