This paper has an impressive topic with large potential information to be explored further. Almost all of components were described, only some minor improvements are required to make this manuscript better.

Title: 1. The title is presented in a modest style, even though it is still informative, relevant, and accurately represent the purpose and content of the descriptive study. It is however could be less appealing for some readers. The authors can choose other wordings such as “The Epidemiology of American Tegumentary Leishamaniasis in the Brazilian Amazon: based on 2010 – 2014 surveillance data”

Abstract 2. The abstract of this paper stated the aim of study clearly after provides concise background and a brief gap of current discussion around the topic. However it is very limited information on the abstract about the analysis technique used by the researchers both spatial and temporal approaches to answer the aim. It would be better to provide explanation about what was the unit of analysis (whether it was yearly or monthly or weekly basis, and how many districts or sub-districts or villages being examined)

1. The authors already well explained the spatial findings of the case distribution, unfortunately there is limited information about temporal pattern of the disease. The result could be enhanced by firstly describe of the total cases reported during 4 years of study, followed by the brief distribution of main findings.

2. The measurement of association used in the research was prevalence, it is could raise concern, considering that the disease being studied is infectious disease with short incubation period, therefore the authors need to consider to use incidence rates (IR) as alternative instead of using prevalence.

3. With the available data, actually the authors are highly possible to do more exploration both spatial and temporal approach, such as correlation and regression analysis. However, this study might be aimed only to provide baseline information for decision maker or further study

Conclusion 6. There is inconsistence of measurement, where in this section, the authors mention incidence. The statement that “the epidemiological profile remained unchanged” would be better to be supported by any single data/information in the result section. The authors are also suggested to provide temporal profile of disease incidence to support the conclusion.

References. All of references have been cited using proper citation technique

Introduction The introduction of this paper provided sufficient background of the topic by structurally discuss from broad / global issue of ATL until the third paragraph, where the authors started to discuss in the local context of the disease’s magnitude in Brazil. The authors also have stated clearly the aim of the study at the end of introduction section.

1. Aside from the information provided, there some rooms for improvement such as: the literature review in this section can be strengthen by more references particularly about the ATL distribution characteristics in Brazil from previous research (if any, for instance literature review or systematic review in Brazil) during certain period, therefore readers could have an overview about the pattern/ the condition of this disease in the past.

2. It also would be more interesting if the author discuss about why spatial and temporal approaches were chosen to present the findings, what is the strength of this technique based on previous application in research and decision making.

3. There is statement about health education/ awareness in the introduction section ( page 2, the last paragraph of introduction section) that even though still relevant to prevent disease distribution, it is however a little bit out of the focus as this manuscript discuss about distribution and transmission not about health promotion and education.

4. The authors already stated the design of this research is ecological study for Amazonas state, however, it is necessary to inform the readers what was the spatial unit of analysis whether it is at province or district or sub-district or village level. As well as the temporal unit of analysis.

5. It is very good that population of study was determined as all newly diagnosed cases of ATL diseases, it would be necessary to add explanation about the case definition (what kind examination: physical, laboratory, etc, who did the examination or test) to confirm of ATL positive cases, it would be better to refer to the national or international guidelines (such as WHO or Ministry of Health), and put the concise description in this section.

6. In order to answer the aim of study “identify the epidemiological profile of ATL and its spatial and temporal distribution in Amazonas from 2010 to 2014”, the descriptive analysis techniques chosen by the researchers was insufficient. The researchers could do more exploration of analysis using correlation and regression.

7. The results section supposed to only displays and informs about results of analysis, without any interpretation. Unfortunately, there are many findings were followed by interpretation such as in the sentences: Page 3, first paragraph: “… reinforce the magnitude of the higher burden of infection in males” Page 3, the second paragraph: “ The occurrence of HIV-ATL coinfection was low” and another statement Page 3, the last sentences of the second paragraph “this clearly indicated that the transmission pattern of the disease was not only wild, but also autochthonous …….” These interpretations should not be put here however can be kept and removed to discussion section.

8. Moreover, the percentage of HIV-ATL can’t be inferred as the final rates, as it does not represents the real percentage of the whole population because the testing rates was not 100%. The wording need to change such as “in 2012, among ATL patients, XX% were tested for HIV and 0.6% of them were confirmed as positive” here the final percentage cannot be used as a final conclusion.

9. Figure 2 (page 5) of box plot is interesting to present the distribution of ATL incidence to see the differences of means value from 5 years observed, however for temporal/ time series analysis, this kind of presentation did not optimally shows the history of diseases incidence over time. It is suggested to use trend and seasonal curves, particularly with monthly variation, it would be more interesting.

10. It would be interesting if the spatial analysis is performed not only for choropleth mapping of IR, but to be continued as cluster analysis and other types of analysis considering the available large spatial units.

11. The authors already stated explicitly the key findings at the beginning of this section. However, it seems one important result about cases distribution based on gender (male or female) was left undiscussed, whereas further discussion, rationale, justification and comparison from other studies would be interesting to explain a large difference between male and female percentage for each of 5 years observed.

12. The rest of discussion was well developed by providing possible explanation of each findings completed by comparison from other study as well as any logical mechanism. Unfortunately, the limitation of the research has not been stated in this section.

The general summary of research was clearly mentioned supported by the results, it was followed with recommendation policy and intervention required to tackle disease’s distribution