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Taal AT, Garg A, Lisam S, Agarwal A, Barreto JG, van Brakel WH, Richardus JH, Blok DJ. Identifying clusters of leprosy patients in India: A comparison of methods. PLoS Negl Trop Dis 2022; 16:e0010972. [PMID: 36525390 PMCID: PMC9757546 DOI: 10.1371/journal.pntd.0010972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Preventive interventions with post-exposure prophylaxis (PEP) are needed in leprosy high-endemic areas to interrupt the transmission of Mycobacterium leprae. Program managers intend to use Geographic Information Systems (GIS) to target preventive interventions considering efficient use of public health resources. Statistical GIS analyses are commonly used to identify clusters of disease without accounting for the local context. Therefore, we propose a contextualized spatial approach that includes expert consultation to identify clusters and compare it with a standard statistical approach. METHODOLOGY/PRINCIPAL FINDINGS We included all leprosy patients registered from 2014 to 2020 at the Health Centers in Fatehpur and Chandauli districts, Uttar Pradesh State, India (n = 3,855). Our contextualized spatial approach included expert consultation determining criteria and definition for the identification of clusters using Density Based Spatial Clustering Algorithm with Noise, followed by creating cluster maps considering natural boundaries and the local context. We compared this approach with the commonly used Anselin Local Moran's I statistic to identify high-risk villages. In the contextualized approach, 374 clusters were identified in Chandauli and 512 in Fatehpur. In total, 75% and 57% of all cases were captured by the identified clusters in Chandauli and Fatehpur, respectively. If 100 individuals per case were targeted for PEP, 33% and 11% of the total cluster population would receive PEP, respectively. In the statistical approach, more clusters in Chandauli and fewer clusters in Fatehpur (508 and 193) and lower proportions of cases in clusters (66% and 43%) were identified, and lower proportions of population targeted for PEP was calculated compared to the contextualized approach (11% and 11%). CONCLUSION A contextualized spatial approach could identify clusters in high-endemic districts more precisely than a standard statistical approach. Therefore, it can be a useful alternative to detect preventive intervention targets in high-endemic areas.
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Affiliation(s)
- Anneke T. Taal
- NLR, Amsterdam, The Netherlands
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | | | | | | | | | | | | | - David J. Blok
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Linhares MSC, Kerr LRFS, Kendall C, Almeida RLFD, Klovdahl A, Frota CC. Spatial distribution pattern of new leprosy cases under 15 years of age and their contacts in Sobral, Ceará, Brazil. CIENCIA & SAUDE COLETIVA 2022; 27:1641-1652. [PMID: 35475842 DOI: 10.1590/1413-81232022274.06902021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/02/2021] [Indexed: 11/22/2022] Open
Abstract
This study's objective was to analyze the spatial distribution pattern of new leprosy cases under 15 years and their contacts. A cross-sectional descriptive study covering sociodemographic characteristics and spatial analysis was carried out. The participants were from the city of Sobral, Ceará and the study was conducted between August 2014 and September 2015. Contacts were identified by the persons responsible for the children. Seropositivity was determined with the NDO-LID antigen, and positive cases were plotted on Voronoi polygons. Nine new cases of leprosy under 15 years of age have been found. The average number of people living with the cases was higher than the number of people living with non-household contacts. All household contacts were aware of other leprosy cases and had a higher rate of seropositive tests than non-household contacts. The index cases lived in the poorest regions of the municipality and hyper-endemic areas. Spatial analysis revealed a cluster of subclinical infection within a radius of 102 meters, suggesting that non-household transmission is related to proximity with seropositive individuals. In conclusion, the search for new leprosy cases cannot be restricted to household contacts.
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Affiliation(s)
- Maria Socorro Carneiro Linhares
- Universidade Estadual Vale do Acaraú. Sobral CE Brasil. Av. da Universidade 850 Campus da Betânia, 62040-370. Sobral CE Brasil. .,Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará. Fortaleza CE Brasil
| | | | - Carl Kendall
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará. Fortaleza CE Brasil.,Center for Global Health Equity, Tulane School of Public Health and Tropical Medicine. New Orleans USA
| | | | | | - Cristiane C Frota
- Departamento de Patologia e Medicina Legal, Faculdade de Medicina, Universidade Federal de Ceará. Fortaleza CE Brasil
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Machado LMG, Dos Santos ES, Cavaliero A, Steinmann P, Ignotti E. Spatio-temporal analysis of leprosy risks in a municipality in the state of Mato Grosso-Brazilian Amazon: results from the leprosy post-exposure prophylaxis program in Brazil. Infect Dis Poverty 2022; 11:21. [PMID: 35193684 PMCID: PMC8862266 DOI: 10.1186/s40249-022-00943-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/02/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Leprosy post-exposure prophylaxis (LPEP) with single dose rifampicin (SDR) can be integrated into different leprosy control program set-ups once contact tracing has been established. We analyzed the spatio-temporal changes in the distribution of index cases (IC) and co-prevalent cases among contacts of leprosy patients (CP) over the course of the LPEP program in one of the four study areas in Brazil, namely the municipality of Alta Floresta, state of Mato Grosso, in the Brazilian Amazon basin. METHODS Leprosy cases were mapped, and socioeconomic indicators were evaluated to explain the leprosy distribution of all leprosy cases diagnosed in the period 2016-2018. Data were obtained on new leprosy cases [Notifiable diseases information system (Sinan)], contacts traced by the LPEP program, and socioeconomic variables [Brazilian Institute of Geography and Statistics (IBGE)]. Kernel, SCAN, factor analysis and spatial regression were applied to analyze changes. RESULTS Overall, the new case detection rate (NCDR) was 20/10 000 inhabitants or 304 new cases, of which 55 were CP cases among the 2076 examined contacts. Changes over time were observed in the geographic distribution of cases. The highest concentration of cases was observed in the northeast of the study area, including one significant cluster (Relative risk = 2.24; population 27 427, P-value < 0.001) in an area characterized by different indicators associated with poverty as identified through spatial regression (Coefficient 3.34, P-value = 0.01). CONCLUSIONS The disease distribution was partly explained by poverty indicators. LPEP influences the spatial dynamic of the disease and results highlighted the relevance of systematic contact surveillance for leprosy elimination.
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Affiliation(s)
- Lúbia Maieles Gomes Machado
- Institute of Public Heath, Post-Graduation Program in Public Health, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Emerson Soares Dos Santos
- Institute of Public Heath, Post-Graduation Program in Public Health, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,Department of Geography, Post-Graduation Program of Geography, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Eliane Ignotti
- School of Medicine, Post-Graduation Program in Health Sciences, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil.,School of Health Sciences, Post-Graduation Program in Environment Sciences, State University of Mato Grosso, Cáceres, Mato Grosso, Brazil
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Taal AT, Blok DJ, Handito A, Wibowo S, Sumarsono, Wardana A, Pontororing G, Sari DF, van Brakel WH, Richardus JH, Prakoeswa CRS. Determining target populations for leprosy prophylactic interventions: a hotspot analysis in Indonesia. BMC Infect Dis 2022; 22:131. [PMID: 35130867 PMCID: PMC8822733 DOI: 10.1186/s12879-022-07103-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Leprosy incidence remained at around 200,000 new cases globally for the last decade. Current strategies to reduce the number of new patients include early detection and providing post-exposure prophylaxis (PEP) to at-risk populations. Because leprosy is distributed unevenly, it is crucial to identify high-risk clusters of leprosy cases for targeting interventions. Geographic Information Systems (GIS) methodology can be used to optimize leprosy control activities by identifying clustering of leprosy cases and determining optimal target populations for PEP. Methods The geolocations of leprosy cases registered from 2014 to 2018 in Pasuruan and Pamekasan (Indonesia) were collected and tested for spatial autocorrelation with the Moran’s I statistic. We did a hotspot analysis using the Heatmap tool of QGIS to identify clusters of leprosy cases in both areas. Fifteen cluster settings were compared, varying the heatmap radius (i.e., 500 m, 1000 m, 1500 m, 2000 m, or 2500 m) and the density of clustering (low, moderate, and high). For each cluster setting, we calculated the number of cases in clusters, the size of the cluster (km2), and the total population targeted for PEP under various strategies. Results The distribution of cases was more focused in Pasuruan (Moran’s I = 0.44) than in Pamekasan (0.27). The proportion of total cases within identified clusters increased with heatmap radius and ranged from 3% to almost 100% in both areas. The proportion of the population in clusters targeted for PEP decreased with heatmap radius from > 100% to 5% in high and from 88 to 3% in moderate and low density clusters. We have developed an example of a practical guideline to determine optimal cluster settings based on a given PEP strategy, distribution of cases, resources available, and proportion of population targeted for PEP. Conclusion Policy and operational decisions related to leprosy control programs can be guided by a hotspot analysis which aid in identifying high-risk clusters and estimating the number of people targeted for prophylactic interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07103-0.
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Affiliation(s)
- A T Taal
- NLR, Amsterdam, The Netherlands. .,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - D J Blok
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A Handito
- Department of Infectious Disease, Leprosy Control Programme, Ministry of Health, Jakarta, Indonesia
| | - S Wibowo
- East Java Provincial Health Office, Surabaya, Indonesia
| | - Sumarsono
- East Java Provincial Health Office, Surabaya, Indonesia
| | | | | | - D F Sari
- NLR Indonesia, Jakarta, Indonesia
| | | | - J H Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - C R S Prakoeswa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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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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de Jesus SM, Santana RS, Leite SN. The organization, weaknesses, and challenges of the control of thalidomide in Brazil: A review. PLoS Negl Trop Dis 2020; 14:e0008329. [PMID: 32760161 PMCID: PMC7410199 DOI: 10.1371/journal.pntd.0008329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The drug thalidomide has resurged in the world market under restrictive conditions for marketing and use. In Brazil, there are still cases of pregnant women using thalidomide even after the implementation of laws that regulate the control of use (Law No. 10.651/2003 and Collegiate Board Resolution No. 11/2011). The objective of this study was to discuss the control of thalidomide use in Brazil, based on a scoping review of the scientific literature, documents, and data from the Ministry of Health. A total of 51 studies and documents related to the following subthemes were selected: (1) organization of access and use of thalidomide in the health system; (2) epidemiological and population characteristics of people affected by leprosy; and (3) occurrence of pregnancy and cases of embryopathy with the use of thalidomide. The results showed that Brazil has no unified information database about thalidomide patients. Furthermore, there is inconsistency in the accreditation of public health centers that dispense this medicine, in a country that has a high consumption of thalidomide in the Unified Health System. A large part of this amount of dispensed medicine is intended for the treatment of erythema nodosum leprosum, mainly in the North, Northeast, and Central-West regions of the country, which are endemic for leprosy. This disease is the only one among the clinical indications of the medicine approved in Brazil that does not have a Clinical Protocol and Therapeutic Guidelines. The control of thalidomide use in Brazil presents historical regulatory failures. These are currently linked to the organization and structure of primary healthcare in the country, as well as to the lack of leadership of the Ministry of Health and National Health Surveillance Agency when it comes to managing the process of control of this use.
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Affiliation(s)
- Soraya Machado de Jesus
- Postgraduate Program in Pharmaceutical Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | | | - Silvana Nair Leite
- Postgraduate Program in Pharmaceutical Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
- Department of Pharmaceutical Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Ramos ACV, Santos Neto M, Arroyo LH, Yamamura M, Assis IS, Alves JD, Arcoverde MAM, Alves LS, Berra TZ, Martoreli Júnior JF, Pieri FM, Arcêncio RA. Magnitude of social determinants in high risk areas of leprosy in a hyperendemic city of northeastern Brazil: An ecological study. LEPROSY REV 2020. [DOI: 10.47276/lr.91.1.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hot spots of leprosy in the endemic area of São Luís, Maranhão State, Northeastern Brazil. J Infect Public Health 2020; 13:228-234. [DOI: 10.1016/j.jiph.2019.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/22/2019] [Accepted: 08/19/2019] [Indexed: 11/20/2022] Open
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Souza CDFD, Magalhães MAFM, Luna CF. Hanseníase e carência social: definição de áreas prioritárias em estado endêmico do Nordeste brasileiro. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200007. [PMID: 32130396 DOI: 10.1590/1980-549720200007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 01/09/2019] [Indexed: 11/21/2022] Open
Abstract
RESUMO: Introdução: A hanseníase é uma doença que guarda estreita relação com as condições sociais e econômicas. O Brasil é o único país que ainda não alcançou a meta de eliminação da doença como problema de saúde pública. Objetivo: Este trabalho teve como objetivo analisar a associação entre a carência social dos municípios baianos e a detecção de casos novos de hanseníase na população, como instrumento para a definição de áreas prioritárias para intervenção. Metodologia: Trata-se de um estudo ecológico realizado no estado da Bahia, no período de 2001 a 2015. Variáveis analisadas: coeficiente de detecção casos novos, índice de carência social (ICS) e hanseníase em menores de 15 anos. O ICS foi construído com base em quatro variáveis: índice de performance socioeconômica, renda per capita, proporção de extremamente pobres e densidade domiciliar. Na análise espacial, foram utilizadas modelagem bayesiana empírica local e estatística de Moran global e local. Na análise estatística, foram empregados regressão multivariada, espacial e logística, cálculo do odds ratio e análise de variância. Resultados: A hanseníase apresentou distribuição heterogênea no estado, com concentração no eixo norte-oeste e sul. Dos municípios, 60,4% (n = 252) apresentaram muito baixa condição de vida. Observou-se associação entre as condições de vida e a detecção da hanseníase, com maiores coeficientes no grupo de município com melhor condição de vida (p < 0,001). Conclusão: As piores condições atuaram como um impeditivo ao diagnóstico, ao mesmo tempo que ampliaram o risco de adoecimento. As boas condições possuem efeito inverso.
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Leano HADM, Araújo KMDFA, Bueno IDC, Niitsuma ENA, Lana FCF. Socioeconomic factors related to leprosy: an integrative literature review. Rev Bras Enferm 2019; 72:1405-1415. [DOI: 10.1590/0034-7167-2017-0651] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To investigate in the literature the relation of socioeconomic factors in the incidence of the disease and other outcomes related to leprosy. Method: Integrative review conducted in Lilacs, Medline, Scopus databases and SciELO online library with studies from 2000 to 2016. Results: 32 studies were included. Only studies that analyzed statistical associations of socioeconomic factors and outcomes related to leprosy were selected. Conclusion: Leprosy is greatly affected by the social context in which the patient is inserted, the chances of exposure to illness are the result of a set of not only individual aspects, but also of contexts or collective conditions. It is imperative for Nursing, as an essential part of the multiprofessional team entrusted with the care and surveillance of the disease, to recognize these factors to predict unfavorable outcomes and to develop new practices capable of reducing inequities.
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Verma P, Kumari P. Does social vulnerability define the risk of leprosy in an endemic region? A time trend analysis in leprosy‐endemic area. J Eur Acad Dermatol Venereol 2019; 33:1447. [DOI: 10.1111/jdv.15797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 11/30/2022]
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de Souza CDF, Rocha VS, Santos NF, Leal TC, de Paiva JPS, Oliveira CCC, Martins-Filho PRS, Magalhães MAFM, Cuevas LE, Santos VS. Spatial clustering, social vulnerability and risk of leprosy in an endemic area in Northeast Brazil: an ecological study. J Eur Acad Dermatol Venereol 2019; 33:1581-1590. [PMID: 30903718 DOI: 10.1111/jdv.15596] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/12/2019] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- C D F de Souza
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
| | - V S Rocha
- Tiradentes University, Aracaju, Brazil
| | | | - T C Leal
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
| | - J P S de Paiva
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
| | | | - P R S Martins-Filho
- Investigative Pathology Laboratory, Federal University of Sergipe, Aracaju, Brazil
| | - M A F M Magalhães
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz (ICICT- Fiocruz), Rio de Janeiro, Brazil
| | - L E Cuevas
- Department of Clinical Science, Liverpool School of Tropical Medicine, Liverpool, UK
| | - V S Santos
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil
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de Souza CDF, Luna CF, Magalhães MDAFM. Spatial modeling of leprosy in the state of Bahia and its social determinants: a study of health inequities. An Bras Dermatol 2019; 94:182-191. [PMID: 31090823 PMCID: PMC6486086 DOI: 10.1590/abd1806-4841.20197554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 01/22/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Leprosy is a neglected disease caused by Mycobacterium leprae. Brazil has the second largest number of cases in the world. OBJECTIVES To analyze the spatial distribution of leprosy in the state of BAHIA, Brazil, and the association between his occurrence and the synthetic indicators of municipal socioeconomic performance, social vulnerability and income inequality. METHODS An ecological study with secondary data obtained from the National System of Notifiable Diseases. Dependent variables: coefficient of detection in the general population and in the population under 15 years old and the rate of grade II of physical disability. Independent variables: Synthetic indicators of socioeconomic performance, social vulnerability and income inequality. RESULTS The highest coefficients of detection of new cases in the general population and in children under 15 years old are concentrated in the north-west axis and in the southern region of the state. On the other hand, the highest rates of degree II of physical incapacity are concentrated in the north, northeast and south regions. Only the Index of Social and Economic Performance(IPESE)-Economy and Finance composed the final regression model of the general detection coefficients and in children under 15 years old. The municipalities with the highest indexes had the highest detection coefficients, reflecting the capacity to diagnose new cases. STUDY LIMITATIONS The use of synthetic indicators is a limitation of the study. CONCLUSIONS Leprosy presents a heterogeneous spatial pattern in the state of BAHIA, and the IPESE-Economics and Finance indicator is the only one with explanatory potential of the disease.
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Affiliation(s)
- Carlos Dornels Freire de Souza
- Discipline of Collective Health, Curso de Medicina,
Universidade Federal de Alagoas, Arapiraca (AL), Brazil
- Instituto Aggeu Magalhães, Fundação
Oswaldo Cruz, Recife (PE), Brazil
| | - Carlos Feitosa Luna
- Instituto Aggeu Magalhães, Fundação
Oswaldo Cruz, Recife (PE), Brazil
- Program of Post-Graduation in Public Health,
Fundação Oswaldo Cruz, Recife (PE), Brazil
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Ferreira FR, Nascimento LFC. Spatial approach of leprosy in the State of São Paulo, 2009-2012. An Bras Dermatol 2019; 94:37-41. [PMID: 30726461 PMCID: PMC6360960 DOI: 10.1590/abd1806-4841.20197351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 02/06/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Leprosy is a chronic, infectious disease that affects the skin and the peripheral nervous system and can lead to permanent disability and/or deformity. OBJECTIVES To identify the distribution and to quantify the spatial dependence of the detection rates of new cases of Hansen's disease in the State of São Paulo, correlating with socioeconomic variables. METHODS Ecological and exploratory study with data on the detection rates of new cases of Hansen's disease among residents of São Paulo State municipalities between 2009-2012. The average rate per 10,0000 inhabitants was estimated. Information on the proportion of the population with low-income and the values of the Gini index were obtained. Thematic maps were constructed with the average rates and with those obtained by the Bayesian estimator; Moran and Kernel maps were also constructed. Spatial analysis by TerraView program. An alpha of 5% was adopted. RESULTS In total, 7163 new cases of Hansen's disease were recorded throughout the state. The average rate per 10,000 inhabitants, was 0.71 (SD = 1.06), ranging from zero to 12.87, with higher rates in the west of the State, in the metropolitan area of the capital and the Paraiba Valley. Municipalities with high priority for intervention were located in the west and northwest of the State. There was no correlation between rates with Gini index and low income. STUDY LIMITATIONS Possible inconsistency of Hansen's disease notification database regarding information quantity, quality and processing. CONCLUSIONS This study identified the distribution and quantified the spatial dependence of the detection rates of new cases of Hansen's disease in the State of São Paulo, corroborating previous studies and serving as a subsidy to health managers.
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Affiliation(s)
- Flávia Regina Ferreira
- Discipline of Dermatology, Department of Medicine, Universidade de
Taubaté, Taubaté (SP), Brazil
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15
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Freitas LRSD, Duarte EC, Garcia LP. Analysis of the epidemiological situation of leprosy in an endemic area in Brazil: spatial distribution in the periods 2001 - 2003 and 2010 - 2012. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 20:702-713. [PMID: 29267754 DOI: 10.1590/1980-5497201700040012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/11/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In Brazil, the spatial distribution of leprosy is heterogeneous. Areas with high transmission of the disease remain in the North, Center-west and Northeast. Areas with high transmission of the disease remain in the Northern, Central-Western and Northeastern regions of the country. OBJECTIVE to describe the spatial distribution of leprosy in municipalities with high risk of transmission, in the periods from 2001 - 2003 and 2010 - 2012. METHODS This was an ecological study using data from the Notifiable Diseases Information System (SINAN). They included all municipalities in the states of Mato Grosso, Tocantins, Rondônia, Pará and Maranhão. The following leprosy indicators were calculated per 100,000 inhabitants: incidence rate of leprosy, incidence rate in children aged less than 15 years and rate of new cases with grade 2 disabilities. The spatial scan statistic was used to detect significant clusters (p ≤ 0.05) in the study area. RESULTS In the period 2001 - 2003, the scan spatial statistics identified 44 significant clusters for the leprosy incidence rate, and 42 significant clusters in the period 2010 - 2012. In the period 2001 - 2003, it was possible to identify 20 significant clusters to the incidence rate in children aged less than 15, and 14 significant clusters in the period 2010 - 2012. For the rate of new cases with grade 2 disability, the scan statistics identified 19 significant clusters in the period 2001 - 2003, and 14 significant clusters in the period 2010 - 2012. CONCLUSIONS Despite the reduction in the detection of leprosy cases, there is a need intensify disease control actions, especially in the clusters identified.
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Matos FZ, Aranha AMF, Borges ÁH, Pedro FLM, Raslan SA, Hamida F, Veiga K, Porto AN. Can different stages of leprosy treatment influence the profile of oral health? Oral status in leprosy. Med Oral Patol Oral Cir Bucal 2018; 23:e376-e383. [PMID: 29924752 PMCID: PMC6051674 DOI: 10.4317/medoral.22220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 04/11/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The aim of study was to evaluate the oral health status, salivary flow and halitosis among individuals diagnosed with leprosy as compared with healthy subjects. MATERIAL AND METHODS A sample of 160 individuals was allocated into four groups, as follows: (G1) individuals with complete leprosy treatment; (G2) individuals diagnosed with leprosy and under multi-drug therapy; (G3) individuals diagnosed with leprosy not yet under treatment; and (G4) healthy individuals. Then individuals were submitted to periodontal clinical examination (visible plaque index, bleeding index, depth of probing and clinical attachment level); DMFT index (decayed-missing-filled teeth index); evaluation of salivary flow and halitosis using a halimeter equipment (Interscan Corp, Chatsworth, CA, USA). RESULTS The data were analyzed using Kruskal-Wallis and chi-square tests. The mean DMFT was found to be higher than 6.6, which is considered very high, with no significant difference between groups (P>0.05). As for salivary flow, 76.2% of the subjects presented normal flow rates, while 10% and 13.7% showed low and very low salivary flow rates, respectively, with hyposalivation being mostly observed in Groups 1 and 2. The highest prevalence of noticeable odor was found in healthy individuals (G4), and the most prevalent periodontal diagnosis was gingivitis (63.1%) in Group 3 (individuals with leprosy not yet under multi-drug therapy) followed by periodontitis (25%) in Group 1 (individuals who had completed leprosy treatment). CONCLUSIONS It was observed that individuals with a history of leprosy present poor oral health similar to that of systemically healthy individuals.
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Affiliation(s)
- F-Z Matos
- University of Cuiaba-UNIC-Mato Grosso,
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Pescarini JM, Strina A, Nery JS, Skalinski LM, de Andrade KVF, Penna MLF, Brickley EB, Rodrigues LC, Barreto ML, Penna GO. Socioeconomic risk markers of leprosy in high-burden countries: A systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12:e0006622. [PMID: 29985930 PMCID: PMC6053250 DOI: 10.1371/journal.pntd.0006622] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/19/2018] [Accepted: 06/19/2018] [Indexed: 11/18/2022] Open
Abstract
Over 200,000 new cases of leprosy are detected each year, of which approximately 7% are associated with grade-2 disabilities (G2Ds). For achieving leprosy elimination, one of the main challenges will be targeting higher risk groups within endemic communities. Nevertheless, the socioeconomic risk markers of leprosy remain poorly understood. To address this gap we systematically reviewed MEDLINE/PubMed, Embase, LILACS and Web of Science for original articles investigating the social determinants of leprosy in countries with > 1000 cases/year in at least five years between 2006 and 2016. Cohort, case-control, cross-sectional, and ecological studies were eligible for inclusion; qualitative studies, case reports, and reviews were excluded. Out of 1,534 non-duplicate records, 96 full-text articles were reviewed, and 39 met inclusion criteria. 17 were included in random-effects meta-analyses for sex, occupation, food shortage, household contact, crowding, and lack of clean (i.e., treated) water. The majority of studies were conducted in Brazil, India, or Bangladesh while none were undertaken in low-income countries. Descriptive synthesis indicated that increased age, poor sanitary and socioeconomic conditions, lower level of education, and food-insecurity are risk markers for leprosy. Additionally, in pooled estimates, leprosy was associated with being male (RR = 1.33, 95% CI = 1.06-1.67), performing manual labor (RR = 2.15, 95% CI = 0.97-4.74), suffering from food shortage in the past (RR = 1.39, 95% CI = 1.05-1.85), being a household contact of a leprosy patient (RR = 3.40, 95% CI = 2.24-5.18), and living in a crowded household (≥5 per household) (RR = 1.38, 95% CI = 1.14-1.67). Lack of clean water did not appear to be a risk marker of leprosy (RR = 0.94, 95% CI = 0.65-1.35). Additionally, ecological studies provided evidence that lower inequality, better human development, increased healthcare coverage, and cash transfer programs are linked with lower leprosy risks. These findings point to a consistent relationship between leprosy and unfavorable economic circumstances and, thereby, underscore the pressing need of leprosy control policies to target socially vulnerable groups in high-burden countries.
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Affiliation(s)
- Julia Moreira Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
| | - Agostino Strina
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joilda Silva Nery
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Universidade Federal do Vale do São Francisco (UNIVASF), Paulo Afonso, Brazil
| | - Lacita Menezes Skalinski
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Universidade Estadual de Santa Cruz (UESC), Ilheus, Brazil
| | - Kaio Vinicius Freitas de Andrade
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Universidade Estadual de Feira de Santana (UEFS), Feira de Santana, Brazil
| | - Maria Lucia F. Penna
- Universidade Federal Fluminense, Instituto de Saúde da Comunidade, Niterói, Brazil
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Laura C. Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mauricio Lima Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Simionato de Assis I, Arcoverde MAM, Ramos ACV, Alves LS, Berra TZ, Arroyo LH, de Queiroz AAR, dos Santos DT, Belchior ADS, Alves JD, Pieri FM, Silva-Sobrinho RA, Pinto IC, Tavares CM, Yamamura M, Frade MAC, Palha PF, Chiaravalloti-Neto F, Arcêncio RA. Social determinants, their relationship with leprosy risk and temporal trends in a tri-border region in Latin America. PLoS Negl Trop Dis 2018; 12:e0006407. [PMID: 29624595 PMCID: PMC5906021 DOI: 10.1371/journal.pntd.0006407] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/18/2018] [Accepted: 03/24/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Brazil is the only country in Latin America that has adopted a national health system. This causes differences in access to health among Latin American countries and induces noticeable migration to Brazilian regions to seek healthcare. This phenomenon has led to difficulties in the control and elimination of diseases related to poverty, such as leprosy. The aim of this study was to evaluate social determinants and their relationship with the risk of leprosy, as well as to examine the temporal trend of its occurrence in a Brazilian municipality located on the tri-border area between Brazil, Paraguay and Argentina. METHODS This ecological study investigated newly-diagnosed cases of leprosy between 2003 and 2015. Exploratory analysis of the data was performed through descriptive statistics. For spatial analysis, geocoding of the data was performed using spatial scan statistic techniques to obtain the Relative Risk (RR) for each census tract, with their respective 95% confidence intervals calculated. The Bivariate Moran I test, Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) models were applied to analyze the spatial relationships of social determinants and leprosy risk. The temporal trend of the annual coefficient of new cases was obtained through the Prais-Winsten regression. A standard error of 5% was considered statistically significant (p < 0.05). RESULTS Of the 840 new cases identified in the study, there was a predominance of females (n = 427, 50.8%), of white race/color (n = 685, 81.6%), age range 15 to 59 years (n = 624, 74.3%), and incomplete elementary education (n = 504, 60.0%). The results obtained from multivariate analysis revealed that the proportion of households with monthly nominal household income per capita greater than 1 minimum wage (β = 0.025, p = 0.036) and people of brown race (β = -0.101, p = 0.024) were statistically-significantly associated with risk of illness due to leprosy. These results also confirmed that social determinants and risk of leprosy were significantly spatially non-stationary. Regarding the temporal trend, a decrease of 4% (95% CI [-0.053, -0.033], p = 0.000) per year was observed in the rate of detection of new cases of leprosy. CONCLUSION The social determinants income and race/color were associated with the risk of leprosy. The study's highlighting of these social determinants can contribute to the development of public policies directed toward the elimination of leprosy in the border region.
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Affiliation(s)
- Ivaneliza Simionato de Assis
- Graduate Program in Public Health Nursing, Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Marcos Augusto Moraes Arcoverde
- Graduate Program in Public Health Nursing, Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Antônio Carlos Viera Ramos
- Graduate Program in Public Health Nursing, Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luana Seles Alves
- Graduate Program in Public Health Nursing, Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Thais Zamboni Berra
- Graduate Program in Public Health Nursing, Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luiz Henrique Arroyo
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | - Danielle Talita dos Santos
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Aylana de Souza Belchior
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Josilene Dália Alves
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Ione Carvalho Pinto
- Graduate Program in Public Health Nursing, Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Clodis Maria Tavares
- Department of School of Nursing and Pharmacy, Federal University of Alagoas, Maceió, Alagoas, Brazil
| | - Mellina Yamamura
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Marco Andrey Cipriani Frade
- Division of Dermatology of the Department of Internal Medicine of the Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Pedro Fredemir Palha
- Graduate Program in Public Health Nursing, Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Ricardo Alexandre Arcêncio
- Graduate Program in Public Health Nursing, Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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Silva CLM, Fonseca SC, Kawa H, Palmer DDOQ. Spatial distribution of leprosy in Brazil: a literature review. Rev Soc Bras Med Trop 2017; 50:439-449. [PMID: 28954063 DOI: 10.1590/0037-8682-0170-2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 06/23/2017] [Indexed: 11/21/2022] Open
Abstract
Leprosy remains a public health problem in developing countries. Among communicable diseases, it is one of the leading causes of permanent disability. Brazil had not reached the goal of reducing cases to less than 1 per 10,000 population. This study aimed to analyze the spatial distribution of leprosy cases in Brazil, using a literature review. The search strategy included the LILACS and MEDLINE databases with no language or period restriction. Ecological studies with spatial data analysis were considered as a criterion for the inclusion. We found 38 studies for review after the selection criteria. Among the epidemiological indicators of the disease, the most common was the new case detection rate. Several articles have explored the association between spatial distribution of leprosy and socioeconomic, demographic, and environmental factors. The most common unit of analysis was the municipality. The spatial distribution methods mostly used were: empirical Bayesian method, autocorrelation (Moran's I index) and Kernel estimates. The distribution of leprosy was very heterogeneous, independent of the unit of analysis. There was a decrease in the rate of detection and among under-15-year-olds, but some regions maintained high endemicity during the study period. The distribution and risk of illness were directly related to living conditions of the population. Improved access to health services was associated with increased detection rate in some regions. Spatial analysis seems to be a very useful tool to study leprosy and to guide interventions and surveillance.
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Affiliation(s)
- Cláuffer Luiz Machado Silva
- Programa de Pós-Graduação em Saúde Coletiva, Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - Sandra Costa Fonseca
- Programa de Pós-Graduação em Saúde Coletiva, Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, RJ, Brasil
| | - Helia Kawa
- Programa de Pós-Graduação em Saúde Coletiva, Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, RJ, Brasil
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20
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Costa JEF, Morais VMS, Gonçales JP, Silva DM, Coêlho MRCD. Prevalence and risk factors for hepatitis B and C viruses in patients with leprosy. Acta Trop 2017; 172:160-163. [PMID: 28457830 DOI: 10.1016/j.actatropica.2017.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/23/2017] [Accepted: 04/23/2017] [Indexed: 01/21/2023]
Abstract
It has been reported a higher seroprevalence of HBV and HCV in leprosy patients than in the general population, but the reasons for these findings are not yet clear. On the other hand, there is evidence that these viruses may influence the onset of leprosy reactional episodes, an important cause of neurological sequelae. This study aimed to determine seroprevalence and risk factors for HBV and HCV in leprosy patients and to investigate its association with leprosy reactions. Patients attended from 2015 to 2016 at a Reference Center in Leprosy in Northeastern region of Brazil, were interviewed, had their records reviewed to investigate biological, clinical, behavioral and socioeconomic factors, and underwent blood sample collection. Biological samples were tested for HBV (HBsAg, anti-HBs and anti-HBs) and HCV (anti-HCV) serological markers by ELISA and, in anti-HCV positive samples, HCV RNA was screened by real time PCR. SPSS program was used to analyze the data. A total of 403 leprosy patients were included. Although anti-HBc was positive in 14.1%, there was no detection of HBsAg, which contradicts the hypothesis that leprosy patients have immune deficit that make them more prone to chronic HBV infection. Multibacillary leprosy (0.057), health-related work (0.011) and lower educational level (0.035) were associated with anti-HBc positivity. Anti-HCV was positive in 0.5%, with no detection of HCV RNA. No association was identified between anti-HCV and the epidemiological analyzed factors. There was also no association of anti-HBc or anti-HCV with type 1 or type 2 leprosy reactions. Thus, the seroprevalence of HBV and HCV in leprosy patients was similar to that of the general population of Northeastern region of Brazil, and no association of HBV or HCV with leprosy reactions was observed.
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Affiliation(s)
- J E F Costa
- Health Sciences Center, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil.
| | - V M S Morais
- Virology Sector, Keizo Asami Immunopathology Laboratory, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil.
| | - J P Gonçales
- Virology Sector, Keizo Asami Immunopathology Laboratory, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil.
| | - D M Silva
- Virology Sector, Keizo Asami Immunopathology Laboratory, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil.
| | - M R C D Coêlho
- Virology Sector, Keizo Asami Immunopathology Laboratory, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil; Department of Physiology and Pharmacology, Center for Biosciences, Federal University of Pernambuco, Av. Prof. Moraes Rego, 1235, Cidade Universitária, 50670-901, Recife, Pernambuco, Brazil.
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Monteiro LD, Mota RMS, Martins-Melo FR, Alencar CH, Heukelbach J. Social determinants of leprosy in a hyperendemic State in North Brazil. Rev Saude Publica 2017; 51:70. [PMID: 28746575 PMCID: PMC5510796 DOI: 10.1590/s1518-8787.2017051006655] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 01/27/2016] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Lorena Dias Monteiro
- Departamento de Saúde Comunitária. Faculdade de Medicina. Universidade Federal do Ceará. Fortaleza, CE, Brasil
- Secretaria de Estado da Saúde do Tocantins. Palmas, TO, Brasil
| | - Rosa Maria Salani Mota
- Departamento de Estatística e Matemática Aplicada. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Francisco Rogerlândio Martins-Melo
- Departamento de Saúde Comunitária. Faculdade de Medicina. Universidade Federal do Ceará. Fortaleza, CE, Brasil
- Instituto Federal de Educação, Ciência e Tecnologia do Ceará. Caucaia, CE, Brasil
| | - Carlos Henrique Alencar
- Departamento de Saúde Comunitária. Faculdade de Medicina. Universidade Federal do Ceará. Fortaleza, CE, Brasil
| | - Jorg Heukelbach
- Departamento de Saúde Comunitária. Faculdade de Medicina. Universidade Federal do Ceará. Fortaleza, CE, Brasil
- School of Public Health. Tropical Medicine and Rehabilitation Sciences. James Cook University. Townsville, Australia
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Gracie R, Peixoto JNDB, Soares FBDR, Hacker MDAVB. Análise da distribuição geográfica dos casos de hanseníase. Rio de Janeiro, 2001 a 2012. CIENCIA & SAUDE COLETIVA 2017; 22:1695-1704. [DOI: 10.1590/1413-81232017225.24422015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 01/23/2016] [Indexed: 01/17/2023] Open
Abstract
Resumo Trabalhos demonstraram que a distribuição geográfica da hanseníase está relacionada a diferentes fatores socioeconômicos. O objetivo deste artigo é estudar a distribuição geográfica da hanseníase no estado do Rio de Janeiro. Os casos de hanseníase notificados no período 2001-2012 foram mapeados segundo município. Foram calculados indicadores epidemiológicos e socioeconômicos. Utilizou-se o programa ArcMap para a construção dos mapas e o Terra View para o cálculo de taxa bayesiana. Observou-se que a hanseníase apresenta-se em níveis hiperendêmicos, especialmente na região metropolitana. No entanto, observa-se também uma redução do coeficiente de detecção no período mais recente do estudo. Em municípios da região metropolitana e da região noroeste a detecção em menores de 15 anos é elevada, indicando situação de transmissão ativa. Em municípios da região centro-sul e especialmente na baixada litorânea, observou-se elevada proporção de casos diagnosticados com grau II de incapacidade, refletindo alto índice de diagnóstico tardio. Não foi observada correlação linear entre os indicadores socioeconômicos e a detecção da hanseníase. Esses resultados contribuem para a análise da distribuição geográfica da hanseníase, importante para a identificação de áreas para alocação de recursos, visando controle e eliminação da doença.
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Ramos ACV, Yamamura M, Arroyo LH, Popolin MP, Chiaravalloti Neto F, Palha PF, Uchoa SADC, Pieri FM, Pinto IC, Fiorati RC, de Queiroz AAR, Belchior ADS, dos Santos DT, Garcia MCDC, Crispim JDA, Alves LS, Berra TZ, Arcêncio RA. Spatial clustering and local risk of leprosy in São Paulo, Brazil. PLoS Negl Trop Dis 2017; 11:e0005381. [PMID: 28241038 PMCID: PMC5344525 DOI: 10.1371/journal.pntd.0005381] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/09/2017] [Accepted: 02/02/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. METHODS Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk-RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. RESULTS A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721-4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133-52.984) and 15.24 (95%CI = 10.114-22.919). CONCLUSION These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.
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Affiliation(s)
- Antônio Carlos Vieira Ramos
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Mellina Yamamura
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Luiz Henrique Arroyo
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Marcela Paschoal Popolin
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Francisco Chiaravalloti Neto
- Department of Epidemiology, School of Public Health of the University of São Paulo, São Paulo, São Paulo, Brazil
| | - Pedro Fredemir Palha
- Maternal-Infant Nursing and Public Health Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Ione Carvalho Pinto
- Maternal-Infant Nursing and Public Health Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Regina Célia Fiorati
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana Angélica Rêgo de Queiroz
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Aylana de Souza Belchior
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Danielle Talita dos Santos
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Maria Concebida da Cunha Garcia
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Juliane de Almeida Crispim
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Luana Seles Alves
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Thaís Zamboni Berra
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- Maternal-Infant Nursing and Public Health Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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Lima LNGC, Frota CC, Mota RMS, Almeida RLF, Pontes MADA, Gonçalves HDS, Rodrigues LC, Kendall C, Kerr L. Widespread nasal carriage of Mycobacterium lepraeamong a healthy population in a hyperendemic region of northeastern Brazil. Mem Inst Oswaldo Cruz 2016; 110:898-905. [PMID: 26560980 PMCID: PMC4660619 DOI: 10.1590/0074-02760150178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 10/02/2015] [Indexed: 11/21/2022] Open
Abstract
A case-control study was conducted to determine the presence ofMycobacterium lepraeDNA in nasal secretions of leprosy cases and nonleprosy individuals in Fortaleza, Brazil. It included 185 cases identified by physicians at the Dona Libânia National Reference Centre for Sanitary Dermatology (CDERM). A control group (Co) (n = 136) was identified among individuals from CDERM not diagnosed as leprosy cases. To augment the spatial analysis of M. leprae specific repetitive element (RLEP) positive prevalence, an external group (EG) (n = 121), a convenience sample of healthy students, were included. Polymerase chain reaction for the RLEP sequence was conducted for all participants. Prevalence of RLEP positivity for cases and Co were 69.2% and 66.9%, respectively, significantly higher than for EG (28.1%), and reported elsewhere. Male sex, belonging to a lower socioeconomic status (D/E), history of a previous contact with a case and being older, were associated with being a leprosy case. Our geographical analysis demonstrated that the bacillus is widespread among the healthy population, with clusters of RLEP positive multibacillary cases concentrated in distinct areas of the city. Our results suggest that in endemic areas, as in Fortaleza, surveillance for both nonhousehold leprosy contacts and members of the general population living in cluster areas should be implemented.
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Affiliation(s)
| | - Cristiane Cunha Frota
- Departamento de Patologia e Medicina Legal, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Rosa Maria Salani Mota
- Departamento de Estatística e Matemática Aplicada, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Rosa Livia Freitas Almeida
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | | | - Heitor de Sá Gonçalves
- Centro de Referência Nacional em Dermatologia Sanitária Dona Libânia, Fortaleza, CE, Brasil
| | - Laura Cunha Rodrigues
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Carl Kendall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Ligia Kerr
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
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Batista e Sá VW, Gomes MK, Rangel MLS, Sanchez TA, Moreira FA, Hoefle S, Souto IB, da Cunha AJLA, Fontana AP, Vargas CD. Primary Motor Cortex Representation of Handgrip Muscles in Patients with Leprosy. PLoS Negl Trop Dis 2015. [PMID: 26203653 PMCID: PMC4512691 DOI: 10.1371/journal.pntd.0003944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leprosy is an endemic infectious disease caused by Mycobacterium leprae that predominantly attacks the skin and peripheral nerves, leading to progressive impairment of motor, sensory and autonomic function. Little is known about how this peripheral neuropathy affects corticospinal excitability of handgrip muscles. Our purpose was to explore the motor cortex organization after progressive peripheral nerve injury and upper-limb dysfunction induced by leprosy using noninvasive transcranial magnetic stimulation (TMS). METHODS In a cross-sectional study design, we mapped bilaterally in the primary motor cortex (M1) the representations of the hand flexor digitorum superficialis (FDS), as well as of the intrinsic hand muscles abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM). All participants underwent clinical assessment, handgrip dynamometry and motor and sensory nerve conduction exams 30 days before mapping. Wilcoxon signed rank and Mann-Whitney tests were performed with an alpha-value of p<0.05. FINDINGS Dynamometry performance of the patients' most affected hand (MAH), was worse than that of the less affected hand (LAH) and of healthy controls participants (p = 0.031), confirming handgrip impairment. Motor threshold (MT) of the FDS muscle was higher in both hemispheres in patients as compared to controls, and lower in the hemisphere contralateral to the MAH when compared to that of the LAH. Moreover, motor evoked potential (MEP) amplitudes collected in the FDS of the MAH were higher in comparison to those of controls. Strikingly, MEPs in the intrinsic hand muscle FDI had lower amplitudes in the hemisphere contralateral to MAH as compared to those of the LAH and the control group. Taken together, these results are suggestive of a more robust representation of an extrinsic hand flexor and impaired intrinsic hand muscle function in the hemisphere contralateral to the MAH due to leprosy. CONCLUSION Decreased sensory-motor function induced by leprosy affects handgrip muscle representation in M1.
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Affiliation(s)
- Vagner Wilian Batista e Sá
- Núcleo de Pesquisas em Fisioterapia, Universidade Castelo Branco, Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho e Departamento de Medicina de Família e Comunidade/Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail: (VWBeS); (CDV)
| | - Maria Katia Gomes
- Programa de Pós-Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho e Departamento de Medicina de Família e Comunidade/Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Luíza Sales Rangel
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tiago Arruda Sanchez
- Programa de Pós-Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho e Departamento de Medicina de Família e Comunidade/Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipe Azaline Moreira
- Programa de Pós-Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho e Departamento de Medicina de Família e Comunidade/Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sebastian Hoefle
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Cognitive and Behavioral Neuroscience Unit and Neuroinformatics Workgroup, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Inaiacy Bittencourt Souto
- Programa de Pós-Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho e Departamento de Medicina de Família e Comunidade/Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antônio José Ledo Alves da Cunha
- Programa de Pós-Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho e Departamento de Medicina de Família e Comunidade/Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Paula Fontana
- Programa de Pós-Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho e Departamento de Medicina de Família e Comunidade/Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia Domingues Vargas
- Laboratório de Neurobiologia II, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Instituto de Neurologia Deolindo Couto da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail: (VWBeS); (CDV)
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Sampaio PB, Madeira ES, Diniz L, Noia EL, Zandonade E. Spatial distribution of leprosy in areas of risk in Vitória, State of Espírito Santo, Brazil, 2005 to 2009. Rev Soc Bras Med Trop 2014; 46:329-34. [PMID: 23856871 DOI: 10.1590/0037-8682-0070-2012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/22/2013] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Leprosy remains a relevant public health issue in Brazil. The objective of this study was to analyze the spatial distribution of new cases of leprosy and to detect areas with higher risks of disease in the City of Vitória. METHODS The study was ecologically based on the spatial distribution of leprosy in the City of Vitória, State of Espírito Santo between 2005 and 2009. The data sources used came from the available records of the State Health Secretary of Espírito Santo. A global and local empirical Bayesian method was used in the spatial analysis to produce a leprosy risk estimation, and the fluctuation effect was smoothed from the detection coefficients. RESULTS The study used thematic maps to illustrate that leprosy is distributed heterogeneously between the neighborhoods and that it is possible to identify areas with high risk of disease. The Pearson correlation coefficient of 0.926 (p = 0.001) for the Local Method indicated highly correlated coefficients. The Moran index was calculated to evaluate correlations between the incidences of adjoining districts. CONCLUSIONS We identified the spatial contexts in which there were the highest incidence rates of leprosy in Vitória during the studied period. The results contribute to the knowledge of the spatial distribution of leprosy in the City of Vitória, which can help establish more cost-effective control strategies because they indicate specific regions and priority planning activities that can interfere with the transmission chain.
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Affiliation(s)
- Poliane Barbosa Sampaio
- Programa de Pós Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.
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Identification of urban leprosy clusters. ScientificWorldJournal 2013; 2013:219143. [PMID: 24288467 PMCID: PMC3833060 DOI: 10.1155/2013/219143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 09/08/2013] [Indexed: 11/17/2022] Open
Abstract
Overpopulation of urban areas results from constant migrations that cause disordered urban growth, constituting clusters defined as sets of people or activities concentrated in relatively small physical spaces that often involve precarious conditions. Aim. Using residential grouping, the aim was to identify possible clusters of individuals in São José do Rio Preto, Sao Paulo, Brazil, who have or have had leprosy. Methods. A population-based, descriptive, ecological study using the MapInfo and CrimeStat techniques, geoprocessing, and space-time analysis evaluated the location of 425 people treated for leprosy between 1998 and 2010. Clusters were defined as concentrations of at least 8 people with leprosy; a distance of up to 300 meters between residences was adopted. Additionally, the year of starting treatment and the clinical forms of the disease were analyzed. Results. Ninety-eight (23.1%) of 425 geocoded cases were located within one of ten clusters identified in this study, and 129 cases (30.3%) were in the region of a second-order cluster, an area considered of high risk for the disease. Conclusion. This study identified ten clusters of leprosy cases in the city and identified an area of high risk for the appearance of new cases of the disease.
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Murto C, Chammartin F, Schwarz K, da Costa LMM, Kaplan C, Heukelbach J. Patterns of migration and risks associated with leprosy among migrants in Maranhão, Brazil. PLoS Negl Trop Dis 2013; 7:e2422. [PMID: 24040433 PMCID: PMC3764227 DOI: 10.1371/journal.pntd.0002422] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 07/29/2013] [Indexed: 11/18/2022] Open
Abstract
Leprosy remains a public health problem in Brazil with new case incidence exceeding World Health Organization (WHO) goals in endemic clusters throughout the country. Migration can facilitate movement of disease between endemic and non-endemic areas, and has been considered a possible factor in continued leprosy incidence in Brazil. A study was conducted to investigate migration as a risk factor for leprosy. The study had three aims: (1) examine past five year migration as a risk factor for leprosy, (2) describe and compare geographic and temporal patterns of migration among past 5-year migrants with leprosy and a control group, and (3) examine social determinants of health associated with leprosy among past 5-year migrants. The study implemented a matched case-control design and analysis comparing individuals newly diagnosed with leprosy (n = 340) and a clinically unapparent control group (n = 340) without clinical signs of leprosy, matched for age, sex and location in four endemic municipalities in the state of Maranhão, northeastern Brazil. Fishers exact test was used to conduct bivariate analyses. A multivariate logistic regression analysis was employed to control for possible confounding variables. Eighty cases (23.5%) migrated 5-years prior to diagnosis, and 55 controls (16.2%) migrated 5-years prior to the corresponding case diagnosis. Past 5 year migration was found to be associated with leprosy (OR: 1.59; 95% CI 1.07-2.38; p = 0.02), and remained significantly associated with leprosy after controlling for leprosy contact in the family, household, and family/household contact. Poverty, as well as leprosy contact in the family, household and other leprosy contact, was associated with leprosy among past 5-year migrants in the bivariate analysis. Alcohol consumption was also associated with leprosy, a relevant risk factor in susceptibility to infection that should be explored in future research. Our findings provide insight into patterns of migration to localize focused control efforts in endemic areas with high population mobility.
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Affiliation(s)
- Christine Murto
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Frédérique Chammartin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Charles Kaplan
- University of Southern California, School of Social Work, Hamovitch Center for Science in the Human Services, Los Angeles, California, United States of America
| | - Jorg Heukelbach
- Federal University of Ceará, Fortaleza, Brazil
- Anton Breinl Centre for Public Health and Tropical Medicine, James Cook University, Townsville, Australia
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