Estimating underreporting of leprosy in Brazil using a Bayesian approach.

<h4>Background</h4>Leprosy 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 c...

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Autores principales:	Guilherme L de Oliveira, Juliane F Oliveira, Júlia M Pescarini, Roberto F S Andrade, Joilda S Nery, Maria Y Ichihara, Liam Smeeth, Elizabeth B Brickley, Maurício L Barreto, Gerson O Penna, Maria L F Penna, Mauro N Sanchez
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/6715060094bf4746963bfd7311ecd685
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spelling	oai:doaj.org-article:6715060094bf4746963bfd7311ecd6852021-12-02T20:24:15ZEstimating underreporting of leprosy in Brazil using a Bayesian approach.1935-27271935-273510.1371/journal.pntd.0009700https://doaj.org/article/6715060094bf4746963bfd7311ecd6852021-08-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009700https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>Leprosy 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.<h4>Methodology/principal findings</h4>Using 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.<h4>Conclusions/significance</h4>The 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.Guilherme L de OliveiraJuliane F OliveiraJúlia M PescariniRoberto F S AndradeJoilda S NeryMaria Y IchiharaLiam SmeethElizabeth B BrickleyMaurício L BarretoGerson O PennaMaria L F PennaMauro N SanchezPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 8, p e0009700 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Guilherme L de Oliveira Juliane F Oliveira Júlia M Pescarini Roberto F S Andrade Joilda S Nery Maria Y Ichihara Liam Smeeth Elizabeth B Brickley Maurício L Barreto Gerson O Penna Maria L F Penna Mauro N Sanchez Estimating underreporting of leprosy in Brazil using a Bayesian approach.
description	<h4>Background</h4>Leprosy 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.<h4>Methodology/principal findings</h4>Using 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.<h4>Conclusions/significance</h4>The 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.
format	article
author	Guilherme L de Oliveira Juliane F Oliveira Júlia M Pescarini Roberto F S Andrade Joilda S Nery Maria Y Ichihara Liam Smeeth Elizabeth B Brickley Maurício L Barreto Gerson O Penna Maria L F Penna Mauro N Sanchez
author_facet	Guilherme L de Oliveira Juliane F Oliveira Júlia M Pescarini Roberto F S Andrade Joilda S Nery Maria Y Ichihara Liam Smeeth Elizabeth B Brickley Maurício L Barreto Gerson O Penna Maria L F Penna Mauro N Sanchez
author_sort	Guilherme L de Oliveira
title	Estimating underreporting of leprosy in Brazil using a Bayesian approach.
title_short	Estimating underreporting of leprosy in Brazil using a Bayesian approach.
title_full	Estimating underreporting of leprosy in Brazil using a Bayesian approach.
title_fullStr	Estimating underreporting of leprosy in Brazil using a Bayesian approach.
title_full_unstemmed	Estimating underreporting of leprosy in Brazil using a Bayesian approach.
title_sort	estimating underreporting of leprosy in brazil using a bayesian approach.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/6715060094bf4746963bfd7311ecd685
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Estimating underreporting of leprosy in Brazil using a Bayesian approach.

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