Physical disabilities at diagnosis of leprosy in a hyperendemic area of Brazil: trends and associated factors

Monteiro, Lorena Dias; Martins-Melo, Francisco Rogerlândio; Brito, Aline Lima; Alencar, Carlos Henrique; Heukelbach, Jörg

doi:10.47276/lr.86.3.240

Cited by 26 publications

(30 citation statements)

References 13 publications

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“…Our study also suggests that higher levels of education were negatively associated with the presence of physical disabilities at diagnosis, which is consistent with the literature [16,17]. Higher education may be associated with a better understanding of the disease and, consequently, better access and utilization of health services.…”

Section: Discussionsupporting

confidence: 91%

“…The higher likelihood of leprosy-related disabilities found among those older than 15 years is similar to previous studies. In a hyperendemic area of the Center-West region of Brazil, the estimated risk ratio of grade 2 disability was 5.3 times higher among patients aged ≥ 45 years [16]. In the state of Minas Gerais, a retrospective study showed that age above 15 years was an important risk factor for the development of physical disability in leprosy patients [17].…”

Section: Discussionmentioning

confidence: 99%

“…The association between the proportion of multibacillary leprosy and presentation of G2D has been shown in the past [16,26,27]. Studies conducted in some Brazilian cities indicate that at the time of diagnosis, the educational level variables and operational classi cation are statistically associated with the development of physical disabilities (p < 0.05).…”

Section: Discussionmentioning

confidence: 99%

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Leprosy physical disabilities in the 100 Million Brazilian Cohort

Sanchez

Nery

Pescarini

et al. 2020

Preprint

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Background Leprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures, as targeted interventions may mitigate their impact on affected individuals. This study investigated such determinants among the most vulnerable portion of the Brazilian population. Methods A large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, spanning the period 2001 to 2015 and including over 114 million individuals. Data were linked to the Leprosy disease notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to the multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervals Results 21,565 new leprosy cases were identified among the original cohort members from the study period. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21 and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2,39 and 1,95 respectively), having less schooling (with a clear dose response effect), being a multibacillary patient (ORs 3,5 and 8,22). Protective factors for both grades were being female (ORs 0,81 and 0,61) and living in a high incidence municipality (ORs 0,85 and 0,65). Conclusions Worse socioeconomic conditions might act as barriers to early diagnosis, which increases the risk of developing physical disabilities. Early diagnosis is paramount to decrease the incidence of leprosy-related disability, and our findings point to the need for strengthening these actions in non-endemic areas, where cases may be missed when presented at early stages in disease progression. In addition, data linkage proved to be useful in generating evidence for improving policy target at leprosy control in Brazil.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Leprosy physical disabilities in the 100 Million Brazilian Cohort

Sanchez

Nery

Pescarini

et al. 2020

Preprint

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Section: Discussionmentioning

confidence: 98%

Physical Disabilities Caused by Leprosy in 100 Million Cohort in Brazil

Sanchez

Nery

Pescarini

et al. 2021

Preprint

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Background: Leprosy continues to be an important cause of physical disability in endemic countries such as Brazil. Knowledge of determinants of these events may lead to better control measures and targeted interventions to mitigate its impact on affected individuals. This study investigated such factors among the most vulnerable portion of the Brazilian population.Methods: A large cohort was built from secondary data originated from a national registry of applicants to social benefit programs, covering the period 2001- 2015, including over 114 million individuals. Data were linked to the leprosy notification system utilizing data from 2007 until 2014. Descriptive and bivariate analyses lead to a multivariate analysis using a multinomial logistic regression model with cluster-robust standard errors. Associations were reported as Odds Ratios with their respective 95% confidence intervalsResults: Among the original cohort members 21,565 new leprosy cases were identified between 2007-2014. Most of the cases (63.1%) had grade zero disability. Grades 1 and 2 represented 21% and 6%, respectively. Factors associated with increasing odds of grades 1 and 2 disability were age over 15 years old (ORs 2,39 and 1,95, respectively), less schooling (with a clear dose response effect) and being a multibacillary patient (ORs 3,5 and 8,22). Protective factors for both grades were being female (ORs 0,81 and 0,61) and living in a high incidence municipality (ORs 0,85 and 0,65).Conclusions: The findings suggest that the developing of physical disabilities remains a public health problem which increases the burden of leprosy, mainly for those with severe clinical features and worse socioeconomic conditions. Early diagnosis is paramount to decrease the incidence of leprosy-related disability and our study points to the need for strengthening control actions in non-endemic areas in Brazil, where cases may be missed when presented at early stages in disease. Both actions are needed, to benefit patients and to achieve the WHO goal in reducing physical disabilities among new cases of leprosy.

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“…These results of our study showed high endemic characteristics of leprosy in this investigated area, suggesting that the delay on leprosy diagnosis still existed in northwest China, 14 which leaded to more serious consequences and disabilities of leprosy. 15 Female leprosy patients were prone to have poor prognosis. MB leprosy had greater impact on males than PB leprosy, even after adjusting the model.…”

Section: Discussionmentioning

confidence: 99%

Multi - Bacillary Leprosy Under Chinese Leprosy Elimination Program

Zhang¹,

Ge²,

Zhang³

et al. 2020

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Background: Objectives: To analyze the sociodemographic and clinical factors associated with multi-bacillary(MB) leprosy in elimination planning areas in Northwest China.Design: Retrospective observational study.Setting: Three specialized hospitals were included.Participants : The medical records of leprosy in Shaanxi Province from 2004 to 2020 were collected from the leprosy management information system (LEPMIS).Primary and secondary outcome measures: The basic situation of leprosy treatment and follow-up were investigated.Results : 305 new cases of leprosy were included in the study. 272 cases (89.18%) were MB leprosy, and 33 (10.82%) were pauci-bacillary (PB) leprosy. Male patients were more likely to have neurological injury ( P <0.001; OR:0.35; 95%CI:0.194-0.630). Patients over 60 years old were more likely to have leprosy deformity ( P <0.001; OR:0.113; 95%CI:0.027-0.478) and nerve injury ( P =0.035; OR:0.333; 95%CI:0.115-0.965). Patients with marriage histories were more likely to have leprosy deformities ( P =0.018; OR:0.842; 95%CI: 0.718-0.987). Patients with passive detection had a lower probability of leprosy reaction ( P =0.011; OR:4.268; 95%CI:1.276-14.272); Patients with nerve damage, positive skin smear test or level I or level II disability were more likely to be classified as MB leprosy.Conclusions : MB leprosy is related to social and demographic factors (with or without marriage history, age at diagnosis, discovery mode) and clinical factors (such as the number of skin lesions and nerve lesions).

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Physical disabilities at diagnosis of leprosy in a hyperendemic area of Brazil: trends and associated factors

Cited by 26 publications

References 13 publications

Leprosy physical disabilities in the 100 Million Brazilian Cohort

Leprosy physical disabilities in the 100 Million Brazilian Cohort

Physical Disabilities Caused by Leprosy in 100 Million Cohort in Brazil

Multi - Bacillary Leprosy Under Chinese Leprosy Elimination Program

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Physical disabilities at diagnosis of leprosy in a hyperendemic area of Brazil: trends and associated factors

Cited by 26 publications

References 13 publications

Leprosy physical disabilities in the 100 Million Brazilian Cohort

Leprosy physical disabilities in the 100 Million Brazilian Cohort

Physical Disabilities Caused by Leprosy in 100 Million Cohort in Brazil

Multi - Bacillary Leprosy Under Chinese&nbsp;Leprosy Elimination Program

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Multi - Bacillary Leprosy Under Chinese Leprosy Elimination Program