title: Physical disabilities at diagnosis of leprosy in a hyperendemic area of Brazil: trends and associated factors.
abstract: BACKGROUND
  Tocantins State in north Brazil remains endemic for leprosy, with high detection rates and occurrence of disabilities at diagnosis. We analyzed trends and identified factors associated with the occurrence of disability at diagnosis.
  
  
  METHODS
  We analyzed data from the Notifiable Diseases Information System (SINAN). We included new leprosy cases resident in Tocantins, diagnosed between 2001 and 2012.
  
  
  RESULTS
  During the study period, there were 14,532 new leprosy cases residing in Tocantins. Of these, 12,328 (84.9%) were assessed for degree of disability at diagnosis: 9,166 (74.4%) with Grade 0; 2,498 (20.3%) with Grade 1; and 664 (5.4%) with Grade 2 disability. The proportion of disability Grade 2 remained stable over time. Factors associated with Grade 2 at diagnosis included: male gender (RR = 2.24; CI: 1.89 - 2.65), age ≥ 45 years (RR = 5.31; CI: 3.21 - 8, 29), illiteracy (RR = 6.70; CI: 3.75 - 11.95), diagnosis made through mass campaigns (RR = 2.40; CI: 1.50 - 3.85), and residency in rural areas (RR = 1.28; CI: 1.06 - 1.5). Grade 2 disabilities at diagnosis were also more common in the presence of ≥ 5 five skin lesions (RR = 4.42, CI: 3.74 - 5.21), leprosy reactions (RR = 2.78; CI: 2.31 - 3.33), multibacillary disease (RR = 7.43; CI: 6.11 - 9.04), and lepromatous clinical form (RR = 16.53, CI: 12.10 - 20.60).
  
  
  CONCLUSIONS
  The leprosy control programme should focus on socio-economically disadvantaged and difficult-to-reach population groups. Leprosy mass campaigns and other collective examinations, to be integrated with other disease control programmes, may be an effective means to reduce disability degree at diagnosis.
authors.forename: Lorena Dias
authors.initials: LD
authors.lastname: Monteiro
authors.forename: Francisco Rogerlândio
authors.initials: FR
authors.lastname: Martins-Melo
authors.forename: Aline Lima
authors.initials: AL
authors.lastname: Brito
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Alencar
authors.forename: Jorg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D018563:Disease Notification; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007918:Leprosy / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D055815:Young Adult