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Martins FDM, Vidal AP, Giddaluru J, da Silva BM, Lee EK, Zhang P, Cardozo LE, Prete CA, Domingues HH, Sabino EC, Sampaio VDS, Monteiro WM, Nakaya HI. Temporal and spatial analysis of over 7,000 measles cases outbreak from 2018 to 2019 in the Brazilian Amazon. EINSTEIN-SAO PAULO 2024; 22:eAO0931. [PMID: 38567917 PMCID: PMC11081026 DOI: 10.31744/einstein_journal/2024ao0931] [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: 12/08/2023] [Accepted: 01/10/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE This study aimed to present a temporal and spatial analysis of the 2018 measles outbreak in Brazil, particularly in the metropolitan city of Manaus in the Amazon region, and further introduce a new tool for spatial analysis. METHODS We analyzed the geographical data of the residences of over 7,000 individuals with measles in Manaus during 2018 and 2019. Spatial and temporal analyses were conducted to characterize various aspects of the outbreak, including the onset and prevalence of symptoms, demographics, and vaccination status. A visualization tool was also constructed to display the geographical and temporal distribution of the reported measles cases. RESULTS Approximately 95% of the included participants had not received vaccination within the past decade. Heterogeneity was observed across all facets of the outbreak, including variations in the incubation period and symptom presentation. Age distribution exhibited two peaks, occurring at one year and 18 years of age, and the potential implications of this distribution on predictive analysis were discussed. Additionally, spatial analysis revealed that areas with the highest case densities tended to have the lowest standard of living. CONCLUSION Understanding the spatial and temporal spread of measles outbreaks provides insights for decision-making regarding measures to mitigate future epidemics.
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Affiliation(s)
- Felipe de Mello Martins
- Universidade do Estado do AmazonasEscola Superior de Ciências da SaúdeManausAMBrazilEscola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
- Fundação de Medicina Tropical Doutor Heitor Vieira DouradoManausAMBrazilFundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
| | - Alessandra Pinheiro Vidal
- Universidade do Estado do AmazonasEscola Superior de Ciências da SaúdeManausAMBrazilEscola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
- Fundação de Medicina Tropical Doutor Heitor Vieira DouradoManausAMBrazilFundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
| | - Jeevan Giddaluru
- Universidade de São PauloFaculdade de Ciências FarmacêuticasSão PauloSPBrazilFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Bernardo Maia da Silva
- Universidade do Estado do AmazonasEscola Superior de Ciências da SaúdeManausAMBrazilEscola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
- Fundação de Medicina Tropical Doutor Heitor Vieira DouradoManausAMBrazilFundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
| | - Eva K. Lee
- Georgia Institute of TechnologyCenter for Operations Research in Medicine and HealthcareAtlantaUSACenter for Operations Research in Medicine and Healthcare, Georgia Institute of Technology, Atlanta, USA.
| | - Peijue Zhang
- Georgia Institute of TechnologyCenter for Operations Research in Medicine and HealthcareAtlantaUSACenter for Operations Research in Medicine and Healthcare, Georgia Institute of Technology, Atlanta, USA.
| | - Lucas Esteves Cardozo
- Universidade de São PauloFaculdade de Ciências FarmacêuticasSão PauloSPBrazilFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Carlos Augusto Prete
- Universidade de São PauloEscola PolitécnicaDepartment of Electronic Systems EngineeringSão PauloSPBrazilDepartment of Electronic Systems Engineering, Escola Politécnica, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Helves Humberto Domingues
- Universidade de São PauloInstituto de Medicinal TropicalFaculdade de MedicinaSão PauloSPBrazilInstituto de Medicinal Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Ester Cerdeira Sabino
- Universidade de São PauloInstituto de Medicinal TropicalFaculdade de MedicinaSão PauloSPBrazilInstituto de Medicinal Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Vanderson de Souza Sampaio
- Fundação de Medicina Tropical Doutor Heitor Vieira DouradoManausAMBrazilFundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
- Rosemary Costa PintoFundação de Vigilância em Saúde do Amazonas DraManausAMBrazilFundação de Vigilância em Saúde do Amazonas Dra. Rosemary Costa Pinto, Manaus, AM, Brazil.
- Instituto Todos pela SaúdeSão PauloSPBrazilInstituto Todos pela Saúde, São Paulo, SP, Brazil.
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do AmazonasEscola Superior de Ciências da SaúdeManausAMBrazilEscola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
- Fundação de Medicina Tropical Doutor Heitor Vieira DouradoManausAMBrazilFundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
- Universidade de São PauloFaculdade de Ciências FarmacêuticasSão PauloSPBrazilFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Helder I Nakaya
- Universidade de São PauloFaculdade de Ciências FarmacêuticasSão PauloSPBrazilFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Urban Scaling of Health Outcomes: a Scoping Review. J Urban Health 2022; 99:409-426. [PMID: 35513600 PMCID: PMC9070109 DOI: 10.1007/s11524-021-00577-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/04/2022]
Abstract
Urban scaling is a framework that describes how city-level characteristics scale with variations in city size. This scoping review mapped the existing evidence on the urban scaling of health outcomes to identify gaps and inform future research. Using a structured search strategy, we identified and reviewed a total of 102 studies, a majority set in high-income countries using diverse city definitions. We found several historical studies that examined the dynamic relationships between city size and mortality occurring during the nineteenth and early twentieth centuries. In more recent years, we documented heterogeneity in the relation between city size and health. Measles and influenza are influenced by city size in conjunction with other factors like geographic proximity, while STIs, HIV, and dengue tend to occur more frequently in larger cities. NCDs showed a heterogeneous pattern that depends on the specific outcome and context. Homicides and other crimes are more common in larger cities, suicides are more common in smaller cities, and traffic-related injuries show a less clear pattern that differs by context and type of injury. Future research should aim to understand the consequences of urban growth on health outcomes in low- and middle-income countries, capitalize on longitudinal designs, systematically adjust for covariates, and examine the implications of using different city definitions.
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de Lima MF, Silvestre MDPSA, dos Santos EC, Martins LC, Quaresma JAS, de Barros BDCV, Silva MJA, Lima LNGC. The Presence of Mycobacterium leprae in Wild Rodents. Microorganisms 2022; 10:microorganisms10061114. [PMID: 35744632 PMCID: PMC9228809 DOI: 10.3390/microorganisms10061114] [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: 03/31/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Leprosy is a chronic infection caused by Mycobacterium leprae. There is a lack of data regarding environmental reservoirs, which may represent a serious public health problem in Brazil, especially in the state of Pará, which occupies the fourth position in incidence of cases in the country. Previous studies report evidence of infection occurring among armadillos, mangabei monkeys, and chimpanzees. In the present study, wild animals were captured and tested for the presence of anti-PGL-1 antibodies and M. leprae DNA. Fieldwork was carried out from October to November of 2016 in the cities of Curionópolis and Canaã dos Carajás, southeast of Pará state. Small and medium-sized wild animals were captured using appropriate traps. A total of 15 animals were captured. Sera and viscera fragments were collected and tested by ELISA and PCR methods. The presence of M. leprae DNA was confirmed by sequencing of specific gyrase gene in three animals of two different species, including one Necromys lasiurus (liver sample) and two Proechimys roberti (kidney and liver samples). This unprecedented finding suggests that species other than those previously reported are responsible for maintaining M. leprae in nature.
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Affiliation(s)
- Maxwell Furtado de Lima
- Bacteriology and Mycology Section, Evandro Chagas Institute (IEC), Ananindeua 67030-000, PA, Brazil; (M.F.d.L.); (M.d.P.S.A.S.); (E.C.d.S.); (M.J.A.S.)
| | | | - Everaldina Cordeiro dos Santos
- Bacteriology and Mycology Section, Evandro Chagas Institute (IEC), Ananindeua 67030-000, PA, Brazil; (M.F.d.L.); (M.d.P.S.A.S.); (E.C.d.S.); (M.J.A.S.)
| | - Lívia Caricio Martins
- Arbovirology and Hemorrhagic Fevers Section, Evandro Chagas Institute (IEC), Ananindeua 67030-000, PA, Brazil;
| | | | | | - Marcos Jessé Abrahão Silva
- Bacteriology and Mycology Section, Evandro Chagas Institute (IEC), Ananindeua 67030-000, PA, Brazil; (M.F.d.L.); (M.d.P.S.A.S.); (E.C.d.S.); (M.J.A.S.)
| | - Luana Nepomuceno Gondim Costa Lima
- Bacteriology and Mycology Section, Evandro Chagas Institute (IEC), Ananindeua 67030-000, PA, Brazil; (M.F.d.L.); (M.d.P.S.A.S.); (E.C.d.S.); (M.J.A.S.)
- Correspondence: ; Tel.: +55-(91)-98379-3537
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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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Santos YLF, Yanai AM, Ramos CJP, Graça PMLA, Veiga JAP, Correia FWS, Fearnside PM. Amazon deforestation and urban expansion: Simulating future growth in the Manaus Metropolitan Region, Brazil. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2022; 304:114279. [PMID: 35021587 DOI: 10.1016/j.jenvman.2021.114279] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Yara L F Santos
- Postgraduate Program in Climate and the Environment, National Institute for Research in Amazonia (INPA), Av. André Araújo, 2936, CEP 69067-375, Manaus, Amazonas, Brazil; Postgraduate Program in Climate and the Environment, State University of Amazonas (UEA), Av. Darcy Vargas, 1200, CEP 69050-020, Manaus, Amazonas, Brazil.
| | - Aurora M Yanai
- Postgraduate Program in Climate and the Environment, National Institute for Research in Amazonia (INPA), Av. André Araújo, 2936, CEP 69067-375, Manaus, Amazonas, Brazil; Department of Environmental Dynamics, National Institute for Research in Amazonia (INPA), Av. André Araújo, 2936, CEP 69067-375, Manaus, Amazonas, Brazil.
| | - Camila J P Ramos
- Postgraduate program in Tropical Forest Science, National Institute for Research in Amazonia (INPA), Av. André Araújo, 2936, CEP 69067-375, Manaus, Amazonas, Brazil; Department of Environmental Dynamics, National Institute for Research in Amazonia (INPA), Av. André Araújo, 2936, CEP 69067-375, Manaus, Amazonas, Brazil.
| | - Paulo M L A Graça
- Department of Environmental Dynamics, National Institute for Research in Amazonia (INPA), Av. André Araújo, 2936, CEP 69067-375, Manaus, Amazonas, Brazil; Brazilian Research Network on Climate Change (RedeClima), Brazil.
| | - Jose A P Veiga
- Postgraduate Program in Climate and the Environment, State University of Amazonas (UEA), Av. Darcy Vargas, 1200, CEP 69050-020, Manaus, Amazonas, Brazil.
| | - Francis W S Correia
- Postgraduate Program in Climate and the Environment, State University of Amazonas (UEA), Av. Darcy Vargas, 1200, CEP 69050-020, Manaus, Amazonas, Brazil.
| | - Philip M Fearnside
- Department of Environmental Dynamics, National Institute for Research in Amazonia (INPA), Av. André Araújo, 2936, CEP 69067-375, Manaus, Amazonas, Brazil; Brazilian Research Network on Climate Change (RedeClima), Brazil.
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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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Bruce ATI, Berra TZ, Dos Santos FL, Alves YM, Souza LLL, Ramos ACV, Arroyo LH, de Almeida Crispim J, Pinto IC, Palha PF, Monroe AA, Yamamura M, Fiorati RC, Moncaio ACS, de Oliveira Gomes DM, Arcêncio RA. Temporal trends in areas at risk for concomitant tuberculosis in a hyperendemic municipality in the Amazon region of Brazil. Infect Dis Poverty 2020; 9:111. [PMID: 32778170 PMCID: PMC7418188 DOI: 10.1186/s40249-020-00732-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/29/2020] [Indexed: 01/19/2023] Open
Abstract
Background Although preventable and curable, tuberculosis (TB) still occurs in poor or developing countries, mainly in metropolitan regions of larger cities. The disease is a serious public health problem, and is directly linked to social issues. We analyzed temporal trend variations in areas at risk for concomitant TB, and characterized the clinical and epidemiological profiles of cases in a hyperendemic municipality in the Amazon region of Brazil. Methods This ecological study was performed in the municipality of Manaus, in northern Brazil. The population comprised cases with concomitant pulmonary and extrapulmonary TB, registered on the Notifiable Diseases Information System (SINAN), between January 1, 2009 and December 31, 2018. For risk cluster detection, spatial and spatiotemporal scanning statistical techniques were used. The Spatial Variation in Temporal Trends (SVTT) approach was used to detect and infer clusters for significantly different time trends. Results Between 2009 and 2018, 873 concomitant TB cases were registered in Manaus. By using purely spatial scanning statistics, we identified two risk clusters. The relative risk (RR) of the clusters was 2.21 (95% confidence interval [CI]: 1.57–2.88; P = 0.0031) and 2.03 (95% CI: 1.58–2.58; P = 0.0029). Using space-time scanning, we identified a risk cluster with an RR of 3.57 (95% CI: 2.84–4.41; P = 0.014), between 2017 and 2018. For SVTT analyses, three clusters with spatial variations were detected in the significant temporal trends: SVTT 1 (P = 0.042), SVTT 2 (P = 0.046) and SVTT 3 (P = 0.036). Conclusions In Brazil, several TB-determining factors such as race/color, gender, low educational level and low income overlap in needy urban areas and communities, demonstrating that it is unlikely to reach the goals, agreed and launched with the END TB Strategy within the deadlines of international agreements, if there is no reduction in existing inequities determinants and risk of illness in the country.
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Affiliation(s)
- Alexandre Tadashi Inomata Bruce
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil.
| | - Thais Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Felipe Lima Dos Santos
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Ludmilla Leidianne Limirio Souza
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Antônio Carlos Vieira Ramos
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Luiz Henrique Arroyo
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Juliane de Almeida Crispim
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Ione Carvalho Pinto
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Pedro Fredemir Palha
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Aline Aparecida Monroe
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Mellina Yamamura
- Department of Nursing, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Regina Célia Fiorati
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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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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Hot spots of leprosy in the endemic area of São Luís, Maranhão State, Northeastern Brazil. J Infect Public Health 2020; 13:228-234. [DOI: 10.1016/j.jiph.2019.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/22/2019] [Accepted: 08/19/2019] [Indexed: 11/20/2022] Open
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Souza CDFD, Magalhães MAFM, Luna CF. Hanseníase e carência social: definição de áreas prioritárias em estado endêmico do Nordeste brasileiro. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2020; 23:e200007. [PMID: 32130396 DOI: 10.1590/1980-549720200007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 01/09/2019] [Indexed: 11/21/2022] Open
Abstract
RESUMO: Introdução: A hanseníase é uma doença que guarda estreita relação com as condições sociais e econômicas. O Brasil é o único país que ainda não alcançou a meta de eliminação da doença como problema de saúde pública. Objetivo: Este trabalho teve como objetivo analisar a associação entre a carência social dos municípios baianos e a detecção de casos novos de hanseníase na população, como instrumento para a definição de áreas prioritárias para intervenção. Metodologia: Trata-se de um estudo ecológico realizado no estado da Bahia, no período de 2001 a 2015. Variáveis analisadas: coeficiente de detecção casos novos, índice de carência social (ICS) e hanseníase em menores de 15 anos. O ICS foi construído com base em quatro variáveis: índice de performance socioeconômica, renda per capita, proporção de extremamente pobres e densidade domiciliar. Na análise espacial, foram utilizadas modelagem bayesiana empírica local e estatística de Moran global e local. Na análise estatística, foram empregados regressão multivariada, espacial e logística, cálculo do odds ratio e análise de variância. Resultados: A hanseníase apresentou distribuição heterogênea no estado, com concentração no eixo norte-oeste e sul. Dos municípios, 60,4% (n = 252) apresentaram muito baixa condição de vida. Observou-se associação entre as condições de vida e a detecção da hanseníase, com maiores coeficientes no grupo de município com melhor condição de vida (p < 0,001). Conclusão: As piores condições atuaram como um impeditivo ao diagnóstico, ao mesmo tempo que ampliaram o risco de adoecimento. As boas condições possuem efeito inverso.
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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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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, Ferreira AF, Boigny RN, Alencar CH, Heukelbach J, Martins-Melo FR, Barbosa JC, Ramos AN. Leprosy and gender in Brazil: trends in an endemic area of the Northeast region, 2001-2014. Rev Saude Publica 2018; 52:20. [PMID: 29489990 PMCID: PMC5825128 DOI: 10.11606/s1518-8787.2018052000335] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/27/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze, stratifield by gender, trends of the new case leprosy detection rates in the general population and in children; of grade 2 disability, and of proportion of multibacillary cases, in the state of Bahia, Brazil from 2001 to 2014. METHODS A time series study based on leprosy data from the National Information System for Notifiable Diseases. The time trend analysis included Poisson regression models by infection points (Joinpoint) stratified by gender. RESULTS There was a total of 40,054 new leprosy cases with a downward trend of the overall detection rate (Average Annual Percent Change [AAPC = -0.4, 95%CI -2.8-1.9] and a non-significant increase in children under 15 years (AAPC = 0.2, 95%CI -3.9-4.5). The proportion of grade 2 disability among new cases increased significantly (AAPC = 4.0, 95%CI 1.3-6.8), as well as the proportion of multibacillary cases (AAPC = 2.2, 95%CI 0.1-4.3). Stratification by gender showed a downward trend of detection rates in females and no significant change in males; in females, there was a more pronounced upward trend of the proportion of multibacillary and grade 2 disability cases. CONCLUSIONS Leprosy is still highly endemic in the state of Bahia, with active transmission, late diagnosis, and a probable hidden endemic. There are different gender patterns, indicating the importance of early diagnosis and prompt treatment, specifically in males without neglecting the situation among females.
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Affiliation(s)
- Eliana Amorim de Souza
- Campus Anísio Teixeira, Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, BA, Brasil
| | - Anderson Fuentes Ferreira
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Reagan Nzundu Boigny
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 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
| | | | - Jaqueline Caracas Barbosa
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - Alberto Novaes Ramos
- Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
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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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Ramos ACV, Yamamura M, Arroyo LH, Popolin MP, Chiaravalloti Neto F, Palha PF, Uchoa SADC, Pieri FM, Pinto IC, Fiorati RC, de Queiroz AAR, Belchior ADS, dos Santos DT, Garcia MCDC, Crispim JDA, Alves LS, Berra TZ, Arcêncio RA. Spatial clustering and local risk of leprosy in São Paulo, Brazil. PLoS Negl Trop Dis 2017; 11:e0005381. [PMID: 28241038 PMCID: PMC5344525 DOI: 10.1371/journal.pntd.0005381] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/09/2017] [Accepted: 02/02/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. METHODS Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk-RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. RESULTS A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721-4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133-52.984) and 15.24 (95%CI = 10.114-22.919). CONCLUSION These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.
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Affiliation(s)
- Antônio Carlos Vieira Ramos
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Mellina Yamamura
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Luiz Henrique Arroyo
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Marcela Paschoal Popolin
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Francisco Chiaravalloti Neto
- Department of Epidemiology, School of Public Health of the University of São Paulo, São Paulo, São Paulo, Brazil
| | - Pedro Fredemir Palha
- Maternal-Infant Nursing and Public Health Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Ione Carvalho Pinto
- Maternal-Infant Nursing and Public Health Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Regina Célia Fiorati
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana Angélica Rêgo de Queiroz
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Aylana de Souza Belchior
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Danielle Talita dos Santos
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Maria Concebida da Cunha Garcia
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Juliane de Almeida Crispim
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Luana Seles Alves
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Thaís Zamboni Berra
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- Maternal-Infant Nursing and Public Health Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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Abstract
BACKGROUND Neglected tropical diseases (NTDs) are generally assumed to be concentrated in poor populations, but evidence on this remains scattered. We describe within-country socioeconomic inequalities in nine NTDs listed in the London Declaration for intensified control and/or elimination: lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminthiasis (STH), trachoma, Chagas' disease, human African trypanosomiasis (HAT), leprosy, and visceral leishmaniasis (VL). METHODOLOGY We conducted a systematic literature review, including publications between 2004-2013 found in Embase, Medline (OvidSP), Cochrane Central, Web of Science, Popline, Lilacs, and Scielo. We included publications in international peer-reviewed journals on studies concerning the top 20 countries in terms of the burden of the NTD under study. PRINCIPAL FINDINGS We identified 5,516 publications, of which 93 met the inclusion criteria. Of these, 59 papers reported substantial and statistically significant socioeconomic inequalities in NTD distribution, with higher odds of infection or disease among poor and less-educated people compared with better-off groups. The findings were mixed in 23 studies, and 11 studies showed no substantial or statistically significant inequality. Most information was available for STH, VL, schistosomiasis, and, to a lesser extent, for trachoma. For the other NTDs, evidence on their socioeconomic distribution was scarce. The magnitude of inequality varied, but often, the odds of infection or disease were twice as high among socioeconomically disadvantaged groups compared with better-off strata. Inequalities often took the form of a gradient, with higher odds of infection or disease each step down the socioeconomic hierarchy. Notwithstanding these inequalities, the prevalence of some NTDs was sometimes also high among better-off groups in some highly endemic areas. CONCLUSIONS While recent evidence on socioeconomic inequalities is scarce for most individual NTDs, for some, there is considerable evidence of substantially higher odds of infection or disease among socioeconomically disadvantaged groups. NTD control activities as proposed in the London Declaration, when set up in a way that they reach the most in need, will benefit the poorest populations in poor countries.
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Monteiro LD, Martins-Melo FR, Brito AL, Alencar CH, Heukelbach J. Spatial patterns of leprosy in a hyperendemic state in Northern Brazil, 2001-2012. Rev Saude Publica 2015; 49:S0034-89102015000100265. [PMID: 26603352 PMCID: PMC4650934 DOI: 10.1590/s0034-8910.2015049005866] [Citation(s) in RCA: 18] [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: 09/19/2014] [Accepted: 03/17/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe the spatial patterns of leprosy in the Brazilian state of Tocantins. METHODS This study was based on morbidity data obtained from the Sistema de Informações de Agravos de Notificação (SINAN - Brazilian Notifiable Diseases Information System), of the Ministry of Health. All new leprosy cases in individuals residing in the state of Tocantins, between 2001 and 2012, were included. In addition to the description of general disease indicators, a descriptive spatial analysis, empirical Bayesian analysis and spatial dependence analysis were performed by means of global and local Moran's indexes. RESULTS A total of 14,542 new cases were recorded during the period under study. Based on the annual case detection rate, 77.0% of the municipalities were classified as hyperendemic (> 40 cases/100,000 inhabitants). Regarding the annual case detection rate in < 15 years-olds, 65.4% of the municipalities were hyperendemic (10.0 to 19.9 cases/100,000 inhabitants); 26.6% had a detection rate of grade 2 disability cases between 5.0 and 9.9 cases/100,000 inhabitants. There was a geographical overlap of clusters of municipalities with high detection rates in hyperendemic areas. Clusters with high disease risk (global Moran's index: 0.51; p < 0.001), ongoing transmission (0.47; p < 0.001) and late diagnosis (0.44; p < 0.001) were identified mainly in the central-north and southwestern regions of Tocantins. CONCLUSIONS We identified high-risk clusters for transmission and late diagnosis of leprosy in the Brazilian state of Tocantins. Surveillance and control measures should be prioritized in these high-risk municipalities.
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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
| | - 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
| | - Aline Lima Brito
- Departamento de Saúde Comunitária. Faculdade de Medicina. Universidade Federal do Ceará. Fortaleza, 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
- Division of Tropical Health and Medicine.Anton Breinl Centre for Public Health and College of Public Health, Medical and Veterinary. James Cook University. Townsville, QLD, Australia
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Abstract
Um dos exercícios teóricos da Saúde Pública diz respeito à necessária e contínua tarefa de se discutirem os conceitos nos quais se ancoram suas práticas. Uma análise crítica sobre os usos do conceito de vulnerabilidade em saúde, com base em uma revisão sistemática, serve de suporte para uma discussão sobre seu conteúdo, alcances e limites, no sentido de fortalecer a potencialidade teórica e prática do conceito e o diálogo entre as distintas áreas de conhecimento implicadas. O conceito de vulnerabilidade apresenta alta capacidade heurística e aplicação diferenciada. Neste artigo, ele é caracterizado com base em complexos processos de fragilização biossocial que exprimem, de maneira inextrincável, valores biológicos, existenciais e sociais. Esta perspectiva considera vulnerabilidade como dimensão ontológica constitutiva e constituinte da vida humana, que reclama distintos e complexos sistemas de segurança.
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Freitas LRS, Duarte EC, Garcia LP. Leprosy in Brazil and its association with characteristics of municipalities: ecological study, 2009-2011. Trop Med Int Health 2014; 19:1216-25. [PMID: 25040160 DOI: 10.1111/tmi.12362] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyse the ecological association between the demographic and socio-economic characteristics of the Brazilian municipalities and average leprosy incidence rate in the period 2009-2011. METHODS An ecological study taking the Brazilian municipalities as its units of analysis. The local empirical Bayes estimation method was used to obtain smoothed incidence rates (SIR) for leprosy. The mean, median, first quartile (Q1) and third quartile (Q3) of the SIR were calculated per 100 000 inhabitants. Hierarchical log-linear negative binomial regression models were used to estimate the incidence rate ratios (IRR). RESULTS In the period 2009-2011, the average SIR of leprosy in Brazil was 20.2 per 100 000 inhabitants, and the median incidence rate among municipalities was 9.1 per 100 000 inhabitants. Significantly higher adjusted IRR were identified for large municipalities (IRR = 1.67) compared to small municipalities, as well as in municipalities with higher illiteracy rates (IRR = 2.15), more urbanised municipalities (IRR = 1.53), those with greater social inequality as per the Gini index (IRR = 1.26), high percentage of households with inadequate sanitation (IRR = 1.63), higher average number of people per room (IRR = 1.41), high proportions of Family Health Programme coverage (IRR = 1.29), high percentage of household contacts investigated (IRR = 2.30) and those with percentage of cases with grade 2 disability considered to be the medium (IRR = 1.26). CONCLUSIONS In this study, SIR was significantly associated with municipalities with low socio-economic status. Disease control activities need to be focused on these municipalities, and investments need to be made in improving the population's living conditions.
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Affiliation(s)
- Lúcia R S Freitas
- Programa de Pós-Graduação em Medicina Tropical, Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
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Medeiros MSD, Sacramento DS, Hurtado-Guerrero JC, Ortiz RA, Fenner ALD. Custo das doenças atribuíveis a fatores ambientais na cidade de Manaus, Amazonas, Brasil. CIENCIA & SAUDE COLETIVA 2014; 19:599-608. [DOI: 10.1590/1413-81232014192.23012012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/02/2013] [Indexed: 05/28/2023] Open
Abstract
O presente estudo estimou o custo das doenças atribuíveis a fatores ambientais na cidade de Manaus, entre os anos de 1998 a 2009. As causas de internação hospitalar foram agrupadas com base nos estudos de Carga Global de Doença e da Análise Comparativa de Risco da Organização Mundial da Saúde. O valor foi estimado por meio da soma dos (i) gastos hospitalares com tratamento das doenças atribuíveis a fatores ambientais com os (ii) valores dos dias de trabalho perdidos resultante da permanência em leito hospitalar, estimados a partir da remuneração média dos trabalhadores de Manaus. Os dados ainda foram calibrados levando-se em consideração a cobertura da população com plano de saúde privado. O custo das doenças, considerando os valores corrigidos pelo Índice Geral de Preços do Mercado para o ano de 2009, foi estimado em R$ 286.852.666,97, dos quais as doenças cardiovasculares, as infecções respiratórias das vias aéreas inferiores e as doenças diarreicas são responsáveis por 78,6%. Das frações atribuíveis a fatores ambientais, as doenças cardiovasculares respondem por 16% (IC: 7-23%), as infecções respiratórias das vias aéreas inferiores por 41% (IC: 32-47%), e as diarreias por 94% (IC: 84-98%) da carga global das doenças.
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Barreto JG, Bisanzio D, Guimarães LDS, Spencer JS, Vazquez-Prokopec GM, Kitron U, Salgado CG. Spatial analysis spotlighting early childhood leprosy transmission in a hyperendemic municipality of the Brazilian Amazon region. PLoS Negl Trop Dis 2014; 8:e2665. [PMID: 24516679 PMCID: PMC3916250 DOI: 10.1371/journal.pntd.0002665] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 12/12/2013] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND More than 200,000 new cases of leprosy were reported by 105 countries in 2011. The disease is a public health problem in Brazil, particularly within high-burden pockets in the Amazon region where leprosy is hyperendemic among children. METHODOLOGY We applied geographic information systems and spatial analysis to determine the spatio-temporal pattern of leprosy cases in a hyperendemic municipality of the Brazilian Amazon region (Castanhal). Moreover, we performed active surveillance to collect clinical, epidemiological and serological data of the household contacts of people affected by leprosy and school children in the general population. The occurrence of subclinical infection and overt disease among the evaluated individuals was correlated with the spatio-temporal pattern of leprosy. PRINCIPAL FINDINGS The pattern of leprosy cases showed significant spatio-temporal heterogeneity (p<0.01). Considering 499 mapped cases, we found spatial clusters of high and low detection rates and spatial autocorrelation of individual cases at fine spatio-temporal scales. The relative risk of contracting leprosy in one specific cluster with a high detection rate is almost four times the risk in the areas of low detection rate (RR = 3.86; 95% CI = 2.26-6.59; p<0.0001). Eight new cases were detected among 302 evaluated household contacts: two living in areas of clusters of high detection rate and six in hyperendemic census tracts. Of 188 examined students, 134 (71.3%) lived in hyperendemic areas, 120 (63.8%) were dwelling less than 100 meters of at least one reported leprosy case, 125 (66.5%) showed immunological evidence (positive anti-PGL-I IgM titer) of subclinical infection, and 9 (4.8%) were diagnosed with leprosy (8 within 200 meters of a case living in the same area). CONCLUSIONS/SIGNIFICANCE Spatial analysis provided a better understanding of the high rate of early childhood leprosy transmission in this region. These findings can be applied to guide leprosy control programs to target intervention to high risk areas.
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Affiliation(s)
- Josafá Gonçalves Barreto
- Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Marituba, Pará, Brasil
- Universidade Federal do Pará, Campus Castanhal, Pará, Brasil
| | - Donal Bisanzio
- Department of Environmental Studies, Emory University, Atlanta, Georgia, United States of America
| | - Layana de Souza Guimarães
- Unidade de Referência Especializada em Dermatologia Sanitária Dr. Marcello Candia, Marituba, Pará, Brasil
| | - John Stewart Spencer
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, United States of America
| | | | - Uriel Kitron
- Department of Environmental Studies, Emory University, Atlanta, Georgia, United States of America
| | - Claudio Guedes Salgado
- Laboratório de Dermato-Imunologia UEPA/UFPA/Marcello Candia, Marituba, Pará, Brasil
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brasil
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Sampaio PB, Madeira ES, Diniz L, Noia EL, Zandonade E. Spatial distribution of leprosy in areas of risk in Vitória, State of Espírito Santo, Brazil, 2005 to 2009. Rev Soc Bras Med Trop 2014; 46:329-34. [PMID: 23856871 DOI: 10.1590/0037-8682-0070-2012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/22/2013] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Leprosy remains a relevant public health issue in Brazil. The objective of this study was to analyze the spatial distribution of new cases of leprosy and to detect areas with higher risks of disease in the City of Vitória. METHODS The study was ecologically based on the spatial distribution of leprosy in the City of Vitória, State of Espírito Santo between 2005 and 2009. The data sources used came from the available records of the State Health Secretary of Espírito Santo. A global and local empirical Bayesian method was used in the spatial analysis to produce a leprosy risk estimation, and the fluctuation effect was smoothed from the detection coefficients. RESULTS The study used thematic maps to illustrate that leprosy is distributed heterogeneously between the neighborhoods and that it is possible to identify areas with high risk of disease. The Pearson correlation coefficient of 0.926 (p = 0.001) for the Local Method indicated highly correlated coefficients. The Moran index was calculated to evaluate correlations between the incidences of adjoining districts. CONCLUSIONS We identified the spatial contexts in which there were the highest incidence rates of leprosy in Vitória during the studied period. The results contribute to the knowledge of the spatial distribution of leprosy in the City of Vitória, which can help establish more cost-effective control strategies because they indicate specific regions and priority planning activities that can interfere with the transmission chain.
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Affiliation(s)
- Poliane Barbosa Sampaio
- Programa de Pós Graduação em Saúde Coletiva, Universidade Federal do Espírito Santo, Vitória, ES, Brazil.
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Schalcher TR, Borges RS, Coleman MD, Batista Júnior J, Salgado CG, Vieira JLF, Romão PRT, Oliveira FR, Monteiro MC. Clinical oxidative stress during leprosy multidrug therapy: impact of dapsone oxidation. PLoS One 2014; 9:e85712. [PMID: 24465659 PMCID: PMC3899049 DOI: 10.1371/journal.pone.0085712] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 11/29/2013] [Indexed: 12/17/2022] Open
Abstract
This study aims to assess the oxidative stress in leprosy patients under multidrug therapy (MDT; dapsone, clofazimine and rifampicin), evaluating the nitric oxide (NO) concentration, catalase (CAT) and superoxide dismutase (SOD) activities, glutathione (GSH) levels, total antioxidant capacity, lipid peroxidation, and methemoglobin formation. For this, we analyzed 23 leprosy patients and 20 healthy individuals from the Amazon region, Brazil, aged between 20 and 45 years. Blood sampling enabled the evaluation of leprosy patients prior to starting multidrug therapy (called MDT 0) and until the third month of multidrug therapy (MDT 3). With regard to dapsone (DDS) plasma levels, we showed that there was no statistical difference in drug plasma levels between multibacillary (0.518±0.029 µg/mL) and paucibacillary (0.662±0.123 µg/mL) patients. The methemoglobin levels and numbers of Heinz bodies were significantly enhanced after the third MDT-supervised dose, but this treatment did not significantly change the lipid peroxidation and NO levels in these leprosy patients. In addition, CAT activity was significantly reduced in MDT-treated leprosy patients, while GSH content was increased in these patients. However, SOD and Trolox equivalent antioxidant capacity levels were similar in patients with and without treatment. These data suggest that MDT can reduce the activity of some antioxidant enzyme and influence ROS accumulation, which may induce hematological changes, such as methemoglobinemia in patients with leprosy. We also explored some redox mechanisms associated with DDS and its main oxidative metabolite DDS-NHOH and we explored the possible binding of DDS to the active site of CYP2C19 with the aid of molecular modeling software.
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Affiliation(s)
- Taysa Ribeiro Schalcher
- Laboratório de Microbiologia e Imunologia Clínica/UFPA and Programa de Pós-graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Pará/UFPA, Rua Augusto Corrêa, Belém, Brasil
| | - Rosivaldo S. Borges
- Laboratório de Microbiologia e Imunologia Clínica/UFPA and Programa de Pós-graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Pará/UFPA, Rua Augusto Corrêa, Belém, Brasil
| | - Michael D. Coleman
- Mechanisms of Drug Toxicity Group, Department of Pharmaceutical Sciences, Aston University, Aston Triangle, Birmingham, United Kingdom
| | - João Batista Júnior
- Centro Universitário do Distrito Federal - UDF, SEP/SUL EQ 704/904 - CONJ A, Brasília/DF, Brasil
| | - Claudio G. Salgado
- Laboratório de Dermato-Imunologia UFPA/MC, Marituba, Pará, and Programa de Pós-graduação em Neurociências e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará/UFPA, Bairro Guamá, Belém, Brasil
| | - Jose Luiz F. Vieira
- Laboratório de Microbiologia e Imunologia Clínica/UFPA and Programa de Pós-graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Pará/UFPA, Rua Augusto Corrêa, Belém, Brasil
| | - Pedro R. T. Romão
- Programa de Pós-graduação em Ciências da Saúde. Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil
| | - Fabio R. Oliveira
- Laboratório de Microbiologia e Imunologia Clínica/UFPA and Programa de Pós-graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Pará/UFPA, Rua Augusto Corrêa, Belém, Brasil
| | - Marta Chagas Monteiro
- Laboratório de Microbiologia e Imunologia Clínica/UFPA and Programa de Pós-graduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Pará/UFPA, Rua Augusto Corrêa, Belém, Brasil
- * E-mail:
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Menezes VM, Nery JAC, Sales AM, Miranda A, Galhardo MCG, Bastos FI, Sarno EN, Hacker MA. Epidemiological and clinical patterns of 92 patients co-infected with HIV and Mycobacterium leprae from Rio de Janeiro State, Brazil. Trans R Soc Trop Med Hyg 2013; 108:63-70. [PMID: 24361943 DOI: 10.1093/trstmh/trt113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many articles have shown that HIV infection can modify the clinical course of leprosy, but very scant epidemiological and clinical data about this co-infection are available in the peer-reviewed literature. METHODS We herein describe the geographical distribution and demographic characteristics of 92 HIV/Mycobacterium leprae co-infected patients assisted in a Brazilian Leprosy referral center. A multivariate analysis was performed in order to establish clinical factors associated with type 1 reaction. RESULTS Co-infected patient admissions have steadily increased over the last years at this referral center. Most patients were men, with a mean age of 32.3 years and presenting with the paucibacillary form of leprosy. The use of antiretroviral therapy (ART) was the only factor associated with type 1 reaction. Most patients were living in the metropolitan area and the north sub area of Rio de Janeiro City. CONCLUSION Co-infected patients receiving ART have a greater chance to develop type 1 reaction. Patients living with both HIV and leprosy are likely to live in regions characterized by a high density impoverished population.
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Kinship and Leprosy in the Contacts of Leprosy Patients: Cohort at the Souza Araújo Outpatient Clinic, Rio de Janeiro, RJ, 1987-2010. J Trop Med 2013; 2013:596316. [PMID: 23690793 PMCID: PMC3649227 DOI: 10.1155/2013/596316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/21/2013] [Accepted: 03/21/2013] [Indexed: 11/18/2022] Open
Abstract
A broad variety of factors have been associated with leprosy among contacts, including socioeconomic, epidemiological, and genetic characteristics. Data from 7,174 contacts of leprosy patients from a leprosy outpatient clinic in Rio de Janeiro, Brazil, 1987–2010, were analyzed to investigate the effects of kinship, individual, and contextual factors on leprosy. Multivariate analyses were performed using a robust estimation method. In the prevalence analysis, close kinship (sibling OR = 2.75, offspring OR = 2.00, and other relatives OR = 1.70), socioeconomic factors, and the duration of exposure to the bacillus were associated to leprosy. In the incidence analysis, significant risks were found for all categories of kinship (parents RR = 10.93, spouse, boyfriend/girlfriend, and bride/groom RR = 7.53, sibling RR = 7.03, offspring RR = 5.34, and other relatives RR = 3.71). Once the treatment of the index case was initiated, other factors lost their significance, and the index case bacteriological index and BCG (Bacillus Calmette-Guérin vaccine) protection had a greater impact. Our findings suggested that both genetic susceptibility and physical exposure play an important role in the epidemiology of leprosy, but it was not possible establishing the role of genetic factor. Analyses of other factors related to the genotype of individuals, such as genetic polymorphisms, are needed.
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Sampaio PB, Rossi TL, Cerutti Junior C, Zandonade E. Spatial analysis of new cases of leprosy in the State of Espírito Santo, Brazil, between 2004 and 2009. Rev Soc Bras Med Trop 2012; 45:380-4. [PMID: 22760140 DOI: 10.1590/s0037-86822012000300019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 09/30/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Leprosy in Brazil is a public health issue, and there are many regions in the State of Espírito Santo with high endemic incidence levels of leprosy, characterizing this state as a priority for leprosy programs. The aim of this study was to determine the spatial distribution of coefficients of new cases of leprosy in the State of Espírito Santo, Brazil. METHODS We conducted a descriptive and ecologic study based on the spatial distribution of leprosy in the State of Espírito Santo between 2004 and 2009. Data were gathered from the available records of the Espírito Santo State Health Secretary. The global and local Bayesian empirical methods were used to produce an estimate of leprosy risk, smoothing the fluctuation effects of the detection coefficients. RESULTS The study resulted in a coefficient adjustment of new cases in 10 towns that changed their classification, among which, 2 went from low to medium, 4 from medium to high, 3 from high to very high, and 1 from very high to hyper-endemic. An average variation of 1.02, fluctuating between 0 and 12.39 cases/100,000 inhabitants, was found in a comparative calculation between the Local Ebest value and the average coefficient of new leprosy cases in the State of Espírito Santo. CONCLUSIONS The spatial analysis of leprosy favors the establishment of control strategies with a better cost-benefit relationship since it reveals specific and priority regions, thereby enabling the development of actions that can interfere in the transmission chain.
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Stephens C. Urban inequities; urban rights: a conceptual analysis and review of impacts on children, and policies to address them. J Urban Health 2012; 89:464-85. [PMID: 22371276 PMCID: PMC3368043 DOI: 10.1007/s11524-011-9655-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This paper explores current conceptual understanding of urban social, environmental, and health inequality and inequity, and looks at the impact of these processes on urban children and young people in the 21st century. This conceptual analysis was commissioned for a discussion paper for UNICEF's flagship publication: State of the World's Children 2012: Children in an Urban World. The aim of the paper is to examine evidence on the meaning of urban inequality and inequity for urban children and young people. It further looks at the controversial policies of targeting "vulnerable" young people, and policies to achieve the urban MDGs. Finally, the paper looks briefly at the potential of concepts such as environment justice and rights to change our understanding of urban inequality and inequity.
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Alencar CH, Ramos AN, dos Santos ES, Richter J, Heukelbach J. Clusters of leprosy transmission and of late diagnosis in a highly endemic area in Brazil: focus on different spatial analysis approaches. Trop Med Int Health 2012; 17:518-25. [PMID: 22248041 DOI: 10.1111/j.1365-3156.2011.02945.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Brazilian National Hansen's Disease Control Program recently identified clusters with high disease transmission. Herein, we present different spatial analytical approaches to define highly vulnerable areas in one of these clusters. METHOD The study area included 373 municipalities in the four Brazilian states Maranhão, Pará, Tocantins and Piauí. Spatial analysis was based on municipalities as the observation unit, considering the following disease indicators: (i) rate of new cases/100,000 population, (ii) rate of cases <15 years/100,000 population, (iii) new cases with grade-2 disability/100,000 population and (iv) proportion of new cases with grade-2 disabilities. We performed descriptive spatial analysis, local empirical Bayesian analysis and spatial scan statistic. RESULTS A total of 254 (68.0%) municipalities were classified as hyperendemic (mean annual detection rates >40 cases/100,000 inhabitants). There was a concentration of municipalities with higher detection rates in Pará and in the center of Maranhão. Spatial scan statistic identified 23 likely clusters of new leprosy case detection rates, most of them localized in these two states. These clusters included only 32% of the total population, but 55.4% of new leprosy cases. We also identified 16 significant clusters for the detection rate <15 years and 11 likely clusters of new cases with grade-2. Several clusters of new cases with grade-2/population overlap with those of new cases detection and detection of children <15 years of age. The proportion of new cases with grade-2 did not reveal any significant clusters. CONCLUSIONS Several municipality clusters for high leprosy transmission and late diagnosis were identified in an endemic area using different statistical approaches. Spatial scan statistic is adequate to validate and confirm high-risk leprosy areas for transmission and late diagnosis, identified using descriptive spatial analysis and using local empirical Bayesian method. National and State leprosy control programs urgently need to intensify control actions in these highly vulnerable municipalities.
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Affiliation(s)
- Carlos H Alencar
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
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