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Open AccessArticle

Epidemiology and Spatiotemporal Patterns of Leprosy Detection in the State of Bahia, Brazilian Northeast Region, 2001–2014

Multidisciplinary Institute for Health, Campus Anísio Teixeira, Federal University of Bahia, Vitória da Conquista BA 45.029-094, Brazil
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza CE 60430-140, Brazil
College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville 4811, Australia
Author to whom correspondence should be addressed.
Trop. Med. Infect. Dis. 2018, 3(3), 79;
Received: 29 April 2018 / Revised: 12 July 2018 / Accepted: 25 July 2018 / Published: 31 July 2018
The detection of leprosy cases is distributed unequally in Brazil, with high-risk clusters mainly in the North and Northeast regions. Knowledge on epidemiology and spatiotemporal patterns of leprosy occurrence and late diagnosis in these areas is critical to improve control measures. We performed a study including all leprosy cases notified in the 417 municipalities of Bahia state, from 2001 to 2014. New case detection (overall and pediatric <15 years) and grade 2 disability (G2D) rates were calculated and stratified according to socio-demographic variables. Spatial analyses were performed to detect high-risk areas for occurrence and late diagnosis. A total of 40,060 new leprosy cases was reported in the period (mean = 2861 cases/year), 3296 (8.2%) in <15-year-olds, and 1921 (4.8%) with G2D. The new case detection rate was 20.41 cases/100,000 inhabitants (95% CI: 19.68–21.17). A higher risk was identified in older age groups (RR = 8.45, 95% CI: 7.08–10.09) and in residents living in the state capital (RR = 5.30, 95% CI: 4.13–6.79), in medium-sized cities (RR = 2.80; 95% CI: 2.50–3.13), and in the west (RR = 6.56, 95% CI: 5.13–8.39) and far south regions of the state (RR = 6.56, 95% CI: 5.13–8.39). A higher risk of G2D was associated with male gender (RR = 2.43, 95% CI: 2.20–2.67), older age (RR = 44.08, 95% CI: 33.21–58.51), Afro-Brazilian ethnicity (RR = 1.59; 95% CI: 1.37–1.85), living in medium-sized cities (RR = 2.60; 95% CI: 2.27–2.96) and residency in the north (RR = 5.02; 95% CI: 3.74–6.73) and far south (RR = 7.46; 95% CI: 5.58–9.98) regions. Heterogeneous space–time patterns of leprosy distribution were identified, indicating high endemicity, recent transmission, and late diagnosis. This heterogeneous distribution of the disease was observed throughout the study period. Leprosy remains a relevant public health problem in Bahia state. The disease has a focal distribution. We reinforce the importance of integrating surveillance, prevention and control actions in regions of higher risk of leprosy detection and late diagnosis, and in the most vulnerable populations. View Full-Text
Keywords: leprosy; epidemiology; spatial analysis; prevention and control; Brazil leprosy; epidemiology; spatial analysis; prevention and control; Brazil
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Amorim de Souza, E.; Fuentes Ferreira, A.; Heukelbach, J.; Nzundu Boigny, R.; Alencar, C.H.; Novaes Ramos, A., Jr. Epidemiology and Spatiotemporal Patterns of Leprosy Detection in the State of Bahia, Brazilian Northeast Region, 2001–2014. Trop. Med. Infect. Dis. 2018, 3, 79.

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