Social inequalities and their association with the leprosy burden in a Brazilian city of low endemicity: An ecological study

Ramos, Antônio Carlos Vieira; Alonso, Jonas Bodini; Berra, Thaís Zamboni; Alves, Luana Seles; Júnior, José Francisco Martoreli; Santos, Felipe Lima dos; Alves, Yan Mathias; Andrade, Hosana Aguiar Freitas de; Costa, Fernanda Bruzadelli Paulino da; Crispim, Juliane de Almeida; Yamamura, Mellina; Alves, Josilene Dália; Neto, Marcelino Santos; Fuentealba-Torres, Miguel; Pinto, Ione Carvalho; Arcêncio, Ricardo Alexandre

doi:10.1016/j.actatropica.2021.105884

Cited by 4 publications

(4 citation statements)

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“…The highest rates of new cases of leprosy with G2D were concentrated among adult males with black skin, low levels of education, and living in the northern and central-western regions of Brazil. National and international studies show a higher prevalence of the disease among men with lower levels of education, which may re ect social and economic inequalities, especially in neglected populations [32][33][34][35][36][37][38][39]. In general, men are more vulnerable to the disease and its more severe forms, often due to behaviours that make it di cult for them to seek appropriate health care, combined with a lack of specialized services to meet their speci c needs [32,40].…”

Section: Discussionmentioning

confidence: 99%

Time trend and identification of risk areas for physical disability due to leprosy in Brazil: An ecological study, 2001-2022

Matos,

Souza,

Fernandes

et al. 2024

Preprint

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BACKGROUND Leprosy is a chronic infectious disease that affects the peripheral nerves, leading to neurological damage and physical disability. This study analysed the temporal trend in the rate of new leprosy cases with grade 2 physical disability in Brazil and identified spatial clusters of risk for physical disability. METHODS This is an ecological study of all new cases of leprosy with grade 2 physical disability (G2D) at diagnosis between 2001 and 2022 in Brazil, macro-regions, states and municipalities. Data were extracted from the National System of Notifiable Diseases and the Brazilian Institute of Geography and Statistics. Sociodemographic and clinical variables such as age, sex, race/colour, education and clinical form of the disease were analysed, as well as the rate of new cases of leprosy with grade 2 physical disability at the time of diagnosis per million inhabitants. Data analysis was divided into three stages: 1- Descriptive analysis of the socio-demographic and clinical profile; 2- Time series analysis: In this stage, the joint-point regression model was used; 3- Spatial analysis, using global and local Moran statistics. RESULTS There were 50,466 new cases of leprosy with G2D during the period studied, 97.4% aged > 14 years, 70.2% male, 45.7% brown, 87.6% with low education, 90.2% multibacillary and 47.5% dimorphic clinical form. There was a downward trend in the detection of leprosy with physical disability grade 2, with an average annual reduction of 2.8% (13.6/1 million in 2001 and 9.1/1 million in 2022). The southeast, south and north regions showed a downward trend. A total of 14 states and 4 capitals showed a decrease in the rate, the most significant being Roraima (-11.0%/year). Tocantins was the only state with an upward trend (3.2%/year). 635 (14.1%) municipalities were in the high-high quadrant. These municipalities belong to 12 Brazilian states and accounted for 30% (n = 15,139) of all cases recorded in the country over the 22 years analysed. CONCLUSIONS These results suggest an overall decrease in the detection of leprosy with physical disability in Brazil and highlight geographical disparities in the occurrence of leprosy disability. Interventions to promote early diagnosis should be targeted at areas with the highest rate of new cases with grade 2 disability.

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Section: Discussionmentioning

confidence: 99%

Time trend and identification of risk areas for physical disability due to leprosy in Brazil: An ecological study, 2001-2022

Matos,

Souza,

Fernandes

et al. 2024

Preprint

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“…The presence of G2D at the time of diagnosis indirectly indicates delayed detection, due perhaps to poor awareness in the community about the early signs of leprosy and the importance of seeking treatment, (World Health Organization (WHO), 2020). The distribution and spread of endemic leprosy are closely related to the social determinants of health that cause inequality, which include poor housing conditions, low education, low income, gender inequality and ethnicracial inequality, (Ramos et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

The Flow of Social Environmental Determinants of Disabilities on Lepers in Tuban City

Rockmawati,

Aris Santjaka,

Lagiono

et al. 2023

JPK

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Background: Leprosy is a neglected tropical disease considered rare in most areas despite having a relatively high incidence in some countries. Objective: Analyze the flow of determinants of the social environment that can affect the occurrence of disability in lepers and their impacts. Method: Research using a qualitative approach. The research was conducted in Tuban Regency, East Java Province. The informant selection technique uses a purposeful sampling technique. Data analysis uses triangulation techniques. Results: The frequency of leprosy in Tuban Regency tended to decrease from 2014-2019. Leprosy distribution occurred in 18 sub-districts; Lepers were found every month in 2019 with various characteristics of lepers that cause the emergence of leprosy and disability in leprosy. The total number of informants in this study was seven informants. Determinants of disability in lepers include informant characteristics and social environment, including knowledge, contact history, family support, self-confidence, and impact. Conclusion: In this study, the social environment that most impact the occurrence of disability in lepers is the informant knowledge factor. Informant knowledge is influenced by education, a large network of friends, and technological literacy. Education will show the type of informant work, and the type of work will determine the income of the informant; income determines economic status. Economic status contributes to food intake, medication seeking, and the home's physical condition. The duration of leprosy treatment will affect the worsening of the disability if good self-care is not carried out and always use PPE when doing activities.

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“…Esses fatores, por sua vez, estão relacionados a um maior risco de infecção e progressão da hanseníase. Além disso, a desidratação crônica pode comprometer a função renal e hepática 132,133 , o que pode levar a um aumento na toxicidade dos medicamentos usados no tratamento da hanseníase e, assim, afetar a eficácia do tratamento.…”

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“…Embora as variáveis de saúde, como acesso aos serviços de saúde e qualidade do atendimento, sejam essenciais para o controle da hanseníase, nossa análise sugere que variáveis de assistência social e educação podem ser mais relevantes no contexto dessa doença, já que nenhuma métrica relacionada a saúde foi considerada significativa nesta etapa do estudo. Isso pode ocorrer porque a hanseníase é uma doença fortemente influenciada por fatores socioeconômicos, como pobreza, analfabetismo e condições precárias de moradia, que estão intimamente relacionados à assistência social e educação 133 .…”

Section: Seleção Da Melhor Rede Neuralunclassified

Políticas públicas e fatores socioeconômicos na dinâmica da hanseníase no Estado do Pará

Feitosa Junior

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A hanseníase é uma doença causada pelo Mycobacterium leprae e é endêmica em várias regiões do mundo. Em 1991, a Organização Mundial da Saúde propôs que a hanseníase fosse eliminada até o ano 2000. No entanto, até hoje a hanseníase se mantém como um grave problema de saúde pública e, apesar dos investimentos em saúde, sabe-se que o período pré-patogênico tem forte influência no desenvolvimento desta doença. Neste sentido, os modelos matemáticos e estatísticos podem desempenhar um papel relevante na tomada de decisão para a manutenção de programas para a eliminação de hanseníase e na identificação e vigilância de casos novos. Assim, de forma a compreender os efeitos do investimento em políticas públicas na dinâmica da hanseníase no Estado do Pará, Brasil, nós objetivamos correlacionar, com uso da inteligência artificial, o gasto em alguns programas na área da saúde, educação e assistência social com o coeficiente de detecção geral, coeficiente de detecção em menores de 15 anos e a proporção de casos de detectados em grau II de deformidade, entre os anos de 2001 e 2020. Para isso, utilizou-se a tecnologia de redes neurais artificias para cruzar os dados de indicadores epidemiológicos da hanseníase com indicadores de políticas públicas na área da saúde, educação e assistência social e estimar os seus impactos na dinâmica da doença. A partir dos dados coletados, observa-se uma diminuição progressiva dos indicadores epidemiológicos no Estado e uma correlação de alguns indicadores socioeconômicos com a evolução da hanseníase, estando esta queda relacionada ao investimento federal em saúde, educação e assistência social. Também, foi possível assimilar as Regiões de Saúde do Marajó I, Carajás, Tapajós, Xingu e Lago do Tucuruí como prioritárias para o combate ao agravo no Pará e, dentre as variáveis estudadas, as que mais impactaram os indicadores epidemiológicos da hanseníase foram: gasto per capta com o Programa Bolsa Família, percentual da população urbana com acesso a água, Índice de Desenvolvimento da Educação Básica nos anos finais do Ensino Fundamental e a taxa de analfabetismo acima dos 15 anos de idade. Por fim, foi detectado que um investimento de R$ 436,99 mensais, em valores atuais, para cada uma das 965.697 famílias paraenses beneficiárias do PBF em 2020 levaria a um coeficiente de detecção geral estimado para o Pará de 9,54 casos/100mil habitantes, considerado médio. Palavras-chave: Hanseníase. Inteligência artificial. Fatores socioeconômicos. Determinantes sociais da saúde. Epidemiologia. Investimentos em saúde.

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Social inequalities and their association with the leprosy burden in a Brazilian city of low endemicity: An ecological study

Cited by 4 publications

References 40 publications

Time trend and identification of risk areas for physical disability due to leprosy in Brazil: An ecological study, 2001-2022

Time trend and identification of risk areas for physical disability due to leprosy in Brazil: An ecological study, 2001-2022

The Flow of Social Environmental Determinants of Disabilities on Lepers in Tuban City

Políticas públicas e fatores socioeconômicos na dinâmica da hanseníase no Estado do Pará

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