Leprosy in urban space, areas of risk for disability and worsening of this health condition in Foz Do Iguaçu, the border region between Brazil, Paraguay and Argentina.

BACKGROUND: Leprosy is a public health problem and a challenge for endemic countries, especially in their border regions where there are intense migration flows. The study aimed to analyse the dynamics of leprosy, in order to identify areas of risk for the occurrence of the disease and disability and places where this health condition is worsening. METHOD: This ecological study considered the new cases of leprosy reported in the municipality of Foz do Iguaçu from 2003 to 2015. Spatial and spatial-temporal scan statistics were used to identify the risk areas for the occurrence of leprosy, as well as the Getis-Ord Gi and Getis-Ord Gi* methods. Areas of risk for disabilities were identified by the scan statistic and kernel density estimation. RESULTS: A total of 840 cases were reported, of which 179 (21.3%) presented Grade 1 or 2 disabilities at the time of diagnosis. Leprosy risk areas were concentrated in the Southern, Eastern and Northeastern Health Districts of the municipality. The cases of Grade 2 disability were observed with higher intensity in regions characterized by high population density and poverty. CONCLUSION: The results of the study have revealed changes in the pattern of areas at risk of leprosy according to the investigated periods. In addition, it was possible to verify disabilities as a condition present in the investigated cases, or that may be related to the late diagnosis of the disease. In the areas of risk identified, patients have reported worse physical disability after diagnostic confirmation, or indicate inadequate clinical examination, reinforcing the need for structuring leprosy control services in a qualified manner.

Risk areas for tuberculosis among children and their inequalities in a city from Southeast Brazil.

BACKGROUND: The objective of the study was to identify areas of risk for the appearance of tuberculosis in children and their association with social inequalities in a municipality in southeastern Brazil. METHODS: Ecological study conducted in Ribeirão Preto, Brazil. To identify areas of spatial risk for tuberculosis in children, we used spatial scanning statistics. To analyze the association of cases of childhood tuberculosis with social vulnerability, we used the Social Vulnerability Index of São Paulo, and four explanatory statistical models were listed. RESULTS: There were 96 cases of childhood tuberculosis, of which 90 were geocoded through a process of converting addresses to geographic coordinates. A risk area was identified in the municipality, where children under 15 years old have 3.14 times greater risk of contracting tuberculosis than those living outside this area. The variables identified as risk factors were: number of private and collective households, proportion of children aged 0 to 5 years in the population, proportion of households without per capita income, and the proportion of private households with monthly nominal incomes of up to one quarter of wage minimums. The variables identified as protection factors were the proportion of women under the age of 30 years responsible for the household under and women responsible for the household with an average income over BRL 2344. CONCLUSION: The study showed areas of risk for the occurrence of tuberculosis in children. The study is in line with the End TB Strategy and the 2030 Agenda, which aim to support strategic actions and, therefore, save the lives of children through the systematic, intensified, and comprehensive identification of children with tuberculosis respiratory symptoms in the community.

Detection of risk clusters for deaths due to tuberculosis specifically in areas of southern Brazil where the disease was supposedly a non-problem.

BACKGROUND: Tuberculosis (TB) is the infectious disease that kills the most people worldwide. The use of geoepidemiological techniques to demonstrate the dynamics of the disease in vulnerable communities is essential for its control. Thus, this study aimed to identify risk clusters for TB deaths and their variation over time. METHODS: This ecological study considered cases of TB deaths in residents of Londrina, Brazil between 2008 and 2015. We used standard, isotonic scan statistics for the detection of spatial risk clusters. The Poisson discrete model was adopted with the high and low rates option used for 10, 30 and 50% of the population at risk, with circular format windows and 999 replications considered the maximum cluster size. Getis-Ord Gi* (Gi*) statistics were used to diagnose hotspot areas for TB mortality. Kernel density was used to identify whether the clusters changed over time. RESULTS: For the standard version, spatial risk clusters for 10, 30 and 50% of the exposed population were 4.9 (95% CI 2.6-9.4), 3.2 (95% CI: 2.1-5.7) and 3.2 (95% CI: 2.1-5.7), respectively. For the isotonic spatial statistics, the risk clusters for 10, 30 and 50% of the exposed population were 2.8 (95% CI: 1.5-5.1), 2.7 (95% CI: 1.6-4.4), 2.2 (95% CI: 1.4-3.9), respectively. All risk clusters were located in the eastern and northern regions of the municipality. Additionally, through Gi*, hotspot areas were identified in the eastern and western regions. CONCLUSIONS: There were important risk areas for tuberculosis mortality in the eastern and northern regions of the municipality. Risk clusters for tuberculosis deaths were observed in areas where TB mortality was supposedly a non-problem. The isotonic and Gi* statistics were more sensitive for the detection of clusters in areas with a low number of cases; however, their applicability in public health is still restricted.

Survival time among patients who were diagnosed with tuberculosis, the precocious deaths and associated factors in southern Brazil.

BACKGROUND: A diagnosis of tuberculosis (TB) does not mean that the disease will be treated successfully, since death may occur even among those who are known to the health services. Here, we aimed to analyze patient survival time from the diagnosis of TB to death, precocious deaths, and associated factors in southern Brazil. METHODS: We conducted a longitudinal study with patients who were diagnosed with TB and who died due to the disease between 2008 and 2015 in southern Brazil. The starting point for measuring survival time was the patient's diagnosis date. Techniques for survival analysis were employed, including the Kaplan-Meier test and Cox's regression. A mixed-effect model was applied for identifying the associated factors to precocious deaths. Hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals (95% CI) were estimated. We defined p value <0.05 as statistically significant for all statistics applied. RESULTS: One hundred forty-six patients were included in the survival analysis, observing a median survival time of 23.5 days. We observed that alcoholism (HR=1.55, 95% CI=1.04-2.30) and being male (HR=6.49, 95% CI=1.03-2.68) were associated with death. The chance of precocious death within 60 days was 10.48 times greater than the chance of early death within 30 days. CONCLUSION: Most of the deaths occurred within 2 months after the diagnosis, during the intensive phase of the treatment. The use of alcohol and gender were associated with death, revealing inequality between men and women. This study advanced knowledge regarding the vulnerability associated with mortality. These findings must be addressed to fill a gap in the care cascades for active TB and ensure equity in health.

Trends and forecasts of leprosy for a hyperendemic city from Brazil's northeast: Evidence from an eleven-year time-series analysis.

This study's objective was to estimate the temporal trends of leprosy according to sex and age groups, as well as to estimate and predict the progression of the disease in a hyperendemic city located in the northeast of Brazil. This ecological time-series study was conducted in Imperatriz, Maranhão, Brazil. Leprosy cases diagnosed between 2006 and 2016 were included. Detection rates stratified by sex and age groups were estimated. The study of temporal trends was accomplished using the Seasonal-Trend Decomposition method and temporal modeling of detection rates using linear seasonal autoregressive integrated moving average model according to Box and Jenkins method. Trend forecasts were performed for the 2017-2020 period. A total of 3,212 cases of leprosy were identified, the average incidence among men aged between 30 and 59 years old was 201.55/100,000 inhabitants and among women in the same age group was 135.28/100,000 inhabitants. Detection rates in total and by sex presented a downward trend, though rates stratified according to sex and age presented a growing trend among men aged less than 15 years old and among women aged 60 years old or over. The final models selected in the time-series analysis show the forecasts of total detection rates and rates for men and women presented a downward trend for the 2017-2020 period. Even though the forecasts show a downward trend in Imperatriz, the city is unlikely to meet a significant decrease of the disease burden by 2020.

Magnitud de los determinantes sociales en el riesgo de mortalidad por tuberculosis en el Centro-Oeste de Brasil / Magnitude of social determinants in the risk of death from tuberculosis in Central-west Brazil

OBJETIVO: Evaluar la magnitud de los determinantes sociales en áreas de riesgo para la mortalidad por tuberculosis en una ciudad de alta incidencia de esta enfermedad. MÉTODO: Estudio ecológico que recogió los casos de muerte por tuberculosis registrados entre 2006 y 2016 en la capital del Estado de Mato Grosso (Brasil). Los determinantes sociales se obtuvieron de las Unidades de Desarrollo Humano. Se utilizó la estadística de barrido para identificar las áreas de riesgo de muerte por tuberculosis. Se realizó un análisis de componentes principales para identificar dimensiones de determinantes sociales, y se aplicó regresión logística múltiple para verificar asociaciones entre las dimensiones de los determinantes sociales y el riesgo de muerte por tuberculosis. El error estándar se estableció en un 5% para todas las pruebas estadísticas. RESULTADOS: Se registraron 225 muertes por tuberculosis en el periodo, distribuidas heterogéneamente en el espacio. Se identificó un conglomerado de riesgo para la mortalidad por tuberculosis, con un riesgo relativo de 2,09 (intervalo de confianza del 95% [IC95%]: 1,48-2,94; p = 0,04). Los determinantes sociales «bajo nivel escolar» y «pobreza» se mostraron asociados al riesgo de muerte por tuberculosis (odds ratio [OR]: 2,92; IC95%: 1,17-7,28). La renta presentó asociación negativa con el riesgo de muerte por tuberculosis (OR: 0,05; IC95%: 0,00-0,70). El valor de la curva ROC del modelo fue del 92,1%. CONCLUSIONES: Los resultados confirman que el riesgo de muerte por tuberculosis es un problema asociado a los determinantes sociales. Las políticas de salud y los programas de protección social pueden contribuir a enfrentarse a este problema

OBJECTIVE: To evaluate the magnitude of social determinants in areas of risk of mortality due to tuberculosis in a high incidence city. METHOD: Ecological study, which recruited the cases of tuberculosis deaths registered between 2006 and 2016 in the capital of Mato Grosso-Brazil. The social determinants were obtained from the Human Development Units. Sweep statistics were used to identify areas of risk of mortality due to tuberculosis. Principal component analysis was carried out to identify dimensions of social determinants. Multiple logistic regression was applied to verify associations between the dimensions of social determinants and the risk of mortality from tuberculosis. A 5% error was fixed. The standard error was established at 5% for all statistical tests. RESULTS: A total of 225 deaths due to tuberculosis were registered in the period, distributed heterogeneously in the space. A cluster of risk for tuberculosis mortality was identified, with RR=2.09 (95%CI: 1.48-2.94; p = 0.04). Social determinants, low educational level and poverty were associated with the risk of mortality due to tuberculosis (OR: 2.92; 95%CI: 1.17-7.28). Income had a negative association with the risk of mortality due to tuberculosis (OR: 0.05; 95%CI: 0.00-0.70). The value of the ROC curve of the model was 92.1%. CONCLUSIONS: The results confirmed that the risk of mortality due to tuberculosis is a problem associated with social determinants. Health policies and social protection programmes can collaborate to address this problem