Risk factors for physical disability due to leprosy: a case-control study

Case-control study carried out at the Notifiable Diseases Information System – Leprosy in the 9^th Regional Health District of the state of Paraíba, Brazil, between 2001 and 2014. Cases were individuals who presented degree of physical disability 1 or 2 at diagnosis or discharge; and controls included individuals with degree of physical disability 0 also at diagnosis and discharge. A 1:1 (case:control) proportion was used. Data were analyzed using the Epi Info and BioEstat software packages.

Results

The following cases and controls (428 each) at risk for physical disability were analyzed: aged ≥15 years (96.5%, OR=0.33, p<0.01), males (59.3%, OR=1.82, p<0.01), low education level (70.4%, OR=2.66, p<0.01), multibacillary classification (72.9%, OR=9.29; p< 0.01), number of lesions ≥5 (34.3%, OR=0.18, p<0.01), and number of nerves affected ≥1 (12.6%, OR=0.05; p<0.01). Late diagnosis, missing/inadequately filled data, absence/non-registration of dermato-neurological evaluation, and low control of contacts were observed.

Conclusion

The need for active surveillance and early detection of leprosy cases and contacts is highlighted.

Keywords:
leprosy; persons with disability; assistance; Primary Health Care

Variables	Cases f (%)		Controls f (%)
Age
<15 years	15	(3.5)	43	(10.0)
≥15 Years	413	(96.5)	384	(89.7)
No record	0	(0.0)	1	(0.3)
Total	428	(100.0)	428	(100.0)
*Mean ±standard deviation*	*49.1*	*(±19.4)*	*41.6*	*(±19.0)*
*Minimum and Maximum*	*4 - 91*		*3 - 86*
Sex
Female	174	(40.7)	238	(55.6)
Male	254	(59.3)	190	(44.4)
Total	428	(100.0)	428	(100.0)
Color/race
Yellow	4	(0.9)	3	(0.7)
White	78	(18.2)	92	(21.5)
Brown	193	(45.1)	169	(39.5)
Black	45	(10.5)	42	(9.8)
Indigenous	0	(0.0)	1	(0.2)
No record	108	(25.2)	121	(28.3)
Total	428	(100.0)	428	(100.0)
Education level
Illiterate	111	(25.9)	67	(15.7)
Incomplete Elementary School	76	(17.8)	67	(15.7)
Complete Elementary School	23	(5.4)	12	(2.8)
Incomplete Junior High School	80	(18.7)	99	(23.1)
Complete Junior High School	11	(2.6)	3	(0.7)
Incomplete High School	20	(4.7)	50	(11.7)
Complete High School	8	(1.9)	7	(1.6)
Incomplete Higher Education	0	(0.0)	3	(0.7)
Complete Higher Education	9	(2.1)	23	(5.4)
Not applicable	3	(0.7)	8	(1.9)
No record	87	(20.3)	89	(20.8)
Total	428	(100.0)	428	(100.0)
Residence area
Rural	40	(9.3)	39	(9.1)
Urban	337	(78.8)	370	(86.4)
No record	51	(11.9)	19	(4.5)
Total	428	(100.0)	428	(100.0)
Occupation
Housewife	23	(5.4)	29	(6.8)
Student	9	(2.1)	13	(3.0)
Farmer	10	(2.3)	5	(1.7)
Retired/pensioner	8	(1.9)	3	(0.7)
Bricklayer	7	(1.6)	1	(0.2)
Salesperson	3	(0.7)	1	(0.2)
Others	11	(2.6)	16	(3.7)
No record	357	(83.4)	360	(84.1)
Total	428	(100.0)	428	(100.0)

Variables	Cases f (%)			Controls f (%)
Clinical form
IL	41		(9.6)	187	(43.7)
TL	69		(16.1)	129	(30.1)
DL	184		(42.9)	67	(15.7)
VL	97		(22.7)	18	(4.2)
Non-classified	6		(1.4)	13	(3.0)
No record	31		(7.2)	14	(3.3)
Total	428		(100.0)	428	(100.0)
Operational form
PB	115		(26.9)	331	(77.3)
MB	312		(72.9)	97	(22.7)
No record	1		(0.2)	0	(0.0)
Total	428		(100.0)	428	(100.0)
Input mode
New case	381		(89.0)	409	(95.6)
Relapse	17		(4.0)	9	(2.1)
Referral from the same municipality	1		(0.2)	0	(0.0)
Referral from other municipalities	5		(1.2)	3	(0.7)
Referral from other states	7		(16.4)	3	(0.7)
Other re-input	15		(3.5)	4	(0.9)
No record	2		(0.5)	0	(0.0)
Total	428		(100.0)	428	(100.0)
Mode of detection of new case
Spontaneous demand	130		(30.7)	150	(3.5)
Referral	198		(46.3)	210	(49.1)
Collective examination	29		(6.8)	28	(6.5)
Contact examination	10		(2.3)	14	(3.3)
Not applicable	42		(9.8)	18	(4.2)
Other modes	10		(2.3)	6	(1.4)
No record	9		(2.1)	2	( 0.5)
Total	428		(100.0)	428	(100.0)
Bacilloscopy
Positive	47		(11.0)	17	(40)
Negative	79		(18.4)	60	(60.0)
Not performed	24		(5.6)	32	(7.5)
No record	278		(65.0)	319	(74.5)
Total	428		(100.0)	428	(100.0)
Reaction
Type 1	24		(5.6)	7	(1.6)
Type 2	6		(1.4)	1	(0.2)
No reaction	156		(36.4)	142	(33.2)
No record	242		(56.5)	278	(65.0)
Total	428		(100.0)	428	(100.0)
Reason for suspension
Recovery	373		(87.1)	421	(98.4)
Withdrawal	22		(5.1)	1	(0.2)
Death	9		(2.1)	0	(0.0)
Referral from the same municipality	2		(0.5)	3	(0.7)
Referral from other municipalities	1		(0.2)	1	(0.2)
Referral from other states	4		(0.9)	2	(0.5)
Registration error	6		(1.4)	0	(0.0)
No record	11		(2.6)	0	(0.0)
Total	428		(100.0)	428	(100.0)
No. of lesions
≤5	267		(62.4)	374	(87.4)
>5	147		(34.3)	48	(11.2)
No record	14		(3.3)	6	(1.4)
Total	428	(100.0)		428	(100.0)
*Mean ±standard deviation*	*6 (±8.0)*			*2 (±4.2)*
*Minimum and maximum*	*0 - 60*			*0 - 40*
No. of nerves affected
0	35		(8.2)	86	(20.1)
1	31		(7.2)	8	(1.9)
>1	54		(12.6)	3	(0.7)
No record	308		(72.0)	331	(77.3)
Total	428		(100.0)	428	(100.0)
*Mean ±standard deviation*	*0.4 (±1.5)*				*0 (±0.4)*
*Minimum and maximum*			*0 - 60*		*0 - 40*
No. of registered contacts	1,558		(100.0)	1,485	(100.0)
No. of evaluated contacts	1,111		(71.3)	1,042	(68.1)

Degree of physical disability	*f (%)*		Evolution (%) and Reason	p ^* * p-value associated with Binomial test.
	Diagnosis	Discharge
G0	34 (7.9)	102 (23.8)	↑200 ~3x	<0.0001
G1	290 (67.8)	129 (30.1)	↓55.5 ~2x	<0.0001
G2	95(22.2)	41 (9.6)	↓56.8 ~2x	<0.0001
Not evaluated	4 (0.9)	89 (20.8)	↑2.125 ~22x	<0.0001
No record	5 (1.2)	67 (15.7)	↑1.240 ~13x	<0.0001

Variables	Cases	Controls	OR (95% CI)	p
Age			0.33 (0.18 – 0.49)	<0.01
<5 years	15	43
≥15 Years	412	384
Total	427	427
Sex			1.82 (1.39 – 2.39)	<0.01
Male	254	190
Female	174	238
Total	428	428
Education level (completed years)			2.66 (1.74 – 4.06)	<0.01
≤9 years	294	248
>9 years	37	83
Total	331	331
Residence area			1.32 (0.81 – 2.17)	0.262
Rural	40	31
Urban	336	345
Total	376	376
Operational form			9.29 (6.80 – 12.68)	<0.01
MB	313	97
PB	115	331
Total	428	428
No. of lesions			0.18 (0.12 – 0.27)	<0.01
<5	154	261
≥5	155	48
Total	309	309
No. of nerves affected			0.05 (0.02 – 0.11)	<0.01
None	27	86
>1	70	11
Total	97	97
Reaction			2.42 (1.01 – 5.76)	0.04
1-2	18	8
No reaction	131	141
Total	149	149
Bacilloscopy			2.02 (0.99 – 4.13)	0.05
Positive	28	17
Negative	48	59
Total	76	76

Instituto de Estudos em Saúde Coletiva da Universidade Federal do Rio de Janeiro Avenida Horácio Macedo, S/N, CEP: 21941-598, Tel.: (55 21) 3938 9494 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@iesc.ufrj.br

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[1] Correspondence: Gerlane Cristinne Bertino Véras. E-mail: gerlaneveras2@gmail.com