Clusters of leprosy transmission and of late diagnosis in a highly endemic area in Brazil: focus on different spatial analysis approaches

Alencar, Carlos H., Ramos, Alberto N., dos Santos, Emerson S., Richter, Joachim, and Heukelbach, Jorg (2012) Clusters of leprosy transmission and of late diagnosis in a highly endemic area in Brazil: focus on different spatial analysis approaches. Tropical Medicine and International Health, 17 (4). pp. 518-525.

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Abstract

Objective: The Brazilian National Hansens Disease Control Program recently identified clusters with high disease transmission. Herein, we present different spatial analytical approaches to define highly vulnerable areas in one of these clusters.

Method: The study area included 373 municipalities in the four Brazilian states Maranhão, Pará, Tocantins and Piauí. Spatial analysis was based on municipalities as the observation unit, considering the following disease indicators: (i) rate of new cases / 100 000 population, (ii) rate of cases < 15 years / 100 000 population, (iii) new cases with grade-2 disability / 100 000 population and (iv) proportion of new cases with grade-2 disabilities. We performed descriptive spatial analysis, local empirical Bayesian analysis and spatial scan statistic.

Results: A total of 254 (68.0%) municipalities were classified as hyperendemic (mean annual detection rates > 40 cases / 100 000 inhabitants). There was a concentration of municipalities with higher detection rates in Pará and in the center of Maranhão. Spatial scan statistic identified 23 likely clusters of new leprosy case detection rates, most of them localized in these two states. These clusters included only 32% of the total population, but 55.4% of new leprosy cases. We also identified 16 significant clusters for the detection rate < 15 years and 11 likely clusters of new cases with grade-2. Several clusters of new cases with grade-2 / population overlap with those of new cases detection and detection of children < 15 years of age. The proportion of new cases with grade-2 did not reveal any significant clusters.

Conclusions: Several municipality clusters for high leprosy transmission and late diagnosis were identified in an endemic area using different statistical approaches. Spatial scan statistic is adequate to validate and confirm high-risk leprosy areas for transmission and late diagnosis, identified using descriptive spatial analysis and using local empirical Bayesian method. National and State leprosy control programs urgently need to intensify control actions in these highly vulnerable municipalities.

Item ID: 22150
Item Type: Article (Research - C1)
ISSN: 1360-2276
Keywords: leprosy, control, public health, spatial analysis, Brazil, epidemiology, lepre, controle, sante publique, analyse spatiale, Bresil, epidemiologie, Lepra, control, salud publica, analisis espacial, Brasil, epidemiologia
Funders: Brazilian Research Council, Department of Science and Technology of the Brazilian Ministry of Health (DECIT)
Projects and Grants: MAPATOPI
Date Deposited: 28 Jun 2012 15:50
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 34%
11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110309 Infectious Diseases @ 33%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111708 Health and Community Services @ 33%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920404 Disease Distribution and Transmission (incl. Surveillance and Response) @ 33%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920109 Infectious Diseases @ 33%
92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 34%
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