Geospatial epidemiology of leprosy in northwest Bangladesh: a 20-year retrospective observational study
Autor: | Bob Bowers, Caroline A. Bulstra, Jan Hendrik Richardus, David J. Blok, Sake J. de Vlas, Khorshed Alam, Peter G. Nicholls, Johan Chandra Roy, C. Ruth Butlin |
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Přispěvatelé: | Public Health |
Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Risk
medicine.medical_specialty Epidemiology Population lcsh:Infectious and parasitic diseases symbols.namesake SDG 3 - Good Health and Well-being Leprosy medicine Humans lcsh:RC109-216 Poisson regression Child education Neglected tropical diseases Retrospective Studies Bangladesh education.field_of_study Patient characteristics Incidence Incidence (epidemiology) lcsh:Public aspects of medicine Public Health Environmental and Occupational Health Geospatial lcsh:RA1-1270 General Medicine medicine.disease Infectious Diseases Geography Relative risk Epidemiology of leprosy symbols Hotspots Research Article Demography |
Zdroj: | Infectious Diseases of Poverty, Vol 10, Iss 1, Pp 1-12 (2021) Infectious Diseases of Poverty Infectious Diseases of Poverty, 10(1):36. BioMed Central Ltd. |
ISSN: | 2049-9957 |
Popis: | Background Leprosy is known to be unevenly distributed between and within countries. High risk areas or ‘hotspots’ are potential targets for preventive interventions, but the underlying epidemiologic mechanisms that enable hotspots to emerge, are not yet fully understood. In this study, we identified and characterized leprosy hotspots in Bangladesh, a country with one of the highest leprosy endemicity levels globally. Methods We used data from four high-endemic districts in northwest Bangladesh including 20 623 registered cases between January 2000 and April 2019 (among ~ 7 million population). Incidences per union (smallest administrative unit) were calculated using geospatial population density estimates. A geospatial Poisson model was used to detect incidence hotspots over three (overlapping) 10-year timeframes: 2000–2009, 2005–2014 and 2010–2019. Ordinal regression models were used to assess whether patient characteristics were significantly different for cases outside hotspots, as compared to cases within weak (i.e., relative risk (RR) of one to two), medium (i.e., RR of two to three), and strong (i.e., RR higher than three) hotspots. Results New case detection rates dropped from 44/100 000 in 2000 to 10/100 000 in 2019. Statistically significant hotspots were identified during all timeframes and were often located at areas with high population densities. The RR for leprosy was up to 12 times higher for inhabitants of hotspots than for people living outside hotspots. Within strong hotspots (1930 cases among less than 1% of the population), significantly more child cases (i.e., below 15 years of age) were detected, indicating recent transmission. Cases in hotspots were not significantly more likely to be detected actively. Conclusions Leprosy showed a heterogeneous distribution with clear hotspots in northwest Bangladesh throughout a 20-year period of decreasing incidence. Findings confirm that leprosy hotspots represent areas of higher transmission activity and are not solely the result of active case finding strategies. |
Databáze: | OpenAIRE |
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