Trends and Characteristics of Pediatric Leprosy Cases in Minas Gerais, Brazil Pubblico

Abstract

Background: Cases of leprosy around the world have steady declined, yet there is still active transmission in pediatric cases around the world, such as Minas Gerais, Brazil. We hypothesized that although the incidence of pediatric cases has declined, areas with lower health care service access would show active transmission of Mycobacterium leprae as measured by incidence and grade 2 disability in pediatric cases. Methods: A cross-sectional study was conducted using the Brazilian Notifiable Diseases Surveillance System, Minas Gerais division (SINAN-MG). Data were collected by passive reporting by health centers across the state upon initial diagnosis during 2002-2017. For this analysis, cases were included if they resided in a municipality that reported pediatric cases. Additionally, municipalities were further stratified based on their medical facility accessibility. Time periods were also assessed by creating two time groups: Time period 1 (2002-2009) and Time period 2 (2010-2017). Incidence was calculated for pediatric cases in the years 2002, 2009, and 2017. Incidence was then calculated for the year 2017 in municipalities with different levels of health services access. Statistical analyses conducted included univariate analysis, Chi-square testing, t-tests, and adjusted odds ratios. A logistic regression was applied to assess the association between health care access and disability. Results: This study had a total of 27,725 cases. Of those, 1,611 were pediatric cases. When time periods were compared time period 2 showed an increase in proportion of pediatric multibacillary leprosy (38.39%) compared to time period 1 (34.42%). There was also an increase in proportion of grade 2 disability in pediatric cases (2.58%) in time period 2 compared to time period 1 (1.91%). Average age of diagnosis in pediatric cases was younger in time period 2 (10.06; 95% CI [9.77-10.35]) than time period 1(10.43; 95% CI [10.27-10.60]). Municipalities with low access to health services reported 857 (53.20%) of all pediatric cases. In 2017, the incidence of pediatric cases in municipalities with low access to health services was 0.95 per 100,000 compared to 0.23 per 100,000 in municipalities with high access to health services (p=0.009). There was significantly higher odds of disability among municipalities with low access to health (OR 1.88 95% CI [1.37-2.59]). Conclusion: This study showed there is still active transmission of Mycobacterium leprae in Minas Gerais, Brazil. The increased proportion of multibacillary in time period 2 and average age of diagnosis highlight ongoing transmission. The increase in proportion of grade 2 disability in time period 2 supports a delay in diagnosis and treatment, suggesting more potential transmission prior to diagnosis. More surveillance is needed in municipalities with lower access to health services since over 50% of pediatric. All cases included in this study resided in those regions, and the odds of disability upon diagnosis in those regions is 1.88 times higher than regions with better access to health care facilities.

Table of Contents

Chapter 1: Introduction................................................................................. 1-2

Chapter 2: Literature Review..................................................................... 3-11

Overiew……....................................................................................... 3-5

Risk Factors and Treament................................................................. 5-6

Pediatric Cases.................................................................................... 6-8

Health Care......................................................................................... 8-9

Future Goals ..................................................................................... 9-10

Study Relevance ............................................................................. ….11

Chapter 3: Manuscript............................................................................ 12-29

Abstract............................................................................................... 12

Introduction................................................................................... 13-14

Methods..........................................................................................15-17

Results............................................................................................17-26

Discussion ......................................................................................27-29

Chapter 4: Implications and Recommendations.................................... 30-31

References...................................................................................................32-36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Health Care Management Health Sciences, Epidemiology
Parola chiave	pediatric leprosy
Committee Chair / Thesis Advisor	Jessica Fairley , Emory University
Committee Members	Julie Clennon , Emory University

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