Abstract
BackgroundLeprosy remains concentrated among the poorest communities in low-and middle-income countries and it is one of the primary infectious causes of disability. Although there have been increasing advances in leprosy surveillance worldwide, leprosy underreporting is still common and can hinder decision-making regarding the distribution of financial and health resources and thereby limit the effectiveness of interventions. In this study, we estimated the proportion of unreported cases of leprosy in Brazilian microregions.Methodology/Principal findingsUsing data collected between 2007 to 2015 from each of the 557 Brazilian microregions, we applied a Bayesian hierarchical model that used the presence of grade 2 leprosy-related physical disabilities as a direct indicator of delayed diagnosis and a proxy for the effectiveness of local leprosy surveillance program. We also analyzed some relevant factors that influence spatial variability in the observed mean incidence rate in the Brazilian microregions, highlighting the importance of socioeconomic factors and how they affect the levels of underreporting. We corrected leprosy incidence rates for each Brazilian microregion and estimated that, on average, 33,252 (9.6%) new leprosy cases went unreported in the country between 2007 to 2015, with this proportion varying from 8.4% to 14.1% across the Brazilian States.Conclusions/SignificanceThe magnitude and distribution of leprosy underreporting were adequately explained by a model using Grade 2 disability as a marker for the ability of the system to detect new missing cases. The percentage of missed cases was significant, and efforts are warranted to improve leprosy case detection. Our estimates in Brazilian microregions can be used to guide effective interventions, efficient resource allocation, and target actions to mitigate transmission.
Highlights
Leprosy is a Neglected Tropical Disease (NTD) caused by Mycobacterium Leprae that remains concentrated among individuals living under poor socioeconomic conditions in low- and middle-income countries [1, 2]
We estimated how many cases were not detected in each Brazilian microregion by the surveillance system during the period of 2007 until 2015
We estimate the posterior mean (Mean), the posterior standard deviation (SD) and the 90% highest posterior density intervals (90%-HPD) for all regression parameters defined on Eqs (3) and (4)
Summary
Leprosy is a Neglected Tropical Disease (NTD) caused by Mycobacterium Leprae that remains concentrated among individuals living under poor socioeconomic conditions in low- and middle-income countries [1, 2]. The WHO Global Leprosy Strategy 2016–2020 reinforces the need to strengthen leprosy surveillance and health information systems for programme monitoring and evaluation and to enhance early detection through active case finding in leprosyendemic areas and among groups with increased risk Despite these recommendations, millions of individuals with leprosy remain undiagnosed and untreated worldwide [4]. We estimated the proportion of unreported cases of leprosy in Brazilian microregions
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