Leprosy trends in Zambia 1991-2009

Temporal trend, high-risk spatial and spatiotemporal clustering of leprosy indicators in Brazil: A 20-year ecological and population-based study

OBJECTIVES

Leprosy still represents a public health concern in Brazil. The country is the only one in America not to reach the global goal of leprosy disease control. Hence, this study aimed to assess the temporal, spatial and space-time patterns of leprosy cases in Brazil of the 20-year time series 2001-2020.

METHODS

An ecological and population-based analysis was carried out, applying temporal and spatial techniques, and using the detection coefficient of sociodemographic and clinical-epidemiological variables of leprosy new cases in the 5570 municipalities of Brazil. Temporal trends were assessed using a segmented linear regression model. For spatial analysis, global and local Moran indexes were applied, and space-time scan statistics was used to identify risk clusters.

RESULTS

The mean detection coefficient was 19.36/100,000 inhabitants, with a higher occurrence among men (21.29/100,000 inhabitants) and in the 60-69 age group (36.31/100,000). A decreasing temporal trend was observed in the country (annual percentage change: -5.20% per year). The North and Midwest regions were the most affected, exhibiting municipalities with a high/high standard, and with the highest annual percentage increase of multibacillary (MB) cases. Leprosy has a heterogeneous distribution throughout Brazil, but with high-risk spatiotemporal clusters, mainly located in the North and Midwest regions.

CONCLUSION

Although Brazil has shown a decreasing temporal trend during the past 20 years, the country is still classified as highly endemic for leprosy, showing an increase in the proportion of new MB cases over the years.

High-risk transmission clusters of leprosy in an endemic area in the Northeastern Brazil: A retrospective spatiotemporal modelling (2001-2019)

OBJECTIVES

To analyse and map the leprosy risk areas in the state of Alagoas, an endemic region in the Northeastern Brazil, between 2001 and 2019.

METHODS

Ecological and time series study, using spatial analysis techniques. First, we analyse the epidemiological aspects of leprosy cases, using the data available in the Notifiable Diseases Information System; then, we used the segmented log-linear regression model to assess time trends. Spatial distribution was analysed by the Local Empirical Bayesian Estimator and by calculating the Global and Local Moran Index. Finally, spatiotemporal clusters were identified through scanning statistics, using the Kulldorf method of retrospective analysis.

RESULTS

We observed that Alagoas showed an average new case detection rate of 14.43/100,000 inhabitants between 2001 and 2019, being classified as highly endemic. The area of highest risk was the 9th health region (state hinterland), with increasing time trend (Annual Percentage Change/APC = 7.2; p-value < 0.05). Several clusters of high risk of leprosy transmission were verified in Alagoas, including the state capital and hinterland municipalities.

CONCLUSIONS

Our data indicate that active M. leprae transmission persists in Alagoas; that diagnosis is delayed and that there are high-risk areas, especially in inland municipalities.

Electrodiagnostic consultations in Zambia: Referral characteristics and neuromuscular disorders

INTRODUCTION

Research on neuromuscular disorders in sub-Saharan Africa is scarce. We aimed to delineate referral characteristics and the neuromuscular disorders observed among electrodiagnostic (EDX) consultations in a tertiary care setting in Zambia.

METHODS

EDX records were reviewed for all specialist-performed studies after the establishment of the laboratory. The frequency of demographic, medical characteristics, and final EDX impressions are presented.

RESULTS

Among 108 referrals, 52% were male, 84% were adults (mean age 44 years). Referrals were predominantly outpatients (85%) and sent by neurologists (68%). HIV infection was common (12%). Diabetes was rare (3%). Overall, 77% of studies were abnormal. Polyneuropathy was the most common abnormal EDX finding, followed by motor neuron disease.

DISCUSSION

A diverse range of neuromuscular diseases was evaluated among EDX referrals in Zambia. Though labor and expertise intensive, access to EDX consultation can enhance clinical care and facilitate research and surveillance of neuromuscular disorders in the region.

Trend of leprosy in individuals under the age of 15 in Mato Grosso (Brazil), 2001-2013

OBJECTIVE

To identify the historical trend of leprosy epidemiological indicators in individuals under the age of 15 in the state of Mato Grosso.

METHODS

Descriptive study with trend analysis of leprosy indicators in individuals under the age of fifteen registered in the Mato Grosso's System for Notifiable Diseases between 2001 and 2013. We used the Prais-Winsten procedure for analyzing generalized linear regression at a significance level of 5%. We considered as increasing time series when the annual percent change was positive, decreasing when negative and stationary when there was no significant difference between its value and zero.

RESULTS

We analyzed 2455 cases of leprosy and the average detection rate in individuals under the age of fifteen was 22.7 per 100 thousand inhabitants. The trend of the general coefficient of incidence was decreasing, with an average annual rate of -5.5% (95%CI -7.5--3.5). Increasing trend was observed with an increase of 6.7% (95%CI 2.7-10.8) in the proportion of multibacillary cases, 9.4% (95%CI 4.4-14.7) of cases diagnosed with dimorphic clinical form and 14% (95%CI 7.9-20.4) of cases with physical disability level 2 at the time of diagnosis. There was an increasing trend in the average proportion of examined contacts, with a growth of 4.1% (95%CI 1.2-7.1) and average proportion of healing was precarious (39.7%), with stationary trend.

CONCLUSIONS

The historical trend of leprosy cases in individuals under the age of fifteen proved to be decreasing in the period, however the trends of epidemiological indicators such as the proportion of multibacillary cases, physical disability level 2 and healing, indicate late diagnosis with stay sources of transmission and consequent worsening of the disease in the state of Mato Grosso.

OBJETIVO

Identificar a tendência histórica dos indicadores epidemiológicos de hanseníase em menores de 15 anos no estado de Mato Grosso.

MÉTODOS

Estudo descritivo com análise de tendência dos indicadores de hanseníase em menores de 15 anos registrados no Sistema Nacional de Agravos de Notificação de Mato Grosso, no período de 2001 a 2013. Utilizou-se o procedimento de Prais-Winsten para análise de regressão linear generalizada, adotando-se nível de significância de 5%. Consideraram-se como série temporal crescente quando a annual percent change era positiva, decrescente quando negativa e estacionária quando não havia diferença significante entre seu valor e o zero.

RESULTADOS

Foram analisados 2.455 casos de hanseníase e o coeficiente médio de incidência em menores de 15 anos foi de 22,7/100 mil habitantes. A tendência geral do coeficiente de incidência foi decrescente, com uma annual percent change de -5,5% (IC95% -7,5-3,5). Observou-se tendência de crescimento, com incremento de 6,7% (IC95% 2,7-10,8) na proporção dos casos multibacilares, de 9,4% (IC95% 4,4-14,7) nos casos com forma clínica dimorfa e de 14% (IC95% 7,9-20,4) nos casos com incapacidade física grau 2 no momento do diagnóstico da doença. Verificou-se crescimento na proporção dos contatos de casos novos examinados, com incremento de 4,1% (IC95% 1,2-7,1) e média da proporção de cura considerada precária (39,7%) com tendência estacionária.

CONCLUSÕES

A tendência histórica dos casos de hanseníase em menores de 15 anos mostrou-se decrescente no período. Entretanto, as tendências dos indicadores epidemiológicos, como a proporção de casos multibacilares, de incapacidade física grau 2 e de cura, indicam o diagnóstico tardio com permanência de fontes de transmissibilidade e consequente agravo da endemia no estado de Mato Grosso.

Trends of main indicators of leprosy in Brazilian municipalities with high risk of leprosy transmission, 2001-2012

Background

Leprosy incidence has reduced in recent years in Brazil, although the disease still persists as a public health problem in some regions. To investigate the trends of selected leprosy indicators in Brazilian municipalities with high risk of transmission is essential to provide effective control of the disease, yet this area has not been investigated.

Methods

This is an ecological time-series study with multiple groups using Notifiable Diseases Information System (SINAN) data. All 692 municipalities of the states of Mato Grosso, Tocantins, Rondônia, Pará and Maranhão were included. The incidence rates of leprosy were calculated, as well as incidence rates in children under 15 years per 100,000 inhabitants and rates of new cases presenting grade-2 disabilities per 100,000 inhabitants. Joinpoint Regression was used to analyse the time trends of the different indicators studied. The spatial distribution of temporal variations of the indicators in the period was presented.

Results

Between 2001 and 2012, 176,929 leprosy cases were notified in the area studied, this being equivalent to 34.6 % of total cases in Brazil. In the aggregate of municipalities, there was a reduction in incidence rate of leprosy from 89.10 to 56.98 new cases per 100,000 inhabitants between 2001 and 2012, with a significant reduction between 2003 and 2012 (APC: − 6.2 %, 95 % CI: −7.2 % to −5.2 %). The incidence rate in <15 years also reduced significantly between 2003 and 2012 (APC: −5.6 %; 95 % CI: −7.2 % to −4.1 %). The rate of new cases with grade 2 disability remained stable between 2001 and 2012 (APC: −1.3 %; 95 % CI: −2.6 % to 0.1 %).

Conclusion

Despite the reduction in the leprosy incidence rate, strategies for controlling this disease need to be enhanced to enable early case detection, especially in hyperendemic municipalities, in order to prevent disability.