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 |
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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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