Systematic Review of Survival Analysis in Leprosy Studies-Including the Following Outcomes: Relapse, Impairment of Nerve Function, Reactions and Physical Disability.

Leprosy is a public health problem in South American, African and Oceanian countries. National programs need to be evaluated, and the survival analysis model can aid in the construction of new indicators. The aim of this study was to assess the period of time until the outcomes of interest for patients with or exposed to leprosy by means of survival analysis surveys. This review researched articles using the databases of PubMed, Science Direct, Scopus, Scielo and BVS published in English and Portuguese. Twenty-eight articles from Brazil, India, Bangladesh, the Philippines and Indonesia were included. The Kaplan-Meier method, which derives the log-rank test, and Cox's proportional hazards regression, which obtains the hazard ratio, were applied. The mean follow-up until the following outcomes were: (I) leprosy (2.3 years) in the population who were exposed to it, (II) relapse (5.9 years), (III) clinical manifestations before, during and after treatment-nerve function impairment (5.2 years), leprosy reactions (4.9 years) and physical disability (8.3 years) in the population of patients with leprosy. Therefore, the use of survival analysis will enable the evaluation of national leprosy programs and assist in the decision-making process to face public health problems.

Prevalence of trachoma in Pernambuco State, Brazil (2014-2015).

To estimate the prevalence of cases of trachoma in the population at social risk aged 1-9 years in Pernambuco State and its mesoregions. This was a cross-sectional study in which secondary data from the National Household Survey on Trachoma (2014-2015) were analyzed. The study covered 96 census tracts distributed across the mesoregions of Pernambuco State (Metropolitan Region of Recife, Zona da Mata, Agreste, Sertao do Sao Francisco and Sertao Pernambucano). The study included all homes with children aged 1-9 years, and all of them were examined for trachoma, using the WHO criteria. Among the total of 7,423 children aged 1-9 years who participated in this survey, 446 presented with active trachoma. Thus, the prevalence of trachoma in Pernambuco State, in children between 1-9 years old was 6.65%, and it was higher among children aged 5-9 years (7.12%) and among girls (7.23%). This result was seen in the majority of the mesoregions studied, except in the Zona da Mata and Sertao do Sao Francisco, where there were higher prevalences in the age group of 1-4 years (5.55%) and among boys (5.90%). A tendency towards a higher prevalence between 1 and 6 years of age was observed. The follicular trachoma continues to be an important public health problem in Pernambuco State. It particularly affects poor people, including those living in urban areas of the State.

Predicting the detection of leprosy in a hyperendemic area of Brazil: Using time series analysis.

BACKGROUND: Brazil has the second highest prevalence of leprosy worldwide. Autoregressive integrated moving average models are useful tools in surveillance systems because they provide reliable forecasts from epidemiological time series. AIM: To evaluate the temporal patterns of leprosy detection from 2001 to 2015 and forecast for 2020 in a hyperendemic area in northeastern Brazil. METHODS: A cross-sectional study was conducted using monthly leprosy detection from the Brazil information system for notifiable diseases. The Box-Jenkins method was applied to fit a seasonal autoregressive integrated moving average model. Forecasting models (95% prediction interval) were developed to predict leprosy detection for 2020. RESULTS: A total of 44,578 cases were registered with a mean of 247.7 cases per month. The best-fitted model to make forecasts was the seasonal autoregressive integrated moving average ((1,1,1); (1,1,1)). It was predicted 0.32 cases/100,000 inhabitants to January of 2016 and 0.38 cases/100,000 inhabitants to December of 2020. LIMITATIONS: This study used secondary data from Brazil information system for notifiable diseases; hence, leprosy data may be underreported. CONCLUSION: The forecast for leprosy detection rate for December 2020 was < 1 case/100,000 inhabitants. Seasonal autoregressive integrated moving average model has been shown to be appropriate and could be used to forecast leprosy detection rates. Thus, this strategy can be used to facilitate prevention and elimination programmes.

Spatial analysis of epidemiological and quality indicators of health services for leprosy in hyperendemic areas in Northeastern Brazil.

Leprosy is a public health problem due to the physical disabilities and deformities it causes. This study aimed to describe new leprosy cases using an operational classification and analyzing spatial patterns by means of epidemiological and quality indicators of health services in Pernambuco State, Brazil, between 2005 and 2014. This was an ecological study performed in 184 municipalities grouped into 12 health regions units for analysis. To analyze spatial patterns, the Bayesian local empirical method and Moran's spatial autocorrelation indicator were applied and box and Moran maps were used. Individuals aged ≥15 years old, grade zero physical disability and complete remission as the treatment outcome were predominant in both paucibacillary and multibacillary cases, the only difference was the predominance of females (n=9,286; 63.00%) and males (n=8,564; 60.70%), respectively. These variables were correlated (p<0.05) with the operational classification. The overall detection rate showed three high-priority areas; the indicator rate of grade 2 physical disability revealed clusters in regions IV, V, and VI; and the indicator rate of cases with some degree of disability showed precarious municipalities in seven health regions. Pernambuco maintains an active chain of transmission and ongoing endemicity of leprosy. Therefore, spatial analysis methods allow the identification of priority areas for intervention, thereby supporting the disease elimination strategy.

Spatial dynamics and socioeconomic factors correlated with American cutaneous leishmaniasis in Pernambuco, Brazil from 2008 to 2017.

INTRODUCTION: American cutaneous leishmaniasis (ACL) is a public health problem and has been associated with country's territory. We aimed to analyze the spatial dynamics and socioeconomic factors correlated to the incidence of ACL in Pernambuco, Brazil from 2008 to 2017. METHODS: A cross-sectional, ecological study was conducted in the Brazilian municipalities. Patient data were obtained from the Health Hazard Notification System (SINAN); indicators and incidence for the total period and for quinquennium were obtained. Socioeconomic factors were analyzed to evaluate the association between the incidence of ACL and presence of bathroom and running water, garbage collection availability, inadequate water supply, sanitation, rural population, per capita income, and vulnerability to poverty. Spatial analysis considered the gross incidence; the Bayesian local empirical method and Moran spatial autocorrelation index were applied using Terra View and QGIS. RESULTS: The incidence of ACL reduced (0.29/100,000 inhabitants per year). Individuals with ACL were young adults (30.3%), men (60.2%), brown skinned (62.9%), rural residents (70.6%), and less educated (46.7%); had autochthonous transmission (78.8%); developed the cutaneous form (97.2%); had evolution to cure (82.7%); and were diagnosed using the clinical epidemiological criterion (70.5%). ACL occurred in the large part of the state and showed heterogeneous distribution, with persistence of two high priority intervention clusters covering Health Regions I, II, III, IV, and XII. CONCLUSIONS: Spatial analysis and epidemiological indicators complement each other. The combination of these methods can improve the understanding on ACL occurrence, which will help subsidize planning and enhance the quality and effectiveness of healthcare interventions.

Spatial dynamics and socioeconomic factors correlated with American cutaneous leishmaniasis in Pernambuco, Brazil from 2008 to 2017

Abstract INTRODUCTION: American cutaneous leishmaniasis (ACL) is a public health problem and has been associated with country's territory. We aimed to analyze the spatial dynamics and socioeconomic factors correlated to the incidence of ACL in Pernambuco, Brazil from 2008 to 2017. METHODS: A cross-sectional, ecological study was conducted in the Brazilian municipalities. Patient data were obtained from the Health Hazard Notification System (SINAN); indicators and incidence for the total period and for quinquennium were obtained. Socioeconomic factors were analyzed to evaluate the association between the incidence of ACL and presence of bathroom and running water, garbage collection availability, inadequate water supply, sanitation, rural population, per capita income, and vulnerability to poverty. Spatial analysis considered the gross incidence; the Bayesian local empirical method and Moran spatial autocorrelation index were applied using Terra View and QGIS. RESULTS: The incidence of ACL reduced (0.29/100,000 inhabitants per year). Individuals with ACL were young adults (30.3%), men (60.2%), brown skinned (62.9%), rural residents (70.6%), and less educated (46.7%); had autochthonous transmission (78.8%); developed the cutaneous form (97.2%); had evolution to cure (82.7%); and were diagnosed using the clinical epidemiological criterion (70.5%). ACL occurred in the large part of the state and showed heterogeneous distribution, with persistence of two high priority intervention clusters covering Health Regions I, II, III, IV, and XII. CONCLUSIONS: Spatial analysis and epidemiological indicators complement each other. The combination of these methods can improve the understanding on ACL occurrence, which will help subsidize planning and enhance the quality and effectiveness of healthcare interventions.

Relationship of databases of live births and infant deaths for analysis of congenital malformations / Análise das malformações congênitas a partir do relacionamento das bases de dados de nascidos vivos e óbitos infantis

Abstract Objectives: to describe the prevalence of congenital malformations in live births in Recife, based on the relationship of birth and infant death data. Methods: a cross-sectional study with data from the Live Birth Information System (Sinasc) and Mortality (MIS) of residents in Recife-PE between 2013 and 2015. The deterministic linkage of deaths and live births (LB) with malformation and the prevalence rate were calculated. Results: 545 (95.1%) deaths and live births were matched. According to the Sinasc, the prevalence of congenital malformations was 10.4 per 1,000 LB. After the linkage, the rate was 12.4. Malformations of the musculoskeletal system (42.1%) among live births were high-lighted, as well as malformations of the circulatory system (35.3%) found in infant deaths. Conclusions: linkage increased the prevalence of congenital malformations in the studied cohort. This demonstrates the potential of this strategy for the monitoring of congenital malformations, which can be used to monitor infant death.

Resumo Objetivos: descrever a prevalência das malformações congênitas em nascidos vivos no Recife, com base no relacionamento de dados de nascimentos e óbitos infantis . Métodos: estudo transversal com dados do Sistema de Informações sobre Nascidos Vivos (Sinasc) e Mortalidade (SIM) de residentes no Recife-PE, entre 2013 e 2015. Realizou-se linkage determinístico dos óbitos e nascidos vivos (NV) com malformação e calculou-se a prevalência. Resultados: obteve-se o pareamento de 545 (95,1%) declarações de óbito e de nascidos vivos. Segundo o Sinasc a prevalência de malformações congênitas foi de 10,4 por 1.000 NV; após o linkage a taxa foi de 12,4. Destacaram-se as malformações do aparelho osteomuscular (42,1%) entre os nascidos vivos, e nos óbitos as do aparelho circulatório (35,3%). Conclusões: o linkage aumentou a prevalência de malformações congênitas nas crianças estudadas. Isso indica a potencialidade dessa estratégia para o monitoramento das malformações congênitas, podendo ser empregada na vigilância do óbito infantil.

Household Survey of Trachoma among Children Living in Pernambuco, Brazil.

This study analyzed the association between individual and household factors and the incidence of trachoma among a population aged between 1 and 9 years in the state of Pernambuco. This was a population-based household study conducted using a population-based sample of residents from 96 census sectors of the 1778 sectors considered to be at social risk in the state. The estimated odds ratio of the univariate analysis presented a confidence interval of 95%. Weights and clusters were adjusted through the Generalized Linear and Latent Mixed Model (GLLAM) method. Trachoma cases were the dependent variable in the multivariate analysis. The independent variables were selected through the stepwise forward method, with an input criterion of 20% (p < 0.20) and an output criterion of 10% (p < 0.10). The prevalence was 6.65%. Trachoma was associated with a female sex, age of 5-9 years, either the absence of use or infrequent use of soap to wash the hands and face, the presence of nasal secretion, a lack of piped water from a public supply system, a greater number of rooms used for sleeping, a greater number of people living in the same household, and a family income of up to one minimum monthly wage. The prevalence of follicular trachoma in Pernambuco was higher than what is recommended by the World Health Organization (WHO).

Spatial analysis of reported new cases and local risk of leprosy in hyper-endemic situation in Northeastern Brazil.

OBJECTIVE: To analyse the spatial distribution of the incidence of leprosy and identify areas at risk for occurrences of hyper-endemic disease in Northeastern Brazil. METHODS: Ecological study using municipalities as the analysis unit. Data on new cases of leprosy came from the Health Hazard Notification System (SINAN). This study focused on Pernambuco and covered the years 2005 to 2014. Indicators for monitoring were calculated per 100 000 inhabitants. The local empirical Bayes method was used to minimise rate variance, and spatial autocorrelation maps were used for spatial pattern analysis (box maps and Moran maps). RESULTS: A total of 28 895 new cases were registered in the study period. The average incidence was 21.88/100 000; the global Moran's I index was 0.36 (P < 0.01), thus indicating the existence of spatial dependence; and the Moran map identified 20 municipalities with high priority for attention. The average incidence rate among individuals under 15 years of age was 8.78/100 000; the global Moran's I index showed the presence of positive spatial autocorrelation (0.43; P < 0.01), and the Moran map showed a main cluster of 15 hyper-endemic municipalities. The average rate of grade 2 physical disability at the time of diagnosis was 1.12/100 000; the global Moran index presented a positive spatial association (0.17; P < 0.01); and the Moran map located clusters of municipalities (high-high) in three mesoregions. CONCLUSION: Application of different spatial analysis methods made it possible to locate areas that would not have been identified by epidemiological indicators alone.