RESUMO
BACKGROUND: Evidence suggests that biological mechanisms involved in helminth infections and vitamin deficiencies increase susceptibility to other infections. The aim of this study was to investigate the associations of helminth co-infection and select micronutrient deficiencies with leprosy using a case-control design. METHODS: From 2016 to 2018, individuals aged ≥3 years were recruited at clinics in and around Governador Valadares, Minas Gerais, Brazil in three groups: cases of leprosy, household contacts and community-matched (non-contact) controls. Helminths were diagnosed through stool Kato Katz examination and serum reactivity to anti-soluble adult worm antigen preparation IgG4. Serum ferritin, 25-OH vitamin D and retinol concentrations were measured. Multi-variate logistic regression was conducted to identify associations with active leprosy. RESULTS: Seventy-nine cases of leprosy, 96 household contacts and 81 non-contact controls were recruited; 48.1% of participants were male with a median age of 40 years. Helminths were found in 7.1% of participants on Kato Katz test, all but one of which were Schistosoma mansoni, and 32.3% of participants were positive for S. mansoni serology. On multi-variate analysis, cases were more likely to be infected with helminths (diagnosed by stool) than household contacts [adjusted odds ratio (aOR) 8.69, 95% confidence interval (CI) 1.50-50.51]. Vitamin D deficiency was common, and was more likely in cases compared with non-contact controls (aOR 4.66, 95% CI 1.42,-15.33). Iron deficiency was not associated with leprosy, and vitamin A deficiency was not detected. CONCLUSION: These associations suggest that the immune consequences of schistosomiasis and vitamin D deficiency may increase the risk of active leprosy. Comorbid conditions of poverty deserve further study as addressing co-infections and nutritional deficiencies could be incorporated into programmes to improve leprosy control.
Assuntos
Coinfecção/complicações , Helmintos/fisiologia , Hanseníase/complicações , Mycobacterium leprae/fisiologia , Deficiência de Vitamina D/complicações , Adolescente , Adulto , Idoso , Animais , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Fezes/parasitologia , Feminino , Humanos , Hanseníase/epidemiologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de RiscoRESUMO
A vigilância epidemiológica da saúde bucal no nível municipal pode fornecer informações úteis para as políticas locais e elucidar questões mais específicas sobre as desigualdades em saúde no país que, por razões operacionais, não podem ser incluídas em levantamentos nacionais. Objetivo: Descrever a tendência da prevalência e gravidade da cárie em escolares de 12 anos da rede pública de Goiânia no período de 1988 a 2010 e conhecer a distribuição da doença nos Distritos Sanitários (DS) do município. Material e método: Foram utilizados dados de estudos transversais realizados no período analisado. Para análise de tendência da prevalência de cárie, utilizou-se o coeficiente de correlação de Spearman. Comparações entre os DS foram feitas entre os anos de 1994 e 2010. Resultados: o CPOD médio diminuiu 78,5% no período analisado, de 8,26 em 1988 para 1,78 em 2010 (r = -1,0; p ? 0,01) e houve queda de 86,8% na média do componente cariado, 73,3% do perdido e 41,7% do obturado. Houve também aumento de 86,8% no número de escolares livres de cárie de 1994 a 2010 (r = 1,0; p ? 0,01). Escolares das instituições localizadas nos DS com piores indicadores socioeconômicos apresentaram maior prevalência de cárie e menor percentual de redução em comparação com aqueles com melhores indicadores. Conclusão: Houve declínio da prevalência de cárie em Goiânia de 1988 a 2010 e desigualdades na distribuição da doença entre os DS do município, que refletem a condição socioeconômica dos mesmos.
Epidemiological surveillance of oral health at the municipal level may provide useful information for local public policies and elucidate more specific questions about health inequalities in the country that, for operational reasons, cannot be included in national surveys. Objective: To describe trends in the prevalence and severity of dental caries in 12 year-old children attending public schools in Goiânia from 1988 to 2010 and to assess the distribution of the disease according to the county Health Districts (HD). Material and Method: Data from cross-sectional studies carried out in the investigated period were analysed. Spearman correlation coefficient was used for the analysis of caries prevalence tendency. Comparisons among the HD were carried out in 1994 and 2010. Results: The DMFT decreased 78.5% in the analyzed period, from 8.26 in 1988 to 1.78 in 2010 (r= -1.0; p ? 0.01) and there was a 86.8% reduction in the average number of decayed teeth, 73.3% of missing and 41.7% of filled teeth. There was also an increase of 86.8% in the number of caries-free schoolchildren from 1994 to 2010 (r = 1.0; p ? 0.01). Schoolchildren from institutions located in the HD with the worst socioeconomic indicators had higher caries prevalence and lower reductions compared with those attending schools located in HD with better indicators. Conclusion: There was a decline in dental caries prevalence in Goiânia from 1988 to 2010 and inequalities in the distribution of the disease among the county districts, as a reflex of their socioeconomic conditions.