|Title||Clusters of leprosy transmission and of late diagnosis in a highly endemic area in Brazil: focus on different spatial analysis approaches|
|Publication Type||Journal Article|
|Authors||Alencar CH, Ramos AN, dos Santos ES, Richter J, Heukelbach J|
|Abbrev. Journal||Trop. Med. Int. Health|
|Journal||Tropical Medicine & International Health|
|Publisher||Blackwell Publishing Ltd|
|Year of Publication||2012|
|Keywords||Brazil, Control, Diagnosis, Epidemiology, Leprosy, Public Health, Spatial analysis|
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.
|Link to full text||http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2011.02945.x/pdf|