Tendências da hanseníase no Tocantins, um estado hiperendêmico do Norte do Brasil, 2001-2012

Spatial analysis of the epidemiological risk of leprosy in the municipalities of Minas Gerais

BACKGROUND

Leprosy remains a significant public health problem of high importance. This investigation aims to analyze the spatial distribution of the leprosy epidemiological risk in the municipalities of Minas Gerais.

METHODS

This ecological study was conducted with new leprosy cases diagnosed from 2004 to 2019 in the municipalities of the state of Minas Gerais. Based on the epidemiological indicators, a composite indicator called the leprosy epidemiological risk index was estimated, classifying municipalities as high, medium, low and very low risk. For the spatial analysis, the global and local spatial autocorrelation statistics were used to identify the spatial distribution of the leprosy epidemiological risk in the periods 2004-2011 and 2012-2019 and classified as High/High, Low/Low, High/Low and Low /High.

RESULTS

Although leprosy is declining in the state of Minas Gerais, the Global Moran Index confirmed the spatial dependence between municipalities for the two analyzed periods, characterizing the formation of clusters. When performing the local spatial autocorrelation, it was found that the macroregions with the highest number of municipalities with high indices, surrounded by other municipalities with high indices (high-high), were Northwest, East, South East, North, and Northeast. The low risk macroregions were Southeast, Center, South-Center and South.

CONCLUSION

Leprosy has a heterogeneous spatial pattern and remains concentrated in historically endemic areas of the state. It underscores the importance of intensifying actions to combat leprosy in these municipalities and macroregions. Promote improved access to health services and combat stigma and prejudice to eliminate leprosy as a public health problem.

Trend of epidemiological indicators of leprosy in an endemic state of the Amazon region

OBJECTIVE

To characterize the temporal trend of epidemiological indicators of leprosy in the State of Amapá.

METHOD

Time series study, carried out in the Notifiable Diseases Information System. The indicators analyzed were: annual detection rate of new cases, detection rate of new cases in the population from 0 to 14 years old, rate of new cases with grade 2 of disability, proportion of new cases with grade 2 and proportion of new multibacillary cases, between 2005 and 2018. The analysis of the temporal evolution was made by linear regression.

RESULTS

The detection rate of new cases and the rate of children under 15 years showed a decreasing trend. The rate of new cases with grade 2 of disability and the proportion of cases with grade 2 showed oscillation. The proportions of multibacillary remained constant.

CONCLUSION

The epidemiological indicators analyzed suggest active transmission and late diagnosis, signaling a possible hidden endemic disease.

Predicting the detection of leprosy in a hyperendemic area of Brazil: Using time series analysis

BACKGROUND

Brazil has the second highest prevalence of leprosy worldwide. Autoregressive integrated moving average models are useful tools in surveillance systems because they provide reliable forecasts from epidemiological time series.

AIM

To evaluate the temporal patterns of leprosy detection from 2001 to 2015 and forecast for 2020 in a hyperendemic area in northeastern Brazil.

METHODS

A cross-sectional study was conducted using monthly leprosy detection from the Brazil information system for notifiable diseases. The Box-Jenkins method was applied to fit a seasonal autoregressive integrated moving average model. Forecasting models (95% prediction interval) were developed to predict leprosy detection for 2020.

RESULTS

A total of 44,578 cases were registered with a mean of 247.7 cases per month. The best-fitted model to make forecasts was the seasonal autoregressive integrated moving average ((1,1,1); (1,1,1)). It was predicted 0.32 cases/100,000 inhabitants to January of 2016 and 0.38 cases/100,000 inhabitants to December of 2020.

LIMITATIONS

This study used secondary data from Brazil information system for notifiable diseases; hence, leprosy data may be underreported.

CONCLUSION

The forecast for leprosy detection rate for December 2020 was < 1 case/100,000 inhabitants. Seasonal autoregressive integrated moving average model has been shown to be appropriate and could be used to forecast leprosy detection rates. Thus, this strategy can be used to facilitate prevention and elimination programmes.

Epidemiological profile and tendency of leprosy in people younger than 15 years

OBJECTIVE

To evaluate the epidemiological characteristics and tendency of new leprosy cases in people younger than 15 years in the state of Bahia, Brazil, between 2007 and 2017.

METHOD

Quantitative, cross-sectional, descriptive study of cases registered in the Notifiable Diseases Information System. The sociodemographic variables were statistically analyzed through the G-test and trend classification was analyzed through linear regression, along with the tendency or percentage change.

RESULTS

The study comprised 2,298 new cases and presented decreasing rate of detection, growing proportion of investigated contacts, and decreasing proportion of healing. Paucibacillary cases are emphasized, with a 63.27% proportion and predominance among females with incomplete primary education and brown race/color living in urban zones. Regarding clinical forms, physical disabilities, and modes of detection, 26.68% were tuberculoid, 73.72% were grade zero, and 36.42% were referral, respectively.

CONCLUSION

The increased tendency in the proportion of investigated contacts and the decrease in the proportion of healing revealed a need for the health system to improve patient follow-up during treatment against leprosy.

Impact of health interventions on epidemiological and operational leprosy indicators in a hyperendemic municipality of Brazil

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.

Perfil epidemiológico dos casos de hanseníase em Porto Nacional - Tocantins de 2007 a 2018

Objetivo: Analisar o perfil epidemiológico da população diagnosticada com hanseníase no município de Porto Nacional, Tocantins. Métodos: Pesquisa epidemiológica transversal, descritiva, quantitativa, dos casos registrados de hanseníase no período de janeiro de 2007 a agosto de 2018. Os dados foram coletados no Sistema de Informação de Agravos de Notificação submetidos a estatística descritiva. Resultados: Foram identificadas 546 notificações de hanseníase no período estudado. Houve prevalência do sexo masculino (n = 296 casos; 54,2%), da cor parda (n = 389; 71,2%) e da faixa etária de 30 a 39 anos (n = 120; 22%). A forma dimorfa foi predominante, com 260 notificações (47,6%), e do tipo multibacilares, com 322 casos (59%). O estudo identificou que centros especializados de saúde realizaram um grande quantitativo de notificações da doença (44,7%) e as unidades básicas de saúde do município proporcionaram uma abrangência maior na detecção dessa patologia (55,3%).  Conclusão: A hanseníase ainda é um problema de saúde pública no município de Porto Nacional -TO, embora curável e de baixa recidiva, encontra-se ativa na população. Medidas de prevenção, promoção de saúde, treinamento multiprofissional e diagnóstico precoce favorecem para melhorar prognóstico.

Hansen's disease in children under 15 years old in the state of Tocantins, Brazil, 2001-2012: epidemiological patterns and temporal trends

INTRODUCTION

Tocantins is the most hyperendemic state for leprosy in Brazil.

OBJECTIVE

To describe the epidemiological characteristics and temporal trends of leprosy indicators in children under 15 years old in Tocantins between the years of 2001 and 2012.

METHODOLOGY

Data analysis of the Notification of Injury Information System (SINAN). New cases under the age of 15 have been included in the state. The indicators were calculated and the temporal trends were analyzed through the join-point regression.

RESULTS

There were 1,225 cases in children, mean age of 10.8 years, and male predominated (52%). The mode of detection by spontaneous demand prevailed (55.8%) and more than 9% had some physical disability. Detection in < 15 years was significantly increased between 2001 and 2008 (anual percent change - APC = 3.8%; confidence interval of 95% - 95%CI 0.1 - 7.6), and showed significant decline between 2008 and 2012 (APC = -9.4%; 95%CI -17.2 - -0.8). There was stability for the detection of grade 2 cases (APC = 4.2%; 95%CI -6.7 - 16.3), proportion of grade 2 cases (APC = 4.1%; 95%CI 6.7 - 16.3), proportion of grade 1 cases (APC = 1.3%; 95%CI -6.2 - 9.3), multibacillary ratio (APC = 2.9%; 95%CI -1.7 - 7.7), and proportion of paucibacillary (APC = 2.9%; 95%CI -1.7 - 7.7).

CONCLUSION

Leprosy remains an important public health problem in Tocantins, with active transmission and persistence of transmission foci. The stability of the indicators points out the permanence of the late diagnosis and the repressed demands.

Trend analysis of leprosy indicators in a hyperendemic Brazilian state, 2001-2015

OBJECTIVE

To analyze the temporal trend of leprosy indicators in a hyperendemic state of Brazil, from 2001-2015.

METHODS

This is a time-series study of leprosy indicators in the state of Maranhão, Northeastern region of Brazil. The study used data from the Brazilian National System of Reportable Diseases, for the period between 2001 and 2015. The following indicators were evaluated: (i) detection coefficient in the general population; (ii) detection coefficient in people under 15 years old; (iii) rate of cases with grade 2 physical disability in the diagnosis; (iv) rate of examined contacts, and (v) proportion of healing . The Prais-Winsten regression model was used for trend analysis. Analyses were performed for the state and by each health region.

RESULTS

77,697 leprosy cases were analyzed in the general population and 7,599 in individuals under 15 years old. The detection coefficient in the general population ranged from 80.7/100 thousand inhabitants in 2001 to 51.2/100 thousand inhabitants in 2015. The coefficient in the general population presented a downward trend (annual percentage variation [APV] = -2.98; 95%CI -4.15- -1.79). For the population under 15 years old, the rate was 24.9/100 thousand inhabitants in 2001, and 19.9/100 thousand inhabitants in 2015, with downward trend (APV = -3.07; 95%CI -4.95- -1.15). It was observed upward trend in rate of contacts examined (APV = 2.35; 95%CI 0.58-4.15) and rate of cases with grade 2 disability (APV = 2.19; 95%CI 0.23-4.19). Stationary trend was observed in the proportion of healing (APV = -0.10; 95%CI -0.50-0.30). Regional differences were found in the performance of the indicators.

CONCLUSIONS

A downward trend for the detection coefficients in the general population and in individuals under 15 years old was found in Maranhão. Despite this result, the rates are still very high, demanding efforts from all spheres of public administration and health professionals to reduce the burden of the disease in the state.

Hanseníase: incapacidades físicas e distribuição espacial em um município do Vale do Jequitinhonha/Minas Gerais

Introdução: A hanseníase no Brasil ainda é considerada como doença de saúde pública. É cada vez mais necessária a adoção de medidas profiláticas para o controle e prevenção da doença. A análise espacial tem se despontado como eficaz para estratégia de planejamento das ações. Objetivos: analisar as características epidemiológicas da hanseníase relacionadas à ocorrência de incapacidades físicas e descrever a distribuição espacial de casos novos de hanseníase no município de Diamantina-MG entre os anos de 2001 a 2014. Material e Métodos: Trata-se de um estudo epidemiológico, transversal, descritivo e analítico. Os dados clínicos e socioeconômicos foram coletados no Sistema de Informação de Agravos de Notificação. Os endereços foram georreferenciados através de técnicas de geoprocessamento, utilizando o software de acesso livre Qgis 2.18.0. Resultados: Foram diagnosticados 91 casos no período de estudo. As características que se associaram às incapacidades físicas foram: ser adulto (p=0,039), menos anos de estudo (p<0,001), forma clínica dimorfa (p<0,001) e modo de detecção passivo (p=0,024). Existe uma área de adoecimento na cidade. Conclusão: Sugere-se que existem dificuldades nos serviços de saúde para o controle e diagnóstico precoce da hanseníase. O estudo pode contribuir com gestores no planejamento das ações e com profissionais de saúde para busca ativa e diagnóstico precoce da hanseníase.

Spatial clustering, social vulnerability and risk of leprosy in an endemic area in Northeast Brazil: an ecological study

BACKGROUND

Despite the global decline in the detection of leprosy cases, its incidence has remained unchanged in certain settings and requires the determination of the factors linked to its persistence. We examined the spatial and space-time distribution of leprosy and the influence of social vulnerability on the occurrence of the disease in an endemic area of Northeast Brazil.

METHODS

We performed an ecological study of all leprosy cases reported by Sergipe state, Northeast Brazil from 2001 to 2015, to examine the association of the Social Vulnerability Index and the prevalence and persistence of leprosy among the State's municipalities. Socio-economic and leprosy surveillance information was collected from the Brazilian information systems, and a Bayesian empirical local model was used to identify fluctuations of the indicators. Spatial and space-time clusters were identified using scan spatial statistic tests and to measure the municipalities' relative risk of leprosy.

RESULTS

Leprosy clusters and burden of disease had a strong statistical association with the municipalities' Social Vulnerability Index. Municipalities with a high social vulnerability had higher leprosy incidence, multibacillary leprosy and newly diagnosed cases with grade 2 disability than areas with low social vulnerability.

CONCLUSION

Social vulnerability is strongly associated with leprosy transmission and maintenance of disease incidence. Leprosy control programmes should be targeted to the populations with high social vulnerability.

[Leprosy trends following implementation of an intervention project in a state capital in the North of Brazil, 2002-2016]

The project Palmas Free of Leprosy was implemented to improve indicators and deal with the disease, since the capital of Tocantins State is the most hyperendemic state capital in Brazil. This study measures the impact of the project's intervention through trend analysis of the priority indicators in Palmas, from 2002 to 2016. The study was based on an analysis of data from the Brazilian Information System for Notifiable Diseases (SINAN) and reports of applied training courses with problem-solving methodology. The indicators for new leprosy cases in Palmas residents were investigated, and the trends were identified by joinpoint regression analysis to assess the results. In the year the intervention project was implemented (2016), the detection rate for new cases in the overall population was 236.3/100,000 inhabitants, and this indicator showed a significant decrease of -7.5% from 2002 to 2014. From 2014 to 2016, there was a significant increase of 104.6% in overall detection. The detection rate in individuals under 15 years of age also showed a reduction of -4.6%, but in the years 2014, 2015, and 2016 there was an increase of 111.1%, together with detection rates for grades 0, 1, and 2, with 59.3%, 225.2%, and 121.7%, respectively. The proportion of cases detected by contact assessment showed a significant increase of 201.1% from 2014 to 2016. The data proved the effectiveness and potentiality of the project's intervention strategy for the diagnosis and control of leprosy in Palmas. The study provided evidence that timely diagnosis by primary care services results in indicators that reflect the real incidence of cases.

Understanding "patient discharge in leprosy": a concept analysis

OBJECTIVE

To analyze the concept of patient discharge in leprosy.

METHODS

Theoretical study guided in the methodological framework of concept analysis. A bibliographical survey was held from December 2015 to January 2016 using the following bases: SCOPUS, CINAHL, PubMed, LILACS, SCIELO and BDENF, by use of the descriptors "Leprosy" and "Patient Discharge", resulting in 13 studies.

RESULTS

The following were identified as possible uses for the concept: discharge by cure, drug use discharge, bacteriological discharge and post-discharge. The attributes defined were completion of multidrug therapy, completion of multidrug therapy for paucibacillary leprosy, completion of multidrug therapy for multibacillary leprosy and cure from leprosy. The presence of an M. leprae infection, symptoms present in skin and peripheral nerves, diagnosis and treatment and leprosy reactions were identified as antecedents. Consequents were exclusion from the active leprosy record and continuity of health care. One case model and one opposing case were presented.

CONCLUSIONS

The analysis broadened the concept "discharge in leprosy", providing other meanings than the clinical definition of multidrug therapy.

Social determinants of leprosy in a hyperendemic State in North Brazil

OBJECTIVE

To identify the socioeconomic, demographic, operational, and health service-related factors associated with the occurrence of leprosy in a hyperendemic State in North Brazil.

METHODS

This is an ecological study based on secondary data from the Sistema de Informações de Agravos de Notificação in municipalities of the State of Tocantins from 2001 to 2012. Units of analysis were the 139 municipalities of the State. Negative binomial log linear regression models were used to estimate incidence rate ratios.

RESULTS

In bivariate analysis, the incidence rate ratios were significantly higher for municipalities with higher income ratio of the poorest 20.0% (1.47; 95%CI 1.19-1.81) and better Municipal Human Development Index (1.53; 95%CI 1.14-2.06). In multivariate analysis, the incidence rate ratios were significantly higher in municipalities with higher proportion of immigrants (1.31; 95%CI 1.11-1.55) and higher proportion of households with waste collection (1.37; 95%CI 1.11-1.69). There was a significant reduction in the incidence rate ratio with increased coverage of the Bolsa Família Program (0.98; 95%CI 0.96-0.99).

CONCLUSIONS

Control programs need to focus on activities in municipalities of greater social vulnerability with intersectoral investment for the improvement of the living conditions of the population.

OBJETIVO

Identificar fatores socioeconômicos, demográficos, operacionais e de serviços de saúde associados à ocorrência da hanseníase em um estado hiperendêmico do norte do Brasil.

MÉTODOS

Estudo ecológico com dados secundários do Sistema de Informações de Agravos de Notificação em municípios do estado do Tocantins de 2001 a 2012. As unidades de análise foram os 139 municípios do estado. Modelos de regressão log linear binomial negativa foram utilizados para estimar as razões de taxas de incidência.

RESULTADOS

Na análise bivariada, a razão de taxa de incidência foi significativamente maior para os municípios com maior razão de renda dos 20,0% mais pobres (1,47; IC95% 1,19-1,81) e melhor Índice de Desenvolvimento Humano Municipal (1,53; IC95% 1,14-2,06). Na múltipla, a razão de taxa de incidência foi significativamente superior em municípios com maior concentração de imigrantes (1,31; IC95% 1,11-1,55) e proporção de domicílios com coleta de lixo (1,37; IC95% 1,11-1,69). Houve redução significativa da razão de taxa de incidência com o aumento da cobertura do programa bolsa família (0,98; IC95% 0,96-0,99).

CONCLUSÕES

Os programas de controle precisam focar as atividades em municípios de maior vulnerabilidade social com investimentos intersetoriais para a melhoria das condições de vida da população.

Spatial patterns of leprosy in a hyperendemic state in Northern Brazil, 2001-2012

OBJECTIVE

To describe the spatial patterns of leprosy in the Brazilian state of Tocantins.

METHODS

This study was based on morbidity data obtained from the Sistema de Informações de Agravos de Notificação (SINAN - Brazilian Notifiable Diseases Information System), of the Ministry of Health. All new leprosy cases in individuals residing in the state of Tocantins, between 2001 and 2012, were included. In addition to the description of general disease indicators, a descriptive spatial analysis, empirical Bayesian analysis and spatial dependence analysis were performed by means of global and local Moran's indexes.

RESULTS

A total of 14,542 new cases were recorded during the period under study. Based on the annual case detection rate, 77.0% of the municipalities were classified as hyperendemic (> 40 cases/100,000 inhabitants). Regarding the annual case detection rate in < 15 years-olds, 65.4% of the municipalities were hyperendemic (10.0 to 19.9 cases/100,000 inhabitants); 26.6% had a detection rate of grade 2 disability cases between 5.0 and 9.9 cases/100,000 inhabitants. There was a geographical overlap of clusters of municipalities with high detection rates in hyperendemic areas. Clusters with high disease risk (global Moran's index: 0.51; p < 0.001), ongoing transmission (0.47; p < 0.001) and late diagnosis (0.44; p < 0.001) were identified mainly in the central-north and southwestern regions of Tocantins.

CONCLUSIONS

We identified high-risk clusters for transmission and late diagnosis of leprosy in the Brazilian state of Tocantins. Surveillance and control measures should be prioritized in these high-risk municipalities.