Magnitude and temporal trend of leprosy indicators in Goiás, Brazil: an ecological study 2001-2017

Mateus Henrique Guiotti Mazão Lima Juliano Porto Nascimento Marcos Loiola de Souza Vanessa Alves Paraizo Patrícia Silva Nunes Rafael Alves Guimarães About the authors

Abstract

Objective:

To analyze the trend of leprosy indicators in Goiás between 2001 and 2017.

Methods:

An ecological time series study was conducted. Leprosy morbidity and operational indicators were calculated using Notifiable Health Conditions Information System data. Prais-Winsten regression was used for trend analysis.

Results:

There was a falling trend in the detection rate in the general population (Annual Percent Change [APC] = -6.8 – 95%CI -8.2;-5.4) and in children under 15 years old (APC = -7.2 – 95%CI -8.5;-5.9); a rising trend in the proportion of grade 2 disability (APC = 3.7 – 95%CI 2.0;5.3) and in the proportion of examined physical disability (APC = 0.6 – 95%CI 0.3;0.8); healing and examined contacts proportions were stable.

Conclusion:

Detection rates decreased while the proportions of grade 2 physical disability and examined physical disability increased.

Keywords:
Leprosy; Time Series Studies; Ecological Studies; Health Status Indicators

Introduction

Leprosy is a serious Public Health problem which is of greater magnitude in low and middle-income countries. In 2017, 210,671 new leprosy cases were recorded in 150 countries, resulting in a detection rate of 2.8 cases/100,000 inhabitants. Of the total number of cases, 80.2% were notified in three countries: India, Brazil and Indonesia.11. World Health Organization - WHO. Global leprosy update, 2017: reducing the disease burden due to leprosy. Wkly Epidemiol Rec [Intenet]. 2018 [cited 2020 Jul 10];93(35):445-56. Available from: https://apps.who.int/iris/handle/10665/274290
https://apps.who.int/iris/handle/10665/2...

The trend analysis of the epidemiological indicators of the disease enables evaluation of the efficiency of prevention measures, as well as monitoring of leprosy behavior patterns and achievement of the target to eliminate leprosy in the country.

Leprosy magnitude is high in Brazil. In 2017, 25,862 new cases were notified, resulting in a detection rate in the general population of 12.9 cases/100,000 inhab. The Federative Units with the highest rates were: Mato Grosso (102.5 cases/100,000 inhabitants), Tocantins (79.9 cases/100,000 inhab.) and Maranhão (44.0 cases/100,000 inhab.)22. Ministério da Saúde (BR). Datasus. Casos de hanseníase (SINAN) [Internet]. Brasília: Ministério da Saúde; 2017 [citado 2020 jan 2]. Disponível em: http://www2.datasus.gov.br/DATASUS/index.php?area=0203&id=31032752
http://www2.datasus.gov.br/DATASUS/index...

Considering the leprosy burden in Brazil, analysis of the epidemiological indicators of the disease enables evaluation of the efficiency of prevention measures, as well as monitoring of leprosy behavior patterns and achievement of the target to eliminate leprosy in the country. Furthermore, indicator behavior provides information for health services to manage the disease, indicating the need to formulate or reformulate prevention strategies and public policies. Specifically, analysis by Federative Unit and identification of those which are most endemic enables implementation of focused interventions, according to regional or local needs and realities.

The objective of this study was to describe the temporal trend of leprosy indicators in Goiás state between 2001 and 2017.

Methods

This is an ecological time series study that analyzed leprosy morbidity indicators and indicators related to the quality of leprosy actions and services (operational) in Goiás state, located in the Midwest region of Brazil, between 2001 and 2017.

According to Brazilian Institute of Geography and Statistics (IBGE) data, Goiás had an estimated population of 6,921,161 inhab. and average per capita income of BRL 1,323 in 2018. In 2010 the state’s human development index was 0.735;33. Instituto Brasileiro de Geografia e Estatística - IBGE. IBGE Cidades: Goiás [Internet]. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2018 [citado 2019 jan 2]. Disponível em: https://cidades.ibge.gov.br/brasil/go/panorama
https://cidades.ibge.gov.br/brasil/go/pa...
at the end of 2018, its Family Health Strategy coverage was estimated as being 66.6%; while Primary Care coverage was estimated as being 73.4%.44. Ministério da Saúde (BR). e-Gestor Atenção Básica. Cobertura da atenção básica [Internet]. Brasília: Ministério da Saúde; 2018 [citado 2019 fev 2]. Disponível em: https://egestorab.saude.gov.br/paginas/acessoPublico/relatorios/relHistoricoCoberturaAB.xhtml
https://egestorab.saude.gov.br/paginas/a...

The study used Notifiable Health Conditions Information System data. The size of the resident population, used as a denominator, was taken from the 2010 Demographic Census and from intercensal projections (2001 to 2017), both of which were carried out by the IBGE.

Two blocks of indicators were calculated, in accordance with Health Ministry recommendations:55. Brasil. Ministério da Saúde. Portaria MS/GM no 3.125, de 7 de outubro de 2010. Aprova as diretrizes para vigilância, atenção e controle da hanseníase [Internet]. Diário Oficial da União, Brasília (DF), 2010 out 15 [citado 2019 fev 27];Seção I:55. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2010/prt3125_07_10_2010.html
http://bvsms.saude.gov.br/bvs/saudelegis...
(i) morbidity indicators; and (ii) action and service quality indicators. The way these indicators were calculated and their meaning are shown in Figure 1.

Figure 1
Calculation, meaning and interpretation parameters of epidemiological indicators of leprosy

The data were analyzed with the aid of the Stata version 15.0 computer program. Prais-Winsten generalized linear regression66. Antunes JLF, Cardoso MRA. Uso da análise de séries temporais em estudos epidemiológicos. Epidemiol Serv Saúde [Internet]. 2015 jul-set [citado 2020 jul 10];24(3):564-76. Disponível em: https://doi.org/10.5123/S1679-49742015000300024
https://doi.org/10.5123/S1679-4974201500...
was used to analyze leprosy trends in the state. The dependent variables used in the models were the logarithmized morbidity and operational indicators; the independent variable corresponded to the year. The regression model equation can be described as follows:

log(Yt)=β0+β1X

where:

β0 = constant or intercept

log(Yt) = logarithmized values of the dependent variable

β1 = trend linear trend coefficient

x = independent variable

The coefficient of determination (R2) was used as the regression model fitting measurement. Following this, annual percent change (APC) and respective 95% confidence interval (95%CI) were calculated.66. Antunes JLF, Cardoso MRA. Uso da análise de séries temporais em estudos epidemiológicos. Epidemiol Serv Saúde [Internet]. 2015 jul-set [citado 2020 jul 10];24(3):564-76. Disponível em: https://doi.org/10.5123/S1679-49742015000300024
https://doi.org/10.5123/S1679-4974201500...
A 5% significance level was adopted. The trends found were classified as rising, stable or falling.66. Antunes JLF, Cardoso MRA. Uso da análise de séries temporais em estudos epidemiológicos. Epidemiol Serv Saúde [Internet]. 2015 jul-set [citado 2020 jul 10];24(3):564-76. Disponível em: https://doi.org/10.5123/S1679-49742015000300024
https://doi.org/10.5123/S1679-4974201500...

Results

Between 2001 and 2017, 42,471 leprosy cases were notified in the general population and 2,068 cases in the population under 15 years old in Goiás state. Mean detection rates in the general population and in under 15 year olds in 2007 and 2017 were 43.3 cases/100,000 inhab. and 7.9 cases/100,000 inhab. respectively. A falling leprosy detection rate was found in the general population, from 60.6 to 20.0 cases/100,000 inhab. between 2001 and 2017 (∆%: -82.6), as well as in the population under 15 years old, from 10.1 to 3.7 per 100,000 inhab. in the same period (∆%: -68.7) (Figure 2A). A falling trend was found in the detection rate in the general population (APC = -6.8 – 95%CI -8.2;-5.4) and in the population under 15 years old (APC = -7.2 – 95%CI -8.5;-5.9) (Table 1).

Figure 2
Evolution of leprosy morbidity indicators (per 100,000 inhabitants) (A) and leprosy operational indicators (B), Goiás state, 2001-2017
Table 1
Prais-Winsten regression analysis of epidemiological indicators of leprosy, Goiás state, 2001-2017

The mean proportion of grade 2 physical disability, specifically in the ten-year period from 2007 to 2017, was 4.5%. This indicator did, however, rise from 3.3 to 6.5%/10,000 inhab. in the period 2001-2017 (∆%: 97.0) (Figure 2B), a rising trend of physical disability caused by leprosy was therefore found in the entire period studied (APC = 3.7 – 95%CI 2.0;5.3) (Table 1).

The mean proportion of cure was 77.6% in the period. The proportion of examined contacts was 67.6%; while the proportion of examined physical disability was 91.9%. The proportion of cure of new cases varied between 83.6 and 84.4% (∆%: 0.3) between 2001 and 2017 (Figure 2B). The proportion of examined contacts increased from 72.3% in 2001 to 85.6% in 2017 (∆%: 18.4). Between 2001 and 2017, the proportion of examined physical disability varied between 88.9 and 95.0% (∆%: 6.9).

A stable trend was found for proportion of cure (APC = 1.1 – 95%CI -0.6;2.7) and for proportion of examined contacts (APC = 4.9 – 95%CI -2.2;12.5); while a rising trend was found for proportion of examined physical disability (APC = 0.6 – 95%CI 0.3;0.8) (Table 1).

Discussion

Between 2007 and 2017, a falling trend was found in leprosy case detection rates, among both the general population and under 15 year olds, resident in Goiás state. A rising trend was found in the proportion of grade 2 physical disability, a stable trend in the proportion of cure and examined contacts, and a rising trend in the proportion examined physical disabilities.

The detection rate in the general population corresponds to the primary indicator of leprosy. It enables overall analysis of the health status of a population, as well as guiding control strategies and indicating risk of leprosy detection.77. World Health Organization - WHO. Global leprosy strategy 2016–2020 [Internet]. Geneva: World Health Organization; 2016 [cited 2019 Jan 7]. Available from: http://www.searo.who.int/srilanka/areas/leprosy/global_leprosy_strategy_2016_2020.pdf
http://www.searo.who.int/srilanka/areas/...
,88. Freitas BHBM, Cortela DCB, Ferreira SMB. Tendência da hanseníase em menores de 15 anos em Mato Grosso (Brasil), 2001-2013. Rev Saúde Pública [Internet]. 2017 [citado 2020 jul 10];51:28. Disponível em: https://doi.org/10.1590/s1518-8787.2017051006884
https://doi.org/10.1590/s1518-8787.20170...
A falling trend was found for this indicator in both the general population and the population under 15 years old. However, the leprosy classification for Goiás continued to be very high (20.0 cases per 100,000 inhab.) in 2017, this rate being higher than the rate for Brazil as a whole (12.9 cases per 100,000 inhab.).22. Ministério da Saúde (BR). Datasus. Casos de hanseníase (SINAN) [Internet]. Brasília: Ministério da Saúde; 2017 [citado 2020 jan 2]. Disponível em: http://www2.datasus.gov.br/DATASUS/index.php?area=0203&id=31032752
http://www2.datasus.gov.br/DATASUS/index...
The same falling trend found for leprosy in this study has also occurred in other Federative Units where the leprosy burden is high, i.e. Tocantins, Maranhão, Paraíba and Bahia, as well as for Brazil as a whole.99. Gillini L, Cooreman E, Wood T, Pemmaraju VR, Saunderson P. Global practices in regard to implementation of preventive measures for leprosy. PLoS Negl Trop Dis [Internet]. 2017 May [cited 2020 Jul 10];11(5):e0005399. Available from: https://dx.doi.org/10.1371%2Fjournal.pntd.0005399
https://dx.doi.org/10.1371%2Fjournal.pnt...

10. Monteiro LD, Martins-Melo FR, Brito AL, Lima MS, Alencar CH, Heukelbach J. Leprosy trends in Tocantins, a hyperendemic State in the North of Brazil, 2001-2012. Cad Saúde Pública [Internet]. 2015 May [cited 2020 Jul 10];31(5):971-80. Available from: https://doi.org/10.1590/0102-311X00075314
https://doi.org/10.1590/0102-311X0007531...

11. Anchieta JJS, Costa LMM, Campos LC, Vieira MR, Mota OS, Morais Neto OL, et al. Trend analysis of leprosy indicators in a hyperendemic Brazilian state, 2001–2015. Rev Saúde Pública [Internet]. 2019 Aug [cited 2020 Jul 10];53:61. Available from: https://doi.org/10.11606/s1518-8787.2019053000752
https://doi.org/10.11606/s1518-8787.2019...

12. Araújo KMFA, Leano HAM, Rodrigues RN, Bueno IC, Lana FCF. Epidemiological trends of leprosy in an endemic state. Rev Rede Enferm Nord [Internet]. 2017 Jan [cited 2020 Jul 10];18(6):771-8. Available from: https://doi.org/10.15253/2175-6783.2017000600010
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-1313. Souza EA, Ferreira AF, Boigny RN, Alencar CH, Heukelbach J, Martins-Melo FR, et al. Hanseníase e gênero no Brasil: tendências em área endêmica da região Nordeste. Rev Saúde Pública [Internet]. 2018 [citado 2020 jul 10];52:20. Disponível em: https://doi.org/10.11606/S1518-8787.2018052000335
https://doi.org/10.11606/S1518-8787.2018...

Certain factors may have contributed to the reduction in leprosy magnitude and incidence in Goiás. Standing out among these factors are (i) increased early diagnosis through prevention actions, (ii) specific polychemotherapy, (iii) increased Family Health Strategy coverage in recent years, contributing to identification and prioritization of families at risk and reduction in health inequities,1414. Schneider PB, Freitas BHMB. Tendência da hanseníase em menores de 15 anos no Brasil, 2001-2016. Cad Saúde Pública [Internet]. 2018 [citado 2020 jul 10];34(3):e00101817. Disponível em: https://doi.org/10.1590/0102-311x00101817
https://doi.org/10.1590/0102-311x0010181...

15. Neves RG, Flores TR, Duro SMS, Nunes BP, Tomasi E. Tendência temporal da cobertura da Estratégia Saúde da Família no Brasil, regiões e Unidades da Federação, 2006-2016. Epidemiol Serv Saúde [Internet]. 2018 [citado 2020 jul 10];27(3):e2017170. Disponível em: https://doi.org/10.5123/s1679-49742018000300008
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-1616. Malta DC, Santos MAS, Stopa SR, Vieira JEB, Melo EA, Reis AAC. A Cobertura da Estratégia de Saúde da Família (ESF) no Brasil, segundo a Pesquisa Nacional de Saúde, 2013. Ciên Saúde Coletiva [Internet]. 2016 fev [citado 2020 jul 10];21(2):327-38. Disponível em: https://doi.org/10.1590/1413-81232015212.23602015
https://doi.org/10.1590/1413-81232015212...
(iv) active tracing of social and/or family contacts and active tracing among school-age children (e.g., campaigns in schools) and (v) vaccination/revaccination against the Calmette-Guérin bacillus (BCG), which, although not specific for leprosy, offers protection and contributes to preventing new cases of the disease.1414. Schneider PB, Freitas BHMB. Tendência da hanseníase em menores de 15 anos no Brasil, 2001-2016. Cad Saúde Pública [Internet]. 2018 [citado 2020 jul 10];34(3):e00101817. Disponível em: https://doi.org/10.1590/0102-311x00101817
https://doi.org/10.1590/0102-311x0010181...
,1717. Barreto JG, Frade MAC, Bernardes Filho F, Silva MB, Spencer JS, Salgado CG. Leprosy in Children. Curr Infect Dis Rep [Internet]. 2017 Jun [cited 2020 Jul 10];19(6):23. Available from: https://doi.org/10.1007/s11908-017-0577-6
https://doi.org/10.1007/s11908-017-0577-...
,1818. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Diretrizes para vigilância, atenção e eliminação da hanseníase como problema de saúde pública: manual técnico-operacional [Internet]. Brasília: Ministério da Saúde; 2016 [citado 2020 jul 10]. 58 p. Disponível em: http://www.saude.gov.br/images/pdf/2016/fevereiro/04/diretrizes-eliminacao-hanseniase-4fev16-web.pdf
http://www.saude.gov.br/images/pdf/2016/...
These leprosy prevention and control measures are established in the ‘Guidelines for surveillance, care and elimination of leprosy as a public health problem’, recommended by the Health Ministry for implementation at all levels of health care.1818. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Diretrizes para vigilância, atenção e eliminação da hanseníase como problema de saúde pública: manual técnico-operacional [Internet]. Brasília: Ministério da Saúde; 2016 [citado 2020 jul 10]. 58 p. Disponível em: http://www.saude.gov.br/images/pdf/2016/fevereiro/04/diretrizes-eliminacao-hanseniase-4fev16-web.pdf
http://www.saude.gov.br/images/pdf/2016/...

A rising trend was found in the proportion of cases with grade 2 physical disability, possibly indicating late detection – despite increased Family Health Strategy coverage –, besides difficulties in preventing disabilities.1919. Freitas LRS, Duarte EC, Garcia LP. Trends of main indicators of leprosy in Brazilian municipalities with high risk of leprosy transmission, 2001-2012. BMC Infect Dis [Internet]. 2016 Sep [cited 2020 Jul 10];16(1):472. Available from: https://dx.doi.org/10.1186%2Fs12879-016-1798-2
https://dx.doi.org/10.1186%2Fs12879-016-...
Previous studies have shown a stationary trend2020. Araújo KMFA, Leano HAM, Rodrigues RN, Bueno IC, Lana FCF. Tendência de indicadores epidemiológicos da hanseníase em um estado endêmico. Rev Rene [Internet]. 2017 nov-dez [citado 2020 jul 10];18(6):771-8. Disponível em: https://doi.org/10.15253/2175-6783.2017000600010
https://doi.org/10.15253/2175-6783.20170...
,2121. Souza CDF, Luna CF, Magalhães MAFM. Transmissão da hanseníase na Bahia, 2001-2015: modelagem a partir de regressão por pontos de inflexão e estatística de varredura espacial. Epidemiol Serv Saúde [Internet]. 2019 [citado 2020 jul 10];28(1):e2018065. Disponível em: https://doi.org/10.5123/s1679-49742019000100015
https://doi.org/10.5123/s1679-4974201900...
or a rising trend88. Freitas BHBM, Cortela DCB, Ferreira SMB. Tendência da hanseníase em menores de 15 anos em Mato Grosso (Brasil), 2001-2013. Rev Saúde Pública [Internet]. 2017 [citado 2020 jul 10];51:28. Disponível em: https://doi.org/10.1590/s1518-8787.2017051006884
https://doi.org/10.1590/s1518-8787.20170...
,1111. Anchieta JJS, Costa LMM, Campos LC, Vieira MR, Mota OS, Morais Neto OL, et al. Trend analysis of leprosy indicators in a hyperendemic Brazilian state, 2001–2015. Rev Saúde Pública [Internet]. 2019 Aug [cited 2020 Jul 10];53:61. Available from: https://doi.org/10.11606/s1518-8787.2019053000752
https://doi.org/10.11606/s1518-8787.2019...
,2020. Araújo KMFA, Leano HAM, Rodrigues RN, Bueno IC, Lana FCF. Tendência de indicadores epidemiológicos da hanseníase em um estado endêmico. Rev Rene [Internet]. 2017 nov-dez [citado 2020 jul 10];18(6):771-8. Disponível em: https://doi.org/10.15253/2175-6783.2017000600010
https://doi.org/10.15253/2175-6783.20170...
in this indicator in Brazil. Assessment of the degree of disability is an important tool for identifying patients at greater risk of developing new disabilities, during treatment, at the end of polychemotherapy and after discharge from medical care, and can contribute to reducing morbidity caused by the disease.1818. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Diretrizes para vigilância, atenção e eliminação da hanseníase como problema de saúde pública: manual técnico-operacional [Internet]. Brasília: Ministério da Saúde; 2016 [citado 2020 jul 10]. 58 p. Disponível em: http://www.saude.gov.br/images/pdf/2016/fevereiro/04/diretrizes-eliminacao-hanseniase-4fev16-web.pdf
http://www.saude.gov.br/images/pdf/2016/...

In this study, proportion of cure had a stable trend in Goiás, as also found by earlier studies.88. Freitas BHBM, Cortela DCB, Ferreira SMB. Tendência da hanseníase em menores de 15 anos em Mato Grosso (Brasil), 2001-2013. Rev Saúde Pública [Internet]. 2017 [citado 2020 jul 10];51:28. Disponível em: https://doi.org/10.1590/s1518-8787.2017051006884
https://doi.org/10.1590/s1518-8787.20170...
,1111. Anchieta JJS, Costa LMM, Campos LC, Vieira MR, Mota OS, Morais Neto OL, et al. Trend analysis of leprosy indicators in a hyperendemic Brazilian state, 2001–2015. Rev Saúde Pública [Internet]. 2019 Aug [cited 2020 Jul 10];53:61. Available from: https://doi.org/10.11606/s1518-8787.2019053000752
https://doi.org/10.11606/s1518-8787.2019...
,2121. Souza CDF, Luna CF, Magalhães MAFM. Transmissão da hanseníase na Bahia, 2001-2015: modelagem a partir de regressão por pontos de inflexão e estatística de varredura espacial. Epidemiol Serv Saúde [Internet]. 2019 [citado 2020 jul 10];28(1):e2018065. Disponível em: https://doi.org/10.5123/s1679-49742019000100015
https://doi.org/10.5123/s1679-4974201900...
This result suggests intensification of actions to promote timely and adequate patient polychemotherapy.2222. Smith WCS, Aerts A. Role of contact tracing and prevention strategies in the interruption of leprosy transmission. Lepr Rev [Internet]. 2014 Mar [cited 2020 Jul 10];85(1):2-17. Available from: https://pubmed.ncbi.nlm.nih.gov/24974438/modelagem a partir de regressão por pontos de inflexão e estatística de varredura espacial. Epidemiol Serv Saúde [Internet]. 2019 [citado 2020 jul 10];28(1):e2018065. Disponível em: https://doi.org/10.5123/s1679-49742019000100015
https://pubmed.ncbi.nlm.nih.gov/24974438...
A stable trend was also found in the proportion of examined contacts. Other studies conducted in Brazil have revealed a rising trend in this indicator.88. Freitas BHBM, Cortela DCB, Ferreira SMB. Tendência da hanseníase em menores de 15 anos em Mato Grosso (Brasil), 2001-2013. Rev Saúde Pública [Internet]. 2017 [citado 2020 jul 10];51:28. Disponível em: https://doi.org/10.1590/s1518-8787.2017051006884
https://doi.org/10.1590/s1518-8787.20170...
,1111. Anchieta JJS, Costa LMM, Campos LC, Vieira MR, Mota OS, Morais Neto OL, et al. Trend analysis of leprosy indicators in a hyperendemic Brazilian state, 2001–2015. Rev Saúde Pública [Internet]. 2019 Aug [cited 2020 Jul 10];53:61. Available from: https://doi.org/10.11606/s1518-8787.2019053000752
https://doi.org/10.11606/s1518-8787.2019...
Assessment of examined contacts is one of the indicators capable of evaluating public leprosy surveillance actions,1818. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Vigilância das Doenças Transmissíveis. Diretrizes para vigilância, atenção e eliminação da hanseníase como problema de saúde pública: manual técnico-operacional [Internet]. Brasília: Ministério da Saúde; 2016 [citado 2020 jul 10]. 58 p. Disponível em: http://www.saude.gov.br/images/pdf/2016/fevereiro/04/diretrizes-eliminacao-hanseniase-4fev16-web.pdf
http://www.saude.gov.br/images/pdf/2016/...
and its increase can contribute to interrupting transmission of infection.2222. Smith WCS, Aerts A. Role of contact tracing and prevention strategies in the interruption of leprosy transmission. Lepr Rev [Internet]. 2014 Mar [cited 2020 Jul 10];85(1):2-17. Available from: https://pubmed.ncbi.nlm.nih.gov/24974438/modelagem a partir de regressão por pontos de inflexão e estatística de varredura espacial. Epidemiol Serv Saúde [Internet]. 2019 [citado 2020 jul 10];28(1):e2018065. Disponível em: https://doi.org/10.5123/s1679-49742019000100015
https://pubmed.ncbi.nlm.nih.gov/24974438...

This study has certain limitations. It used secondary data and these are susceptible to problems with the quality and quantity (coverage) of leprosy case information and variables. The possibility of underreporting can result in the indicators being underestimated. On the other hand, this study assessed the magnitude and the main indicators of leprosy in Goiás, which can assist evaluation of leprosy control interventions and actions already undertaken or yet to be undertaken in the state.

In conclusion, this study found a falling trend in leprosy morbidity indicators – detection rate in the general population and under 15 year olds; prevalence rate – in Goiás, between 2001 and 2017. The proportion of cure and examined contacts was stable, while the proportion of examined physical disability increased. However, leprosy has high magnitude, characterizing a serious Public Health problem in the state. As such, there is a need to intensify actions to control this disease, which affects a considerable number of people in Goiás.

References

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Publication Dates

  • Publication in this collection
    06 Nov 2020
  • Date of issue
    2020

History

  • Received
    08 Jan 2020
  • Accepted
    10 June 2020
Secretaria de Vigilância em Saúde - Ministério da Saúde do Brasil Brasília - Distrito Federal - Brazil
E-mail: leilapgarcia@gmail.com