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1.
Lancet Glob Health ; 10(5): e640-e648, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35427521

RESUMO

BACKGROUND: Neglected tropical diseases (NTDs) are diseases of poverty and affect 1·5 billion people globally. Conditional cash transfer (CCTs) programmes alleviate poverty in many countries, potentially contributing to improved NTD outcomes. This systematic review examines the relationship between CCTs and screening, incidence, or treatment outcomes of NTDs. METHODS: In this systematic review we searched MEDLINE, Embase, Lilacs, EconLit, Global Health, and grey literature websites on Sept 17, 2020, with no date or language restrictions. Controlled quantitative studies including randomised controlled trials (RCTs) and observational studies evaluating CCT interventions in low-income and middle-income countries were included. Any outcome measures related to WHO's 20 diseases classified as NTDs were included. Studies from high-income countries were excluded. Two authors (AA and TH) extracted data from published studies and appraised risk of biases using the Risk of Bias in Non-Randomised Studies of Interventions and Risk of Bias 2 tools. Results were analysed narratively. This study is registered with PROSPERO, CRD42020202480. FINDINGS: From the search, 5165 records were identified; of these, 11 studies were eligible for inclusion covering four CCTs in Brazil, the Philippines, Mexico, and Zambia. Most studies were either RCTs or quasi-experimental studies and ten were assessed to be of moderate quality. Seven studies reported improved NTD outcomes associated with CCTs, in particular, reduced incidence of leprosy and increased uptake of deworming treatments. There was some evidence of greater benefit of CCTS in lower socioeconomic groups but subgroup analysis was scarce. Methodological weaknesses include self-reported outcomes, missing data, improper randomisation, and differences between CCT and comparator populations in observational studies. The available evidence is currently limited, covering a small proportion of CCTs and NTDs. INTERPRETATION: CCTs can be associated with improved NTD outcomes, and could be driven by both improvements in living standards from cash benefits and direct health effects from conditionalities related to health-care use. This evidence adds to the knowledge of health-improving effects from CCTs in poor and vulnerable populations. FUNDING: None.


Assuntos
Países em Desenvolvimento , Renda , Humanos , Pobreza , Fatores Socioeconômicos , Populações Vulneráveis
2.
PLoS Negl Trop Dis ; 15(6): e0009456, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34166403

RESUMO

BACKGROUND: Ethiopia has over 3,200 new cases of leprosy diagnosed every year. Prevention remains a challenge as transmission pathways are poorly understood. Susceptibility and disease manifestations are highly dependent on individual host-immune response. Nutritional deficiencies, such as protein-energy malnutrition, have been linked to reduced cell-mediated immunity, which in the case of leprosy, could lead to a higher chance of active leprosy and thus an increased reservoir of transmissible infection. METHODOLOGY/PRINCIPAL FINDINGS: Between June and August 2018, recently diagnosed patients with leprosy and individuals without known contact with cases were enrolled as controls in North Gondar regional health centers. Participants answered survey questions on biometric data, demographics, socioeconomic situation, and dietary habits. Descriptive statistics, univariate, and multivariate logisitic regression examined associations between undernutrition, specifically body mass index (BMI), middle upper arm circumference (MUAC), and leprosy. Eighty-one participants (40 cases of leprosy, 41 controls) were enrolled (75% male) with an average age of 38.6 years (SD 18.3). The majority of cases were multibacillary (MB) (90%). There was a high prevalence of undernutrition with 24 (29.6%) participants underweight (BMI <18.5) and 17 (21%) having a low MUAC. On multivariate analysis, underweight was significantly associated with leprosy (aOR = 9.25, 95% CI 2.77, 30.81). Also found to be associated with leprosy was cutting the size of meals/skipping meals (OR = 2.9, 95% CI 1.0, 8.32) or not having enough money for food (OR = 10, 95% CI 3.44 29.06). CONCLUSIONS/SIGNIFICANCE: The results suggest a strong association between leprosy and undernutrition, while also supporting the framework that food insecurity may lead to undernutrition that then could increase susceptibility to leprosy. In conclusion, this study highlights the need to study the interplay of undernutrition, food insecurity, and the manifestations of leprosy.


Assuntos
Insegurança Alimentar/economia , Hanseníase/epidemiologia , Hanseníase/etiologia , Desnutrição/complicações , Desnutrição/epidemiologia , Pobreza , Adulto , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
3.
J Infect Dev Ctries ; 14(6.1): 16S-21S, 2020 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-32614791

RESUMO

INTRODUCTION: The majority of neglected tropical diseases (NTDs) have established primary skin manifestations or associated clinical feature. Skin NTDs often result in physical impairment and disfigurement, which can lead to disability. Skin diseases have been proposed as an entry point for integrated NTDs control. However, the magnitude and overlap of skin NTDs is poorly understood. METHODOLOGY: An institution-based cross-sectional study was done using medical records of dermatology patients between July 2017 and June 2018 in a dermatology service in Northeast Ethiopia. A total of 661 patient records were selected using simple random sampling. RESULTS: A total of 656 complete records were included in analysis. Skin NTDs constituted 17.2% (n = 113) of the overall of skin diseases. Of skin NTDS, cutaneous leishmaniasis (n = 40; 35.4%), leprosy (n = 38; 33.6%), and scabies (n = 31; 27.4%) were the most common. Additionally, there were four cases of mycetoma. Of the non NTDs, poverty-related infections such as superficial fungal (n = 118; 21.1%) and bacterial (n = 33; 5.2%) infections were also frequent. Tinea capitis was the most common superficial fungal infections. Impetigo and cellulitis were the predominant bacterial infections. CONCLUSIONS: Skin NTDsand other poverty related skin infections were common at the dermatology service. Dermatological services could act as a good entry point for integrated management of skin NTDs. Future studies should assess how different preventive strategies like contact tracing, early diagnosis and mass drug administration can be integrated.


Assuntos
Doenças Negligenciadas/diagnóstico , Assistência Centrada no Paciente/métodos , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Negligenciadas/epidemiologia , Pobreza , Dermatopatias/microbiologia , Dermatopatias/parasitologia , Medicina Tropical , Adulto Jovem
4.
PLoS Negl Trop Dis ; 14(6): e0008393, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32598386

RESUMO

BACKGROUND: Non-healing plantar ulcers are one of the significant causes of disability in leprosy patients. Plantar ulcers often take months or years to heal, affecting the patient's quality of life. Presence of comorbid conditions in these patients can delay wound healing. The study aimed to evaluate the role of associated comorbid conditions as risk factors in ulcer healing. METHODOLOGY/PRINCIPAL FINDINGS: A total of 66 leprosy patients with plantar ulcers registered at LEPRA Society-Blue Peter Public Health and Research Center (BPHRC), Hyderabad, India from June 2018 to June 2019 were studied. Comprehensive clinical assessment was done, including screening for comorbid conditions and treated as per the recommended guidelines. About two-thirds of the participants were aged 50 and above, of which more than half were illiterates, and 93.5% were living below the poverty line. Majority of ulcers were seen on the forefoot; with the head of meta-tarsal bone 27 (41.6%) as the commonest site, followed by calcaneum 23 (38.3%) and great toe 10 (16.6%). Mean ulcer depth was 0.61 (0.57) cm, the area was 5.24 (6.73) cm2 and ulcer volume was 4.72 (14.33) cm3. Ulcer dimensions were significantly associated with low body mass index, hypertension and smoking. CONCLUSIONS/SIGNIFICANCE: Identifying the risk factors delaying wound healing and detailed assessment of ulcers are of profound importance to predict the outcome of plantar ulcers in leprosy patients. The study findings indicate the need for better policies by the leprosy control program for the comprehensive management of plantar ulcers.


Assuntos
Comorbidade , Úlcera do Pé/complicações , Hanseníase/complicações , Adulto , Idoso , Estudos Transversais , Feminino , , Úlcera do Pé/epidemiologia , Humanos , Índia/epidemiologia , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Pobreza , Fatores de Risco , Cicatrização
5.
Rev Bras Epidemiol ; 23: e200007, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32130396

RESUMO

INTRODUCTION: Leprosy is a disease that reserves close relation with social and economic conditions. Brazil is the only country that has not yet reached the goal of eliminating the disease as a public health problem. OBJECTIVE: This study aimed to analyze social deprivation in the municipalities of Bahia and its relation with the detection of new cases of leprosy in the population. METHODS: It is an ecological study conducted in the state of Bahia, from 2001 to 2015. Variables analyzed: detection rate of new cases, social deprivation index (SDI) and Hansen's disease in children under 15 years of age. The SDI was built on four variables: socioeconomic performance index, per capita income, proportion of extremely poor, and household density. For spatial analysis, local empirical bayesian modeling and global and local Moran statistics were used. Statistical analysis used multivariate, spatial and logistic regression, odds ratio calculation and analysis of variance. RESULTS: Leprosy showed heterogeneous distribution in the state, with concentration in the north-west and south axis. 60.4% (n = 252) of the municipalities presented very low life conditions. An association was observed between living conditions and the detection of leprosy, with higher coefficients in the municipality group with better living conditions (p < 0.001). CONCLUSION: It was concluded that the worst conditions acted as an impediment to the diagnosis, while increasing the risk of illness. Good conditions have the opposite effect.


INTRODUÇÃO: A hanseníase é uma doença que guarda estreita relação com as condições sociais e econômicas. O Brasil é o único país que ainda não alcançou a meta de eliminação da doença como problema de saúde pública. OBJETIVO: Este trabalho teve como objetivo analisar a associação entre a carência social dos municípios baianos e a detecção de casos novos de hanseníase na população, como instrumento para a definição de áreas prioritárias para intervenção. METODOLOGIA: Trata-se de um estudo ecológico realizado no estado da Bahia, no período de 2001 a 2015. Variáveis analisadas: coeficiente de detecção casos novos, índice de carência social (ICS) e hanseníase em menores de 15 anos. O ICS foi construído com base em quatro variáveis: índice de performance socioeconômica, renda per capita, proporção de extremamente pobres e densidade domiciliar. Na análise espacial, foram utilizadas modelagem bayesiana empírica local e estatística de Moran global e local. Na análise estatística, foram empregados regressão multivariada, espacial e logística, cálculo do odds ratio e análise de variância. RESULTADOS: A hanseníase apresentou distribuição heterogênea no estado, com concentração no eixo norte-oeste e sul. Dos municípios, 60,4% (n = 252) apresentaram muito baixa condição de vida. Observou-se associação entre as condições de vida e a detecção da hanseníase, com maiores coeficientes no grupo de município com melhor condição de vida (p < 0,001). CONCLUSÃO: As piores condições atuaram como um impeditivo ao diagnóstico, ao mesmo tempo que ampliaram o risco de adoecimento. As boas condições possuem efeito inverso.


Assuntos
Hanseníase/epidemiologia , Pobreza/estatística & dados numéricos , Adolescente , Análise de Variância , Brasil/epidemiologia , Criança , Pré-Escolar , Cidades/epidemiologia , Doenças Endêmicas , Feminino , Humanos , Modelos Logísticos , Masculino , Fatores de Risco , Fatores Socioeconômicos , Análise Espacial
7.
PLoS Negl Trop Dis ; 14(1): e0008016, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31929530

RESUMO

BACKGROUND: Although leprosy is portrayed as a disappearing disease, leprosy affected persons in India are still suffering massively. Even further, nearly 60% of the world's newly detected cases are appearing from India alone. The problem has exacerbated due to the drastic decrease of global funding after India's official declaration of 'elimination', which did not foster the actual pain of patients beyond prevalence. Leprosy patients have hardships in their lives due to disabilities, stigma and poverty; thus, they require sustained, continuous care even after release from treatment. Yet, current interventions mostly have a vertical, short-term approach, not showing much progress in lightening the burden of leprosy. In contrast, Little Flower Hospital Community (LFHC) in India has been remarkably providing holistic care for thousands of leprosy patients for 35 years. However, there has not been any research conducted to uncover the underlying factors of this longstanding leprosy control model. Therefore, this research explores the in-depth contextual attributes of this hospital community that has been able to successfully provide sustainable care for a long time even without excessive external funds. METHODS AND FINDINGS: This qualitative research used a grounded theory approach, involving 28 in-depth interviews of 11 patients, 13 workers, and 4 board members from the hospital. The interview data were inductively analyzed to examine the contextual factors of the hospital's sustainability. Open coding, axial coding and selective coding were conducted, and Glaser's Six C's model was used to create a theoretical model of the sustainability of LFHC. The fundamental cause of the sustainability was the leprosy patients' strong craving for life with dignity, despite the isolation from the society. The desire resulted in a bottom-up formation of a 'consumer-provider cooperative', where patients mutually support each other with basic treatment learned from experience. The profits earned from the patients' occupational efforts such as dairy farming, cover the costs needed to manage the hospital community, which contributes to economical sustainability. Social sustainability was established through the holistic care including psychosocial, educational, medical, and residential support. The wholesome care socially rehabilitated the patients to be included in the society with satisfaction, social justice and social cohesion. The main limitation of this study is that this study cannot be generalized due to the nature of Grounded Theory based study. CONCLUSIONS: This study investigated the determinants that made LFHC sustainable, and the findings suggested the importance of forming a cooperative community and implementing social rehabilitation for sustainable leprosy control. More exploration on transferring this model to other leprosy colonies will have great impact in maintaining sustainable care for leprosy patients. Furthermore, this research may highlight the importance of sustainable development in policies targeting neglected tropical diseases beyond leprosy as well.


Assuntos
Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Pessoas com Deficiência , Saúde Holística , Hospitais , Humanos , Índia/epidemiologia , Pobreza , Pesquisa Qualitativa , Estigma Social
8.
Rev. bras. epidemiol ; 23: e200007, 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1092619

RESUMO

RESUMO: Introdução: A hanseníase é uma doença que guarda estreita relação com as condições sociais e econômicas. O Brasil é o único país que ainda não alcançou a meta de eliminação da doença como problema de saúde pública. Objetivo: Este trabalho teve como objetivo analisar a associação entre a carência social dos municípios baianos e a detecção de casos novos de hanseníase na população, como instrumento para a definição de áreas prioritárias para intervenção. Metodologia: Trata-se de um estudo ecológico realizado no estado da Bahia, no período de 2001 a 2015. Variáveis analisadas: coeficiente de detecção casos novos, índice de carência social (ICS) e hanseníase em menores de 15 anos. O ICS foi construído com base em quatro variáveis: índice de performance socioeconômica, renda per capita, proporção de extremamente pobres e densidade domiciliar. Na análise espacial, foram utilizadas modelagem bayesiana empírica local e estatística de Moran global e local. Na análise estatística, foram empregados regressão multivariada, espacial e logística, cálculo do odds ratio e análise de variância. Resultados: A hanseníase apresentou distribuição heterogênea no estado, com concentração no eixo norte-oeste e sul. Dos municípios, 60,4% (n = 252) apresentaram muito baixa condição de vida. Observou-se associação entre as condições de vida e a detecção da hanseníase, com maiores coeficientes no grupo de município com melhor condição de vida (p < 0,001). Conclusão: As piores condições atuaram como um impeditivo ao diagnóstico, ao mesmo tempo que ampliaram o risco de adoecimento. As boas condições possuem efeito inverso.


ABSTRACT: Introduction: Leprosy is a disease that reserves close relation with social and economic conditions. Brazil is the only country that has not yet reached the goal of eliminating the disease as a public health problem. Objective: This study aimed to analyze social deprivation in the municipalities of Bahia and its relation with the detection of new cases of leprosy in the population. Methods: It is an ecological study conducted in the state of Bahia, from 2001 to 2015. Variables analyzed: detection rate of new cases, social deprivation index (SDI) and Hansen's disease in children under 15 years of age. The SDI was built on four variables: socioeconomic performance index, per capita income, proportion of extremely poor, and household density. For spatial analysis, local empirical bayesian modeling and global and local Moran statistics were used. Statistical analysis used multivariate, spatial and logistic regression, odds ratio calculation and analysis of variance. Results: Leprosy showed heterogeneous distribution in the state, with concentration in the north-west and south axis. 60.4% (n = 252) of the municipalities presented very low life conditions. An association was observed between living conditions and the detection of leprosy, with higher coefficients in the municipality group with better living conditions (p < 0.001). Conclusion: It was concluded that the worst conditions acted as an impediment to the diagnosis, while increasing the risk of illness. Good conditions have the opposite effect.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Pobreza/estatística & dados numéricos , Hanseníase/epidemiologia , Fatores Socioeconômicos , Brasil/epidemiologia , Modelos Logísticos , Fatores de Risco , Análise de Variância , Cidades/epidemiologia , Doenças Endêmicas , Análise Espacial
9.
Artigo em Inglês | MEDLINE | ID: mdl-30691157

RESUMO

The consequences of leprosy go beyond the physical, social and psychological, as leprosy can drive persons affected and their families into poverty, stigmatization and disability. This paper describes the impact of a socio-economic development (SED) intervention that uses a twin-track approach (two micro-credit models) to reduce leprosy-related stigma in Cirebon District, Indonesia. A randomized-controlled mixed-methods study design was used to test the effectiveness of the SED intervention. Three scales were used to measure stigma and participation restrictions among 30 SED clients and 57 controls, 20 in-depth interviews with SED clients and seven Focus Group Discussions (FGDs) with key persons were held and 65 profiles of the clients were written up and analysed. The qualitative data shows the socio-economic status of 44 out of 65 SED clients (67%) improved. The median family income increased by 25%, more clients reported higher self-esteem, better interaction with neighbours and less stigma than before, although disclosure concerns remained an issue. The scales indicate a positive effect of the intervention on reducing stigma (e.g., Stigma Assessment and Reduction of Impact (SARI) stigma scale mean difference total score of pre and post assessment for SED clients versus the control group was 8.5 versus 5.6). A twin track socio-economic intervention, if embedded and integrated, can increase participation, and be constructive in reducing leprosy-related stigma.


Assuntos
Desenvolvimento Econômico , Hanseníase/psicologia , Estigma Social , Adolescente , Adulto , Idoso , Pessoas com Deficiência/psicologia , Revelação , Feminino , Grupos Focais , Humanos , Indonésia , Masculino , Pessoa de Meia-Idade , Pobreza , Classe Social , Adulto Jovem
10.
Infect Dis Poverty ; 7(1): 87, 2018 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-30173662

RESUMO

BACKGROUND: Health personnel face challenges in diagnosing vector-borne and other diseases of poverty in urban settings. There is a need to know what rapid diagnostic technologies are available, have been properly assessed, and are being implemented to improve control of these diseases in the urban context. This paper characterizes evidence on the field validation and implementation in urban areas of rapid diagnostics for vector-borne diseases and other diseases of poverty. MAIN BODY: A scoping review was conducted. Peer-reviewed and grey literature were searched using terms describing the targeted infectious diseases, diagnostics evaluations, rapid tests, and urban setting. The review was limited to studies published between 2000 and 2016 in English, Spanish, French, and Portuguese. Inclusion and exclusion criteria were refined post hoc to identify relevant literature regardless of study design and geography. A total of 179 documents of the 7806 initially screened were included in the analysis. Malaria (n = 100) and tuberculosis (n = 47) accounted for the majority of studies that reported diagnostics performance, impact, and implementation outcomes. Fewer studies, assessing mainly performance, were identified for visceral leishmaniasis (n = 9), filariasis and leptospirosis (each n = 5), enteric fever and schistosomiasis (each n = 3), dengue and leprosy (each n = 2), and Chagas disease, human African trypanosomiasis, and cholera (each n = 1). Reported sensitivity of rapid tests was variable depending on several factors. Overall, specificities were high (> 80%), except for schistosomiasis and cholera. Impact and implementation outcomes, mainly acceptability and cost, followed by adoption, feasibility, and sustainability of rapid tests are being evaluated in the field. Challenges to implementing rapid tests range from cultural to technical and administrative issues. CONCLUSIONS: Rapid diagnostic tests for vector-borne and other diseases of poverty are being used in the urban context with demonstrated impact on case detection. However, most evidence comes from malaria rapid diagnostics, with variable results. While rapid tests for tuberculosis and visceral leishmaniasis require further implementation studies, more evidence on performance of current tests or development of new alternatives is needed for dengue, Chagas disease, filariasis, leptospirosis, enteric fever, human African trypanosomiasis, schistosomiasis and cholera.


Assuntos
Doenças Transmissíveis/diagnóstico , Testes Diagnósticos de Rotina/métodos , Saúde da População Urbana/economia , Animais , Doenças Transmissíveis/economia , Doenças Transmissíveis/transmissão , Testes Diagnósticos de Rotina/economia , Vetores de Doenças , Humanos , Pobreza
11.
Fontilles, Rev. leprol ; 31(4): 271-289, ene.-abr. 2018. maps, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-173249

RESUMO

La lepra o enfermedad de Hansen es una enfermedad infecciosa crónica incapacitante. Esta enfermedad permanece en el olvido de la ciencia y de la investigación en el campo de la salud; las mujeres que la padecen sufren doblemente la exclusión, por su condición de enfermas y de mujeres. Ser mujer hará que tengan menos probabilidades que los hombres de ser diagnosticadas a tiempo, aumentando el riesgo de desarrollar una discapacidad de por vida. Lo que hace que se observe, dentro de la propia exclusión de la enfermedad, una triple discriminación en las mujeres y niñas enfermas de lepra, por su género, por las discapacidades que resultan de la enfermedad y por sufrir el impacto del estigma, lo que acentúa aún más su pobreza


Leprosy or Hansen's disease is a chronic disabling infectious disease. This disease remains in the oblivion of science and research in the field of health; women who suffer from it suffer double exclusion, because they are sick and women. Being a woman will make them less likely than men to be diagnosed early, increasing the risk of developing a disability for life. What makes observed, within the exclusion of the disease itself, a triple discrimination in women and girls suffering from leprosy, by their gender, by the disabilities that result from the disease and by suffering the impact of stigma, which it further accentuates their poverty


Assuntos
Humanos , Feminino , Estigma Social , Hanseníase/epidemiologia , Gênero e Saúde , Fatores de Risco , Pobreza , Hanseníase/psicologia , Discriminação Social/psicologia , Etiópia/epidemiologia , Instalações Sanitárias
12.
PLoS Negl Trop Dis ; 12(3): e0006250, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29534061

RESUMO

BACKGROUND: The control or elimination of neglected tropical diseases (NTDs) has targets defined by the WHO for 2020, reinforced by the 2012 London Declaration. We estimated the economic impact to individuals of meeting these targets for human African trypanosomiasis, leprosy, visceral leishmaniasis and Chagas disease, NTDs controlled or eliminated by innovative and intensified disease management (IDM). METHODS: A systematic literature review identified information on productivity loss and out-of-pocket payments (OPPs) related to these NTDs, which were combined with projections of the number of people suffering from each NTD, country and year for 2011-2020 and 2021-2030. The ideal scenario in which the WHO's 2020 targets are met was compared with a counterfactual scenario that assumed the situation of 1990 stayed unaltered. Economic benefit equaled the difference between the two scenarios. Values are reported in 2005 US$, purchasing power parity-adjusted, discounted at 3% per annum from 2010. Probabilistic sensitivity analyses were used to quantify the degree of uncertainty around the base-case impact estimate. RESULTS: The total global productivity gained for the four IDM-NTDs was I$ 23.1 (I$ 15.9 -I$ 34.0) billion in 2011-2020 and I$ 35.9 (I$ 25.0 -I$ 51.9) billion in 2021-2030 (2.5th and 97.5th percentiles in brackets), corresponding to US$ 10.7 billion (US$ 7.4 -US$ 15.7) and US$ 16.6 billion (US$ 11.6 -US$ 24.0). Reduction in OPPs was I$ 14 billion (US$ 6.7 billion) and I$ 18 billion (US$ 10.4 billion) for the same periods. CONCLUSIONS: We faced important limitations to our work, such as finding no OPPs for leprosy. We had to combine limited data from various sources, heterogeneous background, and of variable quality. Nevertheless, based on conservative assumptions and subsequent uncertainty analyses, we estimate that the benefits of achieving the targets are considerable. Under plausible scenarios, the economic benefits far exceed the necessary investments by endemic country governments and their development partners. Given the higher frequency of NTDs among the poorest households, these investments represent good value for money in the effort to improve well-being, distribute the world's prosperity more equitably and reduce inequity.


Assuntos
Erradicação de Doenças/economia , Saúde Global/estatística & dados numéricos , Doenças Negligenciadas/economia , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/prevenção & controle , Gerenciamento Clínico , Saúde Global/economia , Gastos em Saúde , Humanos , Pobreza , Literatura de Revisão como Assunto
13.
PLoS Negl Trop Dis ; 12(3): e0006317, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29534113

RESUMO

BACKGROUND: Poverty has long been considered a risk factor for leprosy and is related to nutritional deficiencies. In this study, we aim to investigate the association between poverty-related diet and nutrition with leprosy. METHODOLOGY/PRINCIPAL FINDINGS: In rural leprosy-endemic areas in Indonesia, we conducted a household-based case-control study using two controls for each case patient (100 recently diagnosed leprosy patients and 200 controls), matched for age and gender. All participants were interviewed to collect information on their demographics, socioeconomic situation, health, and diet. Body mass index, dietary diversity score, as well as anemia and iron micronutrient profiles were also obtained. By means of univariate, block-wise multivariate, and integrated logistic regression analyses, we calculated odds ratios between the variables and the occurrence of leprosy. Unstable income (odds ratio [OR], 5.67; 95% confidence interval [CI], 2.54-12.64; p = 0.000), anemia (OR, 4.01; 95% CI, 2.10-7.64; p = 0.000), and higher household food insecurity (OR, 1.13; 95% CI, 1.06-1.21; p = 0.000) are significantly associated with an increased risk of having leprosy. Meanwhile, higher education (OR, 0.34; 95% CI, 0.15-0.77; p = 0.009) and land ownership (OR, 0.39; 95% CI, 0.18-0.86; p = 0.019) have significant protective associations against leprosy. Although lower dietary diversity, lack of food stock, food shortage, low serum iron, and high ferritin were found more commonly in those with leprosy, the occurrence of leprosy was not significantly associated with iron deficiency (OR, 1.06; 95% CI, 0.10-11.37; p = 0.963). CONCLUSIONS/SIGNIFICANCE: Food poverty is an important risk factor for leprosy susceptibility, yet the mechanisms underlying this association other than nutrient deficiencies still need to be identified. With a stable incidence rate of leprosy despite the implementation of chemoprophylaxis and multidrug therapy, improving dietary diversity through food-based approaches should be initiated and directed toward high-prevalence villages. The possible underlying factors that link poverty to leprosy other than nutrient deficiencies also need to be identified.


Assuntos
Abastecimento de Alimentos , Hanseníase/epidemiologia , Estado Nutricional , Pobreza , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Características da Família , Feminino , Humanos , Renda , Indonésia , Modelos Logísticos , Masculino , Micronutrientes , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Adulto Jovem
14.
Rheumatol Int ; 38(4): 549-556, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29445869

RESUMO

Guidelines or recommendations help to provide uniform standards in medical practice. The development of guidelines requires adherence to pre-defined norms prescribed by different international organizations such as the European League against Rheumatism (EULAR). We searched Pubmed and LILACS to identify published papers in five major rheumatic diseases (rheumatoid arthritis, systemic lupus erythematosus, spondyloarthropathies, osteoarthritis, and scleroderma) from different countries based on their economic prosperity and could find a lack of published literature from most economically weaker regions. Similarly, published guidelines in these rheumatic diseases were sparse from Asia and Africa, which are economically developed to a lesser extent than other regions of the world. Considering differing economic realities driving patient care in different regions of the world, unique challenges in certain geographic areas such as musculoskeletal manifestations of infectious diseases like leprosy and tuberculosis, as well as distinct risk of malignancies and other comorbid conditions, National Rheumatology societies should work towards developing more guidelines for rheumatic diseases from regions such as Asia and Africa, while following strictly the prescribed norms for the same. With a paucity of guidelines for such regions currently, an alternative (although less preferable) suggestion would be that major international societies, whose guidelines are widely read and followed the world over, should consider inputs from experts from diverse regions of the world while developing these guidelines.


Assuntos
Atenção à Saúde/normas , Países em Desenvolvimento , Guias de Prática Clínica como Assunto/normas , Doenças Reumáticas/terapia , Reumatologia/normas , Consenso , Atenção à Saúde/economia , Fidelidade a Diretrizes/normas , Custos de Cuidados de Saúde/normas , Humanos , Renda , Pobreza , Padrões de Prática Médica/normas , Doenças Reumáticas/economia , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/fisiopatologia , Reumatologia/economia
15.
Rio de Janeiro; s.n; 2017. 120 p. ilus.
Tese em Português | LILACS | ID: biblio-1026633

RESUMO

No Brasil, as doenças infecciosas têm apresentado importante evolução em seus perfis epidemiológicos, e a população tem sofrido grandes oscilações demográficas nas últimas décadas. A concentração demográfica em um contexto de pobreza pode estar associada à expansão de algumas doenças. Partindo desta hipótese, o presente estudo avaliou, em uma abordagem ecológica, alguns indicadores socioeconômicos e demográficos de 1895 municípios brasileiros que compõem os estados do Rio de Janeiro, Minas Gerais, Rio Grande do Sul, Goiás, Acre e Pernambuco, onde as unidades do estudo foram os municípios. O período avaliado foi entre os anos 2001 a 2012. Consideramos como variáveis explicativas o índice de desenvolvimento humano municipal (IDHM) o produto interno bruto per capita, a proporção de população vivendo em pobreza extrema e o coeficiente de Gini, também a incidência de infecção pelo HIV/AIDS nos municípios analisados para a tuberculose. Como variáveis resposta, consideramos as taxas de incidência anuais para tuberculose, hanseníase, sífilis congênita e dengue, além das taxas de mortalidade específicas para doença de Chagas. Aplicou-se a correlação de Spearman para as análises. Os resultados revelaram um padrão de maior acúmulo de riqueza e desenvolvimento nas cidades onde o IDHM se correlacionou positivamente com o PIB e o tamanho da população dos municípios


Também foi constatado menor proporção de pessoas vivendo em extrema pobreza nestas áreas, e uma tendência de forte urbanização das doenças infecciosas incluídas neste trabalho, com taxas de incidência aumentando ao longo da década analisada para estas cidades. Os resultados sugerem ainda que a concentração de renda, de infraestrutura e serviços, cria paradoxalmente condições para uma maior ocorrência de doenças infecciosas geralmente ligadas à pobreza com diferentes vias de transmissão, seja respiratória, sexual ou por vetores. Possivelmente os centros urbanos, por conterem aglomerados de moradias precárias e grande população carcerária, contribuem para este novo panorama epidemiológico das doenças aqui elencadas, embora apresentem melhores indicadores para qualidade de vida. De tal forma, que algumas infecções se apresentam como o novo desafio às políticas públicas de controle de doenças no ambiente urbano, como exemplo a sífilis congênita. Sugere-se então, abordagens e ações multidisciplinares voltadas para a prevenção da saúde da população em geral com foco na formação dos profissionais de saúde e educação. (AU)


Assuntos
Humanos , Pobreza , Fatores Socioeconômicos , Doenças Transmissíveis , Doenças Negligenciadas
16.
Brasília; IPEA; 2016. 48 p. graf, map.(Texto para Discussão / IPEA).
Monografia em Português | LILACS, ECOS | ID: biblio-991886

RESUMO

O presente estudo tem como objetivo descrever a distribuição espacial dos indicadores epidemiológicos das doenças transmissíveis relacionadas à pobreza nos municípios brasileiros, visando demarcar áreas geográficas com concentração de morbidades e condições socioeconômicas precárias para o direcionamento de ações integradas de políticas públicas de saúde e sociais. Trata-se de estudo ecológico descritivo com abordagem espacial, tendo como unidades de análise os municípios brasileiros. A partir de dados dos sistemas de informação do Ministério da Saúde (MS) e do Instituto Brasileiro de Geografia e Estatística (IBGE), foram calculados indicadores de incidência das seguintes doenças transmissíveis relacionadas à pobreza, segundo sua relevância para a saúde pública e disponibilidade de dados: tuberculose, hanseníase, leishmaniose tegumentar, leishmaniose visceral e malária.


Assuntos
Doenças Negligenciadas , Doenças Transmissíveis , Estudos Ecológicos , Indicadores Básicos de Saúde , Indicadores Sociais , Pobreza , Brasil
17.
PLoS Negl Trop Dis ; 9(1): e0003431, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25590638

RESUMO

BACKGROUND: Erythema nodosum leprosum (ENL) is a common immune-mediated complication of lepromatous (LL) and borderline lepromatous (BL) leprosy. Most patients experience chronic or multiple acute ENL over many years during an economically active period of their lives. Understanding the economic burden of ENL is essential to provide effective patient support, yet this area has not been investigated. METHODS: Ninety-one patients with LL or BL leprosy attending a leprosy hospital in Purulia district of West Bengal, India, were interviewed using a structured questionnaire. Cases (n = 53) were identified as those who had one or more episodes of ENL within the last 3 years. Controls (n = 38) had LL or BL leprosy but no history of ENL. Data were collected on household income, direct and indirect costs, and coping strategies. FINDINGS: The total household cost was Rs 1543 per month or 27.9% (IQR 13.2-52.6) of monthly household income for cases, and Rs 237 per month or 4.9% (IQR 1.7-13.4) of monthly household income for controls. Indirect costs accounted for 65% of total household costs for cases. Direct costs accounted for the remaining 35% of household costs, and resulted almost entirely from treatment-seeking in the private sector. Total household costs exceeded 40% of household income for 37.7% of cases (n = 20) and 2.6% of controls (n = 1) [1 USD = 59 INR]. INTERPRETATION: Households affected by ENL face significant economic burden and are at risk of being pushed further into poverty. Health policy should acknowledge the importance of private sector provision and the significant contribution to total household costs of lost productivity (indirect cost). Further work is needed to explore this area and identify solutions.


Assuntos
Eritema Nodoso/economia , Eritema Nodoso/epidemiologia , Hansenostáticos/efeitos adversos , Hanseníase Dimorfa/complicações , Hanseníase Virchowiana/complicações , População Rural , Adulto , Feminino , Custos de Cuidados de Saúde , Humanos , Renda , Índia/epidemiologia , Hansenostáticos/economia , Hanseníase Dimorfa/epidemiologia , Hanseníase Virchowiana/epidemiologia , Masculino , Pobreza
19.
Lepr Rev ; 85(3): 141-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25509714

RESUMO

INTRODUCTION: The Millennium Development Goals have provided much needed attention to extreme poverty reduction. However, people with disabilities are disproportionately affected by poverty and in some countries, even the goal of US$1 per day is far out of reach. For people with leprosy-related disability living in ultra-poverty (on less than 50 cents a day), many mainstream poverty reduction strategies are inaccessible and inappropriate. METHOD: A project in north-west Bangladesh developed a more contextually meaningful definition of ultra-poverty according to nutrition energy intake. A total of 2372 people with leprosy-related disability were surveyed. Of those, 1285 individuals fell below the ultra-poverty line. Individualised interventions were implemented over an extended period of time, comprised of targeted practical assistance, enhancing community links, advocacy for entitlements, and further linking with other initiatives. RESULTS: Follow-up data available for 856 individuals showed an average increase in per capita income of 83%. Personal contribution to the family income increased by 65%. There was a 51% increase in families having access to a latrine. Finally families reported eating 30% more meals per day, up from an average of two meals per day. CONCLUSIONS: The initiative sought to address poverty in a wide variety of ways, using minimal inputs. Over several years, the results indicate a significant change in the economic situation of individuals with leprosy related disabilities. Other organisations are encouraged to duplicate the intervention and share their results.


Assuntos
Hanseníase/economia , Pobreza , Pessoas com Deficiência , Humanos , Renda , Hanseníase/prevenção & controle
20.
PLoS Negl Trop Dis ; 8(11): e3357, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25412418

RESUMO

BACKGROUND: Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP) and primary health care (Family Health Program-FHP) programs on new case detection rate of leprosy. METHODOLOGY/PRINCIPAL FINDINGS: We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004-2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI  =0.74-0.83) and significantly increased in municipalities with FHP coverage in the medium (72-95%) (Risk Ratio 1.05; 95% CI  =1.02-1.09) and higher coverage tertiles (>95%) (Risk Ratio 1.12; 95% CI  =1.08-1.17). CONCLUSIONS: At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence.


Assuntos
Hanseníase/economia , Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/métodos , Brasil/epidemiologia , Estudos Transversais , Humanos , Pobreza , Reembolso de Incentivo
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