Characterization of cases and epidemiological and operational indicators of leprosy: analysis of time series and spatial distribution, Piauí state, Brazil, 2007-2021.

OBJECTIVE: To analyze epidemiological characteristics, temporal trends and spatial distribution of leprosy cases and indicators in the state of Piauí, 2007-2021. METHODS: This was an ecological time-series study using data from the Notifiable Health Conditions Information System, describing the spatial distribution and the temporal trend of leprosy using Prais-Winsten regression. RESULTS: A total of 17,075 new cases of leprosy were reported. There was a falling trend in the overall detection rate [annual percentage change (APC) = -6.3; 95%CI -8.1;-4.5)], detection in children under 15 years of age (APC = -8,6; 95%CI -12,7;-4,3) and detection of cases with grade 2 physical disability (APC = -4,4; 95%CI -7,0;-1,8). There was a rising trend in the proportion of multibacillary cases. Spatial distribution of the average detection rate identified hyperendemic areas in the Carnaubais, Entre Rios, Vale dos Rios Piauí e Itaueiras regions. CONCLUSION: High leprosy detection rates were found, despite the falling trend of indicators, except the proportion of multibacillary cases. MAIN RESULTS: Between 2007 and 2021, Piauí showed an improving trend in all indicators analyzed, except the proportion of new multibacillary cases. Spatial distribution identified hyperendemic areas in different regions of the state. IMPLICATIONS FOR SERVICES: This study provides health services with a broad overview of the epidemiological situation of leprosy in Piauí, with evidence of the populations and locations most affected by the disease, whereby public authorities need to reinforce the promotion of health actions. PERSPECTIVES: It is expected that actions to prevent and control the disease will be adopted, such as offering early diagnosis, ensuring correct treatment and implementing measures to prevent physical disabilities.

Epidemiology and grade 2 disability of leprosy among migrant and resident patients in Guangdong: an unignorable continued transmission of leprosy.

Introduction: Leprosy remains a major public health concern worldwide and one of the leading causes of disability. New cases of leprosy with grade 2 disability (G2D) often reflect delayed detection due to the limited capacity of the health system to recognize leprosy early. This study aimed to describe the epidemiology and G2D of leprosy among migrant and resident patients with leprosy in Guangdong province, China. Methods: Data on newly diagnosed cases of leprosy were collected from the leprosy management information system in China. Descriptive statistical analysis was used to describe the status of G2D. Joinpoint regression model and logistic regression were performed to analyze the temporal trends and influencing factors for G2D. Results: The G2D rate among migrant, resident, and total patients with leprosy was 17.5%, 18.7%, and 18.4%, respectively. The total G2D rate increased significantly from 18.0% in 2001 to 25.7% in 2021 (average annual per cent change: 2.5%). Multivariate analysis revealed that factors that negatively influence G2D between migrant and resident patients included delayed discovery time (migrants: OR = 2.57; residents: OR = 4.99) and nerve damage when diagnosed (migrants: OR = 9.40; residents: OR = 21.28). Discussion: Our findings indicate that the targeted intervention measures implemented by our health system are urgently needed to improve the current situation, such as programs to promote early detection, strengthen awareness and skills of healthcare workers, and rehabilitation for disabled patients to improve their quality of life.

Impact of basic psychological support on stigma and the mental well-being of people with disabilities due to leprosy and lymphatic filariasis: a postintervention evaluation study.

BACKGROUND: A peer support intervention, called basic psychological support for people affected by neglected tropical diseases (BPS-N), was piloted in India to improve mental well-being and social participation and to reduce stigma among people with disabilities due to leprosy or lymphatic filariasis. Preintervention and postintervention assessments showed improvements in mental well-being and reductions in depression and stigma. This study aimed to further evaluate this intervention at approximately 2 mo after its completion. METHODS: Scales were administered to 62 clients to measure stigma, depression, mental well-being and participation levels. Interviews with 13 clients and six peer supporters were conducted. RESULTS: Stigma scores were significantly reduced at 2 mo postintervention compared with preintervention and postintervention. The improvement in mental well-being detected at immediate postintervention had not changed significantly 2 mo later. Depression levels were higher than at postintervention, but lower than at preintervention levels. No significant differences were found in median participation scores, but the number of clients with moderate and severe participation restrictions reduced significantly from postintervention to 2 mo follow-up. Qualitative results showed that clients received information about their condition and treatment, and that some experienced positive effects on their emotions and self-esteem. CONCLUSIONS: This study provides additional evidence on the proof of concept of BPS-N. CONTEXTE: Une intervention de soutien par les pairs, appelée Soutien psychologique de base pour les personnes atteintes de maladies tropicales négligées (BPS-N), a été pilotée en Inde afin d'améliorer le bien-être mental et la participation sociale, et de réduire la stigmatisation, chez les personnes souffrant d'incapacités dues à la lèpre ou à la filariose lymphatique. Les évaluations avant et après l'intervention ont montré une amélioration du bien-être mental et une réduction de la dépression et de la stigmatisation chez ces personnes. Cette étude avait pour but d'évaluer cette intervention environ 2 mois après son achèvement. MÉTHODES: Des échelles ont été administrées à 62 clients pour mesurer la stigmatisation, la dépression, le bien-être mental et les niveaux de participation. Des entretiens ont été menés avec 13 clients et 6 pairs aidants. RÉSULTATS: Les scores de stigmatisation ont été significativement réduits deux mois après l'intervention par rapport à la situation avant et après l'intervention. L'amélioration du bien-être mental détectée immédiatement après l'intervention n'a pas changé de manière significative deux mois plus tard. Les niveaux de dépression étaient plus élevés qu'après l'intervention, mais plus bas qu'avant l'intervention. Aucune différence significative n'a été constatée dans les scores médians de participation, mais le nombre de clients ayant des restrictions de participation modérées et sévères a diminué de manière significative entre la période post-intervention et les deux mois de suivi. Les résultats qualitatifs ont montré que les clients ont reçu des informations sur leur état et leur traitement, et que certains ont ressenti des effets positifs sur leurs émotions et leur estime de soi. CONCLUSIONS: Cette étude a fourni des preuves supplémentaires de l'efficacité de la BPS-N. INTRODUCCIÓN: Una intervención de apoyo entre iguales, denominada Apoyo Psicológico Básico para personas afectadas por enfermedades tropicales desatendidas (BPS-N), se puso a prueba en la India para mejorar el bienestar mental y la participación social y reducir el estigma entre las personas con discapacidades debidas a la lepra o la filariasis linfática. Las evaluaciones previas y posteriores a la intervención mostraron mejoras en el bienestar mental y reducciones en la depresión y el estigma. El objetivo de este estudio era seguir evaluando esta intervención ∼2 meses después de su finalización. MÉTODOS: Se administraron escalas a 62 clientes para medir el estigma, la depresión, el bienestar mental y los niveles de participación. Se realizaron entrevistas con 13 clientes y 6 compañeros de apoyo. RESULTADOS: Las puntuaciones de estigma se redujeron significativamente a los 2 meses de la intervención, en comparación con antes y después de la misma. La mejora del bienestar mental detectada inmediatamente después de la intervención no había cambiado significativamente 2 meses después. Los niveles de depresión eran más altos que en el postintervención, pero más bajos que en el preintervención. No se encontraron diferencias significativas en las puntuaciones medias de participación, pero el número de clientes con restricciones de participación moderadas y graves se redujo significativamente entre el periodo posterior a la intervención y los 2 meses de seguimiento. Los resultados cualitativos mostraron que los clientes recibieron información sobre su enfermedad y tratamiento, y que algunos experimentaron efectos positivos en sus emociones y autoestima. CONCLUSIONES: Este estudio aportó pruebas adicionales sobre la prueba de concepto de la BPS-N.

Steps towards eliminating Hansen's disease stigma.

Persons affected by Hansen's disease (PAHD) can develop long-term physical disabilities and psychological problems if the disease is not managed promptly and correctly. The complex and multi-faceted nature of stigma related to Hansen's Disease, and the discrimination arising from it, demands multiple parallel steps to improve the health, well-being and lived experience of People Affected by Hansen's Disease, including: 1) adoption and pursuance of a human rights based approach; 2) revocation of discriminatory laws; 3) education and training for healthcare workers; 4) new techniques and therapies to diagnose and treat HD without side-effects and to reduce risk of disabilities; 5) elimination of stigmatising terminology.

An evaluation protocol of 'Replicability Model' project for detection and treatment of leprosy and related disability in Chhattisgarh, India.

INTRODUCTION: People affected by leprosy are at increased risk of impairments and deformities from peripheral nerve damage. This mostly occurs if diagnosis and treatment is delayed and contributes to continued transmission within the community. Champa district of Chhattisgarh state in India is an endemic area with the highest national annual case detection and disability rates for leprosy. The Replicability Model is a system strengthening intervention implemented by the Leprosy Mission Trust India in Champa that aims to promote early diagnosis and treatment of leprosy, improve on-going management of the effects of leprosy and improve welfare for the people affected by leprosy. This protocol presents a plan to describe the overall implementation of the Replicability Model and describe the barriers and facilitators encountered in the process. We will also quantify the effect of the program on one of its key aims- early leprosy diagnosis. METHODS: The replicability model will be implemented over four years, and the work described in this protocol will be conducted in the same timeframe. We have two Work Packages (WPs). In WP1, we will conduct a process evaluation. This will include three methods i) observations of replicability model implementation teams' monthly meetings ii) key informant interviews (n = 10) and interviews with stakeholders (n = 30) iii) observations of key actors (n = 15). Our purpose is to describe the implementation process and identify barriers and facilitators to successful implementation. WP2 will be a quantitative study to track existing and new cases of leprosy using routinely collected data. If the intervention is successful, we expect to see an increase in cases (with a higher proportion detected at an early clinical stage) followed by a decrease in total cases. CONCLUSION: This study will enable us to improve and disseminate the Replicability Model by identifying factors that promote success. It will also identify its effectiveness in fulfilling one of its aims: reducing the incidence of leprosy by finding and tracking cases at an earlier stage in the disease.

Implementing community based inclusive development for people with disability in Latin America: a mixed methods perspective on prioritized needs and lessons learned.

BACKGROUND: Research on the needs of people with disability is scarce, which promotes inadequate programs. Community Based Inclusive Development interventions aim to promote rights but demand a high level of community participation. This study aimed to identify prioritized needs as well as lessons learned for successful project implementation in different Latin American communities. METHODS: This study was based on a Community Based Inclusive Development project conducted from 2018 to 2021 led by a Columbian team in Columbia, Brazil and Bolivia. Within a sequential mixed methods design, we first retrospectively analyzed the project baseline data and then conducted Focus Group Discussions, together with ratings of community participation levels. Quantitative descriptive and between group analysis of the baseline survey were used to identify and compare sociodemographic characteristics and prioritized needs of participating communities. We conducted qualitative thematic analysis on Focus Group Discussions, using deductive main categories for triangulation: 1) prioritized needs and 2) lessons learned, with subcategories project impact, facilitators, barriers and community participation. Community participation was assessed via spidergrams. Key findings were compared with triangulation protocols. RESULTS: A total of 348 people with disability from 6 urban settings participated in the baseline survey, with a mean age of 37.6 years (SD 23.8). Out of these, 18 participated within the four Focus Group Discussions. Less than half of the survey participants were able to read and calculate (42.0%) and reported knowledge on health care routes (46.0%). Unemployment (87.9%) and inadequate housing (57.8%) were other prioritized needs across countries. Focus Group Discussions revealed needs within health, education, livelihood, social and empowerment domains. Participants highlighted positive project impact in work inclusion, self-esteem and ability for self-advocacy. Facilitators included individual leadership, community networks and previous reputation of participating organizations. Barriers against successful project implementation were inadequate contextualization, lack of resources and on-site support, mostly due to the COVID-19 pandemic. The overall level of community participation was high (mean score 4.0/5) with lower levels in Brazil (3.8/5) and Bolivia (3.2/5). CONCLUSION: People with disability still face significant needs. Community Based Inclusive Development can initiate positive changes, but adequate contextualization and on-site support should be assured.

Características sociodemográficas e epidemiológicas relacionadas ao grau de incapacidade física em hanseníase no estado da Paraíba, Brasil / Sociodemographic and epidemiological characteristics related to the degree of physical disability in leprosy in the state of Paraíba, Brazil

Objetivou-se analisar a associação entre características sociodemográficas e clínicas com o desenvolvimento dos graus de incapacidades físicas 1 ou 2 em pessoas com diagnóstico de hanseníase na Paraíba, Brasil. Estudo ecológico, de base populacional, que teve como unidades de análises os 223 municípios do estado. Os dados foram coletados no Núcleo de Doenças Crônicas e Negligenciadas/Hanseníase, pertencente à Gerência Executiva de Vigilância em Saúde da Secretaria de Saúde do estado da Paraíba em junho de 2021, após extração do Sistema de Informação Nacional de Agravos de Notificação. O banco de dados reuniu 2.468 casos novos de hanseníase registrados no período de 2016 a 2020. A chance de uma pessoa diagnosticada com hanseníase desenvolver a incapacidade física 1 ou 2 é maior nas pessoas de sexo masculino, com 15 anos ou mais, estudo formal menor ou igual a nove anos, classificação operacional multibacilar, com mais de cinco lesões e mais de um nervo afetado, além de baciloscopia positiva. Políticas de educação em saúde são fortemente recomendadas no intuito de melhorar o conhecimento dos profissionais e da comunidade. Abordagens sobre a hanseníase, diagnóstico precoce, busca ativa, vigilância e acompanhamento dos casos e de seus contatos, além das incapacidades físicas, em especial para pessoas de maior vulnerabilidade a desenvolvê-las, são fundamentais.(AU)

The objective was to analyze the association between sociodemographic and clinical characteristics with the development of physical physical disabilities of grades 1 and 2 in people diagnosed with leprosy in Paraíba, Brazil. It's an ecological study, population-based, which had the 223 municipalities at the Center of Chronic and Neglected Diseases/Leprosy belonging to the Health Surveillance Executive Management of Health Department of Paraíba State in June 2021, after extraction from the Notifiable Diseases Information System. The database gathered 2,468 new cases of leprosy registered in the period from 2016 to 2020. The probability of a person diagnosed with leprosy developing physical disability 1 or 2 is greater in males, aged 15 or over, formal education less than or equal to nine years, operational classification multibacillary, with more than five lesions and more than one affected nerve, in addition to positive bacilloscopy. Health education policies are strongly recommended in order to improve the knowledge of professionals and the community. Approaches about leprosy, early diagnosis, active search, surveillance and follow-up of cases and their contacts, in addition to physical disabilities, especially for people who are more vulnerable to develop them, are fundamental.(AU)

Evolução do grau de incapacidade física e do escore olhos, mãos e pés em casos novos de hanseníase: do diagnóstico à alta medicamentosa / Evolution of the degree of physical disability and the eye, hand and foot score in new cases of leprosy: from diagnosis to medication discharge

Este estudo tem por objetivo avaliar a evolução do grau de incapacidade física e do escore olhos, mãos e pés, do diagnóstico à alta medicamentosa, segundo as variáveis sociodemográficas e clínicas, em pacientes diagnosticados com hanseníase. Trata-se de estudo transversal, baseado na análise de 71 pacientes com diagnóstico de hanseníase, acompanhados no Hospital Eduardo de Menezes, centro de referência em Belo Horizonte, Minas Gerais, Brasil, entre janeiro de 2017 a dezembro de 2020. Foi observado predomínio do sexo feminino (53,5%), média de idade de 46 anos, sendo a maioria procedente de outros municípios do interior de Minas Gerais (54,9%). A forma clínica mais frequente foi a dimorfa (64,8%), classificação operacional multibacilar (84,5%). O grau de incapacidade física 0 foi o mais prevalente no diagnóstico (56,5%) e na alta (53,1%), e em relação ao escore olhos, mãos e pés, houve variação entre 0 e 10 no diagnóstico e entre 0 e 8 na alta. Pelo teste de McNemar foi observado que dentre os pacientes que apresentavam algum grau de incapacidade física no momento do diagnóstico, 30,8% apresentaram ausência de incapacidade na alta. Ao comparar a evolução do grau de incapacidade física de paucibacilares e multibacilares no momento do diagnóstico e da alta, houve manutenção em 59,3% e melhora em 17,2% dos pacientes. Os dados apresentados indicam que muitos pacientes foram tratados tardiamente já apresentando as formas graves e com sequelas, já que o estudo foi desenvolvido em um centro de referência, que atende casos mais complexos e com complicações já instaladas. Os dados sugerem que pacientes assistidos que realizam o tratamento com poliquimioterapia podem ter melhora das incapacidades já instaladas. O mesmo ocorreu com o escore olhos, mãos e pés, que ao final do tratamento instituído houve melhora se comparado com a admissão.(AU)

This study aims to evaluate the evolution of the degree of physical disability and the eye, hand and foot score, from diagnosis to medication discharge, according to sociodemographic and clinical variables, in patients diagnosed with leprosy. This is a cross-sectional study, based on the analysis of 71 patients diagnosed with leprosy, followed by Hospital Eduardo de Menezes, a reference center in Belo Horizonte, Minas Gerais, Brazil, between January 2017 and December 2020. There was a predominance of females (53.5%), average age of 46 years old, the majority coming from other municipalities in the interior of Minas Gerais (54.9%). The most frequent clinical form was borderline (64.8%), multibacillary operational classification (84.5%). Degree of physical disability 0 was the most prevalent at diagnosis (56.5%) and at discharge (53.1%); in relation to the eye, hand and foot score, there was variation between 0 and 10 at diagnosis and between 0 and 8 at discharge. By the McNemar test, it was observed that of the patients who had degree of physical disability at the time of diagnosis, 30.8% had no disability at discharge. When comparing the evolution of the GIF in paucibacillary and multibacillary patients at the time of diagnosis and discharge, there was maintenance in 59.3% and improvement in 17.2% of the patients. The presented data indicates that many patients were treated late, already presenting severe forms and with sequelae, since the study was carried out in a reference center, which treats cases with complications already installed and more complex cases. The data suggest that assisted patients undergoing treatment with multidrug therapy may experience improvement in disabilities already established. The same occurred with eye, hand and foot score, at the end of the established treatment there was an improvement compared to admission.(AU)

Clinico-Epidemiological profile of new leprosy cases detected in leprosy case detection campaign in North Maharashtra during 2018-2020.

Leprosy is a leading cause of disability in India. The percentage of disability and deformity can be reduced by diagnosing leprosy at an early stage. In order to detect the hidden leprosy cases, leprosy case detection campaigns, on line with Pulse Polio Campaign have been introduced specifically for high endemic districts, by the Central Leprosy Division. Records of cases from 2018 to 2020 were evaluated retrospectively to study the trend of new cases. The present study denotes the presence of hidden undiagnosed cases in the community and will require an intensification of leprosy control activities through contact tracing and active case detection. Continued quality surveillance is required for early detection, timely management, and prevention of the spread of the disease.

Determinant factors of leprosy-related disability; comparison of acceleration failure time and parametric shared frailty models.

BACKGROUND: Leprosy is an illness persisting for a long time or constantly recurring brought about by Mycobacterium leprae. The collusion of the causing agent with Schwann cells leads to incapable of being changed loss of fringe nerve tissue; followed by incapacity and that is not restricted to actual powerlessness yet additionally makes a negative picture, prompting segregation and social disgrace against the altered people also, their families. METHODS: The analysis of this study comprises 205 samples of patients at All African TB and Leprosy Rehabilitation and Training Centre from January 2015 up to December 2019 G.C who were taking medication for leprosy and who possess all necessary data. Territorial conditions in the region of the patients were utilized as a clustering impact in all frailty models. Acceleration failure time models and parametric shared frailty models with Weibull and log-strategic patterns were utilized to dissect hazard factors related to disability ensued by leprosy. All fitted models were looked at by utilizing AIC. RESULTS: From that of 205, 69(33.7%) experienced at least one kind of disability grade during treatment taking. In light of AIC, log-logistic-gamma shared frailty model was the final best fitting model and also there was considerable variation among patients. The final model showed the age of patients, symptom duration, treatment category of patients, and sensory loss were found to be the most significant determinants of leprosy disability. CONCLUSION: In this investigation, there is proof of heterogeneity at the group level and disability was related to the age of patients, symptom duration, treatment category of patient, what's more, sensory loss subsequently, uncommon consideration ought to be given to these huge indicators, which eventually diminish the event of disability. To lessen the patient-related postponement, the program should lay more noteworthy accentuation on bringing issues to light in the local area by zeroing in on key messages like indications, inability result of the late discovery, accessibility of free treatment what's more, accessibility of disease care in general wellbeing office.

Epidemiological characteristics of leprosy from 2000 to 2019 in a state with low endemicity in southern Brazil.

BACKGROUND: Leprosy is an infectious and contagious disease caused by Mycobacterium leprae and is mainly characterized by lesions in the skin and peripheral nerves. In Brazil, it is a public health problem due to its high endemicity. However, the state of Rio Grande do Sul presents low endemicity of this disease. OBJECTIVE: To characterize the epidemiological profile of leprosy in the state of Rio Grande do Sul from 2000 to 2019. METHODS: This was a retrospective observational study. Epidemiological data were collected from the Notifiable Diseases Information System (SINAN, Sistema de Informação de Agravos de Notificação). RESULTS: Among the 497 municipalities in the state, 357 (71.8%) registered cases of leprosy in the assessed period, with an average of 212 (81.5%) new cases per year. The average detection rate was 1.61 new cases per 100,000 inhabitants. The male sex was predominant (51.9%) and the mean age was 50.4 years. Regarding the epidemiological clinical profile; 79.0% of the patients were multibacillary; 37.5% presented the borderline clinical form; 16% had grade 2 physical disability at diagnosis and bacilloscopy was positive in 35.4% of cases. As for treatment, 73.8% of the cases were treated with the standard multibacillary therapeutic regimen. STUDY LIMITATIONS: There were missing/inconsistent data in the database available. CONCLUSIONS: The findings observed in this study indicate that the state presents a low endemicity profile of the disease and these results can support adequate health policies relevant to the reality of Rio Grande do Sul, inserted in a national scenario of highly endemic leprosy.

Leprosy among new child cases in China: Epidemiological and clinical analysis from 2011 to 2020.

BACKGROUND: Leprosy, caused by Mycobacterium leprae infection, mainly affects skin and peripheral nerves and may further lead to disability and deformity if not treated timely. The new case detection rate of leprosy in children reflects the active transmission of leprosy infection. This study aims to present the epidemiology and clinical characteristics of new leprosy cases in children in China from 2011 to 2020. METHODOLOGY/PRINCIPAL FINDINGS: All data from leprosy patients younger than 15 years old were extracted from the Leprosy Management Information System in China (LEPMIS). Statistical Package for the Social Sciences (SPSS) version 12.0 was used for descriptive and analytical statistics of the epidemiological and clinical indicators by the Mann-Whitney test, Kruskal-Wallis test, and Fisher's exact test. And geographical distribution was analyzed by ArcGIS 10.5. A total of 152 pediatric new cases of leprosy were found over the last decade. The new case detection rate of pediatric leprosy cases decreased from 0.13 to 0.02 per 1,000,000 population over the last ten years. New pediatric cases had a higher new case detection rate in Guizhou, Sichuan, and Yunnan Provinces. All but 7 provinces in China achieved zero new child case for consecutive five years. The onset of leprosy peaked between 10 and 14 years of age, and the male to female ratio was 1.71:1. Pediatric patients were predominantly infected from symptomatic household adult contacts HHCs. Multibacillary leprosy (MB) was the most common. However, a low proportion of patients developed leprosy reaction and grade 2 disability. CONCLUSIONS/SIGNIFICANCE: The new case detection rate of pediatric leprosy cases has decreased over the past ten years in China. Spatial analysis indicated clusters in high-endemic areas. Leprosy transmission has stopped in the majority of provinces in China. However, sporadic cases may continue to exist for a long time. Active surveillance especially contact tracing should be focused on in future plan for management of leprosy, and interventions in leprosy clusters should be prioritized.

Clusters of risk for the occurrence of leprosy and disabilities in children under 15 years of age in Cuiabá: a geospatial study. / Aglomerados de risco para ocorrência de hanseníase e as incapacidades em menores de 15 anos em Cuiabá: um estudo geoespacial.

OBJECTIVE: This study aimed to analyze the spatial distribution of leprosy and disabilities in children under 15 years of age in Cuiabá. METHODS: Ecological study carried out in the city of Cuiabá, Mato Grosso, Brazil. The study population consisted of leprosy cases in children under 15 years old notified in the Notifiable Diseases Information System, between 2008 and 2018. Based on residential addresses, cases were georeferenced. In the analysis of the spatial distribution of the cases, the estimation of the Kernel density was used and, later, the statistics of spatial, spatio-temporal and Spatial Variation in Temporal Trends were applied. RESULTS: 514 cases of leprosy were reported in children under 15 years of age in Cuiabá, with a percentage of 10.1% of cases with degree of physical disability 1 and 2.3% with degree of physical disability 2 at the time of diagnosis. With the techniques of spatial and spatio-temporal scanning, clusters of risk for leprosy were identified in the North, West, East and South regions of Cuiabá, and with the technique of Spatial Variation in Temporal Trends, a cluster was identified in the West region of Cuiabá. CONCLUSION: In Cuiabá, cases of leprosy in children under 15 years of age with disabilities were distributed throughout the urban area of the city, with the highest density of cases in the North and West regions, followed by the East region. The clusters with the highest Relative Risk were identified in the East and West regions, characterized by having low and medium income levels.

OBJETIVO: Este estudo teve como objetivo analisar a distribuição espacial da hanseníase e as incapacidades em menores de 15 anos de idade em Cuiabá. MÉTODOS: Estudo ecológico realizado na cidade de Cuiabá, Mato Grosso, Brasil. A população do estudo foi composta de casos de hanseníase em menores de 15 anos notificados no Sistema de Informações de Agravos de Notificação, entre os anos de 2008 e 2018. Com base nos endereços residenciais, os casos foram georreferenciados. Na análise da distribuição espacial dos casos, foi utilizada a estimativa da densidade de Kernel e, posteriormente, aplicada a estatística de varredura espacial, espaço-temporal e variação espacial nas tendências temporais. RESULTADOS: Foram notificados 514 casos de hanseníase em menores de 15 anos em Cuiabá, com percentual de 10,1% de casos com grau de incapacidade física 1 e 2,3% com grau de incapacidade física 2 no momento do diagnóstico. Com as técnicas de varredura espacial e espaço-temporal, foram identificados aglomerados de risco para hanseníase nas regiões norte, oeste, leste e sul de Cuiabá, e com a técnica de variação espacial nas tendências temporais foi identificado um aglomerado na região oeste de Cuiabá. CONCLUSÃO: Em Cuiabá, os casos de hanseníase em menores de 15 anos com incapacidades estavam distribuídos em toda a extensão urbana da cidade, com maior densidade de casos nas regiões norte e oeste, seguida da região leste. Os aglomerados de maior risco relativo foram identificados nas regiões leste e oeste, caracterizadas por apresentar baixo e médio níveis de renda.

Comprometimento da saúde no pós-alta de pacientes tratados por hanseníase e fatores relacionados: revisão de escopo / Post-discharge health impairment of patients treated for leprosy and related factors: scope review / Deterioro de la salud tras el alta en pacientes tratados por lepra y factores re-lacionados: una revisión general

Objetivo: mapear evidências na literatura científica sobre o comprometimento de saúde no pós-alta de pacientes tratados por Hanseníase e fatores relacionados. Materiais e Método: revisão de escopo realizada a partir das bases de dados CINAHL, LILACS, MEDLINE, PUBMED, SCOPUS e Web of Science em março de 2021, norteados pela estratégia mnemônica que auxilia na identificação do Problema, Conceito e Contexto propostos pelo Instituto Joanna Briggs, sistematizados por meio do fluxograma PRISMA-ScR e registrados na Open Science Framework (osf.io/vmdc6). Foram incluídos estudos sobre a temática publicados até fevereiro de 2021 no cenário nacional e internacional. Resultados: dos dez artigos incluídos na amostra final, nove evidenciaram algum grau de comprometimento funcional, demonstrando fragilidades no acompanhamento desde o diagnóstico até o período pós-alta. Conclusões: evidencia-se acometimentos com maior frequência sobretudo de ordem física, que impactam diretamente a funcionalidade nas atividades de vida diária e social dessas pessoas. As fragilidades no monitoramento pós-alta foram relacionadas ao déficit de profissionais capacitados, ao desconhecimento de técnicas de avaliação e classificação do grau de incapacidade, à carência na oferta de educação em saúde, à dificuldade de acesso aos serviços de saúde, ao atraso no tratamento dos episódios reacionais e reabilitação biopsicossocial e à ausência da sistematização do cuidado.(AU)

Objective: to map evidence in the scientific literature on the post-discharge health impairment of patients treated for leprosy and related factors. Materials and Method: scope review carried out from the CINAHL, LILACS, MEDLINE, PUBMED, SCOPUS and Web of Science databases in March 2021, guided by the mnemonic strategy that helps to identify the Problem, Concept and Context proposed by the Joanna Institute Briggs, systematized through the PRISMA-ScR flowchart, and registered in the Open Science Framework (osf.io/vmdc6). Studies on the subject published until February 2021 in the national and international scenario were included. Results: of the ten articles included in the final sample, nine showed some degree of functional impairment, demonstrating weaknesses in follow-up from diagnosis to the post-discharge period. Conclusions: there is evidence of more frequent involvement, especially of a physical nature, which directly impact the functionality of these people's daily and social activities. Weaknesses in post-discharge monitoring were related to the lack of trained professionals, lack of knowledge of assessment techniques and classification of the degree of disability, lack of health education provision, difficulty in accessing health services, delay in treatment of reactional episodes and biopsychosocial rehabilitation and the absence of systematization of care.(AU)

Objetivo: mapear en la literatura científica las evidencias sobre el deterioro de la salud post-alta en pacientes tratados por lepra y factores relacionados. Materiales y Métodos: revisión de alcance realizada a partir de las bases de datos CINAHL, LILACS, MEDLINE, PUBMED, SCOPUS y Web of Science en marzo de 2021, guiada por la estrategia mnemotécnica que ayu-da a identificar el Problema, Concepto y Contexto propuesta por el Instituto Joanna Briggs, sistematizada a través del flujograma PRISMA-ScR y registrada en el Open Science Framework (osf.io/vmdc6). Fueron incluidos estudios sobre el tema, publicados hasta febrero de 2021, en el escenario nacional e internacional. Resultados: de los diez artículos incluidos en la muestra final, nueve mostraron algún grado de deterioro funcional, demostrando debilidades en el seguimiento desde el diagnóstico hasta el período posterior al alta. Conclusiones: se evidencia con mayor frecuencia ataques sobre todo de orden físico que impactan directamente en la funcionalidad en las actividades de la vida diaria y social de las personas. Fragilidades en el seguimiento postoperatorio relacionadas con el déficit de profesionales capacitados, el desco-nocimiento de las técnicas de evaluación y clasificación del grado de incapacidad, la carencia en la oferta de educación en salud, la dificultad de acceso a los servicios de salud, el retraso en el tratamiento de los episodios reaccionarios y la rehabilitación biopsicosocial y la ausencia de...(AU)

Determinants of patients' delay with disability in the diagnosed leprosy cases in the three major states of India: A case-control study.

BACKGROUND: Skin lesions are the most common early symptoms of leprosy, often ignored by patients at an early stage and misdiagnosed as other dermatological diseases by healthcare personnel, leading to delay in diagnosis and treatment of leprosy precipitating permanent neurological deficit, deformities and serious disabilities. AIMS: The objective is to evaluate the duration of delay and factors responsible for the delay in reporting of patients, among the newly detected leprosy cases (Grade 1 and Grade 2 disability patients). METHODS: A case-control study was conducted during 2014-2016 in three major states of India (Delhi, Gujarat and West Bengal) in 140 randomly recruited newly registered adult leprosy patients (aged 18 years and above) with Grade 2/1 disabilities (cases) and 140 Grade 0 disability patients (controls) in each of these Indian states. RESULTS: It is established that the major contributors for the delay in the early diagnosis of leprosy have been patient-related factors. The median patient delay in the three states of Delhi, Gujarat and West Bengal were five months (0.7-1.8), 2.8 months (2-14) and 12 months (2-24), respectively. LIMITATIONS: The study design is case-control and has an inbuilt reporting bias due to the retrospective nature of data collection but the data collection was carried with caution to reduce the recall bias. As the study is carried out in three states, generalisation of interpretation was cautiously executed. The matching ratio of cases and controls was 1:1 in this study, but we could not increase the controls due to operational feasibility during the conduct of the study. CONCLUSION: Patient delay is a crucial factor responsible for the disability among new leprosy cases. A higher patient delay in these three states reflects that the community is not aware about the signs and symptoms of leprosy. Reducing patient delay is very important for reducing disabilities in the newly diagnosed cases.

The burden of physical disability among patients with newly detected leprosy in Yunnan, China, 1990-2020: A population-based, cross-sectional survey.

BACKGROUND: Physical disability is the main complication of leprosy. Although understanding the leprosy rate, prevalence, spatiotemporal distribution, and physical nerve characteristic trends is crucial for the implementation of leprosy control programs and identification of remaining challenges, these data are still unclear. We assessed physical disability trends among newly detected leprosy cases over the past 31 years in 129 counties and territories in Yunnan, China. METHODOLOGY/PRINCIPAL FINDINGS: We analyzed the data of newly detected leprosy cases from the Leprosy Management Information System in Yunnan, China, from 1990-2020. All available data related to physical disability were analyzed, including demographic characteristics (sex, age, ethnicity, education level); clinical characteristics (diagnosis duration, detection mode, contact history, leprosy reaction, skin lesions, nerve lesions, disability classification); World Health Organization (WHO) leprosy physical disability indicators; and nerve and eyes, hands and feet (EHF) involvement. A total of 10758 newly diagnosed leprosy cases were identified, and 7328 (65.60%), 1179 (10.55%) and 2251 (20.15%) were associated with grade 0, 1, and 2 disability (G0D, G1D, and G2D), respectively. Male sex, older age, Han ethnicity, urban employment, a longer diagnosis duration, a contact history, greater nerve involvement, and tuberculoid-related forms of leprosy were associated with increased prevalence rates of physical disability. The rates of physical disability in newly detected leprosy cases per 1 million population decreased from 5.41, 2.83, and 8.24 in 1990 to 0.29, 0.25, and 0.54 per 1 million population in 2020, with decreases of 94.64%, 91.17%, and 93.44% in G2D, G1D and total physical disability (G1D + G2D) rates, respectively. In the same period, the proportions of G2D, G1D and total physical disability decreased from 28.02%, 14.65%, and 42.67% in 1990 to 10.08%, 11.76%, and 21.85% in 2020, with decreases of 64.03%, 19.73%, and 48.79%, respectively. Nerve thickening was more common than nerve tenderness, and claw hand, plantar insensitivity, and lagophthalmos were the most frequently reported EHF-related disabilities. CONCLUSIONS: Despite general progress in reducing the prevalence of leprosy-related physical disability, the proportion of physical disability among leprosy disease remains high, especially in specific counties. This implies that leprosy cases are being detected at a later stage and that transmission in the community still exists. Further efforts focusing on early detection are crucial for leprosy control and the elimination of the disease burden.

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.

Tecnologias educacionais associadas à prevenção de incapacidades advindas da hanseníase / Educational technologies associated with the prevention of disabilities arising from leansesis / Tecnologías educativas asociadas a la prevención de discapacidades derivadas de leansesis

Objetivo:Identificar as tecnologias educacionais existentes para a prevenção de incapacidades advindas da hanseníase. Métodos:Trata-se de uma revisão de escopo, que utilizoucomo fonte de coleta as bases de dados SCOPUS, MEDLINE/PubMed, Embase, Cochrane Library, CINAHL/EBSCO, Science Direct, LILACS, IBECS, BDENF e Web of Science, entre julho e setembro de 2021. Aplicou-se os descritores Tecnologia Educacional, Hanseníase e Pessoa com Incapacidade Física, com o operador booleano AND, em português e inglês. Resultados:Encontrou-se 218 artigos e, após a exclusão dos estudos que não contemplaram os critérios de elegibilidade, três artigos compuseram a amostra final. Conclusão:Astecnologias educacionais existentes contemplam materiais expositivos, como manual de autocuidado, panfletos educacionais, cartilhas, folhetos impressos, kit para curativos das úlceras e vídeo, além de palestras educativas, capacitações e grupos de apoio. No entanto, mesmo havendo essa existência, observou-se que há limitações quanto à disponibilidade para o público-alvo de modo geral.

Objective:To identify existing educational technologies for the prevention of disabilities resulting from leprosy. Methods:This is a scope review, which used the SCOPUS, MEDLINE/PubMed, Embase, Cochrane Library, CINAHL/EBSCO, Science Direct, LILACS, IBECS, BDENF and Web of Science databases as a source of collection. July and September 2021. The descriptors Educational Technology, Leprosy and Person with Physical Disability were applied, with the Boolean operator AND, in Portuguese and English. Results:218 articles were found and, after excluding studies that did not meet the eligibility criteria, three articles made up the final sample. Conclusion:Existing educational technologies include expository materials, such as a self-care manual, educational pamphlets, booklets, printed leaflets, ulcer dressing kits and video, in addition to educational lectures, training and support groups. However, even with this existence, it was observed that there are limitations regarding availability to the target audience in general.

Objetivo:Identificar las tecnologías educativas existentes para la prevención de discapacidades derivadas de la lepra. Métodos:Se trata de una revisión de alcance, que utilizó como fuente de recolección las bases de datos SCOPUS, MEDLINE/PubMed, Embase, Cochrane Library, CINAHL/EBSCO, Science Direct, LILACS, IBECS, BDENF y Web of Science, julio y septiembre de 2021. Se aplicaron los descriptores Tecnología Educativa, Lepra y Persona con Discapacidad Física, con el operador booleano AND, en portugués e inglés. Resultados:se encontraron 218 artículos y, después de excluir los estudios que no cumplían con los criterios de elegibilidad, tres artículos conformaron la muestra final. Conclusión: Las tecnologías educativas existentes incluyen materiales expositivos, como un manual de autocuidado, folletos educativos, cuadernillos, folletos impresos, kits de apósitos para úlceras y video, además de conferencias educativas, grupos de capacitación y apoyo. Sin embargo, aun con esta existencia, se observó que existen limitaciones en cuanto a la disponibilidad para el público objetivo en general.

Prolonged delays in leprosy case detection in a leprosy hot spot setting in Eastern Ethiopia.

BACKGROUND: Leprosy or Hansen's disease is known to cause disability and disfigurement. A delay in case detection of leprosy patients can lead to severe outcomes. In Ethiopia, the disability rates caused by leprosy among new cases are relatively high compared to other endemic countries. This suggests the existence of hidden leprosy cases in the community and a delay in timely detection. To reduce disability rates, it is crucial to identify the factors associated with this delay. This study aimed to determine the extent of delay in case detection among leprosy cases in Eastern Ethiopia. METHODS: This cross-sectional explorative study was conducted in January and February 2019 among 100 leprosy patients diagnosed ≤6 months prior to inclusion. A structured questionnaire was used to collect data, including the initial onset of symptoms, and the reasons for delayed diagnosis. Descriptive statistics, including percentages and medians, were used to describe the case detection delay. Logistic regression analysis was carried out to evaluate the predictors of delay in case detection of >12 months. FINDINGS: The median age of patients was 35 years, with a range of 7 to 72 years. The majority were male (80%) and rural residents (90%). The median delay in case detection was 12 months (interquartile range 10-36 months) among the included patients. The mean delay in case detection was 22 months, with a maximum delay of 96 months. The overall prevalence of disability among the study population was 42% (12% grade I and 30% grade II). Fear of stigma (p = 0.018) and experiencing painless symptoms (p = 0.018) were highly associated with a delay in case detection of >12 months. CONCLUSIONS: Being afraid of stigma and having painless symptoms, which are often misinterpreted as non-alarming at the onset of the disease, were associated with a delay in case detection. This study showed the need to increase knowledge on early symptoms of leprosy among affected communities. Furthermore, it is important to support initiatives that reduce leprosy related stigma and promote health worker training in leprosy control activities.

Social participation restriction among persons with leprosy discharged from a multidrug therapy clinic in northern Nigeria.

BACKGROUND: The burden of leprosy-related disability, stigma and social participation after completing treatment is not well documented in Nigeria. We assessed the extent of disability, level of stigma and predictors of activity limitation and social participation restriction after completing multidrug therapy (MDT) for leprosy in Kano, Nigeria. METHODS: A consecutively recruited cross-section of 354 persons discharged from MDT and 360 community members were interviewed. The Eyes, Hands and Feet sum score, Screening of Activity Limitation and Safety Awareness scale, Participation scale and Jacoby Stigma scale were used for affected persons. The Exploratory Model Interview Catalogue scale was used to assess community-perceived stigma. Levels of disability, activity limitation, participation restriction and stigma were scored. Adjusted ORs for predictors were generated from logistic regression models. RESULTS: Most (91.5%, n=324) respondents had a disability; (8.2%, n=29) and (83.3%, n=295) were WHO grades 1 and 2, respectively. Similarly, 321 participants (90.7%) had activity limitation and 316 respondents (89.3%) experienced participation restriction. Further, 88.7% of participants (n=314) anticipated stigma. Activity limitation was higher among unemployed participants, men, persons with disability and those who anticipated stigma. Participation restriction was higher among low income earners (≤1000 Nigerian Naira per month (equivalent to US$2.50 per month)) and persons with disability, limited activity and anticipated stigma. CONCLUSION: Leprosy-related disability, stigma, activity limitation and social participation restriction are high after treatment. We recommend community-based rehabilitation to sustain self-care, reduce stigma and ensure social inclusion.