1
|
Grossi de Oliveira AL, Brito RMDM, Siqueira WF, Parreiras de Jesus AC, Bueno LL, Fujiwara RT. IgG seroprevalence of Toxoplasma gondii and Leishmania infantum in leprosy patients: Implications for screening and management of co-infections. Diagn Microbiol Infect Dis 2024; 110:116405. [PMID: 38906031 DOI: 10.1016/j.diagmicrobio.2024.116405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 06/23/2024]
Abstract
Parasitic co-infections are common in developing countries and can interfere with leprosy treatment, leading to an increased risk of inflammatory leprosy reactions. This study assessed serum immunoglobulin G (IgG) levels against Toxoplasma gondii and Visceral Leishmaniasis (VL) antigens in 270 leprosy patients from Brazilian states. Regarding the respective cut-offs, the prevalence of IgG seropositivity for T. gondii and VL were 21.05 % and 47.36 % in the leprosy-negative group, and 77.7 % and 52.6 % in the leprosy-positive group. Of the 270 leprosy patients, 158 (58.5 %) presented with inflammatory leprosy reactions. Of those, 72 (59.5 %) had neuritis, 35 (48.6 %) had reverse reactions, and 28 (38.9 %) had ENL in both Brazilian states. Leprosy patients with anti-Leishmania IgG seropositivity were 3.25 times more likely to develop neuritis (95 % C.I.: 1.187 - 9.154; p = 0.019). These findings are particularly relevant for clinical settings where both leprosy and parasitic diseases are prevalent and could provide essential guidance for detecting and addressing complications arising from parasitic co-infections in leprosy patients, thereby improving clinical management strategies.
Collapse
Affiliation(s)
- Ana Laura Grossi de Oliveira
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Imunobiologia e Controle de Parasitos, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Ramayana Morais de Medeiros Brito
- Programa de Pós-Graduação em Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Imunobiologia e Controle de Parasitos, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Williane Fernanda Siqueira
- Laboratório de Imunoquímica de Proteínas, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Augusto César Parreiras de Jesus
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Imunobiologia e Controle de Parasitos, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Lilian Lacerda Bueno
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Programa de Pós-Graduação em Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Imunobiologia e Controle de Parasitos, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Ricardo Toshio Fujiwara
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Programa de Pós-Graduação em Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Imunobiologia e Controle de Parasitos, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| |
Collapse
|
2
|
Wahyuni LK, Nelfidayani N, Harini M, Anestherita F, Wardhani RK, Menaldi SL, Irawati Y, Rahayu T, Andayani G, Daniel H, Savitri I, Hariyanto PKY, Paramita IA. The International Classification of Functioning, Disability and Health to map leprosy-related disability in rural and remote areas in Indonesia. PLoS Negl Trop Dis 2024; 18:e0011539. [PMID: 38771890 PMCID: PMC11161106 DOI: 10.1371/journal.pntd.0011539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 06/07/2024] [Accepted: 03/29/2024] [Indexed: 05/23/2024] Open
Abstract
The International Classification of Function, Disability, and Health (ICF-WHO, 2001) recognizes several dimensions of disability, such as body structure and function (and impairment thereof), activity (and activity restrictions) and participation (and participation restriction) and their interactions with contextual factor (personal and environmental). In this study, we map and analyse the relationship between the components of ICF in leprosy patients from two rural areas in Indonesia: Lewoleba (East Nusa Tenggara) and Likupang (North Minahasa). This study was part of a community outreach program by the KATAMATAKU team from Universitas Indonesia. The body structure was graded using the WHO hand and feet disability grade and the number of enlarged nerves, while the body function was measured by the Jebsen Taylor Hand Function Test (JTT) and Timed-up and Go (TUG). Activity limitation and participation restriction were measured using the Screening Activity Limitation Safety Awareness (SALSA) Scale and Participation Scale (P-scale), respectively. There were 177 leprosy patients from the two regions and 150 patients with complete data were included in the analysis. We found 82% (95% CI: 75.08%-87.32%) of subjects with multibacillary leprosy, 10.67% (95% CI: 6.67%-16.62%) of subjects with grade 2 WHO hand disability, and 9.33% (95% CI: 5.64%-15.06%) of subjects with grade 2 WHO foot disability. Assessment using the SALSA Scale showed 29.33% of subjects with limitation activity and 11.33% with participation restriction. Age was shown to have positive correlations with SALSA, JTT, and TUG. Inter-dimensional analysis showed that the SALSA scale had significant positive correlations with the number of nerve enlargements, P-scale, JTT, and TUG. SALSA scores of grade 2 WHO hand and foot disability were also significantly higher than grades 1 and 0. The participation scale also had a positive correlation with JTT but not TUG. Hand disability seemed to affect societal participation while foot did not. We used the ICF to describe and analyse dimensions of leprosy-related disability in Indonesia.
Collapse
Affiliation(s)
- Luh Karunia Wahyuni
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nelfidayani Nelfidayani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Melinda Harini
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fitri Anestherita
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rizky Kusuma Wardhani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sri Linuwih Menaldi
- Department of Dermatology and Venereology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yunia Irawati
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tri Rahayu
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Gitalisa Andayani
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Hisar Daniel
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Intan Savitri
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Petrus Kanisius Yogi Hariyanto
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Isabela Andhika Paramita
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine Universitas Indonesia, dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Genomik Solidaritas Indonesia (GSI) Laboratory, Jakarta, Indonesia
| |
Collapse
|
3
|
Govindasamy K, Darlong J, Watson SI, Gill P. Prevalence of plantar ulcer and its risk factors in leprosy: a systematic review and meta-analysis. J Foot Ankle Res 2023; 16:77. [PMID: 37953361 PMCID: PMC10641946 DOI: 10.1186/s13047-023-00674-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/22/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Plantar ulcers are a leading complication of leprosy that requires frequent visits to hospital and is associated with stigma. The extent of burden of ulcers in leprosy and its risk factors are scant impeding the development of targeted interventions to prevent and promote healing of ulcers. The aim of this review is to generate evidence on the prevalence of plantar ulcer and its risk factors in leprosy. METHODS Databases (Medline, Embase, Web of Science, CINAHL, BVS), conference abstracts and reference lists were searched for eligible studies. Studies were included that reported a point prevalence of plantar ulcer and/or its "risk factors" associated with development of ulcers (either causatively or predictively), including individual level, disease related and bio-mechanical factors. We followed PRISMA guidelines for this review. Random-effects meta-analysis was undertaken to estimate the pooled point prevalence of ulcers. Reported risk factors in included studies were narratively synthesised. This review is registered in PROSPERO: CRD42022316726. RESULTS Overall, 15 studies (8 for prevalence of ulcer and 7 for risk factors) met the inclusion criteria. The pooled point prevalence of ulcer was 34% (95% CIs: 21%, 46%) and 7% (95% CIs: 4%, 11%) among those with foot anaesthesia and among all people affected by leprosy, respectively. Risk factors for developing ulcers included: unable to feel 10 g of monofilament on sensory testing, pronated/hyper-pronated foot, foot with peak plantar pressure, foot with severe deformities, and those with lower education and the unemployed. CONCLUSIONS The prevalence of plantar ulceration in leprosy is as high as 34% among those with loss of sensation in the feet. However, the incidence and recurrence rates of ulceration are least reported. The inability to feel 10 g of monofilament appears to be a strong predictor of those at risk of developing ulcers. However, there is a paucity of evidence on identifying those at risk of developing plantar ulcers in leprosy. Prospective studies are needed to estimate the incidence of ulcers. Identifying individuals at risk of ulcers will help design targeted interventions to minimize risk factors, prevent ulcers and promote ulcer healing.
Collapse
Affiliation(s)
- Karthikeyan Govindasamy
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
- Research Domain, The Leprosy Mission Trust India, New Delhi, India.
| | - Joydeepa Darlong
- Research Domain, The Leprosy Mission Trust India, New Delhi, India
| | - Samuel I Watson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Paramjit Gill
- Warwick Centre for Global Health, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| |
Collapse
|
4
|
Santos LSD, Drummond MR, Goulart IMB, França AFEDC, Souza EMD, Ferreira Velho PEN. Bartonella henselae as a putative trigger for chronic type 2 leprosy reactions. Braz J Infect Dis 2023; 27:103701. [PMID: 37980941 PMCID: PMC10709108 DOI: 10.1016/j.bjid.2023.103701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/20/2023] [Accepted: 10/31/2023] [Indexed: 11/21/2023] Open
Abstract
Leprosy reactions are an acute inflammatory phenomenon that can arise before diagnosis, during treatment, or after cure of leprosy. These reactions are considered one of the main diseases that cause physical disabilities. Immunosuppressive treatment for these immune responses makes these patients susceptible to coinfections, which can trigger new leprosy reactions. The main objective of this study was to evaluate the occurrence of infection by Bartonella sp. in blood samples from 47 patients who had untreatable episodes of type 2 leprosy reactions for more than six months, comparing them with a control group. Cultures and molecular methods (PCR) were used. Amplicons from species-specific reactions and sequencing showed a higher prevalence of Bartonella henselae infection in patients, 19/47 (40.4 %), compared to control, 9/50 (18.0 %), p = 0.0149. Five patients accepted treatment for coinfection, and all showed improvement in leprosy reactions with treatment for B. henselae infection. We conclude that these bacteria can trigger chronic reactions of type 2 leprosy and should be investigated in these patients. SUMMARY LINE: Patients who have chronic type 2 leprosy reactions are more susceptible to Bartonella henselae infection than controls: 19/47 (40.4 %) compared 9/50 (18.0 %), p = 0.0149.
Collapse
Affiliation(s)
- Luciene Silva Dos Santos
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil.
| | - Marina Rovani Drummond
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil
| | - Isabela Maria Bernardes Goulart
- Universidade Federal de Uberlândia, Centro Nacional de Referência em Dermatologia Sanitária e Hanseníase, Uberlândia, MG, Brazil
| | | | - Elemir Macedo de Souza
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Medicina, Divisão de Dermatologia, Campinas, SP, Brazil
| | - Paulo Eduardo Neves Ferreira Velho
- Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Laboratório de Pesquisa Aplicada em Dermatologia e Infecção por Bartonella, Campinas, SP, Brazil; Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Medicina, Divisão de Dermatologia, Campinas, SP, Brazil
| |
Collapse
|
5
|
Gama MEF, Pereira ADPC. Trend of pediatric leprosy in an endemic area in Northeast of Brazil, 2008-2018. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023:S2529-993X(23)00254-X. [PMID: 37919202 DOI: 10.1016/j.eimce.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 06/16/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The incidence of leprosy in children is an important indicator of the disease's tendency in the general population and suggests intense circulation and transmission of Mycobacterium leprae. OBJECTIVES To describe the clinical, epidemiological characteristics and temporal dynamics of leprosy cases in children under 15 years of age from 2008 to 2018 in an endemic municipality. METHODS A descriptive study with an analytical approach was carried out with data from leprosy cases registered in the Brazilian Information System on Notifiable Diseases for the municipality of Cabo de Santo Agostinho, Pernambuco, Brazil. RESULTS Between 2008 and 2018, 112 new cases of leprosy were registered. Most cases were classified as paucibacillary leprosy and occurred in children living in urban areas. There was no significant difference in the incidence of leprosy during the study period. Only 4.5% of the sample presented reactional episodes, but a high number of cases were not evaluated for the occurrence of reactions. CONCLUSIONS The findings of this study show a high incidence of paucibacillary leprosy in children and adolescents, which reveals active transmission in the community and failures in the detection of new multibacillary cases among adults. Children between 10 and 14 years old are more vulnerable to M. leprae infection and mainly develop paucibacillary leprosy.
Collapse
Affiliation(s)
- Maria Eugênia Farias Gama
- Municipal Health Secretariat in Recife, Health District VI, Recife, Brazil; Facultad Interamericana de Ciencias Sociales, Maestría en Salud Pública, Brazil.
| | - Aline de Paula Caetano Pereira
- Facultad Interamericana de Ciencias Sociales, Maestría en Salud Pública, Brazil; Hospital da Restauração Governador Paulo Guerra, Recife, Brazil
| |
Collapse
|
6
|
Carvalho AG, Dias CLH, Blok DJ, Ignotti E, Luz JGG. Intra-urban differences underlying leprosy spatial distribution in central Brazil: geospatial techniques as potential tools for surveillance. GEOSPATIAL HEALTH 2023; 18. [PMID: 37902566 DOI: 10.4081/gh.2023.1227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023]
Abstract
This ecological study identified an aggregation of urban neighbourhoods spatial patterns in the cumulative new case detection rate (NCDR) of leprosy in the municipality of Rondonópolis, central Brazil, as well as intra-urban socioeconomic differences underlying this distribution. Scan statistics of all leprosy cases reported in the area from 2011 to 2017 were used to investigate spatial and spatiotemporal clusters of the disease at the neighbourhood level. The associations between the log of the smoothed NCDR and demographic, socioeconomic, and structural characteristics were explored by comparing multivariate models based on ordinary least squares (OLS) regression, spatial lag, spatial error, and geographically weighted regression (GWR). Leprosy cases were observed in 84.1% of the neighbourhoods of Rondonópolis, where 848 new cases of leprosy were reported corresponding to a cumulative NCDR of 57.9 cases/100,000 inhabitants. Spatial and spatiotemporal high-risk clusters were identified in western and northern neighbourhoods, whereas central and southern areas comprised low-risk areas. The GWR model was selected as the most appropriate modelling strategy (adjusted R²: 0.305; AIC: 242.85). By mapping the GWR coefficients, we identified that low literacy rate and low mean monthly nominal income per household were associated with a high NCDR of leprosy, especially in the neighbourhoods located within high-risk areas. In conclusion, leprosy presented a heterogeneous and peripheral spatial distribution at the neighbourhood level, which seems to have been shaped by intra-urban differences related to deprivation and poor living conditions. This information should be considered by decision-makers while implementing surveillance measures aimed at leprosy control.
Collapse
Affiliation(s)
- Amanda G Carvalho
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, Rondonópolis, Brazil; Post-Graduation Program in Health Sciences, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá.
| | - Carolina Lorraine H Dias
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, Rondonópolis.
| | - David J Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam.
| | - Eliane Ignotti
- Post-Graduation Program in Health Sciences, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Brazil; Post-Graduation Program in Environmental Sciences, School of Health Sciences, State University of Mato Grosso, Cáceres.
| | - João Gabriel G Luz
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, Rondonópolis.
| |
Collapse
|
7
|
Lua I, Silva AF, Guimarães NS, Magno L, Pescarini J, Anderle RV, Ichihara MY, Barreto ML, Teles Santos CA, Chenciner L, Souza LE, Macinko J, Dourado I, Rasella D. The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individuals. LANCET REGIONAL HEALTH. AMERICAS 2023; 24:100554. [PMID: 37521440 PMCID: PMC10372893 DOI: 10.1016/j.lana.2023.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
Background Social determinants of health (SDH) include factors such as income, education, and race, that could significantly affect the human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). Studies on the effects of SDH on HIV/AIDS are limited, and do not yet provide a systematic understanding of how the various SDH act on important indicators of HIV/AIDS progression. We aimed to evaluate the effects of SDH on AIDS morbidity and mortality. Methods A retrospective cohort of 28.3 million individuals was evaluated over a 9-year period (from 2007 to 2015). Multivariable Poisson regression, with a hierarchical approach, was used to estimate the effects of SDH-at the individual and familial level-on AIDS incidence, mortality, and case-fatality rates. Findings A total of 28,318,532 individuals, representing the low-income Brazilian population, were assessed, who had a mean age of 36.18 (SD: 16.96) years, 52.69% (14,920,049) were female, 57.52% (15,360,569) were pardos, 34.13% (9,113,222) were white/Asian, 7.77% (2,075,977) were black, and 0.58% (154,146) were indigenous. Specific socioeconomic, household, and geographic factors were significantly associated with AIDS-related outcomes. Less wealth was strongly associated with a higher AIDS incidence (rate ratios-RR: 1.55; 95% confidence interval-CI: 1.43-1.68) and mortality (RR: 1.99; 95% CI: 1.70-2.34). Lower educational attainment was also greatly associated with higher AIDS incidence (RR: 1.46; 95% CI: 1.26-1.68), mortality (RR: 2.76; 95% CI: 1.99-3.82) and case-fatality rates (RR: 2.30; 95% CI: 1.31-4.01). Being black was associated with a higher AIDS incidence (RR: 1.53; 95% CI: 1.45-1.61), mortality (RR: 1.69; 95% CI: 1.57-1.83) and case-fatality rates (RR: 1.16; 95% CI: 1.03-1.32). Overall, also considering the other SDH, individuals experiencing greater levels of socioeconomic deprivation were, by far, more likely to acquire AIDS, and to die from it. Interpretation In the population studied, SDH related to poverty and social vulnerability are strongly associated with a higher burden of HIV/AIDS, most notably less wealth, illiteracy, and being black. In the absence of relevant social protection policies, the current worldwide increase in poverty and inequalities-due to the consequences of the COVID-19 pandemic, and the effects of war in the Ukraine-could reverse progress made in the fight against HIV/AIDS in low- and middle-income countries (LMIC). Funding National Institute of Allergy and Infectious Diseases (NAIDS), National Institutes of Health (NIH), US Grant Number: 1R01AI152938.
Collapse
Affiliation(s)
- Iracema Lua
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- Department of Health, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
| | - Andrea F. Silva
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Nathalia S. Guimarães
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Laio Magno
- Department of Life Sciences, State University of Bahia (UNEB), Salvador, Bahia, Brazil
| | - Julia Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rodrigo V.R. Anderle
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Mauricio L. Barreto
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Carlos A.S. Teles Santos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Louisa Chenciner
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Oxford, UK
- Oxford University Hospitals, Oxford, UK
- Department of Infection and Immunity, St George's University London, London, UK
| | - Luis Eugênio Souza
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Ines Dourado
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
8
|
da Silva MLFI, de Farias SJM, Silva APDSC, Rodrigues MOS, de Oliveira ECA. Spatial patterns of new leprosy cases in a northeastern state of Brazil, 2011-2021. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230014. [PMID: 36820751 PMCID: PMC9949489 DOI: 10.1590/1980-549720230014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/25/2022] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To analyze the spatial patterns of leprosy in Pernambuco from 2011 to 2021. METHODS This is an ecological epidemiological study, carried out with data from the Notifiable Diseases Information System, based on new cases of leprosy among inhabitants of Pernambuco, between 2011-2021. An empirical Bayesian analysis of local and spatial dependence was performed with the global and local Moran indices. RESULTS 25,008 new cases of leprosy were registered with an annual case detection rate in the general population of 16.51 cases/100,000 inhabitants - which is considered high. Among those younger than 15 years of age, there were 5.16 cases/100,000 inhabitants (high) and 0.89/100,000 inhabitants with degree II of physical disability (low); there were also many high-risk cases with an overall Moran index of 0.33 (p<0.001), active transmission (0.26; p<0.001), and subsequent diagnosis of the disease (0.12; p<0.006), as well as distribution in macro-region 1 and macro-region 4. CONCLUSION There was a heterogeneous spatial distribution in the state, showing two overviews, the first being the presence of municipalities with high risk of disease transmission and the second with clusters of silent municipalities, reinforcing the character of leprosy neglect as a major public health problem. This study brings reflections for leprosy control actions, due to the identification of priority areas to combat this disease in Pernambuco.
Collapse
|
9
|
Silva MLFID, Farias SJMD, Silva APDSC, Rodrigues MOS, Oliveira ECAD. Padrões espaciais dos casos novos de hanseníase em um estado nordestino do Brasil, 2011–2021. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023. [DOI: 10.1590/1980-549720230014.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
RESUMO Objetivo: Analisar os padrões espaciais da hanseníase em Pernambuco no período de 2011 a 2021. Métodos: Trata-se de um estudo epidemiológico ecológico, realizado com dados do Sistema de Informações de Agravos de Notificação com base nos casos novos de hanseníase em residentes de Pernambuco, entre 2011–2021. Foi realizada uma análise bayesiana empírica local e de dependência espacial com os índices de Moran global e local. Resultados: Foram registrados 25.008 casos novos de hanseníase com coeficiente médio anual de detecção de casos novos na população geral de 16,51 casos/100 mil habitantes — classificado como alto. Na população menor de 15 anos, ocorreu 5,16 casos/100 mil habitantes (muito alto) e 0,89/100 mil habitantes com grau II de incapacidade física (baixo) com aglomerados de alto risco para ocorrência com índice global de Moran de 0,33 (p<0,001), transmissão ativa (0,26; p<0,001) e diagnóstico tardio da doença (0,12; p<0,006), localizados na macrorregião 1 e na macrorregião 4. Conclusão: Houve uma distribuição espacial heterogênea no estado, evidenciando dois panoramas, o primeiro, a presença de municípios com alto risco de transmissão da doença e, o segundo, aglomerados de municípios silenciosos reforçando o caráter de negligência da hanseníase como grande problema de saúde pública. Este estudo traz reflexões para ações de controle da hanseníase, dada a identificação de áreas prioritárias para o enfrentamento dess\a doença em Pernambuco.
Collapse
|
10
|
Palma FAG, Costa F, Lustosa R, Mogaji HO, de Oliveira DS, Souza FN, Reis MG, Ko AI, Begon M, Khalil H. Why is leptospirosis hard to avoid for the impoverished? Deconstructing leptospirosis transmission risk and the drivers of knowledge, attitudes, and practices in a disadvantaged community in Salvador, Brazil. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000408. [PMID: 36962720 PMCID: PMC10022107 DOI: 10.1371/journal.pgph.0000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022]
Abstract
Several studies have identified socioeconomic and environmental risk factors for infectious disease, but the relationship between these and knowledge, attitudes, and practices (KAP), and more importantly their web of effects on individual infection risk, have not previously been evaluated. We conducted a cross-sectional KAP survey in an urban disadvantaged community in Salvador, Brazil, leveraging on simultaneously collected fine-scale environmental and epidemiological data on leptospirosis transmission. Residents' knowledge influenced their attitudes which influenced their practices. However, different KAP variables were driven by different socioeconomic and environmental factors; and while improved KAP variables reduced risk, there were additional effects of socioeconomic and environmental factors on risk. For example, males and those of lower socioeconomic status were at greater risk, but once we controlled for KAP, male gender and lower socioeconomic status themselves were not direct drivers of seropositivity. Employment was linked to better knowledge and a less contaminated environment, and hence lower risk, but being employed was independently associated with a higher, not lower risk of leptospirosis transmission, suggesting travel to work as a high risk activity. Our results show how such complex webs of influence can be disentangled. They indicate that public health messaging and interventions should take into account this complexity and prioritize factors that limit exposure and support appropriate prevention practices.
Collapse
Affiliation(s)
| | - Federico Costa
- Federal University of Bahia, Salvador/Institute Health Collective, Salvador, Bahia, Brazil
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil
| | - Ricardo Lustosa
- Federal University of Bahia, Salvador/Institute Health Collective, Salvador, Bahia, Brazil
| | - Hammed O. Mogaji
- Federal University of Bahia, Salvador/Institute Health Collective, Salvador, Bahia, Brazil
| | | | - Fábio Neves Souza
- Federal University of Bahia/Institute of Biology, Salvador, Bahia, Brazil
| | - Mitermayer G. Reis
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Federal University of Bahia, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Albert I. Ko
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Michael Begon
- Department of Evolution, Ecology and Behaviour, The University of Liverpool, United Kingdom
| | - Hussein Khalil
- Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, Umeå, Sweden
| |
Collapse
|
11
|
Parente EDO, Leal M, Kendall C, Mota RMS, Pires Neto RDJ, Macena RHM, Kerr L. Leprosy among female prisoners in Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:4485-4492. [DOI: 10.1590/1413-812320222712.08842022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract To estimate the prevalence of leprosy among Brazilian female prisoners and identify factors associated with the disease. Cross-sectional study conducted between 2014 and 2015 in 15 Brazilian female prisons. The data of 1,327 women were collected using Audio Computer-Assisted Self-Interviewing and dermatological and neurological examination to identify suspicious lesions of leprosy. The average age was 33.4 years. Suspicion of leprosy was identified in 5.1% of women in prison, and lifetime self-reported prevalence was 7.5%. The variables that were associated with lifetime self-reported leprosy were: women in prison once being twice as likely to have leprosy; white women were 1.4 time more likely to have leprosy than non-white women; women who knew someone with leprosy was 1.9 time more likely to have leprosy; and women who shared a cell with 11 or more women were 2.5 times more likely to have leprosy than women who shared a cell with two or fewer people. The leprosy prevalence among female prisoners in Brazil were greater than that found in a Brazilian woman of the general population and show the extremely high vulnerability of this population generated through pre-incarceration poverty, as well as potential transmission in prison.
Collapse
|
12
|
Abdul Rahman N, Rajaratnam V, Burchell GL, Peters RMH, Zweekhorst MBM. Experiences of living with leprosy: A systematic review and qualitative evidence synthesis. PLoS Negl Trop Dis 2022; 16:e0010761. [PMID: 36197928 PMCID: PMC9576094 DOI: 10.1371/journal.pntd.0010761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/17/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective of the review was to identify, appraise, and synthesise qualitative studies on the lived experience of individuals diagnosed with leprosy, the impact of the disease, and how they coped with the disease burden. INTRODUCTION Leprosy is a chronic disease with long-term biopsychosocial impact and is a leading cause of preventable disabilities. It traps the individuals with leprosy in a vicious circle of disease, stigma, and poverty. The efforts to reduce stigma and discrimination and improve their quality of life have not kept pace with the success of the multidrug treatment. INCLUSION CRITERIA This review considered published literature on the lived experience of individuals diagnosed with leprosy. There were no limitations on gender, background, or country. All qualitative or mixed-methods studies were accepted. METHODS The review followed the JBI meta-aggregation approach for qualitative systematic reviews. A structured literature search was undertaken using multiple electronic databases: PubMed, Embase, Web of Science, and CINAHL. RESULTS The search identified 723 publications, and there were 446 articles after deduplication. Forty-nine studies met the inclusion criteria. The final 173 findings were synthesised into ten categories and aggregated into four synthesised findings: biophysical impact, social impact, economic impact, and mental and emotional impact. These synthesised findings were consistent across the included studies from a patient's perspective. The way people coped with leprosy depended on their interpretation of the disease and its treatment. It affected their help-seeking behaviour and their adherence to treatment and self-care. The review has identified a multi-domain effect on the affected individuals, which goes beyond the biological and physical effects, looking at the social issues, specific difficulties, emotions, and economic hardships. CONCLUSIONS The researchers, health professionals, and policymakers could use the synthesised findings to address the concerns and needs of the leprosy-affected individuals and offer appropriate support to manage their lives. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO Registration number: CRD42021243223.
Collapse
Affiliation(s)
- Norana Abdul Rahman
- CRE, Perdana University, Kuala Lumpur, Malaysia
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Netherlands
- * E-mail:
| | | | | | - Ruth M. H. Peters
- Faculty of Science, Athena Institute, Vrije Universiteit Amsterdam, Netherlands
| | | |
Collapse
|
13
|
Timothy JWS, Rogers E, Halliday KE, Mulbah T, Marks M, Zaizay Z, Giddings R, Kempf M, Marion E, Walker SL, Kollie KK, Pullan RL. Quantifying Population Burden and Effectiveness of Decentralized Surveillance Strategies for Skin-Presenting Neglected Tropical Diseases, Liberia. Emerg Infect Dis 2022; 28:1755-1764. [PMID: 35997318 PMCID: PMC9423900 DOI: 10.3201/eid2809.212126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We evaluated programmatic approaches for skin neglected tropical disease (NTD) surveillance and completed a robust estimation of the burden of skin NTDs endemic to West Africa (Buruli ulcer, leprosy, lymphatic filariasis morbidity, and yaws). In Maryland, Liberia, exhaustive case finding by community health workers of 56,285 persons across 92 clusters identified 3,241 suspected cases. A total of 236 skin NTDs (34.0 [95% CI 29.1–38.9]/10,000 persons) were confirmed by midlevel healthcare workers trained using a tailored program. Cases showed a focal and spatially heterogeneous distribution. This community health worker‒led approach showed a higher skin NTD burden than prevailing surveillance mechanisms, but also showed high (95.1%) and equitable population coverage. Specialized training and task-shifting of diagnoses to midlevel health workers led to reliable identification of skin NTDs, but reliability of individual diagnoses varied. This multifaceted evaluation of skin NTD surveillance strategies quantifies benefits and limitations of key approaches promoted by the 2030 NTD roadmap of the World Health Organization.
Collapse
|
14
|
da Conceição JR, Lopes CPG, Ferreira EI, Epiphanio S, Giarolla J. Neglected tropical diseases and systemic racism especially in Brazil: from socio-economic aspects to the development of new drugs. Acta Trop 2022; 235:106654. [PMID: 35988823 DOI: 10.1016/j.actatropica.2022.106654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/28/2022]
Abstract
Neglected tropical diseases (NTDs) are highly prevalent communicable diseases in tropical and subtropical countries, generally not economically attractive for drug development and related to poverty. In Brazil, more specifically, socioeconomic inequalities and health indicators are strongly influenced by skin color, race, and ethnicity, due to the historical process of slavery. In this context, it is important to understand the concept of systemic racism: a form of indirect racial discrimination present in many institutions, which determines the process of illness and death of the black population, the ethnic group most affected by these diseases. The main objective of this paper was to carry out a literature review on the socioeconomic aspects of these diseases, relating them to institutional racism, and to encourage reflection on the influence of this type of racism in the NTDs context. Therefore, we present a paper that brings a evident correlation between racism versus neglected populations, which are affected by equally neglected diseases. A more humane and comprehensive view is needed to realize that these illnesses affect neglected and vulnerable populations, who require decent living conditions, health, and social justice. We hope to provide, with this paper, enough, but not exhaust, knowledge to initiate the discussion about neglected diseases, their socioeconomic aspects and institutional racism.
Collapse
Affiliation(s)
- Juliana Rodrigues da Conceição
- Department of Pharmacy, School of Pharmaceutical Sciences, University of São Paulo, Brasil, Avenida Prof. Lineu Prestes, 580, Cidade, Universitária
| | - Cecília Petrilli Gatti Lopes
- Department of Pharmacy, School of Pharmaceutical Sciences, University of São Paulo, Brasil, Avenida Prof. Lineu Prestes, 580, Cidade, Universitária
| | - Elizabeth Igne Ferreira
- Department of Pharmacy, School of Pharmaceutical Sciences, University of São Paulo, Brasil, Avenida Prof. Lineu Prestes, 580, Cidade, Universitária
| | - Sabrina Epiphanio
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, Brasil, Avenida Prof. Lineu Prestes, 580, Cidade, Universitária
| | - Jeanine Giarolla
- Department of Pharmacy, School of Pharmaceutical Sciences, University of São Paulo, Brasil, Avenida Prof. Lineu Prestes, 580, Cidade, Universitária.
| |
Collapse
|
15
|
Penna GO, Pontes MADA, Nobre ML, Pinto LF. National Health Survey reveals high percentage of signs and symptoms of leprosy in Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:2255-2258. [PMID: 35649013 DOI: 10.1590/1413-81232022276.18322021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
Abstract
Leprosy is a debilitating, infectious, systemic or localized dermato-neurological disease caused by Mycobacterium lepra. In Brazil, the magnitude and high disabling power keep the disease as a public health problem. Skin spotting and numbness are pathognomonic signs and symptoms in leprosy. The Instituto Brasileiro de Geografia e Estatística (IBGE) 2019 National Health Survey (PNS-2019) considered the following question as a proxy to estimate its magnitude in the country. "Do you have a spot with numbness or part of the skin with numbness?". In Brazil, 1,921,289 adults reported having a patch or part of the skin with numbness, with no regional differences. As for the age group, the older, the higher the prevalence, for example, between 18 to 29 years old (235,445) and 30 to 39 years old (236,485), 0.7% had the condition, between 40 to 59 years old (827,887), 1.5% and among the elderly, 1.8% (621,472). Being able to estimate, in population-based surveys, with statistical representativeness, a reported morbidity such as leprosy is essential to support the formulation of public policies, notably those related to primary health care actions. In this way, the IBGE fulfills its constitutional role of portraying the reality of the Brazilian population and today it is the main external evaluator of the Unified Health System (SUS) and of public policies developed by the federal level.
Collapse
Affiliation(s)
- Gerson Oliveira Penna
- Núcleo de Medicina Tropical, Universidade de Brasília. Escola de Governo - Fiocruz Brasília. SQN 112 bloco J, 307. 70762-100 Brasília DF Brasil.
| | | | - Mauricio Lisboa Nobre
- Hospital Giselda Trigueiro, Secretaria Estadual de Saúde do Rio Grande do Norte. Natal RN Brasil
| | - Luiz Felipe Pinto
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil
| |
Collapse
|
16
|
Klowak M, Boggild AK. A review of nutrition in neuropathic pain of leprosy. Ther Adv Infect Dis 2022; 9:20499361221102663. [PMID: 35677111 PMCID: PMC9168857 DOI: 10.1177/20499361221102663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 05/03/2022] [Indexed: 11/15/2022] Open
Abstract
Leprosy is a neglected tropical disease (NTD) that continues to burden low- and
middle-income countries (LMICs), despite being eliminated as a public health
concern by the World Health Organization (WHO) in 2000. The causative agents,
Mycobacterium leprae and Mycobacterium
lepromatosis, affect nearly 200,000 individuals globally each year,
with over 19,000 new cases detected in the Americas in 2020 alone. Canada has
experienced an increasing incidence of leprosy, due to rising levels of travel
and migration from endemic areas, reaching over 37,000 individuals with leprosy
by the end of 2020. Patients experience a spectrum of signs and symptoms
including hypopigmented cutaneous macules alongside peripheral neuropathy
including peripheral neuropathic pain (PNP) and disabling sensory neuropathies.
Despite the development of effective and curative therapeutics
via multidrug therapy (MDT), many barriers to treatment
adherence and effective immunological control of the pathogen challenge the care
of patients with leprosy. Socioeconomic barriers, such as disability-related
social stigma and often undiagnosed nutritional deficiencies, have resulted in
heightened disease severity. PNP therapeutics are associated with significant
side effects and remain ineffective as the majority of individuals will not
experience a greater than 30% reduction of symptoms. Nutrient supplementation is
known to be instrumental in reducing host oxidative stress, strengthening the
immune system and mitigating comorbidities. Likewise, dietary lifestyle
interventions known to be physiologically beneficial have recently emerged as
powerful tools conferring neuroprotective effects, potentially mitigating PNP
severity. However, a significant knowledge gap concerning the effect of adequate
nutrition on host immunological control of leprosy and PNP severity exists.
Further evaluation of this relationship will provide key insight into the
pathogenesis of leprosy, strengthening the current body of literature.
Collapse
Affiliation(s)
- Michael Klowak
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Andrea K. Boggild
- Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Barreto ML, Ichihara MY, Pescarini JM, Ali MS, Borges GL, Fiaccone RL, Ribeiro-Silva RDC, Teles CA, Almeida D, Sena S, Carreiro RP, Cabral L, Almeida BA, Barbosa GCG, Pita R, Barreto ME, Mendes AAF, Ramos DO, Brickley EB, Bispo N, Machado DB, Paixao ES, Rodrigues LC, Smeeth L. Cohort Profile: The 100 Million Brazilian Cohort. Int J Epidemiol 2022; 51:e27-e38. [PMID: 34922344 PMCID: PMC9082797 DOI: 10.1093/ije/dyab213] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Julia M Pescarini
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - M Sanni Ali
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Center for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Gabriela L Borges
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Rosemeire L Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Rita de Cássia Ribeiro-Silva
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Carlos A Teles
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Daniela Almeida
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Samila Sena
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Roberto P Carreiro
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Liliana Cabral
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Bethania A Almeida
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - George C G Barbosa
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Robespierre Pita
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Marcos E Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Statistics, London School of Economics and Political Science, London, UK
| | - Andre A F Mendes
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Dandara O Ramos
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Elizabeth B Brickley
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Nivea Bispo
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Statistics, Federal University of Bahia, Salvador, Brazil
| | - Daiane B Machado
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Enny S Paixao
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura C Rodrigues
- Centre for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
18
|
The effect of conditional cash transfers on the control of neglected tropical disease: a systematic review. Lancet Glob Health 2022; 10:e640-e648. [PMID: 35427521 DOI: 10.1016/s2214-109x(22)00065-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are diseases of poverty and affect 1·5 billion people globally. Conditional cash transfer (CCTs) programmes alleviate poverty in many countries, potentially contributing to improved NTD outcomes. This systematic review examines the relationship between CCTs and screening, incidence, or treatment outcomes of NTDs. METHODS In this systematic review we searched MEDLINE, Embase, Lilacs, EconLit, Global Health, and grey literature websites on Sept 17, 2020, with no date or language restrictions. Controlled quantitative studies including randomised controlled trials (RCTs) and observational studies evaluating CCT interventions in low-income and middle-income countries were included. Any outcome measures related to WHO's 20 diseases classified as NTDs were included. Studies from high-income countries were excluded. Two authors (AA and TH) extracted data from published studies and appraised risk of biases using the Risk of Bias in Non-Randomised Studies of Interventions and Risk of Bias 2 tools. Results were analysed narratively. This study is registered with PROSPERO, CRD42020202480. FINDINGS From the search, 5165 records were identified; of these, 11 studies were eligible for inclusion covering four CCTs in Brazil, the Philippines, Mexico, and Zambia. Most studies were either RCTs or quasi-experimental studies and ten were assessed to be of moderate quality. Seven studies reported improved NTD outcomes associated with CCTs, in particular, reduced incidence of leprosy and increased uptake of deworming treatments. There was some evidence of greater benefit of CCTS in lower socioeconomic groups but subgroup analysis was scarce. Methodological weaknesses include self-reported outcomes, missing data, improper randomisation, and differences between CCT and comparator populations in observational studies. The available evidence is currently limited, covering a small proportion of CCTs and NTDs. INTERPRETATION CCTs can be associated with improved NTD outcomes, and could be driven by both improvements in living standards from cash benefits and direct health effects from conditionalities related to health-care use. This evidence adds to the knowledge of health-improving effects from CCTs in poor and vulnerable populations. FUNDING None.
Collapse
|
19
|
Linhares MSC, Kerr LRFS, Kendall C, Almeida RLFD, Klovdahl A, Frota CC. Spatial distribution pattern of new leprosy cases under 15 years of age and their contacts in Sobral, Ceará, Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:1641-1652. [PMID: 35475842 DOI: 10.1590/1413-81232022274.06902021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/02/2021] [Indexed: 11/22/2022] Open
Abstract
This study's objective was to analyze the spatial distribution pattern of new leprosy cases under 15 years and their contacts. A cross-sectional descriptive study covering sociodemographic characteristics and spatial analysis was carried out. The participants were from the city of Sobral, Ceará and the study was conducted between August 2014 and September 2015. Contacts were identified by the persons responsible for the children. Seropositivity was determined with the NDO-LID antigen, and positive cases were plotted on Voronoi polygons. Nine new cases of leprosy under 15 years of age have been found. The average number of people living with the cases was higher than the number of people living with non-household contacts. All household contacts were aware of other leprosy cases and had a higher rate of seropositive tests than non-household contacts. The index cases lived in the poorest regions of the municipality and hyper-endemic areas. Spatial analysis revealed a cluster of subclinical infection within a radius of 102 meters, suggesting that non-household transmission is related to proximity with seropositive individuals. In conclusion, the search for new leprosy cases cannot be restricted to household contacts.
Collapse
Affiliation(s)
- Maria Socorro Carneiro Linhares
- Universidade Estadual Vale do Acaraú. Sobral CE Brasil. Av. da Universidade 850 Campus da Betânia, 62040-370. Sobral CE Brasil. .,Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará. Fortaleza CE Brasil
| | | | - Carl Kendall
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará. Fortaleza CE Brasil.,Center for Global Health Equity, Tulane School of Public Health and Tropical Medicine. New Orleans USA
| | | | | | - Cristiane C Frota
- Departamento de Patologia e Medicina Legal, Faculdade de Medicina, Universidade Federal de Ceará. Fortaleza CE Brasil
| |
Collapse
|
20
|
Shaw RJ, Harron KL, Pescarini JM, Pinto Junior EP, Allik M, Siroky AN, Campbell D, Dundas R, Ichihara MY, Leyland AH, Barreto ML, Katikireddi SV. Biases arising from linked administrative data for epidemiological research: a conceptual framework from registration to analyses. Eur J Epidemiol 2022; 37:1215-1224. [PMID: 36333542 PMCID: PMC9792414 DOI: 10.1007/s10654-022-00934-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 10/16/2022] [Indexed: 11/08/2022]
Abstract
Linked administrative data offer a rich source of information that can be harnessed to describe patterns of disease, understand their causes and evaluate interventions. However, administrative data are primarily collected for operational reasons such as recording vital events for legal purposes, and planning, provision and monitoring of services. The processes involved in generating and linking administrative datasets may generate sources of bias that are often not adequately considered by researchers. We provide a framework describing these biases, drawing on our experiences of using the 100 Million Brazilian Cohort (100MCohort) which contains records of more than 131 million people whose families applied for social assistance between 2001 and 2018. Datasets for epidemiological research were derived by linking the 100MCohort to health-related databases such as the Mortality Information System and the Hospital Information System. Using the framework, we demonstrate how selection and misclassification biases may be introduced in three different stages: registering and recording of people's life events and use of services, linkage across administrative databases, and cleaning and coding of variables from derived datasets. Finally, we suggest eight recommendations which may reduce biases when analysing data from administrative sources.
Collapse
Affiliation(s)
- Richard J Shaw
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK.
| | - Katie L Harron
- UCL Great Ormond Street Institute of Child Health, UCL, London, UK
| | - Julia M Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Elzo Pereira Pinto Junior
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Mirjam Allik
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Andressa N Siroky
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Departamento de Estatística, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Desmond Campbell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Alastair H Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| |
Collapse
|
21
|
Ramos ACV, Martoreli Júnior JF, Berra TZ, Alves YM, Barbosa TP, Scholze AR, Assis ISD, Palha PF, Gomes D, Arcêncio RA. Evolução temporal e distribuição espacial da hanseníase em município de baixa endemicidade no estado de São Paulo. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021951. [DOI: 10.1590/s1679-49742022000100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/05/2022] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Analisar a distribuição espacial e temporal da hanseníase em cenário de baixa endemicidade no estado de São Paulo, Brasil. Métodos Estudo ecológico, sobre casos de hanseníase notificados no município de Ribeirão Preto, entre 2006 e 2016. A tendência temporal da taxa de detecção de hanseníase foi verificada mediante decomposição de séries temporais, e identificadas as áreas de alta e de baixa ocorrência da doença utilizando-se a técnica Getis-Ord Gi*. Resultados Foram registrados 890 casos, e a taxa de detecção apresentou uma tendência crescente no período analisado, com crescimento médio de 1% ao mês. Identificaram-se áreas de alta ocorrência da doença na região norte do município (99% e 95% de confiança). Conclusão A taxa de detecção de hanseníase apresentou tendência temporal crescente, e a análise espacial permitiu visualizar que a região do município com maior ocorrência da doença se caracteriza por apresentar as maiores desigualdades sociais.
Collapse
|
22
|
Corrêa CM, Lanza FM, Carvalho APM, Lana FCF. Diálogos sobre a descentralização do programa de controle da hanseníase em município endêmico: uma avaliação participativa. ESCOLA ANNA NERY 2022. [DOI: 10.1590/2177-9465-ean-2021-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo avaliar a descentralização do Programa de Controle da Hanseníase (PCH) em Governador Valadares. Método o referencial teórico-metodológico foi a Avaliação de Quarta Geração, de abordagem qualitativo-participativa. O estudo envolveu 30 sujeitos divididos em quatro grupos: gestores do PCH; profissionais do Centro de Referência (CR); profissionais da atenção básica e usuários. Os dados foram coletados por entrevistas, utilizando-se a técnica do Círculo Hermenêutico-Dialético. Posteriormente, realizaram-se três oficinas de validação e negociação dos dados. Utilizou-se o Método Comparativo Constante para a análise. Resultados evidenciou-se a manutenção do modelo vertical de atenção à hanseníase, sustentado por determinantes sócio-histórico-culturais que se expressam: na permanência da porta de entrada à demanda espontânea no CR; no encaminhamento rotineiro do usuário para a atenção secundária; na ineficiência da contrarreferência; na centralização da poliquimioterapia; na crença na necessidade do atendimento especializado e no estigma. Evidenciaram-se fragilidades no vínculo com a atenção primária. Conclusão a descentralização do PCH envolve a tensão entre os atores de cada ponto de atenção à saúde, gerando disputas de saberes e práticas de saúde. Implicações para a prática a sustentabilidade da descentralização requer envolvimento político e institucional focado no fortalecimento da atenção primária, na reorientação do papel dos serviços na rede de atenção à hanseníase e na educação em saúde.
Collapse
|
23
|
Coriolano CRF, Freitas Neto WAD, Penna GO, Sanchez MN. [Factors associated with timing of lepra reactions in a cohort from 2008 to 2016 in Rondônia, Amazon Region, Brazil]. CAD SAUDE PUBLICA 2021; 37:e00045321. [PMID: 34932680 DOI: 10.1590/0102-311x00045321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022] Open
Abstract
The clinical management of leprosy patients poses a specific challenge, namely lepra reactions. This non-concurrent cohort study aimed to analyze the timing of the first lepra reaction during and after polychemotherapy (PCT) and associated factors. A total of 1,621 patients were assessed (PB = 8.9% and MB = 91.1%) from 2008 to 2016, reported to the System of Reaction States in Leprosy (SisReação/RO) database. Reactions occurred predominantly during PCT (997; 61.5%) and less frequently only after PCT (624; 38.5%). Earliness of the reaction after diagnosis was analyzed with Kaplan-Meier survival curves, with comparison between the PB and MB groups using the Mantel-Cox log-rank test. Univariate and multivariate Cox regression models were constructed to identify factors associated with occurrence of lepra reactions (hazard ratio) and the corresponding 95%CI. The multivariate model included variables with p-values < 0.20 in the univariate analysis. PB patients developed reactions earlier than MB patients. Other characteristics were associated with earlier reactions: female gender and negative smear microscopy. In the aggregate period (during and after PCT), PB presented 24% higher risk of lepra reaction than MB patients, and negative smear microscopy increased this risk by 40% compared to positive smear microscopy. During and after PCT, PB presented 1.3 and 1.6 times the risk, respectively, of reactions when compared to MB patients. We thus recommend prioritizing surveillance of lepra reactions during and after PCT as measures to prevent physical disabilities and to improve quality of life for persons with leprosy.
Collapse
Affiliation(s)
| | | | - Gerson Oliveira Penna
- Universidade de Brasília, Brasília, Brasil.,Escola de Governo, Fundação Oswaldo Cruz, Brasília, Brasil
| | | |
Collapse
|
24
|
de Carvalho AG, Tiwari A, Luz JGG, Nieboer D, Steinmann P, Richardus JH, Ignotti E. Leprosy and cutaneous leishmaniasis affecting the same individuals: A retrospective cohort analysis in a hyperendemic area in Brazil. PLoS Negl Trop Dis 2021; 15:e0010035. [PMID: 34898634 PMCID: PMC8699965 DOI: 10.1371/journal.pntd.0010035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 12/23/2021] [Accepted: 11/28/2021] [Indexed: 12/15/2022] Open
Abstract
Background Leprosy and cutaneous leishmaniasis (CL) are neglected tropical diseases (NTDs) affecting the skin. Their control is challenging but the integration of skin NTDs control programs is recommended to improve timely detection and treatment. However, little is known about the occurrence of leprosy and CL in the same individuals, and what are the characteristics of such patients. This study aimed to identify and characterize patients diagnosed with both leprosy and CL (i.e., outcome) in the hyperendemic state of Mato Grosso, Brazil. Also, we investigated the demographic risk factors associated with the period between the diagnosis of both diseases. Methodology/principal findings A retrospective cohort study was conducted with patients diagnosed between 2008 and 2017. From the leprosy (n = 28,204) and CL (n = 24,771) databases of the national reporting system, 414 (0.8%; 414/52,561) patients presenting both diseases were identified through a probabilistic linkage procedure. This observed number was much higher than the number of patients that would be expected by chance alone (n = 22). The spatial distribution of patients presenting the outcome was concentrated in the North and Northeast mesoregions of the state. Through survival analysis, we detected that the probability of a patient developing both diseases increased over time from 0.2% in the first year to 1.0% within seven years. Further, using a Cox model we identified male sex (HR: 2.3; 95% CI: 1.7–2.9) and low schooling level (HR: 1.5; 95% CI: 1.2–1.9) as positively associated with the outcome. Furthermore, the hazard of developing the outcome was higher among individuals aged 40–55 years. Conclusions/significance Leprosy and CL are affecting the same individuals in the area. Integration of control policies for both diseases will help to efficiently cover such patients. Measures should be focused on timely diagnosis by following-up patients diagnosed with CL, active case detection, and training of health professionals. Leprosy and cutaneous leishmaniasis (CL) are neglected tropical diseases (NTDs) that usually affect poor populations in the same geographical areas. Both affect the skin and can cause physical disability and disfigurement resulting in discrimination. Both diseases occur at hyperendemic levels in several regions of Brazil. The integration of skin NTDs control programs may be a way to improve timely detection and treatment. However, little is known about the occurrence of leprosy and CL in the same individuals, and what are the characteristics of these patients. For the Brazilian state of Mato Grosso, we identified 414 patients diagnosed with leprosy and CL between 2008 and 2017, spatially concentrated mainly in the North and Northeast mesoregions. The individual probability of developing both diseases increased from 0.2% to 1.0% within seven years. Male sex, being in the 40–55 years age group, and low levels of schooling were the risk factors positively associated with the time interval between the diagnosis of both diseases. These findings may inform the implementation of integrated leprosy and CL control policies focused on timely diagnosis. A sustainable integration requires continuous measures, such as the follow-up of patients, active case detection, training of health professionals, besides financial and political support.
Collapse
Affiliation(s)
- Amanda Gabriela de Carvalho
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, Rondonópolis, Mato Grosso, Brazil
- School of Medicine, Post-Graduation Program in Health Sciences, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
- * E-mail:
| | - Anuj Tiwari
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - João Gabriel Guimarães Luz
- School of Medicine, Faculty of Health Sciences, Federal University of Rondonópolis, Rondonópolis, Mato Grosso, Brazil
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eliane Ignotti
- School of Medicine, Post-Graduation Program in Health Sciences, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
- School of Health Sciences, Post-Graduation Program Environment Sciences, State University of Mato Grosso, Cáceres, Mato Grosso, Brazil
| |
Collapse
|
25
|
Urgesa K, Bobosha K, Seyoum B, Weldegebreal F, Mihret A, Howe R, Geda B, Kaba M, Aseffa A. Evidence for hidden leprosy in a high leprosy-endemic setting, Eastern Ethiopia: The application of active case-finding and contact screening. PLoS Negl Trop Dis 2021; 15:e0009640. [PMID: 34473696 PMCID: PMC8454944 DOI: 10.1371/journal.pntd.0009640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 09/21/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
Leprosy or Hansen’s disease is a disabling infectious disease caused by Mycobacterium leprae. Reliance on the self-presentation of patients to the health services results in many numbers of leprosy cases remaining hidden in the community, which in turn results in a longer delay of presentation and therefore leading to more patients with disabilities. Although studies in Ethiopia show pockets of endemic leprosy, the extent of hidden leprosy in such pockets remains unexplored. This study determined the magnitude of hidden leprosy among the general population in Fedis District, eastern Ethiopia. A community-based cross-sectional study was conducted in six randomly selected leprosy-endemic villages in 2019. Health extension workers identified study participants from the selected villages through active case findings and household contact screening. All consenting individuals were enrolled and underwent a standardized physical examination for diagnosis of leprosy. Overall, 262 individuals (214 with skin lesions suspected for leprosy and 48 household contacts of newly diagnosed leprosy cases) were identified for confirmatory investigation. The slit skin smear technique was employed to perform a bacteriological examination. Data on socio-demographic characteristics and clinical profiles were obtained through a structured questionnaire. Descriptive statistics and binary logistic regression were used to assess the association between the outcome variable and predictor variables, and the P-value was set at 0.05. From the 268 individuals identified in the survey, 6 declined consent and 262 (97.8%) were investigated for leprosy. Fifteen cases were confirmed as leprosy, giving a detection rate of 5.7% (95%, CI: 3%, 9%). The prevalence of hidden leprosy cases was 9.3 per 10,000 of the population (15/16107). The majority (93.3%) of the cases were of the multi-bacillary type, and three cases were under 15 years of age. Three cases presented with grade II disability at initial diagnosis. The extent of hidden leprosy was not statistically different based on their sex and contact history difference (p > 0.05). High numbers of leprosy cases were hidden in the community. Active cases findings, and contact screening strategies, play an important role in discovering hidden leprosy. Therefore, targeting all populations living in leprosy pocket areas is required for achieving the leprosy elimination target. Leprosy, also called Hansen’s disease, is a neglected infectious disease leading to deformity and disability. Late presentation and hidden cases are the major risks of leprosy-associated disability. Although leprosy endemic pocket areas and grade II disability with a high proportion were reported in Ethiopia, studies on the burden of hidden leprosy cases are limited. Therefore, this study determined the extent of hidden leprosy cases among the general population in leprosy endemic settings in eastern Ethiopia through active case findings and contact tracing. In this community-based survey, leprosy-suspected individuals in the general population and household contacts of newly diagnosed patients with leprosy were included. Health extension workers, community-based health workers in Ethiopia, visited 16107 individuals in the selected villages and 214 leprosy suspects were enrolled in the study based on the clinical signs of leprosy suspects. Leprosy experts examined all leprosy suspects clinically and a skin slit sample was taken for bacteriological examination. After the confirmation of new cases, 48 of their households’ contacts were then examined by leprosy experts. Of 262 suspects and household contacts evaluated for leprosy, 15 hidden cases confirmed, giving an overall prevalence of 9.3 per 10, 000 population. Most of them were Multi-bacillary (MB) type, and one-fourth of them were younger than 15 years of age, and three cases presented with grade II disability. Hidden leprosy was not statistically associated with participants’ sex, age category, and contact history.
Collapse
Affiliation(s)
- Kedir Urgesa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- * E-mail:
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Fitsum Weldegebreal
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Biftu Geda
- Department of Nursing, Madda Walabu University, Shashamene, Ethiopia
| | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| |
Collapse
|
26
|
Estimating underreporting of leprosy in Brazil using a Bayesian approach. PLoS Negl Trop Dis 2021; 15:e0009700. [PMID: 34432805 PMCID: PMC8423270 DOI: 10.1371/journal.pntd.0009700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/07/2021] [Accepted: 08/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leprosy remains concentrated among the poorest communities in low-and middle-income countries and it is one of the primary infectious causes of disability. Although there have been increasing advances in leprosy surveillance worldwide, leprosy underreporting is still common and can hinder decision-making regarding the distribution of financial and health resources and thereby limit the effectiveness of interventions. In this study, we estimated the proportion of unreported cases of leprosy in Brazilian microregions. METHODOLOGY/PRINCIPAL FINDINGS Using data collected between 2007 to 2015 from each of the 557 Brazilian microregions, we applied a Bayesian hierarchical model that used the presence of grade 2 leprosy-related physical disabilities as a direct indicator of delayed diagnosis and a proxy for the effectiveness of local leprosy surveillance program. We also analyzed some relevant factors that influence spatial variability in the observed mean incidence rate in the Brazilian microregions, highlighting the importance of socioeconomic factors and how they affect the levels of underreporting. We corrected leprosy incidence rates for each Brazilian microregion and estimated that, on average, 33,252 (9.6%) new leprosy cases went unreported in the country between 2007 to 2015, with this proportion varying from 8.4% to 14.1% across the Brazilian States. CONCLUSIONS/SIGNIFICANCE The magnitude and distribution of leprosy underreporting were adequately explained by a model using Grade 2 disability as a marker for the ability of the system to detect new missing cases. The percentage of missed cases was significant, and efforts are warranted to improve leprosy case detection. Our estimates in Brazilian microregions can be used to guide effective interventions, efficient resource allocation, and target actions to mitigate transmission.
Collapse
|
27
|
LoRusso S. Infections of the Peripheral Nervous System. Continuum (Minneap Minn) 2021; 27:921-942. [PMID: 34623098 DOI: 10.1212/con.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article describes infections that affect the peripheral nervous system, including their clinical features, differential diagnoses, and treatments. RECENT FINDINGS Rates of pyomyositis have increased recently in the United States, possibly because of an increase in risk factors such as IV drug use, obesity, and diabetes. Other peripheral nervous system infections, such as diphtheria, have become more common in older patients secondary to a lack of revaccination or waning immunity. Although recommended treatment regimens for most infections remain unchanged over recent years, debate over the ideal dosing and route of administration continues for some infections such as tetanus and leprosy (Hansen disease). SUMMARY Infections of the peripheral nervous system are varied in terms of the type of infection, localization, and potential treatment. Nerve conduction studies and EMG can help determine localization, which is key to determining an initial differential diagnosis. It is important to recognize infections quickly to minimize diagnostic delays that could lead to patient morbidity and mortality.
Collapse
|
28
|
Pescarini JM, Teixeira CSS, Silva NBD, Sanchez MN, Natividade MSD, Rodrigues LC, Penna MLF, Barreto ML, Brickley EB, Penna GO, Nery JS. Epidemiological characteristics and temporal trends of new leprosy cases in Brazil: 2006 to 2017. CAD SAUDE PUBLICA 2021; 37:e00130020. [PMID: 34346981 DOI: 10.1590/0102-311x00130020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022] Open
Abstract
Our study aims to describe trends in new case detection rate (NCDR) of leprosy in Brazil from 2006 to 2017 overall and in subgroups, and to analyze the evolution of clinical and treatment characteristics of patients, with emphasis on cases diagnosed with grade 2 physical disabilities. We conducted a descriptive study to analyze new cases of leprosy registered in the Brazilian Information System for Notificable Diseases (SINAN), from 2006-2017. We calculated the leprosy NCDR per 100,000 inhabitants (overall and for individuals aged < 15 and ≥ 15 years) by sex, age, race/ethnicity, urban/rural areas, and Brazilian regions, and estimated the trends using the Mann-Kendall non-parametric test. We analyzed the distributions of cases according to relevant clinical characteristics over time. In Brazil, there was a sharp decrease in the overall NCDR from 23.4/100,000 in 2006 to 10.3/100,000 in 2017; among children < 15 years, from 6.94 to 3.20/100,000. The decline was consistent in all Brazilian regions and race/ethnicity categories. By 2017, 70.2% of the cases were multibacillary, 30.5% had grade 1 (G1D) or 2 (G2D) physical disabilities at diagnosis and 42.8% were not evaluated at treatment completion/discharge; cases with G2D at diagnosis were mostly detected in urban areas (80%) and 5% of cases died during the treatment (leprosy or other causes). Although the frequency of leprosy NCDR decreased in Brazil from 2006 to 2017 across all evaluated population groups, the large number of cases with multibacillary leprosy, physical disabilities or without adequate evaluation, and among children suggest the need to reinforce timely diagnosis and treatment to control leprosy in Brazil.
Collapse
Affiliation(s)
- Júlia Moreira Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brasil.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, U.K
| | - Camila Silveira Silva Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brasil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Nívea Bispo da Silva
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brasil.,Departamento de Estatística, Universidade Federal da Bahia, Salvador, Brasil
| | - Mauro Niskier Sanchez
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brasil.,Núcleo de Medicina Tropical, Universidade de Brasília, Brasília, Brasil
| | | | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, U.K
| | | | - Maurício Lima Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brasil
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, U.K
| | - Gerson Oliveira Penna
- Núcleo de Medicina Tropical, Universidade de Brasília, Brasília, Brasil.,Gerência Regional de Brasília, Fundação Oswaldo Cruz, Brasília, Brasil
| | - Joilda Silva Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| |
Collapse
|
29
|
de Jesus SM, Santana RS, Leite SN. Comparative analysis of the use and control of thalidomide in Brazil and different countries: is it possible to say there is safety? Expert Opin Drug Saf 2021; 21:67-81. [PMID: 34232089 DOI: 10.1080/14740338.2021.1953467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION One of the biggest drug disasters in history has not prevented thalidomide from being used to treat various clinical conditions. Currently, Brazil has a worrying scenario: high consumption of the drug and, cases of pregnant women using thalidomide, even after adopting restrictive legislation. AREAS COVERED This review of the literature and legislation sought to comparatively analyze the monitoring of thalidomide use in Brazil and other countries that use this drug. Finally, we discuss the differences between the countries. EXPERT OPINION This analysis allows us to think beyond the safe use of thalidomide, but the safety provided by any type of monitoring system. It seems that out-patients that use unsafe drugs are exposed to some degree of risk. To improve safety, more extensive improvements are needed than monitoring systems related to the use of thalidomide. Its safe use depends on a drastic reduction in the incidence of leprosy and Erythema Nodosum Leprosum in the world; investment in research and development of safe and effective therapeutic alternatives to thalidomide; improvement of health systems and their health surveillance systems, particularly in primary health care; awareness of health professionals and patients for greater responsibility in the use of medicines, especially thalidomide.
Collapse
Affiliation(s)
- Soraya Machado de Jesus
- Postgraduate Program in Pharmaceutical Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Silvana Nair Leite
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| |
Collapse
|
30
|
Cerqueira SRPS, Deps PD, Cunha DV, Bezerra NVF, Barroso DH, Pinheiro ABS, Pillegi GS, Repsold TAR, Kurizky PS, Collin SM, Gomes CM. The influence of leprosy-related clinical and epidemiological variables in the occurrence and severity of COVID-19: A prospective real-world cohort study. PLoS Negl Trop Dis 2021; 15:e0009635. [PMID: 34319982 PMCID: PMC8351963 DOI: 10.1371/journal.pntd.0009635] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/09/2021] [Accepted: 07/07/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Protective effects of Bacillus Calmette-Guérin (BCG) vaccination and clofazimine and dapsone treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. Patients at risk for leprosy represent an interesting model for assessing the effects of these therapies on the occurrence and severity of coronavirus disease 2019 (COVID-19). We assessed the influence of leprosy-related variables in the occurrence and severity of COVID-19. METHODOLOGY/PRINCIPAL FINDINGS We performed a 14-month prospective real-world cohort study in which the main risk factor was 2 previous vaccinations with BCG and the main outcome was COVID-19 detection by reverse transcription polymerase chain reaction (RT-PCR). A Cox proportional hazards model was used. Among the 406 included patients, 113 were diagnosed with leprosy. During follow-up, 69 (16.99%) patients contracted COVID-19. Survival analysis showed that leprosy was associated with COVID-19 (p<0.001), but multivariate analysis showed that only COVID-19-positive household contacts (hazard ratio (HR) = 8.04; 95% CI = 4.93-13.11) and diabetes mellitus (HR = 2.06; 95% CI = 1.04-4.06) were significant risk factors for COVID-19. CONCLUSIONS/SIGNIFICANCE Leprosy patients are vulnerable to COVID-19 because they have more frequent contact with SARS-CoV-2-infected patients, possibly due to social and economic limitations. Our model showed that the use of corticosteroids, thalidomide, pentoxifylline, clofazimine, or dapsone or BCG vaccination did not affect the occurrence or severity of COVID-19.
Collapse
Affiliation(s)
- Selma Regina Penha Silva Cerqueira
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | - Patrícia Duarte Deps
- Post-Graduation Programme of Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil
| | - Débora Vilela Cunha
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | | | - Daniel Holanda Barroso
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | | | | | | | - Patrícia Shu Kurizky
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
| | - Simon M. Collin
- Post-Graduation Programme of Infectious Diseases, Federal University of Espírito Santo, Vitória, Brazil
| | - Ciro Martins Gomes
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
- Hospital Universitário de Brasília, Universidade de Brasília, Brasília, Brazil
- Programa de Pós-Graduação em Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| |
Collapse
|
31
|
Ramos ACV, Alonso JB, Berra TZ, Alves LS, Martoreli Júnior JF, Santos FLD, Alves YM, Andrade HLPD, Costa FBPD, Crispim JDA, Yamamura M, Alves JD, Santos Neto M, Fuentealba-Torres M, Pinto IC, Arcêncio RA. Social inequalities and their association with the leprosy burden in a Brazilian city of low endemicity: An ecological study. Acta Trop 2021; 218:105884. [PMID: 33676938 DOI: 10.1016/j.actatropica.2021.105884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the association between social inequalities and the leprosy burden in a low endemicity scenario in the state of São Paulo, Brazil. METHODS This ecological study was carried out in the city of Ribeirão Preto, state of São Paulo, Brazil, considering leprosy cases notified from 2006 to 2016. Regarding social inequalities, dimensions related to high household density, literacy, home occupation conditions, health conditions, household income, ethnicity and age were considered. The generalised additive model for location, scale and shape (GAMLSS) was used to verify the association between the social inequalities and leprosy burden. RESULTS The increase in men and women with no education and people with an income of 1 to 2 minimum wages was associated with a relative increase in the number of leprosy cases (7.37%, 7.10% and 2.44%, respectively). Regarding the ethnicity variables, the increase in the proportion of men (black) and women (mixed race) with no schooling was associated with a relative increase in the number of cases of the disease (10.77% and 4.02%, respectively). Finally, for people of mixed race or ethnicity, the increase in the proportion of households with 1/2 to 1 minimum wage was related to a relative decrease in the total number of cases (-4.90%). CONCLUSION The results show that the determinants associated with the increase in leprosy cases are similar to those in Brazilian hyperendemic regions, and that even in cities with low endemicity, social inequality is one of the main determinants of the disease.
Collapse
Affiliation(s)
- Antônio Carlos Vieira Ramos
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil.
| | - Jonas Bodini Alonso
- Research Support Center at the University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Thaís Zamboni Berra
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Luana Seles Alves
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - José Francisco Martoreli Júnior
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Felipe Lima Dos Santos
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Hamilton Leandro Pinto de Andrade
- Center for Social Sciences, Health and Technology, Federal University of Maranhão, Avenida da Universidade, S/N, Bom Jesus, Imperatriz, Maranhão, Brazil
| | - Fernanda Bruzadelli Paulino da Costa
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Juliane de Almeida Crispim
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Mellina Yamamura
- Nursing Department, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, São Paulo, Brazil
| | - Josilene Dália Alves
- Institute of Biological Sciences and Health, Federal University of Mato Grosso, Campus Barra do Garças, Avenida Valdon Varjão, 6390, Barra do Garças, Mato Grosso, Brazil
| | - Marcelino Santos Neto
- Center for Social Sciences, Health and Technology, Federal University of Maranhão, Avenida da Universidade, S/N, Bom Jesus, Imperatriz, Maranhão, Brazil
| | - Miguel Fuentealba-Torres
- Faculty of Nursing and Obstetrics of the Universidad de los Andes, Chile, Avenida Monseñor Álvaro del Portillo, 12455, Las Condes, Santiago, Chile
| | - Ione Carvalho Pinto
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Avenida dos Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
32
|
Sanchez MN, Nery JS, Pescarini JM, Mendes AA, Ichihara MY, Teixeira CSS, Penna MLF, Smeeth L, Rodrigues LC, Barreto ML, Brickley EB, Penna GO. Physical disabilities caused by leprosy in 100 million cohort in Brazil. BMC Infect Dis 2021; 21:290. [PMID: 33752632 PMCID: PMC7983385 DOI: 10.1186/s12879-021-05846-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures and targeted interventions to mitigate its impact on affected individuals. This study investigated such factors among the most vulnerable portion of the Brazilian population. METHODS A large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, covering the period 2001-2015, including over 114 million individuals. Data were linked to the leprosy notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to a multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervals. RESULTS Among the original cohort members 21,565 new leprosy cases were identified between 2007 and 2014. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21 and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2.39 and 1.95, respectively), less schooling (with a clear dose response effect) and being a multibacillary patient (ORs 3.5 and 8.22). Protective factors for both grades were being female (ORs 0.81 and 0.61) and living in a high incidence municipality (ORs 0.85 and 0.67). CONCLUSIONS The findings suggest that the developing of physical disabilities remains a public health problem which increases the burden of leprosy, mainly for those with severe clinical features and worse socioeconomic conditions. Early diagnosis is paramount to decrease the incidence of leprosy-related disability and our study points to the need for strengthening control actions in non-endemic areas in Brazil, where cases may be missed when presented at early stages in disease. Both actions are needed, to benefit patients and to achieve the WHO goal in reducing physical disabilities among new cases of leprosy.
Collapse
Affiliation(s)
- Mauro Niskier Sanchez
- Núcleo de Medicina Tropical, Universidade de Brasília, Avenida L3 Norte, s/n°, Campus Universitário Darcy Ribeiro, Gleba A, Brasília, Distrito Federal CEP 70297-400 Brazil
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
| | - Joilda Silva Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Basílio da Gama, s/n° - Canela, Salvador, Bahia CEP 40110-040 Brazil
| | - Júlia Moreira Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
| | - André Alves Mendes
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
- Departamento de Estatística, Universidade Federal Bahia, Rua Barão de Jeremoabo, s/n° - Ondina, Salvador, Bahia CEP 40170-115 Brazil
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
| | - Camila Silveira Silva Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Basílio da Gama, s/n° - Canela, Salvador, Bahia CEP 40110-040 Brazil
| | - Maria Lúcia Fernandes Penna
- Departamento de Epidemiologia e Bioestatística, Universidade Federal Fluminense, Bloco do Hospital Universitário Antônio Pedro (Huap) – 3° andar, Rua Marquês do Paraná, 303, Centro, Niterói, Rio de Janeiro, CEP 24030-210 Brazil
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Health Data Research (HDR), London, UK
| | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Maurício Lima Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Gerson Oliveira Penna
- Núcleo de Medicina Tropical, Universidade de Brasília, Avenida L3 Norte, s/n°, Campus Universitário Darcy Ribeiro, Gleba A, Brasília, Distrito Federal CEP 70297-400 Brazil
- Escola Fiocruz de Governo, Fiocruz Brasília. Avenida L3 Norte, s/n°, Campus Universitário Darcy Ribeiro, Gleba A, Brasília, Distrito Federal CEP 70904-130 Brazil
| |
Collapse
|
33
|
Prakoeswa FRS, Awanis GS, Azizah A, Prasetyo B, Martini S, Soebono H, Husada D, Notobroto HB, Listiawan MY, Endaryanto A, Prakoeswa CRS. COMPARING SOCIO-ECONOMIC CONDITIONS OF MOTHER AND CHILDREN WITH LEPROSY IN ENDEMIC AND NON-ENDEMIC AREAS IN EAST JAVA, INDONESIA. Afr J Infect Dis 2021; 15:52-58. [PMID: 33889803 PMCID: PMC8052967 DOI: 10.21010/ajid.v15i2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Leprosy is a disease that causes social, psychological, and economic issues. Failure to treat the causes of the immune system dysregulation in endemic areas of leprosy conditions makes the transmission of the bacteria easier. This paper aims to analyze the comparison of family income, occupation types of mothers and fathers, number of children, access to health facilities, and education of mothers, fathers, and children in mothers and children with leprosy in endemic and non-endemic areas. Materials and Methods A cross sectional study by survey was done in both an endemic and a non-endemic area of leprosy in Tuban Regency, East Java, Indonesia. Retrieval of research data was done using interview techniques. Respondents who participated in this study were 106 pairs of mother and child respondents who met the research restriction criteria. Subjects were divided into 5groups based on diagnosis of leprosy and area of living. Bivariate analysis was performed by comparing the independent variables in each group A, B, C, and D with group E. Results It was found that the variables that differed significantly between the endemic and non-endemic areas were the variable number of children with a p-value=0.004, family income with a p-value=0.049 and the variable mother's education with a p-value=0.016. Meanwhile, other variables do not have significant difference. Conclusions We found significant difference on the number of children, father's education, mother's education, and family income. These variables can be a risk factor for leprosy. To make efforts to prevent the transmission of leprosy, stakeholders should consider these factors.
Collapse
Affiliation(s)
- Flora Ramona Sigit Prakoeswa
- Doctoral Program, Faculty of Medicine, Airlangga University, Indonesia.Department of Dermatology and Venereology, Faculty of Medicine, Universitas Muhammadiyah Surakarta, Indonesia
| | | | - Aini Azizah
- Master of Public Health Program, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada
| | - Budi Prasetyo
- Department of Obstetrics and Gynecology, Faculty of Medicine, Airlangga University / Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Santi Martini
- Faculty of Public Health, Airlangga University, Indonesia
| | - Hardyanto Soebono
- Department of Dermatology and Venereology, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Indonesia
| | - Dominicus Husada
- Department of Pediatric, Faculty of Medicine, Airlangga University / Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | | | - Muhammad Yulianto Listiawan
- Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University / Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Anang Endaryanto
- Department of Pediatric, Faculty of Medicine, Airlangga University / Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Cita Rosita Sigit Prakoeswa
- Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University / Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| |
Collapse
|
34
|
Ferreira AJF, Pescarini J, Sanchez M, Flores-Ortiz RJ, Teixeira CS, Fiaccone R, Ichihara MY, Oliveira R, Aquino EML, Smeeth L, Craig P, Ali S, Leyland AH, Barreto ML, Ribeiro RDC, Katikireddi SV. Evaluating the health effect of a Social Housing programme, Minha Casa Minha Vida, using the 100 million Brazilian Cohort: a natural experiment study protocol. BMJ Open 2021; 11:e041722. [PMID: 33649053 PMCID: PMC8098948 DOI: 10.1136/bmjopen-2020-041722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/03/2020] [Accepted: 01/22/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Social housing programmes have been shown to influence health, but their effects on cardiovascular mortality and incidence of infectious diseases, such as leprosy and tuberculosis, are unknown. We will use individual administrative data to evaluate the effect of the Brazilian housing programme Minha Casa Minha Vida (MCMV) on cardiovascular disease (CVD) mortality and incidence of leprosy and tuberculosis. METHODS AND ANALYSIS We will link the baseline of the 100 Million Brazilian Cohort (2001-2015), which includes information on socioeconomic and demographic variables, to the MCMV (2009-2015), CVD mortality (2007-2015), leprosy (2007-2015) and tuberculosis (2007-2015) registries. We will define our exposed population as individuals who signed the contract to receive a house from MCMV, and our non-exposed group will be comparable individuals within the cohort who have not signed a contract for a house at that time. We will estimate the effect of MCMV on health outcomes using different propensity score approaches to control for observed confounders. Follow-up time of individuals will begin at the date of exposure ascertainment and will end at the time a specific outcome occurs, date of death or end of follow-up (31 December 2015). In addition, we will conduct stratified analyses by the follow-up time, age group, race/ethnicity, gender and socioeconomic position. ETHICS AND DISSEMINATION The study was approved by the ethic committees from Instituto Gonçalo Muniz-Oswaldo Cruz Foundation and University of Glasgow Medical, Veterinary and Life Sciences College. Data analysis will be carried out using an anonymised dataset, accessed by researchers in a secure computational environment according to the Centre for Integration of Data and Health Knowledge procedures. Study findings will be published in high quality peer-reviewed research journals and will also be disseminated to policy makers through stakeholder events and policy briefs.
Collapse
Affiliation(s)
- Andrêa J F Ferreira
- Public Health Institute, Federal University of Bahia, Salvador, Brazil
- Centro de Integração de Dados e Conhecimentos Para Saúde (Cidacs), Fiocruz Bahia, Salvador, Brazil
| | - Julia Pescarini
- Centro de Integração de Dados e Conhecimentos Para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Mauro Sanchez
- Public Health, Universidade de Brasília, Brasilia, Brazil
| | - Renzo Joel Flores-Ortiz
- Center for Integration of Data and Health Knowledge (Cidacs), Fiocruz Bahia, Salvador, Brazil
| | | | - Rosemeire Fiaccone
- Mathematics and Statistics, Universidade Federal da Bahia, Salvador, Brazil
| | | | | | - Estela M L Aquino
- Public Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Liam Smeeth
- Epidemiology and Population Health, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Peter Craig
- Public Health Sciences Unit, University of Glasgow MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
| | - Sanni Ali
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Alastair H Leyland
- Public Health Sciences Unit, University of Glasgow MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
| | | | | | | |
Collapse
|
35
|
Teixeira CSS, Pescarini JM, Alves FJO, Nery JS, Sanchez MN, Teles C, Ichihara MYT, Ramond A, Smeeth L, Fernandes Penna ML, Rodrigues LC, Brickley EB, Penna GO, Barreto ML, Silva RDCR. Incidence of and Factors Associated With Leprosy Among Household Contacts of Patients With Leprosy in Brazil. JAMA Dermatol 2021; 156:640-648. [PMID: 32293649 PMCID: PMC7160739 DOI: 10.1001/jamadermatol.2020.0653] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Despite progress toward reducing global incidence, leprosy control remains a challenge in low- and middle-income countries. Objective To estimate new case detection rates of leprosy among household contacts of patients with previously diagnosed leprosy and to investigate its associated risk factors. Design, Setting, and Participants This population-based cohort study included families registered in the 100 Million Brazilian Cohort linked with nationwide registries of leprosy; data were collected from January 1, 2007, through December 31, 2014. Household contacts of patients with a previous diagnosis of leprosy from each household unit were followed up from the time of detection of the primary case to the time of detection of a subsequent case or until December 31, 2014. Data analysis was performed from May to December 2018. Exposures Clinical characteristics of the primary case and sociodemographic factors of the household contact. Main Outcomes and Measures Incidence of leprosy, estimated as the new case detection rate of leprosy per 100 000 household contacts at risk (person-years at risk). The association between occurrence of a subsequent leprosy case and the exposure risk factors was assessed using multilevel mixed-effects logistic regressions allowing for state- and household-specific random effects. Results Among 42 725 household contacts (22 449 [52.5%] female; mean [SD] age, 22.4 [18.5] years) of 17 876 patients detected with leprosy, the new case detection rate of leprosy was 636.3 (95% CI, 594.4-681.1) per 100 000 person-years at risk overall and 521.9 (95% CI, 466.3-584.1) per 100 000 person-years at risk among children younger than 15 years. Household contacts of patients with multibacillary leprosy had higher odds of developing leprosy (adjusted odds ratio [OR], 1.48; 95% CI, 1.17-1.88), and the odds increased among contacts aged 50 years or older (adjusted OR, 3.11; 95% CI, 2.03-4.76). Leprosy detection was negatively associated with illiterate or preschool educational level (adjusted OR, 0.59; 95% CI, 0.38-0.92). For children, the odds were increased among boys (adjusted OR, 1.70; 95% CI, 1.20-2.42). Conclusions and Relevance The findings in this Brazilian population-based cohort study suggest that the household contacts of patients with leprosy may have increased risk of leprosy, especially in households with existing multibacillary cases and older contacts. Public health interventions, such as contact screening, that specifically target this population appear to be needed.
Collapse
Affiliation(s)
- Camila Silveira Silva Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Júlia Moreira Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Flávia Jôse Oliveira Alves
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Joilda Silva Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Mauro Niskier Sanchez
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil.,Núcleo de Medicina Tropical, Universidade de Brasília, Brasília, Brazil
| | - Carlos Teles
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | - Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Health Data Research, London, United Kingdom
| | | | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gerson Oliveira Penna
- Núcleo de Medicina Tropical, Universidade de Brasília, Brasília, Brazil.,Escola Fiocruz do Governo, Fiocruz Brasília, Brasília, Brazil
| | - Maurício Lima Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil.,Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Rita de Cássia Ribeiro Silva
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil.,Escola de Nutrição, Universidade Federal da Bahia, Salvador, Brazil
| |
Collapse
|
36
|
Hacker MA, Sales AM, Duppre NC, Sarno EN, Moraes MO. Leprosy incidence and risk estimates in a 33-year contact cohort of leprosy patients. Sci Rep 2021; 11:1947. [PMID: 33479421 PMCID: PMC7820484 DOI: 10.1038/s41598-021-81643-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/05/2021] [Indexed: 01/29/2023] Open
Abstract
Reduction in incidence has been associated with the introduction of novel approaches, like chemo/immune-prophylaxis. Incidence determined through follow-up cohort studies can evaluate the implementation of these innovative policies towards control and prevention. We have assessed the incidence in our contacts cohort over past 33 years, considering the effect of demographic and clinical variables. Survival analysis was used to estimate the risk of leprosy. A total of 9024 contacts were evaluated, of which 192 developed leprosy, resulting in an overall incidence of 1.4/1000 person-years. The multivariate analysis showed that the major risk factors were (i) contact from MB index cases and (ii) consanguinity (iii) intra household contact. Lower risk was detected for contacts with BCG scar who were revaccinated. There was a significant decrease in accumulated risk between the 2011-2019 period compared with 1987, probably linked to the improvement in laboratory tools to monitor contacts, thereby providing early diagnosis of contacts at intake and reduction of transmission. Our findings suggest that a combination of contact surveillance and tracing, adequate neurodermatological examination, and availability of molecular tools is highly effective in supporting early diagnosis, while a second dose of the BCG vaccination can exert extra protection.
Collapse
Affiliation(s)
- Mariana Andrea Hacker
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.
| | - Anna Maria Sales
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Nádia Cristina Duppre
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Euzenir Nunes Sarno
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
| | - Milton Ozório Moraes
- Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.
| |
Collapse
|
37
|
Clark J, Stolk WA, Basáñez MG, Coffeng LE, Cucunubá ZM, Dixon MA, Dyson L, Hampson K, Marks M, Medley GF, Pollington TM, Prada JM, Rock KS, Salje H, Toor J, Hollingsworth TD. How modelling can help steer the course set by the World Health Organization 2021-2030 roadmap on neglected tropical diseases. Gates Open Res 2021; 5:112. [PMID: 35169682 PMCID: PMC8816801 DOI: 10.12688/gatesopenres.13327.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 01/12/2023] Open
Abstract
The World Health Organization recently launched its 2021-2030 roadmap, Ending the Neglect to Attain the Sustainable Development Goals , an updated call to arms to end the suffering caused by neglected tropical diseases. Modelling and quantitative analyses played a significant role in forming these latest goals. In this collection, we discuss the insights, the resulting recommendations and identified challenges of public health modelling for 13 of the target diseases: Chagas disease, dengue, gambiense human African trypanosomiasis (gHAT), lymphatic filariasis (LF), onchocerciasis, rabies, scabies, schistosomiasis, soil-transmitted helminthiases (STH), Taenia solium taeniasis/ cysticercosis, trachoma, visceral leishmaniasis (VL) and yaws. This piece reflects the three cross-cutting themes identified across the collection, regarding the contribution that modelling can make to timelines, programme design, drug development and clinical trials.
Collapse
Affiliation(s)
- Jessica Clark
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Wilma A. Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3000 CA, The Netherlands
| | - María-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Luc E. Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3000 CA, The Netherlands
| | - Zulma M. Cucunubá
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Matthew A. Dixon
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Schistosomiasis Control Initiative Foundation, London, SE11 5DP, UK
| | - Louise Dyson
- Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK
- School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Graham F. Medley
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Timothy M. Pollington
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK
| | - Joaquin M. Prada
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK
| | - Kat S. Rock
- Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK
| | - Henrik Salje
- Department of Genetics, University of Cambridge, Cambridge, CB2 3EH, UK
| | - Jaspreet Toor
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - T. Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| |
Collapse
|
38
|
Clark J, Stolk WA, Basáñez MG, Coffeng LE, Cucunubá ZM, Dixon MA, Dyson L, Hampson K, Marks M, Medley GF, Pollington TM, Prada JM, Rock KS, Salje H, Toor J, Hollingsworth TD. How modelling can help steer the course set by the World Health Organization 2021-2030 roadmap on neglected tropical diseases. Gates Open Res 2021; 5:112. [PMID: 35169682 PMCID: PMC8816801 DOI: 10.12688/gatesopenres.13327.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 01/12/2023] Open
Abstract
The World Health Organization recently launched its 2021-2030 roadmap, Ending the Neglect to Attain the Sustainable Development Goals , an updated call to arms to end the suffering caused by neglected tropical diseases. Modelling and quantitative analyses played a significant role in forming these latest goals. In this collection, we discuss the insights, the resulting recommendations and identified challenges of public health modelling for 13 of the target diseases: Chagas disease, dengue, gambiense human African trypanosomiasis (gHAT), lymphatic filariasis (LF), onchocerciasis, rabies, scabies, schistosomiasis, soil-transmitted helminthiases (STH), Taenia solium taeniasis/ cysticercosis, trachoma, visceral leishmaniasis (VL) and yaws. This piece reflects the three cross-cutting themes identified across the collection, regarding the contribution that modelling can make to timelines, programme design, drug development and clinical trials.
Collapse
Affiliation(s)
- Jessica Clark
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Wilma A. Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3000 CA, The Netherlands
| | - María-Gloria Basáñez
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Luc E. Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3000 CA, The Netherlands
| | - Zulma M. Cucunubá
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Matthew A. Dixon
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Schistosomiasis Control Initiative Foundation, London, SE11 5DP, UK
| | - Louise Dyson
- Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK
- School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Katie Hampson
- Institute of Biodiversity, Animal Health & Comparative Medicine, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Graham F. Medley
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Timothy M. Pollington
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK
| | - Joaquin M. Prada
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7AL, UK
| | - Kat S. Rock
- Mathematics Institute, University of Warwick, Coventry, CV4 7AL, UK
| | - Henrik Salje
- Department of Genetics, University of Cambridge, Cambridge, CB2 3EH, UK
| | - Jaspreet Toor
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - T. Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| |
Collapse
|
39
|
Leprosy post-exposure prophylaxis: innovation and precision public health. LANCET GLOBAL HEALTH 2021; 9:e8-e9. [DOI: 10.1016/s2214-109x(20)30512-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022]
|
40
|
Pescarini JM, Williamson E, Ichihara MY, Fiaccone RL, Forastiere L, Ramond A, Nery JS, Penna MLF, Strina A, Reis S, Smeeth L, Rodrigues LC, Brickley EB, Penna GO, Barreto ML. Conditional Cash Transfer Program and Leprosy Incidence: Analysis of 12.9 Million Families From the 100 Million Brazilian Cohort. Am J Epidemiol 2020; 189:1547-1558. [PMID: 32639534 PMCID: PMC7705605 DOI: 10.1093/aje/kwaa127] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 06/23/2020] [Accepted: 06/21/2020] [Indexed: 01/19/2023] Open
Abstract
Leprosy is a neglected tropical disease predominately affecting poor and marginalized populations. To test the hypothesis that poverty-alleviating policies might be associated with reduced leprosy incidence, we evaluated the association between the Brazilian Bolsa Familia (BFP) conditional cash transfer program and new leprosy case detection using linked records from 12,949,730 families in the 100 Million Brazilian Cohort (2007–2014). After propensity score matching BFP beneficiary to nonbeneficiary families, we used Mantel-Haenszel tests and Poisson regressions to estimate incidence rate ratios for new leprosy case detection and secondary endpoints related to operational classification and leprosy-associated disabilities at diagnosis. Overall, cumulative leprosy incidence was 17.4/100,000 person-years at risk (95% CI: 17.1, 17.7) and markedly higher in “priority” (high-burden) versus “nonpriority” (low-burden) municipalities (22.8/100,000 person-years at risk, 95% confidence interval (CI): 22.2, 23.3, compared with 14.3/100,000 person-years at risk, 95% CI: 14.0, 14.7). After matching, BFP participation was not associated with leprosy incidence overall (incidence rate ratio (IRR)Poisson = 0.97, 95% CI: 0.90, 1.04) but was associated with lower leprosy incidence when restricted to families living in high-burden municipalities (IRRPoisson = 0.86, 95% CI: 0.77, 0.96). In high-burden municipalities, the association was particularly pronounced for paucibacillary cases (IRRPoisson = 0.82, 95% CI: 0.68, 0.98) and cases with leprosy-associated disabilities (IRRPoisson = 0.79, 95% CI: 0.65, 0.97). These findings provide policy-relevant evidence that social policies might contribute to ongoing leprosy control efforts in high-burden communities.
Collapse
Affiliation(s)
- Julia M Pescarini
- Correspondence to Dr. Julia M. Pescarini, Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, R. Mundo, 121 – Trobogy, CEP 41301-110, Salvador, Brazil (e-mail: )
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Deps P, Antunes JMADP, Collin SM. Zoonotic risk of Hansen's disease from community contact with wild armadillos: A systematic review and meta-analysis. Zoonoses Public Health 2020; 68:153-164. [PMID: 33226194 DOI: 10.1111/zph.12783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/10/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
Understanding and quantifying the risk of Hansen's disease (HD) through zoonotic transmission of Mycobacterium leprae infection from wild armadillos is important because hunting, handling and consumption of these animals is widespread in communities where HD is endemic, posing a potential threat to the health of individuals and to HD elimination. We conducted a systematic review (PROSPERO CRD42019159891) of publications in MEDLINE, EMBASE, Global Health, Scopus, LILACS, Biblioteca Digital Brasileira de Teses e Dissertações, Catálogo de Teses e Dissertações de CAPES, and Biblioteca Virtual em Saúde up to 09/05/2020 using Mesh and text terms in English, Portuguese, Spanish and French. Random effects meta-analyses were performed including of subgroups by endemicity and type of exposure. Seven of the nine included studies were case-control, four from Brazil and three from the USA, comprising 1,124 cases and 2,023 controls in total. The other two studies, one from Brazil and one from Colombia, were cross-sectional. The overall summary estimate (odds ratio, OR) for the relative odds of HD comparing people who had direct contact with armadillos and/or had eaten armadillo meat with those who had not was OR = 2.60 (95% CI 1.78-3.80, p < .001) with a predictive interval of OR = 1.10-6.17. Summary odds ratios for specific exposures were as follows: indirect contact, OR = 1.39 (95% CI 1.02, 1.89) (p = .04); eating, OR = 2.29 (95% CI 1.13, 4.66) (p = .02); hunting, OR = 2.54 (95% CI 1.21, 5.33) (p = .01). Most of the included studies had moderate risk of bias. Crude estimates were reduced by up to 24% when adjusted for confounders (where reported). Direct contact with wild armadillos was strongly associated with an increased risk of HD, whilst evidence for an increased risk of HD from indirect contact was weaker. The fraction of HD in endemic countries attributable to zoonotic transmission from armadillos remains unknown, but the precautionary principle needs to be adopted to protect public health.
Collapse
Affiliation(s)
- Patrícia Deps
- Department of Social Medicine, Universidade Federal do Espírito Santo, Vitória, Brazil.,Postgraduate Programme in Infectious Diseases, Universidade Federal do Espírito Santo, Vitória, Brazil
| | | | - Simon M Collin
- National Infection Service, Public Health England, London, UK
| |
Collapse
|
42
|
Souza CDFD, Santos VS, Nery JS, Fernandes TRMDO, Magalhães MDAFM. Can the municipal social deprivation index influence the time trend of the leprosy detection rate? Rev Soc Bras Med Trop 2020; 54:e20200228. [PMID: 33206881 PMCID: PMC7670748 DOI: 10.1590/0037-8682-0228-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/29/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Carlos Dornels Freire de Souza
- Universidade Federal de Alagoas, Núcleo de Estudos em Medicina Social e Preventiva, Departamento de Medicina, Arapiraca, AL, Brasil
| | - Victor Santana Santos
- Universidade Federal de Alagoas, Núcleo de Epidemiologia e Saúde Pública, Departamento de Enfermagem, Arapiraca, AL, Brasil
| | - Joilda Silva Nery
- Universidade Federal da Bahia, Instituto de Saúde Coletiva, Salvador, BA, Brasil
| | | | | |
Collapse
|
43
|
Patients with skin smear positive leprosy in Bangladesh are the main risk factor for leprosy development: 21-year follow-up in the household contact study (COCOA). PLoS Negl Trop Dis 2020; 14:e0008687. [PMID: 33125403 PMCID: PMC7598483 DOI: 10.1371/journal.pntd.0008687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/10/2020] [Indexed: 01/19/2023] Open
Abstract
Background Leprosy transmission is ongoing; globally and within Bangladesh. Household contacts of leprosy cases are at increased risk of leprosy development. Identification of household contacts at highest risk would optimize this process. Methods The temporal pattern of new case presentation amongst household contacts was documented in the COCOA (Contact Cohort Analysis) study. The COCOA study actively examined household contacts of confirmed leprosy index cases identified in 1995, and 2000–2014, to provide evidence for timings of contact examination policies. Data was available on 9527 index cases and 38303 household contacts. 666 household contacts were diagnosed with leprosy throughout the follow-up (maximum follow-up of 21 years). Risk factors for leprosy development within the data analysed, were identified using Cox proportional hazard regression. Findings The dominant risk factor for household contacts developing leprosy was having a highly skin smear positive index case in the household. As the grading of initial slit skin smear of the index case increased from negative to high positive (4–6), the hazard of their associated household contacts developing leprosy increases by 3.14 times (p<0.001). Being a blood relative was not a risk factor, no gender differences in susceptibility were found. Interpretation We found a dominance of a single variable predicting risk for leprosy transmission–skin smear positive index cases. A small number of cases are maintaining transmission in the household setting. Focus should be performing contact examinations on these households and detecting new skin smear positive index cases. Conducting slit-skin smears on new cases is needed for predicting risk; such services need supporting. If skin smear positive cases are sustaining leprosy infection within the household setting, the administration of single-dose rifampicin (SDR) to household contacts as the sole intervention in Bangladesh will not be effective. The number of newly detected leprosy cases worldwide has remained stable over the last ten years. Household contacts of leprosy cases are at increased risk of leprosy development. Household contact examinations and case detection are critical aspects of control. Specific risk factors (recognizable by field staff) for leprosy development need to be identified to aid these control efforts. Targeted household examinations could increase early case detection: this is important because untreated leprosy cases are sustaining transmission. This is the largest, most comprehensive study of development of leprosy in household contacts conducted recently with a maximum follow-up of 21 years. We found a single dominant risk factor for the development of leprosy in the household setting, namely slit skin smear positivity in the index case. This is important for leprosy control because household contact examinations can be focused on contacts at highest risk. Implementation would be simple as the risk factor is identified by leprosy staff in the field. Prioritising households known to be at highest risk of leprosy development would allow efficient allocation of resources. Our results cast doubt on the success of administering the recommended prophylactic intervention for contacts; the use of this intervention needs to be re-evaluated.
Collapse
|
44
|
Albuquerque ARD, Silva JVDM, Barreto EDO, Fraga CADC, Santos WOD, Silva MSMD, Souza CDFD, Sales-Marques C. Epidemiological, temporal and spatial dynamics of leprosy in a municipality in northeastern Brazil (2008-2017): an ecological study. Rev Soc Bras Med Trop 2020; 53:e20200246. [PMID: 33111909 PMCID: PMC7580284 DOI: 10.1590/0037-8682-0246-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/13/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Leprosy is a chronic infectious disease caused by Mycobacterium leprae.This study aimed to analyze the epidemiological, temporal, and spatial dynamics ofleprosy in a municipality in northeastern Brazil. METHODS This is an ecological study on new leprosy cases in the population of Arapiraca (Alagoas, Northeast Region, Brazil), from 2008 to 2017. Data extracted from a national database were analyzed forepidemiological indicators, factors associated with physical disabilities, and spatialanalysis in the neighborhoods of Arapiraca. RESULTS A total of 292 new cases of leprosy were recorded, particularly occurring among the following groups: women, the age group of 46-59 years, brown-skinned individuals, people with less than eight years of schooling, and urban residents; the new cases were also predominantly the tuberculoid form and were of the paucibacillary classification of the disease. Almost 1/3 of the people had some degree of physical disability, which was mainly associated with the group 60 years of age and older, black ethnicity, and the multibacillary clinical form of leprosy. The joinpoint regression showed a stationary temporal behavior of indicators. There was a heterogeneous spatial distribution with active transmission areas, especially in the neighborhoods Primavera, Baixão, Ouro Preto, and downtown. CONCLUSIONS The epidemiological indicators revealed complexity in the process of leprosy development. These spatial and temporal studies are relevant to help in the planning, monitoring, and guidance of interventions in the municipality. The spatial analysis showed heterogeneous distribution in the analyzed neighborhoods.
Collapse
Affiliation(s)
| | | | - Emiliano de Oliveira Barreto
- Universidade Federal de Alagoas, Instituto de Ciências Biológicas e da Saúde, Laboratório de Biologia Celular, A/C Simões, AL, Brasil
| | | | | | | | | | - Carolinne Sales-Marques
- Universidade Federal de Alagoas, Centro de Ciências Médicas e Enfermagem, Curso de Medicina, Arapiraca, AL, Brasil
- Universidade Federal de Alagoas, Centro de Ciências Médicas e Enfermagem, Laboratório de Biologia Molecular e Expressão Gênica, Arapiraca, AL, Brasil
| |
Collapse
|
45
|
Avanzi C, Singh P, Truman RW, Suffys PN. Molecular epidemiology of leprosy: An update. INFECTION GENETICS AND EVOLUTION 2020; 86:104581. [PMID: 33022427 DOI: 10.1016/j.meegid.2020.104581] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 12/27/2022]
Abstract
Molecular epidemiology investigations are notoriously challenging in the leprosy field mainly because the inherent characteristics of the disease as well as its yet uncultivated causative agents, Mycobacterium leprae and M. lepromatosis. Despite significant developments in understanding the biology of leprosy bacilli through genomic approaches, the exact mechanisms of transmission is still unclear and the factors underlying pathological variation of the disease in different patients remain as major gaps in our knowledge about leprosy. Despite these difficulties, the last two decades have seen the development of genotyping procedures based on PCR-sequencing of target loci as well as by the genome-wide analysis of an increasing number of geographically diverse isolates of leprosy bacilli. This has provided a foundation for molecular epidemiology studies that are bringing a better understanding of strain evolution associated with ancient human migrations, and phylogeographical insights about the spread of disease globally. This review discusses the advantages and drawbacks of the main tools available for molecular epidemiological investigations of leprosy and summarizes various methods ranging from PCR-based genotyping to genome-typing techniques. We also describe their main applications in analyzing the short-range and long-range transmission of the disease. Finally, we summarise the current gaps and challenges that remain in the field of molecular epidemiology of leprosy.
Collapse
Affiliation(s)
- Charlotte Avanzi
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO, USA; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Pushpendra Singh
- Indian Council of Medical Research - National Institute of Research in Tribal Health, Jabalpur, India
| | - Richard W Truman
- Department of Pathobiological Sciences, Louisiana State University, Baton Rouge, LO, USA
| | - Philip N Suffys
- Laboratory of Molecular Biology Applied to Mycobacteria - Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil.
| |
Collapse
|
46
|
Frota da Rocha Morgado F, Kopp Xavier da Silveira EM, Pinheiro Rodrigues do Nascimento L, Sales AM, da Costa Nery JA, Nunes Sarno E, Illarramendi X. Psychometric assessment of the EMIC Stigma Scale for Brazilians affected by leprosy. PLoS One 2020; 15:e0239186. [PMID: 32941501 PMCID: PMC7498031 DOI: 10.1371/journal.pone.0239186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/01/2020] [Indexed: 11/26/2022] Open
Abstract
Background The Stigma Scale of the Explanatory Model Interview Catalogue (EMIC-SS) is a useful option to investigate leprosy-related stigma, but its psychometric qualities are unknown in Brazil. This study investigated the factor structure, the convergent and known-groups validity, and the reliability of the EMIC-SS for Brazilians affected by leprosy. Methodology The Brazilian Portuguese version of the EMIC-SS was validated in 180 persons affected by leprosy at a Reference Center in Rio de Janeiro. Confirmatory factorial analysis (CFA) and Cronbach alpha were used to assess the EMIC-SS internal consistency. The Construct validity was tested using Spearman Correlation, Kruskal-Wallis, and Mann-Whitney tests comparing with the Participation Scale, Rosenberg Self-esteem Scale, Beck Depression Inventory, and a Sociodemographic Questionnaire. Test-retest reliability was evaluated with intra-class correlation (ICC). Main findings CFA confirmed the one- and two-dimensional models of the scale after retaining 12 of the 15 EMIC-SS items. The 12—item EMIC-SS was consistent (α = 0.78) and reproducible (ICC = 0.751, 95% Confidence Interval = 0.657–0.822, p < 0.0001). A significant correlation was observed between the EMIC-SS and the other scales confirming convergent validity. The EMIC-SS and its factors were able to differentiate several hypothesized groups (age, change of occupation, monthly family income, communicating others about the disease, and perception of difficulty to follow treatment) confirming the scale known-groups validity, both in its one and two-dimensional models. Conclusions/Significance Our study found support for the construct validity and reliability of the EMIC-SS as a measure of stigma experienced by people affected by leprosy in Brazil. However, future studies are necessary in other samples and populations with stigmatizing conditions to determine the optimal factor structure and to strengthen the indications of the validated scale.
Collapse
Affiliation(s)
- Fabiane Frota da Rocha Morgado
- Department of Physical Education and Sports, Federal Rural University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail: (XI); (FFRM)
| | | | | | - Anna Maria Sales
- Souza Araújo Outpatient Clinic, Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - José Augusto da Costa Nery
- Souza Araújo Outpatient Clinic, Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Euzenir Nunes Sarno
- Souza Araújo Outpatient Clinic, Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ximena Illarramendi
- Souza Araújo Outpatient Clinic, Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Center for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- * E-mail: (XI); (FFRM)
| |
Collapse
|
47
|
Ramos ACV, Gomes D, Santos Neto M, Berra TZ, de Assis IS, Yamamura M, Crispim JDA, Martoreli Júnior JF, Bruce ATI, dos Santos FL, Souza LLL, Alves YM, de Andrade HLP, Arcoverde MAM, Pieri FM, Arcêncio RA. Trends and forecasts of leprosy for a hyperendemic city from Brazil's northeast: Evidence from an eleven-year time-series analysis. PLoS One 2020; 15:e0237165. [PMID: 32764785 PMCID: PMC7413479 DOI: 10.1371/journal.pone.0237165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 07/21/2020] [Indexed: 11/23/2022] Open
Abstract
This study’s objective was to estimate the temporal trends of leprosy according to sex and age groups, as well as to estimate and predict the progression of the disease in a hyperendemic city located in the northeast of Brazil. This ecological time-series study was conducted in Imperatriz, Maranhão, Brazil. Leprosy cases diagnosed between 2006 and 2016 were included. Detection rates stratified by sex and age groups were estimated. The study of temporal trends was accomplished using the Seasonal-Trend Decomposition method and temporal modeling of detection rates using linear seasonal autoregressive integrated moving average model according to Box and Jenkins method. Trend forecasts were performed for the 2017–2020 period. A total of 3,212 cases of leprosy were identified, the average incidence among men aged between 30 and 59 years old was 201.55/100,000 inhabitants and among women in the same age group was 135.28/100,000 inhabitants. Detection rates in total and by sex presented a downward trend, though rates stratified according to sex and age presented a growing trend among men aged less than 15 years old and among women aged 60 years old or over. The final models selected in the time-series analysis show the forecasts of total detection rates and rates for men and women presented a downward trend for the 2017–2020 period. Even though the forecasts show a downward trend in Imperatriz, the city is unlikely to meet a significant decrease of the disease burden by 2020.
Collapse
Affiliation(s)
- Antônio Carlos Vieira Ramos
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Dulce Gomes
- Department of Mathematics, University of Évora, Évora, Portugal
| | - Marcelino Santos Neto
- Center for Social Sciences, Health and Technology, Federal University of Maranhão, Imperatriz, Maranhão, Brazil
| | - Thaís Zamboni Berra
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | - Mellina Yamamura
- Nursing Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Juliane de Almeida Crispim
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - José Francisco Martoreli Júnior
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Alexandre Tadashi Inomata Bruce
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Felipe Lima dos Santos
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Ludmilla Leidianne Limirio Souza
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Hamilton Leandro Pinto de Andrade
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Marcos Augusto Moraes Arcoverde
- Center for Education, Letters and Health, Western Paraná State University, Campus Foz do Iguaçu, Foz do Iguaçu, Paraná, Brazil
| | | | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
48
|
de Jesus SM, Santana RS, Leite SN. The organization, weaknesses, and challenges of the control of thalidomide in Brazil: A review. PLoS Negl Trop Dis 2020; 14:e0008329. [PMID: 32760161 PMCID: PMC7410199 DOI: 10.1371/journal.pntd.0008329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The drug thalidomide has resurged in the world market under restrictive conditions for marketing and use. In Brazil, there are still cases of pregnant women using thalidomide even after the implementation of laws that regulate the control of use (Law No. 10.651/2003 and Collegiate Board Resolution No. 11/2011). The objective of this study was to discuss the control of thalidomide use in Brazil, based on a scoping review of the scientific literature, documents, and data from the Ministry of Health. A total of 51 studies and documents related to the following subthemes were selected: (1) organization of access and use of thalidomide in the health system; (2) epidemiological and population characteristics of people affected by leprosy; and (3) occurrence of pregnancy and cases of embryopathy with the use of thalidomide. The results showed that Brazil has no unified information database about thalidomide patients. Furthermore, there is inconsistency in the accreditation of public health centers that dispense this medicine, in a country that has a high consumption of thalidomide in the Unified Health System. A large part of this amount of dispensed medicine is intended for the treatment of erythema nodosum leprosum, mainly in the North, Northeast, and Central-West regions of the country, which are endemic for leprosy. This disease is the only one among the clinical indications of the medicine approved in Brazil that does not have a Clinical Protocol and Therapeutic Guidelines. The control of thalidomide use in Brazil presents historical regulatory failures. These are currently linked to the organization and structure of primary healthcare in the country, as well as to the lack of leadership of the Ministry of Health and National Health Surveillance Agency when it comes to managing the process of control of this use.
Collapse
Affiliation(s)
- Soraya Machado de Jesus
- Postgraduate Program in Pharmaceutical Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Silvana Nair Leite
- Postgraduate Program in Pharmaceutical Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| |
Collapse
|
49
|
Ramos AN, Heukelbach J, Oliveira MLWDR. A conditional cash transfer programme in Brazil improves leprosy treatment outcomes. THE LANCET. INFECTIOUS DISEASES 2020; 20:522-523. [PMID: 32066528 DOI: 10.1016/s1473-3099(19)30750-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceara, Fortaleza 60.430-140, Brazil; Postgraduate Program of Public Health, School of Medicine, Federal University of Ceara, Fortaleza 60.430-140, Brazil.
| | - Jorg Heukelbach
- Postgraduate Program of Public Health, School of Medicine, Federal University of Ceara, Fortaleza 60.430-140, Brazil
| | | |
Collapse
|
50
|
Pescarini JM, Williamson E, Nery JS, Ramond A, Ichihara MY, Fiaccone RL, Penna MLF, Smeeth L, Rodrigues LC, Penna GO, Brickley EB, Barreto ML. Effect of a conditional cash transfer programme on leprosy treatment adherence and cure in patients from the nationwide 100 Million Brazilian Cohort: a quasi-experimental study. THE LANCET. INFECTIOUS DISEASES 2020; 20:618-627. [PMID: 32066527 PMCID: PMC7191267 DOI: 10.1016/s1473-3099(19)30624-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/04/2019] [Accepted: 10/25/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Indirect financial costs and barriers to health-care access might contribute to leprosy treatment non-adherence. We estimated the association of the Brazilian conditional cash transfer programme, the Programa Bolsa Família (PBF), on leprosy treatment adherence and cure in patients in Brazil. METHODS In this quasi-experimental study, we linked baseline demographic and socioeconomic information for individuals who entered the 100 Million Brazilian Cohort between Jan 1, 2007, and Dec 31, 2014, with the PBF payroll database and the Information System for Notifiable Diseases, which includes nationwide leprosy registries. Individuals were eligible for inclusion if they had a household member older than 15 years and had not received PBF aid or been diagnosed with leprosy before entering the 100 Million Brazilian Cohort; they were excluded if they were partial receivers of PBF benefits, had missing data, or had a monthly per-capita income greater than BRL200 (US$50). Individuals who were PBF beneficiaries before leprosy diagnosis were matched to those who were not beneficiaries through propensity-score matching (1:1) with replacement on the basis of baseline covariates, including sex, age, race or ethnicity, education, work, income, place of residence, and household characteristics. We used logistic regression to assess the average treatment effect on the treated of receipt of PBF benefits on leprosy treatment adherence (six or more multidrug therapy doses for paucibacillary cases or 12 or more doses for multibacillary cases) and cure in individuals of all ages. We stratified our analysis according to operational disease classification (paucibacillary or multibacillary). We also did a subgroup analysis of paediatric leprosy restricted to children aged up to 15 years. FINDINGS We included 11 456 new leprosy cases, of whom 8750 (76·3%) had received PBF before diagnosis and 2706 (23·6%) had not. Overall, 9508 (83·0%) patients adhered to treatment and 10 077 (88·0%) were cured. After propensity score matching, receiving PBF before diagnosis was associated with adherence to treatment (OR 1·22, 95% CI 1·01-1·48) and cure (1·26, 1·01-1·58). PBF receipt did not significantly improve treatment adherence (1·37, 0·98-1·91) or cure (1·12, 0·75-1·67) in patients with paucibacillary leprosy. For patients with multibacillary disease, PBF beneficiaries had better treatment adherence (1·37, 1·08-1·74) and cure (1·43, 1·09-1·90) than non-beneficiaries. In the propensity score-matched analysis in 2654 children younger than 15 years with leprosy, PBF exposure was not associated with leprosy treatment adherence (1·55, 0·89-2·68) or cure (1·57, 0·83-2·97). INTERPRETATION Our results suggest that being a beneficiary of the PBF, which facilitates cash transfers and improved access to health care, is associated with greater leprosy multidrug therapy adherence and cure in multibacillary cases. These results are especially relevant for patients with multibacillary disease, who are treated for a longer period and have lower cure rates than those with paucibacillary disease. FUNDING CONFAP/ESRC/MRC/BBSRC/CNPq/FAPDF-Doenças Negligenciadas, the UK Medical Research Council, the Wellcome Trust, and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brazil (CAPES).
Collapse
Affiliation(s)
- Julia M Pescarini
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil.
| | - Elizabeth Williamson
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK; Health Data Research, London, UK
| | - Joilda S Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Rosemeire L Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil; Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Brazil
| | - Maria Lucia F Penna
- Universidade Federal Fluminense, Instituto de Saúde da Comunidade, Niterói, Brazil
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Health Data Research, London, UK
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Gerson O Penna
- Núcleo de Medicina Tropical, Universidade de Brasília, Escola FIOCRUZ de Governo Fundação Oswaldo Crus Brasília, Brazil
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil; Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| |
Collapse
|