Characterization of cases and epidemiological and operational indicators of leprosy: analysis of time series and spatial distribution, Piauí state, Brazil, 2007-2021

Barros, Ian da Costa Araújo; Sousa, Carliane da Conceição Machado; Silva, Neylany Raquel Ferreira da; Mascarenhas, Márcio Dênis Medeiros

doi:10.1590/S2237-96222024v33e2023090.en

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 33 • 2024 • https://doi.org/10.1590/S2237-96222024v33e2023090.en copy

Characterization of cases and epidemiological and operational indicators of leprosy: analysis of time series and spatial distribution, Piauí state, Brazil, 2007-2021

Caracterización de casos e indicadores epidemiológicos y operativos de la lepra: análisis de series temporales y distribución espacial, Piauí, Brasil, 20072021

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To analyze epidemiological characteristics, temporal trends and spatial distribution of leprosy cases and indicators in the state of Piauí, 2007-2021.

Methods

This was an ecological time-series study using data from the Notifiable Health Conditions Information System, describing the spatial distribution and the temporal trend of leprosy using Prais-Winsten regression.

Results

A total of 17,075 new cases of leprosy were reported. There was a falling trend in the overall detection rate [annual percentage change (APC) = -6.3; 95%CI -8.1;-4.5)], detection in children under 15 years of age (APC = -8,6; 95%CI -12,7;-4,3) and detection of cases with grade 2 physical disability (APC = -4,4; 95%CI -7,0;-1,8). There was a rising trend in the proportion of multibacillary cases. Spatial distribution of the average detection rate identified hyperendemic areas in the Carnaubais, Entre Rios, Vale dos Rios Piauí e Itaueiras regions.

Conclusion

High leprosy detection rates were found, despite the falling trend of indicators, except the proportion of multibacillary cases.

Keywords
Leprosy; Disease Notification; Health Information Systems; Time Series Studies; Spatial Distribution

Study contributions

Main results

Between 2007 and 2021, Piauí showed an improving trend in all indicators analyzed, except the proportion of new multibacillary cases. Spatial distribution identified hyperendemic areas in different regions of the state.

Implications for services

This study provides health services with a broad overview of the epidemiological situation of leprosy in Piauí, with evidence of the populations and locations most affected by the disease, whereby public authorities need to reinforce the promotion of health actions.

Perspectives

It is expected that actions to prevent and control the disease will be adopted, such as offering early diagnosis, ensuring correct treatment and implementing measures to prevent physical disabilities.

Variables	Cases		Detection rate^a (per 100,000)		DRR^c	95%CI^b	p-value^d
Variables	N	%	Rate	95%CI ^b	DRR^c	95%CI^b	p-value^d
Total	17,075	100.0	36.5	34.5;38.6	-	-	-
Sex
Female	7,980	46.7	32.2	29.6;35.8	1.00	-	-
Male	9,095	53.3	40.9	37.9;44.2	1.27	1.13;1.43	< 0.001
Age group (in years)
≤ 14	1,188	7.0	10.7	8.6;13.2	1.00	-	-
15-39	5,744	33.6	31.9	29.0;35.0	2.99	2.38;3.77	< 0.001
40-59	5,906	34.6	57.8	52.4;63.8	5.43	4.30;6.85	< 0.001
≥ 60	4,237	24.8	71.2	63.0;80.4	6.68	5.24;8.53	< 0.001
Race skin/color
White	2,313	13.5	18.2	15.4;21.5	1.00	-	-
Black	2,563	15.0	57.7	49.6;67.1	3.17	2.54;3.98	< 0.001
Asian	230	1.3	22.5	13.3;37.4	1.24	0.73;2.11	0.217
Mixed race	11,592	67.9	41.5	38.8;44.5	2.29	1.91;2.74	< 0.001
Indigenous	59	0.3	67.9	1.4;264.5	3.74	0.93; 15.09	0.103^e
No information	318	1.9	-		-	-	-
Health region of residence
Carnaubais	992	5.8	19.7	13.9;28.0	1.14	0.73;1.78	0.289
Chapada das Mangabeiras	1,031	6.0	45.8	37.2;56.4	2.63	1.85;3.74	< 0.001
Cocais	1,237	7.2	17.9	14.1;22.6	1.03	0.71;1.48	0.443
Entre Rios	8,007	46.9	47.9	44.1;51.9	2.75	2.05;3.69	< 0.001
Planície Litorânea	1,117	6.5	17.4	13.1;23.1	1.00	-	-
Serra da Capivara	612	3.6	27.4	20.0;37.4	1.57	1.04;2.39	0.016
Tabuleiros do Alto Parnaíba	202	1.2	34.2	20.6;56.1	1.97	1.12;3.47	0.008
Vale do Canindé	498	2.9	37.1	27.1;50.6	2.13	1.40;3.24	< 0.001
Vale do Rio Guaribas	1,523	8.9	32.5	27.2;38.9	1.87	1.34;2.61	< 0.001
Vale do Sambito	399	2.3	34.7	25.0;47.9	1.99	1.30;3.06	< 0.001
Vale dos Rios Piauí and Itaueiras	1,457	8.5	49.9	41.2;60.5	2.87	2.04;4.04	< 0.001
Health macro-region of residence
Litoral	2,354	13.8	17.7	14.8;21.2	1.00	-	-
Meio-Norte	8,999	52.7	44.5	41.2;48.2	2.52	2.07;3.07	< 0.001
Semiárido	2,420	14.2	33.7	29.4;38.8	1.91	1.52;2.34	< 0.001
Cerrados	3,302	19.3	41.8	36.9;47.4	2.37	1.90;2.94	< 0.001

Variables	Cases		Detection rate^a (per 100,000)		DRR^c	95%CI^b	p-value^d
Variables	N	%	Rate	95%CI ^b	DRR^c	95%CI^b	p-value^d
Total	17,075	100.0	36.5	34.5;38.6	-	-	-
Operational classification ^e
Paucibacillary	7,096	41.6	14.0	12.8;15.4	1.00	-	-
Multibacillary	9,978	58.4	22.5	20.9;24.2	1.61	1.43;1.81	< 0.001
Grade of disability
Grade 0	11,190	65.5	23.6	22.0;25.3	11.55	8.98;14.85	< 0.001
Grade 1	3,251	19.0	6.3	5.5;7.2	3.09	2.34;4.08	< 0.001
Grade 2	956	5.6	2.0	1.6;2.6	1.00	-	-
Not assessed	1,145	6.7	-		-	-	-
No information	533	3.1	-		-	-	-
Clinical form
Indeterminate	3,913	22.9	7.5	6.6;8.5	1.42	1.16;1.73	< 0.001
Tuberculoid	2,709	15.9	5.3	4.5;6.1	1.00	-	-
Borderline	5,509	32.3	11.5	10.4;12.8	2.19	1.83;2.62	< 0.001
Lepromatous	2,561	15.0	6.2	5.4;7.1	1.18	0.97;1.45	0.054
Not classified	1,799	10.5	-		-	-	-
No information	584	3.4	-		-	-	-

Indicators	Average	APC^b (95%CI)^c	p-value^d	Trend
new case detection rate (per 100,000 inhabitants)
Total	36.5	-6.3 (-8.1;-4.5)	< 0.001	Falling
Female	32.2	-7.6 (-9.9;-5.3)	< 0.001	Falling
Male	40.9	-5.2 (-6.6;-3.7)	< 0.001	Falling
Age group (in years)
≤ 14	10.7	-8.6 (-12.7;-4.3)	0.001	Falling
15-39	31.9	-9.0 (-11.1;-6.9)	< 0.001	Falling
40-59	57.8	-6.8 (-8.7;-4.9)	< 0.001	Falling
≥ 60	71.2	-5.4 (-6.9;-3.8)	< 0.001	Falling
Health region of residence
Carnaubais	19.7	-6.5 (-11.0;-1.7)	0.013	Falling
Chapada das Mangabeiras	45.8	-6.8 (-9.7;-3.9)	< 0.001	Falling
Cocais	17.9	-4.2 (-7.7;-.05)	0.028	Falling
Entre Rios	47.9	-7.4 (-9.7;-5.1)	< 0.001	Falling
Planície Litorânea	17.4	-3.7 (-6.4;-0.8)	0.015	Falling
Serra da Capivara	27.4	-3.6 (-5.8;-1.4)	0.004	Falling
Tabuleiros do Alto Parnaíba	34.2	-3.9 (-7.0;-0.6)	0.023	Falling
Vale do Canindé	37.1	-3.9 (-7.4;-0.4)	0.033	Falling
Vale do Rio Guaribas	32.5	-3.1 (-6.1;0.1)	0.055	Stationary
Vale do Sambito	34.7	-4.6 (-8.6;-0.4)	0.033	Falling
Vale dos Rios Piauí e Itaueiras	49.9	-9.2 (-10.8;-7.6)	< 0.001	Falling
Health macro-region of residence
Litoral	17.7	-3.8 (-6.3;-1.3)	0.006	Falling
Meio-Norte	44.5	-7.4 (-9.5;-5.3)	< 0.001	Falling
Semiárido	33.7	-3.6 (-6.7;-0.5)	0.027	Falling
Cerrados	41.8	-7.2 (-8.6;-5.8)	< 0.001	Falling
Detection rate with G2D at the time of diagnosis (per 100,000 inhabitants)	2.0	-4.4 (-7.0;-1.8)	0.003	Falling
Proportion of new multibacillary cases (%)	58.4	4.1 (3.8;4 .5)	< 0.001	Rising
Proportion of new paucibacillary cases (%)	41.6	-6 .3 (-7.6;-4.9)	< 0.001	Falling

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Ian da Costa Araújo Barros | iancosta26@hotmail.com