Socioeconomic, environmental, and behavioural risk factors for leprosy in North-east Brazil: results of a case–control study
Open Access
- 27 April 2006
- journal article
- research article
- Published by Oxford University Press (OUP) in International Journal of Epidemiology
- Vol. 35 (4), 994-1000
- https://doi.org/10.1093/ije/dyl072
Abstract
Background Brazil reports almost 80% of all leprosy cases in the Americas. This study aimed to identify socioeconomic, environmental, and behavioural factors associated with risk of leprosy occurrence in the endemic North-eastern region. Methods A case–control study in four municipalities. Cases: cases of leprosy diagnosed in the previous 2 years, with no other known, current, or past case of leprosy in the household or in the neighbourhood. Controls: individuals presenting for reasons other than skin problems to the health unit where the case was diagnosed and who lived in the same municipality as the case with whom it was matched. For each case four controls were selected. A semi-structured questionnaire was used to collect demographic, socioeconomic, environmental, and behavioural data. A multivariate hierarchical analysis was performed according to a previously defined framework. Results 226 cases and 857 controls were examined. Low education level, ever having experienced food shortage, bathing weekly in open water bodies (creek, river and/or lake) 10 years previously, and a low frequency of changing bed linen or hammock (≥biweekly) currently were all significantly associated with leprosy. Having a BCG vaccination scar was found to be a highly significant protective factor. Conclusions Except for BCG vaccination, variables that remained significant in the hierarchical analysis are cultural or linked to poverty. They may act on different levels of the transmission of Mycobacterium leprae and/or the progress from infection to disease. These findings give credit to the hypothesis that person-to-person is not the only form of M. leprae transmission, and that indirect transmission might occur, and other reservoirs should exist outside the human body.Keywords
This publication has 7 references indexed in Scilit:
- Inequality and leprosy in Northeast Brazil: an ecological studyInternational Journal of Epidemiology, 2004
- Armadillo exposure and Hansen’s disease: An epidemiologic survey in southern TexasJournal of the American Academy of Dermatology, 2000
- Review: Mycobacterium leprae – millennium resistant! Leprosy control on the threshold of a new eraTropical Medicine & International Health, 2000
- The Ecology of MycobacteriaPublished by Springer Science and Business Media LLC ,2000
- Household and Dwelling Contact as Risk Factors for Leprosy in Northern MalawiAmerican Journal of Epidemiology, 1997
- The epidemiology ofmycobacterium leprae: Recent insightFEMS Microbiology Letters, 1996
- Extended studies on the viability ofMycobacterium lepraeoutside the human bodyLeprosy Review, 1995