Patrones endémicos de la hanseniasis en Pernambuco, Brasil

Abstract

BACKGROUND: Despite the considerable decline in prevalence of leprosy in Brazil, since the beginning of the 21st century, it remains a serious public health problem, with important transmission activity and a high incidence of new cases. PURPOSE: The aim of the present study was to characterize the incidence of leprosy in the state of Pernambuco (northeastern Brazil), analyzing the temporal trend in detection rates, spatial inequalities and endemic disease patterns. METHODS: An ecological study was conducted with all new cases of leprosy among residents of Pernambuco detected between 1982 and 2009 using data obtained from the Disease Notification Information System. The 64,530 cases studied were grouped by year and five-year periods of diagnosis and area of residence (municipality and two geographical subdivisions: metropolitan Recife and other regions of the state). To obtain the detection rates, the population was derived from census and inter-census estimates. The population of Pernambuco in 2000 was used for the standardization of rates using the indirect method. In the temporal trend analysis, the cubic polynomial regression model proved to have the best fit and was used to predict annual detection rates from 2010 to 2014. Proportions and rates for demographic and clinical variables were calculated for five-year periods. Inequalities in the distribution of leprosy between metropolitan Recife and other regions of the state were identified using rate ratios (95%), the chi-square test (p 0. 95) demonstrates an upslope in the 1980s and 90s, followed by a short period at a high plateau and the start of a slight decline in the mid-2000s. The detection rates estimated by the model show a decline in prevalence between 2010 and 2014. The magnitude of leprosy remains high and the disease currently reaches a greater number of municipalities in comparison to the beginning of the historical series. In all geographical areas studied, reductions were found in the proportion of affected children less than 15 years of age. An increase in the median age at onset was found as well as an increase in the proportion of affected individuals older than 60 years of age and the proportion of multibacillary cases. An increase was also found in levels of endemicity and cases with physical disabilities at the time of diagnosis. A significant difference in the proportional distribution of cases by age group and clinical characteristics (p 0. 05) was found between metropolitan Recife and other regions of the state. A reduction occurred in the inequality of gross and specific detection rates over time. CONCLUSION: The leprosy endemic currently exhibits a pattern of transition between stabilization and decline in the state of Pernambuco, which is more pronounced in metropolitan Recife than other regions of the state.

Date of Award	4 Nov 1997
Original language	Spanish
Supervisor	J. Canela Soler (Director) & Josep Vaqué Rafart (Tutor)