OBJECTIVETo analyze the effects of maternal pre-pregnancy body mass index and weight gain during pregnancy on the baby's birth weight.METHODSWe conducted a cross-sectional study with 5,024 mothers and their newborns using a Brazilian birth cohort study. In the proposed model, estimated by structural equation modeling, we tested socioeconomic status, age, marital status, pre-pregnancy body mass index, smoking habit and alcohol consumption during pregnancy, hypertension and gestational diabetes, gestational weight gain, and type of delivery as determinants of the baby's birth weight.RESULTSFor a gain of 4 kg/m2 (1 Standard Deviation [SD]) in pre-pregnancy body mass index, there was a 0.126 SD increase in birth weight, corresponding to 68 grams (p < 0.001). A 6 kg increase (1 SD) in gestational weight gain represented a 0.280 SD increase in newborn weight, correponding to 151.2 grams (p < 0.001). The positive effect of pre-pregnancy body mass index on birth weight was direct (standardized coefficient [SC] = 0.202; p < 0.001), but the negative indirect effect was small (SC = -0.076, p < 0.001) and partially mediated by the lower weight gain during pregnancy (SC = -0.070, p < 0.001). The positive effect of weight gain during pregnany on birth weight was predominantly direct (SC = 0.269, p < 0.001), with a small indirect effect of cesarean delivery (SC = 0.011; p < 0.001). Women with a higher pre-pregnancy body mass index gained less weight during pregnancy (p < 0.001).CONCLUSIONSThe effect of gestational weight gain on the increase in birth weight was greater than that of pre-pregnancy body mass index.

Background. Leprosy is an infectious disease that can lead to physical disabilities and stigmatization. It remains an important public health problem, especially in Brazil. Objective. To analyse sociodemographic and clinical factors associated with multibacillary leprosy in a hyperendemic region of the disease in northeastern Brazil. Method. This is a retrospective observational study with secondary data acquired from 2012 to 2015, from a group of leprosy cases reported in a reference outpatient clinic for the treatment and followup of leprosy in the city of Imperatriz, Maranhao, in northeastern Brazil. Results. From 905 new cases of leprosy studied, 656 (72.5%) were classified as multibacillary leprosy and 249 (27.5%) as paucibacillary leprosy. We observed that men were more likely to present 5 to 15 skin lesions (OR: 1.32; 95% CI: 1.18-1.49; p <0.0001) and >15 skin lesions (OR: 1.26; 95% CI: 1.09 -1.45; p = 0.005) and a lower chance of having <5 skin lesions (OR: 0.67; 95% CI: 0.59-0.76; p <0.0001). Women were more likely to have no affected nerves compared to men (OR: 1.46; 95% CI: 1.20-1.77; p <0.0001). The age range of 16 to 60 years showed a greater chance of having <5 skin lesions (OR: 1.01; 95% CI: 1.007-1.20; p = 0.03) and a lower chance of having 5 to 15 skin lesions (OR: 1.12, 95% CI: 1.03-1.23; p= 0.008) and a lower chance of being a grade I disability ( CI= 0.73-0.94; p=0.83) and II (OR: 0.82; 95% CI: 0.77-0.98; p=000.1). Conclusion. Cases of multibacillary leprosy were associated with male gender, low educational level, and clinical variables such as number of skin lesions and grade I or II disability.

Introduction: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. Methods: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chisquare test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. Results: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. Conclusions: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

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Introduction: The Integrated Program of Leprosy Control was initiated in 2003 in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy. Here, we present the evolution of the indicators of leprosy within the established period in children aged <15 years. Methods: This is a descriptive study based on an active search for cases and spontaneous healthcare demand for leprosy, with an evolutionary analysis of the detection coefficient of new cases. We considered individuals aged <15 years diagnosed with leprosy from January 2003 to December 2015. To evaluate the factors associated with clinical and operational forms, Chi-square, Fisher's exact, or Fisher-Freeman-Halton tests were performed. Results: A total of 61 new cases were detected (6.9% of the total leprosy cases diagnosed in the municipality during the study period), and the majority was found in males (62.3%). The most frequent operational classification was paucibacillary (67.2%), and this association increased with age. The tuberculoid clinical form was the most prevalent in both sexes and in the age range of 10 to <15 years. There was a reduction in the detection coefficient from 21.84/100,000 inhabitants in 2003 to 2.79/100,000 in 2015. Conclusions: Despite the progress in the control of leprosy, this historical series shows that it is necessary to strengthen educational measures and implement control actions, so that the disease ceases to be a public health problem in the population aged <15 years.