Effect of the Brazilian Conditional Cash Transfer and Primary Health Care Programs on the New Case Detection Rate of Leprosy

Abstract

BackgroundSocial determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP) and primary health care (Family Health Program-FHP) programs on new case detection rate of leprosy.Methodology/Principal FindingsWe conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004–2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI = 0.74–0.83) and significantly increased in municipalities with FHP coverage in the medium (72–95%) (Risk Ratio 1.05; 95% CI = 1.02–1.09) and higher coverage tertiles (>95%) (Risk Ratio 1.12; 95% CI = 1.08–1.17).ConclusionsAt the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.

Análise da situação epidemiológica da hanseníase em uma área endêmica no Brasil: distribuição espacial dos períodos 2001 - 2003 e 2010 - 2012

“…The under-notification of cases may be associated with the existence of asymptomatic or oligosymptomatic cases, with the precariousness in surveillance services to identify and notify the cases, and with the areas that are geographically difficult to access, therefore making it difficult to reach the health services. Freitas et al 9 observed a gradient increment in the incidence rates of leprosy (attenuated) in the Brazilian cities when the proportion of coverage of the Family Health Program (PSF) units increased, and when the percentage of examinated contacts increased 9,34 . This fact may point to the existence of under-notification of cases, which, gradually, may be overcome when the basic care services improve their ability and quality.…”

Surveillance of intradomiciliary contacts of leprosy cases: perspective of the client in a hyperendemic municipality

“…These figures indicate a country with an endemic disease that is sustained at high levels (2,(8)(9) . Although Brazil has also registered a reduction in the prevalence and detection coefficients of new cases of leprosy, the North, Northeast and Central-West regions maintain hyperendemic patterns, with clusters of important dynamic transmission (9)(10)(11) . Rondônia is considered to be one of the Brazilian states with the highest levels of endemicity.…”

Spatial distribution of leprosy in Brazil: a literature review

“…Consequently, the incidence of infectious diseases declined, but the impact on leprosy is not yet fully clear 5,6 . Studies point out that cash transfer policies were related to the decrease in disease incidence, while the expansion of the Family Health Care Strategy improved t h e detection of new cases 6,7 .…”