Impacto da pandemia da Covid-19 no diagnóstico da hanseníase no Ceará: estudo ecológico, 2017-2022

Abstract

Although some studies have considered the possible impact of the COVID-19 pandemic on the diagnosis of leprosy, analyzes of the state of Ceará have not yet been carried out in full, so the research proposal aimed to fill this gap. This study aimed to describe the clinical-sociodemographic profile of the disease and evaluate the impact of the COVID-19 pandemic on the diagnosis of leprosy in the state of Ceará, the temporal trend of new cases and the spatial distribution of epidemiological indicators. This is an ecological study of time series with spatial analysis. A database from the Notifiable Diseases Information System (SINAN) was used for the period 2017-2022 through Tabnet/DATASUS, to analyze indicators recommended by the Ministry of Health for leprosy control in Brazil rates: of annual detection, detection in children under 15 years of age and of new cases with grade 2 physical disability. The temporal trend analysis was based on Joinpoint regression, in addition to the analysis of time and space dimensions, respectively, using the Monte Carlo permutation method and spatial distribution in time. The trend change points were those with a statistical significance level lower than 0.05 and with a 95% confidence interval (95% CI). The study was designed in accordance with the REporting of Studies Conducted Using Observational Routinely-Collected Data (RECORD) guideline. As this is research using secondary data in the public domain, it was not necessary to submit the study to the ethics and research committee. 8,312 new cases of leprosy were reported in Ceará, with a prevalence of males (60.3%), individuals with low education (38.8%) and mixed race (70.3%). The multibacillary type (69.7%) and the dimorphic clinical form (35.7%) were the most common. A decreasing trend was identified from 2017 to 2022 for the annual detection rate (APC -7.60; 95% CI -14;0.7; p<0.05), detection rate in children under 15 years of age (APC -14.20; 95%CI -22.1;-5.5; p<0.05) and rate of new cases with grade 2 physical disability (APC -7.03; 95%CI -20.28.3; p.<0.05). Despite the declines in proven rates, the joinpoint regression showed no inflection points for the analysis of indicators in the period 2017-2022. In the spatial analysis, an unequal distribution of leprosy was observed between the regions of the state and despite the reduction in the concentration of high detection rates during the pandemic, the Center-South and South regions of the state still had a concentration of the highest rates detection. It is essential to understand to what extent the declining trend in new cases throughout Ceará is associated with areas with higher rates of COVID-19 infection and sociodemographic characteristics. It is concluded that the COVID-19 pandemic was probably the biggest impact factor for the decreasing trend of new leprosy diagnoses and the variations in periods of endemicity between the regions of Ceará in the period tested.