Skip to main content

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

Download Article:

You have access to the full text article on a website external to Ingenta Connect.

Please click here to view this article on Wiley Online Library.

You may be required to register and activate access on Wiley Online Library before you can obtain the full text. If you have any queries please visit Wiley Online Library


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 <15 years/100 000 population, (iii) new cases with grade‐2 disability/100 000 population and (iv) proportion of new cases with grade‐2 disabilities. We performed descriptive spatial analysis, local empirical Bayesian analysis and spatial scan statistic.

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 <15 years and 11 likely clusters of new cases with grade‐2. Several clusters of new cases with grade‐2/population overlap with those of new cases detection and detection of children <15 years of age. The proportion of new cases with grade‐2 did not reveal any significant clusters.

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.
No References
No Citations
No Supplementary Data
No Article Media
No Metrics

Language: English

Document Type: Research Article

Affiliations: 1:  Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil 2:  Department of Geography, School of Philosophy, Literature and Human Sciences, University of São Paulo, São Paulo, Brazil 3:  University Hospital of Gastroenterology, Hepatology and Infectious Diseases Heinrich-Heine-University, Düsseldorf, Germany

Publication date: 01 April 2012

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more