Epidemiology and Spatiotemporal Patterns of Leprosy Detection in the State of Bahia, Brazilian Northeast Region, 2001–2014

Abstract

The detection of leprosy cases is distributed unequally in Brazil, with high-risk clusters mainly in the North and Northeast regions. Knowledge on epidemiology and spatiotemporal patterns of leprosy occurrence and late diagnosis in these areas is critical to improve control measures. We performed a study including all leprosy cases notified in the 417 municipalities of Bahia state, from 2001 to 2014. New case detection (overall and pediatric <15 years) and grade 2 disability (G2D) rates were calculated and stratified according to socio-demographic variables. Spatial analyses were performed to detect high-risk areas for occurrence and late diagnosis. A total of 40,060 new leprosy cases was reported in the period (mean = 2861 cases/year), 3296 (8.2%) in <15-year-olds, and 1921 (4.8%) with G2D. The new case detection rate was 20.41 cases/100,000 inhabitants (95% CI: 19.68–21.17). A higher risk was identified in older age groups (RR = 8.45, 95% CI: 7.08–10.09) and in residents living in the state capital (RR = 5.30, 95% CI: 4.13–6.79), in medium-sized cities (RR = 2.80; 95% CI: 2.50–3.13), and in the west (RR = 6.56, 95% CI: 5.13–8.39) and far south regions of the state (RR = 6.56, 95% CI: 5.13–8.39). A higher risk of G2D was associated with male gender (RR = 2.43, 95% CI: 2.20–2.67), older age (RR = 44.08, 95% CI: 33.21–58.51), Afro-Brazilian ethnicity (RR = 1.59; 95% CI: 1.37–1.85), living in medium-sized cities (RR = 2.60; 95% CI: 2.27–2.96) and residency in the north (RR = 5.02; 95% CI: 3.74–6.73) and far south (RR = 7.46; 95% CI: 5.58–9.98) regions. Heterogeneous space–time patterns of leprosy distribution were identified, indicating high endemicity, recent transmission, and late diagnosis. This heterogeneous distribution of the disease was observed throughout the study period. Leprosy remains a relevant public health problem in Bahia state. The disease has a focal distribution. We reinforce the importance of integrating surveillance, prevention and control actions in regions of higher risk of leprosy detection and late diagnosis, and in the most vulnerable populations.

Perfil epidemiológico da hanseníase em um estado brasileiro

“…Porém, devido a problemas operacionais do SUS, ainda existem falhas na abrangência e na qualidade das ações de controle e prevenção. (AMORIM et al, 2018).…”

Spatial analysis of the epidemiological risk of leprosy in the municipalities of Minas Gerais

“…It is known that municipalities with very high rates are usually neighbors with others with high or intermediate rates. Thus, intensive monitoring is crucial to institute more effective measures to control the disease [ 36 ].…”

Fatores associados à limitação de atividade em casos novos de hanseníase em município hiperendêmico do Nordeste, Brasil

“…[35][36][37][38][39][40] Estudos realizados no próprio estado da Bahia mostraram que a manutenção da transmissão pode estar associada a: densidade domiciliar, proporção de extremamente pobres, renda per capita, desigualdade de renda e nível de ocupação. 41,42 Por outro lado, em áreas endêmicas, é possível que as melhorias sociais gerais resultem, pelo menos em um primeiro momento, em aumento do número de diagnósticos, já que diminui a prevalência oculta. 42 Impactos benéficos das políticas de transferência de renda, a exemplo do programa bolsa família e da expansão da rede de saúde, têm sido destacados como importantes mecanismos capazes de aumentar a adesão à poliquimioterapia e cura da hanseníase em casos multibacilares, além de interromper a transmissão da doença.…”