Neglected tropical diseases in Brazil: lack of correlation between disease burden, research funding and output.

OBJECTIVES: To assess the correlation between the burden of seven priority neglected tropical diseases (NTDs) included in the Brazilian National Agenda of Priorities in Health Research - tuberculosis, Chagas disease, leprosy, malaria, leishmaniasis, dengue and schistosomiasis - and their respective research funding and output. METHODS: This retrospective review obtained data on disease burden from the Global Burden of Disease Study and funding data from open access sources. Publications were retrieved from Scopus and SciELO, and characterised according to the type of research conducted. Correlation between funding, research output and burden was assessed by comparing the 'expected' and 'observed' values for funding and publications relative to the proportional burden for each disease. RESULTS: There was an emphasis in basic biomedical research (average 30% of publications) and a shortage of health policy and systems (average 7%) and social sciences research (average 3%). Research output and funding were poorly correlated with disease burden. Tuberculosis, Chagas disease and schistosomiasis accounted for more than 75% of total NTD-related DALYs, but accounted for only 34% of publications. Leprosy, leishmaniasis and malaria, together, received 49% of NTD-related funding despite being responsible for only 9% of DALYs. CONCLUSIONS: The analysis evidenced a lack of correlation between disease burden, research output and government funding for priority NTDs in Brazil. Our findings highlight the importance of monitoring health needs, research investments and outputs to inform policy and optimise the uptake of evidence for action, particularly in developing countries, where resources are scarce and the research capacity is limited. The results contribute to health policy by highlighting the need for improving coordination of scientific activities and public health needs for effective impact.

OBJECTIFS: Evaluer la corrélation entre la charge de sept maladies tropicales négligées (MTN) prioritaires incluses dans le programme national brésilien des priorités en matière de recherche en santé - tuberculose, maladie de Chagas, lèpre, paludisme, leishmaniose, dengue et schistosomiase - et leurs financements de recherche respectifs et les résultats. MÉTHODES: Cette revue rétrospective a obtenu des données sur la charge de morbidité de l'étude sur la Charge Globale des Maladies et des données de financement provenant de sources en accès publique. Les publications ont été extraites de Scopus et SciELO et caractérisées selon le type de recherche menée. La corrélation entre le financement, les résultats de la recherche et la charge a été évaluée en comparant les valeurs "attendues" et "observées" pour le financement et les publications par rapport à la charge proportionnel de chaque maladie. RÉSULTATS: L'accent a été mis sur la recherche biomédicale fondamentale (en moyenne 30% des publications) et une pénurie de politiques et de systèmes de santé (en moyenne 7%) et de recherche en sciences sociales (en moyenne 3%). Les résultats et le financement de la recherche étaient mal associés à la charge de morbidité. La tuberculose, la maladie de Chagas et la schistosomiase représentaient plus de 75% du total des EVCI, mais ne représentaient que 34% des publications. La lèpre, la leishmaniose et le paludisme, ensemble, ont reçu 49% des financements liés aux MTN alors qu'ils n'étaient responsables que de 9% des EVCI. CONCLUSIONS: L'analyse a mis en évidence une absence de corrélation entre la charge de morbidité, le résultat de la recherche et le financement de la plupart des MTN. Nos résultats soulignent l'importance du suivi des besoins en matière de santé, des investissements dans la recherche et des résultats pour éclairer les politiques et optimiser l'utilisation des données pour l'action, en particulier dans les pays en développement, où les ressources sont rares et la capacité de recherche est limitée. Les résultats contribuent à la politique de santé en soulignant la nécessité d'améliorer la coordination et la planification stratégique des activités scientifiques pour un impact efficace.

Protective efficacy of BCG against leprosy in Sao Paulo

The case-control study reported here evaluated the protective effect of BCG vacine against leprosy in Sao Paulo, Brazil. Seventy-eight patients under age 16 who had been diagnosed as having leprosy (cases) and 385 healthy individuals (controls) were selected and matched by sex, age, place of residence, and type of exposure to leprosy (intradomiciliary or extradomiciliary). The cases were draw from an active patient registry and from a group of new leprosy cases treated at 50 health centers in the cities of Bauru and Ribeirao Preto in the state of Sao Paulo. In order to estimate the protective effect of BCG, the prevalences of BCG scars in cases and controls were compared. The presence of one or more scars was associated with an estimated protective efficacy of 90 percent (95 percent confidence interval: 78 percent to 96 percent). Stratified analysis by age group, sex, socieconomic level, and clinical form of the disease revealed no significant differences in the protection provided by the vaccine, However, it seems clear that more data will be needed in order to accurately assess the true relevance of BCG for leprosy control programs (AU)

Protective efficacy of BCG against leprosy in Sao Paulo

The case-control study reported here evaluated the protective effect of BCG vacine against leprosy in Sao Paulo, Brazil. Seventy-eight patients under age 16 who had been diagnosed as having leprosy (cases) and 385 healthy individuals (controls) were selected and matched by sex, age, place of residence, and type of exposure to leprosy (intradomiciliary or extradomiciliary). The cases were draw from an active patient registry and from a group of new leprosy cases treated at 50 health centers in the cities of Bauru and Ribeirao Preto in the state of Sao Paulo. In order to estimate the protective effect of BCG, the prevalences of BCG scars in cases and controls were compared. The presence of one or more scars was associated with an estimated protective efficacy of 90 percent (95 percent confidence interval: 78 percent to 96 percent). Stratified analysis by age group, sex, socieconomic level, and clinical form of the disease revealed no significant differences in the protection provided by the vaccine, However, it seems clear that more data will be needed in order to accurately assess the true relevance of BCG for leprosy control programs (AU)

This article was also published in Spanish in the Bol. Ofic. Sanit. Panam. Vol. 119(5):415-22, 1995

Eficacia protectora del BCG contra la lepra en Sao Paulo, Brasil / Protective efficacy of BCG against leprosy in Sao Paulo, Brasil

En este estudio se evaluó el efecto protector contra la lepra de la vacunación con BCG mediante un estudio de casos y controles. Se seleccionaron 97 pacientes menores de 16 años diagnosticados de lepra (casos) y 385 personas sanas (controles), que se aparearon según el sexo, la edad, el lugar de residencia y el tipo de contacto (intra o extradomiciliario). Los casos se seleccionaron de un registro activo de pacientes de lepra y de una serie de casos de lepra incidentes atendidos en 50 centros de la ciudad de Sao Paulo, Brasil. Para estimar el efecto protector del BCG, se compararon las prevalencias de cicatrices del BCG de los casos y controles. La presencia de una o más cicatrices se asoció con una eficacia protectora estimada de 90 por ciento (intervalo de confianza de 95 por ciento: 78 por ciento-96 por ciento). El análisis estratificado por grupos de edad, sexo, nivel socioeconómico y forma clínica de la lepra no puso de manifiesto diferencias importantes de protección de la vacuna. Se analiza el significado de estos hallazgos y la pertinencia de utilizar el BCG en los programas del control de la lepra

Eficacia protectora del BCG contra la lepra en Sao Paulo, Brasil / Protective efficacy of BCG against leprosy in Sao Paulo, Brasil

En este estudio se evaluó el efecto protector contra la lepra de la vacunación con BCG mediante un estudio de casos y controles. Se seleccionaron 97 pacientes menores de 16 años diagnosticados de lepra (casos) y 385 personas sanas (controles), que se aparearon según el sexo, la edad, el lugar de residencia y el tipo de contacto (intra o extradomiciliario). Los casos se seleccionaron de un registro activo de pacientes de lepra y de una serie de casos de lepra incidentes atendidos en 50 centros de la ciudad de Sao Paulo, Brasil. Para estimar el efecto protector del BCG, se compararon las prevalencias de cicatrices del BCG de los casos y controles. La presencia de una o más cicatrices se asoció con una eficacia protectora estimada de 90 por ciento (intervalo de confianza de 95 por ciento: 78 por ciento-96 por ciento). El análisis estratificado por grupos de edad, sexo, nivel socioeconómico y forma clínica de la lepra no puso de manifiesto diferencias importantes de protección de la vacuna. Se analiza el significado de estos hallazgos y la pertinencia de utilizar el BCG en los programas del control de la lepra

Association between leprosy and hepatitis B infection: a survey in Goiânia, central Brazil

This investigation presents the results of hepatitis B virus screening among leprosy patients conducted in central Brazil as a preliminary information for a HBV vaccination programme. The main objectives were to assess the seroprevalence of HBV serum markers among lepromatous patients and to analyse institutionalization as risk factor for HBV infection in this population. Two groups of lepromatous patients were studied, 83 outpatients and 171 institutionalized ones. Screening for HBV serum markers included the detection of HBsAg, anti-HBc by radioimmune assay (RIA). The prevalence of carrier state (HBsAg) was 4.8% and 8.8% among outpatients and institutionalized, respectively, (p > 0.05). Seroprevalence of exposure (all markers) was statistically significant different between outpatients (16.9%) and institutionalized ones (50.3%). Institutionalized patients had an almost four fold risk of HBV infection when compared to the outpatients, and the highest risks were among patients with more than 21 years of residence in the colony, after adjusting for age and sex