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Martoreli Júnior JF, Ramos ACV, Alves JD, Crispim JDA, Alves LS, Berra TZ, Barbosa TP, da Costa FBP, Alves YM, dos Santos MS, Gomes D, Yamamura M, Pinto IC, Fuentealba-Torres MA, Nunes C, Pieri FM, Arcoverde MAM, dos Santos FL, Arcêncio RA. Inequality of gender, age and disabilities due to leprosy and trends in a hyperendemic metropolis: Evidence from an eleven-year time series study in Central-West Brazil. PLoS Negl Trop Dis 2021; 15:e0009941. [PMID: 34784350 PMCID: PMC8631739 DOI: 10.1371/journal.pntd.0009941] [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: 03/11/2021] [Revised: 11/30/2021] [Accepted: 10/21/2021] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to investigate the epidemiological situation of leprosy
(Hansen’s Disease), in a hyperendemic metropolis in the Central-West region of
Brazil. We studied trends over eleven years, both in the detection of the
disease and in disabilities, analyzing disparities and/or differences regarding
gender and age. This is an ecological time series study conducted in Cuiabá,
capital of the state of Mato Grosso. The population consisted of patients
diagnosed with leprosy between the years 2008 and 2018. The time series of
leprosy cases was used, stratifying it according to gender (male and female),
disability grade (G0D, G1D, G2D, and not evaluated) and age. The calendar
adjustment technique was applied. For modeling the trends, the Seasonal-Trend
decomposition procedure based on Loess (STL) was used. We identified 9.739
diagnosed cases, in which 58.37% were male and 87.55% aged between 15 and 59
years. Regarding detection according to gender, there was a decrease among women
and an increase in men. The study shows an increasing trend in disabilities in
both genders, which may be related to the delay in diagnosis. There was also an
increasing number of cases that were not assessed for disability at the time of
diagnosis, which denotes the quality of the services. In the 2019 report, Brazil had a detection rate of 13.23 per 100.000 inhabitants
far from the goal of less than 1 leprosy (Hansen’s Disease) case per 10,000
inhabitants describe by the World Health Organization. The present study aimed
to investigate the epidemiological situation of leprosy and its trend between
2008 and 2018 in a hyperendemic metropolis in the Central-West region of Brazil.
A total of 9.739 leprosy cases were reported between 2008 and 2018. The majority
of cases were male (58.37%), with a predominant age of 15 to 59 years (87.55%).
The predominant level of education was incomplete elementary school (43.96%).
The disability grade at diagnosis showed that 40.19% had G0D and for the G2D was
8,.06%.There was a predominance in operational classification of multibacillary
cases (72.85%). While detection rate trends in females and the majority of the
age groups are decreasing, increases are seen in the detection of male patients
and patients already suffering from disabilities. Although declining trends were
presented, the metropolis is still not close to elimination showing the need
prioritize leprosy actions and to improve care for this disease.
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Affiliation(s)
- 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
- * E-mail:
| | - 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
| | - Josilene Dalia Alves
- Departament of Epidemiology, Federal University of Mato Grosso, Cuiába,
Mato Grosso, 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
| | - Luana Seles Alves
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, 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, Ribeirão Preto, São Paulo,
Brazil
| | - Tatiana Pestana Barbosa
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | - Fernanda Bruzadelli Paulino da Costa
- 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
| | - Márcio Souza 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
| | - Dulce Gomes
- Department of Mathematics, University of Évora, Évora,
Portugal
| | - Mellina Yamamura
- Departament of Nursing, Federal University of São Carlos, São Carlos, São
Paulo, Brazil
| | - Ione Carvalho Pinto
- Department of Maternal-Infant Nursing and Public Health, University of
São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo,
Brazil
| | | | - Carla Nunes
- Department of Public Health, New University of Lisbon, Lisbon,
Portugal
| | | | - Marcos Augusto Moraes Arcoverde
- Center for Education, Letters and Health, Western Paraná State
University, Campus Foz do Iguaçu, Foz do Iguaçu, Paraná,
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
| | - 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
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Chen X, Shui TJ. The state of the leprosy epidemic in Yunnan, China 2011-2020: A spatial and spatiotemporal analysis, highlighting areas for intervention. PLoS Negl Trop Dis 2021; 15:e0009783. [PMID: 34613961 PMCID: PMC8494331 DOI: 10.1371/journal.pntd.0009783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/01/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite public health efforts to reduce the leprosy burden in Yunnan, China, leprosy remains an important public health problem in some specific areas. We analyzed the epidemiological characteristics and spatial distribution of leprosy in Yunnan, China, and provide data to guide disease prevention and control efforts. METHODOLOGY/PRINCIPAL FINDINGS The surveillance data of newly detected leprosy cases in Yunnan, China, during 2011-2020 were extracted from the LEPROSY MANAGEMANT INFORMATION SYSTEM IN CHINA (LEPMIS), and spatial distribution analysis, spatial autocorrelation analysis, and spatiotemporal scanning were performed with ArcGIS 10.6.1, GeoDa 1.8.8, and SaTScan 9.4.3 software, respectively. A total of 1907 newly detected leprosy cases were reported in Yunnan, China, during 2011-2020. The new case detection rate (NCDR) decreased from 0.62 in 2011 to 0.25 in 2020, with an annual incidence of 0.41/100,000 population. The proportions of multibacillary (MB) cases, cases in female patients, cases causing grade 2 physical disability (G2D), and cases in pediatric patients were 67.07%, 33.93%, 17.99%, and 2.83%, respectively. The number of counties with an incidence above 1/100,000 population decreased from 30 in 2011 to 8 in 2020. The Moran's I of leprosy in Yunnan, China, during 2011-2020 ranged from 0.076 to 0.260, indicating the presence of spatial clusters. Local spatial autocorrelation (LSA) analysis showed that high-high cluster areas (hot spots) were mainly distributed in the southeastern, northern, and northwestern regions. Spatiotemporal scanning showed three clusters with high NCDRs. The probably primary clusters, occurring during January 1, 2011-December 31, 2015, covered 11 counties in the southeastern region (RR = 5.046515, LRR = 271.749664, P = 0.000). CONCLUSION The number of leprosy cases in Yunnan decreased overall, although some high-NCDR regions remained. Geographic information system (GIS) analysis coupled with spatial analysis indicated regions with leprosy clusters. Continuous leprosy prevention and control strategies in Yunnan Province should be established, and interventions in high-risk regions should be prioritized and further strengthened.
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Affiliation(s)
- Xiaohua Chen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Tie-Jun Shui
- Yunnan Center for Disease Control and Prevention, Yunnan, China
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Ogunsumi DO, Lal V, Puchner KP, van Brakel W, Schwienhorst-Stich EM, Kasang C, Chukwu J, Kreibich S, Parisi S, Richardus JH, Blok DJ. Measuring endemicity and burden of leprosy across countries and regions: A systematic review and Delphi survey. PLoS Negl Trop Dis 2021; 15:e0009769. [PMID: 34543282 PMCID: PMC8483296 DOI: 10.1371/journal.pntd.0009769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/30/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leprosy is a chronic infectious disease caused by Mycobacterium leprae, the annual new case detection in 2019 was 202,189 globally. Measuring endemicity levels and burden in leprosy lacks a uniform approach. As a result, the assessment of leprosy endemicity or burden are not comparable over time and across countries and regions. This can make program planning and evaluation difficult. This study aims to identify relevant metrics and methods for measuring and classifying leprosy endemicity and burden at (sub)national level. METHODS We used a mixed-method approach combining findings from a systematic literature review and a Delphi survey. The literature search was conducted in seven databases, searching for endemicity, burden and leprosy. We reviewed the available evidence on the usage of indicators, classification levels, and scoring methods to measure and classify endemicity and burden. A two round Delphi survey was conducted to ask experts to rank and weigh indicators, classification levels, and scoring methods. RESULTS The literature review showed variation of indicators, levels, and cut-off values to measure leprosy endemicity and/or burden. The most used indicators for endemicity include new case detection rate (NCDR), new cases among children and new cases with grade 2 disability. For burden these include NCDR, MB cases, and prevalence. The classification levels 'high' and 'low' were most important. It was considered most relevant to use separate scoring methods for endemicity and burden. The scores would be derived by use of multiple indicators. CONCLUSION There is great variation in the existing method for measuring endemicity and burden across countries and regions. Our findings contribute to establishing a standardized uniform approach to measure and classify leprosy endemicity and burden at (sub)national level, which would allow effective communication and planning of intervention strategies.
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Affiliation(s)
- Dorcas O. Ogunsumi
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vivek Lal
- Sasakawa-India Leprosy Foundation, New Delhi, India
| | - Karl Philipp Puchner
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
- Medical Faculty/Master’s Programme Global Health and Disaster Medicine, University of Athens, Greece
| | | | - Eva-Maria Schwienhorst-Stich
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
- Faculty of Medicine, University of Würzburg, Würzburg, Germany
| | - Christa Kasang
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Joseph Chukwu
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Saskia Kreibich
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Sandra Parisi
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
- Department for General Practice, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - David J. Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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Lopes FDC, Ramos ACV, Pascoal LM, Santos FS, Rolim ILTP, Serra MAADO, Santos LHD, Santos Neto M. Leprosy in the context of the Family Health Strategy in an endemic scenario in Maranhão: prevalence and associated factors. CIENCIA & SAUDE COLETIVA 2021; 26:1805-1816. [PMID: 34076121 DOI: 10.1590/1413-81232021265.04032021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/20/2021] [Indexed: 11/21/2022] Open
Abstract
This study aimed to describe the prevalence of leprosy and verify the factors associated with multibacillary clinical types in a Family Health Strategy priority setting to control and monitor the disease in northeastern Brazil. This cross-sectional study used data from the Notifiable Diseases Information System related to leprosy cases notified in Imperatriz, Maranhão, between 2008 and 2017. The prevalence was determined yearly and for the period. Poisson regression models with a significance level of 5% were employed to associate the variables and the multibacillary clinical types. Most of the 2,476 leprosy cases analyzed referred to multibacillary clinical types. The prevalence ranged from 7.8 and 15.6/10,000 inhabitants, with high and very high endemicity levels. The variables male, age groups between 30 and 59 years and ≥60 years, schooling <8 years, level 2 physical disability, types 1 and 2 reactive episodes, and urban residence area showed significant associations (p≤0.05) with multibacillary clinical types. Such findings can serve as a basis for elaborating and implementing leprosy control and surveillance measures, gearing actions to the most vulnerable groups, and becoming more effective.
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Affiliation(s)
- Fernanda de Castro Lopes
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil.
| | | | - Lívia Maia Pascoal
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil. .,Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão. Imperatriz MA Brasil
| | - Floriacy Stabnow Santos
- Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão. Imperatriz MA Brasil
| | | | | | | | - Marcelino Santos Neto
- Programa de Pós-Graduação em Enfermagem, Universidade Federal do Maranhão. Av. dos Portugueses 1966, Vila Bacanga. 65080-805 São Luís MA Brasil. .,Programa de Pós-Graduação em Saúde e Tecnologia, Universidade Federal do Maranhão. Imperatriz MA Brasil
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Lopes FDC, Sousa GGDSD, Silva WMD, Costa ACPDJ, Santos FS, Pascoal LM, Santos Neto M. Spatial-temporal analysis of leprosy in a priority Brazilian northeast municipality for disease control. Rev Bras Enferm 2021; 74:e20201101. [PMID: 34161506 DOI: 10.1590/0034-7167-2020-1101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/11/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to analyze the spatial-temporal distribution of leprosy in a priority municipality for leprosy control. METHODS ecological study, conducted in a city in the Northeast of Brazil, whose analysis units were census sectors. The study used compulsory notification data for cases registered between 2008 and 2017. TerraView software and the Batch Geocode tool was used for geocoding. The detection of spatial-temporal agglomerations of high relative risks was done by scanning statistics. RESULTS the spatial-temporal distribution of cases was heterogeneous, creating four agglomerations of high relative risks in the urban area of the municipality between the years 2008 and 2012; and annual prevalence rates classified from high to hyperendemic. CONCLUSIONS areas of higher risk and concentration of the disease in space-time were linked to the characteristics of high population density and social vulnerability of these spaces, raising the prioritization of health professionals' actions, systems, and services for control, and monitoring the disease.
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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.
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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
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Bulstra CA, Blok DJ, Alam K, Butlin CR, Roy JC, Bowers B, Nicholls P, de Vlas SJ, Richardus JH. Geospatial epidemiology of leprosy in northwest Bangladesh: a 20-year retrospective observational study. Infect Dis Poverty 2021; 10:36. [PMID: 33752751 PMCID: PMC7986508 DOI: 10.1186/s40249-021-00817-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background Leprosy is known to be unevenly distributed between and within countries. High risk areas or ‘hotspots’ are potential targets for preventive interventions, but the underlying epidemiologic mechanisms that enable hotspots to emerge, are not yet fully understood. In this study, we identified and characterized leprosy hotspots in Bangladesh, a country with one of the highest leprosy endemicity levels globally. Methods We used data from four high-endemic districts in northwest Bangladesh including 20 623 registered cases between January 2000 and April 2019 (among ~ 7 million population). Incidences per union (smallest administrative unit) were calculated using geospatial population density estimates. A geospatial Poisson model was used to detect incidence hotspots over three (overlapping) 10-year timeframes: 2000–2009, 2005–2014 and 2010–2019. Ordinal regression models were used to assess whether patient characteristics were significantly different for cases outside hotspots, as compared to cases within weak (i.e., relative risk (RR) of one to two), medium (i.e., RR of two to three), and strong (i.e., RR higher than three) hotspots. Results New case detection rates dropped from 44/100 000 in 2000 to 10/100 000 in 2019. Statistically significant hotspots were identified during all timeframes and were often located at areas with high population densities. The RR for leprosy was up to 12 times higher for inhabitants of hotspots than for people living outside hotspots. Within strong hotspots (1930 cases among less than 1% of the population), significantly more child cases (i.e., below 15 years of age) were detected, indicating recent transmission. Cases in hotspots were not significantly more likely to be detected actively. Conclusions Leprosy showed a heterogeneous distribution with clear hotspots in northwest Bangladesh throughout a 20-year period of decreasing incidence. Findings confirm that leprosy hotspots represent areas of higher transmission activity and are not solely the result of active case finding strategies.![]() Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00817-4.
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Affiliation(s)
- Caroline A Bulstra
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany.
| | - David J Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Khorshed Alam
- Rural Health Programme, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - C Ruth Butlin
- The Leprosy Mission England and Wales, Goldhay Way, Orton Goldhay, Peterborough, England
| | - Johan Chandra Roy
- Rural Health Programme, The Leprosy Mission International Bangladesh, Nilphamari, Bangladesh
| | - Bob Bowers
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | | | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Barbosa CC, Bonfim CVD, Brito CMGD, Souza WVD, Melo MFDO, Medeiros ZMD. Spatial analysis of epidemiological and quality indicators of health services for leprosy in hyperendemic areas in Northeastern Brazil. Rev Inst Med Trop Sao Paulo 2020; 62:e93. [PMID: 33263699 PMCID: PMC7694541 DOI: 10.1590/s1678-9946202062093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 09/28/2020] [Indexed: 11/22/2022] Open
Abstract
Leprosy is a public health problem due to the physical disabilities and deformities it causes. This study aimed to describe new leprosy cases using an operational classification and analyzing spatial patterns by means of epidemiological and quality indicators of health services in Pernambuco State, Brazil, between 2005 and 2014. This was an ecological study performed in 184 municipalities grouped into 12 health regions units for analysis. To analyze spatial patterns, the Bayesian local empirical method and Moran's spatial autocorrelation indicator were applied and box and Moran maps were used. Individuals aged ≥15 years old, grade zero physical disability and complete remission as the treatment outcome were predominant in both paucibacillary and multibacillary cases, the only difference was the predominance of females (n=9,286; 63.00%) and males (n=8,564; 60.70%), respectively. These variables were correlated (p<0.05) with the operational classification. The overall detection rate showed three high-priority areas; the indicator rate of grade 2 physical disability revealed clusters in regions IV, V, and VI; and the indicator rate of cases with some degree of disability showed precarious municipalities in seven health regions. Pernambuco maintains an active chain of transmission and ongoing endemicity of leprosy. Therefore, spatial analysis methods allow the identification of priority areas for intervention, thereby supporting the disease elimination strategy.
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Affiliation(s)
- Celivane Cavalcanti Barbosa
- Fundação Oswaldo Cruz, Recife, Instituto Aggeu Magalhães, Departamento de Saúde Pública, Recife, Pernambuco, Brazil
| | - Cristine Vieira do Bonfim
- Universidade Federal de Pernambuco, Programa de Pós-Graduação em Saúde Coletiva, Recife, Pernambuco, Brazil.,Fundação Joaquim Nabuco, Diretoria de Pesquisas Sociais, Recife, Pernambuco, Brazil
| | | | - Wayner Vieira de Souza
- Fundação Oswaldo Cruz, Recife, Instituto Aggeu Magalhães, Departamento de Saúde Pública, Recife, Pernambuco, Brazil
| | | | - Zulma Maria de Medeiros
- Universidade de Pernambuco, Programa de Pós-Graduação Stricto Sensu em Ciências da Saúde, Recife, Pernambuco, Brazil.,Fundação Oswaldo Cruz, Instituto Aggeu Magalhães, Departamento de Parasitologia, Recife, Pernambuco, Brazil
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9
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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.
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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
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10
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Ramos ACV, Santos Neto M, Arroyo LH, Yamamura M, Assis IS, Alves JD, Arcoverde MAM, Alves LS, Berra TZ, Martoreli Júnior JF, Pieri FM, Arcêncio RA. Magnitude of social determinants in high risk areas of leprosy in a hyperendemic city of northeastern Brazil: An ecological study. LEPROSY REV 2020. [DOI: 10.47276/lr.91.1.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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11
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Epidemiology and Spatiotemporal Patterns of Leprosy Detection in the State of Bahia, Brazilian Northeast Region, 2001⁻2014. Trop Med Infect Dis 2018; 3:tropicalmed3030079. [PMID: 30274475 PMCID: PMC6161284 DOI: 10.3390/tropicalmed3030079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/12/2018] [Accepted: 07/25/2018] [Indexed: 11/17/2022] Open
Abstract
The detection of leprosy cases is distributed unequally in Brazil, with high-risk clusters mainly in the North and Northeast regions. Knowledge on epidemiology and spatiotemporal patterns of leprosy occurrence and late diagnosis in these areas is critical to improve control measures. We performed a study including all leprosy cases notified in the 417 municipalities of Bahia state, from 2001 to 2014. New case detection (overall and pediatric <15 years) and grade 2 disability (G2D) rates were calculated and stratified according to socio-demographic variables. Spatial analyses were performed to detect high-risk areas for occurrence and late diagnosis. A total of 40,060 new leprosy cases was reported in the period (mean = 2861 cases/year), 3296 (8.2%) in <15-year-olds, and 1921 (4.8%) with G2D. The new case detection rate was 20.41 cases/100,000 inhabitants (95% CI: 19.68–21.17). A higher risk was identified in older age groups (RR = 8.45, 95% CI: 7.08–10.09) and in residents living in the state capital (RR = 5.30, 95% CI: 4.13–6.79), in medium-sized cities (RR = 2.80; 95% CI: 2.50–3.13), and in the west (RR = 6.56, 95% CI: 5.13–8.39) and far south regions of the state (RR = 6.56, 95% CI: 5.13–8.39). A higher risk of G2D was associated with male gender (RR = 2.43, 95% CI: 2.20–2.67), older age (RR = 44.08, 95% CI: 33.21–58.51), Afro-Brazilian ethnicity (RR = 1.59; 95% CI: 1.37–1.85), living in medium-sized cities (RR = 2.60; 95% CI: 2.27–2.96) and residency in the north (RR = 5.02; 95% CI: 3.74–6.73) and far south (RR = 7.46; 95% CI: 5.58–9.98) regions. Heterogeneous space–time patterns of leprosy distribution were identified, indicating high endemicity, recent transmission, and late diagnosis. This heterogeneous distribution of the disease was observed throughout the study period. Leprosy remains a relevant public health problem in Bahia state. The disease has a focal distribution. We reinforce the importance of integrating surveillance, prevention and control actions in regions of higher risk of leprosy detection and late diagnosis, and in the most vulnerable populations.
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