[Mortality from leprosy in highly endemic contexts: integrated temporal-spatial analysis in BrazilMortalidad por lepra en zonas de alta endemicidad: análisis espacio-temporal integrado en Brasil]

Qualidade de vida e condição clínica de indivíduos com hanseníase

Objetivo: Analisar a qualidade de vida dos indivíduos com hanseníase em tratamento na rede de Atenção Básica e Especializada de saúde e sua comparação de acordo com as condições clínicas dos pacientes. Método: Estudo transversal, de caráter analítico, realizado na Atenção Básica e Especializada de saúde em João Pessoa, Paraíba, Brasil. A amostra foi coletada entre os meses de janeiro a março de 2017, sendo composta por 96 indivíduos em tratamento para doença, na faixa etária acima de 18 anos de idade. As informações foram coletadas utilizando-se formulário semiestruturado contendo variáveis sociodemográficas e clínicas, e o instrumento validado World Health Organization Quality of life Assessment bref. Os dados foram analisados com base nas técnicas de análise descritiva e aplicado os testes de Normalidade (Kolmogorov-Smirnov), Levene, t paramétrico e ANOVA (teste post hoc tukey). Resultados: O escore geral para qualidade de vida entre os 96 participantes da pesquisa manteve-se intermediário (x¯=57,04) sendo o domínio físico mais afetado negativamente (x¯=54,09). Concernente as questões contidas nos domínios, "Recreação e lazer" (x¯=31,41), "Sentimentos negativos" (x¯=35,16), "Recursos Financeiros" (x¯=35,68) e "Dor e desconforto" (x¯=35,68) apresentaram menor escore médio. Pacientes com condições clínicas "osteoporose e artrose" (p = 0,011) e "neurite atual" (p = 0,001) obtiveram qualidade de vida em nível intermediário. Conclusão: Evidenciou-se que pessoas com hanseníase tem qualidade de vida em nível intermediário, principalmente quando associado a neurite e comorbidades, o que ressalva a necessidade de acompanhamento contínuo dos participantes da pesquisa.

Mortalidade por doenças tropicais negligenciadas no Piauí, Nordeste do Brasil: tendência temporal e padrões espaciais, 2001-2018

Resumo Objetivo Analisar tendência temporal e padrões espaciais da mortalidade por doenças tropicais negligenciadas (DTNs) no Piauí, Brasil, 2001-2018. Métodos Estudo ecológico misto, com cálculo de razão de risco (RR), análise de tendência espaço-temporal, regressão de Poisson com pontos de inflexão, utilizando-se dados do Sistema de Informações sobre Mortalidade. Resultados Verificaram-se 2.609 óbitos por DTNs no período (4,60/100 mil habitantes), 55,2% por doença de Chagas. Houve maior risco de morte no sexo masculino (RR=1,76; IC95% 1,25;2,46), idade ≥60 anos (RR=40,71; IC95% 10,01;165,53), municípios com vulnerabilidade social média (RR=1,76; IC95% 1,09;2,84), menor porte populacional (RR=1,99; IC95% 1,28;3,10) e macrorregião dos Cerrados (RR=4,51; IC95% 2,51;8,11). Verificou-se tendência de aumento nas taxas de mortalidade em 2001-2008 e redução em 2009-2018. Conclusão A mortalidade por DTNs no Piauí persiste elevada, particularmente por doença de Chagas, entre grupos de maior vulnerabilidade, concentrando-se as maiores taxas no sudoeste da macrorregião do Semiárido, nordeste e sul dos Cerrados.

High schistosomiasis-related mortality in Northeast Brazil: trends and spatial patterns

Background:

We analyzed the trends and spatial patterns of schistosomiasis-related mortality in Northeast Brazil in 2000-2019.

Methods:

A mixed population-based ecological study was conducted, using information on the underlying or associated causes of death. We used Joinpoint regression analysis to calculate the trends. The spatial analysis included rates, spatial moving averages, and standardized mortality rates. The spatial dependence analysis was based on Getis-Ord's G and Gi* indices (Gi star) and local Moran’s index to check for autocorrelation.

Results:

A total of 5,814,268 deaths were recorded, of which 9,276 (0.16%) were schistosomiasis-related; 51.0% (n=4,732, adjusted rate 0.90/100,000 inhabitants [95% confidence interval (CI) 0.88-0.93]) were males; 40.0% (n=3,715, adjusted rate 7.40/100.000 inhabitants [95%CI: 7.16-7.64]) were ≥70 years old; 54.8% (n=5,087, crude rate 0.80/100,000 inhabitants) were of mixed/Pardo-Brazilian ethnicity; and 77.9% (n=7,229, adjusted rate 0.86/100,000 inhabitants [95%CI: 0.84-0.88]) lived outside state capitals. The highest proportion of deaths was in the state of Pernambuco (53.9%, n=4,996, adjusted rate 2.72/100,000 inhabitants [95%CI: 2.64-2.79]). Increasing mortality rate was verified in the state of Sergipe. On the coast of the state of Rio Grande do Norte and Bahia, there was spatial dependence of spatio-temporal risk patterns with clusters. Throughout the study period, we found positive spatial autocorrelation and cluster formation.

Conclusions:

In Northeast Brazil, schistosomiasis persists with a high mortality rate, especially in the coastal region, with heterogeneous spatial and temporal patterns. To eliminate schistosomiasis by 2030, it is necessary to strengthen the financing and management of the unified health system (SUS).

COVID-19 and the incidence of neglected tropical diseases: reflections from pandemic times

not applicable

[Leprosy-related mortality in the State of Piauí, Brazil: time trends and spatial patterns, 2000-2015]

The study aimed to analyze spatial patterns and time trends in leprosy-related mortality in the State of Piauí, Brazil, from 2000 to 2015. This was a mixed ecological study with a spatial and temporal state-based approach, using data from the Brazilian Mortality Information System. The analysis includes epidemiological characteristics, mortality trends by Joinpoint regression, and spatial analysis, using the state's 224 municipalities (counties) as the geographic unit. Of the 245,413 deaths identified, leprosy was identified in 234 death certificates, 135 (41.7%) as the underlying cause of death and 189 (58.3%) as an associated cause of death. The highest leprosy-related mortality rates were associated with male gender (relative risk - RR = 2.38; 95%CI: 1.87; 3.03), elderly age (RR = 10.52; 95%CI: 7.16; 15.46), brown skin color (RR = 2.22; 95%CI: 1.47; 3.35), and residents of the state's interior (RR = 5.72; 95%CI: 4.54; 7.21). The crude leprosy-related mortality rate showed a significant increase among the elderly (70 years), brown race/color, cities with fewer than 20,000 inhabitants, and the Central region of the state, but not significant for the State of Piauí as a whole. The spatial distribution by age-adjusted mortality was heterogeneous in the municipalities, concentrating high mortality rates in the northern region of the state, close to the coastline. There was a pattern of increasing smoothed mortality rates over the course of the study's four-year periods in the Mid-northern Central and Semiarid regions. Leprosy mortality was spatially heterogeneous and growing over the years. The findings highlight the importance of enhancing integrated surveillance and healthcare activities.

Temporal trend of leprosy among the elderly in Brazil, 2001 - 2018

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.