BackgroundLeprosy continues to be a public health problem in many countries. Difficulties faced by health services include late diagnosis, under-reporting of new cases, adequate monitoring of disabilities and treatment. Furthermore, systematic follow-up after completion of treatment is important, when new disabilities may occur, or existing disabilities may get worse. The objective of the present study was to determine the prevalence of leprosy-associated grade 2 disabilities (G2D) after completion of multidrug therapy (MDT) and to identify factors associated with G2D.MethodsWe performed a cross-sectional study of 222 leprosy cases registered in Vitória da Conquista, Bahia state, Brazil from 2001–2014. We performed a clinical examination of the study participants and collected socio-economic and clinical information by interview. We identified factors associated with grade 2 disability (G2D) using logis tic regression.ResultsIn total, 38 (17.1%) participants were diagnosed with G2D, and 106 (47.7%) with grade 1 disabilities (G1D). The following independent factors were significantly associated with G2D: occurrence of leprosy reaction (adjusted OR = 2.5; 95%CI = 1.09–5.77), thickening and/or tenderness of one or more nerve trunks (adjusted OR = 3.0; CI = 1.13–8.01) and unemployment (adjusted OR = 7.17; CI = 2.44–21.07).ConclusionsThis study shows that physical disabilities remain after completion of MDT and frequently occur in an endemic area in Brazil. Finding new ways to reduce the burden of disability are urgently needed, and may include systematic follow-up of patients after treatment completion combined with evidence-based preventative measures.

Objective To investigate the association between depression and mortality in the elderly living in low‐ and middle‐income countries. Methods A systematic review and meta‐analysis was performed. We searched in five electronic databases for observational studies investigating the association between mortality and depression. Two reviewers worked independently to select articles, extract data, and assess study quality. Results A total of 10 studies including 13 828 participants (2402 depressed and 11 426 nondepressed) from six countries (Brazil, four articles; China, two articles; Botswana, India, South Africa, and South Korea, one article) were included. The overall unadjusted relative risk (RR) of mortality in depressed relative to nondepressed participants was 1.62 (95% CI, 1.39‐1.88; P < 0.001), with high heterogeneity (I2 = 66%; 95% CI, 33‐83; P < 0.005). After adjustment for publication bias, the overall RR decreased to 1.60 (95% CI, 1.37‐1.86; P < 0.001). No significant differences were observed between subgroups except those defined by study quality. The high‐quality studies had a pooled RR of 1.48 (95% CI, 1.32‐1.67; P < 0.001), while the low‐quality studies resulted had a pooled RR of 1.82 (95% CI, 1.25‐2.65; P < 0.005). Conclusions Depression is associated with excess mortality in the elderly living in low‐ and middle‐income countries. In addition, this excess mortality does not differ substantially from that found in high‐income countries. This suggests environmental factors occurring in low‐ and middle‐income countries might not have a direct association with the excess mortality in the depressed elderly.

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