Estimating underreporting of leprosy in Brazil using a Bayesian approach

Background 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. Methodology/Principal findings 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. Conclusions/Significance 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.

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Estimating Under Reporting of Leprosy in Brazil using a Bayesian Approach

10.1101/2020.05.22.20109900 ◽

2020 ◽

Author(s):

Guilherme L Oliveira ◽

Juliane Fonseca Oliveira ◽

Roberto F S Andrade ◽

Joilda S Nery ◽

Julia M Pescarini ◽

...

Keyword(s):

Health Problem ◽

Health Resources ◽

Bayesian Hierarchical Model ◽

Incidence Rates ◽

Grouped Data ◽

Bayesian Hierarchical ◽

Effective Interventions ◽

True Number ◽

Important Health ◽

Resouce Allocation

Leprosy remains an important health problem in Brazil - the country register the second largest number of new leprosy cases each year, accounting for 14% of the world's new cases in 2019. Although there was increasing advances in leprosy surveillance worldwide, the true number of leprosy cases is expected to be much larger than the reported. Leprosy underreporting impair planning effective interventions and thoughful decisions about the distribution of financial and health resources. In this study, we estimated leprosy underreporting for each Brazilian microregion in order to guide effective interventions and resouce allocation to improve leprosy detection in the country. We extracted the number of new cases of leprosy from 2007 to 2015 and population and socioeconomic information from the 2010 Census for each Brazilian municipality and grouped data in microregions. We applied a Bayesian hierarchical model to obtain the best explicative model for leprosy underreporing using Grade 2 of leprosy-related disabilities as a proxy to explain the incidence rates. Then, we estimated the number of missing leprosy cases (underreported cases) and the corrected leprosy incidence rates for each Brazilian microrregion.

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Impact of the New Cooperative Medical Scheme on the trend of catastrophic health expenditure in Chinese rural households: results from nationally representative surveys from 2003 to 2013

BMJ Open ◽

10.1136/bmjopen-2017-019442 ◽

2018 ◽

Vol 8 (2) ◽

pp. e019442 ◽

Cited By ~ 9

Author(s):

Biao Xie ◽

Minghe Huo ◽

Zhiqiang Wang ◽

Yongjie Chen ◽

Rong Fu ◽

...

Keyword(s):

Low Income ◽

Rural China ◽

Rural Households ◽

Catastrophic Health Expenditure ◽

Incidence Rates ◽

New Cooperative Medical Scheme ◽

Middle Income ◽

Cooperative Medical Scheme ◽

Nationally Representative ◽

Using Data

ObjectiveTo evaluate the trend of catastrophic health expenses (CHE) for inpatient care in relation to the commencement of the New Cooperative Medical Scheme (NCMS) in rural China from 2003 to 2013, and the roles of NCMS in protecting affected households from CHE.MethodsWe assessed the 10-year trend of the incidence and severity of CHE in rural households with hospitalised members using data from the Chinese National Health Services Survey. Generalised estimating equations were used to estimate the OR and 95% CI of the association between incidence rates of CHE (RCHE) and NCMS reimbursement.ResultsThe incidence and severity of CHE after NCMS reimbursement both decreased and their changes increased rapidly from 2003 to 2013. After adjustment of the covariates,RCHEbefore reimbursement was significantly higher than that after reimbursement, and the OR (95% CI) was 1.50 (1.24 to 1.81), 1.79 (1.69 to 1.90) and 2.94 (2.77 to 3.11) in 2003, 2008 and 2013, respectively.ConclusionThe incidence and severity of CHE both reduced after NCMS reimbursements in each year. Excluding some confounding factors,RCHEwas significantly associated with NCMS reimbursement. NCMS partly protected the rural households with hospitalised members from CHE. However, the inequalities between different income groups still existed.RCHEin rural households with hospitalised members was still rather high in 2003, 2008 and 2013 even though they were covered by NCMS. This study will provide suggestions for further reforms in China and guidance for other low-income/middle-income countries.

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Epidemiology of pertussis in individuals of all ages hospitalised with respiratory illness in South Africa, January 2013 – December 2018

Clinical Infectious Diseases ◽

10.1093/cid/ciab089 ◽

2021 ◽

Author(s):

Nicole Wolter ◽

Cheryl Cohen ◽

Stefano Tempia ◽

Sibongile Walaza ◽

Fahima Moosa ◽

...

Keyword(s):

South Africa ◽

Clinical Information ◽

Respiratory Illness ◽

Incidence Rates ◽

Surveillance Program ◽

Policy Recommendations ◽

Pertussis Infection ◽

Middle Income ◽

Middle Income Countries ◽

Adjusted Incidence

Abstract Background Policy recommendations on pertussis vaccination need to be guided by data, which are limited from low- and middle-income countries. We aimed to describe the epidemiology of pertussis in South Africa, a country with high HIV prevalence and routine pertussis vaccination for six decades including the acellular vaccine since 2009. Methods Hospitalized patients of all ages were enrolled at five sentinel sites as part of a pneumonia surveillance program from January 2013 through December 2018. Nasopharyngeal specimens and induced sputum were tested by PCR for Bordetella pertussis. In addition, demographic and clinical information were collected. Incidence rates were calculated for 2013-2016, and multivariable logistic regression performed to identify factors associated with pertussis. Results Over the six-year period 19429 individuals were enrolled, of which 239 (1.2%) tested positive for B. pertussis. Detection rate was highest in infants aged <6 months (2.8%, 155/5524). Mean annual incidence was 17 cases per 100,000 population, with the highest incidence in children <1 year of age (228 per 100,000). Age-adjusted incidence was 65.9 per 100,000 in HIV-infected individuals compared to 8.5 per 100,000 in HIV-uninfected individuals (risk ratio 30.4, 95% confidence interval 23.0-40.2). Ten individuals (4.2%) with pertussis died; of which 7 were infants aged <6 months and 3 were immunocompromised adults. Conclusions Pertussis continues to be a significant cause of illness and hospitalization in South Africa, despite routine vaccination. The highest burden of disease and death occurred in infants; however, HIV-infected adults were also identified as an important group at risk of B. pertussis infection.

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Childlessness, Individual Socioeconomic Resources, and Health: Exploring Variation in 20 Countries

Innovation in Aging ◽

10.1093/geroni/igaa057.1664 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 515-516

Author(s):

Nekehia Quashie ◽

Christine Mair ◽

Radoslaw Antczak ◽

Bruno Arpino

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Health Indicators ◽

Data Repository ◽

Middle Income ◽

Individual Level ◽

Socioeconomic Resources ◽

Middle Income Countries ◽

Using Data ◽

The Impact

Abstract Childless older adults may be at risk for poorer health cross-nationally, yet most studies on this topic analyze only a small number of countries and only 1 or 2 health outcomes. To our knowledge, two papers exist that explore associations between childlessness and multiple indicators of health using data from a large number of regionally diverse countries (e.g., 20 countries from North America, Asia, and Europe), but neither study includes an examination of socioeconomic resources. The level of health risk faced by childless older adults is likely to be distinctly shaped by older adults’ socioeconomic resources (e.g., education, income, wealth). Associations between childlessness, socioeconomic resources, and health may also differ by country context. Using harmonized, cross-national data for adults aged 50 and older across 20 high- and middle-income countries (United States (HRS), European Union (SHARE), Mexico (MHAS), and China (CHARLS) from the Gateway to Global Aging data repository), we explore if and how individual-level socioeconomic resources (income, education, wealth) moderate associations between childlessness and five health indicators (self-rated health, ADL limitations, IADL limitations, chronic conditions, and depression). Results suggest that associations between childlessness and health outcomes vary by individual socioeconomic resources in some country contexts, but not in others. We discuss these findings in light of the impact of individual-level socioeconomic resources on older adults’ support options and health outcomes cross-nationally.

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“It Is Like Medicine”: Using Sports to Promote Adult Women’s Health in Rural Kenya

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052347 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2347

Author(s):

Francis Barchi ◽

Millan A. AbiNader ◽

Samantha C. Winter ◽

Lena M. Obara ◽

Daniel Mbogo ◽

...

Keyword(s):

Access To Health Care ◽

Sleep Problems ◽

Health Benefits ◽

Adult Women ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Middle Income ◽

Aerobic Activity ◽

Effective Interventions ◽

Rural Kenya

Despite the well-documented health benefits of recreational sports, few opportunities exist in lower- and middle-income countries for adult women to participate in recreational physical activities. An explanatory sequential mixed methods approach was used to explore associations between an innovative soccer program for adult women and self-reported health status. Cross-sectional survey data were collected in 2018–2019 from 702 women in the Nikumbuke Project, a health and literacy program in southeastern rural Kenya, followed by focus group discussions with 225 women who also participated in the Project’s soccer program. Quantitative findings suggest that women who participated in soccer had 67% greater odds of reporting good or excellent health than their non-soccer playing peers. Thematic analysis of qualitative data indicated that women credited soccer with less pain, fatigue, and stress, as well as weight loss and reduced dependence on medicine for hypertension, pain, and sleep problems. Women equated health benefits with greater ease and efficiency in completing chores, reduced worries, youthful energy, male-like strength, and pleased husbands. Soccer programs for adult women may be particularly effective interventions in settings where access to health care is limited and where lack of opportunity to engage in physical aerobic activity increases women’s risks for poor health outcomes.

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The Economic Impact of Inflammatory Bowel Disease in Canada

Canadian Journal of Gastroenterology ◽

10.1155/2004/354610 ◽

2004 ◽

Vol 18 (4) ◽

pp. 255-257

Author(s):

Robert Hilsden

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Labour Force ◽

Incidence Rates ◽

Age Group ◽

Group Level ◽

The Past ◽

Inflammatory Bowel ◽

Using Data ◽

Very High

Longobardi and colleagues examined the effect of inflammatory bowel disease (IBD) on employment, using data from 10,891 respondents aged 20 to 64 years from the 1998 cycle of the Canadian National Population Health Survey (NPHS) (1). This sample included 187 (1.7%) subjects who self-reported IBD or a similar bowel disorder. A significantly greater proportion of IBD than non-IBD respondents reported that they were not in the labour force (28.9% versus 18.5%). Even after adjusting for other factors (age group, level of pain, etc), subjects with IBD had a 2.9% higher nonparticipation rate (21.4%). For example, among people not hospitalized within the past year and with no limitation of activities due to pain, IBD subjects were 1.2 times more likely to be unemployed than those without IBD. Subjects who reported high levels of pain had a very high probability of being out of the labour force. Based on Canadian annual compensation data for all employed persons in Canada, and age- and sex-specific prevalence, and incidence rates for IBD, the authors estimated that there are 119,980 IBD patients between the ages of 20 and 64 years in Canada and that this group includes 3479 people who are not in the labour force. This translates into lost wages of $104.2 million, or $868 per IBD patient

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Global epidemiology of SARS-CoV-2 infection: a systematic review and meta-analysis of standardized population-based seroprevalence studies, Jan 2020-Oct 2021

10.1101/2021.12.14.21267791 ◽

2021 ◽

Author(s):

Isabel Bergeri ◽

Mairead Whelan ◽

Harriet Ware ◽

Lorenzo Subissi ◽

Anthony Nardone ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Population Based ◽

Control Measures ◽

Middle Income ◽

Global Epidemiology ◽

Using Data ◽

Demographic Subgroups ◽

Over Time

Background COVID-19 case data underestimates infection and immunity, especially in low- and middle-income countries (LMICs). We meta-analyzed standardized SARS-CoV-2 seroprevalence studies to estimate global seroprevalence. Objectives/Methods We conducted a systematic review and meta-analysis, searching MEDLINE, Embase, Web of Science, preprints, and grey literature for SARS-CoV-2 seroprevalence studies aligned with the WHO UNITY protocol published between 2020-01-01 and 2021-10-29. Eligible studies were extracted and critically appraised in duplicate. We meta-analyzed seroprevalence by country and month, pooling to estimate regional and global seroprevalence over time; compared seroprevalence from infection to confirmed cases to estimate under-ascertainment; meta-analyzed differences in seroprevalence between demographic subgroups; and identified national factors associated with seroprevalence using meta-regression. PROSPERO: CRD42020183634. Results We identified 396 full texts reporting 736 distinct seroprevalence studies (41% LMIC), including 355 low/moderate risk of bias studies with national/sub-national scope in further analysis. By April 2021, global SARS-CoV-2 seroprevalence was 26.1%, 95% CI [24.6-27.6%]. Seroprevalence rose steeply in the first half of 2021 due to infection in some regions (e.g., 18.2% to 45.9% in Africa) and vaccination and infection in others (e.g., 11.3% to 57.4% in the Americas high-income countries), but remained low in others (e.g., 0.3% to 1.6% in the Western Pacific). In 2021 Q1, median seroprevalence to case ratios were 1.9:1 in HICs and 61.9:1 in LMICs. Children 0-9 years and adults 60+ were at lower risk of seropositivity than adults 20-29. In a multivariate model using data pre-vaccination, more stringent public health and social measures were associated with lower seroprevalence. Conclusions Global seroprevalence has risen considerably over time and with regional variation, however much of the global population remains susceptible to SARS-CoV-2 infection. True infections far exceed reported COVID-19 cases. Standardized seroprevalence studies are essential to inform COVID-19 control measures, particularly in resource-limited regions.

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Decreasing incidence of subarachnoid hemorrhage

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014038 ◽

2018 ◽

Vol 11 (3) ◽

pp. 320-322 ◽

Cited By ~ 5

Author(s):

Patrick Nicholson ◽

Alan O’Hare ◽

Sarah Power ◽

Seamus Looby ◽

Mohsen Javadpour ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Population Data ◽

Incidence Rates ◽

Public Hospitals ◽

National Database ◽

Irish Hospital ◽

Acute Subarachnoid Hemorrhage ◽

Adjusted Rate ◽

Using Data ◽

Adjusted Incidence

ObjectiveTo determine the incidence and trends in subarachnoid hemorrhage in Ireland using data from a national database.Materials and methodsWe performed a retrospective nationwide query of the Irish Hospital In-patient Enquiry System (HIPE). This is a national database of all in-patient activity in acute public hospitals in Ireland. Each HIPE entry records one episode of in-patient care. The study period ranged from 1997 to 2015. Population data was obtained from the Irish Central Statistics Office, and the annual prevalence of smoking from the Irish National Tobacco Control Office. We were therefore able to calculate both crude annual acute subarachnoid hemorrhage (SAH) incidence rates, as well as population-standardized rates, and compared them with trends in the annual smoking rates.ResultsThe mean number of SAH cases per year is 549, with 465 cases in 1997 and 517 in 2015 (range: 465–624). The absolute incidence of SAH, therefore, remained relatively stable. Due to population increases over time, the population-adjusted rate of SAH therefore decreased, from 126.9/million people/year in 1997 to 111.5/million people/year in 2015. Nationally, there was a decrease in smoking prevalence, from 31% in 1998 to 19.2% in 2015. There was a statistically significant correlation between decreasing smoking rates and decreasing population-adjusted incidence of SAH (P=<0.0001).ConclusionsOur data suggests that the incidence of non-traumatic subarachnoid hemorrhage in our population appears to be decreasing, a decrease which is correlated with decreasing smoking rates. This provides important data both in terms of the epidemiology of SAH, as well as the possible role of public-health interventions in tackling both smoking and declining rates of SAH.

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The Role of Manual Occupation in the Aetiology of Dupuytren’s Disease in Men in England and Wales

Journal of Hand Surgery (European Volume) ◽

10.1016/j.jhsb.2003.08.012 ◽

2004 ◽

Vol 29 (1) ◽

pp. 12-14 ◽

Cited By ~ 35

Author(s):

A. A. KHAN ◽

O. J. RIDER ◽

C. U. JAYADEV ◽

C. HERAS-PALOU ◽

H. GIELE ◽

...

Keyword(s):

The Elderly ◽

Incidence Rates ◽

Social Classes ◽

Dupuytren’S Disease ◽

Dupuytren's Disease ◽

England And Wales ◽

Occupational Social Class ◽

Using Data ◽

Manual Occupation

We compared the incidence of significant Dupuytren’s disease in men across occupational social classes in England and Wales, using data from the National Morbidity Survey. We found that manual occupational social class was not associated with an increased incidence of Dupuytren’s disease. In fact, the incidence rates of Dupuytren’s disease in the elderly were higher in non-manual than in manual social classes.

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