Leprosy in Brazil in the 21st century: analysis of epidemiological and operational indicators using inflection point regression<sup>,</sup>

Souza, Carlos Dornels Freire de; Paiva, João Paulo Silva de; Leal, Thiago Cavalcanti; Urashima, Gabriel da Silva

doi:10.1016/j.abd.2019.09.031

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Tropical/Infectoparasitary Dermatology • An. Bras. Dermatol. 95 (6) • Nov-Dec 2020 • https://doi.org/10.1016/j.abd.2019.09.031 copy

Leprosy in Brazil in the 21st century: analysis of epidemiological and operational indicators using inflection point regression^☆ ☆ How to cite this article: Souza CDF, Paiva JPS, Leal TC, UrashimaGS. Leprosy in Brazil in the 21st century: analysis of epidemiologicaland operational indicators using inflection point regression. An BrasDermatol. 2020;95:743-747. ^,^☆☆ ☆☆ Study conducted at the Center for the Study of Social and Pre-ventative Medicine, Department of Medicine, Universidade Federalde Alagoas, Campus Arapiraca, Arapiraca, AL, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The objective of this study was to analyze the trend of epidemiological and operational indicators of leprosy in Brazil, from 2001 to 2017. This was a time series study involving nine indicators. The inflection point regression model was used. Decreasing trends were observed for the following: general detection (−4.8%), children under 15 (−3.7%), prevalence (−7.0%), and grade 2/million inhabitants (−3.5%). The proportion of individuals with grade 2 disability showed an upward trend (2.0%) from 2001 as well as contacts examined from 2003 (5.0%). The proportions of cure and of individuals with a degree of disability assessed at the time of the diagnosis and the cure showed a stationary behavior. Although advances are noted, there are still challenges to be overcome.

KEYWORDS
Leprosy; Mycobacterium leprae; Time series studies

Indicator	Usefulness	Parameters
Detection rate of new leprosy cases in the general population/100,000 inhabitants.	Measure the strength of the endemic morbidity, magnitude, and tendency.	Hyperendemic: ≥40.0/100,000 inhab.
		Very high: 20.00-39.99/100,000 inhab.
		High: 10.00-19.99/100,000 inhab.
		Medium: 2.00-9.99/100,000 inhab.
		Low: <2.00/100,000 inhab.
Detection rate of new leprosy cases in persons under 15 years/100,000 inhabitants.	Measure the strength of the recent transmission of the endemic and its tendency.	Hyperendemic: ≥10.00/100,000 inhab.
		Very high: 5.00-9.99/100,000 inhab.
		High 2.50-4.99/100,000 inhab.
		Medium: 0.50-2.49/100,000 inhab.
		Low: <0.5/100,000 inhab.
Annual leprosy prevalence rate/10,000 inhabitants.	Measure the magnitude of the endemic.	Hyperendemic: ≥20.0/10,000 inhab.
		Very high: 10.0-19.9/10,000 inhab.
		High 5.0-9.9/10,000 inhab.
		Medium: 1.0-4.9/10,000 inhab.
		Low: <1.0/10,000 inhab.
Rate of new leprosy cases with grade 2 physical disability at the time of diagnosis/1 million inhabitants	Assess the deformities caused by leprosy in the general population and compare them with other disabling diseases.	The tendency to reduce the detection rate, accompanied by a reduction in this indicator, characterizes a reduction in the magnitude of the endemic disease.
Proportion of leprosy cases with grade 2 physical disability at the time of diagnosis among the new cases detected and evaluated in the year.	Evaluate the effectiveness of timely and/or early case detection activities.	High: ≥10%.
		Medium: 5%-9.9%.
		Low: <5%.
Proportion of new leprosy cases with any degree of physical disability assessed at diagnosis.	Measure the quality of care in health services.	Good: ≥90%.
		Fair: ≥75%-89.9%.
		Poor: <75%.
Proportion of new leprosy cases with any degree of physical disability assessed at the time of cure.	Measure the quality of care in health services.	Good: ≥90%.
		Fair: ≥75%-89.9%.
		Poor: <75%.
Proportion of examined contacts of new leprosy cases diagnosed in the years of the cohorts.	Measure the services' capacity to carry out surveillance of contacts of new cases of leprosy, increasing the timely detection of new cases.	Good: ≥90.0%.
		Fair: ≥75.0%-89.9%.
		Poor: <75.0%.
Proportion of leprosy cure among new cases diagnosed in the years of the cohorts.	Assess the quality of care and follow-up of newly diagnosed cases until treatment is complete.	Good: ≥90%.
		Fair: ≥75%-89.9%.
		Poor: <75%.

Indicator	Period	APC (95% CI)	p-value	Trend
Detection rate of new leprosy cases in the general population/100,000 inhabitants	2001-2003	3.8 (-8.8 to 18.1)	0.5	Stationary
	2003-2017	-5.9 (-6.5 to -5.4)	<0.001	Descending
	2001-2017	-4.8 (-6.2 to -3.3)	<0.001	Descending
Detection rate of new leprosy cases in persons under 15 years/100,000 inhabitants	2001-2003	5.5 (-12.1 to 26.7)	0.5	Stationary
	2003-2017	-5.0 (-5.8 to -4.2)	<0.001	Descending
	2001-2017	-3.7 (-5.8 to -1.6)	<0.001	Descending
Annual leprosy prevalence rate/10,000 inhabitants	2001-2017	-7.0% (-9.7 to -4.2)	<0.001	Descending
Rate of new leprosy cases with grade 2 physical disability at the time of diagnosis/1 million inhabitants	2001-2017	-3.5 (-4.5 to -2.5)	<0.001	Descending
Proportion of leprosy cases with grade 2 physical disability at the time of diagnosis among the new cases detected and evaluated in the year	2001-2017	2.0 (0.8 to 3.3)	<0.001	Ascending
Proportion of new leprosy cases with any degree of physical disability assessed at diagnosis	2001-2011	0.6 (0.3 to 1.0)	<0.001	Ascending
	2011-2017	-0.4 (-1.2 to 0.3)	0.2	Stationary
	2001-2017	0.2 (-0.1 to 0.6)	0.2	Stationary
Proportion of new leprosy cases with any degree of physical disability assessed at time of cure	2001-2007	-1.5 (-2.3 to -0.6)	<0.001	Descending
	2007-2010	8.4 (3.1 to 14.0)	<0.001	Ascending
	2010-2017	-1.1 (-1.8 to -0.5)	<0.001	Descending
	2001-2017	0.5 (-0.4 to 1.4)	0.3	Stationary
Proportion of examined contacts of new leprosy cases diagnosed in the years of the cohorts	2001-2003	-20.4 (-35.5 to -1.7)	<0.001	Descending
	2003-2017	5.0 (4.0 to 6.1)	<0.001	Ascending
	2001-2017	1.4 (-1.1 to 4.0)	0.3	Stationary
Proportion of leprosy cure among new cases diagnosed in the years of the cohorts	2001-2004	-6.1 (-8.8 to -3.6)	<0.001	Descending
	2004-2007	7.8 (2.1 to 13.9)	3.1	Descending
	2007-2017	-0.1 (-0.6 to 0.3)	0.5	Stationary
	2001-2017	0.1 (-0.9 to 1.1)	0.8	Stationary

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[1] ⁎ Corresponding author. carlos.freire@arapiraca.ufal.br (C.D.F. Souza).