Socio-demographic and clinical factors of leprosy cases associated with the performance of the evaluation of their contacts in Ceará, Brazil, 2008-2019

Soares, Gerlania Maria Martins de Melo; Souza, Eliana Amorim de; Ferreira, Anderson Fuentes; García, Gabriela Soledad Márdero; Oliveira, Maria Leide Wand-Del-Rey de; Pinheiro, Aquiléa Bezerra de Melo; Santos, Maria Aldenisa Moura dos; Ramos Junior, Alberto Novaes

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 30 (3) • 2021 • https://doi.org/10.1590/S1679-49742021000300024 copy

Socio-demographic and clinical factors of leprosy cases associated with the performance of the evaluation of their contacts in Ceará, Brazil, 2008-2019¹⁰ 2 Article derived from the master’s degree dissertation entitled ‘Surveillance of leprosy contacts in the state of Ceará: epidemiological and operational factors associated with 2008-2019 coverage’, submitted by Gerlania Maria Martins de Melo Soares to the Public Health Postgraduate Program of the School of Medicine of the Federal University of Ceará, in 2020. The study received financial support from the Graduate Support Program (PROAP) of the Coordination for Improvement of Higher Education Personnel (CAPES), the Ministry of Education (MEC). García GSM and Ferreira AF are CAPES PHD fellows. Ramos Jr. AN is a Research Productive fellow of the National Council for Scientific and Technological Development (CNPq), of the Ministry of Science, Technology, Innovations and Communications (MCTIC).

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the effect of sociodemographic and clinical characteristics of new leprosy cases as determinants in the performance of the evaluation of their contacts

Methods

This was a cross-sectional study, with a temporal approach to the evaluation indicator of 100% of contacts examined of each new case (NC) registered in the state of Ceará, Brazil, on the Notifiable Diseases Information System (SINAN), in 2008-2019. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (95%CI). The temporal trends were analyzed using joinpoint regression.

Results

23,675 NCs, 65.4% with contacts examined were analyzed. It was less likely to evaluate 100% of the registered contacts when the new cases were multibacillary (OR=1.19 - 95%CI 1.11;1.28) and with examination of contacts as an entry mode (OR=1.71 - 95%CI 1.35;2.18). There was an increasing temporal trend of the indicator (Annual Percentage Change: 2.1 - 95%CI 1.2;3.0).

Conclusion

Distinct dimensions of individual and social vulnerability among new leprosy cases influenced the persistent unsatisfactory performance of the evaluation of contacts.

Keywords:
Leprosy; Epidemiology; Surveillance; Contact tracing

Variables	New cases	New cases with 100% of contacts examined		Crude OR^a (95%IC)^b	Adjusted OR^a (95%IC)^b
Variables	New cases	Yes (%)	No (%)	Crude OR^a (95%IC)^b	Adjusted OR^a (95%IC)^b
Total	23,675 (100.0)	15,484 (65.4)	8,191 (34.6)	-	-
Sex
Female	10,324 (43.6)	6,535 (42.2)	3.789 (46.3)	1.00	-
Male	13,348 (56.4)	8,949 (57.8)	4.399 (53.7)	1.18 (1.12;1.24)	-
Race/skin color
White	4,414 (18.6)	2,864 (18.5)	1,550 (18.9)	1.00
Black	1,767 (7.5)	1,280 (8.3)	487 (5.9)	1.42 (1.26;1.61)	1.37 (1.19;1.57)
Asian	250 (1.1)	165 (1.1)	85 (1.0)	1.05 (0.80;1.37)	-
Brown	13,643 (57,6)	9,677 (62.5)	3,966 (48.4)	1.32 (1.23;1.42)	1.28 (1.18;1.39)
Indigenous	67 (0,3)	46 (0,3)	21 (0,3)	1,19 (0,70;1,99)	-
Age group (in years)
<15	1,309 (5.5)	748 (4.8)	561 (6.8)	1.00	-
15-59	15,698 (66.3)	10,134 (65.4)	5,564 (67.9)	1.30 (1.19;1.42)	-
≥60	6,668 (28.2)	4.602 (29.7)	2,066 (25.2)	1.57 (1.42;1.74)	-
Schooling
Illiterate	2,680 (17.1)	2,062 (13.3)	618 (7.5)	1.00
Elementary school	9,785 (62.3)	6,825 (44.1)	2,960 (36.1)	0.69 (0.63;0.76)	0.87 (0.81;0.94)
High school.	2,710 (17.3)	1,842 (11.9)	868 (10.6)	0.64 (0.56;0.72)	-
Higher education	525 (3.3)	344 (2.2)	181 (2.2)	0.57 (0.47;0.70)	-
Place of residence
Urban	18,190 (76.8)	11,442 (73.9)	6,748 (82.4)	1.00
Rural	4,253 (18.0)	3.344 (21.6)	909 (11.1)	2.17 (2.00;2.35)	2.01 (1.81;2.22)
Peri-urban	458 (1.9)	232 (1.5)	226 (2.8)	0.61 (0.50;0.73)	0.48 (0.38;0.61)
Degree of disability
Grade 0	13,767 (58.1)	8,.968 (57.9)	4,799 (58.6)	1.00	-
Grade 1	4,577 (19.3)	3,133 (20.2)	1,444 (17.6)	1.16 (1.08;1.25)	-
Grade 2	1,703 (7.2)	1,091 (7.0)	612 (7.5)	0.95 (0.86;1.06)	-
Operational classification of the disease
Paucibacillary	8,704 (36.8)	5,512 (35.6)	3,192 (39.0)	1.00
Multibacillary	14,967 (63.2)	9,968 (64.4)	4,999 (61.0)	1.15 (1.09;1.22)	1.19 (1.11;1.28)
Mode of detection of new cases
Referral	12,755 (53.9)	7,421 (47.9)	5,334 (65.1)	1,00
Spontaneous demand	9,181 (38.8)	6,808 (44.0)	2,373 (29.0)	2.06 (1.94;2.19)	1.55 (1.44;1.66)
Collective examination	441 (1.9)	286 (1.8)	155 (1.9)	1.33 (1.09;1.62)	-
Examination of contacts	582 (2.5)	430 (2.8)	152 (1.9)	2.03 (1.68;2.45)	1.71 (1.35;2.18)

Variables	Annual percentage change (95%CI)
Total	2.1^a (1.2;3.0)
Sex
Female	2.0^a (1.1;2.9)
Male	2.1^a (1.2;3.0)
Race/skin color
White	2,3^a (0.2;4.4)
Black	1.2 (-0.3;2.8)
Asian	1.9 (-0.4;4.3)
Brown	0.7 (-0.8;2.3)
Indigenous	1.6 (-7.6;11.7)
Age group (in years)
<15	1.9^a (0.4;3.3)
15-59	2.1^a (1.1;3.1)
≥60	1.9^a (1.1;2.6)
Schooling
Illiterate	2.0^a (0.4;3.6)
Elementary school	1.0 (-1.0;3.1)
High school	4.5^a (2.6;6.5)
Higher education	11.0^a (6.2;16.1)
Place of residence
Urban	2.3^a (1.5;3.2)
Rural	0.7 (-0.8;2.1)
Peri-urban	-7.8^a (-13.6;-1.7)
Degree of disability
Grade 0	2.7^a (1.8;3.7)
Grade 1	1.9^a (1.0;2.8)
Grade 2	1.6^a (0.5;2.7)
Operational classification of the disease
Paucibacillary	1.9^a (0.6;3.2)
Multibacillary	2.2^a (1.4;2.9)
Mode of detection mode of new cases
Referral	2,3^a (1,0;3,6)
Spontaneous demand	1,5^a (0,5;2,4)
Collective examination	3,1^a (1,5;4,7)
Examination of contacts	1,6^a (0,3;3,0)

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[1] Correspondence:
Eliana Amorim de Souza - Universidade Federal da Bahia, Campus Anísio Teixeira, Instituto Multidisciplinar em Saúde, Núcleo Epidemiologia e Saúde Coletiva, Rua Hormindo Barros, No. 58, Quadra 17, Lote 58, Candeias, Vitória da Conquista, BA, Brazil. CEP: 45029-094. E-mail: eliana.amorim@ufba.br.