Performance of the Health System Network in Formosa, Argentina, in the Diagnosis of Leprosy

Leprosy is a chronic, neglected tropical infectious disease, currently endemic in Formosa, a province in northwestern Argentina. To analyze the performance, distribution, and effectiveness of the health system in leprosy diagnosis in Formosa, we estimated the trend of the number of new cases of leprosy diagnosed between 2002 and 2019 and estimated a forecast for 2022 at the primary health care centers (PHCCs) of at the first level of care (1stLC), at district hospitals (DHs) of the second level of care (2ndLC), high-complexity hospitals at the third level of care (3rdLC), and in rural and urban areas. The general trend was calculated based on the new cases detection rate (NCDR) using the autoregressive–moving average model (ARMA). The 1stLC, 2ndLC, and 3rdLC and the rural/urban variables were assessed using a proportional Bayesian trend ARMA (TrARMA) model. A predictive model was used for estimated forecasts. Markov-Monte Carlo chains were applied with A Metropolis-Hastings’s algorithm. The highest median proportion (Mp) of new cases of leprosy was diagnosed at the 2ndLC (Mp, 0.67; 97.5% credibility interval [CI] [0.56–0.77]), at the 3rdLC (Mp, 0.11; 97.5% CI [0.08–0.15]), and in urban areas (urban median proportion (uMp), 0.86; 97.5% CI [0.83–0.88]), whereas the lowest proportion of new cases was diagnosed at the 1stLC (Mp, 0.082; 97.5% CI [0.061–0.108]) and in rural areas (rural median proportion (rMp), 0.13; 97.5% CI [0.11–0.16]). Our model predicts for 2022 that a median number of new cases of leprosy of 19.70 will be diagnosed in urban areas (97.5% CI [15.94–23.80]), and will continue to be diagnosed at the 2ndLC (median number of cases, 15.33; 97.5% CI [12.40–10.52]) and 3rdLC (median number of cases, 2.43; 97.5% CI [1.97–2.94]).

Fil: Arnaiz, Maria Rosa. Dirección Nacional de Institutos de Investigación. Administración Nacional de Laboratorios e Institutos de Salud. Centro Nacional de Diagnóstico e Investigaciones Endemo-epidémicas; Argentina

Fil: Tobar Abarca, Maria Daniela. Technishe Universitat Berlin; Alemania

Fil: Santini, Maria Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud “Dr. C. G. Malbrán”. Instituto Nacional de Parasitología "Dr. Mario Fatala Chaben”; Argentina

Fil: Franco, José I.. Gobierno de la Provincia de Formosa. Ministerio de Desarrollo Humano;

Fil: Arzamendia, Lucila. Provincia de Formosa; Argentina

Fil: Recalde, Hugo C.. Provincia de Formosa; Argentina

Fil: Bruzzone, Octavio Augusto. Instituto Nacional de Tecnología Agropecuaria. Centro Regional Patagonia Norte. Estación Experimental Agropecuaria San Carlos de Bariloche. Instituto de Investigaciones Forestales y Agropecuarias Bariloche. - Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones Forestales y Agropecuarias Bariloche; Argentina