Lorena Dias Monteiro

Incapacidades físicas em pessoas acometidas pela hanseníase no período pós-alta da poliquimioterapia em um município no Norte do Brasil

Chronic sequelae and disabilities are one of the main problems in leprosy. The current study aimed to estimate the prevalence of disabilities in leprosy patients after successfully completing multidrug therapy in Araguaina, Tocantins State, Brazil. This was a cross-sectional study including 282 cases diagnosed from 2004 to 2009. The degrees of disability at diagnosis and at discharge from treatment were collected from medical records and the National Information System for Notifiable Diseases (SINAN). A simplified neurological workup was performed after discharge from treatment. The prevalence of disabilities at diagnosis was 29.4%, and 8.9% of then was grade II. Between diagnosis and discharge, the degree of physical disability worsened in 25% of cases. At diagnosis, the proportion of deformities was significantly higher in men (RR = 1.7; 95%CI: 1.23-2.37). There was a significant association between disability and multibacillary disease (p < 0.001) and occurrence of reactions (p < 0.001). The data show that after discharge from multidrug therapy, in order to prevent chronic sequelae and functional limitations, continuous monitoring is still needed for individuals that have been recorded as cured and thus deleted from the records.

Limited activity and social participation after hospital discharge from leprosy treatment in a hyperendemic area in north Brazil

INTRODUCTION Neural damages are among the main factors that contribute to physical disability in leprosy. Systematic monitoring using a broad physical, psychological and social approach is necessary. OBJECTIVE The objective of this study was to characterize the limitation of activity and social participation and its correlation with disabilities and/or impairment in individuals after being discharged from a multidrug leprosy therapy. METHOD A cross-sectional study conducted in Araguaína, state of Tocantins, which is a leprosy hyperendemic municipality. We included cases of patients who were discharged from treatment considered as cured from January 2004 to December 2009. We performed dermatological examination and applied the Screening Activity Limitation and Safety Awareness (SALSA) and social participation scales. RESULTS We included 282 individuals (mean age: 45.8 years old). The paucibacillary operational classification was more common (170; 60.3%). The eye-hand-foot score ranged from 0 to 12 (mean: 0.7). A total of 84 (29.8%) individuals presented limited activity. A slight restriction in social participation occurred in 18 (6.3%) cases. There was a statistically significant correlation between activity limitation, age (r = 0.40; p < 0.0001) and degree of functional limitation (r = 0.54; p < 0.0001), as well as of restricted social participation, activity limitation (r = 0.56, p < 0.0001) and functional limitations (r = 0.54, p < 0.0001). CONCLUSION Functional limitation due to leprosy had an impact on the conduct of activities and social participation after the discharge from a leprosy treatment. The association between Screening of Activity Limitation and Safety Awareness and participation scales will assist in designing evidence-based assistance measures.

Spatial patterns of leprosy in a hyperendemic state in Northern Brazil, 2001-2012

ABSTRACT OBJECTIVE To describe the spatial patterns of leprosy in the Brazilian state of Tocantins. METHODS This study was based on morbidity data obtained from the Sistema de Informações de Agravos de Notificação (SINAN – Brazilian Notifiable Diseases Information System), of the Ministry of Health. All new leprosy cases in individuals residing in the state of Tocantins, between 2001 and 2012, were included. In addition to the description of general disease indicators, a descriptive spatial analysis, empirical Bayesian analysis and spatial dependence analysis were performed by means of global and local Moran’s indexes. RESULTS A total of 14,542 new cases were recorded during the period under study. Based on the annual case detection rate, 77.0% of the municipalities were classified as hyperendemic (> 40 cases/100,000 inhabitants). Regarding the annual case detection rate in < 15 years-olds, 65.4% of the municipalities were hyperendemic (10.0 to 19.9 cases/100,000 inhabitants); 26.6% had a detection rate of grade 2 disability cases between 5.0 and 9.9 cases/100,000 inhabitants. There was a geographical overlap of clusters of municipalities with high detection rates in hyperendemic areas. Clusters with high disease risk (global Moran’s index: 0.51; p < 0.001), ongoing transmission (0.47; p < 0.001) and late diagnosis (0.44; p < 0.001) were identified mainly in the central-north and southwestern regions of Tocantins. CONCLUSIONS We identified high-risk clusters for transmission and late diagnosis of leprosy in the Brazilian state of Tocantins. Surveillance and control measures should be prioritized in these high-risk municipalities.

Physical disabilities in leprosy patients after discharge from multidrug therapy in Northern Brazil

Chronic sequelae and disabilities are one of the main problems in leprosy. The current study aimed to estimate the prevalence of disabilities in leprosy patients after successfully completing multidrug therapy in Araguaína, Tocantins State, Brazil. This was a cross-sectional study including 282 cases diagnosed from 2004 to 2009. The degrees of disability at diagnosis and at discharge from treatment were collected from medical records and the National Information System for Notifiable Diseases (SINAN). A simplified neurological workup was performed after discharge from treatment. The prevalence of disabilities at diagnosis was 29.4%, and 8.9% of then was grade II. Between diagnosis and discharge, the degree of physical disability worsened in 25% of cases. At diagnosis, the proportion of deformities was significantly higher in men (RR = 1.7; 95%CI: 1.23-2.37). There was a significant association between disability and multibacillary disease (p < 0.001) and occurrence of reactions (p < 0.001). The data show that after discharge from multidrug therapy, in order to prevent chronic sequelae and functional limitations, continuous monitoring is still needed for individuals that have been recorded as cured and thus deleted from the records.

Tendências da hanseníase no Tocantins, um estado hiperendêmico do Norte do Brasil, 2001-2012

A hanseniase e hiperendemica no Estado do Tocantins, Brasil. O objetivo do estudo foi analisar as tendencias dos indicadores da hanseniase no Tocantins em 2001-2012. Analise de dados advindos do Sistema de Informacao de Agravos de Notificacao (SINAN). Incluiram-se casos novos de residentes no Tocantins. Calcularam-se os indicadores da hanseniase e analisaram-se as tendencias temporais por meio de regressao polinomial. Houve tendencia significativa e decrescente para a deteccao geral (R2 = 0,40; p 0,05), deteccao de casos com grau 2 de incapacidade fisica (R2 = 0,37; p > 0,05) e proporcao de casos com grau 2 (R2 = 0,49; p > 0,05). Houve aumento significativo para a proporcao de casos com grau 1 de incapacidade (R2 = 0,82; p < 0,05) e proporcao de casos multibacilares (R2 = 0,81; p < 0,05). O Tocantins apresenta regioes com alta transmissao e diagnostico tardio da hanseniase, apontando a expansao da doenca de forma heterogenea na analise temporal.Leprosy is hyperendemic in the State of Tocantins, Brazil. The aim of the study was to analyze trends in leprosy indicators in Tocantins from 2001 to 2012, based on analysis of data from the Information System for Notifiable Diseases (SINAN), including incident cases living in Tocantins. The study calculated leprosy indicators and analyzed time trends using polynomial regression. There was a significant downward trend in overall case detection (R2 = 0.40; p < 0.05) and proportion of paucibacillary cases (R2 = 0.81). Detection rates remained stable in individuals < 15 years (R2 = 0.48; p > 0.05) and cases with grade 2 physical disability (R2 = 0.37; p > 0.05), as did the proportion of grade 2 cases (R2 = 0.49; p > 0.05). There were significant increases in the proportions of cases with grade 1 disability (R2 = 0.82; p < 0.05) and multibacillary cases (R2 = 0.81; p < 0.05). Tocantins has regions with high transmission and late diagnosis of leprosy, indicating heterogeneous dissemination of the disease in the time trend analysis.

Tendência temporal da hanseníase em uma capital do Nordeste do Brasil: epidemiologia e análise por pontos de inflexão, 2001 a 2012

The objective of this study was to characterize epidemiological and temporal trends of leprosy in the city of Fortaleza, Ceará, Brazil, from 2001 to 2012. A total of 9,658 new cases were reported. Their temporal trend was analyzed by the jointpoint regression model. The overall detection rate showed a declining trend, with annual percent change (APC) of -4.0 and 95% confidence interval (95%CI) -5.6 - -2.3. The detection rate in children under 15 years of age (APC = -1.4; 95%CI -5.4 - 2.8) and the detection rate of disability grade 2 (APC = -0.8; 95%CI -4.5 - 3.1) were stable. The proportion of female patients was descending (APC = -1,5; 95%CI -2.3 - -0.8). The proportion of multibacillary cases from 2005 to 2012 (APC = 1.4; 95%CI 0.6 - 2.3) and among them, lepromatous cases from 2004 to 2012 (APC = 6.0; 95%CI 3.4 - 8.6) were increasing. There was stability in the proportion of cases with grade 1 (APC = 1.4; 95%CI -0.9 - 3.7) and grade 2 disability (APC = 3.7; 95%CI -0.1 - 7.8). Despite the trend towards a reduction in detection, the disease transmission persists in the city. The data also suggest late diagnosis.The objective of this study was to characterize epidemiological and temporal trends of leprosy in the city of Fortaleza, Ceara, Brazil, from 2001 to 2012. A total of 9,658 new cases were reported. Their temporal trend was analyzed by the jointpoint regression model. The overall detection rate showed a declining trend, with annual percent change (APC) of -4.0 and 95% confidence interval (95%CI) -5.6 - -2.3. The detection rate in children under 15 years of age (APC = -1.4; 95%CI -5.4 - 2.8) and the detection rate of disability grade 2 (APC = -0.8; 95%CI -4.5 - 3.1) were stable. The proportion of female patients was descending (APC = -1,5; 95%CI -2.3 - -0.8). The proportion of multibacillary cases from 2005 to 2012 (APC = 1.4; 95%CI 0.6 - 2.3) and among them, lepromatous cases from 2004 to 2012 (APC = 6.0; 95%CI 3.4 - 8.6) were increasing. There was stability in the proportion of cases with grade 1 (APC = 1.4; 95%CI -0.9 - 3.7) and grade 2 disability (APC = 3.7; 95%CI -0.1 - 7.8). Despite the trend towards a reduction in detection, the disease transmission persists in the city. The data also suggest late diagnosis.

Determinantes sociais da hanseníase em um estado hiperendêmico da região Norte do Brasil

ABSTRACT OBJECTIVE To identify the socioeconomic, demographic, operational, and health service-related factors associated with the occurrence of leprosy in a hyperendemic State in North Brazil. METHODS This is an ecological study based on secondary data from the Sistema de Informações de Agravos de Notificação in municipalities of the State of Tocantins from 2001 to 2012. Units of analysis were the 139 municipalities of the State. Negative binomial log linear regression models were used to estimate incidence rate ratios. RESULTS In bivariate analysis, the incidence rate ratios were significantly higher for municipalities with higher income ratio of the poorest 20.0% (1.47; 95%CI 1.19–1.81) and better Municipal Human Development Index (1.53; 95%CI 1.14–2.06). In multivariate analysis, the incidence rate ratios were significantly higher in municipalities with higher proportion of immigrants (1.31; 95%CI 1.11–1.55) and higher proportion of households with waste collection (1.37; 95%CI 1.11–1.69). There was a significant reduction in the incidence rate ratio with increased coverage of the Bolsa Família Program (0.98; 95%CI 0.96–0.99). CONCLUSIONS Control programs need to focus on activities in municipalities of greater social vulnerability with intersectoral investment for the improvement of the living conditions of the population.OBJETIVO Identificar fatores socioeconomicos, demograficos, operacionais e de servicos de saude associados a ocorrencia da hanseniase em um estado hiperendemico do norte do Brasil. METODOS Estudo ecologico com dados secundarios do Sistema de Informacoes de Agravos de Notificacao em municipios do estado do Tocantins de 2001 a 2012. As unidades de analise foram os 139 […]

Clinical and epidemiological profile of leprosy patients attended at Ceará, 2007-2011

Background Leprosy is an infectious chronic condition associated with potentially serious physical, social and psychological impacts. Objectives To characterize the clinical and epidemiological profile of leprosy patients treated from 2007 to 2011 in the University Hospital of Ceará, Northeastern Brazil. Methods This is a retrospective and descriptive study. The study population consisted of residents in the state of Ceará treated in a dermatology clinic between 2007-2011. Clinical and epidemiological data analyzed were obtained from medical records and from the database of national Information System for Notifiable Diseases. Results 475 cases were analyzed, mostly women (51.8%), aged 45-59 years (35.0%) - mean of 45.2 years at diagnosis - with 6.3% of children under 15 , with low education (73.7%), white color (68.8%), residency in the city of Fortaleza (82.3%), and no defined work occupation (59.6%). At diagnosis, most patients were multibacillary (MB) (65.5%), had borderline clinical form (48.0%), and 22.7% had physical disability (8.0% with grade 2), predominantly in MB cases (p <0.001). We observe worsening of disability in 5.1% of cases post-MDT. The proportion of cases with reactional episodes was 42.7%, mainly during MDT (51.2%). Conclusion This is the first study conducted in this hospital context, revealing late diagnosis, high burden of disease, hidden endemicity, and high social vulnerability in the state of Ceará. This study reinforces the need to strengthen health care network for timely diagnosis and treatment, aiming at longitudinality of assistance.

Leprosy trends in Tocantins, a hyperendemic State in the North of Brazil, 2001-2012/Tendências da hanseníase no Tocantins, um estado hiperendêmico do Norte do Brasil, 2001-2012

A hanseniase e hiperendemica no Estado do Tocantins, Brasil. O objetivo do estudo foi analisar as tendencias dos indicadores da hanseniase no Tocantins em 2001-2012. Analise de dados advindos do Sistema de Informacao de Agravos de Notificacao (SINAN). Incluiram-se casos novos de residentes no Tocantins. Calcularam-se os indicadores da hanseniase e analisaram-se as tendencias temporais por meio de regressao polinomial. Houve tendencia significativa e decrescente para a deteccao geral (R2 = 0,40; p 0,05), deteccao de casos com grau 2 de incapacidade fisica (R2 = 0,37; p > 0,05) e proporcao de casos com grau 2 (R2 = 0,49; p > 0,05). Houve aumento significativo para a proporcao de casos com grau 1 de incapacidade (R2 = 0,82; p < 0,05) e proporcao de casos multibacilares (R2 = 0,81; p < 0,05). O Tocantins apresenta regioes com alta transmissao e diagnostico tardio da hanseniase, apontando a expansao da doenca de forma heterogenea na analise temporal.Leprosy is hyperendemic in the State of Tocantins, Brazil. The aim of the study was to analyze trends in leprosy indicators in Tocantins from 2001 to 2012, based on analysis of data from the Information System for Notifiable Diseases (SINAN), including incident cases living in Tocantins. The study calculated leprosy indicators and analyzed time trends using polynomial regression. There was a significant downward trend in overall case detection (R2 = 0.40; p < 0.05) and proportion of paucibacillary cases (R2 = 0.81). Detection rates remained stable in individuals < 15 years (R2 = 0.48; p > 0.05) and cases with grade 2 physical disability (R2 = 0.37; p > 0.05), as did the proportion of grade 2 cases (R2 = 0.49; p > 0.05). There were significant increases in the proportions of cases with grade 1 disability (R2 = 0.82; p < 0.05) and multibacillary cases (R2 = 0.81; p < 0.05). Tocantins has regions with high transmission and late diagnosis of leprosy, indicating heterogeneous dissemination of the disease in the time trend analysis.

Tendencias de la lepra en Tocantins, un estado hiperendémico del norte de Brasil, 2001-2012

A hanseniase e hiperendemica no Estado do Tocantins, Brasil. O objetivo do estudo foi analisar as tendencias dos indicadores da hanseniase no Tocantins em 2001-2012. Analise de dados advindos do Sistema de Informacao de Agravos de Notificacao (SINAN). Incluiram-se casos novos de residentes no Tocantins. Calcularam-se os indicadores da hanseniase e analisaram-se as tendencias temporais por meio de regressao polinomial. Houve tendencia significativa e decrescente para a deteccao geral (R2 = 0,40; p 0,05), deteccao de casos com grau 2 de incapacidade fisica (R2 = 0,37; p > 0,05) e proporcao de casos com grau 2 (R2 = 0,49; p > 0,05). Houve aumento significativo para a proporcao de casos com grau 1 de incapacidade (R2 = 0,82; p < 0,05) e proporcao de casos multibacilares (R2 = 0,81; p < 0,05). O Tocantins apresenta regioes com alta transmissao e diagnostico tardio da hanseniase, apontando a expansao da doenca de forma heterogenea na analise temporal.Leprosy is hyperendemic in the State of Tocantins, Brazil. The aim of the study was to analyze trends in leprosy indicators in Tocantins from 2001 to 2012, based on analysis of data from the Information System for Notifiable Diseases (SINAN), including incident cases living in Tocantins. The study calculated leprosy indicators and analyzed time trends using polynomial regression. There was a significant downward trend in overall case detection (R2 = 0.40; p < 0.05) and proportion of paucibacillary cases (R2 = 0.81). Detection rates remained stable in individuals < 15 years (R2 = 0.48; p > 0.05) and cases with grade 2 physical disability (R2 = 0.37; p > 0.05), as did the proportion of grade 2 cases (R2 = 0.49; p > 0.05). There were significant increases in the proportions of cases with grade 1 disability (R2 = 0.82; p < 0.05) and multibacillary cases (R2 = 0.81; p < 0.05). Tocantins has regions with high transmission and late diagnosis of leprosy, indicating heterogeneous dissemination of the disease in the time trend analysis.