Tropical/Infectoparasitary Dermatology
Epidemiological monitoring of leprosy indicators in Sergipe (2001–2015): segmented regression analysis
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class="elsevierStyleSimplePara elsevierViewall">Distribuição espacial dos percentuais de variação médios anuais e classificação da tendência dos indicadores de magnitude da hanseníase em Sergipe, Brasil, 2001‐2015.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">AAPC</span>, variação percentual anual média (do inglês, <span class="elsevierStyleItalic">average annual percent change</span>).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Dornels Freire de Souza, Thiago Cavalcanti Leal, João Paulo Silva de Paiva, Victor Santana Santos" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Carlos Dornels Freire de" "apellidos" => "Souza" ] 1 => array:2 [ "nombre" => "Thiago Cavalcanti" "apellidos" => "Leal" ] 2 => array:2 [ "nombre" => "João Paulo Silva de" "apellidos" => "Paiva" ] 3 => array:2 [ "nombre" => "Victor Santana" "apellidos" => "Santos" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ 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AAPC, average annual percent change.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Leprosy is an infectious disease caused by <span class="elsevierStyleItalic">Mycobacterium leprae</span>,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> which affects the skin and peripheral nerves, resulting in neuro-dermatological lesions and physical disabilities.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Only Brazil has not reached the goal of eliminating leprosy as a public health problem.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In 2017, 26,875 new leprosy cases were diagnosed in Brazil (12.94/100,000 population). Of these, 1718 were diagnosed in children under 15 years of age (3.72/100,000). The detection coefficient of new leprosy cases with grade 2 disability was 9.39/100,000.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2017, Sergipe recorded a general detection coefficient of 15.78/100,000 population, a detection coefficient in children under 15 of 2.75/100,000, and detection coefficient of new leprosy cases with grade 2 disability of 16.61/100,000.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The monitoring of these indicators is recommended by the World Health Organization (WHO),<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> because of the commitments to eliminate the disease signed by Brazil.</p><p id="par0020" class="elsevierStylePara elsevierViewall">This study aimed to analyze the trend of leprosy indicators in the state of Sergipe from 2001 to 2015.</p><p id="par0025" class="elsevierStylePara elsevierViewall">For this purpose, an ecological time series study was performed, with the municipalities of Sergipe (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>75) being the units for analysis. Data were obtained from the National Information System for Notifiable Diseases (SINAN). Three indicators were analyzed: general detection coefficient rate per 100,000 population; detection coefficient rate in children under 15 per 100,000 population, and detection coefficient of new leprosy cases with grade 2 disability per 100,000 population (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). For the temporal analysis, the joinpoint regression model was used. The annual percent change (APC) and the average annual percent change (AAPC) were calculated. A 95% confidence interval (95% CI) and an alpha of 5% were considered. Because of the use of secondary data, the approval of the Research Ethics Committee was not needed.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In the study period, 8238 new leprosy cases were identified, 6.25% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>515) in children under 15 and 7.27% (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>599) in new leprosy cases with grade 2 disability. Of the 75 municipalities, only two had an increasing trend of the general detection coefficient: Carira (AAPC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>59.2%) and Moita Bonita (AAPC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>27.3%). Eight municipalities had a decreasing trend (Canindé do São Francisco, Cumbe, Estância, Ilha das Flores, Japoatã, Santa Luiza do Itanhy, Santana do São Francisco, and Santos Amaro das Brotas). In this group, the average annual reduction was 22.56% (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the detection coefficient in children under 15, five municipalities presented an increasing trend (Carira, Itabaianinha, Pacatuba, Poço Verde, and Salgado), with emphasis on Carira (AAPC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>56.2%). Only Aracaju (AAPC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−8.8%) and Malhada dos Bois (AAPC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−2.0%) had a decreasing trend for detection rate in children. For grade 2 disability, 19 municipalities had an increasing trend, especially Propriá (AAPC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>50.0%) and Divina Pastora (AAPC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>38.30%). No municipality presented any trend of reduction in the grade 2 disability indicator. This group had an average increasing trend of 29.3% (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Although leprosy burden has declined over recent years,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,3</span></a> recent studies have suggested that the number of patients registered in official information systems is substantially lower than the number of individuals with leprosy in Brazil.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Studies performed in areas considered low endemicity have evidenced underdiagnosis and, therefore, a high hidden leprosy prevalence.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The highest number of municipalities with a trend of increase in the detection in children under 15 (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) and the detection of new leprosy cases having grade 2 disability (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9) suggests the maintenance of leprosy transmission in Sergipe, a hidden leprosy prevalence, underdiagnosis of leprosy, and failures of the leprosy control programs in municipalities.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,3,9</span></a> The mismatch between the three indicators has already been evidenced in investigations carried out in the states of Bahia<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> and Alagoas,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> which have geographical boundaries with Sergipe.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The detection coefficient of new leprosy cases with grade 2 disability is one of the most important indicators for evaluating the disease, and suggests a late diagnosis of leprosy.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In Sergipe, municipalities with a tendency of increase of this indicator should receive special attention from the policymakers, especially through actions that facilitate early diagnosis.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Despite the advances observed in the reduction of general detection coefficient and in children under 15, leprosy still represents a public health problem in Sergipe.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Financial support</span><p id="par0080" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Authors’ contributions</span><p id="par0060" class="elsevierStylePara elsevierViewall">Carlos Dornels Freire de Souza: Statistical analysis; approval of final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; participation in design of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Thiago Cavalcanti Leal: Statistical analysis; approval of final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; participation in design of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0070" class="elsevierStylePara elsevierViewall">João Paulo Silva de Paiva: Statistical analysis; approval of final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; participation in design of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Victor Santana Santos: Statistical analysis; approval of final version of the manuscript; conception and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; participation in design of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:3 [ "identificador" => "xres1370011" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1259083" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 3 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contributions" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-04-01" "fechaAceptado" => "2019-07-01" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1259083" "palabras" => array:3 [ 0 => "Epidemiology" 1 => "Leprosy" 2 => "Time series studies" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study analyzed the trend of leprosy indicators in Sergipe, between 2001 and 2015. It was a time series study that analyzed the trend for general detection coefficient, children under 15 years of age, and new cases with grade 2 disability. The joinpoint model was used. Two (2.6%) municipalities had an increasing trend in general detection coefficient, five (6.6%) had an increasing trend in detection rate in children under 15, and 19 (25.3%) had an increasing trend in detection coefficient of new leprosy cases with grade 2 disability. The findings suggest maintenance of the chain of transmission.</p></span>" ] ] "NotaPie" => array:3 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Souza CDF, Leal TC, Paiva JPS, Santos VS. Epidemiological monitoring of leprosy indicators in Sergipe (2001–2015): segmented regression analysis. An Bras Dermatol. 2020;95:508–10.</p>" ] 1 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0015"><span class="elsevierStyleInterRef" id="intr0005" href="http://lattes.cnpq.br/6453724595999982">http://lattes.cnpq.br/6453724595999982</span>.</p>" "identificador" => "fn0005" ] 2 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Department of Medicine, Center for the Study of Social and Preventative Medicine, Universidade Federal de Alagoas, Arapiraca, AL, Brazil.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1393 "Ancho" => 2091 "Tamanyo" => 439579 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Spatial distribution of average annual percent changes and classification of the trend of leprosy magnitude indicators in Sergipe, Brazil, 2001–2015. AAPC, average annual percent change.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indicator \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Utility \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Parameters \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">New leprosy case detection rate in the general population/100,000 inhabitants.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Measures the strength of the disease's morbidity, magnitude, and trend.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperendemic: ≥40.0/100,000 inhab. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Very high: 20.00–39.99/100,000 inhab. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High: 10.00–19.99/100,000 inhab. Medium: 2.00–9.99/100,000 inhab. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low: <2.00/100,000 inhab. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Very high: 20.00–39.99/100,000 inhab. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">New leprosy case detection rate in the population under 15 years/100,000 inhabitants.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="5" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Measures the strength of recent transmission of the disease and its trend.</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperendemic: ≥10.00/100,000 inhab. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Very high: 5.00–9.99/100,000 inhab. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High: 2.50–4.99/100,000 inhab. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medium: 0.50–2.49/100,000 inhab. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low: <0.5/100,000 inhab. \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rate of new leprosy cases with grade 2 physical disability at the time of diagnosis/100,000 inhabitants. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Evaluates deformities caused by leprosy in the general population and compares them with other debilitating diseases. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">The reduction trend of detection rate, followed by decreasing of this indicator, characterizes a reduction of the endemic disease's magnitude. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2352766.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Epidemiological indicators and methods selected for the study.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Leprosy: current situation, clinical and laboratory aspects, treatment history and perspective of the uniform multidrug therapy for all patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.C.D.S. 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