Bridging the Gaps: Investigating the Complex Impact of the COVID-19 Pandemic on Tuberculosis Records in Brazil.

BACKGROUND: This study aimed to analyze the temporal evolution, spatial distribution, and impact of the COVID-19 pandemic on tuberculosis records in a northeastern state of Brazil. METHODS: This is an ecological study involving all diagnoses of Tuberculosis (TB) in residents of the state of Pernambuco/Brazil. Data were extracted from the National System of Notifiable Diseases. A pre-pandemic COVID-19 temporal analysis (2001-2019), a spatial analysis before (2015-2019) and during the first two pandemic years (2020-2021), and the impact of the COVID-19 pandemic on cases of TB diagnoses in Pernambuco in the years 2020 and 2021 were performed. Inflection point regression models, Global and Local Moran's statistics, and spatial scan statistics were used. RESULTS: In the period from 2001 to 2019, 91,225 cases of TB were registered in Pernambuco (48.40/100,000 inhabitants), with a tendency of growth starting in 2007 (0.7% per year; p = 0.005). In the pre-pandemic period (2015-2019), 10.8% (n = 20) of Pernambuco municipalities had TB incidence rates below 10/100,000. In 2020, this percentage reached 27.0% (n = 50) and in 2021 it was 17.8% (n = 33). Risk clusters were identified in the eastern region of the state, with five clusters in the pre-pandemic period and in 2021 and six in 2020. In the first year of the pandemic, an 8.5% reduction in the number of new TB cases was observed. In 2021, the state showed a slight increase (1.1%) in the number of new TB cases. CONCLUSIONS: The data indicate that the COVID-19 pandemic may have caused a reduction in the number of new TB case reports in the state of Pernambuco, Brazil.

Temporal trend, space risk and factors associated with the occurrence of dengue in northeast Brazil, 2009-2018.

BACKGROUND: Dengue is an acute viral disease of major relevance and impact on public health, causing major epidemics around the world, especially in tropical regions. Here we aimed to analyse the temporal trend and spatial risk, as well as social vulnerability factors, associated with the occurrence of dengue in the state of Bahia, Brazil between 2009 and 2018. METHODS: This is an ecological study carried out with all suspected cases of dengue in Bahia between 2009 and 2018. The data were obtained from the National Notifiable Diseases Information System, available on the website of the Health Department of the State of Bahia, and from the Brazilian Institute of Geography and Statistics. We used the Joinpoint regression model, local empirical Bayesian model for smoothing, global and local Moran statistics and spatial scanning statistics. The relationship between the dengue incidence rate and social determinants was tested using Moran's bivariate correlation. RESULTS: During the study period, 451 847 probable dengue cases were registered in Bahia. A declining trend was observed in 39.28% (n=11) of the state's health regions and 60.71% (n=17) showed a stationary tendency. The spatiotemporal scanning statistic showed nine clusters of dengue occurrence. The largest cluster had a radius of 342.14 km, consisting of 160 municipalities, 120 094 cases (710.20 cases/100 000 inhabitants) and a relative risk of 2.80. In the multivariate regression model, 11 variables showed a significant association: Social Vulnerability Index (SVI), Municipal Human Development Index (MHDI), SVI urban infrastructure, SVI human capital, MHDI longevity, MHDI education, proportion of people living in households with per capita income less than half the minimum wage (in 2010) and who spend more than 1 h commuting, proportion of mothers who are heads of household who did not complete elementary school and with children <15 y of age, activity rate of persons ages 10-14 y and per capita income. CONCLUSIONS: In the analysis of the spatial distribution, areas of risk of disease transmission throughout the state were identified. These results can provide subsidies for the strategic planning of actions, as well as for the implementation of programs and/or public policies in order to control the incidence of dengue in the population.

Epidemiological, neurofunctional profile and prevalence of factors associated with the occurrence of physical disabilities due to leprosy in a reference center in Northeast Brasil: a sectional study.

OBJECTIVE: To describe the epidemiological and neurofunctional profile, as well as the prevalence of factors associated with the occurrence of physical disabilities due to leprosy in a reference center in Northeast Brasil. METHODS: A cross-sectional study including 50 leprosy patients diagnosed in Juazeiro-Bahia. Variables analyzed: sex, age, history of leprosy in the family, time to diagnosis, clinical form, operational classification, degree of disability, eyes-hand-foot score, peripheral nerve function, muscle strength and sensitivity. Descriptive statistics and inferential statistics (χ² test or Fisher's exact, Poisson regression with robust estimation and prevalence reason were used. Significance of 5%). RESULTS: An equal distribution was found between men and women of economically active age and low education; multibacillary forms in men (64%) and paucibacillary forms in women (60%). 78% of individuals had some degree of disability and 64% had a compromised ulnar nerve. Plantar sensitivity was decreased in 66% of patients. The predictors of disability were: age ≥45 years (PR 1.44; p=0.005), no education (PR 1.21; p=0.013) and OMP score ≥6 (PR 1.29; p<0.001). CONCLUSION: The findings show the importance of monitoring neural functions and developing measures that allow early diagnosis, the opportune method and the prevention of disabilities, especially in the male population.

Impact of the COVID-19 pandemic on the diagnosis of new leprosy cases in Northeastern Brazil, 2020.

This study analyzed the impact of the COVID-19 pandemic on the detection of new cases of leprosy in the state of Bahia, Brazil. The periods January-September 2019 and January-September 2020 were compared. There was a 44.40% reduction in the diagnosis of leprosy when comparing the two periods (1,705 in 2019 and 948 in 2020). There was a reduction in the number of municipalities with reported cases: 251 municipalities in 2019 and 202 in 2020, expressing a reduction of 24.25%. Considering only the months following the arrival of the virus (April-September), the reduction was 51.10%. An inverse correlation was observed between the number of new cases of leprosy and the cumulative number of cases of COVID-19 (Spearman's correlation coefficient = -0.840; P < 0.001) and the number of new monthly cases of COVID-19 (Spearman's correlation coefficient = -0.817; P < 0.001). A slight increase was also observed in the proportion of multibacillary cases in the state (70.38% in 2019 and 72.69% in 2020) as well as in the proportion of individuals with the degree of physical disability not assessed at diagnosis, whose proportion rose from 16.39% in 2019 to 22.53% in 2020. The negative impact of COVID-19 in tackling leprosy should be seen as a warning sign for health and political authorities.

Leprosy in the elderly population of an endemic state in the Brazilian Northeast (2001-2017): epidemiological scenario.

This ecological study aims to analyze both the tendency and the characteristics of leprosy in the elderly population in the state of Bahia, 2001-2017. The tendency was analyzed through joinpoint regression. Epidemiological variables were also included in the study. The average detection rate was 38.73/100,000, with prevalence of men (45.19/100,000). A downward trend occurred in both genders, from 2004, with a greater magnitude in women (annual percent change [APC]=-3.4%). Men presented higher proportions of the multibacillary forms and physical disabilities. The epidemiological scenario indicates the need of implementation of actions that stimulate early diagnosis and treatment of the elderly population.

Time trend of infant mortality in Pernambuco, 2001-2019: a population-based ecological study / Tendência temporal da mortalidade infantil em Pernambuco, 2001-2019: um estudo ecológico de base populacional

Abstract Objectives: to analyze the temporal trend and spatial distribution of infant mortality in Pernambuco from 2001 to 2019. Methods: an ecological study involving all deaths in children under one year of age living in the state. Data were collected from the Mortality Information System and the Live Birth Information System. Four mortality rates were calculated and the temporal analysis was performed by applying the regression model by inflection points of the rates at different spatial levels. Results: 47,949 deaths were recorded, of which 51.0% (n=24,447) occurred in the first six days of life. A statistically significant downward trend was observed in all the rates analyzed (-4.5%/year in overall mortality, -3.6%/year in early neonatal mortality, -1.9%/year in the late neonatal component, and -6.3%/year in the post-neonatal component). Additionally, 64.3% of the municipalities (n=119) showed a declining trend in the overall infant mortality rate. Less than 50% of the municipalities showed a downward trend in early neonatal and late neonatal mortality (41.08%; n=76 and 43.2%; n=80, respectively). In post-neonatal mortality, 57.3% (n=106) showed decreasing trends. Conclusions: there was a temporal trend of decline in overall infant mortality, although there is an important portion of municipalities with a stationary trend, justifying the need to reduce social inequalities and geographical asymmetries.

Resumo Objetivos: analisar a tendência temporal e a distribuição espacial da mortalidade infantil em Pernambuco no período de 2001 a 2019. Métodos: estudo ecológico envolvendo todos os óbitos em crianças menores de um ano residentes no estado. Os dados foram coletados no Sistema de Informações sobre Mortalidade e no Sistema de Informação sobre Nascidos Vivos. Foram calculados quatro coeficientes de mortalidade e a análise temporal foi realizada aplicando o modelo de regressão por pontos de inflexão dos coeficientes em diferentes níveis espaciais. Resultados: foram registrados 47.949 óbitos, dos quais 51,0% (n=24.447) ocorreram nos seis primeiros dias de vida. Foi observada tendência de declínio estatisticamente significativo em todos os coeficientes analisados (-4,5%/ano na mortalidade geral, -3,6%/ano na neonatal precoce, -1,9%/ano no componente neonatal tardio e de -6,3%/ano no componente pós-neonatal). Adicionalmente, 64,3% dos municípios (n=119) apresentaram tendência de declínio no coeficiente de mortalidade infantil geral. Menos de 50% dos municípios apresentaram tendência de redução na mortalidade neonatal precoce e neonatal tardia (41,08%; n=76 e 43,2%; n=80, respectivamente). Na mortalidade pós-neonatal, 57,3% (n=106) apresentaram tendências decrescentes. Conclusões: houve tendência temporal de declínio da mortalidade infantil geral, embora haja importante parcela de municípios com tendência estacionária, justificando a necessidade de reduzir desigualdades sociais e assimetrias geográficas.

Epidemiological, neurofunctional profile and prevalence of factors associated with the occurrence of physical disabilities due to leprosy in a reference center in Northeast Brasil: a sectional study

SUMMARY OBJECTIVE: To describe the epidemiological and neurofunctional profile, as well as the prevalence of factors associated with the occurrence of physical disabilities due to leprosy in a reference center in Northeast Brasil. METHODS: A cross-sectional study including 50 leprosy patients diagnosed in Juazeiro-Bahia. Variables analyzed: sex, age, history of leprosy in the family, time to diagnosis, clinical form, operational classification, degree of disability, eyes-hand-foot score, peripheral nerve function, muscle strength and sensitivity. Descriptive statistics and inferential statistics (χ² test or Fisher's exact, Poisson regression with robust estimation and prevalence reason were used. Significance of 5%). RESULTS: An equal distribution was found between men and women of economically active age and low education; multibacillary forms in men (64%) and paucibacillary forms in women (60%). 78% of individuals had some degree of disability and 64% had a compromised ulnar nerve. Plantar sensitivity was decreased in 66% of patients. The predictors of disability were: age ≥45 years (PR 1.44; p=0.005), no education (PR 1.21; p=0.013) and OMP score ≥6 (PR 1.29; p<0.001). CONCLUSION: The findings show the importance of monitoring neural functions and developing measures that allow early diagnosis, the opportune method and the prevention of disabilities, especially in the male population.

Leprosy in the elderly population of an endemic state in the Brazilian Northeast (2001-2017): epidemiological scenario

Abstract This ecological study aims to analyze both the tendency and the characteristics of leprosy in the elderly population in the state of Bahia, 2001-2017. The tendency was analyzed through joinpoint regression. Epidemiological variables were also included in the study. The average detection rate was 38.73/100,000, with prevalence of men (45.19/100,000). A downward trend occurred in both genders, from 2004, with a greater magnitude in women (annual percent change [APC] = −3.4%). Men presented higher proportions of the multibacillary forms and physical disabilities. The epidemiological scenario indicates the need of implementation of actions that stimulate early diagnosis and treatment of the elderly population.

Characterization of leprosy in children under 15 years inan important municipality of north-eastern Brazil / Caracterização da hanseníase em menores de 15 anos em município prioritário do nordeste brasileiro

The presence of leprosy in children younger than 15 years is a strong indicator of the maintenance of the epidemiologicalchain of transmission and evidences of the early exposure. This study aims to identify the family, clinical andepidemiological characteristics of individuals younger than 15 years who were diagnosed with leprosy in the city ofJuazeiro-BA. This is an observational, cross-sectional and descriptive study. The study population consisted of all casesof leprosy diagnosed in children under 15 between 2012 and 2014, in the city of Juazeiro-BA. The ComplementaryProtocol for the Diagnostic Investigation of Cases of Leprosy in Children Under 15 (PCID <15) was used as the datasource. The protocol was completed at the time of diagnosis at the Leprosy Reference Centre of the municipality understudy. This document is part of the medical records of the patients being treated, and is filed in the outpatient clinic. Afterthe data collection, the data were analyzed using the SPSS software version 20. Adoption of significance was 95%. 42cases were diagnosed in the age group studied, and the mean annual detection coefficient was 24.85 cases / 100,000individuals in this age group. Of the total, 66.7% were female. The mean age of the girls was lower than the mean ageof the boys, with a significant difference between the genders (p = 0.021). The anamnesis showed that in 33.3% of thecases, the first diagnosis was wrong and leprosy was treated as other diseases. It is also noted that 54.8% of patientshad a family history of leprosy. The tuberculoid form and paucibacillary operational classification stood out (88.0% and90.5%, respectively). The study showed that PCID <15 years is an important instrument capable of identifying problemsin the quality of leprosy services, such as the fragility in the diagnosis of the disease in the population under 15 years

A presença da hanseníase em menores de 15 anos é um forte indicador da manutenção da cadeia epidemiológica detransmissão, além de evidenciar a exposição precoce. Este trabalho teve como objetivo identificar as característicasfamiliares, clínicas e epidemiológicas dos indivíduos menores de 15 anos diagnosticados com hanseníase no municípiode Juazeiro/BA. Trata-se de um estudo observacional, transversal e descritivo. A população do estudo foi composta portodos os casos de hanseníase diagnosticados em menores de 15 anos entre 2012 e 2014, no município de Juazeiro/BA.Como fonte de dados foi utilizado o Protocolo Complementar de Investigação Diagnóstica de Casos de Hanseníaseem menores de 15 anos– PCID<15 anos, preenchidos no momento do diagnóstico no Centro de Referência emHanseníase do município estudado. Este documento é parte do prontuário dos pacientes atendidos e arquivadosno referido ambulatório. Após a coleta, os dados foram analisados utilizando o software SPSS, versão 20. Adotousignificância de 95%. Foram diagnosticados 42 casos na faixa etária estudada, sendo o coeficiente de detecção médioanual de 24,85 casos/ 100 mil indivíduos nessa faixa etária. Desse total, 66,7% eram do sexo feminino. A média deidade das meninas foi inferior à média de idade dos meninos, com diferença significativa entre os gêneros (p=0,021). Aanamnese mostrou que em 33,3% dos casos houve um primeiro diagnóstico errado, sendo a hanseníase tratada comooutras doenças. Chama atenção também que 54,8% dos pacientes tinham histórico de hanseníase na família. A formatuberculóide e a classificação operacional Paucibacilar destacaram-se (88,0% e 90,5%, respectivamente). O estudomostrou que o PCID<15 anos é um importante instrumento capaz de identificar problemas na qualidade dos serviçosde hanseníase, como a fragilidade no diagnóstico da doença na população menor de 15 anos

Grau de incapacidade física na população idosa afetada pela hanseníase no estado da Bahia, Brasil / Physical disability degree in the elderly population affected by leprosy in the state of Bahia, Brazil

Objetivo: Analisar o grau de incapacidade física na população idosa afetada pela hanseníase no estado da Bahia, entre 2001 e 2012. Métodos: Os dados referentes aos casos de hanseníase foram obtidos do Sistema Nacional de Agravos de Notificação. Variáveis analisadas: sexo, faixa etária, raça/cor, escolaridade, classificação clínica e operacional, grau de incapacidade física no diagnóstico e na alta. Foram calculados indicadores epidemiológicos relacionados à incapacidade física. Resultados: A hanseníase apresenta elevada magnitude na população idosa, com coeficiente de detecção de casos novos superior ao da população geral, situando-se em nível hiperendêmico. Quanto ao perfil epidemiológico da hanseníase em idosos, destaca-se: homens, faixa etária 60 a 69 anos, raça branca, baixa escolaridade, forma clínica dimorfa e classificação operacional multibacilar. 36,25% dos casos diagnosticados apresentavam incapacidade física no momento do diagnóstico, com destaque para o gênero masculino. Conclusão: A elevada proporção de indivíduos com incapacidades físicas no momento do diagnóstico sugere diagnóstico tardio e prevalência oculta da doença, sobretudo em indivíduos do gênero masculino

Objective: To analyze the degree of physical disability in the elderly population affected by leprosy in Bahia State, between 2001 and 2012. Methods: The data relating to cases of leprosy was obtained from National System of Notifiable Diseases. Variables analyzed gender, age, race/color, education level, clinical and operational classification, degree of physical incapacity in diagnosis and discharge. Epidemiological indicators related to physical incapacity were calculated. Results: The leprosy features high magnitude in the elderly population, with a coefficient of detection of new cases higher than the general population, situated at a hyperendemic level. As to the epidemiological profile of leprosy in elderly, stands out: men, age 60 to 69 years, white race, low education level, dimorphic clinical manifestation and multibacillary operational classification. 36.25% of diagnosed cases had a physical incapacity at the time of diagnosis, with emphasis on the masculine gender. Conclusion: The high proportion of individuals with physical incapacity at the time of diagnosis suggests late diagnosis and hidden prevalence of the disease, mostly in Individuals of the male gender