Spatial clustering and local risk of leprosy in São Paulo, Brazil

Autor: Ricardo Alexandre Arcêncio, Mellina Yamamura, Pedro Fredemir Palha, Juliane de Almeida Crispim, Thaís Zamboni Berra, Antônio Carlos Vieira Ramos, Luana Seles Alves, Marcela Paschoal Popolin, Aylana de Souza Belchior, Severina Alice da Costa Uchôa, Maria Concebida da Cunha Garcia, Danielle Talita dos Santos, Flávia Meneguetti Pieri, Francisco Chiaravalloti Neto, Luiz Henrique Arroyo, Ana Angélica Rêgo de Queiroz, Ione Carvalho Pinto, Regina Célia Fiorati
Rok vydání: 2017
Předmět:
Bacterial Diseases
Male
Geographical locations
0302 clinical medicine
Geoinformatics
Medicine and Health Sciences
Cluster Analysis
Public and Occupational Health
Health Systems Strengthening
Child
Statistic
Aged
80 and over
Lepromatous leprosy
education.field_of_study
Geography
lcsh:Public aspects of medicine
Middle Aged
Socioeconomic Aspects of Health
Infectious Diseases
Research Design
Child
Preschool
Female
Topography
Medical
Leprosy
0305 other medical science
Brazil
Research Article
Neglected Tropical Diseases
Adult
Census
Computer and Information Sciences
lcsh:Arctic medicine. Tropical medicine
Adolescent
lcsh:RC955-962
Scan statistic
Disabilities
030231 tropical medicine
Population
Research and Analysis Methods
Risk Assessment
03 medical and health sciences
Young Adult
medicine
Humans
education
Aged
Spatial Analysis
030505 public health
Borderline leprosy
Survey Research
Health Care Policy
Public Health
Environmental and Occupational Health
Infant
lcsh:RA1-1270
South America
medicine.disease
Tropical Diseases
Confidence interval
Health Care
Spatial clustering
Earth Sciences
HANSENÍASE
People and places
Demography
Zdroj: Repositório Institucional da USP (Biblioteca Digital da Produção Intelectual)
Universidade de São Paulo (USP)
instacron:USP
PLoS Neglected Tropical Diseases
PLoS Neglected Tropical Diseases, Vol 11, Iss 2, p e0005381 (2017)
Popis: 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.
Author summary Brazil has still not achieved the goal of leprosy elimination established by the World Health Organization. The diagnosis and treatment of leprosy are available and the country is striving to fully integrate leprosy services into the existing general health services. Access to information, diagnosis and treatment with multidrug therapy (MDT) remain key elements in the strategy to eliminate the disease as a public health problem, defined as reaching a prevalence of less than 1 leprosy case per 10,000 inhabitants. Thus, this study aimed to identify spatial clustering of leprosy and to classify high-risk areas in a major leprosy cluster. A total of 434 cases were identified, with 188 (43.31%) being of borderline leprosy and 101 (23.28%) lepromatous leprosy. 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. These results can assist health services and policy makers to improve the health conditions of the Brazilian population, advancing towards the goal of elimination in Brazil.
Databáze: OpenAIRE
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