Abstract
Leprosy remains a public health problem in developing countries. Among communicable diseases, it is one of the leading causes of permanent disability. Brazil had not reached the goal of reducing cases to less than 1 per 10,000 population. This study aimed to analyze the spatial distribution of leprosy cases in Brazil, using a literature review. The search strategy included the LILACS and MEDLINE databases with no language or period restriction. Ecological studies with spatial data analysis were considered as a criterion for the inclusion. We found 38 studies for review after the selection criteria. Among the epidemiological indicators of the disease, the most common was the new case detection rate. Several articles have explored the association between spatial distribution of leprosy and socioeconomic, demographic, and environmental factors. The most common unit of analysis was the municipality. The spatial distribution methods mostly used were: empirical Bayesian method, autocorrelation (Moran's I index) and Kernel estimates. The distribution of leprosy was very heterogeneous, independent of the unit of analysis. There was a decrease in the rate of detection and among under-15-year-olds, but some regions maintained high endemicity during the study period. The distribution and risk of illness were directly related to living conditions of the population. Improved access to health services was associated with increased detection rate in some regions. Spatial analysis seems to be a very useful tool to study leprosy and to guide interventions and surveillance.
Highlights
Leprosy is still a public health problem in low and middleincome countries
We reviewed the spatial distribution of leprosy and methods used for spatial analysis in Brazil, according to different scales, and its relationship with demographic and socioeconomic factors
Seven studies[10,19,20,23,32,33,36,38] evaluated the new case detection rate (NCDR) indicator of individuals under 15 years of age, 3 evaluated the disability-degree indicator[19,20,22] and one article explored the spatial distribution of mortality due to leprosy[18]
Summary
Leprosy is still a public health problem in low and middleincome countries. It is a leading cause of permanent disability and social stigma[1], and stands out as one of the neglected infectious diseases in those countries. Despite the magnitude and impact on health, leprosy has little investment regarding therapeutic research and development[2,3]. The incidence of infectious diseases declined, but the impact on leprosy is not yet fully clear[5,6]. Studies point out that cash transfer policies were related to the decrease in disease incidence, while the expansion of the Family Health Care Strategy improved t h e detection of new cases[6,7]
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