title: Social inequality, urban growth and leprosy in Manaus: a spatial approach.
abstract: OBJECTIVE
  To analyze the epidemiology of leprosy according to spatial distribution and living conditions of the population.
  
  
  METHODS
  Ecological study based on the spatial distribution of leprosy in the municipality of Manaus, Northern Brazil, from 1998 to 2004. The 4,104 cases identified in the Sistema de Informações de Agravos de Notificação (Sinan -National Notification System) were georeferenced according to the addresses in the 1,536 urban census tracts through four different sources: postal service (73.7% of addresses found), Property Registration Program (7.3%), Family Health Program (2.1%), and Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics) data sheet (1.5%). Calculation of detection coefficient was performed based on the 2001 population. Local empirical Bayesian method was used for the spatial distribution analysis, in order to estimate leprosy risk, making rate variation shorter when they were calculated for small areas. Logistic regression was employed to analyze the association between geographical distribution and risk factors. The incidence of cases in children under 15 (severity indicator) and Social Need Index built from variables of the 2000 census were adopted as explicative variables.
  
  
  RESULTS
  The mean coefficient of detection was hyperendemic in 34.0% of the census tracts, and very high in 26.7%. Odds ratio was obtained for explicative variables and proved to be significant. Low-income and incidence in children under 15 were combined to identify priority areas for intervention.
  
  
  CONCLUSIONS
  Spatial analysis of leprosy showed that the distribution of the disease is heterogeneous and is more strongly present in regions inhabited by more vulnerable groups.
authors.affiliation: Instituto Leônidas & Maria Deane, Manaus, AM, Brasil. elsia@amazonia.fiocruz.br
authors.forename: Elsia Nascimento Belo
authors.initials: EN
authors.lastname: Imbiriba
authors.forename: Antônio Levino da
authors.initials: AL
authors.lastname: Silva Neto
authors.forename: Wayner Vieira de
authors.initials: WV
authors.lastname: Souza
authors.forename: Valderiza
authors.initials: V
authors.lastname: Pedrosa
authors.forename: Maria da Graça
authors.initials: Mda G
authors.lastname: Cunha
authors.forename: Luiza
authors.initials: L
authors.lastname: Garnelo
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007182:Income; D007223:Infant; D007918:Leprosy / Q000453:epidemiology*; D016015:Logistic Models; D020380:Needs Assessment; D016017:Odds Ratio; D011158:Population Growth; D012959:Socioeconomic Factors; D013029:Space-Time Clustering; D014505:Urban Population / Q000706:statistics & numerical data*; D014507:Urbanization