%0 Journal Article
%T Factors Associated with Migration in Individuals Affected by Leprosy, Maranh£¿o, Brazil: An Exploratory Cross-Sectional Study
%A C. Murto
%A C. Kaplan
%A L. Ariza
%A K. Schwarz
%A C. H. Alencar
%A L. M. M. da Costa
%A J. Heukelbach
%J Journal of Tropical Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/495076
%X In Brazil, leprosy is endemic and concentrated in high-risk clusters. Internal migration is common in the country and may influence leprosy transmission and hamper control efforts. We performed a cross-sectional study with two separate analyses evaluating factors associated with migration in Brazil¡¯s Northeast: one among individuals newly diagnosed with leprosy and the other among a clinically unapparent population with no symptoms of leprosy for comparison. We included 394 individuals newly diagnosed with leprosy and 391 from the clinically unapparent population. Of those with leprosy, 258 (65.5%) were birth migrants, 105 (26.6%) were past five-year migrants, and 43 (10.9%) were circular migrants. In multivariate logistic regression, three independent factors were found to be significantly associated with migration among those with leprosy: (1) alcohol consumption, (2) separation from family/friends, and (3) difficulty reaching the healthcare facility. Separation from family/friends was also associated with migration in the clinically unapparent population. The health sector may consider adapting services to meet the needs of migrating populations. Future research is needed to explore risks associated with leprosy susceptibility from life stressors, such as separation from family and friends, access to healthcare facilities, and alcohol consumption to establish causal relationships. 1. Introduction Migration has been identified as one of the social determinants influencing transmission dynamics of Neglected Tropical Diseases (NTDs) [1, 2]. In fact, population movement can introduce new diseases when infected migrants move from endemic to nonendemic areas [2, 3]. As strategies of disease control become increasingly important to meet World Health Organization (WHO) standards, a more thorough approach is needed to investigate migration as a risk factor for disease and determine factors associated with migration in a local context. Migration can influence transmission of NTDs when circumstances influence conditions and risks associated with disease transmission, particularly among the poor who are disproportionately affected [4]. Environmental aspects as a consequence of poverty, such as poor sanitation and overcrowded substandard housing in areas of uncontrolled urbanization [3, 5], as well as lifestyle stressors [6, 7] and behaviors associated with migration [8, 9] can increase susceptibility to infection and disease risk. Many of these factors have also been associated with leprosy transmission [10, 11]. It is estimated that 740 million people are
%U http://www.hindawi.com/journals/jtm/2013/495076/