Upward trend in the rate of detection of new cases of leprosy in the State of Bahia, Brazil.

BACKGROUND: The worldwide fall in the rate of detection of new cases of leprosy has been partly attributed to the introduction of multidrug therapy and other improvements in control programs. However, the rate of detection of new cases has not decreased in Brazil. METHODS: An analysis was made of the temporal distribution of 18,872 newly reported leprosy cases in Bahia, Brazil, from 1974 to 1997. Population denominators for the annual detection rate were obtained from population estimates based on the national census. Trends were presented by sex, date of birth, date of diagnosis, date of release, clinical form and by residence in areas which had notified cases in the 5 years prior to the rise in detection rate. RESULTS: There was a marked increase in the new case detection rate (NCDR) in the State of Bahia, from 0.19 to 1.43 cases per 10,000 inhabitants during the study period, an increment of nearly 7% to 8% per year. This increase was also observed in people aged 14 years and younger. During this period tuberculoid and indeterminate forms have become predominant among women and younger people. The average age of male cases has shifted toward younger ages. CONCLUSIONS: We interpret this pattern to mean that the increase in NCDR reflects a real increase in incidence of leprosy, whether or not accompanied by improved detection.