Perfil epidemiológico da hanseníase em município hiperendêmico no nordeste do Brasil / Perfil epidemiológico de la lepra en un municipio hiperendémico en el noreste de Brasil / Epidemiological profile of leprosy in a hyperendemic municipality in northeastern Brazil

Introdução: a hanseníase ainda configura-se como uma endemia, que em razão do potencial incapacitante, deve-se garantir atenção especializada. A análise do perfil epidemiológico no município de Floriano torna-se importante estratégia para monitoramento dos indicadores, avaliação e organização dos serviços, com a finalidade de orientar os gestores e profissionais de saúde. Objetivo: analisar o perfil epidemiológico da hanseníase em Floriano, Piauí. Métodos: trata-se de um estudo transversal e descritivo. Os dados foram coletados no Sistema de Informação de Agravos de Notificação, referentes ao período de 2009 a 2013. As variáveis analisadas foram: faixa etária, sexo, forma clínica, grau de incapacidade, classificação operacional, modo de entrada e número de lesões. Realizaram-se análises descritivas dos dados, com a apuração de frequências simples absolutas e relativas para as variáveis categóricas em estudo, organizando esses resultados em gráficos e tabelas. Resultados: no intervalo de tempo estudado foram registrados 388 casos de hanseníase sendo a maior incidência em indivíduos com idade superior a 15 anos, sexo masculino e com predomínio da classe paucibacilar, forma indeterminada e grau 0 de incapacidade física no diagnóstico. A prevalência oculta da hanseníase no período em estudo foi de 46 casos. Conclusões: o perfil epidemiológico da hanseníase em Floriano/PI sugere prevalência oculta pois os altos valores dos indicadores apontam para uma elevada circulação do bacilo. Além disso, nota-se possibilidade de maiores riscos de surgimento de incapacidades dentre os homens, devido associação entre o sexo masculino e as formas de apresentação tardia da doença(AU)

Introducción: la lepra sigue apareciendo como una enfermedad endémica, que debido al potencial incapacitante, debe garantizar una atención especializada. El análisis del perfil epidemiológico en el municipio de Floriano se convierte en estrategia importante para el seguimiento de indicadores, evaluación y organización de los servicios, con el fin de orientar a los administradores y profesionales de la salud. Objetivo: analizar el perfil epidemiológico de la lepra en la ciudad de Floriano, Piauí. Métodos: estudio transversal y descriptivo. Los datos fueron recogidos en el sistema de información de notificación de enfermedades, para el período 2009-2013. Las variables analizadas fueron: edad, sexo, forma clínica, grado de discapacidad, clasificación operacional, modo de entrada y el número de lesiones. El análisis descriptivo de los datos, el cálculo de las frecuencias absolutas y relativas para las variables categóricas simples objeto de estudio, la organización de los resultados en gráficos y tablas. Resultados: en el periodo estudiado fueron grabados 388 casos de lepra por la mayor incidencia en individuos sobre la edad de 15 años, varones y con un predominio de clase paucibacilaria, forma indeterminada y 0 grados de discapacidad en el diagnóstico. La prevalencia de la lepra estaba escondida en 46 de los casos. Conclusiones: el perfil epidemiológico de la lepra en Floriano/PI sugiere prevalencia oculta, porque los altos valores de los indicadores apuntan a una alta circulación del bacilo. Además, se notificó la posibilidad de mayores riesgos de aparición de discapacidades entre los hombres, debido a la asociación entre el hombre y las formas de presentación tardía de la enfermedad(AU)

Introduction: Leprosy still appears as an endemic disease, which because of the crippling potential, should ensure specialized care. The analysis of the epidemiological profile in Floriano municipality becomes important strategy for monitoring indicators, evaluation and organization of services, in order to guide managers and health professionals. Objective: Analyzing the epidemiological profile of leprosy in Floriano, Piauí. Methods: This is a cross-sectional and descriptive study. The data were collected in the Information System of Reportable Diseases, referred to the period from 2009 to 2013. The variables analyzed were: age, sex, clinical form, degree of disability, operational classification, input mode and number of lesions. The descriptive analysis of data, the calculation of simple absolute and relative frequencies for categorical variables under study, organizing the results into graphs and tables. Results: In the studied period there were recorded 388 cases of leprosy, being the highest incidence in individuals over the age of 15 years old, males and with a predominance of class paucibacillary, indeterminate form and 0 degree of disability in the diagnosis. The prevalence of leprosy was hidden in 46 percent of the cases. Conclusions: The epidemiological profile of leprosy in Floriano/PI suggests hidden prevalence, because the high values of the indicators point to a high circulation of the Bacillus. In addition, it is noted the possibility of increased risks of emergence of disabilities among men, because of association between the male and the late presentation forms of the disease(AU)

Analysis of newly detected leprosy in Sohag Governorate, Upper Egypt, 2004-2008.

INTRODUCTION: Leprosy is a chronic and complex infectious illness; the new-case detection rate is better than prevalence as an indicator of disease trends. This study presents an analysis of pattern of new cases of leprosy detected annually from 2004 to 2008 in Sohag Governorate, Upper Egypt. PATIENTS AND METHODS: Data about patients with newly diagnosed leprosy were collected from Sohag leprosy hospital, the main referral centre in the governorate. Case detection rates (CDR) were calculated for each year by dividing the newly diagnosed cases by mid-year populations for the same year. RESULTS: 587 patients were newly diagnosed between 2004 and 2008. The mean age of patients at diagnosis was 34 years, 62% were males, and 11% were children below 15 years of age. The overall leprosy case detection rate was 3-1/100,000 population and it decreased from 3.4/100,000 population in 2004 to 2.8/100,000 population in 2008. Ninety three percent were classified as multibacillary, and 20.4% had Grade 2 disability at diagnosis. CONCLUSIONS: Leprosy remains a health problem in Sohag Governorate. It is possible that new cases are being detected late owing to inadequate community awareness of the disease. Leprosy control activities should be provided in primary health care units in order to detect new cases, and continued surveillance is required to detect relapses and to ensure good patient compliance with treatment.

Inverse sampling to study disease burden of leprosy.

BACKGROUND & OBJECTIVES: Estimation of disease burden due to leprosy by conventional sampling procedure is difficult due to large sample size requirement. In such situation, inverse sampling procedure could be a choice. A pilot study was undertaken to study the feasibility of adopting inverse sampling procedure over conventional sampling in an endemic area of Uttar Pradesh, India. METHODS: Two community development blocks one with high endemic, namely, Fatehganj, and other low endemic, Ramnagar, in Bareilly district of Uttar Pradesh, India, were selected. The Inverse sampling was adopted in Fatehganj and conventional cluster sampling was used in Ramnagar. As per the design of inverse sampling, 25 new cases of leprosy were to be detected from a population that could provide the cases. Under conventional sampling, a sample of 44,000 subjects (population) was targeted for the survey. RESULTS: In Fatehganj, 25 new cases of leprosy were detected from a sample of 14734 individuals. In Ramnagar, a total of 63 new cases of leprosy were found after covering a sample of 44686 individuals. Both the techniques provided similar estimates. The precision obtained under inverse sampling was though less than that under conventional sampling but found to be more feasible and suitable for estimation of leprosy due to less population to be covered, time and cost. INTERPRETATION & CONCLUSION: Our findings showed reveals that inverse sampling was advantageous over conventional sampling and could be adopted for the large scale survey at national level.

Proyecto global sobre la historia de la lepra por la asociación internacional de lepra

El autor describe los procedimientos y modos empleados para conseguir acumular una vasta base de datos con archivos y registros sobre la Lepra. Se comenta la información ya disponible básicamente en tres lugares: África, India y China, describiendo y concretando su localización geográfica local y periodo al que corresponden la información. Se insiste en la necesidad de completar el contenido de los archivos y registros de la base de datos y sobretodo de su mantenimiento y puesta al día (AU)

Lessons in integration--operations research in an Indian leprosy NGO.

Since the Alma Ata Declaration in 1978, health systems supporting the treatment and control of infectious diseases like leprosy and tuberculosis have been encouraged to 'integrate' into the primary health care structure within countries. Now, more than 20 years later, countries are still grappling with the concept of integration and looking for ways to achieve it. This study reports findings from a leprosy/Tuberculosis/AIDS awareness pilot project conducted by LEPRA India, a leprosy non-governmental organization (NGO), between 1996 and 2000 in Koraput district, Orissa. The project addressed the issue of integration on two levels. On the one hand LEPRA used the context of the project to explore ways in which to integrate TB services into their existing leprosy control structure. On the other hand, lessons from the pilot study were intended to help the organization find ways of linking with the government health care structure. Following a 'qualitative approach', this operations research project assessed the perceptions of communities and providers about leprosy and tuberculosis services. Providers across the spectrum of this plural healthcare system were asked to provide comment on developing stronger networks with each other, with NGOs and with government, while patients and communities were asked to describe the resources available to them and the constraints they face in accessing health care in general, and for leprosy and TB in particular. LEPRA staff from top management to the outreach workers were also approached for their views. Patients and communities noted that physical access to treatment was a major constraint, while the existence of local providers and family support structures facilitated health and health care. Providers expressed a willingness to collaborate (with LEPRA and the government), but lacked training, adequate staff support and the appropriate equipment/technical resources. Also lacking were adequate information campaigns to inform the public about these diseases and their treatment. This information has provided LEPRA with an understanding of how they might best fill gaps in the existing system and therefore assist in the process of integrating services in their own organization and through the primary health care structure. To achieve this aim, LEPRA will increasingly become involved in developing relationships and partnerships with government in the delivery of training and services and in infrastructure development.

Nerve function impairment in leprosy: design, methodology, and intake status of a prospective cohort study of 2664 new leprosy cases in Bangladesh (The Bangladesh Acute Nerve Damage Study).

The Bangladesh Acute Nerve Damage Study (BANDS) is a prospective cohort study designed to investigate epidemiological, diagnostic, therapeutic and operational aspects of acute nerve function impairment in leprosy. The study is based at a single centre in Bangladesh, in an area with a high prevalence of leprosy. The centre, Danish Bangladesh Leprosy Mission, has a well-established vertical leprosy control programme. In this paper, the study design and methodology are described, together with definitions of nerve function impairment (NFI) used in this and subsequent papers. The study recruited 2664 new leprosy cases in a 12-month period. The male:female ratio is 1.25:1, and 17.61% of the cohort are under 15 years of age. In all, 83.33% of the cohort are paucibacillary (PB), and 16.67% multibacillary (MB). However, the MB rate amongst males is 19.72%, and amongst females is 12.85%, despite an equal period of delay to diagnosis. 55% of patients presented for treatment within 12 months of developing symptoms 6.12% of the total number of cases were smear positive, and 36.71% of the MB cases were smear positive. 9.61% of the total number of cases were graded as having World Health Organisation (WHO) disability grade 1, and 5.97% had grade 2. Amongst MB cases, 27.48% had WHO grade 1 disability present, and 18.24% had grade 2 present, compared with 6.04% and 3.51%, respectively, amongst PB cases. A total of 11.90% of the cohort had sensory NFI of any kind, and 7.39% had motor NFI. Ninety patients presented with NFI needing treatment (3.38%), and of these, 61 (67.78%) had silent NFI. MB patients had a prevalence of reaction/NFI needing treatment nearly 7 times higher than PB cases (15.32% amongst MB; 2.30% amongst PB), and males nearly double that of females (5.67% amongst males, 2.96% amongst females). The most commonly affected nerve by function impairment was the posterior tibial (sensory) with 6.46% of nerves affected (9.38% of patients), followed by the ulnar nerve with 3.23% of nerves impaired (5.56% of patients). Future research and publications, building on this foundation, will focus on the following areas: the incidence of NFI and reactive events, the risk factors for developing NFI, and the response to treatment of patients developing acute NFI.

Caracteristicas epidemiologicas dos comunicantes de hanseniase que desenvolveram a doença, notificados no C.S.I. de Fernandopolis (1933 a 1997) / Characteristic epidemiologists of the comunicantes of hanseníase that they had developed the illness, Notifying in the CSI de Fernandópolis

Trata-se de um estudo descritivo, realizado a partir de um levantamento de dados efetuado nas Fichas de Investigaçao Epidemiologica de Hanseniase, dos casos notificados no Centro de Saude I de Fernandopolis, no periodo de 1993 a 1997, que informaram conviver ou ter convivido com doente de hanseniase; constituindo-se de uma populaçao de 57 doentes, o que corresponde a 42,2 por cento dos 135 doentes de hanseniase, residentes em Fernandopolis, e notificados nesta unidade de saude nesse periodo. O objetivo foi caracterizar o perfil epidemiologico dessa populaçao de estudo. Os dados revelaram que a maioria é do sexo masculino, adultos jovens e adultos, de formas clinicas polarizadas, residentes na zona urbana, com baixo grau de escolaridade, desenvolvendo ocupaçoes variadas, caracterizadas pelo baixo grau de especializaçao ou por atividades domesticas. A maioria dessa populaçao de estudo foi detectada por meio do exame de contatos, de forma tardia; o grau de parentesco com o caso indice predominante foi o de filhos; detectou-se tambem que, com essa populaçao de estudo conviviam outras 169 pessoas, e que a maioria da populaçao desse estudo nao tinha cicatriz vacinal BCG-id e nao apresentavam incapacidades fisicas no momento do diagnostico. A analise dos dados epidemiologicos evidenciou problemas operacionais relativos ao desenvolvimento das açoes do Programa de Controle de Hanseniase, no que se refere ao controle dos comunicantes, o que podera comprometer as metas do Plano Nacional de Eliminaçao da Hanseniase como Problema de Saude Publica....

Opinöes sobre a doença entre membros da rede social de pacientes de hanseníase no Recife / Opinions about Hansen's disease among the members of patients' social network in Recife

This article describes a study done in Recife, Brazil, between November 1993 and July 1994 to explore the opinions of the members of the social network (for example, family members, friends, and neighbors) of carriers of Hansen's disease regarding their estimation, interpretation, and management of physical manifestations of the disease in the time leading up to diagnosis. The sample consisted of 93 members of the social network, ranging in age between 20 and 70 years, who supported the course of action of 83 patients diagnosed in the study period. The analysis sought to detect differing capacities among the members of the patients' social network to discriminate between persons classified as cases (presence of disabilities or precursor lesions) or controls. The study found a lack of information about transmission of Hansen's disease and revealed a transitional phase in which there was expectation of cure along with a stigmatizing view of the consequences of the disease. Only one-quarter of the study subjects suspected prior to diagnosis that the patient had Hansen's disease, which suggests low perception of the risk represented by the disease and reinforces the idea that its physical manifestations can be invisible. The results reveal a profile of perception and management of Hansen's disease that favors its propagation and the development or worsening of its physical and social consequences

O presente artigo descreve um estudo realizado no Recife, Brasil, entre novembro de 1993 e julho de 1994, com a finalidade de explorar as opiniões dos membros da rede social (por exemplo, familiares, amigos e vizinhos) de portadores de hanseníase na avaliação, interpretação e manejo das manifestações corporais da doença na trajetória que levou ao diagnóstico. A amostra constou de 93 membros da rede social, com idade entre 20 e 70 anos, que apoiaram o curso de ação de 83 pacientes diagnosticados no período do estudo. A análise buscou detectar variáveis capazes de discriminar os membros da rede de apoio dos pacientes de hanseníase classificados como casos (presença de incapacidades ou lesões precursoras de incapacidades) ou controles. O estudo evidenciou a escassez de informações sobre a transmissão da hanseníase e revelou um quadro transicional onde se confrontam expectativa de cura e uma visão estigmatizante das conseqüências da doença. Apenas uma quarta parte dos sujeitos do estudo suspeitou, antes do diagnóstico, que o paciente era portador de hanseníase, o que sugere baixa percepção do risco representado pela doença e reforça a concepção da invisibilidade das suas manifestações corporais. Os resultados mostram um perfil de percepção e manejo da hanseníase que pode facilitar a propagação da doença e a instalação ou agravamento das suas conseqüências físicas e sociais.

Algunos factores que inciden en la demora en el diagnóstico de la lepra / Some factors leading to delays in the diagnosis of leprosy

Los objetivos del estudio fueron estimar el tiempo empleado en establecer el diagnóstico de certeza de lepra, el tiempo que tarda el enfermo en acudir al médico después de percibir los primeros síntomas de la enfermedad y el nivel de connocimientos del personal de salud sobre la misma. La investigación se realizó en las ciudades de La Habana y Guantámano, cuyas prevalencias de la enfermedad son, respectivamente, moderada y alta. Los participantes fueron todos los pacientes de lepra diagnosticados en 1989 y 1990 en ambas ciudades. Los datos de los enfermos se obtuvieron de sus historias clínicas y administrándoles un cuestionario elaborado según los criterios de varios expertos, y los del personal de salud, entrevistando a una muestra de conveniencia integrada por especialistas y residentes en medicina interna, dermatología, ginecobstetricia, médicos de familia y enfermeras especializadas del Programa de Control de la Lepra. En La Habana se entrevistaron 971 profesionales y en Guantánamo, 139. La demora en el diagnóstico en La Habana fue de 16,6 meses y en Guantánamo de 10,7 meses. En La Habana, los médicos tardaron en promedio 15,6 meses en establecer el diagnóstico y en Guantánamo, 5 meses. En La Habana, los enfermos esperaban en promedio 1 mes en acudir al médico, y en Guantánamo, 5,7 meses. El personal de salud de Guantánamo conocía mejor la enfermedad que el de La Habana. Se recomienda realizar una intervención educativa con distintas estrategias en cada ciudad (AU)

The epidemiological transition in an overseas territory: disease mapping in French Polynesia.

During the last 200 years in French Polynesia the people have experienced several dramatic changes in the pathological scene. First the discovery of Tahiti and the surrounding islands at the end of the eighteenth century caused the spread of diseases previously unknown, usually in the form of epidemic outbreaks. In contrast, from the 1860s to soon after the end of the Second World War, health amelioration in French Polynesia was slowly occurring. This constituted a first epidemiological transition in which infectious disease mortality was sharply reduced. The distribution of vaccines, hygiene education and legislation stemmed the long period of some 100 years of demographic disaster and at last the population was able to increase. However for a long time infectious or parasitic diseases remained the main causes of morbidity and mortality. Only from the end of the 1950s has the situation evolved to the present state where morbidity and mortality of the circulatory system and cancer are similar in prevalence to industrialized countries. Diachronistic mapping of some of the most noteworthy diseases is presented to illustrate this last and most important phase of the epidemiological transition.

Dimensionamento do pessoal dos serviços de nutrição e dietética de hospitais gerais no Município de São Paulo / Dimensioning staff of nutrition and dietetics services in general hospitals in the municipality of São Paulo

Visando preencher a lacuna sobre informacoes referentes ao pessoal necessario aos Servicos de Nutricao e Dietetica (SND) de hospitais nacionais, propusemo-nos a realizar este trabalho, onde estudamos o dimensionamento de pessoal em SDN de 49 hospitais gerais de grande porte e de capacidade extra (hospitais com mais de 150 leitos), localizados no Municipio de Sao Paulo. Para isso, valemo-nos de indicadores especificos que utilizam a produtividade do servico como um dos elementos fundamentais para determinar o numero de funcionarios necessarios ao SND. Os resultados do Indicador de Pessoal Total (I.P.T.) foram estudados por meio de um indice de adequacao, cujos valores foram classificados em quatro niveis:

Age of onset of leprosy.

Age of onset of leprosy is merely a subjective information based upon the memory, intelligent appreciation and awareness of the patient and his relatives, in absence of a more reliable method. In the present study, a modification of the conventional method which we named "Complemented recall" method was adopted to determine the age of onset of 400 leprosy patients, in an attempt to collect a better approximate data.

An information system for leprosy control (OMSLEP Recording and Reporting System).

This study reports the various steps involved in the design of a simplified information system for leprosy (OMSLEP), developed in cooperation between the Unit of Epidemiology, University of Louvain, Belgium, and WHO. The objective of the system is to permit the evaluation of a) the efficiency of programs within the context of established strategies and norms; b) the effectiveness of leprosy control methods from an epidemiological point of view; c) the efficacy and productivity of certain program components. Prior to designing the system, the relevant epidemiological and operational indices have been reviewed. A survey was also made of the forms used by some 78 leprosy control schemes throughout the world in order to analyze the current information now being collected. The proposed system is described. It includes individual record form to be filled at registration and once yearly in subsequent years of follow-up, a detection form, and an annual statistics form for the tabulation of total patients. The system is presently being tested in some 15 countries.