Migration among individuals with leprosy: a population-based study in Central Brazil

Murto, Christine; Ariza, Liana; Alencar, Carlos Henrique; Chichava, Olga André; Oliveira, Alexcian Rodrigues; Kaplan, Charles; Silva, Luciana Ferreira Marques da; Heukelbach, Jorg

doi:10.1590/0102-311X00005913

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ARTICLE • Cad. Saúde Pública 30 (3) • Mar 2014 • https://doi.org/10.1590/0102-311X00005913 linkcopy

Migration among individuals with leprosy: a population-based study in Central Brazil

Migração entre pessoas com hanseníase: estudo de base populacional no Centro-Oeste do Brasil

La migración entre personas con lepra: un estudio basado en la población en el centro de Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstracts

This study investigates social and clinical factors associated with migration among individuals affected by leprosy. A cross-sectional study was conducted among those newly diagnosed with leprosy (2006-2008), in 79 endemic municipalities in the state of Tocantins, Brazil (N = 1,074). In total, 76.2% were born in a municipality different from their current residence. In the five years before diagnosis 16.7% migrated, and 3.6% migrated after leprosy diagnosis. Findings reflect aspects associated with historical rural-urban population movement in Brazil. Indicators of poverty were prominent among before-diagnosis migrants but not after-diagnosis migrants. Migration after diagnosis was associated with prior migration. The association of multibacillary leprosy with migration indicates healthcare access may be an obstacle to early diagnosis among before-diagnosis migrants, which may also be related to the high mobility of this group.

Internal Migration; Leprosy; Poverty

			After birth migration				Migration before diagnosis				After diagnosis migration
			Total ** [n = 1,050]	Positive n (%)	OR (95%CI)	p- value	Total [n = 1,071]	Positive n (%)	OR (95% CI)	p- value	Total ** [n = 1,062]	Positive n (%)	OR (95%CI)	p- value
			Total ** [n = 1,050]	Positive n (%)	OR (95%CI)	p- value	Total [n = 1,071]	Positive n (%)	OR (95% CI)	p- value	Total ** [n = 1,062]	Positive n (%)	OR (95%CI)	p- value
Socio-demographic variables
	Sex
		Male	545	413 (75.8)	0.95 (0.71-1.28)	0.77	553	102 (18.4)	1.30 (0.93-1.82)	0.12	548	28 (5.1)	2.71 (1.26-6.32)	0.007 ***
		Female	505	387 (76.6)	Reference	0.77	518	77 (14.9)	Reference	0.12	541	10 (2.0)	Reference	0.007 ***
	Age groups (years)
		0-14	82	40 (48.8)	Reference		79	8 (10.1)	Reference		80	2 (2.5)	Reference
		15-29	236	135 (57.2)	1.4 (0.82-2.4)	0.20	239	52 (21.8)	2.46 (1.09-6.30)	0.20	237	10 (4.2)	1.72 (0.35-16.44)	0.74
		30-44	261	194 (74.3)	3.04 (1.76-5.42)	< 0.0001 ***	269	64 (23.8)	2.77 (1.24 – 7.00)	0.01 ***	267	12 (4.5)	1.84 (0.40-17.21)	0.54
		45-59	254	224 (88.2)	7.84 (4.23-14.54)	< 0.0001 ***	257	30 (11.7)	1.17 (0.50-3.10)	0.84	254	12 (4.7)	1.93 (0.42-18.13)	0.53
		≥ 60	217	207 (95.4)	21.74 (9.62-51.95)	< 0.0001 *	227	25 (11.0)	1.10 (0.45-2.95)	1.00	224	2 (1.0)	0.35 (0.03-4.94)	0.28
	Education
		Illiterate/Never attended school	231	210 (90.9)	3.86 (2.38-6.53)	< 0.0001 ***	240	37 (15.4)	0.88 (0.58-1.32)	0.56	236	5 (2.1)	0.52 (0.16-1.36)	0.23
		Attended school any time	815	588 (72.2)	Reference	< 0.0001 ***	827	142 (17.2)	Reference	0.56	822	33 (4.0)	Reference	0.23
	Work status
		Employed	453	346 (76.4)	Reference		458	79 (17.3)	Reference		455	17 (3.7)	Reference
		Unemployed	155	122 (78.7)	1.14 (0.72-1.84)	0.58	162	28 (17.3)	1.00 (0.60-1.64)	1.00	161	10 (6.2)	1.71 (0.68-4.04)	0.19
		Part-time	55	43 (78.2)	1.11 (0.55-2.40)	0.87	55	15 (27.3)	1.80 (0.88-3.52)	0.09	54	4 (7.4)	2.06 (0.48-6.65)	0.26
		Retired/Pensioner	170	160 (94.1)	4.95 (2.50-10.88)	< 0.0001 ***	178	22 (12.4)	0.67 (0.39-1.14)	0.08	174	1 (0.6)	0.15 (0.0-0.97)	0.03 ***
		Student/Housewife/Others	217	129 (59.5)	0.45 (0.32-0.65)	< 0.0001 *	218	35 (16.1)	0.92 (0.58-1.44)	0.74	218	6 (2.8)	0.73 (0.23-1.97)	0.65
Socio-demographic variables
	Farm worker (any time in life)
		Yes	413	351 (85.0)	2.38 (1.71-3.33)	< 0.0001 ***	427	74 (17.3)	1.09 (0.77-1.53)	0.68	423	13 (3.1)	0.80 (0.37-1.66)	0.61
		No	629	443 (70.4)	Reference	< 0.0001 ***	636	103 (16.2)	Reference	0.68	632	24 (3.8)	Reference	0.61
Housing- and economic-related variables
	Household monthly income ^#
		≥ R$ 465,00	736	566 (76.9)	Reference	0.42	298	52 (17.4)	1.06 (0.73-1.53)	0.78	299	12 (4.0)	1.14 (0.52-2.40)	0.72
		< R$ 465,00 (≈ US$ 270)	289	215 (74.4)	0.87 (0.63-1.21)	0.42	750	124 (16.5)	Reference	0.78	741	26 (3.5)	Reference	0.72
	Residence area
		Rural/Settlement	252	194 (77.0)	1.06 (0.75-1.51)	0.80	256	53 (20.7)	1.43 (0.98-2.06)	0.06	256	12 (4.7)	1.47 (0.67-3.08)	0.33
		Urban	797	605 (75.9)	Reference	0.80	814	126 (15.5)	Reference	0.06	805	26 (3.2)	Reference	0.33
	Electricity
		No	64	42 (65.6)	0.57 (0.33-1.03)	0.049 ***	64	18 (28.1)	2.05 (1.09-3.72)	0.02 ***	65	3 (4.6)	1.33 (0.25-4.40)	0.42
		Yes	985	757 (76.9)	Reference	0.049 ***	1006	161 (16.0)	Reference	0.02 ***	996	35 (3.5)	Reference	0.42
	Public waste collection
		No	291	221 (76.0)	0.98 (0.71-1.37)	0.93	297	64 (21.6)	1.57 (1.11-2.23)	0.01 *	295	14 (4.8)	1.54 (0.73-3.15)	0.20
		Yes	758	578 (76.2)	Reference	0.93	773	115 (14.9)	Reference	0.01 *	766	24 (3.1)	Reference	0.20
	Public sewer system
		No	120	86 (71.7)	0.76 (0.49-1.20)	0.21	123	27 (21.0)	1.47 (0.89-2.37)	0.12	122	4 (3.3)	0.90 (0.23-2.60)	1.00
		Yes	929	714 (76.9)	Reference	0.21	947	152 (16.1)	Reference	0.12	939	34 (3.6)	Reference	1.00
	Public water supply
		No	194	150 (77.3)	1.08 (0.74-1.60)	0.71	197	43 (21.8)	1.52 (1.01-2.25)	0.44	196	9 (4.6)	1.39 (0.57-3.08)	0.40
		Yes	856	650 (75.9)	Reference	0.71	874	136 (15.6)	Reference	0.44	866	29 (3.4)	Reference	0.40
	Housing- and economic-related variables
	Brick/Adobe house construction
		No	192	147 (76.6)	1.03 (0.70-1.52)	0.93	197	44 (22.34)	1.57 (1.05-2.33)	0.03 ***	194	6 (3.1)	0.83 (0.28-2.06)	0.83
		Yes	858	653 (76.1)	Reference	0.93	874	135 (15.5)	Reference	0.03 ***	868	32 (3.7)	Reference	0.83
	Number of rooms/household
		1-2	67	50 (74.6)	0.91 (0.50-1.71)	0.77	67	11 (16.4)	0.97 (0.45-1.93)	1.00	66	1 (1.5)	0.40 (0.0-2.44)	0.51
		> 2	980	749 (76.4)	Reference	0.77	1,001	168 (16.8)	Reference	1.00	993	37 (3.7)	Reference	0.51
	Living alone
		1 person	56	52 (92.9)	4.28 (1.55 – 16.44)	0.002*	58	10 (17.2)	1.04 (0.46 – 2.13)	0.86	58	(6.9)	2.11 (0.52-6.23)	0.15
		> 1 person	993	747 (75.2)	Reference	0.002*	1,012	169 (16.7)	Reference	0.86	1,003	34 (3.4)	Reference	0.15
Disease-related variables at diagnosis
	Clinical form
		Tuberculoid	182	133 (73.1)	1.04 (0.68-1.61)	0.92	185	29 (15.7)	1.00 (0.58-1.68)	1.0	185	10 (5.4)	1.81 (0.66-4.93)	0.24
		Borderline	247	194 (78.5)	1.41 (0.94-2.12)	0.10	255	45(17.7)	1.15 (0.72-1.82)	0.58	255	9 (3.5)	1.16 (0.41-3.22)	0.82
		Lepromatous	92	79 (85.9)	2.33 (1.21-4.80)	0.01 ***	94	19 (20.2)	1.36 (0.71-2.51)	0.35	94	2 (2.1)	0.69 (0.07-3.31)	1.00
		Indeterminate	324	234 (72.2)	Reference		331	52 (15.7)	Reference		326	10 (3.1)	Reference
	Operational classification
		Multibacillary	416	335 (80.5)	1.54 (1.12-2.11)	0.006 ***	426	79 (18.5)	1.37 (0.96-1.95)	0.07	424	12 (2.8)	0.74 (0.33-1.58)	0.48
		Paucibacillary	572	417 (72.9)	Reference	0.006 ***	583	83 (14.2)	Reference	0.07	579	22 (3.8)	Reference	0.48
	Disability grade at diagnosis
		Disability grade II	29	26 (89.7)	2.98 (0.90-15.56)	0.08	30	5 (16.7)	1.20 (0.35-3.28)	0.79	30	0 (0.0)	-	1.00
		Disability grade 0 or I	703	523 (74.4)	Reference	0.08	719	103 (14.3)	Reference	0.79	717	22 (3.1)	Reference	1.00

	Time from symptom onset and sought diagnosis (months)
		> 6	271	214 (79.0)	1.24 (0.87-1.78)	0.24	276	51 (18.5)	1.16 (0.78-1.69)	0.45	274	11 (4.0)	1.07 (0.47-2.30)	0.85
		≤ 6	661	497 (75.2)	Reference	0.24	671	110 (16.4)	Reference	0.45	667	25 (3.8)	Reference
Health service-related variables
	Regular home community health worker visit (≤ 1 months)
		No	338	267 (79.0)	1.26 (0.91-1.75)	0.16	345	59 (17.1)	1.04 (0.73-1.48)	0.86	343	15 (4.4)	1.38 (0.66-2.80)	0.38
		Yes	712	533 (74.9)	Reference		726	120 (16.5)	Reference	0.86	719	23 (3.2)	Reference	0.38
	Time to reach the health care centre (minutes)
		> 30	181	137 (75.7)	0.98 (0.66-1.46)	0.92	407	64 (15.7)	0.87 (0.61-1.23)	0.45	189	8 (4.2)	1.21 (0.47-2.77)	0.67
		≤ 30	850	647 (76.1)	Reference	0.92	647	114 (17.6)	Reference	0.45	856	30 (3.5)	Reference	0.67
	Difficulty reaching health care center
		Yes	201	158 (78.6)	1.19 (0.81-1.77)	0.41	209	37 (17.7)	1.07 (0.70-1.61)	0.76	207	11 (5.3)	1.70 (0.74-3.60)	0.15
		No	835	631 (75.6)	Reference	0.41	848	142 (16.8)	Reference	0.76	841	27 (3.2)	Reference	0.15
Migration
	Migrant after diagnosis
		Yes	-	-	-	-	38	22 (57.9)	7.87 (3.83- 16.38)	< 0.0001 ***	-	-	-	-
		No	-	-	-	-	1,022	152 (14.9)	Reference	< 0.0001 ***	-	-	-	-
	Migrant 5-years prior to diagnosis
		Yes	-	-	-	-	-	-	-	-	174	22 (12.6)	7.87 (3.83-16.38)	< 0.0001 ***
		No	-	-	-	-	-	-	-	-	886	16 (1.8)	Reference	< 0.0001 ***
	Health service-related variables
	Time at residence (years)
		0-5	470	349 (74.3)	0.79 (0.56-1.11)	0.18	476	146 (30.7)	25.22 (11.06-70.63)	< 0.0001 ***	469	33 (7.0)	8.70 (2.69-44.64)	< 0.0001 ***
		6-10	237	183 (77.2)	0.93 (0.61-1.41)	0.76	245	27 (11.0)	7.06 (2.79-21.2)	< 0.0001 ***	243	2 (0.8)	0.95 (0.8-8.40)	1.00
		≥ 11	340	267 (78.5)	Reference		348	6 (1.7)	Reference		348	3 (0.9)	Reference
Practices and attitudes
	Sought other health service prior to diagnosis
		Yes	-	-	-	-	181	36 (19.9)	1.29 (0.83-1.96)	0.23	179	10 (5.6)	1.80 (0.76-3.90)	0.12
		No	-	-	-	-	886	143 (16.1)	Reference	0.23	879	28 (3.2)	Reference	0.12
	Hide leprosy diagnosis due of fear of prejudice
		Yes	-	-	-	-	-	-	-	-	1,039	38 (3.7)	-	1.00
		No	-	-	-	-	-	-	-	-	20	0 (0.0)	Reference	1.00
	Different behavior from others after diagnosis
		Yes	-	-	-	-	-	-	-	-	157	3 (1.9)	0.48 (0.09-1.55)	0.35
		No	-	-	-	-	-	-	-	-	898	35 (3.9)	Reference	0.35

		Adjusted OR (95%CI)	p-value
		Before diagnosis migration
Socio-demographic variables
	No public water	1.65 (1.12-2.43)	0.012 *
	No trash service	1.70 (1.2-2.41)	0.003 *
	Living in a non-brick home	1.57 (1.01-2.32)	0.022 *
	Diagnosis multibacillary	1.55 (1.09-2.19)	0.014 *
Migration variables
	Years at current residence 0-5 years	23.38 (10.1-54.09)	< 0.0001 *
	Years at current residence 6-10 years	6.77 (2.73-16.75)	< 0.0001 *

		Adjusted OR (95% CI)	p-value
		After diagnosis migration
Socio-demographic variables
	Male sex	2.87 (1.38-5.99)	0.005 *
Migration variables
	Before diagnosis migration	7.74 (3.89-15.37)	< 0.0001 *
	Years at current residence 0-5 years	8.69 (2.57-29.32)	< 0.0001 *

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