Table_1_Prevalence of paucibacillary cases of leprosy in Brazil: a 20-year systematic review and meta-analysis.XLSX

IntroductionLeprosy is a chronic infectious disease caused by the agent Mycobacterium leprae, characterized by its high disabling power. Data points to Brazil being the second country with the highest number of cases in the world, behind only India, representing a major challenge for public health. This work aims to determine the prevalence of paucibacillary (PB) cases in relation to leprosy cases in Brazil, using data published in the literature.
MethodsThis is a systematic review and meta-analysis carried out with studies from the last 20 years, being developed based on the Preferred Reporting Items for Systematic Review and Meta-analyzes (PRISMA).The search was carried out in the databases: PUBMED, SciELO, LILACS (via VHL)and Science Direct in October 2023, using the following descriptors (((“Brazil” [Mesh]) AND (“Leprosy, paucibacillary” [Mesh])) AND “Epidemiology” [Mesh]), in English, Portuguese and Spanish. Original studies of the analytical case–control, cohort, cross-sectional, epidemiological types were selected, as well as articles with satisfactory information for numerical extraction with separate data on the paucibacillary and multibacillary clinical forms. The methodological quality assessment followed the JBI critical appraisal checklist. Statistical analysis was performed using the Comprehensive Meta-Analyses-CMA software, version 3.0 (Biostat, Engewood, NJ, United States).
ResultsThe meta-analysis of the 48 studies obtained a paucibacillary prevalence rate in Brazil of 50.5% or 0.505 (95% CI = 0.502–0.509).The differences in the analyzes were statistically significant (Q-value 4302.681;df 47; I 98.905), with a high heterogeneity value evidenced by I2 (98.905). This analysis demonstrated that the frequency in the Midwest region was the highest and the South region was the lowest (21.4%). Begg’s (Kendall Tau p = 0.35) and Egger’s tests (p = 0.20) were performed, in which no high publication bias was noted. Subgroup analysis indicated that paucibacillary cases varied from region to region, with the Midwest region having the highest prevalence and the South region having the lowest.
ConclusionThe results stand out significantly for the research gaps that investigate PB cases, requiring more research aimed at investigating the paucibacillary clinical form that can contribute to the early diagnosis of leprosy.
Systematic review registrationPROSPERO code: CRD42024514106.

**引言**：麻风病（Leprosy）是由麻风分枝杆菌（Mycobacterium leprae）引起的慢性传染病，以极强的致残性为特征。数据显示，巴西是全球麻风病例数第二高的国家，仅次于印度，这对公共卫生而言是一项重大挑战。本研究旨在利用已发表的文献数据，明确巴西麻风病例中少菌型（paucibacillary, PB）病例的患病率占比。

**方法**：本研究为一项基于近20年文献的系统综述与Meta分析，研究严格遵循《系统综述和Meta分析优先报告条目》（Preferred Reporting Items for Systematic Review and Meta-Analyzes, PRISMA）进行。检索于2023年10月开展，检索数据库包括PUBMED、SciELO、LILACS（通过虚拟健康图书馆VHL访问）及Science Direct，检索语言涵盖英语、葡萄牙语及西班牙语，检索式为：(("Brazil" [Mesh]) AND ("Leprosy, paucibacillary" [Mesh])) AND "Epidemiology" [Mesh]。本研究纳入分析性病例对照研究、队列研究、横断面研究及流行病学类原创研究，同时纳入可成功提取数值数据、且分别提供少菌型与多菌型麻风临床分型数据的文献。研究方法学质量评价采用乔安娜布里格斯研究所（JBI）临界评价清单（JBI critical appraisal checklist）。统计分析采用美国新泽西州恩格伍德Biostat公司开发的3.0版综合Meta分析（Comprehensive Meta-Analyses-CMA）软件完成。

**结果**：对纳入的48项研究进行Meta分析后显示，巴西麻风病例中少菌型病例的患病率为50.5%（即0.505；95%置信区间CI：0.502~0.509）。各研究间的分析差异具有统计学意义（Q值=4302.681；自由度df=47；I²=98.905），I²值提示存在高度异质性。分析结果显示，中西部地区的少菌型麻风病例占比最高，南部地区占比最低（21.4%）。本研究开展了Begg检验（Kendall Tau，p=0.35）与Egger检验（p=0.20），结果未提示存在显著的发表偏倚。亚组分析表明，少菌型麻风病例占比存在区域差异，中西部地区患病率最高，南部地区最低。

**结论**：本研究结果凸显了当前少菌型麻风病例相关研究的空白，亟需开展更多针对少菌型麻风临床分型的研究，以助力麻风病的早期诊断。

**系统综述注册信息**：PROSPERO注册编号：CRD42024514106。