Silvana Margarida Benevides Ferreira

Fatores associados à recidiva em hanseníase em Mato Grosso

OBJETIVO: Analizar factores asociados a la ocurrencia de recidiva en hanseniasis. METODOS: Estudio retrospectivo caso-control con 159 pacientes mayores de 15 anos diagnosticados con hanseniasis en cinco municipios del Estado de Mato Grosso, Centro-oeste de Brasil, cuyas unidades de salud eran consideradas de referencia para el atendimiento. El grupo de casos incluyo 53 individuos con recidiva de 2005 a 2007 y fue comparado con el grupo control (106 con alta por cura en 2005), pareados por sexo y clasificacion operacional. Se usaron datos del Sistema de Informacion de Agravios de Notificacion, Prontuarios y entrevistas. Se utilizo regresion logistica condicional y abordaje jerarquico. RESULTADOS: Posterior al analisis ajustado, se mostraron asociados a la ocurrencia de recidiva: individuos residentes en casas alquiladas (OR=4,1; IC95%:1,43;12,04), en domicilio de madera/tapia (OR=3,2; IC 95%:1,16;8,76), que moraban con mas de cinco personas (OR=2,1; IC95%:1,03;4,36), con trastorno por uso de alcohol (OR=2,8;IC95%:1,17;6,79), irregularidad del tratamiento (OR= 3,8; IC95%: 1,44;10,02), sin esclarecimiento sobre la enfermedad/tratamiento (OR= 2,6; IC95%:1,09,6,13), que usaban transporte colectivo para el acceso a la unidad de salud (OR=5,5; IC95%: 2,36;12,63), forma clinica de la enfermedad (OR= 7,1;IC95%: 2,48;20,52) y esquema terapeutico (OR= 3,7; IC95%:1,49;9,11). CONCLUSIONES: Los factores predictivos de recidiva se relacionan con condiciones de vivienda, habitos de vida, organizacion de los servicios de salud, formas clinicas y esquemas terapeuticos. Compete a los servicios de salud ofrecer orientaciones adecuadas a los pacientes, asi como garantizar la regularidad del tratamiento.OBJETIVO: Analisar fatores associados a ocorrencia de recidiva em hanseniase. METODOS: Estudo retrospectivo caso-controle com 159 pacientes maiores de 15 anos diagnosticados com hanseniase em cinco municipios do estado de Mato Grosso, cujas unidades de saude eram consideradas de referencia para o atendimento. O grupo de casos incluiu 53 individuos com recidiva de 2005 a 2007 e foi comparado ao grupo controle (106 com alta por cura em 2005), pareados por sexo e classificacao operacional. Foram usados dados do Sistema de Informacao de Agravos de Notificacao, prontuarios e entrevistas. Utilizou-se regressao logistica condicional e abordagem hierarquica. RESULTADOS: Apos analise ajustada, mostraram-se associados a ocorrencia de recidiva: individuos residentes em casas alugadas (OR = 4,1; IC95%:1,43;12,04), em domicilio de madeira/taipa (OR = 3,2; IC95%: 1,16;8,76), que moravam com mais de cinco pessoas (OR = 2,1; IC95% : 1,03;4,36), com transtorno de uso de alcool (OR = 2,8; IC95%: 1,17;6,79), irregularidade do tratamento (OR = 3,8;IC95%: 1,44;10,02), sem esclarecimento sobre a doenca/tratamento (OR = 2,6; IC95%: 1,09;6,13), que usavam transporte coletivo para o acesso a unidade de saude (OR = 5,5; IC95%: 2,36;12,63), forma clinica da doenca (OR = 7,1; IC95%: 2,48;20,52) e esquema terapeutico (OR = 3,7; IC95%: 1,49;9,11). CONCLUSOES: Os fatores preditivos de recidiva relacionam-se com condicoes de moradia, habitos de vida, organizacao dos servicos de saude, formas clinicas e esquemas terapeuticos. Cabe aos servicos de saude oferecer orientacoes adequadas aos pacientes, bem como garantir a regularidade do tratamento.

Recidivas de casos de hanseníase no estado de Mato Grosso

OBJECTIVE To compare new registrations of recurrences of leprosy cases in primary healthcare units (PHUs) and in specialized units in the State of Mato Grosso. METHODS This was a cross-sectional study based on all new registrations (N = 323) of recurrences of leprosy cases within the Notifiable Disease Information System (SINAN) between 2004 and 2006 that were made in the State of Mato Grosso, Central-West Brazil. The cases diagnosed were compared regarding sex, age, clinical-laboratory characteristics and geographical distribution among the municipalities. To compare and calculate the proportions of the variables, the chi-square test at the significance level of 5% was used. RESULTS Among the new registrations of recurrences, 20% were confirmed at specialized units and 80% at PHUs. However, most of the diagnoses at PHUs presented negative bacilloscopy findings (c2 = 12.34; p = 0.002). Seventy-one per cent of the cases were among males; the mean age was 43 years. No differences in the percentages of registrations were observed between the healthcare units with regard to clinical form, operational classification or degree of physical incapacity. Out of the total number of municipalities in the state, 64.7% presented recurrences and these accounted for 6 to 20% of all registrations. CONCLUSIONS The new registrations of cases of recurrence in Mato Grosso were influenced by the diagnoses made at PHUs, thus suggesting that there is a deficiency within the healthcare services in recognizing cases of recurrence.OBJECTIVE: To compare new registrations of recurrences of leprosy cases in primary healthcare units (PHUs) and in specialized units in the State of Mato Grosso. METHODS: This was a cross-sectional study based on all new registrations (N = 323) of recurrences of leprosy cases within the Notifiable Disease Information System (SINAN) between 2004 and 2006 that were made in the State of Mato Grosso, Central-West Brazil. The cases diagnosed were compared regarding sex, age, clinical-laboratory characteristics and geographical distribution among the municipalities. To compare and calculate the proportions of the variables, the chi-square test at the significance level of 5% was used. RESULTS: Among the new registrations of recurrences, 20% were confirmed at specialized units and 80% at PHUs. However, most of the diagnoses at PHUs presented negative bacilloscopy findings (c2 = 12.34; p = 0.002). Seventy-one per cent of the cases were among males; the mean age was 43 years. No differences in the percentages of registrations were observed between the healthcare units with regard to clinical form, operational classification or degree of physical incapacity. Out of the total number of municipalities in the state, 64.7% presented recurrences and these accounted for 6 to 20% of all registrations. CONCLUSIONS: The new registrations of cases of recurrence in Mato Grosso were influenced by the diagnoses made at PHUs, thus suggesting that there is a deficiency within the healthcare services in recognizing cases of recurrence.

Factors associated to relapse of leprosy in Mato Grosso, Central-Western Brazil

OBJETIVO: Analizar factores asociados a la ocurrencia de recidiva en hanseniasis. METODOS: Estudio retrospectivo caso-control con 159 pacientes mayores de 15 anos diagnosticados con hanseniasis en cinco municipios del Estado de Mato Grosso, Centro-oeste de Brasil, cuyas unidades de salud eran consideradas de referencia para el atendimiento. El grupo de casos incluyo 53 individuos con recidiva de 2005 a 2007 y fue comparado con el grupo control (106 con alta por cura en 2005), pareados por sexo y clasificacion operacional. Se usaron datos del Sistema de Informacion de Agravios de Notificacion, Prontuarios y entrevistas. Se utilizo regresion logistica condicional y abordaje jerarquico. RESULTADOS: Posterior al analisis ajustado, se mostraron asociados a la ocurrencia de recidiva: individuos residentes en casas alquiladas (OR=4,1; IC95%:1,43;12,04), en domicilio de madera/tapia (OR=3,2; IC 95%:1,16;8,76), que moraban con mas de cinco personas (OR=2,1; IC95%:1,03;4,36), con trastorno por uso de alcohol (OR=2,8;IC95%:1,17;6,79), irregularidad del tratamiento (OR= 3,8; IC95%: 1,44;10,02), sin esclarecimiento sobre la enfermedad/tratamiento (OR= 2,6; IC95%:1,09,6,13), que usaban transporte colectivo para el acceso a la unidad de salud (OR=5,5; IC95%: 2,36;12,63), forma clinica de la enfermedad (OR= 7,1;IC95%: 2,48;20,52) y esquema terapeutico (OR= 3,7; IC95%:1,49;9,11). CONCLUSIONES: Los factores predictivos de recidiva se relacionan con condiciones de vivienda, habitos de vida, organizacion de los servicios de salud, formas clinicas y esquemas terapeuticos. Compete a los servicios de salud ofrecer orientaciones adecuadas a los pacientes, asi como garantizar la regularidad del tratamiento.OBJETIVO: Analisar fatores associados a ocorrencia de recidiva em hanseniase. METODOS: Estudo retrospectivo caso-controle com 159 pacientes maiores de 15 anos diagnosticados com hanseniase em cinco municipios do estado de Mato Grosso, cujas unidades de saude eram consideradas de referencia para o atendimento. O grupo de casos incluiu 53 individuos com recidiva de 2005 a 2007 e foi comparado ao grupo controle (106 com alta por cura em 2005), pareados por sexo e classificacao operacional. Foram usados dados do Sistema de Informacao de Agravos de Notificacao, prontuarios e entrevistas. Utilizou-se regressao logistica condicional e abordagem hierarquica. RESULTADOS: Apos analise ajustada, mostraram-se associados a ocorrencia de recidiva: individuos residentes em casas alugadas (OR = 4,1; IC95%:1,43;12,04), em domicilio de madeira/taipa (OR = 3,2; IC95%: 1,16;8,76), que moravam com mais de cinco pessoas (OR = 2,1; IC95% : 1,03;4,36), com transtorno de uso de alcool (OR = 2,8; IC95%: 1,17;6,79), irregularidade do tratamento (OR = 3,8;IC95%: 1,44;10,02), sem esclarecimento sobre a doenca/tratamento (OR = 2,6; IC95%: 1,09;6,13), que usavam transporte coletivo para o acesso a unidade de saude (OR = 5,5; IC95%: 2,36;12,63), forma clinica da doenca (OR = 7,1; IC95%: 2,48;20,52) e esquema terapeutico (OR = 3,7; IC95%: 1,49;9,11). CONCLUSOES: Os fatores preditivos de recidiva relacionam-se com condicoes de moradia, habitos de vida, organizacao dos servicos de saude, formas clinicas e esquemas terapeuticos. Cabe aos servicos de saude oferecer orientacoes adequadas aos pacientes, bem como garantir a regularidade do tratamento.

Características clínico-laboratoriais no retratamento por recidiva em hanseníase

OBJECTIVE: To compare clinical and laboratory data of leprosy patients diagnosed in specialized services in the State of Mato Grosso, Brazil, during the initial treatment and the retreatment of relapse. METHODS: A cross-sectional study of patients with diagnosis of leprosy relapse was conducted in specialized health services of five cities, between 2005 and 2007. Initial treatment was described as t1 and relapse treatment as t2. DATA SOURCE: Sistema de Informacao de Agravos de Notificacao (Sinan - Reportable Diseases Information System), medical records, laboratory tests, and files of individual reports and of physical disability assessments. The chi-square test (c2) was applied at a significance level of 5%. RESULTS: The clinical dimorphic form prevailed in t2 when compared with t1 (39.6% versus 11.3%; p = 0.003); 20.8% of relapse cases showed a bacilloscopy index ≥ 4+ in relation to those in t1 (p = 0.034)]; an increase in the number of (17%) cases of relapse with physical disability at level 0 was found, compared to patients evaluated during the diagnosis (58.5% versus 41.5%); an increase (7.5%) in the recurrence of disabilities at level 2 was observed, when compared to t1 (9.4% versus a 9%); and there was a higher prevalence of cases not evaluated for disability between t1 (45.3%) and t2 (22.6%) (p = 0.040). CONCLUSION: Cases of relapse characterized the aggravation of the disease, indicated by the increase in the bacilloscopy index and level of physical disability. Attention should be paid to the diagnostic confirmation of relapse using bacilloscopy tests, especially in multibacillary cases, and systematic neurological assessment of all leprosy patients.

Rifampicin chemoprophylaxis in preventing leprosy in contacts of patients with leprosy: a comprehensive systematic review protocol

Review question/objective What is the effectiveness of rifampicin chemoprophylaxis in preventing leprosy in contacts of patients with leprosy? What are the experiences and acceptability with the use of rifampin chemoprophylaxis in the prevention of disease from contacts with patients who have leprosy, in patients with leprosy following treatment and in family and health care professionals? Background Leprosy is globally acknowledged as a millenary and stigmatizing disease and a condition with attributed consequences such as physical deformities and disabilities. From a multi‐causal perspective, there is evidence that leprosy occurs more often in men than in women, is distributed across all age groups and occurs mainly among people living in unfavorable socioeconomic circumstances, who are also the most affected by public segregation policies. 1–4 In 2013, a total of 215,656 new cases of leprosy were detected worldwide. Regions with the highest number of cases are Southeast Asia (72.1%) the Americas (15.3%). Whereas the countries with the highest prevalence were India (58.8%) and Brazil (14.4%). 5 Hansens bacillus (Mycobacterium leprae) is considered a microorganism of high infectivity and low pathogenicity and virulence. It is transmitted via nasal oropharyngeal secretions and breaks in the skin of infected patients. Therefore, the main form of transmissibility is inter‐human and the greatest risk of contagion is cohabitation with these patients.1–3 It is estimated that most individuals have a natural resistance to Mycobacterium leprae (M. leprae) and that some are prone to developing a severe form of the disease, the multibacillary forms. Studies on exogenous reinfection and endogenous reactivation in chronic diseases, such as tuberculosis and leprosy, show that susceptible individuals become infected by the bacillus through contact with multibacillary patients.1–3,6,7 The surveillance of leprosy contacts is a priority action for control of the disease. Children are exposed to the highest risk of becoming infected by being in contact with a family member or anyone close to them who has the disease. Having a current case of leprosy in the family is associated with a 2.9 times greater risk of a healthy family member becoming infected, and that risk increases when the family has a history of the disease.3,6–9 Bakker et al.7 reported that household contacts of multibacillary patients presented a four times greater risk of becoming infected with the disease compared to non‐contacts. For Ximenes et al.,10 the condition of being a contact of individuals with leprosy represented twice the risk of retreatment due to recurrence in relation to the control group. Therefore, alternative or complementary strategies, such as chemoprophylaxis, must be sought as a form of prevention of the disease. Chemoprophylaxis is defined as the administration of drugs capable of preventing an infection or keeping infected individuals from falling ill. In leprosy, the preventive strategy consists of employing medications to prevent the infection by M. leprae in people with a higher risk of exposure to the disease, i.e. those in contact with the patient. Therefore, chemoprophylaxis plays an important role in the protection of individuals vulnerable to the disease. However, studies regarding its effective utilization are inconclusive.11–15 The first investigations of the utilization of prophylaxis in leprosy contacts in the 1960s and 1970s included dapsone and acedapsone and later in the 1980s and 1990s rifampicin. However, interest in this type of research decreased after 1982 when the World Health Organization (WHO) introduced multidrugtherapy (MDT) for the treatment of leprosy.16–19 Multidrugtherapy is a combination of three drugs, dapsone, rifampicin and clofazimine, to prevent the selection of resistant strains. As of 1997, the WHO adopted the alternative rifampicin, ofloxacin and minocycline (ROM) regimen, recommended for paucibacillary cases with a single lesion without the involvement of nerve stems.19,20 Adoption of these measures was expected to result in a reduction in the incidence of leprosy as a public health problem; however, the observed result was not significant in terms of reducing the incidence of newly detected cases. Furthermore, considering the evidence of resistance to monotherapy with dapsone, there was a rise in interest in intervention studies, particularly using rifampicin in household and community contacts.1,2,5,11,12 However, some studies have indicated little or no protection against the disease through the use of rifampicin. While Moet et al.14 and Feenstra et al.21 observed protection of two years in household contacts with a single dose of rifampicin, Bakker et al.13 showed no difference between the experimental group and the control group with two doses of rifampicin, 600 mg for adults and 300 mg for children. Another study of people at high risk of contracting the disease that used a single dose of ROM and rifampicin showed that there was a reduction of type immunoglobulin M antibodies among adults in both interventions.22 Meta‐analyis of dapsone, acepdapsone and rifampicin compared with placebo showed that chemoprophlasys is an effective measure to prevent leprosy. 12 Currently, strategies using a combination of the Bacillus Calmette‐Guérin (BCG) and chemoprophylaxis with rifampicin in leprosy contacts appear to be complementary measures for protection against the disease. This strategy showed a protective effect of 80%.23 Studies of acceptability and experience of chemoprophylaxis to control leprosy with individuals and health professionals are scarce. In a qualitative study, Feenstra et al.24 concluded that chemoprophylaxis for household contacts of leprosy patients is an effective and socially acceptable addition to the current leprosy control program. A preliminary search of the Joanna Briggs Database of Systematic Reviews and Implementation Reports, the Cochrane Library, CINAHL, PubMed and PROSPERO has revealed that there are no systematic reviews (either published or underway) on this topic. In this context, it is unquestionably useful to integrate the scientific evidence from studies that evaluated the effectiveness of the rifampicin chemoprophylaxis in leprosy contacts, the experiences and acceptability of contacts of leprosy patients, patients with leprosy following treatment and family and health care professionals about this strategy for the prevention of the disease. This knowledge can support the measures adopted to reduce endemicity, which strengthens the quality of the care delivered to the population most vulnerable to becoming ill. Operational definitions: Leprosy patients: individuals who present one or more of the following cardinal signs and who require multidrugtherapy: lesion(s) and/or skin areas with altered sensitivity; affected peripheral nerve(s), with or without thickening, associated with sensitive and/or motor and/or autonomic changes; and a positive skin smear bacilloscopy. Cases are classified as paucibacillary or multibacillary based on the number of lesions and/or bacilloscopy when available; cases are considered paucibacillary when patients present five or fewer skin lesions and/or negative bacilloscopy, corresponding to the undetermined and tuberculoid clinical forms; multibacillary cases are when patients present more than five skin lesions and positive bacilloscopy,corresponding to the dimorphous and Virchows forms of the disease.1–4,25 Leprosy case: term used in epidemiology to identify individuals with leprosy for purposes of monitoring the health conditions of a population.2,26 Chemoprophylaxis: the administration of drugs capable of preventing the infection or keeping infected individuals from falling ill.11,12 Contacts: those who cohabit or have cohabited with leprosy patients.12,14,21 Index case: the first case of the disease among several similar cases that are epidemiologically related with the secondary case (index case contacts).21 Recurrence: the reappearance of signs and symptoms of the disease after recuperation from a first occurrence of the disease, usually within five years.6,10,27 Treatment abandonment: interrupting treatment for over twelve months.6,10 Therapeutic regimen established for confirmed leprosy cases: for paucibacillary (PB) cases, six monthly supervised doses of rifampicin (RFM) 450‐600mg, and daily self‐administered doses of dapsone (DDS) 50‐100mg, for up to nine months; for multibacillary (MB) cases, twelve supervised monthly doses of rifampicin (RFM) 450‐600mg and clofazimine (CFZ) 100‐300mg, associated to daily self‐administered doses of dapsone (DDS) 50‐100mg and CFZ 50mg, for up to 18 months. An alternative treatment for MB is 24 doses within 36 months.1,2,19 Rifampicin chemoprophylaxis regimens: single‐dose rifampicin of 25 mg/kg or monthly dose for six months; double‐dose rifampicin or combined regimens of ROM ‐ rifampicin (600 mg), ofloxacin (400 mg) and minocycline (100mg), according to body weight.13–15,21 Efficacy/effectiveness: proof (or not) of successful intervention. Efficacy is the result of an intervention performed under ideal, well‐controlled conditions, such as in randomized clinical trials. Effectiveness refers to the result of an intervention applied under usual medical practice conditions.28 Operational classification: paucibacillary and multibacillary.1,2, 25 Comorbidities: morbidities possibly associated with leprosy, such as tuberculosis, diabetes, HIV/AIDS, and others.1,2 BCG vaccination scar: resulting from the intradermal injection of Bacillus Calmette‐Guérin (BCG) vaccine on the deltoid, used to prevent tuberculosis and leprosy.23,29 Adverse events: negative effects resulting from the actions of drugs.1,2 Incidence rate: measures the frequency or likelihood of new cases of diseases occurring in a population.30 Estimated effect of an intervention: shows the theoretical distribution of possible effects in

Recurrence of leprosy cases in the State of Mato Grosso, Central-West Brazil

OBJECTIVE To compare new registrations of recurrences of leprosy cases in primary healthcare units (PHUs) and in specialized units in the State of Mato Grosso. METHODS This was a cross-sectional study based on all new registrations (N = 323) of recurrences of leprosy cases within the Notifiable Disease Information System (SINAN) between 2004 and 2006 that were made in the State of Mato Grosso, Central-West Brazil. The cases diagnosed were compared regarding sex, age, clinical-laboratory characteristics and geographical distribution among the municipalities. To compare and calculate the proportions of the variables, the chi-square test at the significance level of 5% was used. RESULTS Among the new registrations of recurrences, 20% were confirmed at specialized units and 80% at PHUs. However, most of the diagnoses at PHUs presented negative bacilloscopy findings (c2 = 12.34; p = 0.002). Seventy-one per cent of the cases were among males; the mean age was 43 years. No differences in the percentages of registrations were observed between the healthcare units with regard to clinical form, operational classification or degree of physical incapacity. Out of the total number of municipalities in the state, 64.7% presented recurrences and these accounted for 6 to 20% of all registrations. CONCLUSIONS The new registrations of cases of recurrence in Mato Grosso were influenced by the diagnoses made at PHUs, thus suggesting that there is a deficiency within the healthcare services in recognizing cases of recurrence.OBJECTIVE: To compare new registrations of recurrences of leprosy cases in primary healthcare units (PHUs) and in specialized units in the State of Mato Grosso. METHODS: This was a cross-sectional study based on all new registrations (N = 323) of recurrences of leprosy cases within the Notifiable Disease Information System (SINAN) between 2004 and 2006 that were made in the State of Mato Grosso, Central-West Brazil. The cases diagnosed were compared regarding sex, age, clinical-laboratory characteristics and geographical distribution among the municipalities. To compare and calculate the proportions of the variables, the chi-square test at the significance level of 5% was used. RESULTS: Among the new registrations of recurrences, 20% were confirmed at specialized units and 80% at PHUs. However, most of the diagnoses at PHUs presented negative bacilloscopy findings (c2 = 12.34; p = 0.002). Seventy-one per cent of the cases were among males; the mean age was 43 years. No differences in the percentages of registrations were observed between the healthcare units with regard to clinical form, operational classification or degree of physical incapacity. Out of the total number of municipalities in the state, 64.7% presented recurrences and these accounted for 6 to 20% of all registrations. CONCLUSIONS: The new registrations of cases of recurrence in Mato Grosso were influenced by the diagnoses made at PHUs, thus suggesting that there is a deficiency within the healthcare services in recognizing cases of recurrence.

Hanseníase em menores de quinze anos em municípios prioritários, Mato Grosso, Brasil

OBJECTIVES We aimed to compare the sociodemographic, clinical and epidemiological characteristics of individuals under the age of 15, reported to have leprosy, and who lived in priority and non-priority cities, as well as to compare the spatial distribution of these reported cases in such cities. This is a cross-sectional study of new leprosy cases in individuals under the age of 15 (n=429) registered in the Information System for Notifiable Diseases from the State of Mato Grosso, Brazil, between 2011 and 2013. The diagnosed cases were compared regarding sociodemographic, clinical and epidemiological aspects using the chi-square test at a 5% significance level. The spatial distribution was made through ArcGIS 10.2 software. RESULTS Of the 141 assessed cities in the state, according to the spatial distribution, 58.1% (n=82) showed a high, very high and hyper-endemic mean incidence coefficient, and, of these, 34.1% (n=28) include the group of priority municipalities. Of the new cases included in the study, 73.9% (n=317) were reported in priority cities. We observed a difference in the proportion of cases registered among the cities, with a greater proportion in priority cities, in the age group from five to nine years old (χ²=4.09; p=0.043), in the white race (χ²=7.01; p=0.008) and in the tuberculoid clinical form (χ²=3.89; p=0.048). There was a greater proportion in non-priority cases with regard to non-urban areas (χ²=24.23; p<0.001), two to five skin lesions (χ²=5.93; p=0.014) and spontaneous demand (χ²=6.16; p=0.013). CONCLUSION The differences highlighted regarding clinical and epidemiological characteristics between the cities demonstrate the difficulty of endemic control in both municipality groups.

Tendência da hanseníase em menores de 15 anos em Mato Grosso (Brasil), 2001-2013

MÉTODOS: Estudo descritivo com análise de tendência dos indicadores de hanseníase em menores de 15 anos registrados no Sistema Nacional de Agravos de Notificação de Mato Grosso, no período de 2001 a 2013. Utilizou-se o procedimento de Prais-Winsten para análise de regressão linear generalizada, adotando-se nível de significância de 5%. Consideraram-se como série temporal crescente quando a annual percent change era positiva, decrescente quando negativa e estacionária quando não havia diferença significante entre seu valor e o zero.ABSTRACT OBJECTIVE To identify the historical trend of leprosy epidemiological indicators in individuals under the age of 15 in the state of Mato Grosso. METHODS Descriptive study with trend analysis of leprosy indicators in individuals under the age of fifteen registered in the Mato Grosso’s System for Notifiable Diseases between 2001 and 2013. We used the Prais-Winsten procedure for analyzing generalized linear regression at a significance level of 5%. We considered as increasing time series when the annual percent change was positive, decreasing when negative and stationary when there was no significant difference between its value and zero. RESULTS We analyzed 2455 cases of leprosy and the average detection rate in individuals under the age of fifteen was 22.7 per 100 thousand inhabitants. The trend of the general coefficient of incidence was decreasing, with an average annual rate of -5.5% (95%CI -7.5–-3.5). Increasing trend was observed with an increase of 6.7% (95%CI 2.7–10.8) in the proportion of multibacillary cases, 9.4% (95%CI 4.4–14.7) of cases diagnosed with dimorphic clinical form and 14% (95%CI 7.9–20.4) of cases with physical disability level 2 at the time of diagnosis. There was an increasing trend in the average proportion of examined contacts, with a growth of 4.1% (95%CI 1.2–7.1) and average proportion of healing was precarious (39.7%), with stationary trend. CONCLUSIONS The historical trend of leprosy cases in individuals under the age of fifteen proved to be decreasing in the period, however the trends of epidemiological indicators such as the proportion of multibacillary cases, physical disability level 2 and healing, indicate late diagnosis with stay sources of transmission and consequent worsening of the disease in the state of Mato Grosso.

Factores asociados a recidiva en hanseníasis en Mato Grosso, Centro-oeste de Brasil

OBJETIVO: Analizar factores asociados a la ocurrencia de recidiva en hanseniasis. METODOS: Estudio retrospectivo caso-control con 159 pacientes mayores de 15 anos diagnosticados con hanseniasis en cinco municipios del Estado de Mato Grosso, Centro-oeste de Brasil, cuyas unidades de salud eran consideradas de referencia para el atendimiento. El grupo de casos incluyo 53 individuos con recidiva de 2005 a 2007 y fue comparado con el grupo control (106 con alta por cura en 2005), pareados por sexo y clasificacion operacional. Se usaron datos del Sistema de Informacion de Agravios de Notificacion, Prontuarios y entrevistas. Se utilizo regresion logistica condicional y abordaje jerarquico. RESULTADOS: Posterior al analisis ajustado, se mostraron asociados a la ocurrencia de recidiva: individuos residentes en casas alquiladas (OR=4,1; IC95%:1,43;12,04), en domicilio de madera/tapia (OR=3,2; IC 95%:1,16;8,76), que moraban con mas de cinco personas (OR=2,1; IC95%:1,03;4,36), con trastorno por uso de alcohol (OR=2,8;IC95%:1,17;6,79), irregularidad del tratamiento (OR= 3,8; IC95%: 1,44;10,02), sin esclarecimiento sobre la enfermedad/tratamiento (OR= 2,6; IC95%:1,09,6,13), que usaban transporte colectivo para el acceso a la unidad de salud (OR=5,5; IC95%: 2,36;12,63), forma clinica de la enfermedad (OR= 7,1;IC95%: 2,48;20,52) y esquema terapeutico (OR= 3,7; IC95%:1,49;9,11). CONCLUSIONES: Los factores predictivos de recidiva se relacionan con condiciones de vivienda, habitos de vida, organizacion de los servicios de salud, formas clinicas y esquemas terapeuticos. Compete a los servicios de salud ofrecer orientaciones adecuadas a los pacientes, asi como garantizar la regularidad del tratamiento.OBJETIVO: Analisar fatores associados a ocorrencia de recidiva em hanseniase. METODOS: Estudo retrospectivo caso-controle com 159 pacientes maiores de 15 anos diagnosticados com hanseniase em cinco municipios do estado de Mato Grosso, cujas unidades de saude eram consideradas de referencia para o atendimento. O grupo de casos incluiu 53 individuos com recidiva de 2005 a 2007 e foi comparado ao grupo controle (106 com alta por cura em 2005), pareados por sexo e classificacao operacional. Foram usados dados do Sistema de Informacao de Agravos de Notificacao, prontuarios e entrevistas. Utilizou-se regressao logistica condicional e abordagem hierarquica. RESULTADOS: Apos analise ajustada, mostraram-se associados a ocorrencia de recidiva: individuos residentes em casas alugadas (OR = 4,1; IC95%:1,43;12,04), em domicilio de madeira/taipa (OR = 3,2; IC95%: 1,16;8,76), que moravam com mais de cinco pessoas (OR = 2,1; IC95% : 1,03;4,36), com transtorno de uso de alcool (OR = 2,8; IC95%: 1,17;6,79), irregularidade do tratamento (OR = 3,8;IC95%: 1,44;10,02), sem esclarecimento sobre a doenca/tratamento (OR = 2,6; IC95%: 1,09;6,13), que usavam transporte coletivo para o acesso a unidade de saude (OR = 5,5; IC95%: 2,36;12,63), forma clinica da doenca (OR = 7,1; IC95%: 2,48;20,52) e esquema terapeutico (OR = 3,7; IC95%: 1,49;9,11). CONCLUSOES: Os fatores preditivos de recidiva relacionam-se com condicoes de moradia, habitos de vida, organizacao dos servicos de saude, formas clinicas e esquemas terapeuticos. Cabe aos servicos de saude oferecer orientacoes adequadas aos pacientes, bem como garantir a regularidade do tratamento.

Recurrencia de casos de hanseníasis en el estado de Mato Grosso, Centro-Oeste de Brasil, 2004-2006

OBJECTIVE To compare new registrations of recurrences of leprosy cases in primary healthcare units (PHUs) and in specialized units in the State of Mato Grosso. METHODS This was a cross-sectional study based on all new registrations (N = 323) of recurrences of leprosy cases within the Notifiable Disease Information System (SINAN) between 2004 and 2006 that were made in the State of Mato Grosso, Central-West Brazil. The cases diagnosed were compared regarding sex, age, clinical-laboratory characteristics and geographical distribution among the municipalities. To compare and calculate the proportions of the variables, the chi-square test at the significance level of 5% was used. RESULTS Among the new registrations of recurrences, 20% were confirmed at specialized units and 80% at PHUs. However, most of the diagnoses at PHUs presented negative bacilloscopy findings (c2 = 12.34; p = 0.002). Seventy-one per cent of the cases were among males; the mean age was 43 years. No differences in the percentages of registrations were observed between the healthcare units with regard to clinical form, operational classification or degree of physical incapacity. Out of the total number of municipalities in the state, 64.7% presented recurrences and these accounted for 6 to 20% of all registrations. CONCLUSIONS The new registrations of cases of recurrence in Mato Grosso were influenced by the diagnoses made at PHUs, thus suggesting that there is a deficiency within the healthcare services in recognizing cases of recurrence.OBJECTIVE: To compare new registrations of recurrences of leprosy cases in primary healthcare units (PHUs) and in specialized units in the State of Mato Grosso. METHODS: This was a cross-sectional study based on all new registrations (N = 323) of recurrences of leprosy cases within the Notifiable Disease Information System (SINAN) between 2004 and 2006 that were made in the State of Mato Grosso, Central-West Brazil. The cases diagnosed were compared regarding sex, age, clinical-laboratory characteristics and geographical distribution among the municipalities. To compare and calculate the proportions of the variables, the chi-square test at the significance level of 5% was used. RESULTS: Among the new registrations of recurrences, 20% were confirmed at specialized units and 80% at PHUs. However, most of the diagnoses at PHUs presented negative bacilloscopy findings (c2 = 12.34; p = 0.002). Seventy-one per cent of the cases were among males; the mean age was 43 years. No differences in the percentages of registrations were observed between the healthcare units with regard to clinical form, operational classification or degree of physical incapacity. Out of the total number of municipalities in the state, 64.7% presented recurrences and these accounted for 6 to 20% of all registrations. CONCLUSIONS: The new registrations of cases of recurrence in Mato Grosso were influenced by the diagnoses made at PHUs, thus suggesting that there is a deficiency within the healthcare services in recognizing cases of recurrence.