02686nas a2200229   4500000000100000008004100001653001000042653001400052653001200066653001100078100001200089700001700101700001400118700001200132700001300144245009500157856007700252300001000329490000600339050001500345520209600360       2013                            d10aRisks10aMigration10aleprosy10aBrazil1 aMurto C1 aChammartin F1 aSchwarz K1 aCosta L1 aKaplan C00aPatterns of migration and risks associated with Leprosy among migrants in maranhao, Brazil  uhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764227/pdf/pntd.0002422.pdf  ae24220 v7  aMURTO 20133 aLeprosy remains a public health problem in Brazil with new case incidence exceeding World Health Organization (WHO)
goals in endemic clusters throughout the country. Migration can facilitate movement of disease between endemic and nonendemic
areas, and has been considered a possible factor in continued leprosy incidence in Brazil. A study was conducted
to investigate migration as a risk factor for leprosy. The study had three aims: (1) examine past five year migration as a risk
factor for leprosy, (2) describe and compare geographic and temporal patterns of migration among past 5-year migrants
with leprosy and a control group, and (3) examine social determinants of health associated with leprosy among past 5-year
migrants. The study implemented a matched case-control design and analysis comparing individuals newly diagnosed with
leprosy (n = 340) and a clinically unapparent control group (n = 340) without clinical signs of leprosy, matched for age, sex
and location in four endemic municipalities in the state of Maranha˜o, northeastern Brazil. Fishers exact test was used to
conduct bivariate analyses. A multivariate logistic regression analysis was employed to control for possible confounding
variables. Eighty cases (23.5%) migrated 5-years prior to diagnosis, and 55 controls (16.2%) migrated 5-years prior to the
corresponding case diagnosis. Past 5 year migration was found to be associated with leprosy (OR: 1.59; 95% CI 1.07–2.38;
p = 0.02), and remained significantly associated with leprosy after controlling for leprosy contact in the family, household,
and family/household contact. Poverty, as well as leprosy contact in the family, household and other leprosy contact, was
associated with leprosy among past 5-year migrants in the bivariate analysis. Alcohol consumption was also associated with
leprosy, a relevant risk factor in susceptibility to infection that should be explored in future research. Our findings provide
insight into patterns of migration to localize focused control efforts in endemic areas with high population mobility.