Social determinants of leprosy in a hyperendemic State in North Brazil

Abstract

OBJECTIVE To identify the socioeconomic, demographic, operational, and health service-related factors associated with the occurrence of leprosy in a hyperendemic State in North Brazil.METHODS This is an ecological study based on secondary data from the Sistema de Informações de Agravos de Notificação in municipalities of the State of Tocantins from 2001 to 2012. Units of analysis were the 139 municipalities of the State. Negative binomial log linear regression models were used to estimate incidence rate ratios.RESULTS In bivariate analysis, the incidence rate ratios were significantly higher for municipalities with higher income ratio of the poorest 20.0% (1.47; 95%CI 1.19–1.81) and better Municipal Human Development Index (1.53; 95%CI 1.14–2.06). In multivariate analysis, the incidence rate ratios were significantly higher in municipalities with higher proportion of immigrants (1.31; 95%CI 1.11–1.55) and higher proportion of households with waste collection (1.37; 95%CI 1.11–1.69). There was a significant reduction in the incidence rate ratio with increased coverage of the Bolsa Família Program (0.98; 95%CI 0.96–0.99).CONCLUSIONS Control programs need to focus on activities in municipalities of greater social vulnerability with intersectoral investment for the improvement of the living conditions of the population.

Spatial clustering, social vulnerability and risk of leprosy in an endemic area in Northeast Brazil: an ecological study

“…The 2006 decrease followed the lower prevalence reported from other regions in Brazil and is likely a reflection of the removal of long-standing cases by the elimination initiative. 18,21,22 Despite the elimination initiative, leprosy transmission and incidence have continued in the community, and other factors, such as living conditions and socio-economic factors, are likely to play a role in facilitating its persistence.…”

Hanseníase em menores de 15 anos no estado do Tocantins, Brasil, 2001-2012: padrão epidemiológico e tendência temporal

“…Recently, the diagnosis of the disease with campaigns was associated with late diagnosis in the Tocantins territory, demonstrating the importance of carrying out this strategy to search for suppressed demands, especially in extensive areas, focusing on high-risk groups and socioeconomically disadvantaged populations 8,16 . Active search is an important tool to control leprosy in hyperendemic areas.…”

“…Some studies described unequal patterns in the space-time trend of leprosy indicators for Tocantins, related to issues such as health service coverage, borders with hyperendemic states, migration, social vulnerability of the disease, and urbanization 3,[6][7][8]27 . One of these studies identified spatial patterns to detect cases in children under 15 years of age using local empirical Bayesian analysis, which classified more than 90% of the cities of Tocantins as hyperendemic 4 .…”

“…This scenario shows the magnitude and strength of leprosy transmission in Tocantins. Some studies have contributed to improving the understanding of the epidemiology of leprosy in that territory [6][7][8] . A recent study revealed that the raw detection coefficient in children under 15 years of age was hyperendemic (10.0 to 19.9 cases/100 thousand inhabitants) in 65.4% (91/139) of the cities of Tocantins.…”

Áreas de risco para a ocorrência de hanseníase e sua relação com os determinantes sociais em município da região de fronteira Brasil, Paraguai e Argentina

“…Outro aspecto relacionado a baixas condições socioeconômicas é o acesso a alimentação adequada, pois a baixa nutrição está relacionada ao risco aumentado para a hanseníase (PATIL, 2013;FEENSTRA et al, 2011). Monteiro et al (2017) fazem uma relação importante entre a incidência da hanseníase e a cobertura do Programa Bolsa Família (PBF), pois demonstram que a razão das taxas de incidência da doença foram superiores em municípios com menor percentual da população com cobertura pelo PBF pois, ao considerar a renda per capita de até meio salário por domicílio (condição mínima para o recebimento do benefício), apresentou um risco menor. Todavia tal resultado não foi observado no cenário de de Foz do Iguaçu pois os resultados demonstraram que conforme diminui a renda, o risco para hanseníase aumenta.…”