Leprosy in children under fifteen years of age in the most hyperendemic municipality in Brazil

Costa, Ricardo Milhomem; Menezes, Marcela Silva; Guimarães, Maria Sortênia Alves; Franchi, Eliane Patrícia Pereira; Monteiro, Lorena Dias; Alvim, Mariana Caroline Tocantins

doi:10.1590/1984-0462/2024/42/2023022

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Brasil

Revista Paulista de Pediatria

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Original Article • Rev. paul. pediatr. 42 • 2024 • https://doi.org/10.1590/1984-0462/2024/42/2023022 copy

Leprosy in children under fifteen years of age in the most hyperendemic municipality in Brazil

Hanseníase em menores de quinze anos no município mais hiperendêmico do Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To describe leprosy involvement and physical disability profiles in children and adolescents under 15 years old.

Methods:

Ecological time series study, based on data from the Brazilian Notifiable Diseases Information System, including new cases of leprosy residing in Palmas (TO), from 2001 to 2020.

Results:

A total of 471 notified cases in children and adolescents under 15 years of age were evaluated, resulting in a detection coefficient of 26.5 per 100,000 inhabitants. Of these, 52% (n=243) were women, 5% (n=24) corresponded to grade two disability, and 36% (n=168) were diagnosed through spontaneous demand. The temporal trend analysis showed a 0.5% reduction in the detection coefficient. There was a significant decrease in the diagnosis of the undetermined and tuberculoid clinical forms and a significant increase in the dimorphous form. Diagnosis through contact examination increased significantly by 13.1% and that through spontaneous demand decreased by 4.9%. The detection coefficient of cases with grade two disability reduced significantly by 7.4% while those with grade one increased by 16.8%.

Conclusions:

Despite the downward trend in the detection coefficient in children and adolescents under 15 years of age and in cases with grade two disability, other factors indicate failure in the adequate management of leprosy in Palmas.

Keywords:
Leprosy; Neglected diseases; Epidemiology; Children

	DC^* * Detection coefficient <15 years per 100,000 inhabitants;	% Male^† † % Male;	% G0^‡ ‡ % Grade zero;	% G1^§ § % grade one;	% G2^// // % Grade two;	% Pauc.^¶ ¶ % Paucibacillary;	% Multib.^# # % Multibacillary;	% Ref.^ % Diagnosis by referral;	% Sd.^†† †† % Diagnosis by spontaneous demand;	% Col.^‡‡ ‡‡ % Diagnosis by collective examination;	%Cont.^§§ §§ % Diagnosis by contact tracing.
2001	47.4	58	91.7	0	8.3	91.7	8.3	20.8	66.7	0	12.5
2002	35.6	37	94.7	0	5.3	68.4	31.6	31.6	63.2	0	5.3
2003	46.2	54	69.2	3.9	26.9	84.6	15.4	23.1	50	7.7	7.7
2004	25.4	47	93.3	0	6.7	80	20	20	60	6.7	13.3
2005	27.5	29	70.6	11.8	17.7	88.2	11.8	35.3	52.9	0	11.8
2006	22.4	50	85.7	14.3	0	71.4	28.6	35.7	50	0	7.1
2007	28.6	50	83.3	11.1	5.6	66.7	33.3	27.8	50	0	16.7
2008	20.6	69	92.3	0	7.7	84.6	15.4	15.4	69.2	0	15.4
2009	25.2	63	87.5	12.5	0	75	25	18.8	62.5	0	12.5
2010	20.5	38	61.5	30.8	7.7	46.2	53.9	30.8	61.5	0	7.7
2011	15.4	40	100	0	0	70	30	20	50	0	30
2012	12.1	38	100	0	0	87.5	12.5	37.5	50	0	12.5
2013	19.2	31	61.5	30.8	7.7	46.2	53.9	15.4	61.5	0	15.4
2014	18.8	46	100	0	0	92.3	7.7	38.5	38.5	7.7	15.4
2015	22.7	56	87.5	12.5	0	37.5	62.5	31.3	18.8	43.8	6.3
2016	73	48	63.5	30.8	5.8	21.2	78.9	5.8	23.1	25	46.2
2017	62.6	60	64.4	28.9	6.7	8.9	91.1	17.8	13.3	4.4	57.8
2018	79.6	48	72.4	27.6	0	1.7	98.3	8.6	13.8	8.6	55.2
2019	74.5	47	78.2	21.8	0	3.6	96.4	14.5	20	0	63.6
2020	34.8	35	61.5	38.5	0	0	100	7.7	15.4	0	73.1

		Detection coefficient^* * Detection coefficient < 15 years/100,000 inhabitants;	% Paucibacillary	% Multibacillary	% Undetermined	% Tuberculoid	% Borderline	% Lepromatous
Trend 1	Period	2001/12	2001/20	2001/12	2001/20	2001/20	2001/20	2001/13
	APC	-9.9^† † Significantly different from 0 (p<0,005).	-9.4^† † Significantly different from 0 (p<0,005).	-0.7	-9.6^† † Significantly different from 0 (p<0,005).	-11.1^† † Significantly different from 0 (p<0,005).	20.4^† † Significantly different from 0 (p<0,005).	-3.2
	95%CI	-15.3; −4.2	-12.3; −6.3	-13.9; 14.4	-12.6; −6.5	-15.0; −7.1	13.4; 27.8	-10.8; 5.1
Trend 2	Period	2012/18		2012/18				2013/17
	APC	36.4^* * Detection coefficient < 15 years/100,000 inhabitants;		55.0^* * Detection coefficient < 15 years/100,000 inhabitants;				34.9
	95%CI	14.5; 62.4		18.0; 103.6				-12.4; 107.6
Trend 3	Period	2018/20		2018/20				2017/20
	APC	-32.9		-33.7				-44.4
	95%CI	-63.8; 24.4		-67.3; 34.4				-69.7; 1.8
	AAPC	-0.5	-9.4^* * Detection coefficient < 15 years/100,000 inhabitants;	9.5	-9.6^* * Detection coefficient < 15 years/100,000 inhabitants;	-11.1^* * Detection coefficient < 15 years/100,000 inhabitants;	20.4^* * Detection coefficient < 15 years/100,000 inhabitants;	-4.9
	95%CI	-8.4; 8.2	-18.6	-3.5; 24.3	-12.6; −6.5	-15.0; −7.1	13.4; 27.8	-16.3; 8.0

		% G0^* * % Disability Grade zero;	% G1^† † % Disability Grade one;	% G2^‡ ‡ % Disability Grade two;	% G2c^§ § Disability Grade two/100,000 inhabitants;	% Cont.^// // % Cases detected by contact tracing;	% Col.^¶ ¶ % Cases detected by collective examination;	% Ref.^# # % Cases detected by referral;	% Sd.^ % Cases detected by spontaneous demand;
Trend 1	Period	2001/13	2001/20	2001/20	2001/20	2001/20	2001/12	2001/20	2001/20
	APC	-8.8^†† †† Significantly different from 0 (p<0,005).	16.8^†† †† Significantly different from 0 (p<0,005).	-7.4^†† †† Significantly different from 0 (p<0,005).	-9.0^†† †† Significantly different from 0 (p<0,005).	13.1^†† †† Significantly different from 0 (p<0,005).	-4.7	-1.3	-4.9^†† †† Significantly different from 0 (p<0,005).
	95%CI	-12.4; −4.9	10.1; 23.9	-13.5; −0.7	-13.5; −4.4	10.2; 16.0	-19.6; 13.0	-4.4; 2.0	-7.5; −2.2
Trend 2	Period	2013/18					2012/15
	APC	40.5^†† †† Significantly different from 0 (p<0,005).					138.1
	95%CI	16.8; 69.0					-78.2; 2.498.1
Trend 3	Period	2018/20					2015/20
	APC	-33.1					-47.2^†† †† Significantly different from 0 (p<0,005).
	95%CI	-60.4; 13.0					-60.0; −30.3
	AAPC	-1.1	16.8^†† †† Significantly different from 0 (p<0,005).	-7.4^†† †† Significantly different from 0 (p<0,005).	-9.0^†† †† Significantly different from 0 (p<0,005).	13.1^†† †† Significantly different from 0 (p<0,005).	-5.7	-1.3	-4.9^†† †† Significantly different from 0 (p<0,005).
	95%CI	-7.8; 6.1	10.1; 23.9	-13.5; −0.7	-13.5; −4.4	10.2; 16.0	-34.0; 34.8	-4.4; 2.0	-7.5; −2.2

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[1] Corresponding author. E-mail: ricardomilhomem@gmail.com (R. M. Costa)