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Wasson MK, Whitson C, Miller B, Abebe W, Tessema B, Emerson LE, Anantharam P, Tesfaye AB, Fairley JK. Potential drivers of leprosy infection: A case–control study of parasitic coinfection and water, sanitation, and hygiene in North Gondar, Ethiopia. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.934030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundDespite extensive control measures and a declining number of human reservoirs, the incidence of leprosy in excess of 200,000 new cases each year suggests that alternative pathways of transmission may play a role in continued endemicity. Parasitic coinfection and limited water, sanitation, and hygiene (WASH) have been suggested to predispose individuals to Mycobacterium leprae infection and were further explored in this study.MethodsLeprosy cases and uninfected controls were recruited from areas around North Gondar, Ethiopia throughout 2019. Participants completed dietary and WASH surveys in addition to providing stool for helminth microscopic diagnosis and urine for Schistosoma mansoni Point-of-care circulating cathodic antigen (POC-CCA)™ rapid diagnostic testing. A similar methodology was employed for a case–control study of leprosy previously conducted by our research team in North Gondar from May to October of 2018. To more comprehensively evaluate associations between the above exposures and leprosy, data from the present 2019 study and the previous 2018 study were combined in select multivariate logistic regression analyses.ResultsA total of 47 men (59%) and 33 women (41%) participated in this study with an average age of 40 (SD 15.0 years). Most leprosy cases were multibacillary (93%). There was a high prevalence of parasitic coinfection among both cases (71%) and controls (60%). WASH insecurities were also widespread. On multivariate analysis, lack of soap for handwashing [aOR= 2.53, 95% CI (1.17, 5.47)] and the lack of toilet facilities [Adjusted odds ratio (aOR)= 2.32, 95% CI (1.05, 5.12)] were significantly associated with leprosy. Positive directionality was identified for a number of other inputs, including helminth infection [aOR= 3.23, 95% CI (0.85, 12.35)].ConclusionsTaken together, these findings strengthen previous research conducted in 2018 implicating poor WASH conditions as a driver of leprosy infection. Leprosy remains the leading infectious cause of disability in the world. As such, future research should explore the above susceptibilities in more depth to curtail the global burden of disease.
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The effect of conditional cash transfers on the control of neglected tropical disease: a systematic review. Lancet Glob Health 2022; 10:e640-e648. [PMID: 35427521 DOI: 10.1016/s2214-109x(22)00065-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neglected tropical diseases (NTDs) are diseases of poverty and affect 1·5 billion people globally. Conditional cash transfer (CCTs) programmes alleviate poverty in many countries, potentially contributing to improved NTD outcomes. This systematic review examines the relationship between CCTs and screening, incidence, or treatment outcomes of NTDs. METHODS In this systematic review we searched MEDLINE, Embase, Lilacs, EconLit, Global Health, and grey literature websites on Sept 17, 2020, with no date or language restrictions. Controlled quantitative studies including randomised controlled trials (RCTs) and observational studies evaluating CCT interventions in low-income and middle-income countries were included. Any outcome measures related to WHO's 20 diseases classified as NTDs were included. Studies from high-income countries were excluded. Two authors (AA and TH) extracted data from published studies and appraised risk of biases using the Risk of Bias in Non-Randomised Studies of Interventions and Risk of Bias 2 tools. Results were analysed narratively. This study is registered with PROSPERO, CRD42020202480. FINDINGS From the search, 5165 records were identified; of these, 11 studies were eligible for inclusion covering four CCTs in Brazil, the Philippines, Mexico, and Zambia. Most studies were either RCTs or quasi-experimental studies and ten were assessed to be of moderate quality. Seven studies reported improved NTD outcomes associated with CCTs, in particular, reduced incidence of leprosy and increased uptake of deworming treatments. There was some evidence of greater benefit of CCTS in lower socioeconomic groups but subgroup analysis was scarce. Methodological weaknesses include self-reported outcomes, missing data, improper randomisation, and differences between CCT and comparator populations in observational studies. The available evidence is currently limited, covering a small proportion of CCTs and NTDs. INTERPRETATION CCTs can be associated with improved NTD outcomes, and could be driven by both improvements in living standards from cash benefits and direct health effects from conditionalities related to health-care use. This evidence adds to the knowledge of health-improving effects from CCTs in poor and vulnerable populations. FUNDING None.
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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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de Paiva JPS, Magalhães MAFM, Leal TC, da Silva LF, da Silva LG, do Carmo RF, de Souza CDF. Time trend, social vulnerability, and identification of risk areas for tuberculosis in Brazil: An ecological study. PLoS One 2022; 17:e0247894. [PMID: 35077447 PMCID: PMC8789117 DOI: 10.1371/journal.pone.0247894] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Tuberculosis is one of the ten leading causes of death and the leading infectious cause worldwide. The disease represents a challenge to health systems around the world. In 2018, it is estimated that 10 million people were affected by tuberculosis, and approximately 1.5 million people died due to the disease worldwide, including 251,000 patients coinfected with HIV. In Brazil, the disease caused 4,490 deaths, with rate of 2.2 deaths per 100,000 inhabitants. The objective of this study was to analyze the time behavior, spatial, spatial-temporal distribution, and the effects of social vulnerability on the incidence of TB in Brazil during the period from 2001 to 2017. Materials and methods A spatial-temporal ecological study was conducted, including all new cases of tuberculosis registered in Brazil during the period from 2001 to 2017. The following variables were analyzed: incidence rate of tuberculosis, the Social Vulnerability Index, its subindices, its 16 indicators, and an additional 14 variables available on the Atlas of Social Vulnerability. The statistical treatment of the data consisted of the following three stages: a) time trend analysis with a joinpoint regression model; b) spatial analysis and identification of risk areas based on smoothing of the incidence rate by local empirical Bayesian model, application of global and local Moran statistics, and, finally, spatial-temporal scan statistics; and c) analysis of association between the incidence rate and the indicators of social vulnerability. Results Brazil reduced the incidence of tuberculosis from 42.8 per 100,000 to 35.2 per 100,000 between 2001 and 2017. Only the state of Minas Gerais showed an increasing trend, whereas nine other states showed a stationary trend. A total of 326 Brazilian municipalities were classified as high priority, and 22 high-risk spatial-temporal clusters were identified. The overall Social Vulnerability Index and the subindices of Human Capital and Income and Work were associated with the incidence of tuberculosis. It was also observed that the incidence rates were greater in municipalities with greater social vulnerability. Conclusions This study identified clusters with high risk of TB in Brazil. A significant association was observed between the incidence rate of TB and the indices of social vulnerability.
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Affiliation(s)
| | - Mônica Avelar Figueiredo Mafra Magalhães
- Health Information Laboratory, GIS Laboratory, Institute of Scientific and Technological Information and Communication in Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Rodrigo Feliciano do Carmo
- Postgraduate Program in Health and Biological Sciences, Federal University of Vale do São Francisco (UNIVASF), Petrolina, PE, Brazil
- Postgraduate Program in Biosciences, UNIVASF, Petrolina, PE, Brazil
| | - Carlos Dornels Freire de Souza
- Department of Medicine, Federal University of Alagoas, Arapiraca, AL, Brazil
- Postgraduate Program in Family Health, Department of Medicine, Federal University of Alagoas, Arapiraca, AL, Brazil
- * E-mail:
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Ramos ACV, Martoreli Júnior JF, Berra TZ, Alves YM, Barbosa TP, Scholze AR, Assis ISD, Palha PF, Gomes D, Arcêncio RA. Evolução temporal e distribuição espacial da hanseníase em município de baixa endemicidade no estado de São Paulo. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2021951. [DOI: 10.1590/s1679-49742022000100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/05/2022] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Analisar a distribuição espacial e temporal da hanseníase em cenário de baixa endemicidade no estado de São Paulo, Brasil. Métodos Estudo ecológico, sobre casos de hanseníase notificados no município de Ribeirão Preto, entre 2006 e 2016. A tendência temporal da taxa de detecção de hanseníase foi verificada mediante decomposição de séries temporais, e identificadas as áreas de alta e de baixa ocorrência da doença utilizando-se a técnica Getis-Ord Gi*. Resultados Foram registrados 890 casos, e a taxa de detecção apresentou uma tendência crescente no período analisado, com crescimento médio de 1% ao mês. Identificaram-se áreas de alta ocorrência da doença na região norte do município (99% e 95% de confiança). Conclusão A taxa de detecção de hanseníase apresentou tendência temporal crescente, e a análise espacial permitiu visualizar que a região do município com maior ocorrência da doença se caracteriza por apresentar as maiores desigualdades sociais.
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Alecrin ESD, Oliveira ALGD, Guimarães NS, Lyon S, Martins MAP, Rocha MODC. Factors associated with the development of leprosy in Brazilian contacts: a systematic review. Rev Inst Med Trop Sao Paulo 2022; 64:e55. [PMID: 36197417 PMCID: PMC9528391 DOI: 10.1590/s1678-9946202264055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 07/13/2022] [Indexed: 12/01/2022] Open
Abstract
People who interact with leprosy patients in their environment, neighborhood, family, or social relationships are at risk to develop the disease. This systematic review investigated the risk and protective factors associated with the development of leprosy in Brazilian contacts. The studies were found in Cochrane Library, PubMed (MEDLINE), Embase, Virtual Health Library, grey literature and hand search until July 2021. The study selection, data extraction and quality assessment were independently performed by two investigators. The quality assessment was performed using the Newcastle-Ottawa Scale (NOS). This review was registered in PROSPERO (CRD42020160680). Seventeen articles fulfilled the inclusion criteria (n=544). The immunological and molecular factors, such as Anti-phenolic Glycolipid Antibodies (Anti-PGL-1) seropositivity, negative Mitsuda test, absence of Bacillus Calmette-Guérin (BCG) scar, positive Polymerase Chain Reaction (PCR) in blood; age and race; conviviality, education, contact time and type of contact, as well as elements related to the index case (bacilloscopic index; genetic conditions, family relationships), and some combined factors were shown to be relevant risk factors associated with the development of the disease in Brazilian leprosy contacts. The protective factors reported were the presence of one or more BCG scars, positive Mitsuda test, and education level. All selected studies were considered of high quality according to NOS. The knowledge of disease-related risk and protective factors provides the scientific basis for decision-making in the management of the disease in leprosy contacts.
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Affiliation(s)
- Edilamar Silva de Alecrin
- Universidade Federal de Minas Gerais, Brazil; Hospital Eduardo de Menezes, Ambulatório de Dermatologia, Brazil
| | | | | | - Sandra Lyon
- Universidade Federal de Minas Gerais, Brazil; Faculdade de Saúde e Ecologia Humana, Brazil
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Serrano-Coll H, Osorio-Leal Y, Escobar-Builes MV, Cardona-Castro N. Detection of Mycobacterium leprae infection in family clusters from six leprosy-endemic regions in Colombia. Trans R Soc Trop Med Hyg 2021; 116:501-508. [PMID: 34791501 DOI: 10.1093/trstmh/trab170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/04/2021] [Accepted: 10/22/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which continues to be endemic in tropical countries, making it necessary to implement strategies for its elimination. The objective of the current article was to detect M. leprae infection and associated factors through serological and epidemiological evaluation in family clusters of leprosy patients. METHODS Mycobacterium leprae infection was determined in 50 family clusters of leprosy patients from the departments of Bolívar, Atlántico, Santander, Boyacá, Chocó and Antioquia through the detection of antibodies (protein A, IgM, IgG) against anti-natural octyl disacharide-leprosy IDRI diagnostic (NDO-LID). RESULTS Higher seroconversion and elevated titers of these antibodies against NDO-LID were observed in the population of Chocó and Atlántico (p<0.05). Additionally, a higher frequency of infection was observed in large family groups that consumed armadillo meat and belonged to a low socioeconomic stratum (p<0.05). Multivariate analysis established that the main associated factors for a family cluster experiencing this infection were belonging to a vulnerable economic stratum and a large family group. CONCLUSIONS This study found that the set of social and demographic variables (i.e. armadillo consumption, geographic area, low socioeconomic status and belonging to a large family cluster) are related to the promotion of seropositivity in family clusters.
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Affiliation(s)
- Héctor Serrano-Coll
- Colombian Institute of Tropical Medicine CES University, Sabaneta, Antioquia, Colombia Cra 43 A # 52 Sur 99. Post code 055457
| | - Yuliana Osorio-Leal
- Universidad de Antioquia, Public Health School, Calle 62b No. 52-59. Medellin Colombia. Post code 050010
| | - María Victoria Escobar-Builes
- Colombian Institute of Tropical Medicine CES University, Sabaneta, Antioquia, Colombia Cra 43 A # 52 Sur 99. Post code 055457
| | - Nora Cardona-Castro
- Colombian Institute of Tropical Medicine CES University, Sabaneta, Antioquia, Colombia Cra 43 A # 52 Sur 99. Post code 055457
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Damasceno DM, da Paz WS, de Souza CDF, Dos Santos AD, Bezerra-Santos M. High-risk transmission clusters of leprosy in an endemic area in the Northeastern Brazil: A retrospective spatiotemporal modelling (2001-2019). Trop Med Int Health 2021; 26:1438-1445. [PMID: 34288290 DOI: 10.1111/tmi.13657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyse and map the leprosy risk areas in the state of Alagoas, an endemic region in the Northeastern Brazil, between 2001 and 2019. METHODS Ecological and time series study, using spatial analysis techniques. First, we analyse the epidemiological aspects of leprosy cases, using the data available in the Notifiable Diseases Information System; then, we used the segmented log-linear regression model to assess time trends. Spatial distribution was analysed by the Local Empirical Bayesian Estimator and by calculating the Global and Local Moran Index. Finally, spatiotemporal clusters were identified through scanning statistics, using the Kulldorf method of retrospective analysis. RESULTS We observed that Alagoas showed an average new case detection rate of 14.43/100,000 inhabitants between 2001 and 2019, being classified as highly endemic. The area of highest risk was the 9th health region (state hinterland), with increasing time trend (Annual Percentage Change/APC = 7.2; p-value < 0.05). Several clusters of high risk of leprosy transmission were verified in Alagoas, including the state capital and hinterland municipalities. CONCLUSIONS Our data indicate that active M. leprae transmission persists in Alagoas; that diagnosis is delayed and that there are high-risk areas, especially in inland municipalities.
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Affiliation(s)
- Dayanne Maria Damasceno
- Post-Graduate Program in Parasitic Diseases and Environment, Universidade Estadual de Alagoas, Santana do Ipanema, Brazil
| | | | | | - Allan Dantas Dos Santos
- Department of Nursing, Universidade Federal de Sergipe, Lagarto, Brazil.,Nursing Graduate Program, Aracaju, Brazil
| | - Márcio Bezerra-Santos
- Health Science Graduate Program, Aracaju, Brazil.,Department of Morphology, Universidade Federal de Sergipe, Aracaju, Brazil.,Immunology and Molecular Biology Laboratory, University Hospital, Universidade Federal de Sergipe, Aracaju, Brazil
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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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Sanchez MN, Nery JS, Pescarini JM, Mendes AA, Ichihara MY, Teixeira CSS, Penna MLF, Smeeth L, Rodrigues LC, Barreto ML, Brickley EB, Penna GO. Physical disabilities caused by leprosy in 100 million cohort in Brazil. BMC Infect Dis 2021; 21:290. [PMID: 33752632 PMCID: PMC7983385 DOI: 10.1186/s12879-021-05846-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures and targeted interventions to mitigate its impact on affected individuals. This study investigated such factors among the most vulnerable portion of the Brazilian population. METHODS A large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, covering the period 2001-2015, including over 114 million individuals. Data were linked to the leprosy notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to a multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervals. RESULTS Among the original cohort members 21,565 new leprosy cases were identified between 2007 and 2014. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21 and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2.39 and 1.95, respectively), less schooling (with a clear dose response effect) and being a multibacillary patient (ORs 3.5 and 8.22). Protective factors for both grades were being female (ORs 0.81 and 0.61) and living in a high incidence municipality (ORs 0.85 and 0.67). CONCLUSIONS The findings suggest that the developing of physical disabilities remains a public health problem which increases the burden of leprosy, mainly for those with severe clinical features and worse socioeconomic conditions. Early diagnosis is paramount to decrease the incidence of leprosy-related disability and our study points to the need for strengthening control actions in non-endemic areas in Brazil, where cases may be missed when presented at early stages in disease. Both actions are needed, to benefit patients and to achieve the WHO goal in reducing physical disabilities among new cases of leprosy.
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Affiliation(s)
- Mauro Niskier Sanchez
- Núcleo de Medicina Tropical, Universidade de Brasília, Avenida L3 Norte, s/n°, Campus Universitário Darcy Ribeiro, Gleba A, Brasília, Distrito Federal CEP 70297-400 Brazil
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
| | - Joilda Silva Nery
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Basílio da Gama, s/n° - Canela, Salvador, Bahia CEP 40110-040 Brazil
| | - Júlia Moreira Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
| | - André Alves Mendes
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
- Departamento de Estatística, Universidade Federal Bahia, Rua Barão de Jeremoabo, s/n° - Ondina, Salvador, Bahia CEP 40170-115 Brazil
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
| | - Camila Silveira Silva Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Rua Basílio da Gama, s/n° - Canela, Salvador, Bahia CEP 40110-040 Brazil
| | - Maria Lúcia Fernandes Penna
- Departamento de Epidemiologia e Bioestatística, Universidade Federal Fluminense, Bloco do Hospital Universitário Antônio Pedro (Huap) – 3° andar, Rua Marquês do Paraná, 303, Centro, Niterói, Rio de Janeiro, CEP 24030-210 Brazil
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
- Health Data Research (HDR), London, UK
| | - Laura Cunha Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Maurício Lima Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Rua Mundo, s/n° Parque Tecnológico da Bahia – Trobogy, Salvador, CEP 41745-715 Brazil
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Gerson Oliveira Penna
- Núcleo de Medicina Tropical, Universidade de Brasília, Avenida L3 Norte, s/n°, Campus Universitário Darcy Ribeiro, Gleba A, Brasília, Distrito Federal CEP 70297-400 Brazil
- Escola Fiocruz de Governo, Fiocruz Brasília. Avenida L3 Norte, s/n°, Campus Universitário Darcy Ribeiro, Gleba A, Brasília, Distrito Federal CEP 70904-130 Brazil
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Rocha MCN, Nobre ML, Garcia LP. [Epidemiological characteristics of leprosy in elderly Brazilians and comparison with other age groups (2016-2018)]. CAD SAUDE PUBLICA 2020; 36:e00048019. [PMID: 32965374 DOI: 10.1590/0102/311x00048019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 02/13/2020] [Indexed: 11/21/2022] Open
Abstract
The article aimed to describe epidemiological indicators and characteristics of new cases of leprosy in elderly Brazilians in 2016-2018, compared to other age groups. A descriptive cross-sectional cohort study was conducted with data from the Information System on Diseases of Notification (SINAN). New leprosy cases were categorized by age groups: 60 or more, 40-59, 15-39, and 15 years of age. Pearson's chi-square test was used to verify differences between groups. A total of 81,205 new leprosy cases were reported in Brazil. Of these, 24.1% were elderly, 37.7% from 40-59 years, 31.9% from 15-39 years, and 6.3% in individuals under 15 years of age. The elderly showed higher proportions (p < 0.001) of cases in males (60.1%), with multibacillary classification (81.3%), and with physical disability grade 2 (PDG2) (11.4%) when compared to the other groups. However, the proportion of new cases detected in the elderly based on contact testing (4.9%) was the lowest among all the age brackets (p < 0.001). The mean detection rate and rate of new cases with PDG2 at diagnosis were higher among the elderly (25.1/100,000 and 28.6/million inhabitants, respectively) compared to other age groups in Brazil as a whole and in the regions and states. Important differences were seen in the epidemiological and clinical profile of leprosy in the elderly compared to other age brackets, especially higher proportions of multibacillary cases, new cases with PDG2, and low detection by contact testing. The findings highlighted the need for leprosy control in this age group, aimed at contributing to interruption of transmission of the disease.
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Affiliation(s)
| | - Maurício Lisboa Nobre
- Hospital Giselda Trigueiro, Secretaria Estadual de Saúde do Rio Grande do Norte, Natal, Brasil
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Souza CDFD, Medronho RDA, Santos FGB, Magalhães MDAFM, Luna CF. Modelagem espacial da hanseníase no estado da Bahia, Brasil, (2001-2015) e determinantes sociais da saúde. CIENCIA & SAUDE COLETIVA 2020; 25:2915-2926. [DOI: 10.1590/1413-81232020258.21522018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022] Open
Abstract
Resumo O trabalho analisa a distribuição espacial da hanseníase na Bahia e os determinantes sociais relacionados. Estudo ecológico com dados de hanseníase do período 2001-2015. Três indicadores epidemiológicos foram selecionados: coeficiente de detecção na população geral e em menores de 15 anos e a taxa de casos novos com grau II de incapacidade. Os indicadores foram suavizados pelo Modelo Bayesiano Empírico Local e aplicou-se estatística de Moran Global e Local. As variáveis independentes foram selecionadas a partir do Censo IBGE-2010. Regressões multivariadas foram empregadas, seguidas de regressão espacial. Observou-se distribuição heterogênea no estado, com concentração no eixo norte-oeste e região sul. Para o coeficiente de detecção geral, cinco variáveis compuseram o modelo: densidade demográfica, proporção da população urbana, renda per capita, proporção de extremamente pobres e domicílios com mais de três pessoas por dormitório. A proporção de analfabetismo compôs o modelo final para a taxa de grau II de incapacidade física. Não foram identificados determinantes da ocorrência da doença em menores de 15 anos. A modelagem utilizada contribuiu para demonstrar a heterogeneidade espacial e os determinantes sociais da doença na Bahia, colocando em evidência a complexidade do problema.
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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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Rocha MCN, Nobre ML, Garcia LP. Temporal trend of leprosy among the elderly in Brazil, 2001 - 2018. Rev Panam Salud Publica 2020; 44:e12. [PMID: 32104169 PMCID: PMC7025571 DOI: 10.26633/rpsp.2020.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/05/2019] [Indexed: 12/01/2022] Open
Abstract
Objective. To describe the temporal trends of leprosy indicators among the elderly in Brazil in 2001 – 2018. Methods. This was an ecological time-series study of new leprosy cases in the elderly reported to the Notifiable Diseases Information System. Prais-Winsten generalized linear regression was used to estimate temporal variations. Results. There were 687 317 new leprosy cases in Brazil from 2001 – 2018, of which 129 214 (18.8%) were among elderly people. Overall detection rates in the elderly and of new cases with grade-2 disability showed a falling trend, with an annual percent change of -4.6% (95%CI = -5.1 to -4.0) and -3.9% (95%CI = -4.6 to -3.2). New case and new multibacillary case proportions showed an increasing trend, with an annual percent change of 2.9% (95%CI = 2.6 to 3.3) and 1.4% (95%CI = 1.0 to 1.7), respectively. Detection rates for new leprosy cases in elderly people in Brazil are decreasing, but the proportion of new cases and multibacillary cases are trending upwards. Conclusions. New cases are shifting to older age groups, and demographic transition and immunosenescence are an influence. Inadequate reduction of grade-2 disability indicates a high risk of physical disability persists. Improved contact tracing and more effective action are needed in this age group.
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Affiliation(s)
- Margarida Cristiana Napoleão Rocha
- Postgraduate Program in Public Health University of Brasilia Brasilia Brazil Postgraduate Program in Public Health, University of Brasilia, Brasilia, Brazil
| | - Mauricio Lisboa Nobre
- Tropical Medicine Institute Federal University of Rio Grande do Norte Rio Grande do Norte Brazil Tropical Medicine Institute, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Leila Posenato Garcia
- Institute of Applied Economic Research Institute of Applied Economic Research Brasilia Brazil Institute of Applied Economic Research, Brasilia, Brazil
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de Assis IS, Berra TZ, Alves LS, Ramos ACV, Arroyo LH, Dos Santos DT, Arcoverde MAM, Alves JD, de Almeida Crispim J, Pieri FM, Frade MAC, Pinto IC, Nunes C, Arcêncio RA. Leprosy in urban space, areas of risk for disability and worsening of this health condition in Foz Do Iguaçu, the border region between Brazil, Paraguay and Argentina. BMC Public Health 2020; 20:119. [PMID: 31996183 PMCID: PMC6988226 DOI: 10.1186/s12889-020-8236-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 01/16/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Leprosy is a public health problem and a challenge for endemic countries, especially in their border regions where there are intense migration flows. The study aimed to analyse the dynamics of leprosy, in order to identify areas of risk for the occurrence of the disease and disability and places where this health condition is worsening. METHOD This ecological study considered the new cases of leprosy reported in the municipality of Foz do Iguaçu from 2003 to 2015. Spatial and spatial-temporal scan statistics were used to identify the risk areas for the occurrence of leprosy, as well as the Getis-Ord Gi and Getis-Ord Gi* methods. Areas of risk for disabilities were identified by the scan statistic and kernel density estimation. RESULTS A total of 840 cases were reported, of which 179 (21.3%) presented Grade 1 or 2 disabilities at the time of diagnosis. Leprosy risk areas were concentrated in the Southern, Eastern and Northeastern Health Districts of the municipality. The cases of Grade 2 disability were observed with higher intensity in regions characterized by high population density and poverty. CONCLUSION The results of the study have revealed changes in the pattern of areas at risk of leprosy according to the investigated periods. In addition, it was possible to verify disabilities as a condition present in the investigated cases, or that may be related to the late diagnosis of the disease. In the areas of risk identified, patients have reported worse physical disability after diagnostic confirmation, or indicate inadequate clinical examination, reinforcing the need for structuring leprosy control services in a qualified manner.
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Affiliation(s)
- Ivaneliza Simionato de Assis
- Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
- University Center Dinâmica of Cataratas, Foz do Iguaçu, Paraná, Brazil.
| | - Thais Zamboni Berra
- Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luana Seles Alves
- Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Luiz Henrique Arroyo
- Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | | | | | | | | | - Ione Carvalho Pinto
- Nursing College of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
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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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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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Factors Associated with Multibacillary Leprosy in a Priority Region for Disease Control in Northeastern Brazil: A Retrospective Observational Study. J Trop Med 2019; 2019:5738924. [PMID: 30911302 PMCID: PMC6397966 DOI: 10.1155/2019/5738924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/09/2018] [Accepted: 01/17/2019] [Indexed: 01/09/2023] Open
Abstract
Background Leprosy is an infectious disease that can lead to physical disabilities and stigmatization. It remains an important public health problem, especially in Brazil. Objective To analyse sociodemographic and clinical factors associated with multibacillary leprosy in a hyperendemic region of the disease in northeastern Brazil. Method This is a retrospective observational study with secondary data acquired from 2012 to 2015, from a group of leprosy cases reported in a reference outpatient clinic for the treatment and followup of leprosy in the city of Imperatriz, Maranhao, in northeastern Brazil. Results From 905 new cases of leprosy studied, 656 (72.5%) were classified as multibacillary leprosy and 249 (27.5%) as paucibacillary leprosy. We observed that men were more likely to present 5 to 15 skin lesions (OR: 1.32; 95% CI: 1.18-1.49; p <0.0001) and >15 skin lesions (OR: 1.26; 95% CI: 1.09 -1.45; p = 0.005) and a lower chance of having <5 skin lesions (OR: 0.67; 95% CI: 0.59-0.76; p <0.0001). Women were more likely to have no affected nerves compared to men (OR: 1.46; 95% CI: 1.20-1.77; p <0.0001). The age range of 16 to 60 years showed a greater chance of having <5 skin lesions (OR: 1.01; 95% CI: 1.007-1.20; p = 0.03) and a lower chance of having 5 to 15 skin lesions (OR: 1.12, 95% CI: 1.03-1.23; p= 0.008) and a lower chance of being a grade I disability ( CI= 0.73-0.94; p=0.83) and II (OR: 0.82; 95% CI: 0.77-0.98; p=000.1). Conclusion Cases of multibacillary leprosy were associated with male gender, low educational level, and clinical variables such as number of skin lesions and grade I or II disability.
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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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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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Marciano LHSC, Belone ADFF, Rosa PS, Coelho NMB, Ghidella CC, Nardi SMT, Miranda WC, Barrozo LV, Lastória JC. Epidemiological and geographical characterization of leprosy in a Brazilian hyperendemic municipality. CAD SAUDE PUBLICA 2018; 34:e00197216. [DOI: 10.1590/0102-311x00197216] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/23/2018] [Indexed: 11/22/2022] Open
Abstract
Abstract: This study aimed to identify the distribution pattern of leprosy in a hyperendemic municipality in Brazil and determine its relationship with the clinico-epidemiological situation over 11 years. The geographic information system, MapInfo, spatial scan statistics and the Moran I index were used to analyze new cases. The digital cartographic base was used to map clusters of new paucibacillary and multibacillary cases and cases in minors under 15 years old. Socioeconomic indicators are shown using the choropleth mapping technique. A reduction in the detection coefficient, increases in high-risk spatial clusters, marked changes in the distribution of high-risk and low-risk clusters, and high-risk clusters of minors under 15 years old were observed from 2006 to 2010, showing recent illness, the presence of active foci, and overlapping of high-risk clusters of multibacillary infection in minors under 15 years old. Leprosy remains a public health problem in Rondonópolis, Mato Grosso State; the high-risk areas require an intensification of control measures and active search strategies to detect new cases.
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Raposo MT, Reis MC, Caminha AVDQ, Heukelbach J, Parker LA, Pastor-Valero M, Nemes MIB. Grade 2 disabilities in leprosy patients from Brazil: Need for follow-up after completion of multidrug therapy. PLoS Negl Trop Dis 2018; 12:e0006645. [PMID: 30011288 PMCID: PMC6062121 DOI: 10.1371/journal.pntd.0006645] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/26/2018] [Accepted: 06/28/2018] [Indexed: 12/03/2022] Open
Abstract
Background Leprosy continues to be a public health problem in many countries. Difficulties faced by health services include late diagnosis, under-reporting of new cases, adequate monitoring of disabilities and treatment. Furthermore, systematic follow-up after completion of treatment is important, when new disabilities may occur, or existing disabilities may get worse. The objective of the present study was to determine the prevalence of leprosy-associated grade 2 disabilities (G2D) after completion of multidrug therapy (MDT) and to identify factors associated with G2D. Methods We performed a cross-sectional study of 222 leprosy cases registered in Vitória da Conquista, Bahia state, Brazil from 2001–2014. We performed a clinical examination of the study participants and collected socio-economic and clinical information by interview. We identified factors associated with grade 2 disability (G2D) using logis tic regression. Results In total, 38 (17.1%) participants were diagnosed with G2D, and 106 (47.7%) with grade 1 disabilities (G1D). The following independent factors were significantly associated with G2D: occurrence of leprosy reaction (adjusted OR = 2.5; 95%CI = 1.09–5.77), thickening and/or tenderness of one or more nerve trunks (adjusted OR = 3.0; CI = 1.13–8.01) and unemployment (adjusted OR = 7.17; CI = 2.44–21.07). Conclusions This study shows that physical disabilities remain after completion of MDT and frequently occur in an endemic area in Brazil. Finding new ways to reduce the burden of disability are urgently needed, and may include systematic follow-up of patients after treatment completion combined with evidence-based preventative measures. Leprosy is a Neglected Tropical Disease that is still common in many countries. Patients who have had leprosy often suffer long-term physical disabilities. For some patients, disabilities occur after finishing treatment or existing disabilities may get worse. We contacted 222 leprosy patients who had previously completed multidrug therapy (MDT) in a typical endemic area in Brazil and assessed leprosy-associated disabilities, and the associated clinical or sociodemographic factors. We found that 17.1% of the participants had severe (grade 2) disabilities. Disabilities were more common among patients who had had a leprosy reaction, thickening and/or tenderness of one or more nerve trunks and were unemployed. The findings are important because we show that physical disabilities occur frequently after treatment completion in this area, and that patients need long-term follow-up by the health system. Integrated measures that consider clinical and socio-economic aspects are also needed to reduce leprosy burden after completion of treatment, such as devising of public policies, implementation of clinical monitoring and the development of evidence-based guidelines for follow-up after release from MDT.
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Affiliation(s)
- Marcos Túlio Raposo
- Departamento de Saúde I, Universidade Estadual do Sudoeste da Bahia, Jequié, Bahia, Brazil
| | | | | | - Jörg Heukelbach
- Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Lucy Anne Parker
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Alicante, Alicante, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Pastor-Valero
- Departamento de Salud Pública, Historia de la Ciencia y Ginecología, Universidad Miguel Hernández, Alicante, Alicante, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Abstract
Leprosy still represents a serious health problem in a number of countries, including Brazil. Although leprosy has been associated with poverty for a long time, it is still difficult to accurately define this relationship. Here, we evaluated in an endemic municipality the progress from 1995 to 2015 of epidemiological indicators to establish if there were any strong associations between social indicators and the occurrence of leprosy. An ecological study was conducted using the SINAN database (Brazilian leprosy-national notifiable diseases information system) in combination with georeferencing of leprosy cases. The georeferencing used the ArcGis programme and occurrence of cases was evaluated in relation to the Health Vulnerability Index (HVI), an indicator that categorises socio-economic and sanitation factors. The data identified a marked decrease in the overall prevalence of leprosy, a reduction in the new case-detection rate and a reduction in the number of cases with grade 2 disabilities (albeit with transient peaks in 2007 and 2015). Logistic regression analysis showed association of detection rates with elevated HVI. Thus, while the epidemiological indicators point to the elimination of leprosy, there is evidence of hidden cases and an association between higher rates of leprosy detection and greater social vulnerability remain.
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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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Souza EAD, Boigny RN, Oliveira HX, Oliveira MLWDRD, Heukelbach J, Alencar CH, Martins-Melo FR, Ramos Júnior AN. Tendências e padrões espaço-temporais da mortalidade relacionada à hanseníase no Estado da Bahia, Nordeste do Brasil, 1999-2014. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/1414-462x201800020255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Resumo Introdução A hanseníase é uma condição negligenciada, com alta carga de morbimortalidade, especialmente em áreas mais desfavoráveis. O objetivo deste estudo foi analisar as tendências e os padrões espaço-temporais da mortalidade relacionada à hanseníase no estado da Bahia, 1999-2014. Objetivo Analisar tendências e padrões espaço-temporais da mortalidade relacionada à hanseníase no Estado da Bahia de 1999 a 2014. Método Estudo de base populacional com dados secundários de mortalidade. Incluíram-se todos os óbitos em que a hanseníase foi mencionada como causa de morte. Resultados Foram registrados 1.152.262 óbitos, dos quais a hanseníase foi identificada em 481 (0,04%) casos, resultando em coeficiente bruto médio anual de mortalidade de 0,21 óbito/100 mil habitantes (intervalo de confiança [IC] de 95%: 0,13-0,29). Hanseníase não especificada (87,73%, ou 422/481) e complicações da hanseníase (6,44%, ou 31/481) foram as formas clínicas mais comumente mencionadas. O risco de óbito relacionado à hanseníase foi maior entre os homens (risco relativo [RR]: 2,38; IC 95%: 0,19-0,46), em idosos (RR: 74,79; IC 95%: 9,57-582,20) e na região oeste do Estado (RR: 4,08; IC 95%: 2,33-7,15). A mortalidade apresentou tendência temporal de aumento significativo no período ( Average Annual Percentual Change [AAPC] 7,3; IC 95%: 4,5 a 10,3), assim como a mortalidade proporcional (AAPC 5,3; IC 95%: 2,2 a 8,3). Conclusões A hanseníase representa uma causa negligenciada de óbito no Estado da Bahia. Apresenta tendências espaço-temporais desiguais nas regiões de saúde, com riscos associados, principalmente, à população masculina e idosa.
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Affiliation(s)
| | | | | | | | - Jorg Heukelbach
- Universidade Federal do Ceará, Brasil; James Cook University, Australia
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Barbosa CC, Bonfim CVD, de Brito CMG, Ferreira AT, Gregório VRDN, de Oliveira ALS, Portugal JL, de Medeiros ZM. Spatial analysis of reported new cases and local risk of leprosy in hyper-endemic situation in Northeastern Brazil. Trop Med Int Health 2018; 23:748-757. [DOI: 10.1111/tmi.13067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Celivane Cavalcanti Barbosa
- Department of Collective Health; Aggeu Magalhães Institute; Oswaldo Cruz Foundation; Recife Brazil
- Department of Epidemiological Surveillance; First Health District of the State Health Department of Pernambuco; Recife Brazil
| | | | - Cintia Michele Gondim de Brito
- Department of Epidemiological Surveillance; First Health District of the State Health Department of Pernambuco; Recife Brazil
- Postgraduate Health Sciences; University of Pernambuco; Recife Brazil
| | - Andrea Torres Ferreira
- Department of Epidemiological Surveillance; First Health District of the State Health Department of Pernambuco; Recife Brazil
| | | | - André Luiz Sá de Oliveira
- Nucleus of Statistics and Geoprocessing; Aggeu Magalhães Institute; Oswaldo Cruz Foundation; Recife Brazil
| | - José Luiz Portugal
- Department of Cartographic Engineering; Federal University of Pernambuco; Recife Brazil
| | - Zulma Maria de Medeiros
- Postgraduate Health Sciences; University of Pernambuco; Recife Brazil
- Department of Parasitology; Aggeu Magalhães Institute; Oswaldo Cruz Foundation; Recife 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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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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Phillips DA, Ferreira JA, Ansah D, Teixeira HSA, Kitron U, de Filippis T, de Alcântara MH, Fairley JK. A tale of two neglected tropical infections: using GIS to assess the spatial and temporal overlap of schistosomiasis and leprosy in a region of Minas Gerais, Brazil. Mem Inst Oswaldo Cruz 2017; 112:275-280. [PMID: 28327791 PMCID: PMC5354614 DOI: 10.1590/0074-02760160395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/23/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite public health efforts to reduce the global burden of leprosy, gaps remain in the knowledge surrounding transmission of infection. Helminth co-infections have been associated with a shift towards the lepromatous end of the disease spectrum, potentially increasing transmission in co-endemic areas. OBJECTIVES Using this biologically plausible association, we conducted a geographic information systems (GIS) study to investigate the spatial associations of schistosomiasis and leprosy in an endemic area of Minas Gerais (MG), Brazil. METHODS Data on new cases of Mycobacterium leprae and Schistosoma mansoni infections from 2007-2014 were retrieved from the Brazilian national notifiable diseases information system for seven municipalities in and surrounding Vespasiano, MG. A total of 139 cases of leprosy and 200 cases of schistosomiasis were mapped to a municipality level. For one municipality, cases were mapped to a neighborhood level and a stratified analysis was conducted to identify spatial associations. FINDINGS A relative risk of 6.80 [95% confidence interval (CI) 1.46 - 31.64] of leprosy was found in neighborhoods with schistosomiasis. Incidence rates of leprosy increased with corresponding incidence rates of schistosomiasis, and the temporal trends of both infections were similar. CONCLUSIONS The associations found in this project support the hypothesis that helminth infections may influence the transmission of leprosy in co-endemic areas.
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Affiliation(s)
| | | | - Deidra Ansah
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA, United States
| | - Herica SA Teixeira
- Escola de Medicina, Faculdade da Saúde e Ecologia Humana, Vespasiano, MG, Brasil
- Secretaria Municipal de Saúde, Vespasiano, MG, Brasil
| | - Uriel Kitron
- Emory University, Department of Environmental Science, Atlanta, GA, United States
| | - Thelma de Filippis
- Escola de Medicina, Faculdade da Saúde e Ecologia Humana, Vespasiano, MG, Brasil
| | | | - Jessica K Fairley
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, United States
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Freitas LRS, Duarte EC, Garcia LP. Trends of main indicators of leprosy in Brazilian municipalities with high risk of leprosy transmission, 2001-2012. BMC Infect Dis 2016; 16:472. [PMID: 27595751 PMCID: PMC5011946 DOI: 10.1186/s12879-016-1798-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 08/23/2016] [Indexed: 11/26/2022] Open
Abstract
Background Leprosy incidence has reduced in recent years in Brazil, although the disease still persists as a public health problem in some regions. To investigate the trends of selected leprosy indicators in Brazilian municipalities with high risk of transmission is essential to provide effective control of the disease, yet this area has not been investigated. Methods This is an ecological time-series study with multiple groups using Notifiable Diseases Information System (SINAN) data. All 692 municipalities of the states of Mato Grosso, Tocantins, Rondônia, Pará and Maranhão were included. The incidence rates of leprosy were calculated, as well as incidence rates in children under 15 years per 100,000 inhabitants and rates of new cases presenting grade-2 disabilities per 100,000 inhabitants. Joinpoint Regression was used to analyse the time trends of the different indicators studied. The spatial distribution of temporal variations of the indicators in the period was presented. Results Between 2001 and 2012, 176,929 leprosy cases were notified in the area studied, this being equivalent to 34.6 % of total cases in Brazil. In the aggregate of municipalities, there was a reduction in incidence rate of leprosy from 89.10 to 56.98 new cases per 100,000 inhabitants between 2001 and 2012, with a significant reduction between 2003 and 2012 (APC: − 6.2 %, 95 % CI: −7.2 % to −5.2 %). The incidence rate in <15 years also reduced significantly between 2003 and 2012 (APC: −5.6 %; 95 % CI: −7.2 % to −4.1 %). The rate of new cases with grade 2 disability remained stable between 2001 and 2012 (APC: −1.3 %; 95 % CI: −2.6 % to 0.1 %). Conclusion Despite the reduction in the leprosy incidence rate, strategies for controlling this disease need to be enhanced to enable early case detection, especially in hyperendemic municipalities, in order to prevent disability.
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Affiliation(s)
- Lucia R S Freitas
- Programa de Pós-Graduação em Medicina Tropical, Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil.
| | - Elisabeth C Duarte
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Leila P Garcia
- Instituto de Pesquisa Econômica Aplicada, Brasília, Brazil
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Hirai KE, Aarão TLDS, Silva LM, de Sousa JR, de Souza J, Dias LB, Carneiro FRO, Fuzii HT, Quaresma JAS. Langerhans cells (CD1a and CD207), dermal dendrocytes (FXIIIa) and plasmacytoid dendritic cells (CD123) in skin lesions of leprosy patients. Microb Pathog 2015; 91:18-25. [PMID: 26639680 DOI: 10.1016/j.micpath.2015.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 01/10/2023]
Abstract
The clinical course of infection with Mycobacterium leprae varies widely and depends on the pattern of the host immune response. Dendritic cells play an important role in the activation of the innate and adaptive immune system and seem to be essential for the development of the disease. To analyze the presence of epidermal dendritic cells (CD1a and CD207), plasmacytoid dendritic cells (CD123) and dermal dendrocytes (factor XIIIa) in lesion fragments of leprosy patients, skin samples from 30 patients were studied. These samples were submitted to immunohistochemistry against CD1a, CD207, FXIIIa, and CD123. The results showed a larger number of Langerhans cells, detected with the CD1a or CD207 marker, dermal dendrocytes and plasmacytoid dendritic cells in patients with the tuberculoid form. A positive correlation was observed between the Langerhans cell markers CD1a and CD207 in both the tuberculoid and lepromatous forms, and between Langerhans cells and dermal dendrocytes in samples with the tuberculoid form. The present results indicate the existence of a larger number of dendritic cells in patients at the resistant pole of the disease (tuberculoid) and suggest that the different dendritic cells studied play a role, favoring an efficient immune response against infection with M. leprae.
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Affiliation(s)
- Kelly Emi Hirai
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil
| | | | - Luciana Mota Silva
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil
| | | | - Juarez de Souza
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil
| | - Leonidas Braga Dias
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil
| | | | - Hellen Thais Fuzii
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, Para, Brazil
| | - Juarez Antonio Simões Quaresma
- Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem, Para, Brazil; Nucleo de Medicina Tropical, Universidade Federal do Para, Belem, Para, Brazil.
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Martins-Melo FR, Assunção-Ramos AV, Ramos AN, Alencar CH, Montenegro RM, Wand-Del-Rey de Oliveira ML, Heukelbach J. Leprosy-related mortality in Brazil: a neglected condition of a neglected disease. Trans R Soc Trop Med Hyg 2015; 109:643-52. [DOI: 10.1093/trstmh/trv069] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/05/2015] [Indexed: 11/15/2022] Open
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Albuquerque RV, Malcher NS, Amado LL, Coleman MD, dos Santos DC, Borges RS, Valente SAS, Valente VC, Monteiro MC. In Vitro Protective Effect and Antioxidant Mechanism of Resveratrol Induced by Dapsone Hydroxylamine in Human Cells. PLoS One 2015; 10:e0134768. [PMID: 26284371 PMCID: PMC4540410 DOI: 10.1371/journal.pone.0134768] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 06/27/2015] [Indexed: 01/24/2023] Open
Abstract
Dapsone (DDS) hydroxylamine metabolites cause oxidative stress- linked adverse effects in patients, such as methemoglobin formation and DNA damage. This study evaluated the ameliorating effect of the antioxidant resveratrol (RSV) on DDS hydroxylamine (DDS-NHOH) mediated toxicity in vitro using human erythrocytes and lymphocytes. The antioxidant mechanism was also studied using in-silico methods. In addition, RSV provided intracellular protection by inhibiting DNA damage in human lymphocytes induced by DDS-NHOH. However, whilst pretreatment with RSV (10–1000 μM significantly attenuated DDS-NHOH-induced methemoglobinemia, but it was not only significantly less effective than methylene blue (MET), but also post-treatment with RSV did not reverse methemoglobin formation, contrarily to that observed with MET. DDS-NHOH inhibited catalase (CAT) activity and reactive oxygen species (ROS) generation, but did not alter superoxide dismutase (SOD) activity in erythrocytes. Pretreatment with RSV did not alter these antioxidant enzymes activities in erythrocytes treated with DDS-NHOH. Theoretical calculations using density functional theory methods showed that DDS-NHOH has a pro-oxidant effect, whereas RSV and MET have antioxidant effect on ROS. The effect on methemoglobinemia reversion for MET was significantly higher than that of RSV. These data suggest that the pretreatment with resveratrol may decrease heme-iron oxidation and DNA damage through reduction of ROS generated in cells during DDS therapy.
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Affiliation(s)
- Rosyana V. Albuquerque
- Programa de Pós-graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Pará/UFPA, Rua Augusto Corrêa, 01, Bairro Guamá, 66075–110, Belém, PA, Brasil
| | - Nívea S. Malcher
- Faculdade de Farmácia, Universidade Federal do Pará/UFPA, Belém, Pará, Brasil
| | - Lílian L. Amado
- Instituto de Ciências Biológicas, Universidade Federal do Pará/UFPA, Belém, PA, Brasil
| | - Michael D. Coleman
- Mechanisms of Drug Toxicity Group, School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, United Kingdom
| | | | - Rosivaldo Sa. Borges
- Programa de Pós-graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Pará/UFPA, Rua Augusto Corrêa, 01, Bairro Guamá, 66075–110, Belém, PA, Brasil
| | | | - Vera C. Valente
- Seção de Parasitologia, Instituto Evandro Chagas, SVS, MS, Pará, Brazil
| | - Marta Chagas Monteiro
- Programa de Pós-graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Pará/UFPA, Rua Augusto Corrêa, 01, Bairro Guamá, 66075–110, Belém, PA, Brasil
- * E-mail:
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