Characterization of cases and epidemiological and operational indicators of leprosy: analysis of time series and spatial distribution, Piauí state, Brazil, 2007-2021

OBJECTIVE

To analyze epidemiological characteristics, temporal trends and spatial distribution of leprosy cases and indicators in the state of Piauí, 2007-2021.

METHODS

This was an ecological time-series study using data from the Notifiable Health Conditions Information System, describing the spatial distribution and the temporal trend of leprosy using Prais-Winsten regression.

RESULTS

A total of 17,075 new cases of leprosy were reported. There was a falling trend in the overall detection rate [annual percentage change (APC) = -6.3; 95%CI -8.1;-4.5)], detection in children under 15 years of age (APC = -8,6; 95%CI -12,7;-4,3) and detection of cases with grade 2 physical disability (APC = -4,4; 95%CI -7,0;-1,8). There was a rising trend in the proportion of multibacillary cases. Spatial distribution of the average detection rate identified hyperendemic areas in the Carnaubais, Entre Rios, Vale dos Rios Piauí e Itaueiras regions.

CONCLUSION

High leprosy detection rates were found, despite the falling trend of indicators, except the proportion of multibacillary cases.

MAIN RESULTS

Between 2007 and 2021, Piauí showed an improving trend in all indicators analyzed, except the proportion of new multibacillary cases. Spatial distribution identified hyperendemic areas in different regions of the state.

IMPLICATIONS FOR SERVICES

This study provides health services with a broad overview of the epidemiological situation of leprosy in Piauí, with evidence of the populations and locations most affected by the disease, whereby public authorities need to reinforce the promotion of health actions.

PERSPECTIVES

It is expected that actions to prevent and control the disease will be adopted, such as offering early diagnosis, ensuring correct treatment and implementing measures to prevent physical disabilities.

Factors associated with delayed diagnosis of leprosy in an endemic area in Northeastern Brazil: a cross-sectional study

This study aimed to investigate the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy in an endemic area in the Northeastern Brazil. This is a cross-sectional study of 120 individuals with leprosy. Demographic and clinical data and information on the factors related to the individual and the health system that contribute to delayed diagnosis of leprosy were obtained. Delayed diagnosis in months was estimated for each participant by interviews. A multivariate Poisson's regression analysis was performed between the outcome and the independent variables. The median delay in the diagnosis of leprosy was 10.5 (4.0-24.0) months. Approximately 12.6% of participants had grade 2 disability (G2D) at the time of diagnosis. In the multivariate Poisson regression analysis, males, older age, low schooling level, residing in urban areas, multibacellar or tuberculoid leprosy, not seeking healthcare immediately after symptom onset, suspected leprosy, excessive referrals, and the need for three or more consultations to confirm the diagnosis were associated with longer diagnostic delay. This study found a significant delay in the diagnosis of leprosy in Arapiraca, Northeastern Brazil, which may explain the continuously high rate of G2D among new cases. Factors related to the individual and the health system were associated with longer diagnostic delay. Interventions to raise awareness of the disease among the general population and strengthen primary health care are urgently needed.

A cost-effectiveness analysis of a novel algorithm to sequentially diagnose leprosy based on manufactured tests under the SUS perspective

Brazil has the second largest number of leprosy cases (a disease with a significant burden) in the world. Despite global and local efforts to eliminate this public health problem, inadequate or late diagnosis contribute to perpetuate its transmission, especially among household contacts. Tests such as the rapid IgM antibody detection (RT) and real-time polymerase chain reaction (RT-PCR) were developed to overcome the challenges of early diagnosis of leprosy. This study aimed to analyze the cost-effectiveness of a new diagnostic algorithm recommended by the Brazilian government to diagnose leprosy in household contacts of confirmed leprosy cases, which includes the RT and RT-PCR tests. A decision tree model was constructed and the perspective of the Brazilian Unified National Health System (SUS) and a 1-year time horizon were adopted. Only direct medical costs related to diagnostic tests were included. Effectiveness was measured as the number of avoided undiagnosed leprosy cases. Different scenarios were analyzed. The sequential use of RT, slit-skin smear (SSS) microscopy, and RT-PCR as recommended by the Brazilian Ministry of Health was compared to a base case (isolated SSS microscopy), yielding an incremental cost-effectiveness ratio of USD 616.46 per avoided undiagnosed leprosy case. Univariate sensitivity analysis showed that the prevalence of leprosy among household contacts was the variable that influenced the model the most. This is the first economic model to analyze a diagnostic algorithm of leprosy. Results may aid managers to define policies and strategies to eradicate leprosy in Brazil.

Simulation-based training in Leprosy: development and validation of a scenario for community health workers

OBJECTIVES

To build and validate a clinical simulation scenario designed to instruct community health workers (CHWs) in active leprosy case detection.

METHODS

Methodological study involving the development of a simulated clinical scenario and content validation by experts. The Content Validity Index (CVI) was used to determine the level of agreement among the judging commitee, and a descriptive analysis of their recommendations was performed.

RESULTS

A simulated scenario with a simulated participant was developed - a simulation characterized by low complexity, moderate physical/environmental fidelity, moderate to high psychological fidelity, and high conceptual fidelity, lasting 50 minutes and capable of training up to 10 CHWs simultaneously. The scenario was validated by 14 experts, with a CVI exceeding 80% for all components.

CONCLUSIONS

The validated clinical simulation possesses attributes that make it highly reproducible in various national health contexts, thereby contributing to the global "Towards Zero Leprosy" strategy.

Clinical-epidemiological characteristics and temporal trend of new cases of grade 2 disability leprosy in the state of Maranhão, Brazil, 2011- 2020

MAIN RESULTS

Out of 2,147 grade 2 disability leprosy cases, the majority were male, of mixed race/skin color, multibacillary and borderline. The São Luís regional health unit showed a falling trend.

IMPLICATIONS FOR SERVICES

The results can guide strategies for the leprosy control program in the state, aiming at new approaches towards early diagnosis, treatment and prevention of disabilities.

PERSPECTIVES

Further studies are needed, such as spatial distribution of cases and detection rates of leprosy in children under 15 years of age, in order to gain a better understanding of the epidemiological profile of leprosy in Maranhão.

OBJECTIVE

to describe the clinical and epidemiological characteristics of new cases of grade 2 disability leprosy and to analyze its trend in the state of Maranhão, from 2011 to 2020.

METHODS

this was a descriptive cross-sectional and ecological time-series study, using data from the Notifiable Health Conditions Information System. A descriptive analysis of the event was carried out according to the sociodemographic and clinical-laboratory characteristics of the cases. The temporal trend of event incidence was analyzed using Prais-Winsten regression.

RESULTS

of the 2,147 cases, 71.5% were male, 48.9% had up to 8 years of schooling, 66.5% were of mixed race/color, 95.5% had the multibacillary form, 58.8% were borderline, 32.3% had negative bacilloscopy at diagnosis. There was a stationary trend in the state and a falling trend in the São Luís Health Region (annual percentage change = -64.4%; 95% confidence interval: -73.7;-51.9).

CONCLUSION

incidence trend was stable in the state of Maranhão and falling in São Luís.

Leprosy prevalence spatial distribution and trend in a health region in Northeast Brazil, 2008-2017: an ecological study

MAIN RESULTS

A total of 4,029 leprosy cases were notified. Mean prevalence varied between 2.0 and 11.5 cases/10,000 inhab. Spatial distribution of the cases was heterogeneous and there was a falling prevalence trend over the years studied.

IMPLICATIONS FOR SERVICES

These findings point to the need to strengthen active tracing strategies and expand health actions and services targeting leprosy, with the aim of increasing detection and early treatment of cases.

PERSPECTIVES

It is important to carry out epidemiological investigations on the spatial distribution and prevalence of leprosy in other health regions in the state, in order to identify other areas with greater vulnerability to leprosy.

OBJECTIVE

to analyse the spatial distribution and trend of leprosy in municipalities of a health region in a Northeast Brazilian state.

METHODS

this was an ecological time-series study based on compulsory notification of leprosy cases by the municipalities covered by the Imperatriz-MA Regional Health Management Unit, between 2008 and 2017; prevalence and mean prevalence for the period were calculated; spatial analysis of the area was carried out and maps were generated using ArcGis 10.5. Prais-Winsten regression was used for trend analysis.

RESULT

4,029 cases of the disease were identified, and average prevalence ranged from 2.0 to 11.5 cases/10,000 inhabitants-year. The overall trend was downward. Governador Edson Lobão had the highest prevalence, 11.5 cases/10,000 inhabitants, and Lajeado Novo had the lowest prevalence, 2.0 cases/10,000 inhabitants.

CONCLUSION

spatial distribution of leprosy cases was heterogeneous in the municipalities studied and prevalence had a falling trend.

Spatial patterns of new leprosy cases in a northeastern state of Brazil, 2011-2021

OBJECTIVE

To analyze the spatial patterns of leprosy in Pernambuco from 2011 to 2021.

METHODS

This is an ecological epidemiological study, carried out with data from the Notifiable Diseases Information System, based on new cases of leprosy among inhabitants of Pernambuco, between 2011-2021. An empirical Bayesian analysis of local and spatial dependence was performed with the global and local Moran indices.

RESULTS

25,008 new cases of leprosy were registered with an annual case detection rate in the general population of 16.51 cases/100,000 inhabitants - which is considered high. Among those younger than 15 years of age, there were 5.16 cases/100,000 inhabitants (high) and 0.89/100,000 inhabitants with degree II of physical disability (low); there were also many high-risk cases with an overall Moran index of 0.33 (p<0.001), active transmission (0.26; p<0.001), and subsequent diagnosis of the disease (0.12; p<0.006), as well as distribution in macro-region 1 and macro-region 4.

CONCLUSION

There was a heterogeneous spatial distribution in the state, showing two overviews, the first being the presence of municipalities with high risk of disease transmission and the second with clusters of silent municipalities, reinforcing the character of leprosy neglect as a major public health problem. This study brings reflections for leprosy control actions, due to the identification of priority areas to combat this disease in Pernambuco.

Clusters of risk for the occurrence of leprosy and disabilities in children under 15 years of age in Cuiabá: a geospatial study

OBJECTIVE

This study aimed to analyze the spatial distribution of leprosy and disabilities in children under 15 years of age in Cuiabá.

METHODS

Ecological study carried out in the city of Cuiabá, Mato Grosso, Brazil. The study population consisted of leprosy cases in children under 15 years old notified in the Notifiable Diseases Information System, between 2008 and 2018. Based on residential addresses, cases were georeferenced. In the analysis of the spatial distribution of the cases, the estimation of the Kernel density was used and, later, the statistics of spatial, spatio-temporal and Spatial Variation in Temporal Trends were applied.

RESULTS

514 cases of leprosy were reported in children under 15 years of age in Cuiabá, with a percentage of 10.1% of cases with degree of physical disability 1 and 2.3% with degree of physical disability 2 at the time of diagnosis. With the techniques of spatial and spatio-temporal scanning, clusters of risk for leprosy were identified in the North, West, East and South regions of Cuiabá, and with the technique of Spatial Variation in Temporal Trends, a cluster was identified in the West region of Cuiabá.

CONCLUSION

In Cuiabá, cases of leprosy in children under 15 years of age with disabilities were distributed throughout the urban area of the city, with the highest density of cases in the North and West regions, followed by the East region. The clusters with the highest Relative Risk were identified in the East and West regions, characterized by having low and medium income levels.