Migration and leprosy in Brazil

摘要: Background: Leprosy is among the Neglected Tropical Diseases (NTDs), and an endemic public health problem in high-risk clusters throughout Brazil. caused by intracellular bacteria Mycobacterium leprae, affecting skin peripheral nerve function. The disease can cause significant disabilities through damage secondary infection. Nasal mucosa considered primary transmission site due to presence of active bacilli. However, continues remain unclear. Environmental risk has also been considered, as leprosy found local water soil sources areas, mycobacteria survive outside body for up 60 days. While household contact with multibacillary cases (>5 lesions) remains factor leprosy, genetic relationships are thought be a independent physical contact. Socioeconomic factors conditions poverty, such inadequate housing sanitation, poor nutrition density, related proximity, have Brazil other countries. These increase both onset symptoms, particularly when associated poverty compromise immune response. Migration social determinant NTDs, including leprosy. Social disparities migration place non-immune migrants at infection exposed disease. Migration additionally influence distribution movement baciliferous individuals into previously non-endemic areas. Thus, control may hindered increased migration. In Brazil, new case incidence 1.77/10.000 inhabitants nationally above World Health Organization elimination goal <1 per 10,000, some states exceeding 5.0 10,000 North, Central West Northeast areas country. Objectives: overarching this PhD research was support Brazilian Control program improve targeted service delivery towards migrating populations, investigating social, behavioral There were four objectives: 1) identify motives determinants residence change after diagnosis; 2) describe influencing before diagnosis those infected leprosy; 3) environmental newly diagnosed compared uninfected reference population; 4) determine patterns risks past five year migrants. Methods: This study entailed two comprehensive population-based epidemiological studies conducted identified Ministry highly transmission, Tocantins Maranhao municipalities Maranhao, 2009 2010 population matched age, sex geographic location interviewed. Tocantins, 79 between 2006 2008 interviewed, using structured questionnaires. Results: migration, more severe prominent Among migrants, family contact, alcohol consumption poverty. Many largely facilitated familial indicators consumption. unique comparison population. Family separation although all not only Limited access services barrier that majority lifestyle changes purpose seeking medical care. Conclusion: relationship internal aspects investigated. further investigation consumption, well stressor from friends’ which Additionally, late evident Future should assess role life stressors symptom onset. National efforts take account distinguish non-migrant populations. Based on these, interventions targeting factors, i.e. substance abuse stress affected could help reduce transmission. extension clinic hours availability meet needs populations recommended order early disability.