Clusters of leprosy transmission and of late diagnosis in a highly endemic area in Brazil: focus on different spatial analysis approaches

Printer-friendly version
TitleClusters of leprosy transmission and of late diagnosis in a highly endemic area in Brazil: focus on different spatial analysis approaches
Publication TypeJournal Article
AuthorsAlencar CH, Ramos AN, dos Santos ES, Richter J, Heukelbach J
Abbrev. JournalTrop. Med. Int. Health
JournalTropical Medicine & International Health
Place PublishedOxford
PublisherBlackwell Publishing Ltd
Year of Publication2012
Publication Languageeng
KeywordsBrazil, Control, Diagnosis, Epidemiology, Leprosy, Public Health, Spatial analysis
Abstract

Objective  The Brazilian National Hansen’s Disease Control Program recently identified clusters with high disease transmission. Herein, we present different spatial analytical approaches to define highly vulnerable areas in one of these clusters.

Method  The study area included 373 municipalities in the four Brazilian states Maranhão, Pará, Tocantins and Piauí. Spatial analysis was based on municipalities as the observation unit, considering the following disease indicators: (i) rate of new cases/100 000 population, (ii) rate of cases

Results  A total of 254 (68.0%) municipalities were classified as hyperendemic (mean annual detection rates >40 cases/100 000 inhabitants). There was a concentration of municipalities with higher detection rates in Pará and in the center of Maranhão. Spatial scan statistic identified 23 likely clusters of new leprosy case detection rates, most of them localized in these two states. These clusters included only 32% of the total population, but 55.4% of new leprosy cases. We also identified 16 significant clusters for the detection rate

Conclusions  Several municipality clusters for high leprosy transmission and late diagnosis were identified in an endemic area using different statistical approaches. Spatial scan statistic is adequate to validate and confirm high-risk leprosy areas for transmission and late diagnosis, identified using descriptive spatial analysis and using local empirical Bayesian method. National and State leprosy control programs urgently need to intensify control actions in these highly vulnerable municipalities.

PubMed URL

http://www.ncbi.nlm.nih.gov/pubmed/22248041?dopt=Abstract

DOI10.1111/j.1365-3156.2011.02945.x
Link to full texthttp://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2011.02945.x/pdf