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Barros IDCA, Sousa CDCM, da Silva NRF, Mascarenhas MDM. Characterization of cases and epidemiological and operational indicators of leprosy: analysis of time series and spatial distribution, Piauí state, Brazil, 2007-2021. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2024; 33:e2023090. [PMID: 38232240 PMCID: PMC10807012 DOI: 10.1590/s2237-96222024v33e2023090.en] [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: 03/15/2023] [Accepted: 10/23/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To analyze epidemiological characteristics, temporal trends and spatial distribution of leprosy cases and indicators in the state of Piauí, 2007-2021. METHODS This was an ecological time-series study using data from the Notifiable Health Conditions Information System, describing the spatial distribution and the temporal trend of leprosy using Prais-Winsten regression. RESULTS A total of 17,075 new cases of leprosy were reported. There was a falling trend in the overall detection rate [annual percentage change (APC) = -6.3; 95%CI -8.1;-4.5)], detection in children under 15 years of age (APC = -8,6; 95%CI -12,7;-4,3) and detection of cases with grade 2 physical disability (APC = -4,4; 95%CI -7,0;-1,8). There was a rising trend in the proportion of multibacillary cases. Spatial distribution of the average detection rate identified hyperendemic areas in the Carnaubais, Entre Rios, Vale dos Rios Piauí e Itaueiras regions. CONCLUSION High leprosy detection rates were found, despite the falling trend of indicators, except the proportion of multibacillary cases. MAIN RESULTS Between 2007 and 2021, Piauí showed an improving trend in all indicators analyzed, except the proportion of new multibacillary cases. Spatial distribution identified hyperendemic areas in different regions of the state. IMPLICATIONS FOR SERVICES This study provides health services with a broad overview of the epidemiological situation of leprosy in Piauí, with evidence of the populations and locations most affected by the disease, whereby public authorities need to reinforce the promotion of health actions. PERSPECTIVES It is expected that actions to prevent and control the disease will be adopted, such as offering early diagnosis, ensuring correct treatment and implementing measures to prevent physical disabilities.
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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.
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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.
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Guevara A, Vicente VA, de Souza Lima BJF, Nery AF, Hagen F, Hahn RC. Chromoblastomycosis-Leprosy Co-Infection in Central West Brazil. Presentation of Three Cases and Literature Review. Mycopathologia 2022; 187:363-374. [PMID: 35764905 PMCID: PMC9325793 DOI: 10.1007/s11046-022-00646-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022]
Abstract
Chromoblastomycosis and leprosy are chronic diseases with high prevalence in tropical and subtropical regions. Brazil is one of the countries with the highest incidence and prevalence for both diseases, however, reports of co-infections are scarce. The aim of this study was to describe three cases of chromoblastomycosis-leprosy co-infection in patients from Mato Grosso state, Brazil. A review of chromoblastomycosis-leprosy co-infection was performed of English, Portuguese and Spanish publications in LILACS, SciELO, PubMed and Web of Science databases using the descriptors (chromoblastomycosis OR cromoblastomicose OR cromoblastomicosis) AND (leprosy OR hanseníase OR lepra), without time period delimitation. Nineteen cases were included, 16 cases were published in 11 articles, plus the three cases reported in the current study. Most reported coninfection cases came from Brazil. Majority of the patients were male with a mean age of 52.2 years. Farmer was the main occupational activity reported. In 12 patients, the clinical signs and symptoms of leprosy started first. No contacts with patients affected by leprosy, armadillos or history of injuries at the anatomical site of chromoblastomycosis lesions were reported. Five leprosy patients who received steroid treatment for leprosy reactions or neuropathies, were diagnosed with chromoblastomycosis during immunosuppressive therapy. Four cases (21.1%) were reported among the elderly patients. Co-infections in patients with chromoblastomycosis or leprosy are uncommon, but the possibility should always be considered, especially if the patient is undergoing immunosuppressive treatment or is elder.
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Affiliation(s)
- Armando Guevara
- Laboratory of Mycology/Research, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Vânia Aparecida Vicente
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Bruna Jacomel F de Souza Lima
- Microbiology, Parasitology and Pathology Post-Graduation Program, Department of Pathology, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Andréia Ferreira Nery
- Júlio Muller University Hospital - Ebserh, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Ferry Hagen
- Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Uppsalalaan 8, 3584CT, Utrecht, The Netherlands.
- Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Rosane Christine Hahn
- Laboratory of Mycology/Research, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.
- Júlio Muller University Hospital - Ebserh, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.
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do Espírito Santo RB, Serafim RA, Loureiro RM, Sumi DV, de Mello RAF, Nascimento IF, Lee AFJM, Collin JD, Collin SM, Deps P. Clinical and radiological assessment of rhinomaxillary syndrome in Hansen's disease. Indian J Dermatol Venereol Leprol 2022; 88:483-493. [PMID: 35138068 DOI: 10.25259/ijdvl_1203_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/01/2021] [Indexed: 11/04/2022]
Abstract
Background More than four million people today live with Hansen's disease, and 200,000 new cases are diagnosed every year. Lifetime effects of Hansen's disease manifest as changes to bones of the face, hands and feet, resulting in physical impairment, secondary complications and facial changes that can be detrimental to quality of life, particularly among the elderly. Aims This study aimed to perform a detailed characterization of rhinomaxillary syndrome and its clinical manifestations in older persons treated in the past for Hansen's disease. Methods This was a cross-sectional study to characterize rhinomaxillary syndrome among older persons (age 60+ years) resident at Pedro Fontes Hospital, Cariacica, Espírito Santo, Brazil. Computed tomography images were examined with three-dimensional reconstructions to assess alterations to maxillofacial bones according to criteria for radiological rhinomaxillary syndrome. Participants were examined to assess facial alterations according to criteria for clinical rhinomaxillary syndrome. Results Rhinomaxillary syndrome was investigated in 16 participants (ten females and six males), median age 70 (range 60-89) years, age at diagnosis 20 (6-43) years and time since diagnosis 46 (26-70) years. Four participants fully met radiological rhinomaxillary syndrome criteria, four partially. All participants with full radiological rhinomaxillary syndrome presented with facial changes which met criteria for clinical rhinomaxillary syndrome, including "saddle nose" (loss of nasal dorsal height and shortened length of nose, due to cartilaginous and/or bone collapse), concave middle third of the face with sunken nose, maxillary retrognathia and inverted upper lip. Limitations Clinical histories were incomplete for some participants because records were lost at the hospital over time. Conclusion Until Hansen's disease is eliminated from endemic countries, persons affected will continue to present with rhinomaxillofacial alterations caused by Mycobacterium leprae infection. Clinical protocols for assessment and long-term care need to include otorhinolaryngological evaluation, mainly to prevent secondary complications. When rhinomaxillofacial bone changes are suspected, this evaluation should be supported by computed tomography imaging, if available.
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Affiliation(s)
| | - Rachel Azevedo Serafim
- Postgraduate Programme in Infectious Diseases, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | | | - Daniel Vaccaro Sumi
- Department of Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Izabelle Felix Nascimento
- Department of Social Medicine, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | | | - John D Collin
- Department of Oral and Maxillofacial Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Simon M Collin
- National Infection Service, Public Health England, London, United Kingdom
| | - Patrícia Deps
- Department of Social Medicine, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
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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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Tavares AMR. Epidemiological profile of leprosy in the state of Mato Grosso: descriptive study. EINSTEIN-SAO PAULO 2021; 19:eAO5622. [PMID: 34495085 PMCID: PMC8386686 DOI: 10.31744/einstein_journal/2021ao5622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/16/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To analyze the prevalence of leprosy cases using as parameters the number of diagnosed cases, age group, sex, clinical form of the disease, degree of physical disability, affected nerves, and therapeutic methods. Methods This was a descriptive study. Data were collected in the Information System for Notifiable Diseases (Sistema de Informações de Agravos de Notificação) from 2014 to 2017 in the state of Mato Grosso (MT), Brazil. Results In the studied period, 11,388 cases were notified in the state, with a higher prevalence in the year 2017. Most cases were diagnosed in individuals older than 15 years with a slight predominance of men. During diagnosis, there was prevalence of zero degree of physical disability and among individuals with affected nerves, mostly had less than five nerves affected. Conclusion Analyzing the prevalence and epidemiological profile of leprosy cases in the state of Mato Grosso (MT) turns to be essential for coping with the disease, as it helps in its management and treatment, with an emphasis on multidisciplinary approach for the recovery of existing cases and prevention of new cases, especially at hyperendemic states.
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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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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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9
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Jaiswal AK, Tiwari S, Jamal SB, Oliveira LDC, Sales-Campos H, Andrade-Silva LE, Oliveira CJF, Ghosh P, Barh D, Azevedo V, Soares SC, Rodrigues VR, da Silva MV. Reverse vaccinology and subtractive genomics approaches for identifying common therapeutics against Mycobacterium leprae and Mycobacterium lepromatosis. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20200027. [PMID: 33889182 PMCID: PMC8040911 DOI: 10.1590/1678-9199-jvatitd-2020-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mycobacterium leprae and Mycobacterium lepromatosis are gram-positive bacterial pathogens and the causative agents of leprosy in humans across the world. The elimination of leprosy cannot be achieved by multidrug therapy alone, and highlights the need for new tools and drugs to prevent the emergence of new resistant strains. METHODS In this study, our contribution includes the prediction of vaccine targets and new putative drugs against leprosy, using reverse vaccinology and subtractive genomics. Six strains of Mycobacterium leprae and Mycobacterium lepromatosis (4 and 2 strains, respectively) were used for comparison taking Mycobacterium leprae strain TN as the reference genome. Briefly, we used a combined reverse vaccinology and subtractive genomics approach. RESULTS As a result, we identified 12 common putative antigenic proteins as vaccine targets and three common drug targets against Mycobacterium leprae and Mycobacterium lepromatosis. Furthermore, the docking analysis using 28 natural compounds with three drug targets was done. CONCLUSIONS The bis-naphthoquinone compound Diospyrin (CID 308140) obtained from indigenous plant Diospyros spp. showed the most favored binding affinity against predicted drug targets, which can be a candidate therapeutic target in the future against leprosy.
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Affiliation(s)
- Arun Kumar Jaiswal
- Graduate Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Sandeep Tiwari
- Graduate Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Syed Babar Jamal
- Department of Biological Sciences, National University of Medical Sciences, Rawalpindi, Punjab, Pakistan
| | - Letícia de Castro Oliveira
- Graduate Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Helioswilton Sales-Campos
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
- Institute of Tropical Pathology and Public Health, Federal University of Goias (UFG), Goiânia, Goiás, Brazil
| | - Leonardo Eurípedes Andrade-Silva
- Infectious Disease Department, Institute of Health Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Carlo Jose Freire Oliveira
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Preetam Ghosh
- Department of Computer Science, Virginia Commonwealth University, Richmond, VA, USA
| | - Debmalya Barh
- Centre for Genomics and Applied Gene Technology, Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur, West Bengal, India
| | - Vasco Azevedo
- Graduate Program in Bioinformatics, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Siomar C. Soares
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Virmondes Rodrigues Rodrigues
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
| | - Marcos Vinicius da Silva
- Department of Immunology, Microbiology and Parasitology, Institute of Biological Sciences and Natural Sciences, Federal University of Triângulo Mineiro (UFTM), Uberaba, MG, Brazil
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10
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Araújo ODD, Ferreira AF, Araújo TMED, Silva LCLD, Lopes WMPS, Neri ÉAR, Cardoso JA, Costa JM, Moura EH, Bezerra SMG, Macêdo MS, Ramos AN. [Leprosy-related mortality in the State of Piauí, Brazil: time trends and spatial patterns, 2000-2015]. CAD SAUDE PUBLICA 2020; 36:e00093919. [PMID: 33027473 DOI: 10.1590/0102-311x00093919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 02/13/2020] [Indexed: 11/22/2022] Open
Abstract
The study aimed to analyze spatial patterns and time trends in leprosy-related mortality in the State of Piauí, Brazil, from 2000 to 2015. This was a mixed ecological study with a spatial and temporal state-based approach, using data from the Brazilian Mortality Information System. The analysis includes epidemiological characteristics, mortality trends by Joinpoint regression, and spatial analysis, using the state's 224 municipalities (counties) as the geographic unit. Of the 245,413 deaths identified, leprosy was identified in 234 death certificates, 135 (41.7%) as the underlying cause of death and 189 (58.3%) as an associated cause of death. The highest leprosy-related mortality rates were associated with male gender (relative risk - RR = 2.38; 95%CI: 1.87; 3.03), elderly age (RR = 10.52; 95%CI: 7.16; 15.46), brown skin color (RR = 2.22; 95%CI: 1.47; 3.35), and residents of the state's interior (RR = 5.72; 95%CI: 4.54; 7.21). The crude leprosy-related mortality rate showed a significant increase among the elderly (70 years), brown race/color, cities with fewer than 20,000 inhabitants, and the Central region of the state, but not significant for the State of Piauí as a whole. The spatial distribution by age-adjusted mortality was heterogeneous in the municipalities, concentrating high mortality rates in the northern region of the state, close to the coastline. There was a pattern of increasing smoothed mortality rates over the course of the study's four-year periods in the Mid-northern Central and Semiarid regions. Leprosy mortality was spatially heterogeneous and growing over the years. The findings highlight the importance of enhancing integrated surveillance and healthcare activities.
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11
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Silva CRD, Sampaio LHF, Souza JPFD, Caetano GTP, Wastoswki IJ. Epidemiological trends of leprosy in Goiás, Brasil. CIENCIA & SAUDE COLETIVA 2020; 25:3723-3730. [PMID: 32997006 DOI: 10.1590/1413-812320202510.31022018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/18/2018] [Indexed: 11/21/2022] Open
Abstract
Brazil is the second nation in absolute number of new cases of leprosy in the world. The country presents many regions highly endemic to the disease, as is the case of the Goiás. The present study aims to analyze the temporal trends of leprosy indicators in Goiás between 2006 and 2015. This study showed a significant trend of decline for the coefficient of detection. Although the central-western region of the state presented the highest absolute number of cases, the Northeast of the state presents the worst epidemiological situation, with an increase in the number of cases of patients with physical disabilities and those under 14 years of age. The data also showed that there is an increase in the cases of patients with physical deformities in almost all macroregions of the state, indicative of late diagnosis. It is very important that there is a more effective and continuous training of the health professionals of the non-centralized units, for a real control of leprosy as a public health problem in the state. In addition, special attention should be given to the poorer regions of the state, which have shown a tendency to increase the diagnosis of patients younger than 14 years and with physical disabilities caused by leprosy.
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Affiliation(s)
- Camila Rodrigues da Silva
- Faculdade de Medicina, Universidade Federal de Goiás. R. 235 s/n, Setor Leste Universitário. 74605-050 Goiânia GO Brasil,
| | | | | | | | - Isabela Jubé Wastoswki
- Programa de Ciências Aplicadas a Produtos para Saúde, Universidade Estadual de Goiás (UEG). Anápolis GO Brasil
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12
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da Silva CS, Barreto JA, Avelino-Silva VI, Bierrenbach AL. Impact of health interventions on epidemiological and operational leprosy indicators in a hyperendemic municipality of Brazil. Rev Inst Med Trop Sao Paulo 2020; 62:e72. [PMID: 33027396 PMCID: PMC7534405 DOI: 10.1590/s1678-9946202062072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/01/2020] [Indexed: 11/24/2022] Open
Abstract
The study aimed to analyze the impact of health interventions carried out in the city of Palmas, Brazil, on the epidemiological and operational indicators of leprosy between 2007 and 2017. The intervention consisted of training healthcare personnel on the diagnosis and follow-up of patients and organizing the referral of patients to health units. Estimates of the impact were calculated by taking the differences between indicators reported in two equal periods of 1.5 years pre- and post-intervention, with a transition period of six months. During the study period, the database contained 1,875 notifications, with 66% of cases diagnosed in the post-intervention period. There was a predominance of males (52%); aged 50 years or more (34.9%); with mixed ethnicity (63.5%). The low level of education was noticeable, with more than half of the cases (51.7%) reporting illiteracy or ≤ 7 years of education. The intervention resulted in an increase in both, epidemiological and operational indicators, suggesting a positive impact of the intervention on leprosy detection and treatment. Our results also emphasize the need for further studies addressing the impact of pragmatic health interventions aiming at controlling and eliminating the disease.
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Affiliation(s)
| | | | - Vivian Iida Avelino-Silva
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Ana Luiza Bierrenbach
- Hospital Sírio-Libanês, Instituto Sírio-Libanês de Ensino e Pesquisa, São Paulo, São Paulo, Brazil
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13
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Júnior EVDS, Cruz DP, Caricchio GMN, Santos JSD, Boery RNSDO, Boery EN. Leprosy: epidemiology of the morbidity, mortality and public spending in the northeast of brazil. REVISTA DE PESQUISA CUIDADO É FUNDAMENTAL ONLINE 2020. [DOI: 10.9789/2175-5361.rpcfo.v12.8022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objetivo: descrever a morbimortalidade e gastos públicos por hanseníase no nordeste brasileiro entre 2012 e 2017. Métodos: estudo ecológico e descritivo realizado com dados do Sistema de Informações Hospitalares. Selecionou-se as variáveis: unidades federativas, faixa etária, sexo, raça/cor e gastos públicos. Resultados: registrou-se 7.067 internações, 147 óbitos e mortalidade de 2,08%. As internações se destacaram em Pernambuco (33,82%), idade entre 30 a 34 anos (9,31%), sexo masculino (64,94%) e pardos (49,80%). Já os óbitos se destacaram no Maranhão (22,45%), idade entre 75 a 79 anos (12,93%), sexo masculino (68,71%) e raça/cor sem informação (48,30%). A maior mortalidade ocorreu em Sergipe (6,06%), idade entre 75 a 79 anos (9,69%), sexo masculino (2,2%) e raça/cor sem informação (2,47%). Houve impacto financeiro superior a 3,7 milhões de reais e Pernambuco onerou 42% desse valor. Conclusão: a mortalidade apresentou comportamento crescente, evidenciando a importância da precocidade diagnóstica e terapêutica para prevenir complicações.
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14
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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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15
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Disability progression among leprosy patients released from treatment: a survival analysis. Infect Dis Poverty 2020; 9:53. [PMID: 32448360 PMCID: PMC7245886 DOI: 10.1186/s40249-020-00669-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background Leprosy can be cured, but physical disability (PD) as a result of the infection can progress in the post-release from treatment phase. This study evaluated the likelihood of, and factors associated with, the progression of the PD grade post-release from treatment among leprosy patients treated in Cáceres-MT, Brazil in the period 2000 to 2017. Methods A retrospective cohort study and survival analysis were performed in the hyperendemic municipality of Cáceres in the state of Mato Grosso. The study population consisted of newly diagnosed leprosy patients released from treatment between January 1, 2000 and December 31, 2017. The main outcome was the progression of the PD grade with regard to probability and time; and the evaluated covariates included clinical, operational and demographic variables. The Cox proportional risk model was used to estimate the risk ratio (Hazard Ratios) of the covariates. Both an univariate and a multivariate analysis were implemented, with 95% confidence intervals. Results The mean time for progression of the PD grade was 162 months for PB and 151 months for MB leprosy patients. The survival curve showed that 15 years after the release from treatment, the probability of PD grade progression was 35%, with no difference between PB and MB or age groups. Leprosy reactions and registered medical complaints of any kind during treatment were identified as risk factors with Hazard Ratios of 1.6 and 1.8 respectively. Conclusions People released from treatment as cured of leprosy are susceptible to worsening of the PD, especially those who have had complications during multi-drug therapy treatment. This indicates that leprosy patients should be periodically monitored, even after the successful completion of multidrug therapy.
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16
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Souza CDFD, Fernandes TRMDO, Matos TS, Tavares CM. Leprosy in the elderly population of an endemic state in the Brazilian Northeast (2001-2017): epidemiological scenario. An Bras Dermatol 2020; 95:91-94. [PMID: 31889593 PMCID: PMC7058885 DOI: 10.1016/j.abd.2019.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/13/2019] [Indexed: 10/29/2022] Open
Abstract
This ecological study aims to analyze both the tendency and the characteristics of leprosy in the elderly population in the state of Bahia, 2001-2017. The tendency was analyzed through joinpoint regression. Epidemiological variables were also included in the study. The average detection rate was 38.73/100,000, with prevalence of men (45.19/100,000). A downward trend occurred in both genders, from 2004, with a greater magnitude in women (annual percent change [APC]=-3.4%). Men presented higher proportions of the multibacillary forms and physical disabilities. The epidemiological scenario indicates the need of implementation of actions that stimulate early diagnosis and treatment of the elderly population.
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Affiliation(s)
- Carlos Dornels Freire de Souza
- Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil; Medical Program of Universidade Federal de Alagoas, Arapiraca, AL, Brazil.
| | | | - Thais Silva Matos
- Program of Biological Sciences and Health of Universidade Federal do Vale do São Francisco, Petrolina, PE, Brazil; Dr. Altino Lemos Santiago Leprosy Reference Center, Juazeiro, BA, Brazil
| | - Clódis Maria Tavares
- Universidade de São Paulo, São Paulo, SP, Brazil; School of Nursery and Pharmacy, Universidade Federal de Alagoas, Maceió, AL, Brazil
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17
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Ferreira AF, Amorim de Sousa E, Soledad Márdero García G, da Silva Dos Reis A, Corona F, da Silveira Lima M, Silva Nascimento Andrade E, Ribeiro Filha C, Alves de Sena Neto S, Mendes Donato I, Novaes Ramos A. Leprosy in the North and Northeast regions of Brazil: an integrated spatiotemporal approach. Trop Med Int Health 2019; 25:193-208. [PMID: 31713982 DOI: 10.1111/tmi.13343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the spatiotemporal patterns of leprosy occurrence in the North and Northeast regions of Brazil from 2001 to 2017. METHODS Mixed population-based ecological study with spatial and temporal trend analysis of epidemiological indicators based on new cases reported to the Information System for Notifiable Diseases of the Ministry of Health occurring in individuals residing in North and Northeast states of Brazil. RESULTS A total of 396 987 new cases were analysed; 9.2% of these involved children <15 years of age, and 5.4% involved individuals with grade 2 disability (G2D). The Northeast region recorded 66.4% of the new cases. Most cases involved males between 15 and 59 years of age and of brown race/colour. The temporal trend showed a reduction in most of the indicators and study variables. The G2D rate did not have trends over time in the Northeast Region, in individuals 0-14 years of age, or in municipalities with 'very high' social vulnerability indexes. The spatial and spatiotemporal analysis showed the presence of hyperendemic foci with high detection risk involving municipalities in the states of Tocantins, Pará and Maranhão. CONCLUSION Leprosy in the North and Northeast regions of Brazil persists as a critical public health problem. Temporal and spatiotemporal patterns identified in this study confirm that leprosy remains epidemiologically relevant in vulnerable areas. Surveillance and control interventions are needed in municipalities with low detection in the general population, in children and in individuals with G2D, to reduce late diagnosis.
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Affiliation(s)
- Anderson Fuentes Ferreira
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Eliana Amorim de Sousa
- Multidisciplinary Health Institute, Federal University of Bahia - Anísio Teixeira Campus, Vitória da Conquista, Bahia, Brazil
| | | | - Adriana da Silva Dos Reis
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Francesco Corona
- Science Centre, Department of Computer Science, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Carmelita Ribeiro Filha
- General Coordination of Leprosy and Disappearing Diseases, Ministry of Health, Brasília, Federal District, Brazil
| | | | - Isaac Mendes Donato
- School of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
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18
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Reis ADSD, Souza EAD, Ferreira AF, Silva GVD, Macedo SFD, Araújo ODD, Cruz JR, García GSM, Carneiro MAG, Barbosa JC, Ramos AN. [Overlapping of new leprosy cases in household contact networks in two municipalities in North and Northeast Brazil, 2001-2014]. CAD SAUDE PUBLICA 2019; 35:e00014419. [PMID: 31596392 DOI: 10.1590/0102-311x00014419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/02/2019] [Indexed: 11/22/2022] Open
Abstract
The study aimed to analyze the magnitude and sociodemographic profile of leprosy cases linked to household contact networks with overlapping of the disease in two Brazilian municipalities (counties), one in the North and the other in the Northeast, from 2001 to 2014. This was a cross-sectional, descriptive, analytical study based on primary and secondary data from new leprosy cases in Picos, Piauí State, and Rolim de Moura, Rondônia State. "Overlapping" was defined as new cases with the occurrence of at least one more leprosy case in the individual's household contact network. Each household contact network consisted of the index case (first reported case), co-prevalent cases (contacts that became new cases), and household contacts of the index case. A total of 437 new cases treated by the INTEGRAHANS North-Northeast and Piauí projects were assessed, of which 287 (65.7%) were in Picos and 150 (34.3%) in Rolim de Moura. Of all the cases assessed, 129 (44.9%) in Picos and 98 (65.3%) in Rolim de Moura reported overlapping. There were proportionally more females in Rolim de Moura (n = 95, 63.3%) and males in Picos (n = 147, 51.2%); in the 41-60-year age bracket (Rolim de Moura n = 70, 46.7%; Picos n = 115, 40.1%); with elementary schooling (Rolim de Moura n = 80, 54%; Picos n = 125, 44.5%); and individuals living in the same household with up to 3 persons in Rolim de Moura (n = 105, 70%) and with more than 4 persons in Picos (n = 287, 100%). Overlapping of leprosy cases in household contact networks was considerably high in the contexts analyzed here, displaying aspects of expanded vulnerability. This perspective should be considered and integrated into leprosy surveillance and control activities.
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Affiliation(s)
- Adriana da Silva Dos Reis
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Ceará, Fortaleza, Brasil.,Netherlands Hanseniasis Relief do Brasil, Fortaleza, Brasil
| | - Eliana Amorim de Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil
| | | | | | - Suyanne Freire de Macedo
- Programa de Pós-graduação em Saúde Coletiva, Universidade Estadual do Ceará, Fortaleza, Brasil.,Departamento de Enfermagem, Universidade Federal do Piauí, Picos, Brasil
| | | | - Jessíca Reco Cruz
- Faculdade de Ciências Biomédicas de Cacoal, Cacoal, Brasil.,Secretaria Municipal de Saúde de Cacoal, Cacoal, Brasil
| | | | | | - Jaqueline Caracas Barbosa
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Ceará, Fortaleza, Brasil.,Netherlands Hanseniasis Relief do Brasil, Fortaleza, Brasil
| | - Alberto Novaes Ramos
- Netherlands Hanseniasis Relief do Brasil, Fortaleza, Brasil.,Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Brasil
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19
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Pereira TM, Silva LMSD, Dias MSDA, Monteiro LD, Silva MRFD, Alencar OMD. Temporal trend of leprosy in a region of high endemicity in the Brazilian Northeast. Rev Bras Enferm 2019; 72:1356-1362. [PMID: 31531662 DOI: 10.1590/0034-7167-2018-0682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/19/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the temporal trend and epidemiological patterns of leprosy indicators in Sobral, a municipality countryside of the state of Ceará, from 2001 to 2016. METHOD a time series study based on data from the Department of Informatics of the Unified Health System. The time trend analysis was performed using the join point regression model. RESULTS There were 2,220 new cases of leprosy in Sobral from 2001 to 2016. Of these, 158 (7.2%) in children younger than 15 years of age, the proportion of new male cases was 52.8% (1,162), cases with grade 2 were 7.0% (156), and proportion of cases diagnosed by contact examination 5.7% (126). FINAL CONSIDERATIONS leprosy remains hyperendemic in adults and children, demonstrating the character of neglected disease. Analysis of the temporal trend allowed to verify that the instability in the detection coefficients, reflect operational problems in the organization of the services.
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Souza EAD, Ferreira AF, Pinto MSAP, Heukelbach J, Oliveira HX, Barbosa JC, Ramos AN. [Performance of leprosy case-contact surveillance: a space-time analysis in Bahia State, Northeast Brazil]. CAD SAUDE PUBLICA 2019; 35:e00209518. [PMID: 31508701 DOI: 10.1590/0102-311x00209518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/29/2019] [Indexed: 11/22/2022] Open
Abstract
The aim was to analyze the space-time trend in the proportion of contacts examined among those recorded, according to demographic profile of new leprosy cases in the State of Bahia, Brazil, in the 2003-2014 cohort. This was a state population-based ecological study with temporal and spatial analyses of the proportion of contacts examined among those recorded, according to characteristics of the reference leprosy case, based on the Information System for Notifiable Diseases of the Brazilian Ministry of Health. The time trend analysis was based on Poisson regression (Joinpoints). Spatial analysis used spatial autocorrelation by local indicators of spatial association. Over the course of the historical series, 52.9% (55,116/104,142) of the recorded contacts were examined, with lower proportions in persons < 60 years of age, indigenous individuals, and residents of large cities (especially the state capital Salvador). There was an upward trend in the proportion of contacts examined, less evident when the reference leprosy case was a male, black, living in the rural area, and in small towns or the state capital. Spatial distribution showed that the majority of the municipalities showed precarious performance, with clusters identified in the North and Far South of the state. Bahia shows precarious performance on contact surveillance, particular in conditions of greater social vulnerability. Additional strategies should be implemented in order to overcome the operational obstacles to contact surveillance, considered essential for interrupting leprosy transmission in the state.
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Affiliation(s)
- Eliana Amorim de Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brasil.,Programa de Pós-graduação em Saúde Pública, Universidade Federal do Ceará, Fortaleza, Brasil
| | | | | | - Jorg Heukelbach
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Ceará, Fortaleza, Brasil.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Héllen Xavier Oliveira
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Jaqueline Caracas Barbosa
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Ceará, Fortaleza, Brasil.,Netherlands Hanseniasis Relief do Brasil, Fortaleza, Brasil
| | - Alberto Novaes Ramos
- Programa de Pós-graduação em Saúde Pública, Universidade Federal do Ceará, Fortaleza, Brasil.,Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Brasil
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Nery JS, Ramond A, Pescarini JM, Alves A, Strina A, Ichihara MY, Fernandes Penna ML, Smeeth L, Rodrigues LC, Barreto ML, Brickley EB, Penna GO. Socioeconomic determinants of leprosy new case detection in the 100 Million Brazilian Cohort: a population-based linkage study. Lancet Glob Health 2019; 7:e1226-e1236. [PMID: 31331811 PMCID: PMC6688099 DOI: 10.1016/s2214-109x(19)30260-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although leprosy is recognised as a disease of poverty, there is little evidence on the specific socioeconomic factors associated with disease risk. To inform targeted strategies for disease elimination, we investigated socioeconomic markers of leprosy risk in Brazil. METHODS Socioeconomic data from the 100 Million Brazilian Cohort were linked to the Brazilian national disease registry (Sistema de Informação de Agravos de Notificação) for leprosy from Jan 1, 2007, to Dec 31, 2014. Using Poisson regression, we assessed the association of socioeconomic factors with risk of incident leprosy in the full cohort and in children (aged 0-15 years), by leprosy subtype and region of residence. FINDINGS In an analysis of 23 899 942 individuals including 18 518 patients with leprosy, increased levels of deprivation were associated with an increased risk of leprosy in Brazil. Directions of effect were consistent in children younger than 15 years and across disease subtypes. Individuals residing in regions with the highest poverty in the country (central-west, north, and northeast regions) had a risk of leprosy incidence five-to-eight times greater than did other individuals. Decreased levels of income and education and factors reflecting unfavourable living conditions were associated with an up to two-times increase in leprosy incidence (incidence rate ratio 1·46, 95% CI 1·32-1·62, for lowest vs highest quartile of income per capita; 2·09, 95% CI 1·62-2·72, for lowest vs highest level of education). INTERPRETATION Within the poorest half of the Brazilian population, the most deprived individuals have the greatest risk of leprosy. Strategies focusing on early detection and treatment in the poorest populations could contribute substantially to global disease control. FUNDING Medical Research Council, Wellcome Trust, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Brazil), the Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa, Economic and Social Research Council, Biotechnology and Biological Sciences Research Council, Conselho Nacional de Desenvolvimento Científico e Tecnológico, and Fundação de Apoio à Pesquisa do Distrito Federal.
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Affiliation(s)
- Joilda Silva 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
| | - Julia Moreira Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil
| | - André Alves
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Agostino Strina
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK; Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | - Liam Smeeth
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil; Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Gerson Oliveira Penna
- Tropical Medicine Centre, University of Brasília, Fiocruz School of Goverment Brasília, Brazil
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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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Raposo MT, Reis MC, Caminha AVDQ, Heukelbach J, Parker LA, Pastor-Valero M, Nemes MIB. Grade 2 disabilities in leprosy patients from Brazil: Need for follow-up after completion of multidrug therapy. PLoS Negl Trop Dis 2018; 12:e0006645. [PMID: 30011288 PMCID: PMC6062121 DOI: 10.1371/journal.pntd.0006645] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/26/2018] [Accepted: 06/28/2018] [Indexed: 12/03/2022] Open
Abstract
Background Leprosy continues to be a public health problem in many countries. Difficulties faced by health services include late diagnosis, under-reporting of new cases, adequate monitoring of disabilities and treatment. Furthermore, systematic follow-up after completion of treatment is important, when new disabilities may occur, or existing disabilities may get worse. The objective of the present study was to determine the prevalence of leprosy-associated grade 2 disabilities (G2D) after completion of multidrug therapy (MDT) and to identify factors associated with G2D. Methods We performed a cross-sectional study of 222 leprosy cases registered in Vitória da Conquista, Bahia state, Brazil from 2001–2014. We performed a clinical examination of the study participants and collected socio-economic and clinical information by interview. We identified factors associated with grade 2 disability (G2D) using logis tic regression. Results In total, 38 (17.1%) participants were diagnosed with G2D, and 106 (47.7%) with grade 1 disabilities (G1D). The following independent factors were significantly associated with G2D: occurrence of leprosy reaction (adjusted OR = 2.5; 95%CI = 1.09–5.77), thickening and/or tenderness of one or more nerve trunks (adjusted OR = 3.0; CI = 1.13–8.01) and unemployment (adjusted OR = 7.17; CI = 2.44–21.07). Conclusions This study shows that physical disabilities remain after completion of MDT and frequently occur in an endemic area in Brazil. Finding new ways to reduce the burden of disability are urgently needed, and may include systematic follow-up of patients after treatment completion combined with evidence-based preventative measures. Leprosy is a Neglected Tropical Disease that is still common in many countries. Patients who have had leprosy often suffer long-term physical disabilities. For some patients, disabilities occur after finishing treatment or existing disabilities may get worse. We contacted 222 leprosy patients who had previously completed multidrug therapy (MDT) in a typical endemic area in Brazil and assessed leprosy-associated disabilities, and the associated clinical or sociodemographic factors. We found that 17.1% of the participants had severe (grade 2) disabilities. Disabilities were more common among patients who had had a leprosy reaction, thickening and/or tenderness of one or more nerve trunks and were unemployed. The findings are important because we show that physical disabilities occur frequently after treatment completion in this area, and that patients need long-term follow-up by the health system. Integrated measures that consider clinical and socio-economic aspects are also needed to reduce leprosy burden after completion of treatment, such as devising of public policies, implementation of clinical monitoring and the development of evidence-based guidelines for follow-up after release from MDT.
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Affiliation(s)
- Marcos Túlio Raposo
- Departamento de Saúde I, Universidade Estadual do Sudoeste da Bahia, Jequié, Bahia, Brazil
| | | | | | - Jörg Heukelbach
- Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Lucy Anne Parker
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Alicante, Alicante, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Pastor-Valero
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Alicante, Alicante, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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